Sacrifice (3 page)

‘I’ll try to remember that. In the meantime, we need to do something about that horse.’

She stood up. My heart quickened.

‘We’ll need to get rid of the carcass,’ she went on. ‘As quickly as possible.’

I stared at her.

‘Today,’ she emphasized, when I hadn’t responded.

‘I’ll bury him myself just as soon as you’re done,’ I said, as firmly as I knew how.

She shook her head. ‘I’m afraid that won’t be possible. The Scientific Support Unit from the mainland will be arriving soon. They’ll need to sweep the entire area. We may be here for weeks. We can’t work around a rotting horse.’

I think it was her choice of words, accurate but insensitive, that caused the tight ball to materialize in my chest, the one that tells me I’m mad as hell and I really, really need to take care what I say for the next few minutes.

‘And, as I’m sure you’re aware, burying your own horse has been illegal for several years,’ she continued. I glared back at her. Of course I was
bloody aware: my mother had been running a riding school for the last thirty years. But I was not about to argue with Sergeant Tulloch about the prohibitive cost of having a horse taken away on Shetland. Nor was I going to tell her about my (admittedly very sentimental) need to keep Jamie close.

Tulloch stood up and looked round. She spotted the wall-mounted telephone above the fridge and walked over to it.

‘Would you like to make the arrangements,’ she said, ‘or should I?’

I honestly think I might have hit her at that point; I even started to stride towards her and, out of the corner of my eye, I saw the WPC step forward too. Fortunately for us both, before Tulloch could lift the receiver, the phone rang. To my increasing annoyance, she answered it, then held it out. ‘For you,’ she said.

‘You don’t say!’ I made no move to take it from her.

She withdrew her hand. ‘Do you want to take the call or not? Sounds important.’

Giving her my best glare, I grabbed the phone and turned my back on her. A voice I’d never heard before started talking.

‘Miss Hamilton, Kenn Gifford here. We have a twenty-eight-year-old patient. Thirty-six weeks pregnant. She arrived about fifteen minutes ago, haemorrhaging badly. Foetus showing signs of mild distress.’

I willed myself to focus. Who the hell was Kenn
Gifford? Couldn’t place him at all; one of the house officers, maybe, or a locum?

‘Who is she?’ I said.

Gifford paused. I could hear paper being shuffled. ‘Janet Kennedy.’

I swore under my breath. I’d been keeping a close eye on Janet. She was about three stone overweight, had a placenta praevia and, to cap it all, was a rhesus negative blood group. She was booked in for a Caesarean six days from now but had gone into labour early. I looked at the clock. It was five-fifteen. I thought for a second.

Placenta praevia means that the placenta has implanted in the lower, rather than the upper, part of the uterus. It blocks the baby’s exit, meaning the little tyke is either stuck where it is – not a good situation – or is forced to dislodge the placenta and interrupt its own blood supply – an even worse situation. Placenta praevia is a major cause of bleeding in the second and third trimesters and of haemorrhage in the final two months.

I took a deep breath. ‘Get her into theatre. We need to anticipate intra-operative bleeding so let the blood bank know. I’ll be twenty minutes.’

The line went dead, just as I remembered that Kenn Gifford was the Chief Consultant Surgeon and Medical Director at the Franklin Stone Hospital, Lerwick. In other words, my boss. He’d been on sabbatical for the past six months, his departure pretty much coinciding with my arrival on Shetland. Although he’d approved my appointment, we’d
never met. Now he was about to watch me perform a difficult procedure with a serious possibility the patient might die.

And there I’d been, thinking the day couldn’t possibly get any worse.

2

TWENTY-FIVE MINUTES LATER
I was gowned up, scrubbed and heading for Theatre 2 when a house officer stopped me.

‘What?’

‘We don’t have any blood,’ the young Scotsman replied. ‘The bank’s out of AB negative.’

I stared at him. What the hell else was going to go wrong? ‘You’re kidding me,’ I managed.

He wasn’t kidding. ‘It’s a rare group. We had an RTA two days ago. We have one unit, that’s all.’

‘Well, get some more, for God’s sake!’ On top of everything I’d been through already that day, I was sick with nerves about the coming procedure. I’m afraid I don’t do polite in those circumstances.

‘I’m not an idiot, you know. We’ve ordered it. But the helicopter can’t take off at the moment. The wind’s too strong.’

