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'No, not common,' Clay agreed, 'but not rare either. It's something that we always have to be aware of when a man notices a lump in his breast tissue. A man has ducts in his breast, just like a woman, but he doesn't have the globules that produce milk in the way that a woman does. He can get cancer of the ducts and it can spread to the lymph glands under the arm and to other parts of the body—something which it doesn't seem to have done so far in this case.'

'Will you take a biopsy of the underarm glands?' she asked.

'Yes, we will, just to be on the safe side,' he said. 'And I'll take out the entire mass in the breast and some of the surrounding tissue as well. He presented with a lump and some fixation of the breast tissue to the skin, so I was suspicious as soon as I saw it.'

When he was gowned and gloved, they proceeded to prep the patient's skin.

The remainder of the day went quickly and smoothly, busy yet without complications. At three
o'clock Clay was in the surgeons' locker room having a shower, after making a quick call to Eva to arrange to meet her for a cup of tea in the hospital cafeteria. As he shampooed his hair vigorously, he thought back to the past when he and Eva had had an affair. They had met in one of the on-call rooms near the emergency department, situated in a quiet side corridor.

The room they had chosen in those days had been one that no one had wanted to use for sleeping in as it was around the corner from some elevators, so either he or Eva had managed to get the two keys to the room from the nursing station in Emergency, and they had met there on occasion for fifteen minutes of passionate love-making. They'd taken the second key so that no one else had been able to come in.

They'd had a routine whereby she'd left the room first, taking the two keys back to the desk, while he'd waited for three minutes and then left. No one had ever seen them together, as far as he knew. Now, some years later, he looked back on that interlude with nostalgia. He put on a clean scrub suit and lab coat, then made his way to the cafeteria.

Eva was already there, sitting alone at a table with a mug of tea in front of her, and she waved as he came through the main double doors. Ahead of him at the serving counters he saw a small group of OR nurses getting themselves mugs of tea and muffins. Clay couldn't help his eyes resting on Sophie, who was one of them. Her hair was loose, a shiny auburn, tumbling in charming disarray to just below her jawline.

'Hi, Sophie,' he said, coming to stand beside her at the counter as she helped herself to tea from a large urn, surprised to see her, 'and what brings you to the
cafeteria at this time of the day? I thought you'd be on your way home by now.'

She turned her large, hazel eyes on him, and for once he was able to really look at her full on, able to study her features—the heart-shaped face, the delicate bone structure and full, soft-looking mouth. He found his eyes dwelling on her lips, devoid of make-up. Her face had that look of tiredness that they all had, after putting in a full day's work, starting early.

'Some of us have been asked to work extra hours, and I'm one of them,' she said, adding milk and sugar to her tea. 'Haven't you heard? We got a call from Emergency to say that we'll probably be getting several patients with gunshot wounds. Apparently there was some sort of gang shoot-out a little while ago down near the waterfront, so the police told us. Something to do with drugs.'

Clay poured himself tea quickly. 'Really?' he said. 'No, I hadn't heard.' Automatically he felt in his pocket for his pager to make sure he hadn't left it in the OR. 'I hope we don't have to operate on gangsters. That's not something I fancy doing.'

'Neither do I,' she said, starting to move away. 'They've gone to Gresham General, so we heard. There were a few innocent bystanders, apparently, so I think we'll be getting those. Excuse me...haven't got much time. See you up there, I expect, Dr Sotheby.'

'Yes.'

Quickly he made his way over to Eva, bending down to kiss her before sliding into a seat beside her. 'Well, how's life treating you?'

'Can't complain,' she said, smiling, 'although life does tend to be all work and no play. Not a great deal of sleep either.'

Clay laughed wryly. 'Tell me about it! I've just heard that we've got some gunshot wounds coming in, so I expect my pager to go off any second.'

'Oh.' Eva smiled. 'And here I was about to ask you if I should get the keys to the on-call room.'

They laughed together. 'I was sure thinking about it,' he admitted truthfully. Hurriedly they drank tea.

'Ah, this is good.' Eva sighed. 'So, how are you, Clay? I've heard a rumour or two that you might be applying for Jerry's job. If you are, I wish you luck.'

'I
am
thinking about it,' he said. 'Like you, there's not much play.'

