The Vanishing Surgeons: A Mystery

By Graham Lister

The Vanishing Surgeons takes the reader into Glasgow Royal Infirmary in Scotland during the nineteen-fifties. The Royal is two hundred years old with a proud history including the first use of antiseptic surgery and the establishment of the first school of nursing, the discipline of which is still apparent.
But all is not well in this proud and disciplined hospital. A surgeon disappears without trace, and then another. When they are finally found it is in the least likely of locations. How did it happen? Was it an accident? Or was a young and ambitious surgical intern responsible?

• Language: English
• Publisher: Xlibris US
• Release date: Nov 21, 2005
• ISBN: 9781462842469

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Copyright © 2006 by Graham Lister.

All rights reserved. No part of this book may be reproduced or transmitted in any

form or by any means, electronic or mechanical, including photocopying, recording,

or by any information storage and retrieval system, without permission in writing

from the copyright owner.

This is a work of fiction. Names, characters, places and incidents either are the

product of the author’s imagination or are used fictitiously, and any resemblance to

any actual persons, living or dead, events, or locales is entirely coincidental.

This book was printed in the United States of America.

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Contents

Chapter One

Chapter Two

Chapter Three

Chapter Four

Chapter Five

Chapter Six

Chapter Seven

Chapter Eight

Chapter Nine

Chapter Ten

Chapter Eleven

Chapter Twelve

Chapter Thirteen

Chapter Fourteen

Chapter Fifteen

Chapter Sixteen

Chapter Seventeen

Chapter Eighteen

Chapter Nineteen

Chapter Twenty

Chapter Twenty One

Chapter Twenty Two

Chapter Twenty Three

Chapter Twenty Four

Chapter Twenty Five

Chapter Twenty Six

Epilogue

Chapter One

Through the windows that formed the entire north wall of the operating theater, fifteen feet high, the gray morning light now filled the room; only the powerful overhead lamps over the sleeping patient held it at bay. The room was large, its floor of granite, walls of tile. It was sufficiently large that, even when both of the tables in the room were in use, surrounded by surgeons and assistants, by the scrub nurses at each table, by the high unwieldy anesthetic machines with their bottles of gases and clicking valves attended by the anesthesiologist and his trainees, even then there was more than enough room for several students to watch and for senior surgeons to consult. Indeed it was common practice for the Professor or one of his Senior Lecturers to move freely from table to table, examining problems, giving advice, criticizing the work that was being done.

Damn, said Charles Wilson, breaking the dawn silence as a jet of blood spurted from the wound in an arc that splattered to the floor beyond the patient’s feet.

As he spoke he reached out with his right hand, grabbed the stack of swabs the scrub nurse was holding out in anticipation, and thrust them into the incision in the groin. Placing his left hand over the swabs, he leaned forward, his left elbow extended to bring pressure on the leak in the femoral artery. Within three seconds of its unexpected onset, the bleeding was under control.

Over his mask, Wilson’s eyes met those of Andrew Grant.

You are a clumsy fellow, aren’t you? said Wilson.

Me?

Well, I certainly didn’t take the clamp off the sling.

But you did, thought Andrew, although you do not know it. As you moved that retractor that was in your way, you popped open the teeth on the locking clamp. But Andrew said nothing.

Let’s get on, shall we? said Wilson. I see that the sun’s up and I have a ten o’clock tee time. Here, keep the pressure on these swabs. Right. Now, put a rake retractor in the top end of the wound.

Once Andrew was so positioned, Wilson found the sling around the femoral artery, lifted it firmly and reapplied the clamp. Crisis over. Blood loss minimal.

Wilson finished closing the incision he had made in the artery. He checked the pulse on the top of the patient’s foot. The foot was now pink, in marked contrast to the mottled blue and gray Andrew had found when he had been called to the ward earlier.

Good pulse, said Wilson.

You can send for that dressing change, he said to the circulating staff nurse as she handed closing sutures to the scrub nurse, the one that Dr. Grant has scheduled. I might as well take a look at that before I go.

Later, as he and Andrew Grant entered the surgeon’s lounge, Charles Wilson continued to ride his young intern.

You fouled up on that degloving, didn’t you? asked Wilson, smiling at his junior with evident pleasure, but little warmth.

Well . . . said Andrew.

