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Damaged Soul

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The first time it happens Serena doesn’t really notice. She’s in the middle of surgery - a standard routine surgery, something she could have done in her sleep. She’s done the same procedure countless times before - If not more times than she’s had glasses of Shiraz then it must at least be a close run thing. The ED had sent the patient up due to his ischemic left leg. They maintained that he needed Serena’s vascular skill. Serena maintained (to herself at least) that it looked much more like the ED needed the bed. Regardless it was clear that the patient, Mr Burgess, did indeed need an emergency embolectomy. Emergency for him, bread and butter for a vascular surgeon of Serena’s calibre.

At first everything went exactly to plan. Identifying the site of the blood clot causing the obstruction had been text book. The balloon catheter had gone in at the perfect angle and made its way straight to where it was needed. The balloon inflated smoothly and, to start with, the slow and gradual removal of the captured clot and balloon went like clockwork - until it didn’t.

It was Serena’s years of experience that meant she realised almost as soon as it happened. The artery had ruptured.
“Oh! Come on!” Serena exclaimed. It was entirely possible for an artery to rupture during a balloon embolectomy, especially if the obstruction was the result of a trauma. It wasn’t a question of the skill of the Surgeon - some arteries were just weaker than others, some were already damaged. There were a whole host of reasons why it could happen. It just didn’t happen to Serena though. Not to her, a Vascular Surgeon at the peak of her career. Certainly it didn’t happen without Serena taking it as a personal affront. For Serena, usually calm, cool and collected in theatre, totally in control, to lose that facade even for a second (especially during what should have been a routine, if urgent, procedure) was unusual enough to reduce the Operating Theatre to a hushed silence. Then it was broken by Bernie’s voice.

“Convert to a graft.” she says. “Bypass the rupture.”

“Not enough time. We’ll lose the leg if we leave it without blood long enough to do a graft. The leg will last thirty minutes without a blood supply at most. I can’t do a graft in that time.”

“Believe.” Bernie replies. Serena can feel the certainty and confidence Bernie exudes in that one word wash over her. The feeling is like a warm and cosy blanket gently covering her. It takes her back to the way she had always felt when she and Bernie had operated together before; how they worked together seamlessly, bringing out the best in each other, pushing each other to excel, pre-empting each others every thought and moving like a finely choreographed ballet. 

“Prep for a graft.” Serena calls across the theatre in a voice now full of authority and confidence. She looks up from the patient on the table to check that the surgical team are following her instructions. Like the well trained team they are hands were already in action, reaching for clamps, scalpels and swabs. Just for a moment though, as she looked round, she saw a glance fly between Donna and Fletch. It was subtle, too subtle for her to be able to identify exactly what it was attempting to convey. Some kind of concern or worry she thought. It’s not the time to try and work out what’s going on between them though, her patient needs her.

“Scalpel.” she calls as she turns her attention back to Mr Burgess and his leg laid out on the operating table. Within seconds her focus is back on the surgical challenge ahead of her, and her world has shrunk to the blood, flesh and tangle of veins and arteries in front of her.

 

Almost wo hours later Serena, clad in her scrubs, is sat at her desk up in AAU. She’s just finished writing up Mr Burgess’ surgical notes and is sitting back in her chair stretching out the kinks in her spine. She’s decided that she has more than earnt ten minutes to herself. Ten minutes of peace and quiet before she changes out of her scrubs and into her work ‘uniform’ of black trousers and a bright loose blouse. Ten minutes before she has to plaster back on her professional personna and head out onto the ward.

Her eyes have just flickered closed when there is a knock at the purposely shut door of the office. Beneath their lids her eyes roll. Trying to keep any hint of annoyance at the interruption and regret at the loss of her precious quiet time out of her voice she calls

“Come in.” Fletch’s head appears from the other side of the now opening door.

“What can I do for you?” Serena asks.

“Other way round.” Fletch replies as the rest of his body follows his head round the door. He’s clutching two steaming paper cups in Pulses’ instantly recognisable vivid shade of red. “I thought that you might be in need of a coffee after that masterclass in Theatre. You take it hot and strong, right?” Serena smiles.

“Coffee would be very welcome. Thank you.” Fletch steps fully into the room, kicks the door firmly shut behind him and hands one of the cups to Serena. Without waiting for an invitation of any kind he sits himself down on the sofa along the wall of the office. Leaning back he makes himself comfortable and takes a gulp of his hot coffee. Not just a social visit then, thinks Serena. It’s just too engineered.

