Seeing the entire ER looking his way but pretending not to, he adjusted his scrubs and gave a small bow, inadvertently mooning anyone behind him. A couple of the nurses clapped.
Villanueva started to examine the remnants of the stool, half expecting to find an obvious defect. Then he looked around. “One question,” he boomed. “Was this stool already broken before I got here?” The giggles turned into uproarious laughter. Villanueva tried his best to look angry, but eventually joining the laughter while stuffing the rest of the doughnut in his mouth.
S
ydney left the OR to answer a page. She wasn’t worried. The operation, a CABG, was almost done. She thought everyone knew the acronym until one day she received a call from the billing office where a new staff member wondered why Sydney had billed twelve thousand dollars for cabbage. Sydney had patiently explained it was coronary artery bypass grafting. “No, CABG was an acronym, not an abbreviation,” she had patiently explained. There was a response on the other end of the line, to which Sydney replied, “Actually, I am not the only one in the country to use that acronym,” with a little less patience.
The chest was still open, but senior resident Sanford Williams appeared to have everything well in hand when she stepped out into the scrub area. Williams had come a long way and was now one of the best young surgeons at the hospital. Sydney had a great deal of pride in her residents, and spent a lot of time training them in the operating room as well as in the animal labs. She had started with Williams seven years ago showing him how to attach skin grafts on the backs of rats. Now he was methodically sewing blood vessels together on top of a beating heart with suture too small to be seen by the human eye. Sydney was returning a call to the paging operator when she heard shouting from the OR.
She hung up her cell and hurried back into the OR. She saw Williams and nurse Monique Tran nose-to-nose—or they would have been nose-to-nose if Tran wasn’t a foot shorter than the surgeon. A tall Southern man, Williams wore clothes that would best be described as preppy when he wasn’t in the operating room. Even now, he wore a surgical scrub cap that had an argyle pattern. Tran, on the other hand, was a diminutive Vietnamese woman who wore Birkenstocks and baggy shirts. They were about as opposite as they came. Right now they both wore masks, but their narrowed eyes and their tone—even muffled—made their anger and frustration clear with most of their features covered.
Next to the doctor and nurse, bloody detritus was spread across the floor beside an overturned track bin fitted with a red bag for medical waste. Packaging, syringes, tubing, tissue, blue surgical draping stained dark, gloves, a couple of once-white towels, now crimson with splotches of blood. Above the mess on the floor, a rack held little bits of blood gauze, each in its own compartment.
Behind Monique and Williams, a junior resident stood frozen over the patient’s split sternum holding the large curved suture needle loaded with a wire.
“I don’t care,” Tran said.
“You don’t care?”
“I don’t care. The patient can lie there all friggin’ night for all I care.” Monique crossed her arms, a gesture of defiance and resolve in case he didn’t catch the meaning of her words. “No one is closing this patient until we find that four-by-four.”
“I did not leave a four-by-four in the patient,” Williams said, almost shouting. “That is not something I do.” Neither he nor Tran had seen Sydney come back into the OR. “You are so—
Gây phiền nhiễu
.”
“
Chao?
… Are you calling me annoying? Don’t try your god-awful Vietnamese on me. Look, maybe even the great Sanford Williams left a four-by-four in the patient…” Tran gesticulated.
Williams now crossed his arms and tilted his head back, appraising. Calmer now.
“Since when have you become so emotional?”
“Twenty-two went in. Only twenty-one came out. Either do an X-ray or help me find the missing four-by-four in the red bags. No one is leaving until we find it.”
“Like hell.” Williams turned to the junior resident. “Close him.”
“You want emotional?” Tran asked, poking Williams in the chest. “How’s that for emotional.”
“Jesus, Monique.”
The resident remained frozen over the empty chest cavity, needle and suture in hand. He was like an obedient child waiting to be told by a parent to start eating.
