Chapter 9: The Betrayal
Kane was at home when Sophie rang from the emergency department early in the evening.
‘Hi, Kane, I have an eighteen-year-old male who tripped while running this afternoon. He has a closed oblique fracture of his lower tib and fib with rotation and moderate displacement. There’s no other injury, and he’s otherwise well. I think he should have a tibial nail.’
‘OK,’ Kane responded. ‘Are you happy to do that on your own?’
‘I’d like to give it a bash. Do you think I should ream it first?’
‘No,’ Kane said and hung up.
Emma, some years older and working full time, was all prepared when Sophie arrived in Theatre Three. ‘Fun to work with you again,’ she said. ‘How’s Ann Armitage going?’
‘She’s fine. Good to work with you, too.’
‘How are you settling into Cairns?’
‘A bit slow getting a social life.’
‘Sorry, yes, it’s not easy when you’re new and working. I’ll arrange something and invite some friends.’
‘Terrific. Thank you.’
Sophie made a small vertical incision on the medial side of the patella tendon just below the inside of the patient’s knee. She dissected down to the top of the tibia, careful to stay outside the knee joint. Using a small awl, she made a hole in the bone and passed a guidewire down the marrow in the middle of the tibia, negotiating it through the fracture site using X-ray control. The fracture was in a good position, out to length, straight and not rotated. She chose a cannulated tibial nail, estimating a suitable length and diameter, and threaded it over the guidewire. As the nail passed through the fracture, it stuck in the tight bony canal and would go no further. Sophie gave it a few light taps with a hammer. The nail didn’t move. She hit harder, and it still didn’t move. She hit even harder, and the nail went through.
‘That’s done it,’ said Emma, who was watching with interest from her end of the table.
Sophie was devastated. ‘Bloody hell! I’ve split the tibia above the fracture. Made it unstable. Should have reamed it.’
‘At least the nail’s down; you can stabilise it with some cross screws,’ Emma said, thinking she was being helpful.
‘Yes, I can save it. Won’t be as good.’ Sophie picked up a drill and briefly looked out the window towards the lights of the suburbs. ‘Won’t look so good on Monday morning either.’
After arguing with Isobel from the moment they woke, Kane was late leaving for work the following Monday. He pushed in and out of the morning peak traffic, punching the horn every time someone got in his way. Isobel had said if he was as horny at home, their marriage would have been much improved. Taking a shortcut down McKenzie Street, he pushed up on the inside of a truck at the roundabout on Lake Street, not leaving himself much room. Not able to see to his right, he started with the truck when it moved off, accelerating to get past. A red Mercedes coming through the roundabout moved faster than Kane expected. He braked suddenly, slowing, but still smashing into the car’s front side. Leaving his car on the roundabout, Kane jumped out, fists clenching, and approached the other driver, who had only just started to open his door. The man’s face was almost as white as his hair.
‘Why were you going so fast?’ Kane demanded.
‘I had the right of way,’ the Mercedes driver pointed out.
‘You should be more careful, you old goat.’
‘You were rushing. You came out from behind the truck. Young idiot.’
The truck driver leant out of his window and supported the Mercedes man. ‘Now, please move your car so we can all get to work,’ he told Kane.
Kane moved it into Lake Street and hurried back to an impatient Mercedes driver, wounded by the damage to his car. They grudgingly exchanged addresses and insurance details, Kane still not admitting he was in the wrong.
‘You’re the stupid idiot,’ Kane shouted as he withdrew.
At the meeting, Sophie was showing the X-rays when Kane arrived.
‘I had a lot of trouble with this closed nail the other night. It got stuck, and in hammering it further, I split the tibia. After that, it went down, but the position is not as good as it should be, nor as stable.’
‘In a young male with hard bone, you should have reamed it first,’ Judith told her.
Sophie looked across at Kane, expecting him to say something.
He was silent as he took a seat in the back row.
Sophie’s face froze.
One of the students broke the silence by asking the difference between a reamed and an unreamed nail.
‘Tell them, Sophie,’ Judith said.
Sophie paused, took a deep breath and exhaled slowly. ‘When you put a nail down the tibia, you make a small hole in the bone and pass a guidewire down the middle as you reduce the fracture. To ream it, you thread a cutting head over the wire, like drilling an oil well. This gives more room to get the nail down. It makes it easier—but not as tight a fit. The hold on the fracture is not as stable.’
Sophie turned to Kane. ‘That’s right, isn’t it?’
Kane looked hard at her. ‘Yes,’ he mumbled.
Sophie continued, ‘It used to be thought that reaming would damage the blood supply to the fracture and reduce its chance of healing. We now know this is wrong, and the decision to ream or not depends on balancing stability against the possibility of complications. In this case, I got it wrong.’
‘In orthopedics, perfection is sometimes the enemy of good enough,’ reflected Judith. ‘We are all guilty of it sometimes. It’s a forgivable mistake. Sophie will learn from it.’
Kane said nothing.
As soon as she could after the meeting, Sophie called into Judith’s office. She didn’t admire the view and heard no calming music. Nor did she wait to be asked to sit down. Standing in front of Judith’s desk, she blurted, ‘I asked Kane about whether to ream. He said not to.’