'There'll be even less if you get Jerry's job,' Eva said. 'You ought to be married, Clay. Why aren't you?'

'I'm addicted to work, Eva—you know that. Who would have me?'

'Just about every eligible female in this hospital, and you know it, I'm sure.' Eva smiled knowingly at him. 'You need a woman, Clay. You're lonely, I think.'

'How can you tell in the space of two minutes?' he said, looking at her sideways and smiling fondly. 'And what about you?'

'Oh, I'll get married and have children, because I want to. I've still got a few years on you, Clay.'

'I know it,' he said. Just then his pager went off, its tinny, bleating summons grating on them both.

'Don't you just feel like smashing that damn thing?' Eva said. 'Well, it's been nice seeing you, Clay...for all of three minutes.'

'I'll see you again soon,' he said, kissing her again on the mouth quickly. 'Next month in the on-call room?' He stood up to leave, winking at her lasciviously, knowing she would understand his joke.

'Sure. I wish.' Eva smiled up at him ruefully. 'Bye, Clay.' .

As he strode over to the exit he saw Sophie, also hurrying to leave. Momentarily their eyes met. Hers were neutral, yet he knew instinctively that she'd seen the quick kiss he'd given Eva. For some reason he was oddly chagrined. So what? he told himself. He knew he was annoyed because Eva was wrong on one count—Sophie Dunhill, one of the eligible females in the hospital, didn't seem accessible to him. She still seemed to be wearing that 'keep off sign, subtle but nonetheless there. Again he queried why the hell he should care...except that she was a very attractive woman.

After leaving the table, he'd checked the number displayed on his pager—as he'd anticipated, it had been that of the emergency department. Initially he would go there to help assess the patients, then he would go straight up to the operating rooms. There would be internal injuries and haemorrhaging. Right now the ambulances would be arriving.

'Put that first X-ray up again, would you, Cathy?' he said later, as he bent over the patient on the table in the operating room. 'Then put up the lateral view, please.'

Once again, Sophie was his scrub nurse, while Cathy Stravinsky was the circulating nurse. All the operating lists of scheduled cases were finished and now a few rooms were occupied in the operating suite with emergencies, three of them given over to the gunshot victims.

Cathy put up another X-ray film in the lighted display box affixed to the wall. Several X-rays showed different views of a bullet lodged in the patient's abdomen near the liver, having grazed the liver itself, causing haemorrhage. While the bleeding had been stopped and the lacerated liver sutured closed, Clay had still not located the bullet. The patient, a middle-aged woman, was having a blood transfusion, as well as some fresh-frozen plasma. The abdominal cavity had been awash with blood when he'd first opened it. Most of that had been suctioned out, then he'd spent some time searching to make sure that there had been no other bleeding site.

Clay walked over to the X-ray for a closer look, and Rick came with him. 'Looks like it's just a fraction below the diaphragm,' Rick commented, 'more dorsal than anterior.'

'Hmm...yeah,' Clay said, looking closely at the anterior and lateral films.

'Looks easy when you see it like this,' Rick added.

Going back to the operating table, Clay decided what he would do next. 'Sophie,' he said, 'give me one of those large Deever retractors and a large sponge. Rick, would you very gently retract the liver underneath with the sponge, then put the Deever under it. I want to get a good look under the liver because that's where the bullet is.'

'Right,' Rick said, taking a large, square, gauze sponge from Sophie, then the large curved metal retractor which was part of the set-up for major abdominal operations. The abdominal cavity was already being held open with a large self-retaining retractor which enabled them to have a good view of the internal organs.

'Easy does it, Rick,' Clay said. 'We don't want to start the liver bleeding again.'

Very carefully Rick eased his hand and the gauze pad under the liver to lift it up slightly, then he slipped the retractor over the gauze and removed his hand, pulling lightly on the handle of the retractor so that they could get a better view under the liver.

'Do you want the table raised a bit, Clay?' Claude Moreau asked.

'Yes, please, Claude. And could you tilt it head down a bit?'

'Sure.' Dr Moreau pressed the foot pedal under the operating table that raised it electronically. 'Say when,' he said.

'Stop right there,' Clay said.

'I'm tilting the head down now,' Claude said. 'Say when.'

