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It’s still good. And now no-one will see it
Pulling scrubs over the curve of her hips, or breathing the press of her breasts against the mattress at night, the thought haunted Ros daily. This was before Guy.
Front, back, together
On the Northern line, the 45-minute commute permitted hundreds of repetitions, and in a packed carriage during a heatwave, handbag squatting on her lap, the effort was making Ros sweat. Were the tremors perceptible to adjacent passengers, like a silent but powerful fart into the sofa? Ros assumed not. She hadn’t thought of her pelvic floor since being pregnant with Lou, when she had been diligent. But vaginal muscle tone had since slid way down her list of concerns. Until Guy. While they’d been together for almost two years, Ros still couldn’t stop thinking about it, along with a hundred other aspects of her body as it was now, shadowed by the memory of how it once was. She crossed her legs, twining them at the ankle.
Heels or trainers?
Was not a superficial consideration. Ros picked a small square heel that morning. About five hours in her ankles would swell, but by that point her head and feet would be having little to say to each to other, her head being more busy dealing with eyes and fingers – hers – as well as skin and organs – the patient’s. Trainers were comfier, but when operating, heels gave valuable height.
Excuse me nurse
Patients tended to ignore the colour-coded garments distinguishing doctors from nurses, nurses from orderlies. Despite 24 years of training, Ros was still technically a junior doctor, albeit a registrar. From having the thought to slicing into a person’s body is a long arc as a single mother. She’d never imagined surgery, given the stereotypes, and her core training years were like being in a water park on tidal wave mode. Navigating the streams and chutes, she hurtled between pools so fast she barely knew water from air. Suddenly she’d specialised, and there was no going back. Ros had trained herself not to respond to “Excuse me nurse.” Not unless she heard that tone of desperation which signals a patient in freefall.
Mummy, it hurts
When Lou was younger, little enough not to have developed expectations, she loved having a doctor for a mummy. She flirted with hypochondria, her imaginary illnesses creating puzzles for Ros to solve. Wait ‘til you get properly ill, Ros would say, you’re courting it. Or, the wind’ll change and you’ll stick like that. Years later, when the lumps rose on Lou’s neck, it shocked them both.
We should be on the move shortly
It often happened on the way to work. A sudden lurch, then the quiet filled with huffs and eye rolls. But today’s train was not quickly on the move. Ros relaxed her pelvic floor, feeling suddenly exposed without the train’s motion. Five sweltering minutes later they juddered into Warren Street, speakers quacking. She walked the rest of the way. Should have worn trainers. Would have brought them in her handbag, at least, if she’d known. She rummaged in it now, extracting an apple, then held it in her teeth while unzipping her mobile from the middle compartment. She dialled Lou while moving from the narrow alley to the pavement, heels careful over cobbles.
Mum, I’ve not been well
Lou wasn’t answering. Obviously she wasn’t. Fridays were days off, meaning she’d still be in bed or sunbathing in the back garden. The daily shots of bright heat were making her look unreasonably healthy. When she wasn’t behind the checkout at Sainsbury’s, Lou mainly slept, watched Netflix or read on the lawn, as far as Ros could tell during the brief hours she spent at home. But despite the lack of challenge or direction, Lou seemed to be lifting from her dullness, doing her hair and wearing earrings again. The local supermarket wasn’t the destination Ros had imagined for her daughter, that sunny September when she drove her to Manchester. She’d looked at Lou over their pub roasts and been almost dizzied by the scale of her daughter’s potential. Driving back down, none of the radio stations seemed right for her feeling, painful but triumphant. Lou had fledged, and Ros’s house was her own again. She hadn’t expected her back for any reason, certainly not the leukaemia reason.