I glared at him and then pushed my way into theatre just as a huge man in airforce-blue cotton scrubs made the final incision into Janet’s uterus.

‘Suction,’ he said. He took a tube from the attendant scrub nurse and inserted it to drain off the amniotic fluid.

In spite of the mask and theatre hat he wore, I could see at once that Kenn Gifford was exceptional-looking; not handsome, quite the opposite in fact, but striking all the same. The skin I could see above the mask was fair, the type that reveals the blood vessels beneath it and looks permanently pink after a certain age. He hadn’t reached that age yet, but the theatre was hot and his colour was high. His eyes were small and deep set, hardly visible from a distance and of an indeterminate colour, even close up. They weren’t blue or brown or green or hazel. Dark rather than light; grey perhaps came the closest, and yet I didn’t look at him and think, grey eyes. Large, half-moon shadows lay beneath them.

He saw me and stepped back, holding his hands at shoulder height and, with his head, gestured me forward. A screen had been set up to shield Janet and her husband from the gorier aspects of the operation. I looked down, determined to think about nothing but the job in hand; certainly not of Gifford, who was standing, uncomfortably close, just behind my left shoulder.

‘I’ll need some fundal pressure,’ I said, and Gifford moved round to face me.

I went through the usual checklist in my head, noting the position of the baby, location of the umbilical cord. I put my hand under the baby’s shoulder and eased gently. Gifford began to push on
Janet’s abdomen as my other hand slipped in around the baby’s bottom. My left hand moved upwards to cup the head and neck and then gently, forcing myself to go slowly, I lifted the mucus-covered, blood-smeared little body out of his mother and into his life. I felt that second of sheer emotion – of triumph, elation and misery all at once – that makes my face sting, my eyes water and my voice tremble. It passes quickly. Maybe one day it won’t happen at all; maybe I’ll get so used to bringing new life into the world that it will cease to affect me. I hope not.

The baby began to scream and I allowed myself to smile, to relax for a second, before I handed him to Gifford – who had been watching me very closely – and turned back to Janet to clamp and cut the cord.

‘What is it? It is all right?’ came her voice from behind the screen.

Gifford took the baby to the Kennedys, allowing them a few moments to cuddle and greet their son before the weighing and testing would begin. My job was to take care of the mother.

Over at the paediatrician’s table, Gifford was calling out numbers to the midwife, who was recording them on a chart.

‘Two, two, two, one, two.’

He was checking the baby against the Apgar score, a test devised to check the health and fitness of the newborn. Baby Kennedy had scored nine; the test would be repeated twice more but I didn’t need the results. I knew he was pretty much perfect.

I couldn’t say the same for the mother. She’d lost
a lot of blood, more than we were able to replace and the bleeding was continuing. Immediately after delivery the anaesthetist had given her Syntocinon, the drug routinely administered to prevent post-partum haemorrhage. In most cases it worked. In a very few it didn’t. This was going to be one of the few. I delivered the placenta and then called my boss over.

‘Mr Gifford.’

He crossed the room and we stood a little back from the Kennedys.

‘How much blood would you say she’s lost?’ I asked. Glancing to the left, my eyes were on a level with his shoulder.

‘Couple of units, maybe more.’

‘We have exactly one unit in stock.’

He cursed under his breath.

‘She’s still haemorrhaging,’ I said. ‘She can’t lose any more.’

He stepped closer to Janet and looked at her. Then at me. He nodded. We walked round the screen and stood facing the Kennedys. John was holding his son, joy beaming out of every muscle in his face. His wife, on the other hand, did not look well.

‘Janet, can you hear me?’

She turned and made eye contact.

‘Janet, you’re losing too much blood. The drug we’ve given you to stop the bleeding hasn’t worked and you’re getting very weak. I need to perform a hysterectomy.’

Her eyes widened in shock.

‘Now?’ her husband said, his face draining pale.

I nodded. ‘Yes, now. As soon as possible.’

He looked at Gifford. ‘Do you agree with this?’

‘Yes,’ said Gifford. ‘I think your wife will die if we don’t.’

Pretty blunt, even by my standards, but I couldn’t argue with him.

The Kennedys looked at each other. Then John spoke to Gifford again. ‘Can you do it?’

‘No,’ he said. ‘Miss Hamilton will do it better than I can.’

