Dr Macleod had given up smoking over twenty years ago, but as he prepared himself for a second attempt to remove the malformed foetus from Susan Nicholls’s womb, he would have given almost anything for a cigarette.
Once he had tied on his surgical mask, he stared at himself in the mirror over the washbasin, trying to see if his eyes were betraying any sign of his anxiety, but he was surprised how dispassionate they looked. He held out both hands, to make sure they weren’t trembling, but they were rock steady.
‘Right, Stuart,’ he told himself, out loud, his voice muffled behind his mask. ‘Ghosts or no ghosts, this thing is coming out of her. Full stop.’
He had been trying his best to persuade himself that what had appeared yesterday – that smoky apparition – was only an illusion, caused by stress. A shared illusion, yes, which was mind-shrinkingly rare, but an illusion nonetheless.
Yesterday afternoon, the centre’s maintenance crew had checked the theatre’s fuse box and all the electrical circuits but found nothing that could have caused the lights to malfunction. They had also dismantled the air-conditioning unit, but they had been unable to explain how any smoke could possibly have leaked into the operating theatre.
Dr Macleod used his elbows to push open the double doors that led from the scrubs into the theatre. Susan Nicholls was already anaesthetised, lying on the operating table as she had before, like a brightly lit human sacrifice on a catafalque. Dr Bhaduri and Dr Symonds were waiting for him on either side of her, and Janet Horrocks, the midwife, was sitting in the right-hand corner of the theatre, along with another junior midwife, Kisi Adomako.
Duncan, the anaesthetist, gave him a thumbs up and said, ‘Heart rate, blood pressure, everything’s normal.’
‘Any movement from the foetus?’
‘Its vital signs are the same as before, so it is still alive,’ said Dr Bhaduri. ‘The latest scan shows that it is already firmly attached with microvilli to the wall of the uterus, but there is no movement, no. Perhaps it is waiting for us. Perhaps it sleeps.’
Dr Macleod looked across at him but said nothing. He could clearly imagine that angelic face with its eyes closed and its tentacle-like limbs tangled all around it, and the thought of that gave him a crawling sensation down his spine. In a matter of minutes he would have to cut it out and confront it, and this time he would euthanise it, instantly. Nurse Harris had already prepared a hypodermic with a three-milligram dose of fentanyl, which was easily enough to kill an adult, let alone an unformed foetus.
‘Okay, everybody,’ he told them, ‘let’s go for it.’
Dr Symonds folded back the sheet that had been covering Susan Nicholls’s stomach. Dr Macleod stepped up to the operating table and held out his hand for the scalpel to make his first incision. He hesitated and looked up, in case there was any indication that the surgical lamps were starting to flicker or change colour, but they remained steady, without even the faintest tinge of green.
Once the thick gauze dressing had been peeled off, he snipped apart the sutures with which Dr Bhaduri had temporarily closed the incision that he had started to make yesterday. Blood slid out again, which Nurse Harris quickly dabbed up. Then he slit open Susan Nicholls’s uterus, and a glistening flood of yellowish amniotic fluid poured out, streaked with pink.
He was fully prepared for the foetus to twitch or writhe or shrink away from him. But as soon as the walls of the uterus parted, it boiled into furious life, its limbs thrashing and waving, and its muscles contracting again and again in one powerful spasm after another. For a split second, behind its tentacles, he saw its blue eyes staring up at him through a thin film of mucus, and its look was one of utter hostility.
Susan Nicholls started to jerk up and down on the operating table, thumping on it loudly, and Dr Macleod said, ‘Hold her down! For God’s sake, keep her still!’
Nurse Harris and Nurse Yeom gripped her knees and her ankles, while Dr Symonds and Dr Bhaduri pinned her shoulders flat. That didn’t stop her from repeatedly banging her head, and tossing it wildly from side to side.
Dr Macleod took a deep breath before he plunged his left hand into the wetness of her womb. He buried his fingers into the wriggling bony mass of the foetus’s limbs to keep it as immobile as he could. Its slippery, bony tentacles fought furiously against him, but with one deft scalpel stroke after another, he started to slice it free.
Once his last stroke had detached it from the lining of her womb, he paused, his chest rising and falling while he summoned up all of his strength, and then he slowly dragged it out. It came away with an obscene sucking sound, and he held it up in his fist, still squirming.
