The theatre was twice the size of the minor surgical facility that had been used in the morning and was packed with much more technical equipment and people. Beavis, a tall serious looking man who favoured rimless glasses and a severe side parting in his hair that made him look like a Gestapo officer to Neef’s way of thinking, was very much in charge. There was no first name familiarity in his theatre. The ‘Yes Mr Beavises’ and ‘No Mr Beavises’ came thick and fast as he fired questions at the assembled team.
The patient, Thomas Downy, was positioned face down on the table, his small body draped in surgical sheeting and the back of his skull painted near the base with a yellow antiseptic solution in preparation for the first incision. Two technicians were making last minute adjustments to the CT scan equipment.
“Is everyone ready?” asked Beavis.
There was general assent.
“Is anyone not ready?”
Silence.
“Do we have the virus to hand?”
The theatre sister replied, “All ready, sir.” She indicated to a glass vial that sat in an ice bucket by the side of her instrument tray.
“Let’s get started then.”
Beavis cut into the back of Thomas Downy’s head and Neef leaned over to explain to Pereira what was going on. “He’s cutting back a flap of skin to expose the skull.”
Pereira nodded mutely.
Beavis discarded the scalpel in favour of an electric drilling tool which he tested in the air before applying it to the base of Thomas’ skull to start drilling out a plug of bone. The air was heavy with the smell of burning by the time he’d finished. He dropped the plug into a waiting bowl. Neef heard Pereira swallow.
“Will he put that back?” Pereira croaked.
“No,” replied Neef. “He’ll close the skin flap over the opening and in time the hole will fibrose and virtually close itself.”
Beavis inserted a long needle gently through the opening in Thomas Downy’s skull and stopped. “First scan!” he ordered.
The CT scan team moved into action and a few seconds later the image the scan had produced was displayed on a screen. Beavis moved the needle in deeper and repeated his request. The record of the needle’s progress came up on the screen.
“What’s happening?” asked Pereira.
“We can’t use ultrasound for brain surgery and we can’t get a camera inside the patient’s head so we have to take a series of CT scans as the operation progresses.
“You get the picture after the event?” asked Pereira.
“It has to be that way,” said Neef.
“Jesus,” said Pereira softly.
The needle continued its monitored progress towards Thomas Downy’s tumour until Beavis said, “We’re there. Can I have the virus please?”
The theatre sister reached out a gloved hand to pick up the glass vial from the ice bucket. Unfortunately its outside was wet from being in the ice and it slipped from her grasp. It bounced off the edge of the instrument tray and fell to the floor where it shattered. It sent tiny shards of glass everywhere and created a jagged wet splash where the virus had spilled out. Her gloved hands flew to her face in anguish and her eyes above her mask went as wide as saucers. Beavis couldn’t turn his head to see what had happened. His hand was holding the needle steady inside the patient’s skull. “What’s going on?” he demanded.
“We’ve lost the virus,” said Neef. “It’s fallen on the floor.” He stepped forward to put a hand lightly on the shoulder of the hapless sister as everyone else seemed paralysed by shock.
“Is there any danger?” exclaimed Beavis.
Neef looked at Pereira who shook his head.
“No danger,” said Neef. “The virus has been disabled but we better have some disinfectant on it anyway.”
One of the theatre technicians poured antiseptic solution on to the puddle on the floor and then swabbed it up with cotton wool pads. The glass was collected into a small, metal bowl.
“So now we don’t have any virus to inject. Is that right?” asked Beavis. His voice was controlled but the implications to everyone were obvious. The operation had been a waste of time. Beavis still concentrated on keeping the needle steady inside his patient’s head while he waited for an answer.
“There is some more,” interjected Pereira. “There’s a back-up supply in Pharmacy.”
“Will someone please get it,” said Beavis. “Quickly!” There was no mistaking the anxiety in his voice. There was no question of his extracting the needle and then going back in again. The risk of serious brain damage was too great. He was faced with holding the needle in situ until the new virus arrived.
As the minutes passed, Beavis said, “I think my hand’s starting to shake. Could someone please prepare to take over here?” He said it matter of factly but everyone knew the seriousness of what he was saying. There would be danger in the needle changing hands but this would be preferable to the brain damage caused by an involuntary hand tremor. Beavis’ assistant for the operation moved round into place at his elbow. “Ready when you are, sir.”
“The virus has arrived,” announced one of the nurses at the back of the theatre.
“I think I’ll be all right,” said Beavis. In the interim, he had piled up a number of surgical swabs under his scalpel hand in order to give himself some support. His assistant moved back round to the other side of the table.
The tray of glass vials was passed through the theatre doors and a nurse brought them to the table.
“Which one?” asked the theatre sister.
Pereira moved in to the table and selected one of the vials. “This one,” he said. “Five millilitres.”
The virus suspension was measured out into the barrel of a syringe and handed to Beavis who attached it to the needle already inserted in Thomas Downy’s tumour. He slowly applied pressure to the plunger until the contents disappeared then permitted himself a slight sigh of relief as he withdrew the needle slowly out of the back of his patient’s skull and dropped it into one of the steel discard dishes. He took a few moments rest during which he flexed his fingers to free them of the stiffness that had developed during the long wait. He nodded to his assistant who took over and carefully sutured the flap of skin back into place over the opening in Thomas’ skull.
“All done,” he said.
“Heavy stuff,” Pereira whispered to Neef, rolling his eyes above his mask.
“We could have done without the drama,” agreed Neef.
The nurse who had dropped the virus was still flushed with discomfort and embarrassment. She moved towards Beavis as he stripped off his gloves and said, “Mr Beavis, I’m so terribly sorry about...”
Beavis stopped her in mid sentence and said, “Don’t worry about it, Sister. It could have happened to anyone. No harm done.”
Neef decided to try and kill off the Gestapo officer image he had of Beavis.
The relief in the nurse’s eyes was obvious to all. One of her colleagues put an arm round her shoulders and as Thomas Downy was wheeled out to the recovery area, it seemed as if the whole theatre suddenly relaxed as tension evaporated.
Neef walked back to the unit with Max Pereira. Pereira had been subdued all day but now he seemed to have perked up again. “There was more to it than I thought,” he confessed. “I thought you could just stick a needle in and that was that.”
“So we medics have our uses then?” smiled Neef.
“I guess I really need you guys to get the vectors in,” replied Pereira, without a trace of humour. “Two more tomorrow?”
“Two more,” agreed Neef. “And then we’re all up and running.”
Neef went straight to the duty room to see Kate Morse. “How’s Charlie?” he asked.
“He’s not good,” replied Kate. “The lab haven’t come up with a confirmation of the Klebsiella diagnosis and he doesn’t seem to be responding to the ampicillin treatment.”