Sydney, too, watched and said nothing. She was trying to decipher what she was seeing. She knew the cause of the outburst must have been more than a missing 4x4, but she couldn’t figure out what. And since she couldn’t figure it out, she couldn’t decide what she—as the senior doctor there—should be doing. And when the heck did Sanford learn Vietnamese? She waited and watched. She thought the answer to what was happening here might suddenly become clear. That was the nature of a puzzle. Look long enough, and maybe you will notice something you missed, just like Joanna Whitman. Yes, there was more than just a missing gauze at stake here, but what?
There was something else, though. There was a rawness and passion between these two, and suddenly Sydney felt the awkward thrill of the voyeur. She was watching something, for lack of a better word, “real.” And for that reason, too, she was loath to interrupt. So often the nurses and the residents acted around her the way they were supposed to act: obedient and eager.
Monique Tran glowered at Williams. The Red Hot Chili Peppers played loudly through the ceiling speakers,
Southern girl with a scarlet drawl…
Sydney had playlists for the various parts of the operation. She liked Bryan Ferry or some other soothing vocals for pre-op and the initial incision. During the operation itself Sydney liked U2, which she always found uplifting. When it was closing time, the beat was hard and fast.
Without a word, Tran bent down on the floor and began sorting through bloody pieces of flesh, sterilization kits—everything that had been tossed in the medical waste bag during the two hours they had been operating. She was muttering as she did, a rapid-fire Vietnamese invective.
“You think I tossed it in here. Mr. Smart-Ass. I mean, Dr. Smart-Ass. We’ll see. You think you know friggin’ everything. You don’t even know how to say pho,” Monique said, not pronouncing the Vietnamese dish
faux
but more like
fuh
.
It was only now that Williams noticed Sydney taking it all in. The sight startled him.
“Dr. Saxena.”
Monique Tran looked up, and she, too, was startled to see Sydney Saxena standing in the OR.
“Dr. Williams. May I have a moment?”
Sydney did not like to countermand Williams, who was the surgeon in charge inside the OR in her absence. But she was the surgeon of record should anything go wrong. More than that, there was a right and a wrong, and in this case Williams was wrong. Sydney and Williams pushed through the double doors. She looked at the young surgeon.
“Monique is such an obstructionist—” He stopped, blushed, then awaited word from his attending.
“She’s right. Look, every year, more than a thousand patients have something left in their body during surgery. In fact, it is closer to fifteen hundred. It is not a sign of weakness to forget something—but if you never bothered to check, well, that is unforgivable. Not to mention, my name is going on the operative record. I don’t want to be coming back here tomorrow to dig out your gauze. I don’t want to get sued, and I sure as hell don’t want to be in front of the rabid spectators in the coliseum next Monday morning.” The last comment got Williams’s attention.
“Either you order an X-ray or I do. Or you can join Monique on the floor with the red bag waste.” Sydney was trying hard to act the way Hooten might in a situation like this. It was no secret to anyone that she was angling for his job one day. “You can’t close up the patient without knowing.”
Williams pursed his lips and sucked air through his nostrils. He turned and pushed his way back into the OR.
“Okay. We’re doing an X-ray.” Twenty minutes later the missing 4x4 rectangle of gauze was located in the patient’s chest cavity.
T
he operation on the Ahmad boy was straightforward and had gone well. The boy was awake now, and was starting to ask questions. Ty shined a bright light into both his eyes and asked him to lift both his arms in the air. He looked at the curvilinear incision he’d made on the boy’s scalp. Ty silently dictated into a small recording device that would produce an electronic record for the boy’s chart. “Pupils are equal, round, and reactive,” Ty said. “He has full power in all four limbs, and he is oriented to person, place, and time,” he finished. He wanted to add,
The boy still doesn’t know his father is dead or that the kindly pediatrician had smoked a joint prior to buckling his son into the car
. He thought better of it. Hooten had emerged from his twelfth-floor sanctuary to help operate on Mrs. Ahmad. Surprisingly, he wasn’t at all upset that Sung Park couldn’t be located. Mrs. Ahmad was still sedated, but she would wake up soon to start reassembling her family’s shattered lives.
