Going Under Page 6

  In the darkness, I could be anywhere.

  nine

  ‘So you’re here to see Dr Prince?’ I clarify, simultaneously fighting rising frustration and a day-old hangover.

  The man in front of me gives me a look that suggests he isn’t impressed. ‘Who are you?’ he demands.

  He’s at least sixty and judging by his clothes he’s stepped straight off a farm.

  ‘We’ve driven six hours to be here,’ the woman with him—his wife, I assume—explains, looking anxious. ‘We thought we’d be seeing Professor Prince.’

  ‘Where is he?’ the farmer snaps. ‘Why are we talking to a nurse when I have an appointment to see the doctor?’

  The mild ache behind my left eye is threatening to turn into a full-on migraine. Even though it’s Monday and our house party was on Saturday night, I still feel wretched. For a second I picture the state the house is still in, knowing I’ll be walking home to it this afternoon, and resist the urge to groan loudly. Winnie, Max, Estelle and I spent most of Sunday discussing whether Laura (Estelle knew her name), our intern comrade, needed (in the interests of collegiality) some fellow junior doctor support. I called Laura that night, but she said she was just drunk and didn’t remember saying anything. Estelle followed up with another call, which only made Laura angry and upset; she told Estelle in no uncertain terms that she was perfectly fine, that being a doctor was great, she was just drunk, and suggested we should all just fuck right off as she had her career as a future cardiologist to focus on, and a PhD to finish. Case closed.

  ‘I am a doctor,’ I say, mentally returning to the patient in front of me. ‘I’m Dr Prince’s intern. I’m going to see you first and then he’ll come by this afternoon.’

  ‘What?’ The man looks affronted. ‘I can’t stay until this afternoon, so he’ll have to come right now.’

  I raise my eyebrows. ‘He’s operating all day.’

  I realise I need to actually figure out what this guy is doing here before the argument continues.

  ‘Where’s your paperwork?’ I ask. ‘If I could have a look at your referral that might make things a bit easier.’

  His wife rummages through an old leather handbag and produces a folder with John—Medical written on the top.

  I open the folder to see the letters GBM beaming up at me.

  John’s wife must have seen my facial expression, because she leans in. ‘We tried to get him treated at the hospital near our farm,’ she confides, ‘but they said it wasn’t worth operating on. The tumour is too close to something or other.’

  GBM is the acronym for glioblastoma multiforme—unfortunately for John, as it is the most common and most deadly primary brain tumour. For a second, absurdly, I remember the Shark on a ward round telling me that in the latest WHO classification they’ve dropped the ‘multiforme’ and technically we should just refer to it now as ‘glioblastoma’. ‘Neurosurgeons are inherently lazy,’ he said to me, looking irritated. ‘They keep saying GBM instead of the correct term: glioblastoma.’

  I look at John, who’s staring steadfastly out the window, and doubt very much that he gives two hoots what we call the tumour non-consensually invading his mind. I could refer to it as ‘Fred the Bastard’ and it wouldn’t make a difference.

  ‘So, we got a bit desperate,’ Mrs Wilde finishes.

  Fair enough.

  ‘Our daughter started googling surgeons who might want to operate, and we found Dr Prince on the internet.’

  ‘So where is he?’ John suddenly turns around. ‘He’s not even here. I knew these big smoke surgeons weren’t going to be any good.’ He folds his arms and glares at me.

  ‘John!’ his wife exclaims, looking at me anxiously.

  I feel sorry for him.

  ‘It’s all right,’ I say, ‘Dr Prince will definitely see you. But you’re going to have to stay on the ward at least overnight.’ Then, seeing his frown, I add, ‘I’ll organise accommodation for your wife. The hospital will cover it.’

  John’s silent. I look down at his worn leather boots, slightly caked with mud, and I don’t know whether to laugh or cry.

  I turn back to the file. Mr John Wilde is a sixty-year-old farmer from somewhere west of the middle of nowhere, and now he’s dying. No one wants to operate because no one thinks they can save him. His cardiac function is crap, his lungs are damaged by years of smoking, and now he has a huge malignant brain tumour. The hospital closest to his farm tried radiotherapy, chemotherapy and more radiotherapy to no effect, and now he’s staring the end of the road square in the face. Or, as Mr Wilde says to me later, the horse has well and truly bolted.

