Not a Penny More, Not a Penny Less

Robin, scrubbed up and gowned, was there to meet them at the door and while they were strapping Harvey Metcalfe to the operating table in the small room next to the theater, he spoke for the first time:

“All of you, change your clothes. And Jean-Pierre, you scrub up as instructed.”

All three of them changed and Jean-Pierre started to wash immediately—a long, laborious process which Robin had firmly taught him must never be cut short. Postoperative septicaemia formed no part of his plan. Jean-Pierre appeared from the scrubbing-up room ready for action.

“Now, relax. We’ve done this nine times already. Just carry on exactly as if we were still in St. Thomas’s.”

Stephen moved behind the mobile Boyles machine. For four weeks he had been training as an anesthetist: he had rendered James and a faintly protesting Jean-Pierre unconscious twice each in practice runs at St. Thomas’s. Now was his chance to exercise his new powers over Harvey Metcalfe.

Robin removed a syringe from a plastic packet and injected 250 mg. of thiopentone into Harvey’s arm. The patient sank back into a deep sleep. Quickly and efficiently Jean-Pierre and James undressed Harvey and then covered him in a sheet. Stephen placed the mask from the Boyles machine over Metcalfe’s nose. The two flow-meters on the back of the machine showed 5 liters of nitrous oxide and 3 liters of oxygen.

“Take his pulse,” said Robin.

Stephen placed a finger in front of the ear just above the lobe to check the pre-auricular pulse. It was 70.

“Wheel him through into the theater,” instructed Robin.

James pushed the trolley into the next room until it was just under the operating lights. Stephen trundled the Boyles machine along behind them.

The operating theater was windowless and coldly sterile. Gleaming white tiles covered every wall from floor to ceiling, and it contained only the equipment needed for one operation. Jean-Pierre had covered Harvey with a sterile green sheet, leaving only his head and left arm exposed. One trolley of sterile instruments, drapes and towels had been carefully laid out by the theater nurse, and stood covered with a ster

ile sheet. Robin hung the bottle of intravenous fluid from a standard near the head of the table and taped the end of the tubing to Harvey’s left arm to complete the preparation. Stephen sat at the head of the table with the Boyles machine and adjusted the face mask over Harvey’s mouth and nose. Only one of the three massive operating lights hanging directly over Harvey had been turned on, causing a spotlight effect on the protruding bulge of his abdomen.

Eight eyes stared down on their victim. Robin continued:

“I shall give exactly the same instructions as I did in all our rehearsals, so just concentrate. First, I shall clean the abdomen with a skin preparation of iodine.”

Robin had all the instruments ready on the side of the table next to Harvey’s feet. James lifted the sheet and folded it back over Harvey’s legs, then he carefully removed the sterile sheet covering the trolley of instruments and poured iodine into one of the small basins. Robin picked up a swab in a pair of forceps and dipped it in the iodine solution. With a swift action up, down, and over the abdomen, he cleaned about 1 square foot of Harvey’s massive body, throwing the swab into a bin and repeating the action with a fresh one. Next he placed a sterile towel below Harvey’s chin, covering his chest, and another over his hips and thighs. A third one he placed lengthways along the left-hand side of his body and a final one along the right-hand side, leaving a 9-inch square of flabby belly exposed. He put a towel clip on each corner to secure them safely and then placed the laparotomy drapes over the prepared site. Robin was now ready.

“Scalpel.”

Jean-Pierre placed what he would have called a knife firmly in Robin’s outstretched palm, as a runner might when passing a baton. James’s apprehensive eyes met Jean-Pierre’s across the operating table, while Stephen concentrated on Harvey’s breathing. Robin hesitated only for a second and then made a 10 cm. paramedian incision, reaching about 3 cm. into the fat. Robin had rarely seen a larger stomach: he could probably have gone as far as 8 cm. deep without reaching the muscle. Blood started flowing everywhere, which Robin stopped with diathermy. No sooner had he finished the incision and stanched the flow of blood than he began to stitch up the patient’s wound with a 3/0 interrupted plain catgut for ten stitches.

“That will dissolve within a week,” he explained.

He then closed the skin with a 2/0 interrupted plain silk, using an atraumatic needle. Then he cleaned the wound, removing the patches of blood that still remained. Finally, he placed a medium self-adhesive wound dressing over his handiwork.

James took off the drapes and sterile towels and placed them in the bin while Robin and Jean-Pierre put Metcalfe into a hospital gown and carefully packed his clothes in a gray plastic bag.

“He’s coming around,” said Stephen.

Robin took another syringe and injected 10 mg. of diazepan.

“That will keep him asleep for at least 30 minutes,” he said, “and in any case, he’ll be ga-ga for about three hours and won’t remember much of what has happened. James, fetch the ambulance immediately and bring it around to the front of the hospital.”

James left the theater and changed back into his clothes, a procedure which he could now perform in 90 seconds. He disappeared to the car park.

“Now, you two, get changed and then place Harvey very carefully in the ambulance and Jean-Pierre, wait in the back with him. Stephen, you carry out your next assignment.”

Stephen and Jean-Pierre changed quickly, back into their long white coats and wheeled the slumbering Harvey Metcalfe gently toward the ambulance. Once safely in, Stephen ran to the public telephone by the hospital entrance, checked a piece of paper in his wallet and dialed.

“Hello, Nice-Matin? My name’s Terry Robards of the New York Times. I’m here on holiday, and I have a great little story for you…”

Robin returned to the operating theater and wheeled the trolley of instruments he had used to the sterilizing room, and left them there to be dealt with by the hospital theater staff in the morning. He picked up the plastic bag containing Harvey’s clothes and, going through to the changing room, quickly removed his operating gown, cap and mask and put on his own clothes. He went in search of the theater sister, and smiled charmingly at her.

“All finished, ma soeur. I have left the instruments by the sterilizer. Please thank Monsieur Bartise for me once again.”

“Oui, Monsieur. Notre plaisir. Je suis heureuse d’être à même de vous aider. Votre infirmière de l’Auxiliaire Médicale est arrivée.”