Cutting Edge

Thirty-five

The senior Consultant Anesthetist was a trim-looking man of medium build, a livid mark high on his left cheek, birthmark or burn. He greeted Jack Skelton as though he and the superintendent might long ago have been at school together, even shared the same dorm, eaten at the same refectory table, though, of course, they had not. The two men hadn’t even leaned elbows against the same golf club bar, though, true to say, the consultant had done so with the Chief Constable. Yes, and the Chief Constable before that. Skelton was a runner not a golfer, a few rounds of pitch and putt on long-past family holidays the nearest he had ever come to a tight-fought eighteen holes then large gins and business at the nineteenth. His education had been grammar school, a good one at that, bringing the industrious middle classes the trappings of a public school-houses, prefects, an emphasis on keeping a straight bat while all around you are flashing across the line-without the expense. Or the kudos, automatic entry into the elite.

It would have been easy for the consultant to have patronized Skelton, so easy as to be automatic. Better, though, to rein that back, keep it under control; treat the man as a fellow professional, one who’s risen to the top, an equal.

They shook hands and sat in comfortable chairs inclined towards the window; with only a slight effort it was possible to see the trees along the avenues of the university park, those around Wollaton Lake and the ornate turrets and chimneys of Wollaton House itself.

Skelton declined sherry, accepted the offer of coffee, which came in white china and with biscuits on the side. There was a preliminary feeling-out, during which the consultant let Skelton know how many officers be knew in the Force who were senior to the rank of superintendent. In total it didn’t number many and the consultant knew nearly all of them.

Skelton had his best suit on and he felt scruffy; the fact that the man was so clearly making an effort to be pleasant and polite made it all the worse. He set down his cup and saucer and explained in terms as sharp and defined as the crease of the consultant’s trousers what he needed to know and why.

“Anesthetic failure,” the consultant said.

“Exactly.”

“You really believe, as a line of inquiry, this is … er … germane?”

“Amongst others, yes. Otherwise, I wouldn’t dream of wasting your time.”

Don’t patronize me, the consultant thought, taking his china cup towards the window and gazing out. To the left, just out of sight, was the bridge across the ring road where this wretched business had all started.

“What do you want to know?” he asked.

“Everything,” Skelton said. “Everything that’s relevant.”

The consultant drew a breath. “What you must realize. First. The phenomenon we’re talking about here is precisely that. Its occurrence is restricted to a tiny number of cases.”

Skelton waited.

“I wonder if you know how many operations are carried out each year in this country?”

The superintendent shook his head.

“Somewhere in excess of three million. So whatever incidents we’re discussing, they have to be seen against that context.”

Skelton crossed his legs and waited some more.

“Recent research suggests-and like all research of this nature these results should not be considered conclusive-there may be some degree of anesthetic failure in as few as one in every five hundred cases.”

It was very quiet in the room.

“As few?” Skelton said.

“Exactly.”

“But not exactly.”

“I’m sorry …”

“The figures, one in five hundred, you said they shouldn’t be thought of as conclusive.”

The consultant nodded. “They could be less.”

“They could be more.”

“In theory, yes, but …”

“But that’s not a theory you would necessarily go along with.”

“That’s correct.”

Time for Skelton to nibble a biscuit, recross his legs; for the consultant to check through his window that the trees were still there.

“As far as the patient is concerned,” Skelton said, “some degree of anesthetic failure means …”

“It means,” interrupting sharply, “there is likely to be some small form of awareness …”

“Small form?”

“Some awareness of what is happening.”

“To the patient?”

“Yes, yes, of course. That’s what we’re talking about. For some reason, some mechanical failure, or mismanagement, or something unique to that particular patient, the nitrous oxide, the anesthetic gases fail to function correctly.”

“The patient feels pain.”

“Yes, of course. The patient is being operated upon. The …”

“Cut open.”

“Generally, yes. The whole technique, the reason …”

“Then why doesn’t he scream? He or she, whoever it is, as soon as the surgeon makes the first incision, why don’t they scream?”

The consultant shook his head. “They can’t.”

“Why ever not?”

“Because, usually, although the anesthetic is failing to have the desired effect, the other substance that is being breathed in, the muscle relaxant, is effective.”

“Effective?”

“Yes.”

“Please explain.”

“The patient’s muscles are totally relaxed, any movement is impossible; there is no effect on either consciousness or the control of pain.”

There was a fly now, in the still room, somehow a fly, impossibly loud.

“All the patient can do, while the surgeon does his work, is lie there and give no sign.”

“Not actively, that is correct.”

“But there are signs?”

“Oh, yes. Generally. Arrhythmia of the heart, a rise in blood pressure-the difficulty is that these same signs more commonly occur in association with other causes.”

“So there is nothing specific? Nothing that somebody around the patient might recognize as a sign of pain, a cry for help?”

“Sometimes,” the consultant said carefully, “the patient may sweat and sometimes …”

“Yes?”

“Sometimes, although the eyes are taped shut, there may be tears.”