  John Wilde wants to be saved. I don’t blame him, the poor bastard. Until you’re dead in the ground the human instinct is to cling on. His brain tumour is a pit of crocodiles and he’s found one surgeon who might offer him a rope.

  Mrs Wilde had called Dr Prince’s room’s directly and, after battling with his less-than-pleasant receptionist, managed to get an urgent appointment. Dr Prince is clearly something of a humanitarian. Any other surgeon would take one look at Mr Wilde’s scans and say, ‘No fucking way.’

  In a fairy tale, the patient would be grateful and happy. How fortunate for him that this big-time brain surgeon has agreed to see him. Mr Wilde acts like he doesn’t care—and, who knows, maybe he’s beyond caring. But it’s clear that he’s mortally afraid. His fear hovers around him like a thick grey fog. His eyes are tired, and his body’s battered. The cancer has rendered him unable to swallow, so food is delivered via a tube that’s been inserted into his stomach, like a grotesque abstract painting.

  By the end of the day Dr Prince still hasn’t shown up to the ward. It’s getting dark and I’m about to go home.

  ‘Where is he?’ Mrs Wilde asks when I pop by to check on Mr Wilde. ‘He is going to come, isn’t he?’

  I feel so sorry for her that I muster up the courage to call Dr Prince on his mobile.

  He doesn’t answer, and I leave a rambling voicemail message, like a complete idiot.

  It turns out I needn’t have bothered, because five minutes later he appears, looking at his phone, then at me.

  ‘Hello, Katarina. Did you call me?’

  ‘Yeah … just, ah, ignore the message.’

  ‘Is everything all right?’ Absent-mindedly he brushes his cap off. He’s just come from theatre and is still in his scrubs.

  His eyes are blue today. The scrubs make them blue.

  ‘Everything’s fine,’ I say quickly. ‘I just wanted to check when you were going to see Mr Wilde.’

  Mr Wilde is looking at Dr Prince with a suspicious expression. ‘Took you long enough,’ he says grumpily.

  Most other surgeons would have been annoyed, or snapped back, or even turned on their heel and left. Dr Prince apologises. ‘I’m sorry,’ he says, and he looks like he means it. ‘I had a really difficult case. I got stuck in theatre. But I can see that Kitty has been looking after you.’

  I raise my eyebrows at the use of my nickname, and he looks over at me and smiles. I find myself smiling back.

  ‘She’s a very good doctor,’ Mrs Wilde says loyally.

  ‘I know she is,’ Dr Prince says. ‘She’s going to help me with your operation.’

  I nearly fall over.

  ‘So, you are going to operate?’ Mrs Wilde asks hopefully.

  ‘I think so,’ Dr Prince says. ‘I looked at your scans this morning, and I think we can probably manage it. It’s in a very unusual place for this kind of tumour, the third ventricle of the brain. Extremely rare. I’m worried about the risk of hydrocephalus, as well as other things. I’ll have to run it by some other doctors first—we always consult with the rest of the multidiscipinary team before undertaking a major operation.’

  Mrs Wilde starts to cry. Mr Wilde thanks Dr Prince gruffly; he sounds as if he’s on the verge of crying too. I realise even I have tears in my eyes.

  Dr Prince and I leave the Wildes and walk through the darkened ward together. We stop a
t the doors. There’s an awkward pause.

  ‘Sorry I missed the operation the other day,’ I say. ‘I got a bit caught up.’

  He looks at me. It’s weird; he doesn’t say that much, but when he does it always seems to mean something. Even though our encounters are brief and I always seem to be doing something embarrassing, when he looks at me it’s always directly in the eye.

  ‘I heard,’ he says, something else in his voice. ‘Did your senior doctors come and help you? How long did it take them to get there?’

  I want to tell him the truth, that I’d been left alone on the ward while Mr Waters nearly bled to death, but I just mutter that it all worked out in the end.

  He leaves it, but I know that he knows.

  ‘Thanks for understanding, anyway,’ I say, and without thinking I reach out and touch him on the arm.

  He looks down at my hand on his arm. I quickly snatch my hand back.

