The Nightingale Sings Page 23

  ‘You know what they say about revenge.’

  ‘It’s a dish better eaten cold.’

  ‘Or a luscious fruit you must leave to ripen. Either way—’ Joel shrugged again, and returned to finishing his fish.

  Cassie put her knife and fork down and thought for a while. ‘No,’ she decided, with a shake of her head. ‘Tyrone would never have left behind that sort of legacy.’

  ‘Not wittingly perhaps,’ Joel agreed. ‘But he might have upset somebody without realizing it.’

  ‘But who?’ Cassie demanded. ‘And how?’

  ‘I don’t know. But I intend to try to find out. Now finish up your food.’

  After dinner they sat in the elegantly furnished drawing room in front of the log fire and talked of other things, mostly what they were going to do and what they had to do in the immediate future.

  ‘I have to get back home some time. I’ve got work to do.’

  ‘When are you thinking of going?’ Cassie asked, trying not to admit her heart was sinking at the very idea.

  ‘I don’t know. In a couple of days’ time, perhaps.’

  ‘Then let’s not stay here.’

  ‘I thought you liked this place.’

  ‘I do. But I like Coomenhoule even more.’

  Joel looked at her steadily, his dark eyes fixed on her. ‘You sure?’

  ‘Yes. Absolutely.’

  They took their time driving back to Dingle, skirting along the west coast of Kerry to take in Valencia Island and then swing back north-east and cross country to spy the magnificent range of the Macgillicuddy Reeks. It was Joel’s idea to take a detour, Cassie having been keen to drive straight up to the house since it seemed they were to be short of time, but then as if to torment her Joel had taken the driving seat so that he could control the pace of the journey and indeed the day.

  ‘You’re a sadist,’ Cassie had told him, after they had driven over the bridge at Portmagee onto Valencia Island to head for Culloo Head. ‘You’re doing this on purpose.’

  ‘We only pass this way once, Mrs Rosse,’ Joel had replied, ‘and I for one have never been this way before.’

  But as always the drive was worth it, such was the wonder of the Kerry scenery bathed in soft sunlight on yet another Indian summer day. So intoxicating was the beauty of the land that by the time they had reached their destination Cassie felt as if she had already spent the day in her lover’s bed rather than at arm’s length in the passenger seat of a motor car.

  ‘I think things of moment deserve an overture,’ Joel said as he opened a bottle of champagne he had stopped especially to buy in Killorglin. ‘And what better prelude than a drive like that.’

  ‘I’ll always remember today,’ Cassie said, raising her glass. ‘Slainte.’

  ‘Slainte.’

  At which point the telephone rang. They both eyed it with horror.

  ‘You’d better answer it.’

  ‘I don’t have to.’

  ‘It’ll be on your mind if you don’t.’

  Joel walked to the kitchen window and looked out at the view across to the Blaskets while Cassie answered the telephone. Above a darkening Atlantic he watched as the first grey clouds of the day gathered.

  ‘That was Niall Brogan,’ Cassie told him, putting down the telephone and staring blankly out of the window. ‘Nightie’s down with a suspected twisted gut. He thinks he might have to shoot him.’

  Joel drained his glass. ‘Right. Then you must go home this minute,’ he said. ‘I’ll drive you.’

  Mattie was waiting for them when they arrived back at Claremore.

  ‘He went as mad as a wet cat during the night,’ he said, leading the way to the yard. ‘Then this morning he went down. He tried to attack Liam and myself and if Bridie hadn’t intervened God alone knows what might have happened. Niall’s with him now. He’s shot Nightie up with some new analgesic mixed with acetylpromazine and an antispasmodic, but it’s looking pretty grim. The horse was beside himself with the pain.’

  The Nightingale was still down when they opened his box door, lying flat out on his bedding bathed in sweat with his neck arched backwards and his head twisted against the wall. Niall was kneeling down by the animal’s stomach to which he was listening through his stethoscope while the ever-faithful Bridie sat stroking the horse’s head.

  Cassie waited until Niall had finished his investigation before speaking. ‘I won’t have him shot, Niall.’

