Chapter 9
The Rotation
LUKE
The hurricane has passed, the floodwaters have receded, and St. Jude’s has returned to its normal state of controlled chaos. But for Preston York, the storm has just begun.
It is Rotation Day.
For an intern, Rotation Day is like Russian Roulette. You might land in Pediatrics and spend a month handing out stickers. You might land in Proctology and… well.
Preston, through a twist of fate (or, more likely, administrative tampering by his older brother), has landed in Cardiothoracic Surgery.
I am scrubbing in to observe a coronary artery bypass graft, watching through the glass of the OR door as Max preps his "student."
“He looks green,” Jax O'Connell comments, leaning against the wall beside me. He’s eating a bag of gummy bears, which I’m pretty sure violates several sterile field protocols. “Like, Grinch green.”
“He looks focused,” I defend, though I don’t sound convincing even to myself.
Inside the OR, Preston is holding his hands up in the sterile position, but he’s standing so far back from the table he’s practically in the hallway. Max is gesturing enthusiastically at the patient’s chest. Preston looks like he’s watching a horror movie he can’t turn off.
“Max has been waiting for this,” Jax chews a red bear happily. “He’s going to make him touch the pericardium. It’s squishy. Preston hates squishy.”
I sigh, pushing off the wall. “I’m going in. Someone has to make sure Preston doesn’t faint into the open chest cavity.”
I back into the OR, the cool, highly oxygenated air hitting my face. The rhythmic whoosh-click of the ventilator is the only sound besides the upbeat 80s pop playing on the speakers.
“—it’s the engine of the soul, Preston!” Max is beaming behind his mask, holding a scalpel like a conductor’s baton. “Look at it beat. It’s a symphony of muscle and electricity.”
“It looks like a wet bag of angry meat,” Preston says, his voice muffled and flat. “And it’s moving too much. Can we make it stop? It’s aggressive.”
“It’s a heart, Dr. York,” Max says dryly. “Beating is a feature, not a bug. Now, step in. I need you to hold the suction.”
Preston takes a breath. He shuffles forward about an inch. “Max, there is so much fluid. Why are humans so… moist? It’s design flaw.”
“Suction. Here.” Max points to a spot terrifyingly close to the aorta.
Preston leans in, extending his arm to its absolute limit so his face remains in a different zip code. He inserts the suction wand.
Crunch.
Max engages the rib spreader.
Preston flinches so hard he nearly drops the suction. “Oh god. That sounded like a chicken bone snapping. Why did it sound like that?”
“Access granted,” Max hums, ignoring him. “Look at that exposure. Beautiful. Preston, do you see the blockage?”
“I see a lot of red,” Preston gagged. “And some yellow. Is that fat? It looks like pudding. I’m never eating pudding again.”
“It’s the left anterior descending artery. The Widowmaker.” Max looks up, eyes twinkling. “Want to touch it?”
“Absolutely not,” Preston says immediately. “I am happy from here. I am happy observing from the viewing gallery. In a different building.”
“Touch it,” Max commands. “Feel the thrill.”
Preston extends a gloved finger, shaking visibly. He pokes the beating heart for exactly 0.2 seconds before recoiling as if he’s been burned. “It’s warm. It’s warm and slippery and I hate it. I hate you. I hate science.”
By the time we scrub out three hours later, Preston looks like he’s survived a war. He rips his mask off, taking a deep, desperate gulp of hallway air.
“That was medieval,” Preston announces, stripping off his surgical gown with violent efficiency. “We are savages, Luke. We crack people open like walnuts. I need a shower. I need to scrub my soul with bleach.”
Max walks out behind him, looking fresh as a daisy and humming Walking on Sunshine. “You did adequate work, Preston. Though your commentary on the texture of the myocardium was unprofessional.”
“I said it felt like a stress ball dipped in slime. I stand by it.”
“See you at dinner on Sunday,” Max replies, patting him on the cheek with a fresh glove. “We’re having ribs.”
Preston slides down the wall until he hits the floor, burying his face in his hands. “I’m not going. Tell Mom I died. Tell her I died of ‘wet meat exposure.’”
I lean down awkwardly, trying to reassure him. "Don't worry, it only gets worse from here."
Preston glares up at me. "Has anyone told you that you suck at this? Cause you do."
PRESTON
I do not get to scrub my soul. Instead, twenty minutes later, I am dragged into the Trauma Bay by Dr. Jax O’Connell.
“Trauma is different, Princess!” Jax bellows, shoving a breakfast burrito into his mouth. “Surgery is for nerds who like chess. Trauma is for athletes. It’s rugby with needles.”
He kicks open the curtain to Bay 2.
“Shoulder dislocation,” Jax announces, spraying a few crumbs of egg. “Patient is Mike. Mike tried to tackle a vending machine. The vending machine won.”
Mike, a linebacker-sized man, is sitting on the gurney, clutching his right arm and groaning. His shoulder is sitting at an angle that defies anatomy.
“It ate my dollar,” Mike whimpers.
