Past Imperfect

The two people, an elderly couple heading for a door at the end, passed them. His porter's uniform shouldn't raise suspicions; it was an almost exact match. Optimology? His mind spun, panning frantically for options. His eyes fixed on the number of the furthest door. 'I've just come from optimology, and they said I might find him in 6C.'

'What's the patient's name?'

'They didn't say.'

The doctor shrugged. 'There's nobody in 6C right now. New patient isn't coming in till tonight, and the old patient was moved back to the general ward yesterday.'

'Okay. I'll try there.' Chapeau headed back the way he'd come. Pacing, calming his breath. He silently cursed: crucial seconds had been lost, and the doctor might later remember him. Behind him, at the end of the corridor, the couple had already disappeared. Calming. The sound of the doctor's footsteps receded beyond his own rapid, shallow breaths. But ahead now, at the angle of the L, he could see the first trails of smoke drifting across, misty grey suffused with stark sunlight from the window. And he begged that the doctor didn't turn around suddenly and see it. He listened intently to the sounds of the doctor’s fading footsteps between his own, a faint shuffle, a door opening… slowly closing. All too slowly.

Chapeau let out a long breath as it finally shut, then ran the last few steps towards the smoke. A nurse had come out from the general ward at the far end, looking equally startled as she noticed the smoke. Chapeau lifted one arm in acknowledgement and ran back towards the alarm. Halfway along, he heard the plaintive cry of 'Fire!..' from the nurse.

He took the small brass hammer on a chain at the side of the alarm and swung it sharply, smashing the glass and releasing the alarm button.

The bell was deafening, echoing from the stark walls and floor. Chapeau ran back swiftly towards the smoke and room 4A. He heard a door open behind him, some muttering, a sudden startled voice — but he didn't look back. As he turned the L and came back into the main corridor, five or six people had come out of their rooms.

'Is it another fire drill?' someone asked.

Faint babble of replies, more startled voices rising above, the final realization — as the build up of smoke became evident — that this was the real thing. Sudden mobilization, more people starting to spill out of the rooms, most of them from the large general ward at the end. Some were now heading for the stairs and the five or six quickly grew to over twenty. Panic, confusion.

Chapeau suddenly felt more secure among the milling crowd; hardly anyone was paying him any attention. He took the syringe from his pocket. The needle was already attached, and he slipped off the plastic protection cap. Room 4A was only a few yards to one side. He tucked the syringe neatly up inside his sleeve, and reached out for the door.

A quick intake of breath, but he felt confident. His adrenaline was racing because of the fire and activity around, not nerves. The scenario was perfect. It would all be over within a minute.

It didn't strike him as odd that he'd seen nobody run from 4A until he opened the door wide. No nurse or doctor, nobody in attendance. A split second elation that he'd been lucky and chosen a totally un-guarded moment before realizing — as he looked through the glass screen — that there was no boy either.

'Shit… Shiiit!' He stood transfixed, staring at the empty space. Around him, pandemonium was building. He was the only person on the second floor not in motion. A steady stream was now heading for the stairs, and a medic with a fire extinguisher was spraying the inside of the store room while a porter rushed for another extinguisher.

It took a moment for Chapeau to break himself out of his trance and ask someone passing where the boy had gone. He'd stopped three nurses before finding someone who knew. 'He was taken into the operating theatre over an hour ago.'

'Thanks.' Chapeau merged with the throng heading down the stairs. The porter had joined the medic with a second fire extinguisher. They would probably have the fire out within a few minutes.

In the first floor operating theatre, the alarm bell rang ominously in the background. The Chief Surgeon, Dr Trichot, asked one of the nurses to find out what was wrong.

She came back in after a moment. 'Fire on the second floor, apparently.'

'Is it confined to there?'

'I don't know, I didn't ask.'

Trichot nodded for his assisting nurse to dab his forehead, and silently cursed. 'Let's assume that there's no immediate danger, or at least someone will come running in when there is, and continue. Please! '

The assisting nurse took the scalpel from him as he held it out tersely. She thrust a self-retaining retractor into the same hand.

The boy, Christian Rosselot, had been on the operating table over thirty minutes now, but they'd lost vital time getting X-rays and angiograms and preparing for anaesthetic. In that time, the temporal skull section by the boy's ear had bulged alarmingly with an active clot.

But two nights ago he'd operated on the boy for a similar clot in the parietal lobe, snatched him within minutes from the jaws of death — and he was determined not to be defeated now. Fire or no fire. The clanging bell was enfuriating, grating at his nerves. It couldn't have come at a worse time. He needed all his concentration at this point. Implements were placed in his hand and taken back without him looking up, the last an electric burr drill. Its high pitched drone lowered as Trichot cut into the bone of the skull.

The extradural cortex was exposed. There was no sign of haematoma, and Trichot began to worry. He would have to go deeper. 'We must go into the subdural.'

Partly gelateneous, Trichot sliced through the dura easily with the scalpel, pulled back with a hook and prompted his assistant to shine a penlight into the aperture.

Grey and white tissue and vessels reflected brightly under the light; the dark matter of the blood clot only showed up as Trichot widened the arc of the penlight. It was in the upper portion of the temporal. He wouldn't be able to judge its size or remove all of it without a larger incision.

A nod, a dab. Trichot passed back the penlight. 'I'll have to go higher.'

The attending anaesthetist announced, 'Pulse rate sixty to sixty-five,' as the sound of the drill cut in again.

From seventy, seventy-five just a few minutes ago, thought Trichot. He looked across briefly at the blood pressure gauge. It had dropped 20 points to 116 over 67 in the same period. The burr hole made, he started sawing across, joining the two. The bleep rate dropped still further.

‘Fifty-four, fifty-one.' Now with a note of urgency.

Trichot was sweating profusely. Another dab. It was going to be a race against time. Another ten seconds of sawing, fifteen or twenty seconds to cut through the dura and widen the aperture. Then the time needed to suck away the clot itself would depend on how large it was. How much more would the pulse have dropped by then?

Trichot finished sawing, and pulled back with the hook. All but a small portion of the clot was now visible. The air pressure sucker was passed across.

'Forty-five….three... dropping fast! Forty!'

Trichot felt a twinge of panic. Once the pulse rate fell to thirty, thirty-two, it was effectively all over. He'd fought too hard for the boy to let him go now.

The air sucker ate into the congealed dark red mass of the clot. Within twenty seconds, Trichot had removed almost a third of it.

'…. Thirty-eight… seven.'

The rate of pulse drop had slowed, but part of the clot was still out of sight. Trichot glanced at the blood pressure gauge: 104 over 61. It was going to be a close call. If the rupture was behind the last portion of the clot; if it was difficult to reach to cauterize; if the pulse rate dropped more rapidly; if there was more than one rupture. Any one factor meant that he wouldn't make it in time. Beads of sweat massed on his forehead, and his own pulse drummed a double beat to the bleep from the monitor. Trichot moved his way upward with the sucker, praying that the ruptured vessel would soon come into view.