It’s a damn good job that I stayed for that dressing change. Wilson interrupted. Those flaps of skin should have been cut away the day that woman was admitted.

The older surgeon peeled off his gloves with a snap and fired them across the changing room with practiced ease, as if he were using a catapult. They hit the wall, leaving a smear of blood as a message of Wilson’s disregard for the hospital cleaners, and fell limply into the wastebasket. Wilson’s smile changed to one of self-satisfaction, the pride of a man skilled in all he attempts.

Yes, I know that they should, said Andrew.

Then why the hell didn’t you do it? But, anyway, it’s all fixed now. And I really must be off.

Wilson turned his back. He untied and removed his surgical gown from over his outdoor clothes; he wore a white shirt and tie beneath the waistcoat and trousers of a gray pinstriped suit. Andrew realized that Wilson must have changed after the arterial case, before he came in to look at the dressing. Wilson dropped the gown on the floor, and stepped to the mirror. He retrieved a comb from his pocket and ran it through his dark wavy hair. He inspected his features with satisfaction, licked a finger and smoothed each of his bushy eyebrows, adjusted his Inverclyde Old Boys’ tie, with its gold lion rampant set on diagonal stripes of alternating blue and green, and ran a finger between his neck and starched white collar. Well pleased, he drew himself up to his full six feet three inches and braced his shoulders. With a final loving glance at his favorite person in the whole world, Charles Wilson turned to leave, taking his jacket from one of the row of pegs along the wall. Holding open the door into the hospital corridor, he paused to look at Andrew.

You’d better not have any more of these screw-ups, Wilson used the Americanism with relish, not if you’re hoping for a registrar job.

And then he was gone, the slam of the door placing an exclamation mark on his parting thrust.

Bastard, said Andrew.

True.

The voice came from the lounge area beneath the window that looked out over the rain-blackened roofs of the Glasgow tenements encircling the Royal Infirmary. A head appeared above the back of the battered leather couch. The sand-colored hair was tousled, the watery blue eyes were bleary with sleep, one side of the rounded, almost infant-like features was flushed, creased and glistening with a fine sheen of sweat. Jimmy Soutar had been taking one of his frequent naps.

Christ, said Andrew, you scared me.

Not as much as Lord Charles did, apparently, said his fellow house officer.

Andrew and Jimmy were the two junior house officers for the Professorial surgical unit. They were more often called residents, because they were. Resident, that is. Both were doing their pre-registration training. In June, three months previous, both had passed their final examinations following six years of medical school; before any graduate could register as a medical practitioner, he or she had to complete two six month house jobs, one in surgery, one in medicine.

What happened after that depended on where the practitioner could find employment. If either Jimmy Soutar or Andrew Grant hoped to make a career in surgery, not only did they have to pass two sets of examinations each with a pass rate around twenty per cent, they also had to get a series of hospital appointments. The first step on the ladder after residency was senior house officer, the next registrar—equivalent to a surgical resident in the United States—and then senior registrar. None of these steps guaranteed the next, so they would have to hang around at one level until either they won a post at the next or their contract was terminated. In the latter case they would then abandon any hopes of a surgical career.

To add to the uncertainty, or rather the certainty that a high number would fail in the endeavor, there were significantly less posts on one step than there were on the previous, lower one. For example, there might be well over two hundred registrars competing for twenty senior registrar jobs. And those twenty senior registrars were waiting for a consultant to either retire or drop dead; consultants held the only permanent appointment in the British National Health Service. And the number of consultant positions was limited by Government decree. It was a rat race; an outwardly distinguished and genteel one, true, but one in which the participants metaphorically clawed and bit their peers to get ahead.

Jimmy Soutar ran his fingers through his wispy hair, attempting, with little success, to redistribute it over his bald patch; he licked his fleshy lips and stretched his arms high above his head. He groaned and rolled his head around to stretch his neck muscles.

Lordy, Lordy, what a night, he said.

You out with Elspeth again?

Yeah.

Jimmy grasped his head in both hands and shook it, an act he regretted, judging by his groan. He raised blood-shot eyes and looked at Andrew.

"That girl is wild. We went to a party over in Hillhead—some friend of hers at Art School, it was crazy—then on to her place. I didn’t get back here until after four.

Came in here looking for some coffee. Jimmy rubbed his face with both hands and gazed around as if he were seeing the room for the first time. Must have crashed.