“And you fought it. I respect that,” Jax says, tossing his burrito wrapper into the bin (he misses; I pick it up). “Alright, Preston. Reduce it.”
I stare at the shoulder. It looks like a fleshy, angry geometric puzzle.
“Reduce it?” I ask. “Don't we need... imaging? A sedative? A priest?”
“No time,” Jax says. “The joint is cold. Muscles are spasming. You wait for X-rays, he’s in pain for an hour. You pop it in now, he’s happy in ten seconds. It’s the Cunningham Technique. Massage the bicep, distract the brain, slide it home.”
He grabs a new burrito from his pocket (where does he keep them?).
“Go on. Touch the meat.”
I step forward. I put my hands on Mike’s massive, sweaty arm.
“Okay, Mike,” I say, my voice trembling. “I’m going to... massage you.”
“Just fix it, doc!” Mike yells.
“I’m trying! Your deltoid is very tense!”
“Stop petting him like a cat, Preston!” Jax barks. “Use leverage! It’s simple physics. Fulcrum and load. You know physics, right? You memorized the textbook?”
“I know theoretical physics!” I snap. “I know how to calculate the trajectory of a particle in a vacuum! I do not know how to shove a humerus back into a glenoid fossa while the patient smells like gym socks!”
“Less talking, more popping!”
I close my eyes. I visualize the skeletal structure. I visualize the torque required.
I take a breath. I rotate the arm externally. I lift.
SCHLUCK.
The sound is wet. It is loud. It sounds like a boot being pulled out of a swamp.
Mike screams. Then he stops. He blinks.
“Oh,” Mike says. “That feels better.”
“There it is!” Jax cheers, clapping me on the back so hard I stumble. “The sweet sound of reduction. Good job, kid. You have the hands of a safecracker.”
I look at my hands. They are shaking.
“I heard it,” I whisper, horrified. “I heard the cartilage rub against the bone. It sounded like gravel.”
“That’s the music of healing!” Jax says. “Now, grab the staple gun. We have a guy in Bay 5 who fell on a fence.”
“Staple gun?” I back away. “No. Absolutely not. I draw the line at hardware store supplies.”
“Preston! Come back! We’re just getting started!”
I flee the Trauma Bay. I run straight into Luke in the hallway.
“Psychiatry,” I gasp, clutching Luke’s scrubs. “Put me in Psych. I can’t do the popping. I can’t do the staples. I need a room where people sit in chairs and nobody’s limbs are pointing the wrong direction.”
Luke looks at my pale face. He looks at Jax, who is waving a staple gun in the distance.
“Psychiatry it is,” Luke agrees.
PRESTON
I walk into the Psych ward. It is quiet. It is clean. There are no staple guns.
“Who is the intake?” I ask the charge nurse, Brenda.
“Mr. Finch,” Brenda says, looking exhausted. “Room 708. He’s manic. He’s been ranting for three hours about ‘The Blue Boy’ and refusing his meds. He thinks the doctors are stealing his pigment.”
“Pigment?”
“He says we’re 'diluting the satin.' Dr. Evans thinks he’s hallucinating a child.”
I take the chart. I walk into Room 708.
Mr. Finch is pacing. He is a disheveled man in a hospital gown, waving his hands frantically.
“It’s wrong!” Finch yells at the wall. “The hue is wrong! It’s supposed to be Lapis Lazuli! They’re using Cobalt! It’s cheap! It’s pedestrian!”
Dr. Evans is standing in the corner, looking ready to sedate him.
“Mr. Finch,” Evans says slowly. “There is no blue boy here. The boy is safe.”
“The boy is not safe!” Finch screams. “The satin is ruining the composition!”
I stop. I listen.
Lapis Lazuli. Satin composition. The Blue Boy.
I step forward.
“He’s not talking about a child,” I announce.
Evans turns. “Excuse me?”
“He’s talking about Gainsborough,” I say. I turn to Mr. Finch. “Thomas Gainsborough. The Blue Boy. Painted in 1770. Oil on canvas. Currently residing at the Huntington Library in California.”
Mr. Finch stops pacing. He looks at me. His eyes widen.
“The satin,” Finch whispers. “You know the satin?”
“I know it,” I nod confidently. “Gainsborough used a specific layering technique to achieve that shimmering blue. It wasn't just Cobalt. He used Lapis Lazuli glazes over a lead white base to catch the light. It was revolutionary for 18th-century portraiture.”
Finch grabs my shoulders. He looks like he’s found a prophet.
“Yes! Yes! And these... these philistines,” he gestures at Dr. Evans, “they keep trying to give me pills that make the blue fade! They want to mute the palette!”
“We can’t have that,” I say smoothly. “But here is the problem, Mr. Finch. If your brain chemistry is too chaotic, you can’t appreciate the brushwork. The mania distorts the colour theory.”
I pick up the small paper cup of medication from the table.
“This isn't a pill,” I lie. “This is a stabilizer. It’s a varnish. It preserves the integrity of the image. If you take this, the blue stays crisp. If you don't? It all turns to mud.”