I somehow doubted that, but it wasn’t the place to argue. I looked over at the anaesthetist. She nodded at me, already set up to administer the general anaesthetic that would be needed for the procedure. A nurse arrived with the consent forms and John Kennedy and his son left the theatre. I shut my eyes briefly, took a deep breath and got to work.

Two hours later, Janet Kennedy was weak but stable, the wind had dropped and the blood she badly needed was on its way. She was probably going to be OK. Baby Kennedy, now named Tamary, was fine and dandy and John was dozing in the chair by his wife’s bed. I’d showered and changed, but felt the need to stay at the hospital until the blood arrived. I phoned home to check messages but Duncan hadn’t called. I had no idea if the police were still there or not.

Gifford had stayed in theatre throughout the hysterectomy. He might have pretended absolute
confidence when speaking to the Kennedys but he’d kept a pretty close eye on me throughout. Only once had he spoken: a sharp ‘Check your clamps, Miss Hamilton’ when my concentration had slipped a fraction. He’d left the theatre without a word when the operation was over, at least trusting me to close by myself.

I really wasn’t sure whether he’d been satisfied with me or not. It had all gone pretty smoothly, but there’d been nothing slick, certainly nothing polished about what I’d done. I’d looked like what I was: a newly qualified and very nervous consultant, desperate not to put a foot wrong.

And now I was annoyed with him. He should have said something; even criticism would have been better than just leaving. I may not have been brilliant but I’d done OK and now I was tired, a bit weepy and rather in need of an encouraging word and a pat on the back. It’s a part of myself that I really don’t like, this constant need for approval. When I was younger, I assumed it was something I’d eventually grow out of; that self-assurance would come with greater experience and maturity. Just lately, though, I’ve started to have doubts about that, to wonder if maybe I’ll always need the reassurance of others.

I was standing at my office window, watching people and vehicles move around in the car park below. I jumped as the phone rang and rushed back over to my desk, thinking the blood had arrived sooner than expected.

‘Miss Hamilton, this is Stephen Renney.’

‘Hello,’ I said, stalling for time, thinking,
Renney, Renney, I should know that name
.

‘I heard you’d been called in. If you’re not too busy, there’s something you can help me with. Any chance of you popping down?’

‘Of course,’ I said. ‘Anything I need to bring?’

‘No, no, just your expertise. Call it professional pride, even professional conceit, if you like, but I do want to hand over a complete report when the big boys get here. I’ve got a suspicion that could be important and I don’t want a couple of smart-arses from the mainland waving it in my face tomorrow morning like some big discovery.’

I had no idea what he was talking about but I’d heard it all before. So reluctant were the islanders to be thought in any way inferior to their mainland counterparts that they created a climate of excellence, even over-achievement, as the norm. Sometimes it actually got in the way of doing the job; sometimes
good enough
was really, honestly, all you needed. When I was in a bad mood and some bolshie registrar was giving me a hard time, I called it the Collective Chip on the Shetland Shoulder.

‘I’m on my way,’ I said. ‘What room are you in?’

‘103,’ he replied. A room on the ground floor. I put the phone down and left the office. I made my way along the corridor and down the stairs, past radiology, paediatrics and accident & emergency. I followed the corridor, counting off room numbers as I went. I couldn’t place room 103 and had no idea of
Stephen Renney’s field. I saw the number and pushed open the door.

On the other side, totally blocking the corridor were DI Dunn, DS Tulloch and Kenn Gifford, still in scrubs but having lost the mask and hat. Also a small, bespectacled man with thinning hair who I knew I’d seen before. I guessed he was Stephen Renney and, feeling like a complete idiot, I finally remembered that he was the hospital’s locum pathologist.

Room 103 was the morgue.

3

THE SMALL MAN
came forward, holding out a bony hand. There were traces of eczema around his wrist. I took it, trying not to shiver at how cold it felt.

‘Miss Hamilton, Stephen Renney. I’m so grateful. I’ve just been explaining to the detectives that, in the interests of completeness, I really do need—’

The doors opened again and a porter wheeled in a trolley. We all had to stand back against the wall to let him past. Gifford spoke and, away from the tension of theatre, I realized he had one of those deep, educated Highland voices that, prior to my moving here and hearing them on a regular basis, had been guaranteed to put a tickle behind my knees and a smile on my face. One of those ‘oh, just keep talking’ voices.