Andrew knew Elspeth Cunningham, a rangy blond with a figure that held one’s attention. He had seen her blue eyes narrow as she watched Jimmy hungrily at one of the impromptu parties the residents held in their communal lounge. She was like a lioness fixed on her prey, especially if Jimmy were talking to some other girl.

You’d better watch yourself, said Andrew, or she’ll have you down the aisle.

Not me, she won’t. Jimmy stood up. Marriage kills a career, and I’ve told her so.

He looked at Andrew.

What exactly were you doing in theater this early that caused Charles Wilson to yank your chain?

We took Elsie Harper back, you know, the patient from Friday. She’d clotted off her graft. And then we were doing a dressing change on that degloving injury from last Tuesday. The one that went under the wheels of the trolley bus. Mrs. Williamson.

Oh right, Jimmy nodded his head, the ‘banana’ got both legs, didn’t it?

The trolley buses in Glasgow were known as bananas, because, as the locals commented, they were green and yellow, their availability, as with bananas in the years after the Second World War, was unpredictable, and, when they did appear, they always came in bunches. They were also called silent death. The rubbershod electric vehicles had replaced almost all of the clanging, rattling, iron-wheeled tramcars on the city’s streets, but not in the hearts of its people.

The trolley buses had an open platform up front where passengers boarded. The middle-aged ladies of the town, overweight and bronchitic from the un-tipped Woodbine cigarettes they smoked, laden down with one or more string bags containing their groceries, these worthies often slipped on the rubber surface of the platform, made slick by the ever-present rain, and fell from the bus. Like water skiers in a distant clime, they released their hold on the pole only reluctantly and then too late, causing their legs to pass beneath the wheels of the vehicle, wheels that waited, like beasts of prey, right behind the platform. The rubber pneumatic tires stripped the skin from the legs of the unfortunate housewife, like peel coming off an orange. Most of the folds of hanging skin could not be stitched back, as they had lost their blood supply. They had to be cut away, leaving a large expanse of bare muscle. When the unfortunate patient was stable, some three to four days later, the wounds were skin grafted.

So what was Lord Charles giving you a rough time about? continued Soutar.

Both legs looked hellish. The flaps of skin were bright red and there must have been a pint of pus under there. And the fat on the underside of the flaps was dead.

The door to the changing room opened. The two men turned and the new arrival stopped abruptly.

Oh, sorry, he exclaimed and began to back out.

No, no, come on in, said Jimmy Soutar. What’s a young medical student doing here on a Sunday morning? Come to worship at the shrine?

The man in the doorway laughed nervously. His skin, of a black so dense that it seemed to absorb the light, shone with sudden embarrassment, contrasting with the short white jacket that marked him as an undergraduate.

No, sir, he replied, shifting from one foot to the other, I just thought I would come in and read up on the patients on Ward 31. That’s where I have been assigned. Starting tomorrow.

Hallelujah, cried Jimmy, raising both hands in mock praise. Let’s hope this fervor lasts longer than a week. Though I doubt it will. What’s your name, young man?

John Senbanjo, sir.

"Don’t call me ‘sir.’ Save that for professors, examiners and older patients clearly your social inferior. I’m Dr. Soutar. This is Dr. Grant. We’re the residents. The lowest of the low. At least until you showed up.

But where were we, Andrew, my friend, when this young enthusiast joined us? Jimmy went on. "Oh, yes, the dressing change. Why was Lord Charles reaming you out? You didn’t do the debridement, did you?"

What’s a debridement? said John Senbanjo.

What’s this? said Soutar. Don’t you carry a medical dictionary?

Och, Jimmy, said Andrew. Give him a break.

Turning to the student, Andrew explained. Debridement is to cut away all the tissue in a wound that is dead.

But you’re right, Jimmy, said Andrew, I didn’t do the debridement.

Gavin Forsyth did it, didn’t he? Although why he’d get involved with routine emergencies I don’t know. Where was Gordon Mackenzie?

Oh, Gordon was here. He’s the registrar, the other’s on research rotation, Andrew added for Senbanjo’s sake. Mr. Forsyth was finishing up an acute gall bladder on the other table. The general practitioner who called it in had taken Forsyth by surprise. Told him he’d like to come in and see the surgery.

Andrew grinned at Jimmy.