  ‘You might have to, Cassie.’ Niall got to his feet, stuffing his stethoscope away in a pocket. ‘I was hoping it might just have been an impactive colic and we could stimulate the gut sufficiently to get relief, but it isn’t. It’s an intestinal catastrophy, I’m afraid. No wonder the poor chap started going berserk.’

  ‘Intestinal catastrophy. That the same as or worse than a twisted gut?’ Joel enquired.

  ‘Same thing, Joel, but its proper name describes the syndrome more accurately,’ Niall replied tersely with another look down at the horse. ‘It really is catastrophic because not only can it involve volvulus of the intestines, it can also include intussusception – which is when a length of intestine becomes telescoped into the following piece, which as you may imagine isn’t frightfully funny – or even in the worst cases the rotation of the intestine about its mesentary, the mesentary being a fold of peritoneum which attaches the intestinal canal to the posterior wall of the abdomen. So you can imagine the agony it causes.’

  ‘And there’s really nothing you can do.’

  ‘There is, but it’s frightfully risky. Which is why generally in cases as severe as this –’ Niall left the rest unsaid, shaking his head instead then rubbing his chin with one hand.

  ‘I should never have gone away,’ Cassie said suddenly. ‘It was tempting the fates.’

  ‘That’s hardly being fair on yourself, Cassie,’ Niall replied. ‘A horse can get this sort of attack at any time.’

  ‘I don’t know what I thought I was doing,’ Cassie continued. ‘You fiddle and Rome burns.’

  ‘Cassie,’ Niall said, seeing her obvious distress and putting a hand on her arm. ‘Cassie, whether you were here or yonder wouldn’t have made the damnedest bit of difference.’

  ‘Of course it would, Niall,’ Cassie replied vehemently. ‘I don’t know what I thought I was doing.’

  ‘You were living your life, as we all must. Besides, you’re not a vet. I am, and now all we’re going to discuss is what we’re going to do.’

  While they were talking and unseen by Cassie, Rosemary Corcoran arrived and took Joel aside. After she had talked to him briefly, Joel detached himself from the group without anyone noticing and slipped away.

  ‘You know what we’re going to do,’ Cassie replied. ‘You shouldn’t even have to ask. I’d rather lose him on the table trying to save him than just destroy him in cold blood.’

  ‘In that case we don’t have a second to lose,’ Niall replied.

  Part of Cassie’s investment in Claremore had included the building of a fully equipped and state of the art equine operating theatre where her veterinary team could perform urgent and major surgery without the need to travel horses away from the estate. The move had already saved not only the limbs but the lives of several valuable horses, although to date Niall Brogan had not yet had to call on all his considerable skills to untangle a mess such as he found inside The Nightingale once he had cut him open.

  ‘Jesus God,’ he sighed behind his mask when he saw the state of the animal’s gut. ‘This is going to take some sort of major miracle.’

  ‘You’re not dealing with an ordinary horse,’ Kathleen his assistant said as she started to position the abdominal clamps. ‘With this fellow anything is possible.’

  ‘I think this might be the one contest even The Nightingale can’t win,’ Niall replied. ‘If it’s as bad as I think it is there’s really nothing we can do.’

  A figure appeared beside Niall, dressed in surgical green. ‘There is if you’ll just listen,’ said Cassie’s voi
ce from behind a theatre mask. ‘Not to me, to someone on the telephone.’

  ‘I don’t really have the time for an idle chat,’ Niall replied.

  ‘This is a vet I met in America. He’s pioneered some form of intestinal surgery for twisted gut and it works because I saw him operate on a friend’s horse. Name’s Rufus Werner. I suddenly remembered him as you were getting Nightie onto the table.’

  ‘And you have him on the line now? What the hell time’s it over there?’

  ‘Bedtime.’

  Niall took the call on the extension in the washing up room. Sure enough on the other end of the line was a patient although still sleepy-sounding Rufus Werner. After Niall had listened intently to him for a while he interrupted the transatlantic conversation to say that he was going to transfer the call to the loudspeaker facility in the operating theatre itself so that the California-based veterinarian could talk him through the operation step by step.