It’s why operating is like getting a plane ready for take-off, Ros told Guy when flying out to Santorini last spring. As the plane taxied she listed examples of Never Events, hospital parlance for serious safety breaches, the acceptable incidence of which was never. Foreign objects left in a person’s body. Wrong blood transfused. Wrong limb removed. Whole systems existed to guard against any assault on zero’s perfect circle. Once breached, zero becomes one, risking two, then unchecked growth. Ros paused, tongue running over her front teeth, then continued. Guy watched the flight attendant manhandling oxygen masks while she whispered pre-theatre checklists, knowing he was listening. He liked technical talk. She explained the procedures to check the rightness of this leg rather than that. Let’s not say rightness, he interrupted, if it’s the left leg, we need to stay away from any hint of the word right. The correctly selected leg is identified and marked, she went on, the instruments checked in, a dozen procedures ensure the wrong leg Cannot Happen, or not “cannot,” which still has a seed of possibility in it but can not. Righty tighty, laughed Guy, slipping a hand under her coat where it lay across her lap, better check you’re all present and correct. She’d loved his lasciviousness in those early months, probably a result of his being much younger. He was closer to Lou’s age really, an initial concern which was quickly replaced by the firm realities of their relationship. As the plane jerked upwards throwing them back against their seats, Ros traced a finger up his bare forearm. The nurse draws an arrow, she told him, so you can’t go wrong. This way up. This one off.
Should I call him?
Falling in love as the mother of a teen, there followed a swift transition from “does he like me?” to “will she like him?” Operating theatre schedules prevented dating, dinners or cinema. Parents’ evenings were one of the few nights a year when Ros became an ordinary woman in normal clothes. A parent among others. A service user sitting on uncomfortable chairs, waiting to be called. And this was the last time it would happen. It was all UCAS and options and Lou’s future, and something about Lou’s chemistry teacher, Mr Hatfield, made Ros conscious of her facial muscles as she smiled. He texted just as she left the school. A risk-taker, Guy Hatfield. Goes hand in hand with the job, giving fire, acid and combustibles to a bunch of teenagers. Ros felt practically eighteen herself, with Lou eyeing Manchester and her own life in flux, ready to be something else. Driving home she bit her lip and noticed for the first time the strange beauty of the street lamps, bright glowing balls of high pressure sodium, perfectly spaced.
Excuse me nurse, I am so cold
At lunch Ros clicked through scans in the theatre staffroom, coffee burning her fingers through the plastic cup. She stared into the sharp deep black of the screen, searching the pale swirled smears for clues. She would track it down, whatever was causing the pain in this patient’s leg. Around 8am, just as she’d pushed through the double doors of the main entrance, a young cyclist swung out onto Old Street roundabout. Not too bad when brought in, apparently. Minor crush injuries. He’d seemed fine on the ward round. An hour later, buried under blankets in 37-degree heat he was complaining of cold, shrieking and clutching his bruised leg.
Ros never thought, now, of the time when Lou’s bruises blared. In theatre, she blocked out any thoughts of her daughter, as light poked into the broken corners of people and her fingers slipped into stretched cavities. She boxed them mentally, those memories. Of keening cannulas, bags of soup-slow chemo flowing through Lou like gruel – please Sir, Ros shouting at the nurse, can she have some –
More to the point
She’s out of it. Through it. Any anxiety is down to a quiet hum now Lou’s in remission, she could go again, to university, teach English in Thailand, any of it, the fat remittance of life come back. But Ros was remiss – was that muscle oedema? – the symptoms of the patient in Bay 4 still in a brutal flowering that was yet to be nipped in the bud.
Nurse, I can’t feel it
Morphine hadn’t stemmed the moans, and Ros palpated, mind whirring like a picture flick book as the young man spoke. She let his words gather then cracked them open like fruit to pull out the symptoms.
Pallor. Pain. Perishing cold. Paresthesia. Pulseless. Paralysis. Compartment Syndrome sometimes follows a crush injury. Part of the body becomes a closed loop, cut off from the owner like a child leaving home, and the luckless limb, its vessels pinched shut for too long –
it has to come off.
