The Knife’s Edge. Stephen Westaby

Чтение книги онлайн.

СКАЧАТЬ and her children were still napping on a single bed and an armchair in their room. Consumed by my own misery and her husband’s impending doom, I tentatively knocked on the door. Hilary read my gaunt expression and realised that this was not a social call.

      ‘He’s dead, isn’t he?’

      I hesitated to say no, since Steve’s chances of survival were negligible. I just told her the truth. That he had a dilated pupil and the brain scan looked bad, that I’d immediately persuaded the finest neurosurgeon in the country to help, but we were both doubtful that Steve could recover now. It was a waiting game. More of our medical school friends arrived, hoping for better news. I heard that old chestnut – ‘If anyone can save him, Westaby can.’ But he couldn’t. Great dissection repair, pity about the outcome. Soon afterwards, the second pupil dilated. Neither reacted to light. Despite the decompression, his brain was not going to recover. Hilary and the children had lost him.

      Unbeknown to me, both Hilary and her eldest son had congenital polycystic kidneys, and the lad was teetering on the edge of needing renal dialysis. With remarkable composure, she asked whether he could be given his father’s functioning kidney. An organ from his dad would provide the best possible chance of immune compatibility – same blood group, same genes, no rejection. For a brief moment I thought I could generate something positive out of this disaster. At the same time as the intensive care doctors carried out tests for brain stem death, I called the director of the transplant service.

What I learned was barely believable. While Steve was conscious he could have voluntarily donated a kidney to his son. Now that he was functionally dead, the family could request that he become an organ donor. But now the body blow. Whatever was still transplantable must go to the national donor pool. Those were the rules. The transplant authorities would not allow Steve’s kidney to be used for his son, nor given to Hilary, who was close to needing a transplant herself. That was the law, so the Oxford transplant team couldn’t get involved. I was dumbstruck, then apoplectic about it. Fucking bureaucracy.

      Steve’s ventilator was switched off at lunchtime. He died peacefully, surrounded by his family, with many of my medical school year grieving in the hospital corridors. I was alone in my office when his proud heart fibrillated, when the metallic click of his prosthetic valve finally came to a stop. Twelve hours earlier I had watched it beating vigorously and I had been confident that I’d saved him. Now it was forever still. All his organs died with him, except the corneas from his eyes. Despite my protestations, the transplant authorities had their way.

      When Sue went home she left a note on my desk – ‘The medical director wants to see you.’

      ‘One day,’ I said to myself, and drove home with Gemma’s present still tucked away in the passenger seat.

Next day I was back in the car park by 6.10 am, another three cases on the operating list, beginning with a newborn infant whose right ventricle was missing. The car park lies between the graveyard and the mortuary at the back of the hospital. I always attended the autopsies of my own patients, so the morticians knew me well enough. This morning was a social call. I wanted to let Steve know that we had done our best for him. He was cold, pale and peaceful now. It was the only time I’d known him to be speechless. Had he still been able to talk, he would have said, ‘You bastard. You were meant to get me out of this mess!’ My instinct was to remove the drips and drains left in his lifeless body, but I was not allowed to. Those who die soon after surgery are the coroner’s property, and the pathologists must satisfy themselves as to the cause of death. Not difficult in this case, but it was an autopsy I wouldn’t be returning to watch. So I said my goodbyes to a great character.

      There were many sad moments in my professional career, but this one stayed with me. Steve had devoted his life to the NHS but was caught up in the pass the parcel lottery that was out-of-hours surgery for aortic dissection. Eventually a decree was issued by the Society for Cardiothoracic Surgery that each regional centre must take responsibility for patients in their area. Special aortic dissection rotas were established in London and specific experienced surgeons designated to operate on the cases. That brought the mortality rate down. After UK Transplant prevented us taking a kidney for Steve’s son, the issue of organ donation was not discussed further. A healthy liver and two lungs could have gone in to the pool, had that single functioning kidney been used in Oxford.

Later that year Steve’s son Tom received a kidney donated by his wife. Steve’s daughter Kate was given one of her husband’s kidneys in 2015. Hilary was fortunate enough to meet a new partner and received one of his kidneys in 2011. They are all well.

3

       risk

      As a boy, my stoical and religious parents taught me that I should never take risks – never to gamble with money, never to be deceitful or steal, never to cheat in exams. Not even to climb over the stadium wall to watch Scunthorpe United, because that was a form of stealing too. Consequently, I began life as both boring and introspective.

      Eventually I learned that the ability to take risks is an indispensable part of human psychology. Victory in war depends upon risk-takers and recklessness, hence the adage ‘Who dares wins’. The economy depends upon financial risk-takers. Innovation, speculation, even the exploration of the planet and outer space – all depend on putting something you cherish on the line in the hope of greater rewards. Thus risk-taking is the world’s principal driver for progress, but it requires a particular character type, one defined by courage and daring, not reticence and prudence – Winston Churchill rather than Clement Attlee, Boris Johnson not Jeremy Corbyn.

In 1925, when Henry Souttar first stuck a finger into the heart and tried to relieve mitral stenosis, it posed a risk to his reputation and livelihood. When Dwight Harken removed a piece of shrapnel from a soldier’s heart in the Cotswolds, it was a risk that went against all he’d learned from the medical textbooks of the day. By exposing blood to the foreign surfaces of the heart–lung machine, John Gibbon took a huge risk, as did Walton Lillehei with his reckless but brilliant cross-circulation operations, the only medical interventions in history outside the maternity ward that posed the risk of 200 per cent mortality. All progress in medicine and surgery is predicated on risk, yet I was taught to avoid it. Fortunately, things changed.

      Character is said to be the product of nature and nurture, the former being the hand genetics deals to us. Then from birth onwards we are moulded by life’s events. I started out well enough. My mother was an intelligent woman who was deprived of an education but read The Times. During the Second World War with the men away, she managed the Trustee Savings Bank on the High Street. One of my earliest recollections was that every birthday she took me, along with a bunch of flowers, to another woman’s home. I thought that strange, but eventually I came to learn the significance of her pilgrimage.

After a long and painful labour my mother brought me safely back from the carnage of the delivery suite. She was exhausted, torn and bleeding, but elated to have a pink, robust son wailing from the depths of his newly expanded lungs. In the next bed, a wide-eyed factory girl was suffering noisily. Spurred on by the bossy midwife, she was preoccupied with pushing and pain. Finally, her perineum split. The straining emptied her uterus, bowels and bladder all at the same time, and the midwife caught the greasy, bloodied newborn like a cricket ball in the slips. The bonny little girl lay on a starched white towel soaked in urine, while the slithering umbilical cord was clamped and cut. Her baby’s only dependable source of oxygen was now gone. Finally, the whole placenta separated and squelched out, to join the party in the outside world. Mother would need a gynaecologist to put things back where they should be – but not yet.

      All babies are blue at birth, then they bawl as loudly as I did. It’s cold outside and they no longer СКАЧАТЬ