‘Nurse!’ he snapped, beckoning Nurse Yeom to pass him the stainless-steel kidney dish. Susan Nicholls had stopped jerking now and was lying flat, although she was quaking as if she were suffering from hypothermia. Dr Symonds and Dr Bhaduri were already swabbing her gaping uterus and preparing to stitch it up. Janet Horrocks and her junior had come forward now and were waiting to see if Dr Macleod needed any assistance with the foetus. As inhuman as it looked, it was their duty to make sure that this wriggling mass didn’t suffer before it was euthanised.
Nurse Yeom set down the kidney dish on the side of the operating table. Dr Macleod held the foetus over it, prising its limbs away from his surgical glove one by one. Nurse Harris stood close by his shoulder, holding up the hypodermic with the lethal dose of fentanyl.
‘Come on, come on, you obstinate little freak,’ Dr Macleod whispered at it, with his teeth clenched together. It was hard to believe how strong it was, and how tightly it was clinging on to his fingers.
He had nearly pulled the last tentacle free when the foetus suddenly untangled itself. It slithered out of his grasp and around his wrist, and before he had a chance to snatch at any of its limbs, it burrowed its way underneath his elasticated cuff and up inside his sleeve. In a matter of seconds it had disappeared from sight, and he could feel its nails tearing at his forearm as it pulled itself higher and higher, up toward his elbow.
‘Jesus Christ!’ he shouted, wildly swinging his left arm and smacking at the bump underneath his sleeve. But the foetus carried on climbing, around his elbow and up toward his shoulder. The pain was excruciating, as if he were being clawed over and over again by a vicious cat, and he could feel blood and amniotic slime running down inside his sleeve.
Dr Bhaduri hurried around the operating table and managed to get a grip on the foetus as it bulged up under the shoulder of Dr Macleod’s blue polypropylene gown, even though it was wriggling so ferociously. He pulled at it again and again, but at least a dozen of its nails were hooked under Dr Macleod’s skin, and it refused to let go.
‘Christ almighty, stop!’ Dr Macleod shouted at him. ‘You’re tearing my arm off!’
Dr Bhaduri backed away, his hands lifted helplessly. Dr Macleod reached across to the instrument tray, scrabbling to pick up a scalpel and dropping at least half a dozen of them onto the floor. Raising his shoulder as high as he could, he stabbed at the foetus six or seven times. It reacted to each stab with a spastic contraction, but still it clung on to him, and when he started to slash open the fabric of his surgical gown to get at it, it clawed its way over his shoulder and started to climb down his back.
Now he was staggering around and around, first of all trying to stab at his own back then holding out the scalpel to Dr Bhaduri and shouting, ‘Kill it, Kumar! For God’s sake, kill it!’
Nurse Harris held up her hypodermic. ‘Dr Bhaduri – here, jab it with this!’
But Dr Bhaduri shook his head and said, ‘No, no – too risky. If I miss it and jab Dr Macleod, it will kill him in seconds!’
‘Just kill it, Kumar! Get it off me!’
Dr Macleod dropped to his knees in front of them, bowing his head like a religious penitent. They could see the bump of the foetus underneath the back of his gown, crawling slowly down his left shoulder blade. Dr Bhaduri danced around him, trying to find the best position to stab the foetus without stabbing Dr Macleod too, but when he lifted up the scalpel like a dagger, Dr Macleod screamed and frantically waved both hands.
‘No! No! Don’t do it! Jesus, what’s it doing to me? Aaagh! No! Aaagh!’
Spots of blood appeared on his gown, only four or five of them at first, but then it was flooded with a wide red stain. He fell sideways onto the floor, his legs kicking and his arms thrashing, jerking up and down on the tiles in the same way that Susan Nicholls had jerked up and down on the operating table. He screamed and kept on screaming, not only jerking but rolling from side to side.
Duncan came scrambling around from the other side of the operating table and knelt down beside him. ‘Kumar – help me get this gown off him!’
Between them, Duncan and Dr Bhaduri managed to wrestle Dr Macleod onto his stomach, so that Dr Bhaduri could cut the ties that fastened his gown at his waist and the back of his neck. Dr Macleod was in so much pain that he was fighting against them, but they managed to wrench the bloodstained gown inch by inch off his shoulders then lever his arms out of his sleeves. Underneath he was wearing a white T-shirt, now soaked in blood, and pale-blue boxer shorts. The bump of the foetus had shifted now from his shoulder blade to the lower left side of his back, and it seemed to be creeping toward his spine.