“Anything on your mind, Nurse Fletcher?” with the sound of a raised eyebrow in her voice, even if not visible on her face.

“Just thought you might need some coffee. And anyway, I’ve not seen you since you came back from your break. I wanted to find out how you were doing. You know, just generally catch up,”

“Right.” says Serena, still not convinced that this is all the visit is about. Fletch’s nonchalance is far too casual for it to be totally genuine. “Well, my break was very peaceful thank you. Very restful. But, as you can see, I’m back now. Refreshed and ready to get on with it.”

“That’s great Boss. Still, that surgery was quite the dramatic way to come back.”

“Arteries do rupture Fletch, you should know that.”

“Well, yes.” Fletch admits, “But I don’t think I’ve ever any one pull off a graft quite that quickly. “

“Years of practice Fletch.” Serena watches his face. He’s obviously searching for another way to get the the point he’s trying to make 

“Got a bit hairy there for a minute though.” He tries.

“A little. Nothing we couldn’t handle. We have a good team.

“We do. There was a moment there though when you seemed to be talking to someone."

“I spoke to lots of people, everyone on the team probably. Talking to the people you are working with is quite a vital part of surgery. It does tend to help things run more smoothly.” Serena notes, still not quite sure she knows this is going.

“It wasn’t any of the team you were talking to though.” Fletch says cautiously. “Or it didn’t seem like you were.” He adds in attempted mitigation.

“Really?” queries Serena, not able to recall anything which might match what Fletch is describing. Whatever it is Serena is confident that it’s the reason Fletch has engineered this chat.

“Um. You were saying something about not having enough time to do the graft before the leg would be too starved of blood to be viable.” It takes Serena a few seconds to piece together what Fletch is referring to, to piece together what had happened in Theatre. For a moment her face registers shock and disbelief before she wrestles it back into a mask of disinterested calm.

“Thinking aloud Fletch. Nothing more.” she offers as a rather unconvincing explanation. Before Fletch can push her any further on the topic she adds “As nice as this cosy chat is, I’m sure that you have things to be getting on with - and if you don’t I certainly do!”

“Right ho Boss.” Fletch capitulates gracefully recognising Serena closing down a conversation when he sees it. 

“Thank you for the coffee. Maybe we can catch up properly soon over a drink in Albie’s.” Serena offers as Fletch stands up and heads for the door.

“Absolutely.” Fletch replies as his hand reaches the door handle and he flashes Serena his trademark cheeky chappie smile. Serena waits until she hears the door click shut behind him before she buries her face in her hands and lets herself get lost in the flood of emotions threatening to overwhelm her. 

 

She hadn’t been thinking aloud, or even been talking to anyone else in the room. She’d been talking to Bernie; brave, talented Bernie who had never been afraid to take a risk in surgery; Bernie who had pulled off more minor miracles in Theatre than Serena could count. Bernie who’d survived being blown up in Afghanistan but hadn’t survived the bomb blast in Somalia. Beautiful, wonderful Bernie who was dead. She’d heard Bernie’s voice though, as loud and clear as if she’d been standing right next to her, as she had been so many times in the past. She’d felt the same certainty and calm decisiveness that Bernie had always brought to an Operating Theatre with her almost as if it had been a physical presence. It had been the most natural thing in the world for Serena to reply to her. Except it wasn’t because Bernie hadn’t been there, couldn’t have been there, because Bernie was dead. 

Of course, Serena knew Bernie was dead. She’d been to the funeral. Put on a brave face at the memorial in the hospital Peace Garden. For those few moments in Theatre though, Bernie had - for her at least - been as alive and present as she had ever been. Serena thought that she ought to have felt a fresh surge of grief at the realisation that Bernie had never been there earlier and could never be there again. Of course she felt did feel grief - absolutely and deeply. There was another feeling though. Another feeling that was insisting on being heard. Fear. 