‘I guessed as much,’ Judith said.
‘What should I do? I feel like ramming a rod up his arse.’
‘Let him stew. If he’s smart enough to work out what he’s done, he won’t do it again. If he isn’t so smart, there’s not much hope.’ Judith waved at a chair. ‘Please sit down.’
Sophie remained standing. ‘Is that it? I feel betrayed and humiliated. It’s as though I’m of no consequence to him.’
Ted knocked on the door. He’d also seen her reaction. Sophie repeated what she’d told Judith, leaving out what she would like to do to Kane. Then she sat down.
Ted found another seat. ‘I understand how you feel. Would you like me to talk to him?’
‘No. Just another way some men want to screw you. I’ll get over it.’
Ted’s eyebrows rose. ‘I was proud of the way you handled it. You hardly batted an eyelid, went straight on and calmly answered the student’s question. Full marks for that.’ Ted smiled at her.
Judith changed the subject. ‘I saw Ann Armitage walking with a frame this morning; how’s she going?’
‘Pretty good. She has a low-grade temperature that seems to be slowly settling. We’ll get her back to the nursing home soon,’ Sophie said.
Ted looked at Sophie and beckoned with his head. ‘Come for a walk.’ She followed him out.
The rain had cleared, leaving heavy humidity and a searing sun. They sat on a bench in the shade of a dense Leichardt tree, sweating and not noticing much around them. It was mid-morning with the sea breeze hours away.
‘Why do I feel so angry?’ Sophie said. ‘I felt bad enough botching the operation, but this is gut-wrenching.’
‘You should be able to trust your seniors to support you,’ Ted said. ‘Kane put his own reputation before yours. He let you down.’
Sophie stared at him. ‘It feels much worse than that.’
Ted leant forward. ‘Yes, I was being charitable to Kane. He betrayed you. He ought to be able to understand how inexperienced and vulnerable you are. It was his decision to let you do it on your own, and he is responsible for the result. If he was not certain you could do it, he should have come in to help. You rescued the situation, and there was no major harm done. We’ve all had complications like you had—and not always done so well.’
Sophie looked glumly at her feet. ‘I suppose so.’
‘By what I’ve seen of you, you’ll get over it. Don’t lose trust in everyone; most of us are doing our best. Kane may learn from it.’
‘I hope so.’
‘Let’s go in,’ Ted said, standing and mopping his face. ‘Even I think it’s hot.’
‘Thanks for supporting me.’
They walked back to the hospital, close together in the heat, continuing the conversation.
Kane left work early and drove home to an empty house, except for Toby, joyfully running around in circles. Kane ignored him and went to the fridge, looking for something sweet. He found a chocolate cake, put it on the table and went to the toilet. When he came back, Toby was on the table finishing off the cake. Kane roared and raced towards him, waving his arms wildly, ‘Get off! Get off!’
The dog scooted. Kane chased him around the room, shouting. He picked up a cushion and threw it, striking Toby in the back legs, tumbling him over. Cornered, the dog quivered with fear. Kane shaped to kick him, lifted his foot, but pulled back. He put his hand down to grab Toby by the collar. Toby snarled. Kane stopped. He was shuddering, head pounding. My God, it’s happened again.
Slowly, palms out and low, Kane moved towards Toby, waiting for him to stop cowering. After a few moments, he was able to put his arms around him and gently scruff his fur.
‘I’m sorry, sorry.’
Toby licked him. Tentatively.
Kane fell onto the couch and called out in despair, ‘Help me.’ No one heard.
When the children arrived home later, Kane didn’t stir from the couch. Toby, recovered and unaffected, danced around them. The children ran towards their father.
‘Look what I’ve got,’ cried Milly, brandishing a mouth organ. ‘Mummy got it for me.’
The others jostled behind her, each bearing their gifts. Kane gently pushed them away. ‘Not now; I’m not in the mood.’
Olivia persisted. ‘Look what I got.’
‘I said go away.’
‘It’s a wabbit.’
‘GO AWAY!’
Olivia’s face collapsed. Tears flowed.
‘You shit,’ he heard Isobel say.
That night, when all were asleep, Kane sat and thought and wrote:
The dark crag castle
stood all dim,
the deep dank moat
that none could swim
defied him entrance,
bid him stop,
and yet he climbed
to reach the top.
The high grey walls
shout out no! no!
But he was drawn
towards them so.
The gate was shut
the bridge was drawn
the gloomy castle
cold and worn,
and yet he came
he knew not why.
The grim grey walls
were dark and high,
the grim grey walls
they shrieked, they rocked,
when on the gate
he rudely knocked.
The door was shut
the sign was clear
to all who come.
No entrance here.
The grim grey walls
they writhe, they shout,
their message clear
move on, get out.
And yet he came,
he climbed the walls
he never paused
to hear their calls.
He scaled the top
he stopped to stare
his heart felt cold.
There was nothing there.
The walls forbad
the gate was shut
and yet he came.
All for nothing.