This will not change who you are
Ros stepped into the office and messaged Guy she’d be home late again, smothering the familiar sense of guilt before returning to the task at hand. If it had been picked up when he was first brought in, this could possibly have been avoided. Even now, if it weren’t for the vascular damage, there would be options. It is a hard thing to accept, for anyone, and this man was in terrible pain. Still catching up with the schism in a morning which didn’t lead to his City Road office, the profit and loss accounts, his Nespresso Capriccio. Instead this hospital bed and the cool circle of a doctor’s stethoscope pressed against his back. Ros tended to start the conversation at moments like this, of fleeting physical contact where she was just out of sight. It was a question of how it was couched; the saving of the upper limb, addressing the pain both now and in the long term. Consent. Reassurance. The role of anaesthesia.
Ok to start?
He was already under, and Ros counted in. The needle, the scissors, the clips, the saw. Soft pads of surgical gauze sat on their torn open packaging. She blinked under the moveable light which pushed out brightness overhead. Glanced at the anaesthetist, who was perched to the side on a stool, eyeing the screens. Ros swallowed behind her mask. Everything was in place, was sterile, was prepared. A clutch of junior doctors hovered, pale blue and grimly angelic, the senior nurse was on maternity leave, consultants absent, it wasn’t that Ros was nervous but the situation was now acute for this patient, his gown hiked up, white skin, black pen.
No more pedalling, she thought suddenly, no chink of the D-lock or whir of the chain in freewheel, only prosthetical possibilities, tap drag, but first the sheering hum of the saw then the gobbled click of the last snip.
Ok to start
As she picked up the scalpel her stomach lifted, flittering on its apple and coffee. She liked it like that. It sharpened her focus. She wasn’t doubting her absolute competence, it was just that she should have been assisting a consultant, but one was in the Dordogne, the other operating at St George’s today. This leg wouldn’t wait, this man couldn’t wait, the competence was there and the rising terror, the damping underarms, shoes pinching at feet she hadn’t felt or thought of for hours. She performed the checks, then performed them again.
Yellow for sharps, red for hazardous
As a surgeon, other aspects of routine life changed shape. When cleaning the kitchen, for example. Process imposed itself, items laid out in the order to be used, hand washing in between tasks. Brains thus moulded struggle to allow adolescents loose with knives and gas flames, or with almost any tool, and for this reason Lou had grown strangely shaped. Reaching in odd directions like a plant too far from the window, at times she leaned out of Ros’s orbit entirely.
Sewing the final stitches, Ros’s breathing relaxed. The wound was closed, the patient stable. Wheels rolled over linoleum as the offensive waste was spirited away. Ros kept her sense of the patient’s loss and the asymmetries that awaited him to a professional numbness. The surgery had been smooth, easy, and despite every possible caution, she had finished in record time.
Saw, clips, scissors, needle. Counting back through the instruments, Ros mentally rehearsed a casual reference to the operation in earshot of her seniors on Monday. Smuggling the impression of success into a throwaway remark. If she’d stopped to think about it, it would have irritated her that she even had these thoughts. She should lean into her strengths, not diminish herself. Ros had progressed through each stage of her training in the minimum amount of time, with two years out for Lou, then more years of speciality training, until the point when she herself should have become a consultant. Four years on this had not happened, and it jabbed at her sense of herself, the constant feeling she was behind and would never catch up. With omnidirectional effort, she had applied herself to study, revision, reading and practice. Taken every opportunity to operate. She had never said no.
I’m not wearing a wig
No was a word Lou knew well, had fully absorbed since she was old enough to understand speech. She knew all of its variants, from not today, to when you’re older, to “if I’m home in time,” to the slammed door of her mother’s study. Lou had absorbed refusal, which manifested in her stubborn will to resist. Not keen on losing her hair she’d shaved it close in anticipation, daring it to go, pulling a move on the imagined loss which in the end never came. It had almost grown back now, thick blonde twists surrounding eyes that were green and questioning. Like the vaulted space of a church, looking at Lou gave people a feeling of uplift, made them wonder whether there was a god.
