One
“Suction.” A bead of sweat slid down Adam's back beneath his scrubs, tugging on his focus. He ignored it, peering through the pooling red to find the tear. With a practiced hand, catheter at the ready, Shanni leaned forward and cleared the fluid.
There! The diaphragmatic hernia was worse than Adam had hoped. Fred’s liver and intestines were spilling into his chest cavity, compressing his lungs. That’ll happen when you get hit by a bicycle at full speed.
The steady beeping of the ECG was a constant reassurance that his patient was doing fine, but every minute in open surgery was a risk. Holding the incision open with the forceps, he snatched up the other pair and got to work.
Under the glaring white lights above, Adam gently coerced the displaced organs back to their proper position. His fingers moved calmly and carefully, masking the thrumming knot of anxiety in his chest. The shiny pink intestines were slippery; the banded rings of muscle reluctant to cooperate. Adam’s brows furrowed and he clenched his jaw. “Suction.”
Shanni was quick about it, her nerves showing only in the sharpness of her movements. She retracted the catheter, and a warning blip sounded on the monitor. Adam didn’t look up. “SpO2 dropping—eighty-three.” Shanni’s tone was clipped. Less than ninety percent oxygen saturation wasn’t great. The ECG was next, the beeps increasing rapidly as the patient’s heart beat faster, trying to compensate.
Adam shifted the forceps and tilted his head to get a better angle, peering into the incision to find the issue. And there it was—a loop of intestine snuggled up against the right ventricle of Fred’s heart. Adam had been inadvertently tightening it as he was threading it through the hernia.
No problem, he thought to himself as sweat beaded on his brow and he felt suddenly warm under his mask. Just fix it. You’ve got time.
The steel rings of the forceps bit into his fingers, but he couldn’t afford to shift his grip. With precision, Adam nudged the section of intestine away from the heart, and slowly worked it back into position through the diaphragm. The monitor spat out another alert. “BP crashing.”
“Bolus, Shanni.”
She didn’t miss a beat. She primed the IV line and fed it through the pump. “Twenty mills per kilo.” The machine hummed to life and Adam waited, deliberately taking slow, deep breaths. He could do nothing until Shanni was able to clear the fluid again. “BP rising.”
“Suction, please,” Adam said, keeping his voice calm and level. Shanni jumped to it with her trademark efficiency. Once the blood was clear, Adam finally caught sight of the problem; the intestine was kinked around a frayed section of the torn diaphragm. He would have to cut it loose.
“Hold the incision.”
Adam loosened his grip on the forceps and Shanni was right there to take them from him. He plucked up a scalpel with one hand and secured the diaphragm in forceps with his other.
In two careful strokes, he severed the segment of diaphragm, releasing the kinked intestine. The organ slipped easily back into place. Drawing in a steadying breath, Adam dropped the bloodied scalpel into a dish and picked up the curved suture needle. He stitched the diaphragm in two layers, returning it to a strong wall of muscle protecting his patient’s lungs.
The machines blaring around him slowly calmed. “SpO2 normalising,” Shanni said with far less urgency than before. “Back up to ninety-six. Heart rate steady.”
“All done. Flush, please.”
Shanni picked up the saline flush, aiming the nozzle into the incision, flushing out any clots. Adam double-checked the position of the organs and began closing up. Shanni monitored the patient’s vitals and administered post-ops through the IV.
Once Fred was all closed up, and the pink, shaved belly around his stitches was doused with iodine, Adam breathed a sigh of relief.
He reached up to his patient’s shoulder and stroked his soft fur. “Good boy, Fred. No more chasing bikes, okay?” The basset hound’s long tongue lolled over the shiny steel slab, the oximeter still clipped to it. His floppy ears were arranged haphazardly, draping over the edge of the table.
Shanni’s hand, now without its latex glove, gripped Adam’s upper arm in a gentle squeeze. She gave him a warm smile. “Well done.”
Adam grinned under his mask. “You, too. Let’s get him into ICU.” Adam shed his blood-stained plastic apron, paper mask, and blue latex gloves before running a hand through his hair and pushing his glasses up the bridge of his nose.
Together, they gingerly hefted the slightly overweight hound into an ICU kennel, placing his IV bag on a mobile stand. Once Adam was confident that Fred was comfortable, he sent Shanni out to deliver the good news to his owner, Tom.
“Oh, and Shanni,” Adam called to her as she turned to leave the surgery room. “Tell Isla to set up a payment plan for him. Whatever he can afford is fine.”
Shanni gave him an indulgent smile, flashing her dazzling white teeth in stark contrast to her ebony skin, and turned back to the door. “You’re the boss!”
Adam waited in the surgery room, watching Fred’s vitals. “Is Doctor Blake coming out? I’d love to thank him personally. Shake his hand at least.” Tom’s voice was strained with emotion, making Adam squirm.