  He doesn’t say goodbye. He just pushes through the doors and walks quickly away, leaving me standing there staring at his retreating figure.

  I go to the doctors’ room and grab my bag, then walk home.

  For some reason I can’t put into words, I’m feeling down. When Winnie asks me why I seem so morose, all I can say is, ‘It’s been a long day.’ I slump onto the couch, completely exhausted.

  ‘You could probably do with a break from the hospital,’ Winnie remarks. ‘Maybe the rural secondment isn’t such a bad thing. I’ll miss you and Estelle, though. And Max was saying he’s going to try to swap so he can go at the same time as you guys.’

  ‘I don’t want to go,’ I say. It’s been hard enough getting used to Holy Innocents, which is a major Sydney hospital; the thought of an understaffed rural hospital gives me the willies.

  ‘You never know,’ Winnie says optimistically. ‘It could be a relaxing escape from the city.’

  ‘Unlikely,’ I say. Although, I think to myself as I give in and walk into the kitchen to pour a glass of wine, Dr Holliday could sure use a bloody holiday.

  ten

  The next afternoon, I sit in the multidisciplinary oncology meeting and listen to consultants who’ve never met Mr Wilde discuss whether he should be allowed to survive.

  ‘The tumour is near too much eloquent brain,’ one of the surgeons argues, looking at the MRI on the screen in front of us.

  I’m startled by the word ‘eloquent’. It’s almost poetic to describe important bits of brain tissue as eloquent. Maybe neurosurgeons do have souls, after all.

  ‘We can’t leave it,’ Dr Prince says, ‘otherwise he’ll end up dying from obstructive hydrocephalus anyway.’

  ‘If you do an open craniotomy you could easily damage his fornix, which would be a disaster. He’ll end up a goldfish jack with no short-term memory whatsoever.’

  ‘I’ll go in with the ventriculoscope and have a look. I might be able to get some out that way,’ Dr Prince counters.

  I feel like I’m watching a verbal chess match. I don’t really understand anything but realise that the tumour is in a bad and unusual place, putting a lot of pressure on important bits of brain, and operating is high risk, but leaving it means he’s toast too. Caught between a rock and a hard place, as Dad would say, except the rock is horrific disability, and the hard place is death. Fantastic.

  Everyone starts to argue with each other, loudly. The Shark is gesturing angrily at the MRI, the oncologist is shaking his head in obvious disgust, and the game continues. Check. Check. Check. Stalemate.

  I nibble on my mini quiche, which is really rather good, and wonder if anyone would notice if I took another.

  ‘I think it’s pointless,’ an oncologist sitting behind me says, sounding annoyed. ‘It’s too advanced.’

  ‘It’s clearly isolated,’ Dr Prince responds calmly.

  Go, Dr P! I cheer mentally.

  ‘It’s not worth the risk,’ Mr Angry Pants oncologist snaps, gesturing at the MRI.

  This is the problem with medicine. Too many decisions are made in big meetings by doctors who have never met the patient. They look at pictures and read blood results, but they have no idea who the patient is or even what they look like. I wonder how Mrs Wilde would feel if she and her husband had to drive all the way back to the west of the middle of nowhere after being told that no one is prepared to operate.

  ‘The tumour IS very close to eloquent brain,’ the Shark says, glancing at Dr Prince, then back at the MRI. ‘What if he wakes up and you’ve destroyed his short-term memory?’

  This is a loaded question. Everyone knows that there was a big complication earlier in the year and the mud is still being slung. Everything is suddenly very quiet. I try not to breathe too loudly. I look over at Dr Prince.

  ‘Well?’ The Shark smiles, and the tension in the room increases. I’m reminded of hyenas circling a wounded tiger.

  Dr Prince looks at the MRI, considering. He clears his throat.

  The Shark’s lip curls slightly in anticipation.

  ‘I’d definitely have to make sure I had a coffee before the operation,’ Dr Prince says seriously.

  I snort into my quiche and try to turn it into a cough as the Shark glares.

  ‘I don’t think the executive would take kindly to another big complication,’ he says darkly. ‘If you operate and make him ECOG 2 he won’t even be able to tolerate chemorads. Then where will we be left? Tread carefully, Jack.’