Sandy Shore’s Rathke’s cleft cyst had also been completed without incident. Mac was a quick learner with good hands and an unshakable confidence Ty now envied. Ty mused that he was now on the outside, looking in. No matter how many ways he surgically dissected the situation in his mind, he kept coming back to the same conclusion. He had all but put a gun to Quinn McDaniel’s head and pulled the trigger. It was an assassination. Isn’t that what you would call a reckless mistake like the one he’d made? He felt a little spill of gastric acid in his stomach. The boy’s death had shaken his mojo, his
wa
, the kind of fusion of thought and action that the philosopher Mihaly Csikszentmihalyi called
flow
. Whatever Ty once had, he now realized he had lost it. The pressing question was: How could he get it back? He tried not to think about what he’d do if he couldn’t.
Changing out of his scrubs, Ty thought about how quickly his confidence had fled. He had done the two spines without a thought, and then seized up when he needed his skills most. He had started thinking, and that was it. The doubts flooded in. He made a mental note not to think too much and almost nervously laughed out loud. The quickest way to obsess on something was to try not to think about it. Just ask any baseball player in a batting slump, or basketball player at the free-throw line.
Ty had been a standout athlete in high school. He pitched and played outfield for San Luis Obispo High, and was shooting guard for the Tigers basketball team. Ty remembered teammates with mental blocks that crippled their abilities to perform in games. Don Blankenship, the first baseman on his baseball team, would choke when he had to make even the shortest throw. His arm would move forward and the ball would travel almost straight down into the ground. Fortunately for the Tigers, first basemen did not need to throw often. This strange mental block was not limited to obscure high school players. The New York Yankees’ Chuck Knoblauch had suffered a similar curse. And there were well-documented cases of major-league pitchers whose careers were ruined when they suddenly lost their pinpoint control.
Then there was Ty’s teammate on the high school basketball team, a sinewy power forward named Trent Brown. He missed a foul shot in the district finals one year and from that point on made only about a third of his free throws, an abysmal percentage. Ty thought Trent’s horrific foul shooting cost him a Division I scholarship—all because he could not overcome the belief he could not perform the simple act of shooting a ball into the hoop from the free-throw line fourteen feet away.
Golfers called these jitters “the yips,” and sports psychologists made good money helping athletes overcome these mental hang-ups. Of course, sports were not the only arena where you could choke.
I’m proof of that
, Ty thought. Remembering his days as a standout athlete gave him an idea. He was supposed to prepare a lecture on the use of the hormone progesterone for traumatic brain injuries. It was an idea he’d developed with one of his colleagues in the ER. They noticed women often did better than men after similar head injuries. They thought it might be the female hormone progesterone that was somehow protecting the brain. Turned out they were right, and Ty wrote his fifteenth publication for the
New England Journal of Medicine
. Instead of working on his talk, he left the hospital on his Hayabusa, went home to his condo, and changed into shorts, a T-shirt, and high-tops. He took a quick peek in the mirror and pushed away a couple of gray hairs that had started to creep in along his sideburns. His cobalt-blue eyes looked right back at him, challenging him. Then he drove down Oak Street to a local elementary school playground where high school players and a few adults gathered in the afternoons to play basketball on the asphalt court. Ty left his pager behind.
When they chose up sides, Ty was picked last, but he stayed with the run-and-gun high schoolers, to the younger players’ surprise. Ty’s game was typically smooth. He moved fluidly, cut quickly, and found an open space to take a pass, square up to the basket, and let loose with his textbook jump shot. He was also a smart player. He anticipated where the ball was going to be. He put his body in position to get the offensive rebound, set a pick or dodge one, box out the opposing player on defense, kick out for a fast break. He quickly gauged his most useful role on a pickup team and filled it, whether it was shooting, rebounding, or ball handling. As a result his teams usually won. These were all products of his restless childhood days in California, playing hours upon hours of pickup basketball, playing at every opportunity until his focus shifted from petty crime and sports to doing whatever it took to be the best surgeon he could be.
But as they moved up and down the court now, Ty did not find his rhythm. The first time he got the ball on the wing, he hurried his shot and missed the basket entirely. The next time, he drove to the basket but had the ball stripped from his hands by an opposing player half his age. The player raced downcourt and laid the ball into the hoop.