Serena was caught tightly in the grip of fear. She’d have a conversation with Bernie in the middle of surgery, in front of her friends and colleagues. That in itself would have been bad enough, but she hadn’t even realised what she’d done until Fletch had called her out on it. She’d had a conversation with a dead woman and hadn’t even realised it. What was wrong with her? What on earth had happened to her. Serena took a deep breath and tried to put her thoughts into a semblance of order.
She thought she’d come to terms with Bernies’ death; She’d taken time off to grieve for her. She’d learned from the way she handled Elinors’ death that there was no way you could work your way around grief. No matter how busy you kept yourself, how many interesting cases you took on, grief would always find a way in. Grief was an opportunist. It would slip into those quiet moments between one task and the next, in the suspension of reality in the moments before sleep claimed you, and every other chance it got. There was no blocking it out, and once it had found itself a foothold it spread. It brought itself into every aspect of your life, touched them all and made everything its business. 

She’d learned this when her Father had died, the lesson had been brutally reinforced when she’d watched her Mother’s health fail before she’s finally passed away. When Elinor had been torn away from her the grief had very nearly claimed everything. Towards the end of the lengthy sabbatical she’d taken after Elinor’s death she’d promised herself that she’d never let grief overwhelm her that way again, warp and change her so much that she could no longer recognise who she was, didn’t believe that her actions had actually been hers. She’d promised herself that next time she’d handle it differently, better. At the time it had seemed an easy enough promise to make herself. Nothing, she had believed, could hit her as hard and as painfully as her daughter’s death had done. She’d been wrong. She’d never considered she’d lose Bernie too - not so soon and not like that. It had been just as hard and as painful losing Bernie as it had been losing Elinor. Not in the same way. Watching your only daughter die was its own particular form of torture. Knowing the woman you loved, even though you couldn’t be together, was no longer in the world was a highly specific form of misery. Mourning the loss of the woman who had been your rock whilst you had been consumed by grief for your daughter was torment of the kind only ancient Greek Gods were capable of thinking up.

Serena’s hands unconsciously make their way to the pendant around her neck, her fingers twisting and twirling it round whilst her whirling thoughts started to still. She’d thought that taking some time, taking a break, was the right thing to do. She was still sure that it was the right decision. She considered if she might have come back too early. She didn’t think so. No matter how good her reasons there was a limit to how long she could stay home and brood; when the need for time and space stopped being healing and started to become self indulgence. She had certainly reached that point. There were, after all, people who needed her at Holby, people who relied on her. No, she thought, it had been the right thing to do, to come back. 

What on earth had happened in Theatre then? If she hadn’t been talking to Bernie - and she obviously hadn’t been - then who had she been talking to? She quickly rules out having been talking to herself - the voice had been Bernie’s: the choice of words, the feeling of calm reassurance that had come with them - they were all unmistakably Bernie. If it wasn’t herself she had been talking to she could rule out anyone else in the Theatre for the same reasons. The whole of the exchange had been too ‘Bernie’ to be anyone but her. Maybe that was it, she wondered? Maybe her desire for Bernie, her longing for Bernie to be by her side had played tricks on her? Brought a version of Bernie to life in her mind so vividly that she’d believed, for those brief moments, that Bernie had actually been there. Serena tossed the idea around, looked at it from all the analytical angles that her mind could think up. There were certainly enough memories and echos of Bernie in AAU for her active imagination to latch onto. Bernie’s presence in every corner and corridor had been both curse and blessing to Serena. The memories of the good times - the successes, the teasing, the laughter, the joy of operating seamlessly together, the all too brief window of happiness they had experienced together, the glances, the simmering sexual tension, the feeling of having built the Trauma Bay together, and of course the kisses. Dear God, the kisses! Etched on her mind and lips for eternity.

The flip side of those joyous memories were, of course, the ones she’d like to forget: The reminders of her return to Holby alone; facing the nurses station without Bernie leaning on it, the second chair in what had been their joint office without Bernie sitting in it. Then there had been the growing realisation that whilst her heart had been with Bernie in Nairobi her home was in Holby; and the heart rending pain the realisation brought when she had finally stopped hiding it from herself. The feeling when she had walked away from Bernie to go where she was needed, to Greta, Jason and her Grand Niece rather than where she wanted to be. The aching loneliness of long shifts wondering what Bernie was doing, what Bernie would say or do if she was with her. The struggling with the reality of the love of her life being in a different continent and not at her side. More painful yet were the memories of the way she had behaved over Leah. AAU was full of memories of waiting for, longing for Bernie; both because Bernie wasn’t hers, then because she was and wasn’t there, and finally because she no longer was either there or hers. The memories of what she had lost, what she could have had, were the worst, she decided, except she hadn’t ‘lost’ Bernie she had let her go, set her free. Painful as all these memories were Serena knew that she would not only accept their bitterness but embrace it in order to have the sweetness of the other, happier, memories. 