'That's great,' Clay said. 'Sophie, could you, please, angle the light so that it's shining right under here where I've got my hand, right under the liver?'

'Yes.' Sophie put her gloved hand on the sterile metal handle that was in the centre of one of the overhead arc lamps, one of two positioned just above their heads. Pulling it to one side, then angling it back, she was able to direct the powerful light under the liver.

'Good,' Clay said, bending his head down sideways to get a better view. 'Suction under there, would you, Rick?'

With the metal suction nozzle, attached to suction tubing, Rick very carefully suctioned out blood and the residue of irrigation fluid that obscured their view.

'Give me long, curved artery forceps, Sophie,' Clay said, 'and give Dr Sommers a sponge on a stick.'

Without speaking, Sophie handed him the forceps, and a small gauze sponge mounted on long sponge-holding forceps to Rick, who then proceeded to use it to mop up the remaining obscuring fluid in the area under their scrutiny. Very gently Clay began to explore the area where, according to the X-ray, the bullet was located. With the tip of the long forceps he probed the tissues.

'There's a bit of ooze right there, just to the left of the tip of the forceps,' Rick commented.

'Yeah, I see it.'

'Maybe that's where the bullet went in,' Rick said.

'Right on!' Clay said. 'Keep sponging just there... Be gentle—we don't want to push the thing in any further, otherwise it will be coming: out the back through her skin. I'm going to probe about a bit.'

Very gently he pushed the fine tip of the closed artery forceps through the soft tissue where he could see a slight ooze of blood. Once he'd penetrated a few millimetres he opened the tips of the forceps to enlarge the area slightly, then he probed further, feeling the tips of the forceps touch something hard.

'It's there, I'm pretty sure,' he said. 'Now, how to get it out is the question. Sophie, give me the long-handled knife with a fifteen blade. I'm going to made a cut so that I can see the damn thing, then I'll try to get a grip on it.'

Just over five minutes later he had the bullet out, removing it carefully, gripped in the jaws of the artery forceps.

'Bingo!' Rick said. 'Wow! That was a bummer all right.'

Clay dropped the bullet into a small dish that Sophie held for him, and he discarded both it and the forceps that held it. 'I'd like to irrigate this little bullet wound with some saline in a 20 cc syringe and an irrigation catheter, please,' he said to Sophie. 'Then I want to sew it up with some of the fine catgut... Give me 2/0 chromic on a fine needle.'

'Right,' she said.

At last it was over. Clay let Rick sew the patient's abdomen closed after they'd counted all the sponges and instruments to make sure they'd left nothing inside the abdominal cavity. While Clay took the patient's chart to write up the details of his surgical procedure, Rick tackled his task.

When they were just about finished the door to their operating room opened and one of the other surgeons came in, tying a surgical mask around his face as he entered. Clay saw that it was Jason Ritt.

'Clay, I have a great favour to ask you,' Jason said, without preamble. 'And you, too, Claude.'

'What is it, Jason?' Clay said, putting the cap on the pen he'd been using. He had an idea what might be coming, as Jason seemed to live a large part of his professional life on the edge of possible disaster, doing his utmost to avert that disaster.

'I have a case coming in with what sounds like a dissecting aortic aneurysm. He's coming in by helicopter—should be here any minute,' Jason said as he advanced into the room. 'I was hoping that you could give me a hand, Clay. All the other guys are tied up. It's like a zoo in here right now, with these gunshot wounds, plus several transplants going on. I sure hope he doesn't blow before we can get at him.'

'Sure, I'll help you,' Clay said. 'I need a few minutes to wrap up here.' It had been a while since he'd helped Jason with a dissecting abdominal aortic aneurysm, a weakening and ballooning of a small section of a major artery which had begun to split open and leak, constituting a dire surgical emergency. If the aorta—the larg
est artery in the body—ruptured, the patient could bleed to death in about three minutes or less. The fact that it was already dissecting wasn't a good sign. As Jason had said, it could blow any minute.

He wanted to see his own patient into the recovery room, wait until she'd regained consciousness sufficiently to have a few words with her and make sure there was no post-op bleeding. Since it wasn't an operating day for him tomorrow, maybe he could cancel or postpone some of his office appointments scheduled for the morning in order to get some much-needed sleep.