Everything was going according to plan. Though Jake was always meticulous in preparing for surgery, so he wasn't expecting any nasty surprises. 'I'm going to do intra-operative angiography to make sure the blood is flowing correctly through the artery—if it isn't, I can correct it now. If I leave this until after the operation and there's a problem, it means back to Theatre and another anaesthetic, so it's better to do it now.' To his relief, all was well. 'OK. The blood's flowing properly and the clip's in place.' He removed the retractors. 'Now we close the dura. Sutures. Bone flap back in place—secured to the skull with titanium plates and screws. Suture the muscles and skin back together, soft adhesive dressing over the incision...and wait for her to wake up.'
Back in the scrub room, Charlie said, 'Neat work. If you ever fancy switching to plastics...'
Jake smiled and shook his head. 'I like neurology.'
'So what's next?' Seb asked.
'Wait for her to come round,' Jake said. 'She'll be in Intensive Care for a couple of days, then moved up to the ward for the rest of the week.'
'And in the meantime, she's at risk of hydrocephalus,' Charlie said. Hydrocephalus was an excess amount of cerebrospinal fluid within the skull, and it was a possible complication after brain surgery.
'But she'll be under neuro obs so they'll see if there's any sign of raised intracranial pressure,' Seb said. 'Headache, vomiting, any deteriorating of mental function—and an MRI will show up the excess fluid. A shunt will drain it away safely to the peritoneal cavity.'
Jake grinned. 'Hey. Want to swap jobs?'
Seb shook his head. 'No way. Emergency medicine's a buzz. Neurology is scary. If I make a slip, I can fix it. If you make a slip...' His voice faded.
'I didn't. It was a textbook op. No complications during surgery.' Jake immediately found a piece of wood to touch. Please, God, don't let there be any post-op problems. 'And, as you said, she'll be under observation. We'll spot the symptoms of early hydrocephalus or vasospasm straight away and deal with it.' Vasospasm was the sudden constriction of a blood vessel, which led to a decrease in blood flow and could lead to a stroke.
'What if you're in Theatre with another patient?' Charlie asked.
'I won't be,' Jake said quietly. 'As of now, I'm off duty until Vicky's out of hospital. I'm here if my locum or anyone on the team needs a second opinion, but I'm not moving from Vicky's bedside. She's my priority.' For now and for always. He took a deep breath. 'Let's go and see if your sister's woken up.'
'Hello, beautiful. How are you feeling?' Jake asked.
"S if a horse just kicked me in the head,' Vicky mumbled.
'I can give you something for that.'
Vicky's eyelids fluttered and she forced them to stay open. 'How'd it go?'
'Textbook. So you now have a nice MRI-friendly clip sitting in your head.'
'Mmm-hmm.' It was hard to concentrate. She just wanted to go back to sleep.
Jake quickly checked her pulse, temperature and respirations. 'You're doing OK. But you need to tell me if you feel sick, your head hurts or you're in pain.'
'Yes. I'm doing your obs.'
'Make a nice nurse.' She tried for a smile. 'Blue dress'll suit you.'
He chuckled. 'Yeah, right! Seb and Charlie want to see you. Do you feel up to it?'
'Mmm.' It was too much effort to force words out.
'I'll take that as a "not really". How about I get them to be porters and wheel you down to ICU?'
They must have been waiting right outside the recovery room, because then they were there by her bed, wheeling her down the corridor.
'Well done, squirt,' Seb said. 'You picked a good surgeon there.'
'And his stitches are as neat as mine,' Charlie said. 'He'll do.'
'Uh-huh.' She couldn't keep her eyes open. But she heard Jake say, 'OK, that's enough. She needs rest. I'm staying with her, so I'll text you both every hour on the hour with an update, and I'll ring you if I'm not happy about anything.'
And then everything faded out.
She woke later in a room she vaguely realised was the intensive care unit. There were cables and catheters everywhere. Her throat felt sore.
'Sweetheart?' Jake's voice. 'Don't try to speak. You've got a nasogastric tube in and I've got you on a trickle of oxygen right now.'
So that was the tight feeling across her face. Oxygen mask.
His fingers gently pressed hers. 'If you're in any pain, just press my hand.'
No. No pain. A dull ache, but nothing to warrant pain relief.
She managed to turn her head towards him. He had what looked like a full day's growth of beard and his scrubs were rumpled. Clearly he'd spent the night at her bedside. Had she been out that long? Or had he kept her lightly sedated to give her body time to recover from the stress of the operation?
'You're doing well,' he said softly. 'We'll have the tubes out tomorrow. Then you'll be back on our ward in a day or so. You'll be home in a week.'