Hah, laughed Soutar. "So Forsyth had to be here. And he couldn’t just walk out once he was done. Had to show off a little for the GP.

He’s a bloody disaster, Jimmy went on, shaking his head. He may be the much revered Senior Lecturer in Surgery, but he couldn’t operate his way out of a paper bag.

Jimmy, hush, said Andrew, inclining his head towards the medical student.

If Dr. John Senbanjo is keen enough to come in here on a Sunday, declared Soutar, "he’s surely smart enough to measure up Gavin Forsyth in a heart beat.

But, Andrew, didn’t you assist Forsyth on that degloving?

That’s right, I did.

Well then, didn’t you tell him to cut those flaps out? That they were sure to die?

Well, I didn’t tell him. I asked if it would be a good idea.

So that’s why he left the dead stuff! What any junior suggests, he always does the opposite. What did he say?

He asked me who I thought I was, telling him how to operate.

Typical, Soutar snorted. And of course Forsyth’s got it in for you for sure, getting with Miss Research Park of 1961 before he did.

Jimmy, will you stop your nonsense? said Andrew Grant, his color rising. I only went out with her a couple of times.

Hey, two or twenty, Gavin Forsyth just hates that one of his slaves got to Helga Sorenson before he did.

But that’s crazy. He’s been going steady with her for months now. And, in any case, I never could understand what she saw in me. I mean, I’m only a house officer and she’s the Director of Research.

A young chewchter virgin, that’s what she saw, retorted Soutar, with a cackle.

What’s chewchter? asked the medical student.

Goodness, you must be new to these parts, said Jimmy. "Where are you from, anyway?"

I was born in Sierra Leone, replied Senbanjo. I did my pre-clinical years in Nairobi.

Oh, you really are bright, shining new, aren’t you, like polished ebony?

Andrew drew in his breath, but then said nothing. He understood that Jimmy was goading the young medical student on purpose, seeing how he would react to racial prejudice. A good idea probably. He would be bound to meet it amongst the patients, and the staff, for that matter. But Senbanjo grinned.

Yes, sah, he said, in a tone that mimicked that of the old ‘black-face’ minstrel shows, a bright shining new Sambo, massa sah.

The two residents laughed, and Senbanjo joined in, a deep rich laugh that hinted at a fine bass voice. He would be all right.

A chewchter is someone from the Western Highlands and Islands of Scotland, Jimmy told him, like young Doctor Grant here. All chewchters are known to be ill versed in the ways of the world, but as strong as oxen and twice as smart. And great lovers.

Enough, laughed Andrew.

So, tell me, o chewchter lover, said Jimmy Soutar, why did you not tell Wilson that Forsyth did the worthless debridement? What is worse, I do believe that I heard you admit that you did it. At least, you didn’t deny it.

Och, well, that’s right, I suppose I did, said Andrew. But I couldn’t say that Forsyth did it.

Why ever not?

I don’t clipe. That’s to tell tales, you know? This for Senbanjo. And anyway, Wilson and Forsyth are as thick as thieves.

And you’re worried about that registrar job, huh? Well, it wouldn’t have stopped me, I’ll tell you.

That’s easy for you to say, Jimmy.

How d’you mean?

Well, you know.

No, I don’t.

Andrew just shrugged and remained silent. Jimmy must recognize that his position was quite different from Andrew’s. Henry Soutar, Jimmy’s father, was a consultant pathologist at the Western Infirmary, over by the University. Henry Soutar and Gavin

Forsyth, the senior lecturer, and Jimmy himself had all gone to the same school, the Royal High. All three were members of the Glasgow Golf Club, known by everyone as Killermont, the emphasis placed precisely, by those who were anyone in Glasgow society, on the second syllable. And everyone in Glasgow knew that it took decades to achieve membership in that elite group.

Andrew’s background was different. Born on the island of Mull, off the west coast of Scotland, as a child Andrew had come to the city with his parents. Unemployment was chronically high in the islands; like so many of their kind from the islands, Andrew’s folks had found work in Glasgow, his father as a policeman, his mother as a nurse’s aide.

Oh, well, said Soutar, jumping up from the couch, this isn’t going to get the day’s labors done.

He headed for the door.

Jimmy, said Andrew, would you look at Mrs. Johnstone with me?

She’s the lady with the large bowel obstruction? Be happy to.

Thanks. I’m worried about her.

