DISCLAIMER: I don't own the characters or the scenario, and I'm not making a bloody penny off this.
The soundtrack of his working life: The beeping of the heart monitor, the sighing of the respirator, the clinking of surgical instruments, the sound of his own voice issuing demands or commenting on the situation, other voices supplying information. It was almost peaceful sometimes, at least superficially.
The purely rational part of his brain was convinced this surgery was pointless. The patient, an eight-year-old girl, was bleeding internally, extensively; her skull fracture was terrifying; her brain was certainly damaged; one lung was punctured; and she was malnourished and weakened by prior abuse. The other part wanted to try anyway. This might be one of those times when the patient beat the odds, or the surgeon misjudged the odds in the first place.
But what kind of life would she have if she does survive? asked that rational part of his mind.
What kind of life have you had? the other part replied. She deserves a chance.
I wasn't hurt this badly.
I'm trying anyway.
Of course. Hippocratic Oath and all that. No point telling you not to get your hopes up – you do anyway.
He always felt like a fucking cliché when he asked for a scalpel. He used it quickly.
He caught the change in the heart monitor's beeping before the anesthesiologist spoke up.
"Blood pressure 70 over 50, still dropping, heart rate 95." She paused. "66 over 48 ... 63 over 42 -- Vyv, hurry."
"Sutures. I'm hurrying as fast as I fucking can," he said in a controlled tone. "Give her a unit of blood."
"Her parents have religious objections."
"Well, that bloody figures," Vyvyan muttered, sewing rapidly. Once in a similar situation he had asked the parents about that part of the Bible where it says "You shall live by my commandments and not die by them," and saved their three-year-old boy as a result, but got a reprimand for not respecting the parents' religious preferences.
"Besides, she's O negative," the anesthesiologist said. "And we're out of that."
"Sponge. How's her pressure now?"
"65 over 48 and rising," the anesthesiologist said as he blotted inside the wound. No new blood appeared. "68 over 50 ... 74 over 54 ... I think you got it all."
There was a chance for her, then – at least there was until he saw the red welling up slightly.
"She's bleeding again. Suction!" He took the tube from the nurse and began clearing out the wound so he could see where it was coming from. "Ah, there you are, you little wanker, thought you could hide from me – CHRIST!"
A gout of blood shot up from the wound and hit him in the face. Blindly he grouped inside for the artery that he instinctively knew was most likely to be causing the bleeding. But even as he pinched it off, the heart monitor started jeering at him.
"Defibrillator!" He seized the paddles and rubbed a small amount of jelly between them as it charged up. "And ... clear!"
The tone did not change. He shocked her twice more, upping the voltage each time.
"Vyv, I think she's gone," the anesthesiologist said.
"Not bloody yet! I haven't gone to maximum!"
"Vyv, you said it yourself – she's lost too much blood to save. And she's brain dead, too."
He knew she was right. No way to save her, and nothing left to save. He set the paddles back on the defibrillator and glanced over at the clock. The words didn't want to come; they never did. But they had to be said – the first of many he had to say whenever he failed.
"Time of death ... twenty-three eighteen."
He pulled down on his mask, peeled off his gloves, threw them on the floor and left the OR. In the changing room, he took a corner a little too sharply and banged his shoulder hard against a locker.
"Aw, fuck!" he shouted, leaning against the locker. The physical pain loosened his grip on the other pain he was feeling. At last, he had found the words. He covered his face with his hands and swore quietly. "Why couldn't you have let me have this one, you fucking prick? You bastard. I hate you sometimes. What the fucking hell did she ever do to you? I know what I did to deserve this, but why her?" He threw his head back and shouted at the ceiling. "WHY, GOD? WHY?"
There was never an answer, but the immediate rage cooled. He smiled – a feral, predatory smile. This time, there was someone else to hold responsible.
He burst into the conference room, which had been allocated to the girl's parents when their daughter went into that long and fruitless surgery. The room, decorated with oak furniture and high-backed black leather chairs, was used most often for doctors' meetings. The two occupants jumped. They both had that strange mixture of youthful bodies and aged, toothless faces that belied long-term meth habits The woman probably couldn't qualify as a blood donor if she wanted to on the basis of weight alone. The man was still a normal weight, but his face looked like he had picked a dozen zits.
