Just the Nicest Couple(3)

I push myself upright on the sofa, into a sitting position, rubbing at a kink in my neck. I must have been lying on it funny. Despite the nap, I don’t feel any more rested. If anything I feel more tired. I just need to carry myself up to bed, but Jake isn’t home yet and I don’t want to go to bed before he is. I want to talk to him. I want to talk things out. Things got heated last night and I feel bad for it now. Looking back on it, it was mostly my fault, but, in the moment, I was being stubborn. I didn’t see it that way. I said things I shouldn’t have said and it’s been eating at me all day. I thought over and over again about calling him at work to apologize, but I didn’t want to interrupt him because he’s so busy when he’s at work, doing things that matter, like saving lives. He never likes it when I call him at work.

The papers I was grading are fanned out on the coffee table; I only got through a few of them before nodding off. They’re for my honors English classes. We’ve just finished reading 1984 and the kids were asked to write about ways in which our modern society is Orwellian. I love reading their responses. I didn’t mean to sleep for as long as I did. I told myself I was just going to close my eyes for a bit, and then get back to grading, but I must have slept for hours. I feel guilty now because I promised the kids I would have them graded by tomorrow. They put so much work into them and are anxious to know what they got. The honors kids are hard on themselves. But now it’s dark outside and I’m tired, worried about what happened with Jake and needing him to come home so that we can talk.

I stand from the sofa and go to the kitchen for coffee. It’s been a long time since I’ve pulled an all-nighter but a good night’s sleep is not in the cards for me. I fill the Keurig’s water reservoir, replace it on the unit and let it warm, checking my phone to see if I missed a call or a text from Jake. It’s ten thirty-five at night. I don’t know why he isn’t home.

Jake saw patients in his office today. These days tend to be his shorter days because there’s a predictability about them. Patients come in for consults or pre-op appointments. They have set appointment times, which may run over a few minutes if a patient is late or Jake gets behind, but never by more than a few minutes. The rest of the time, Jake spends these days catching up on paperwork. If anything, he’s said, nonsurgery days are boring. Jake prefers being in surgery because that’s when he’s at his best.

Despite that, the days he performs surgeries are astonishingly long. He wakes up at four thirty in the morning when the alarm goes off on his watch. The workday starts just after dawn with rounds, prechecks and discussing patients on his list with the rest of the surgical team. They end sometimes as late as nine or ten o’clock. Surgery days are the most unpredictable too. While surgeries are sometimes planned, like removing a tumor, sometimes, like last week, a patient comes in with a gunshot wound to the head and Jake has to spend unanticipated hours trying to save a life. That gunshot victim died. She was practically dead to begin with. That’s how Jake phrased it. There is a detachment in the way he speaks of his patients because there has to be. He can’t get all emotional about it, otherwise he wouldn’t be a good surgeon. There is a whole psychology about how doctors like him get through the day. It started in med school for Jake, where he referred to cadavers as things, not people, so he could cut into them more easily. For most people, seeing a dead body is a defining moment in their life; for Jake, it’s frequent.

With this gunshot victim, Jake said that, even before she landed on his operating table, before he cut into her, she was fucked. Her odds of survival were infinitesimal, something like 5 percent, with even smaller odds of her having a good quality of life if she survived.

“That must have been hard for you, then, knowing she was likely to die and still doing the surgery anyway. It must feel futile,” I’d said, trying to be empathetic because there’s been a rift between Jake and me these past few months. He says it’s my fault, and I’ve been trying so hard to be present in the moment, to not be distracted by other things when I’m with Jake.

He was drinking a whiskey sour. He lowered it to the table, his eyes watching me intensely over the glass. I think he took offense at what I’d said. I wasn’t trying to suggest that what he did for a living was futile, but that was what he heard. What I did often felt futile too: talking for hours to students who were half-asleep and not listening.

“How could you be so sure she wouldn’t survive?” I asked.

“With gunshot wounds, it depends mostly on the location and trajectory of the bullet,” Jake said, sounding smart. “This bullet entered her head at the anterior temporal lobe. It traveled from one side of the brain to the other, crossing the midline, which is not ideal,” he said, as if there was an ideal way for a bullet to travel in one’s brain. “The bullet went in, but it didn’t come out. It tore through both hemispheres, all four lobes of the brain before getting lodged in there.”

“Did she die in surgery?”

“After.”

“How?”

“Brain stem death.”

“What does that mean?”

“The brain stem.” I could see him thinking in his head how to dumb this down for me. I was grateful, not offended. Sometimes he throws out words like globulus pallidus and acoustic neuromas as if I should know what they mean. He’s so used to tossing them around with ease among colleagues, he forgets I’m not one of them, that I didn’t go to med school for years. “It’s responsible for all the things that keep us alive. Breathing. Blood circulation. Digesting food. When the brain stem is dead, you are too.”