She’s in her seventies, he added to John Senbanjo. She was admitted Friday last with a large bowel obstruction. An old patient of Mr. Forsyth’s. He decided to treat her conservatively, you know, without surgery. She’s been on intravenous fluids and gastric suction since, but I think she’s getting worse.

Do you want to go now? asked Jimmy.

No, I need to change. I’ll be on Ward 33 once you’re finished on your wards.

"Okay then.

Do you want to join me? Soutar asked the young African, I have the honor of caring for the sick and wounded in Ward 31, so I carry the additional burden of instructing you.

Certainly, thank you, said Senbanjo.

Andrew untied his mask and gown and, scooping up Charles Wilson’s gown from the floor, threw them all into the linen hamper. Stepping in to the small toilet, he moistened four sheets of paper and returned to clean the blood from the wall where Charles Wilson’s gloves had left their mark. That done, he looked in the mirror in which Wilson had found so much to please him. Andrew removed a spot of blood that had dried on his cheek.

Jimmy Soutar obviously thinks that I am toadying up to Forsyth and Wilson, trying to get a registrar job. Grant frowned at his image in the mirror. Well, he admitted to himself, I can see how it looks that way. But I do want to be a surgeon. And I am not sure that working and studying hard are enough to get a foot on the next rung of the ladder. Having the right people supporting you seems to help. A lot.

The face he regarded in the mirror looked the part of the surgeon: black hair, starting to thin at the temples, steady gray-blue eyes, a straight, slender nose and a good jaw line. All hinted at the intelligence that Andrew had in abundance, also at a confidence that was evident when he was working with patients but that he lacked when left alone with his thoughts. His build was athletic, a little under six feet, but made apparently taller by the square set of broad shoulders and a posture he had inherited from his father, the ex-policeman and former sergeant in the Black Watch.

The bleat of the pager at his belt interrupted Andrew’s reverie. He went to the telephone and dialed the hospital operator.

It’s the Gatehouse, Dr. Grant, the operator told him, naming the building that housed the casualty department, I’ll put you through.

Dr. Grant, said the nurse in casualty, we have a wee boy here with appendicitis.

I’ll be right down.

Chapter Two

My God, not again, Gavin Forsyth’s voice rose. That woman does not need surgery. Dammit, how many times do I have to tell you?

The consultant’s face was scarlet above his mask, the blush extending up into the curls of graying red hair that showed beneath his cap. His bushy, gray eyebrows were gathered in anger, his bloodshot, watery brown eyes bright with rage.

Forsyth was leaning over the abdominal wound that Andrew Grant was closing. The two had just repaired a perforated duodenal ulcer, the third ‘perf’ of the day. Peptic ulcers in the first section of gut following the stomach were the most common abdominal condition in the males of the west of Scotland, ascribed to cigarette smoking, regular boozing and a diet heavy in fat. When told of these causes, the average citizen shrugged his shoulders and drank a glass of milk, which was said to be good for peptic ulcers. But that was the extent of his health care efforts, so perforations were frequent surgical emergencies.

The clock over the operating theater door showed that it was just after one in the morning. All in the room, the two surgeons, the anesthesiologist and his registrar, the scrub nurse and circulating nurse, knew that this was the last emergency of the day, for their twenty-four hours of receiving or covering the Gate, as emergency duty was variously called, had ended at midnight.

The day had brought the customary stream of surgical cases: the three perfs, one strangulated hernia, two appendectomies, including the boy about whom Andrew had taken the call so many hours ago, one embolectomy to remove a clot from the main artery to an arm that had been threatening gangrene, the hand mottled blue and cold, and two youths with severe and complicated razor slashes to the face, sustained in an encounter between the YY Peg and the Tongs, two Glasgow gangs. The gang razors had cut deep, on one of the lads slashing both eyelids and lacerating the cornea, on the other dividing the facial nerve, which controls all the muscles of expression, and the salivary duct.

Andrew had assisted Gordon Mackenzie, the surgical registrar, with the majority of the cases. As he worked on the second razor slash Mackenzie left Andrew Grant to close the long facial laceration of the first. Using over eighty closely spaced stitches of fine 6/0 nylon, Andrew took over an hour to complete the closure.

My, that’s pretty, the senior night nurse, Jane Goodsmith, had commented, much to Andrew’s surprise. Goodsmith was normally distant, a silent