  ‘It seems he advocates no-surgery surgery,’ Niall said to Cassie as they hurried back into the theatre. ‘We don’t cut or section, we go in and unravel.’

  ‘Apparently it works,’ Cassie said.

  ‘I’ll have to resection if we have tissue death. Otherwise there’s a very real danger of peritonitis.’

  ‘Just try doing what he says, Niall. I know the state of play. I know it’s the only chance the horse has.’

  ‘What about your friend’s horse? Did he make it?’

  ‘Well enough for him to be covering a full book of mares every year.’

  Time was of the essence, particularly since according to Niall he could have done with intervening sooner. Rufus Werner confirmed his apprehension, saying that the quicker Niall now got in and began direct manipulation of the affected gut the better.

  ‘If there’s any bowel volvulus or torsion of any significant kind, you’re going to be looking at a diminished blood supply and possible tissue death,’ Werner advised over the loudspeakers. ‘Even so don’t panic and start cutting. If you try doing what I recommend and attempt to reposition the affected gut manually and in situ you can still prevent any absorption of toxins from the devitalized bowel. Too many times we cut and then look, because we’ve been expecting a variety of bad things to have happened already. This isn’t always the case. I like to take a good look first and have a good feel round before even thinking about enterotomy.’

  ‘Incision into the intestine,’ Niall muttered to Cassie, who was bracing herself to watch the entire procedure.

  ‘I know what enterotomy is, Niall,’ she said, catching his eye over the top of their masks. ‘Now do what the man says.’

  ‘Suppose I lose him?’

  ‘It won’t be through anyone’s fault, Niall. You’re not going to save him now by any standard procedure.’

  As soon as Niall began the operation Rufus Werner began talking quietly and persuasively, for all the world as if he was there looking over Niall’s shoulder and could see everything that was going on. Everything he told Niall to do, Niall did, plunging his arms into the insides of the animal until he was literally up to his elbows in entrails.

  ‘I’ve found it,’ he said into the microphone hanging above the table. ‘I have definitely got the twist right here in my hand – and I’d say just as definitely it’s a volvulus.’

  Michael Delaney, another of Niall’s assistants, swore under his breath at the news as he struggled to hold up the heavy and bulky structures inside the animal. But Rufus Werner did not panic. Instead he instructed Niall to make sure it wasn’t simply a malposition and then to try to positively identify where the twist of gut exactly was.

  There was a long silence while Niall did as he was instructed, getting as close in to the affected part as the space around the horse’s intestines would allow. ‘Colon,’ he said at last. ‘But not where I first thought. It’s the large colon and you may be right. It may well just be a malposition.’

  ‘If it is, we’re in business,’ Werner’s voice said quickly over the loudspeakers. ‘What we’re going to do is reposition it. We’re going to manipulate that length of affected gut back into place and simultaneously try to ease out any obstruction. So put your knife away, we are going to untangle the knitting.’

  Again, as if he could see exactly what Niall was doing, Rufus Werner talked him through the entire process, even down to suggesting the exact amount of pressure which should be exerted on the attempted easing of the obstruction.

  ‘Think of a tennis ball full of water, with a very small hole in the ball,’ he said. ‘And you’re going to try to squeeze that water out in just a trickle. If it spurts, you lose the game. You just have to squeeze that water out so it just trickles. That’s precisely the amount of pressure required – no more and no less.’

  Cassie saw the sweat standing on Niall’s brow as he struggled not only to hold up the great weight of gut in his hands but to do as instructed and squeeze the affected portion slowly and gently.

  ‘I’m not going to tell you to hurry,’ Werner said, ‘because you might start squeezing too hard and we’ll have lost the day. Just remember that prolonged manipulation carries its own set of risks and weigh one option against the other.’

  At that moment for the life of her Cassie could not see how Niall could possibly succeed, so deep into a pile of tangled gut was he. But Niall just listened and did everything he was advised to do without further query, inspired by the distant American veterinary genius who was seemingly convinced that they were going to snatch a victory from the very jaws of death.

  Then suddenly Cassie saw Niall’s whole body stiffen.