  I don’t understand the neurosurgical jargon, but I’m in no doubt as to the barely veiled threat left hanging in the air. I sneak a look at Dr Prince, whose face is completely expressionless.

  ‘I think it’s worth going in with the ventriculoscope,’ he says evenly.

  The Shark’s only response to this is to nod tersely.

  After the meeting, I’m walking along the corridor back to the ward when I notice someone has fallen into step beside me.

  ‘What do you think, Katarina?’ Dr Prince asks. ‘What would you do?’

  I feel momentarily disappointed that we’re back to Katarina, not Kitty, then remember I’m an idiot and answer the question. ‘Well, seeing as I’m an expert …’ I say with a grin, then, anger rising, ‘I think it’s shit that they can make all these decisions and write him off so quickly when they’ve never even met him! I mean, I know it’s in a weird place for a GBM, but the tumour’s isolated—why can’t we just have a look? If there’s nothing to be done we can close up, but at least we’ve tried!’

  I don’t know why I keep saying ‘we’. It isn’t as if I’ll be performing these amazing, death-defying surgical feats. I’ll be snipping a stitch or two, if I’m lucky.

  ‘If I mess this up,’ he says, ‘they’ll tell me I can never perform this kind of operation again.’

  ‘What?!’

  ‘Welcome to the hospital.’

  For a moment when I look at him the windows open. Light shines into my eyes and I see the struggles, the victories, the weight of being a surgeon performing the most difficult operations in the world. I touch his feelings and, strangely, they feel just like mine. In the hierarchy of medicine, I’m nothing and he’s everything, and yet here we are.

  I swallow and look away. You’re nothing, I remind myself. You are a lowly intern who has only just mastered the art of cannulation. You can’t make a difference, and your opinion doesn’t matter.

  ‘Actually …’ I start speaking then stop, feeling a bit embarrassed.

  He looks over at me. ‘Yes?’

  ‘What’s a ventriculoscope?’ I ask, annoyingly feeling myself start to blush.

  He smiles. ‘Usually we use it trying to resect a colloid cyst,’ he explains. ‘They live in the anterior part of the third ventricle, block off the foramen of Monro and cause hydrocephalus.’

  I nod, pretending to understand.

  ‘Well, this tumour, unusually, is in almost the same place as that. It’s better to go in and have a look with the scope and try to remove it that way. If we can’t, we can convert to an open craniotomy later.’
r />   ‘Gee, sounds … hard,’ I say, having nothing more meaningful to add.

  He laughs. ‘It is. The major risk with either approach is, like we said at the meeting, damaging the fornix. That could render the patient with terrible short-term memory impairment.’

  ‘That’s why the other surgeon said he’d be a goldfish.’

  Dr Prince half smiles, half grimaces. ‘We need to think of better comparisons. But, yes, the risk of the goldfish outcome is higher with an open approach, so it’s better to have a look first with the ventriculoscope.’

  ‘I sort of get it,’ I say.

  ‘Come into theatre this afternoon and you can see it all first hand,’ he says lightly. ‘It’d be good to have you there.’

  ‘It’s not like I can make a difference,’ I protest, rolling my eyes. ‘No one cares if I care. I’m just a shitty intern.’

  ‘I was an intern once too,’ he points out. ‘Come along.’

  Even though I’d meant it when I said that no one cared if I cared, as I stand in the operating theatre later that day watching the surgeons use the scope to look into Mr Wilde’s brain, I can’t help but feel as if caring does matter. I see the red mass of the tumour and even to me its ugliness is confronting.

  When Dr Prince has finished, I ask the question that has been echoing so loudly in the room though no one has voiced it.

  ‘Can you save him?’

  I realise as soon as I open my mouth that it definitely isn’t my place to ask sensitive questions about sensitive cases. I feel myself blushing as Dr Prince looks up and over the surgical mask, his eyes catching mine. For a brief, startling moment I find myself wondering what he’d be like in the bedroom, rather than the operating theatre. I frown and try to get my brain back on track. Tumour. Operation. Work. Doctors. Life. Death. Important. Stay focused, I tell myself. How can you be thinking about sex at a time like this? But another part of me is thinking that, when you’re a doctor, life and death and sex are intertwined. We are constantly leaping from one extreme peak to the next, with little regard for the abyss below.