While Dr Macleod continued to scream and batter the floor with his fists, Dr Bhaduri cut open his T-shirt to expose his back. It was then that they saw why he was in so much agony. The foetus had used its nails to tear a ragged diagonal hole over his left shoulder blade, and now it was tunnelling its way under the outer layer of his skin, separating it inch by inch from the flesh below. As it crawled across his back, it was flaying him alive, from the inside. Already the skin on the left side of his back was hanging loose and floppy and wrinkled, and through its semi-transparent layers, Duncan and Dr Bhaduri could see the writhing outline of the foetus as it crawled over his backbone. They could hear it too, because the epidermis made a crackling sound as the foetus gradually ripped it away from the subcutaneous tissue underneath.
Dr Bhaduri used the scalpel to stab the foetus again, and each time he stabbed it, its limbs bunched up, but it continued its progress across Dr Macleod’s back.
‘Morphine, that should do it,’ said Duncan. ‘A damn great shot of morphine. Here – hold him down for me, nurse.’
Nurse Harris knelt on Dr Macleod’s left elbow and gripped his wrist to keep him pinned to the floor. Duncan pulled himself up onto his feet and went back around to his station. His hands shaking, he filled a syringe with morphine sulfate solution and then came back, dropping down beside her. By now the foetus was forcing itself under the skin of Dr Macleod’s right hip and his screaming had become thin and repetitive, like a child crying.
Duncan located one of the foetus’s squirming limbs through Dr Macleod’s skin, pinching it hard between finger and thumb to keep the foetus as still as possible while he injected it. But before he could stick the needle into it, all the lights went out, with a loud click, and the operating theatre was plunged into total blackness.
Duncan jabbed blindly at the foetus, but he heard the needle snap, and the foetus twisted its limb free from him. There was nothing that he could do but help Nurse Harris and Dr Bhaduri keep Dr Macleod pressed flat to the floor.
‘Open the doors!’ he shouted, and he heard Janet Horrocks and Kisi Adomako blundering around in the darkness, colliding with the trolley full of instruments.
After a few moments, Janet Horrocks cried out, ‘I can’t!’
‘What?’ said Duncan.
‘They’re stuck! Just like they were before ! I can’t open them!’
‘Try the scrubs doors!’
‘I am trying that!’ said Nurse Yeom. ‘I can’t open them either!’
Duncan took out his phone and jabbed at it, but it was dead.
‘Who’s got a phone? We need light!’
‘I don’t have mine with me,’ said Janet Horrocks. ‘I never bring it into the OR.’
‘I have,’ said Dr Symonds. ‘Hold on a second. No… no, it’s not working.’
Dr Macleod had stopped kicking and rolling from side to side, and his screaming was now reduced to a scratchy, high-pitched whining. He lay still, with only an occasional twitch, and after Duncan was satisfied that he was going to stay that way, he stood up, reaching out for the side of the operating table to guide himself. He stepped over Dr Macleod’s legs and shuffled his way toward the doors, his arms held out in front of him. The darkness was overwhelming, without even a glimmer of light from the corridor outside. He bumped into Janet Horrocks then reached out for the doors. He pushed against them, hard, but they remained immovable.
‘This is insane,’ he said. He took two steps back from the doors and threw his whole body weight at them, jarring his shoulder. The doors stayed shut.
He threw himself at them a second time, and he heard a cracking sound, but they still wouldn’t open. He gave them a frustrated kick, and then another, and another.
‘Hey!’ he shouted. ‘Anybody! We’re trapped in here! Theatre number two! Can anybody hear us? The doors are stuck and we can’t get out!’
‘How is this even possible?’ said Janet Horrocks, and Duncan could tell by her voice that she was beginning to panic.
Out of the darkness behind him, Dr Bhaduri said, ‘The foetus… I can’t feel it anymore. It was crawling down the back of his thigh, but now I don’t know where it has gone to.’
‘Anybody!’ Duncan shouted out again. ‘We’re trapped in here! All the lights have gone out and the doors are stuck and we can’t get out!’