  At first she thought something terrible had happened, but then she saw the look in the surgeon’s eyes as he glanced up.

  ‘Yes,’ Niall said quietly. ‘God is watching us.’ Then he called out loudly into the microphone. ‘Rufus? I’ve got it! I’ve got the length of telescoped gut free! And the section that had all but doubled back on itself! Wonderful! You are a genius, fella! A one hundred per cent sixty carat genius! Now if I can only just pack him all back the way he was—’

  ‘Come on – that’s the easy part!’ Rufus Werner joked. ‘You can do that from your book on anatomy! What’s the actual state of the colon that was twisted? Can you see any signs of devitalization?’

  ‘Oddly enough, no!’ Niall called back when he’d taken another close look, ‘No – it looks as vital as the rest of the gut around it! No sign either of a strangulated blood supply! Not so far as I can see—’

  ‘OK – so what you’re going to have to look out for – no, you’re a top vet, you know what you’re going to have to look out for,’ Werner corrected himself.

  ‘We’re going to have to watch for shock,’ Niall agreed. ‘Shock and in the post-operative period any sign of paralytic ileus. We’ve got to ensure the gut re-establishes its normal mobility.’

  ‘Look out for intra-abdominal adhesions as well.’

  ‘Will do. Rufus – if this chap pulls through we can never thank you enough.’

  ‘He’ll pull through,’ Rufus Werner replied. ‘I’ve seen that beauty race.’

  Niall’s team spent the last part of the operation reassembling the horse’s intestinal anatomy unaided by any further telephoned instructions, much to the silent wonder of Cassie who despite her own determination had all but lost hope when she realized what she was asking of her vet. Yet thanks to Niall’s considerable skills and the vision of a Californian surgeon 6,000 miles away they had triumphed, at least over the initial and possibly the most lethal part of the procedure.

  ‘Yes indeed,’ Niall said quietly as he stood up over the still living animal. ‘God was watching us all right. OK – we’re all sewn up here, Tony, so how are things your end?’ He gave a look to his anaesthetist who as soon as the huge incision had been fully sutured had begun to reduce the concentration of the anaesthetic gas in the mixture the horse had been inhaling. Now it was just oxygen with no anaesthetic mixed in which he then allowed the horse to breathe for well over
ten minutes while everyone waited around the table. Finally he detached the endotracheal tube from the oxygen to leave the horse to breathe ordinary air via the tube which was left in the trachea until at last the animal swallowed, when it was at once taken out.

  But before the patient was in a position to try to struggle to his feet the operating team moved him by way of the motorized operating table into the deeply padded recovery room which had been purpose built immediately off the operating theatre. Here the horse would remain under constant supervision until he managed to stand unaided, until he had got up on his feet and stood supported by two of the surgical staff, one holding him under his head and the other under his tail, for as long as it took until The Nightingale could once again stand safely all by himself.

  ‘First thing to look out for besides shock is any post-operative myopathy,’ Niall said for the benefit of the newer members of his squad as he and the rest of the team washed off. ‘As you may remember, horses can suffer muscle cell damage from being positioned on their backs for a long period. Even though the operation didn’t take as long as I’d anticipated, thanks to where and what the twist actually was, Himself’s not exactly a well horse at the moment so we must be on the look-out for every single possible complication.’

  ‘And the chances of survival?’ Cassie wondered as they made their way up to the main house for a much needed drink.

  ‘Realistically I’d say fifty to one.’

  ‘For a moment there I hoped you’d said fifty fifty.’

  ‘I’ve just been manhandling the most delicate part of a horse’s anatomy, Cassie. The risk of post-operative infection is enormous.’

  ‘He’s got good cover.’

  ‘We’ve availed ourselves of the best drugs and antibiotics available,’ Niall said. ‘But with manipulative surgery like that – fifty to one might be being generous.’

  ‘OK,’ Cassie said as levelly as she could. ‘And how long before we know one way or the other?’

  ‘The first twenty-four hours will be critical,’ Niall replied. ‘If there’s going to be any serious complication it’ll have shown itself by this time tomorrow.’