The Spanish accent of the nurse specialist broke Ros’s name into unfamiliar patterns. She re-focused on the paperwork she had been given, signed, then handed it over. Back to the operation notes, which were always best done straight afterwards. In the background, her mind hummed with the coming evening, a mere smoked black line away, counting down the stops. Guy would have cooked, and Ros would actually be back for dinner, maybe even in time to help with the cooking. She would have energy to wash up. Lou might or might not be in, she was often out now, her friends close round her again. If it was just the two of them it would be the cut glass tumblers for G&Ts, if Lou was in they’d have to use the tall ones. Over dinner they’d have the expensive wine from last Christmas, then finish with ice cream, then dark chocolate, maybe brandy. Everything.
Pushing out through the double doors she felt their weight swing away, pulled off her hospital pass and stuffed it into her handbag. Walking to the tube she felt light, her feet uncomplaining, this is the year it will happen, she thought. A position was coming up at Barts in November and this time, probably, yes. She got an iced coffee at the stand by the tube station, allowing herself to be upsold an unnecessary biscotti, and thought briefly of messaging Guy that she wouldn’t be late after all. But no. She’d surprise him. She never surprised him. Ros stood for a moment in the sun, watching after-work crowds spill across the park with their beers and ice lollies. When she gets it, this thing for which she’s sacrificed everything, there will be nothing left to long for. She will hang up her wanting forever.
Have you thought ahead love?
As Ros turned into her street she felt for the keys, fingers probing her handbag’s pockets for hard metal. At some point this weekend she’d try talking to Lou about next steps, what she really wants in life, encourage her to broaden her horizons a bit. She saw herself beside Lou on the lawn, helping her with her sun-tan lotion. Lou would be relaxed, Ros would be easy, she could tackle her paperwork on Sunday night but for now, on this sunny weekend afternoon, she would try to cut through her daughter’s vagueness, her complete lack of desire to move on with her life.
Standing in the kitchen doorway, Ros only half felt her handbag falling away from her shoulder, sliding over her wrist, hospital pass snaking out. Her phone cracked against the stone flags, which actually weren’t original, they’d had them put in, Guy and she, one of those unnecessary home improvements which says We Are Together. Her lipstick rolled under the washing machine, a box of tampons bursting open by the foot of the kitchen chair in which Guy, but not Guy, was sitting. An arrangement of Guy with the wrong number of limbs. There were other legs, no longer dressed by Ros in Mothercare pink tights, nor wrapped in grey flannel during the long year of listless loungewear, but tanned from the garden, tiny pale hairs picking up the light, the legs were bared under a short red skirt. Just behind the skirt was the fruit bowl bought in Santorini, apples bright against its turquoise lip and in front of of the fruit bowl, the skirt, her daughter’s skirt, was moving rhythmically, backwards and forwards, over Guy’s blue jeans.
In the fruit bowl, sheened wax glared from green skin. The apple of her eye of course was Lou, had always been Lou, and it came to Ros now how hard it was, when you’re apple-eyed, to see properly. Like trying to read a message in peelings thrown over the shoulder, indeterminate half-torn letters that don’t clearly spell anything.
Images flicked through Ros’s mind showing the scene with light sucked out in the crucial places. She saw all three of them in cross-section, frozen in space, Guy, Lou, herself, suddenly aware of the omissions, the lists left unchecked, boxes un-ticked. Her keys cut into the palm of her hand and she held them tighter, as if they could remedy the situation. As if the point of the Yale could slice through this abominable joining, allowing her to rearrange the limbs into an acceptable configuration, to sew her family back into place, for decades she had been preparing for entirely the wrong kind of operation. Ros held out her keys towards the two faces which stared blank as pips, her palm out flat, a tangle of metal lying across damp skin ridged with red bumps. I’m home, she said.