He kicked at the doors again and again, but they stayed firmly shut. Then he remembered the fire extinguisher hanging in a bracket next to the scrubs doors. Reaching out for the wall to guide himself, he groped his way blindly toward it. Once he had found it, he unfastened it and lifted it out, and started to carry it back to the main doors. All the time, Janet Horrocks and Kisi Adomako kept on screaming out shrilly for help, as if they were on the top floor of a blazing building.
‘Help us! Help us! We’re trapped in here! Help us!’
‘Janet, Kisi – where are you?’ said Duncan. ‘Stay well back… I’m going to try and bash the doors open with the fire extinguisher.’
He braced himself in front of the doors and then swung the fire extinguisher like a battering ram. It hit the doors with a loud bang, and they shook, and he heard that cracking sound again. With any luck, he could knock the screws out of the hinges and the doors would fall flat.
He swung the fire extinguisher again, but as it struck the doors, they both burst open inward, knocking him backward onto the floor. The fire extinguisher fell on top of him and hit him on the side of his head, just above his left eye, stunning him.
Even though the doors had been flung wide open, the operating theatre was still in complete darkness. Something had entered though, something they could all feel and hear even if they couldn’t see it. A whistling draught began to blow, softly at first, but it rapidly grew stronger and louder. Then they heard a low-pitched moaning and that grew louder too, until the glass vials and syringes on the instrument trolley started to rattle and clink, and they could hardly hear themselves think.
The moaning grew higher and higher in pitch, until it sounded like singing.
Dr Bhaduri shouted out, ‘What is it? Duncan – what’s happening?’
‘There’s somebody in here!’ Janet Horrocks cried out. ‘Oh my God, there’s somebody in here!’
Duncan rolled the fire extinguisher off his chest so that it clanked onto the floor. He propped himself up on one elbow and strained to see into the darkness. The draught was blowing so strongly now that it ruffled his hair and made his eyes water. He was still half stunned, but he could feel a huge physical presence in the theatre, something that was swirling around and around, invisible in the darkness but powerful, like a thunderstorm at night.
He could smell something, too. An acrid smell, like woodsmoke, and a citric tang – an acid overtone of lemons.
‘Duncan!’ Nurse Harris suddenly shrilled out. ‘Duncan, help! It’s Dr Macleod! He’s… Duncan, I can’t hold on to him!’
‘The same!’ shouted Dr Bhaduri. ‘Somebody’s pulling him away from me!’
Duncan tried to climb to his feet, but before he could stand up properly, Dr Macleod came sliding along the floor, bumping into him so that he fell backward again. As far as Duncan could tell in the darkness, Dr Macleod was still lying flat on his stomach. He reached out to seize his arm or his gown or whatever he could, but he was gone.
A few seconds passed. The moaning died away, and the whistling draught subsided. The lights in the operating theatre flickered and buzzed then lit up again, with a sharp ping.
The seven of them stared at each other in disbelief. Nurse Harris and Dr Bhaduri were still on their knees, but Dr Macleod had disappeared. Several parallel lines of blood were smeared across the beige epoxy flooring – a trail that led out of the wide-open doors. Duncan went out into the corridor and saw that the trail continued for about fifteen or twenty metres then abruptly came to an end, as if Dr Macleod had been picked up.
As he stood there, he heard Dr Symonds’s phone playing a marimba ringtone.
‘Call security, now,’ he said. ‘Maybe he hasn’t been taken out of the building yet. And we need to call the police.’
‘I’ll do that,’ Nurse Harris told him, standing up. She went across to the scrubs doors, cautiously pushed at them, and they opened.
Dr Symonds turned to Susan Nicholls, who was lying anaesthetised on the operating table with her incision still gaping open.
‘Kumar – we have to finish closing her,’ she said flatly. All of them were so shocked by what had just happened that they could hardly speak.
Dr Bhaduri said, ‘That smoke… I can still smell that smoke.’
He bent over to pick up the scattered scalpels and forceps. As he did so, Susan Nicholls’s eyelids fluttered, then she opened her eyes. Dr Symonds went over to the operating table and said, ‘How do you feel, Susan? We’ve had a problem, and we may have to give you another anaesthetic, but only a local.’
Susan Nicholls frowned at her. Then she whispered, ‘Where’s my baby?’