Maybe the memories weren’t as strong for the others - and why would they be she asked herself? She’d walked back into the hospital after her break and had been immediately struck by how unchanged it was. How for all her colleagues, well almost all of her colleagues, life was continuing just the same as it ever had done. Nothing had changed for them - yet, for her, everything had changed and nothing would ever be the same again. Bernie was never coming back. Not a chance. Up until Alex had brought the news that Bernie was dead, up until a few weeks ago, there had been the slenderest of threads of hope hidden in the depths of Serean’s heart; well protected and shielded. That slender thread of hope had refused to accept that she would likely never see Bernie, refused to accept that they would never, after all, make ‘them’ work, that there would never, at some point in the future, be a time and place that was right for them, when they could finally be together and happy, could be enough for each other. Now, though, the logical and analytical part of her brain had forced her to confront and accept the horrible truth that Bernie was gone and wasn’t coming back. That the bomb in Somalia hadn’t just blown Bernie up, it had blown up Serena’s hopes and dreams.

With a considerable effort Serena lifts her head up off her hands, sit back in her chair and attempts to steer her thoughts away from the overly emotive track they were on into a more pragmatic direction - answering the question at hand: What exactly had happened in Theatre. Bernie couldn’t have been there, she was dead. It just wasn’t possible. Neither did Serena believe in ghosts, so any kind of paranormal explanation just wasn’t going to fly. She’s certain that she hadn’t been talking to herself, way, maybe in a way she had. The most logical way of explaining what had happened, Serena thought, was some kind of ‘wishful thinking’. At that moment, in the highly charged atmosphere of the Operating Theatre when things stopped going to plan Serena had needed a rock, something to cling to, something to bring her clarity and confidence in her assessment of the situation and her plan of action. Of all the people she had operated with, and there had been many, Bernie was the one who brought out the best in her, whose confidence in her own surgical skills was so rightly high that it flowed out into Serena. Not that she didn’t have confidence in her own abilities, she did, she knew that she was an excellent surgeon. Yet she’d spent years of feeling less than: less than good enough daughter to her mother, less than good enough mother to her daughter, less than good enough wife to her husband, a less than good enough partner to Bernie. She’d been less than good enough for the CEO position, but, she had to admit, it seemed, good enough to step up to fill the breach when there was no better option- dispensable when there was. Although on a cognitive level she knew her surgical skill were nothing short of top notch her history of feeling less than good enough had left a part of her, on a deep and more emotional level, which refused to let her believe that her surgical skills could be enough. Was there, she wondered, any surprise that in a moment when self doubt threatened to raise its’ ugly head she should search out reassurance? Reassurance from the person who had always believed in her skills and brought out the best in her. 

Serena didn’t really do deep introspection. She was more of a practical person, especially where work was concerned, but she was willing to give it a go now. She very much felt that summoning some kind of mental recreation of Bernie in a moment when she was in need of the things only Bernie gave her was very much the most likely explanation. The fact that it was the least concerning explanation as well as the one that showed Serena in the best light  was neither here nor there. Still, she thought, not really ought to happen again. She really did have to pull herself together. It really wouldn’t do if word got out that the Director of Medicine was talking to dead people - no matter how innocent it was.

Having found, and settled, on a logical explanation for what had happened Serena’s mind began to calm. It was, after all an innocent one off thing. She was on top of things now, it wasn’t as if it was going to happen again. Safe to put it to one side and say no more about it.

Her focus started to shift back to work. She took a sip of the coffee Fletch had brought her, and recoiled when she realised that it was barely lukewarm anymore. She wonders how long she has been sitting pondering in her office. Obviously far too long she decides without needing to consult a watch. She considers what needs doing before the end of her shift - which is rapidly approaching. For once there is no urgent paperwork she needs to complete - well nothing that won’t wait until tomorrow anyway. Hansen isn’t currently pushing her to produce one report or another for the Board. No, it seems that all she needs to do before she goes off duty (and can get herself on the outside of at least one glass of Shiraz) is a ward round and handover notes. Not in her scrubs though. Most certainly not her favourite look. Time to change back into her own clothes and face her colleagues and the ward. She has nothing to be embarrassed about, she reassures herself as stands up, pushes her chair back and fixes her professional demeanour firmly in place. It would be business as usual she tells herself as she steps out of the office door and heads towards the locker room.