"I'm sorry," Vyvyan said. "I did everything I could, but her injuries, her blood loss ..." he bit off the rest of the rant that was building up in him. "She didn't make it."
"God's will," the mother said brokenly, fractionally lowering the charges she faced in Judge Vyvyan's court. "I'm sure you did everything you could, doctor."
The father smirked, convicting himself.
"I would like to think I did, ma'am ... but it looked like someone else did everything they could to her, too."
Even before Vyvyan shot a glare at the girl's father, he was squirming. "What does that mean?"
Vyvyan put both hands on the table and leaned across it. "She didn't crack her head on the pavement. The fracture was shaped wrong for that. And anyway, that doesn't explain the broken ribs, contusions, recent burns, and internal bleeding – that's what really killed her, the internal bleeding."
"Well," the mother intervened nervously, "we didn't see her fall, she always was very clumsy –"
"Oh, I bet she was clumsy!" Vyvyan snarled. "Terribly clumsy! She'd just happen to be in the way of someone's fist when it was swinging, didn't she?"
The girl's father stood up. He must have been half a foot taller and three stone heavier than Vyvyan. In terms of courage, though, the man was a dwarf, and Vyvyan knew it.
"Did she run into doorknobs a lot? Fall on knives and into fireplaces?" He started slowly around the table, and the man retreated. "Did she put cigarettes out on herself, tip boiling water on herself, fall into the bath and almost drown herself? And did she just happen to get her head in the way of a baseball bat when it was swinging?"
The man stumbled over a chair.
"This wasn't an accident; someone beat her. Didn't they?"
"Are you trying to say he did it?" the mother asked.
"That's for the police to decide. But I'll tell you something –" Vyvyan started around the table again, and the man continued to keep it between them "—I know who had custody. I know the CPS were called on the girl's parents just two weeks ago for something like the eighth time." Vyvyan watched the man's face flush dark red. "I think I know the chickenshit weasel who did it –" his voice dropped an octave "--and I hope he burns in hell."
Vyvyan turned to go, but the woman's scream put him on the defensive just in time – the father had leaped the table. Vyvyan ducked a punch without even seeing it, drove an elbow into the man's gut, whirled around, caught him across the jaw with his right fist, jumped on his supine body and began grinding his face into the carpet. But the man bucked Vyvyan off, knocking his head into the table ...
"... and you struck Mr. Macintosh in the jaw and called Mrs. Macintosh a two-bit whore—"
"Two-pence whore," Vyvyan interrupted calmly.
He was facing his boss, the chief of medicine. She was a tiny woman about 60 years old, with gray hair all in place and a white coat that seemed crisper and whiter than anyone else's. She always made Vyvyan feel like a punk, even when he was freshly showered and wearing khakhis, a silk tie and a starched white shirt under his starched white lab coat. He touched the stitches on his forehead and reminded himself not to scratch.
"Vyvyan, I might have been able to write this off as frustration and self-defense had this been the first or even second time it's happened, but we've been getting a number of complaints about you lately, and they're getting worse. And it's not just from the patients' families. Some of the newer members of the staff are starting to say they feel threatened by you."
Vyvyan rolled his eyes.
"Or that you're contemptuous of them."
"So you waited until now to throw this into my face."
"I was trying to figure out the validity of these concerns before I presented them to you, knowing that with your acute and detail-oriented mind you would pick through my arguments with an electron microscope. I mean, look at this one --" she picked up a piece of paper -- "'I must protest the surgeon's constant reference to himself as "Doctor Bastard." I—'"
"That's my bloody name!" Vyvyan shouted.
"Of course, Vyv."
"Am I not supposed to use my own bloody name because it has a few unfortunate connotations? What am I supposed to say? 'Hello! My name is Doctor Saccharine Sweet Cheeks'?"
"Or maybe 'I'm Doctor My-Parents-Were-Unmarried-And-Mum-Never-Was-Sure-Who-My-Dad-Was'!"
"Vyv, that's what I was trying to illustrate. I haven't had time to look over all these complaints and see which ones are valid and which aren't." Vyvyan tried to speak, but she kept going. "Vyvyan, you're under a lot of stress these days, with your mother's illness and your family problems and -- and I should have suggested a leave before it got out of hand – but I'm going to have to put you on leave immediately for the altercation with Mr. Macintosh."
She paused. "And we are going to have to begin termination procedures."