“Sorry, Tom, he’s running Fred’s post-operation care.”
“Well, just tell him I owe him a lot. Fred’s all I’ve got, really. I’m just... grateful.”
“I’ll let him know, Tom, but it’s our pleasure to look after Fred. With a little luck, you’ll be able to pick him up tomorrow afternoon. Okay? You have a good night, Tom.”
When Adam heard the tinkle of the bell above the door that signalled Tom’s departure, he drew in a slow breath, idly scratching at Fred’s ear. After a beat that brought certainty that Tom wasn’t going to suddenly reappear, only then did Adam slink out into the hall and slip into his office, where Shanni was already waiting, arms folded. He deflated when he saw the bemused look on her face. “Why do you do that?” She wore a frown that was equal parts chiding and amused—a look she seemed to reserve just for him.
Playing dumb seemed the smart thing to do. “Do what?” He slipped his hands into his pockets, the very picture of innocence.
She scoffed and rolled her eyes so hard he was amazed it didn’t damage her optic nerves. “I know you’re not a people person, Adam, but do you need to hide from them? Tom wanted to thank you, and I had to practically chase him out of here. Is it really so bad to be thanked?” She softened a bit, opening her arms as though to welcome his explanation.
“I...” Adam had no excuses left. Shanni would see through them anyway. He sighed and scratched at the back of his neck to break the eye contact. “I don’t like it. I just want to do my job, Shanni.”
“What don’t you like? Gratitude? Because I’ve worked for you for four years, and you have never once let someone thank you.”
“I don’t know why. I just... don’t like it.” He sounded childish. He did know why—exactly why—but he couldn’t tell her. He’d never tried to put it into words, and didn’t ever want to.
She gave him an appraising look, clearly not buying it. “You know Isla calls you Doctor Robot behind your back?”
Adam huffed a laugh and shook his head. “That might be the nicest name she has for me.”
“Mm-hmm. I’d have fired her ass months ago if I were you.”
He shrugged. “She has a kid, Shanni.” He moved towards her, stepping around his desk and dropping into his chair.
“That doesn’t make her a good receptionist.”
“No,” Adam sighed, “being a good receptionist makes her a good receptionist. She can call me whatever she wants as long as she keeps the books properly, which she does.” Before Shanni could chime in again, he stopped her with a glance at his watch. “It’s past closing, Shanni, go home. I’ll lock up.”
She scrutinised him closely and he glanced away, unable to hold her gaze. “Promise me you aren’t gonna sleep here tonight.” She looked pointedly at the pull-out couch in the corner with a rumpled blanket on it.
Adam blinked at her mutely.
“You need to get a life, Adam.”
“I need to keep an eye on Fred tonight.” Shanni opened her mouth to argue, but Adam held up his hand to stall her. “I promise I will not sleep here tomorrow night. Okay?” Shanni crossed her arms again, looking unimpressed. “...barring an emergency,” he finished.
“Adam!” she threw her hands up in exasperation and he couldn’t help but laugh.
“Go home, Shanni.”
“Fine! I know a lost cause when I see one. ’Night, Adam.” She stomped over to the office door.
“’Night, Shanni.”
As he heard the door chiming Shanni’s exit, he sighed, taking off his glasses and rubbing his eyes. He was tired. Leaning back in his chair, he swivelled to peer out of the window at the rapidly darkening sky. In the dying light, the pinks and oranges of dusk shimmered across the top of the bubble-like forcefield protecting Aspasia City from the rest of the world. Birds ducked and dived, swerving in front of it to catch the moths drawn to the iridescent sheen of its surface. The clinic wasn’t close to the boundary by any means, but the dome was visible in every part of the human-only city. He’d always found it pretty to look at, but couldn’t help but wonder what lay beyond. The way it reflected the skyscrapers of Aspasia made it impossible to see, though he knew what lurked out there. All humans did.
He shook his head to clear it of the morbid thoughts, before getting up to check on Fred and lock the door. He microwaved the lunch he’d been too busy to eat that day and ate it slowly, trying not to cringe at the blandness. He picked up the packaging and looked at the picture on the ready-made meal sceptically. Comparing the image to what sat in front of him, the “cottage pie” had watery mashed potato and grey meat with the odd cube of carrot or wrinkled pea mixed in. He sighed and pushed away from the table to stand with a scrape of the chair over linoleum. He grabbed the rubbish bin and swiped the meal and its packing into it with a heavy thud.
With little else to do, he sat back at his desk, writing reports until late into the night. When his eyes burned from looking at his computer screen, he checked on Fred one more time, and then tucked himself into his couch, leaving his office door open to hear alerts on Fred’s vitals. It didn’t take him long to drift off to sleep.
