The Queen of Hearts(23)
Clancy and Dr. Kalena and Dr. X met us at six o’clock to get an update on overnight events, although it seemed that most of the time Dr. X knew everything anyway. (Did he live here? Did he have spies?) Then we rounded again, for the third time, with Dr. Hollister, the attending surgeon, followed by formal trauma rounds in the TICU with Dr. Markham, the department chair.
On this particular morning, our OR day began with a laparoscopy—a surgery done via long slender instruments inserted through small incisions—on one of the patients who was suspected of having some complications related to his initial surgery. He’d had a steady and stubborn decline despite all indications that he should have been thriving, and Dr. X, who suspected Clancy of possibly having nicked the bowel during the first case, had scheduled a quick look with the scope. As Clancy finished writing orders, Dr. X got the ball rolling by prepping the patient, allowing me to make the initial laparoscopic incisions.
“Nice,” he said, as I carefully incised through the skin near the patient’s navel. “You have good hands. I’ve noticed that you’re good at keeping your cool,” he continued. “You’re fun to have around this month.”
“People don’t usually accuse me of being calm,” I answered honestly, although I was pleased. I had been doing a good job so far on trauma; the rhythms and technicalities of the procedures made an innate sense to me.
Dr. X’s eyes crinkled behind his mask. “Maybe ‘cool’ was the wrong word,” he acknowledged. “You do strike me as fairly . . . vivid. But it’s good to have a med student so fired up about trauma.”
The usual bright lights of the OR had been dimmed way down so we could all see the TV monitor, which featured a vast yellow sea bounded by pinkish blobby walls. The patient’s abdomen had been insufflated with carbon dioxide, blowing it up like a balloon, which, from the outside, gave him the appearance of a late-stage pregnancy. The inside of the abdominal cavity had a bright, weird illumination from the fiber-optic light source. Dr. X demonstrated to me how to manipulate the instruments and pivot the camera so I could see. Clancy, holding his freshly scrubbed hands out in front of him, bumped open the OR doors with his ass and marched up to the circulating nurse for her to gown and glove him.
As things progressed, visualization of the intestine should have been good. Clancy, assuming control, repeatedly drove the camera in exactly the opposite direction as he intended. Consequently, all we had on the monitor screen was a super-close-up view of something that looked like half-squashed yellow grapes, which turned out to be a bunch of globular fat.
“Doh!” X said. “Clancy, get us out of this fucking fat forest. You’re going left when you mean to go right and up when you mean to go down. Your instincts here are bass-ackward.”
“Erpmpth,” said Clancy helplessly, as the camera pivoted wildly and crashed into a glistening maroon structure.
“Attaboy,” X said encouragingly. “You still completely suck, but that sucks a little less. Maybe.”
On to the next case: a colostomy takedown and bowel reanastomosis for a perennial trauma patient named Clarence Higginbottom. Clarence, who had been shot on no fewer than five separate occasions, actually listed his profession as “street pharmacist” on hospital paperwork.
I was fascinated by Clarence’s intestines. Seeing a disemboweled person up close was unnerving. The color, for one thing, was a bright, shiny pink, and the intestines were constantly in motion throughout the case, like a great snake hell-bent on escape. It was gross, but I found myself more mesmerized than repulsed. I was also acutely aware of Dr. X’s presence across the OR table from me, his eyes intent windows into his thoughts, isolated from the rest of his face by his mask. We were doing the case together, just the two of us operating, alongside the scrub nurse, the circulator, and the nurse anesthetist. Clancy had been dispatched to handle some urgent pages emanating from the unit. It was a busy day in the OR, with trauma season kicked into high gear by the last gasp of miserable summer heat. We were on call today, so the circulator kept busy answering pages.
Dr. X showed me how to do the anastomosis. “Here,” he offered. “You can take a couple of the sutures. No, use bigger bites. Yes, there. Angle the needle driver a little more. If Clarence develops an anastomotic leak, he will be your private patient for the rest of the year. I don’t care what service you’re on. I will hunt you down whenever he shows up to trauma clinic.”
“I thought he was going to jail.”
“Oh, the prison van has worn a groove in the road going back and forth to the clinic. It knows exactly how to find us. They all come to trauma clinic; it’s a fun outing for them. There you go; that looks nice.” His eyes scrunched up; he must have been smiling under his mask. He looked directly at me, then put his hand on mine, guiding my final suture with the needle driver. I could feel the warmth of his hand even through all our gloves (we were both double-gloved, on the theory that Clarence must have been a hepatitis factory by this point), and I felt a thrill. He left his hand on mine, kept his eyes on mine; we stared at each other and I knew, suddenly, that he wanted me too.
—
My pager was going off. I fumbled in the darkness to silence it, but it would not shut up. It dinged out its stupid little melody, which somehow transformed in my mind to an annoying ditty: Someonespagingme, someonespagingme. Oh, someonespagingme. Why would it not stop? Dimly, I realized that it was Ethan’s pager, and thank the Lord, he had finally risen out of his coma to answer it. I could hear him murmuring obediently into the phone from his Spartan cot next to mine. I waited for my pager to start blaring too, while Ethan lumbered away, shutting the door behind him with a gentle nudge. Maybe I was safe for a while. My pager was strangely silent; I might as well catch another few winks while I could . . .