CHAPTER 2
Elena
◆
I touch each button on the cardigan I do not wear to work. There are five; there have always been five; I mark them anyway because the kitchen is cold and the kettle is slow and counting is a piece of furniture I can sit on when the morning is too big.
The chain at my throat has been resoldered twice. The silver medallion against my sternum is cold for the first two minutes of any morning and then it warms to my body and I do not think about it again until something inside me asks me to.
I learned to count by myself. Nobody in this borough teaches you how to be afraid quietly.
It is six-fifteen on a Tuesday in October.
The chlorhexidine smell of last night's third hand-wash is still on my knuckles even after coffee, even after toast, even after the radiator clanked itself awake at five.
Day two of the new wing. I lock the apartment behind me at six-thirty and I take the long way to the avenue because the long way passes a church and the church is empty at this hour and I like to look at the empty door.
The door stays a door. Six years now, I have looked and walked past.
---
Beatriz is at the long bench in front of the mirror when I get to the locker room, lacing her own shoe-covers. Salt-and-pepper bob, cut at the jaw. The Vicks already under her upper lip. Reading glasses on the beaded chain.
"Watch yourself, mija."
Her eyes stay on the lace. She finishes the second shoe-cover and stands. The chain on her glasses swings once and settles.
"Anything specific, Beatriz?"
"Later. " She tilts her chin at the door. "Just. Watch yourself."
One ask is enough. Locker two-fourteen. Third row, second from the end.
I dial the combination — thirty-two, eighteen, four — and the ceil-blue scrub stack is folded as she folds it.
I get the cap and the shoe-covers and I tie my hair as I always tie it, the yellow pencil through the knot.
The pediatric pin on my lanyard catches a fluorescent and throws back a small blue-silver spark.
I straighten it without thinking. She sees the gesture, files it, and walks out without another word.
She has been a charge nurse for thirty-two years. She does not use sentences she does not mean.
I file watch yourself, mija as she filed the pin.
---
OR-2 at seven-ten is a hernia repair with a senior attending whose name is on the board and whose name I do not yet need.
His resident is third-year, careful, and afraid of the wrong things.
I anticipate the Adson with teeth before he asks; I anticipate the Metzenbaum scissors before his shoulder drops the half-inch that means he is about to ask; I track the suture throws in fours and the laps three times and my breaths under the mask in eights.
Halfway through the closure the attending says, soft, to the resident, the abdominal wall is thicker here than it looks, and the abdominal wall is not thicker than it looks.
It is exactly as thin as the tissue plane in front of him.
He is lying for teaching purposes. He wants the resident to push harder and to be wrong about why.
I tuck my left ear behind my hair without thinking.
My body speaks; I keep it to myself. The resident finishes the closure. The patient does well.
I scrub at the OR-1 anteroom sink. Chlorhexidine to the elbows, three minutes by the wall clock.
My reflection in the chrome above the taps is the one I had last night and the night before and the night before — auburn-knotted, pencil through, the pediatric pin a small ceil-blue flash at my collarbone — and the smell of the soap is the smell that followed me home from the hospital I did not work at when I was nineteen.
It is October. Two thousand twenty-five. Indian-summer warmth is climbing the windows on the east side of the building and the autumn light at this hour is the same shallow honey light that was on the NICU window across the lightwell on the worst night of my life.
She died on a trauma table in two thousand eighteen.
My sister. Twenty-three years old. A motorcycle had gone down at the second curve of the Henry Hudson on a Sunday night in May.
Massive intra-abdominal bleeding. They did the laparotomy.
The bleed was bigger than the surgeon and the bleed was bigger than the surgical team.
The laparotomy ended when the attending called time. I did not see the attending's face.
Every attending's face since has come to me in pieces — jaw, mask line, the edge of a brow.
The geometry of an OR is the geometry of an OR.
A femur fix is not a trauma laparotomy. Bone, not vessel.
Metal, not red. But the pool of yellow light on the surgical drape is the same pool, and the shadows it throws are the same shadows, and as the room outside the pool goes black is the same black I have been counting against since I was nineteen.
I dry my hands. I drop the towel in the bin. The cross stays inside my head — Saint Raphael, very quietly: I am here. I am still here. She is gone; I am still here. The sentence steadies under my ribs.
The medallion waits at my sternum, untouched.
I am saving it.
---
The OR-3 gallery at eight-thirty has the orthopedic case staged for the femur fix at nine.
The operating lamp at the table below is lit and centered, three articulated arms locked into a quadruple-shadow pose over the empty drape, the pool of yellow light the warmth of summer butter and the smell — even up here behind glass — the clean surgical metal smell of an instrument tray that has been opened and laid out by hands that knew what they were doing.
The Mayo stand is at the foot of the table. I am here because the OR-1 charge asked me to observe the femur from above for the residents' teaching log; I am here because I wanted to count the stand before the room filled.
I take inventory: Mayo scissors curved. Mayo scissors straight.
Adson tissue forceps with teeth. Adson without.
Two needle drivers — one diamond jaw, one without.
A Bovie pencil seated nose-down in its sterile holster.
A Senn retractor with the rake side up. Two Allis clamps.
A Kocher clamp. A Frazier suction. A Yankauer suction in its cradle.
A periosteal elevator. A Hohmann retractor at the foot of the tray with the broad blade flat against the cloth.
Bone curettes in three sizes laid in descending order along the back row. A box of three-O Vicryl on cutting needles, the foil packets stacked in fours.
Fourteen. I register fourteen things on a Mayo stand at eight-thirty-six in the morning and the brass lamp puts a pool of yellow light over all of them that has not changed since the room was empty and will not change when the room is full.
The lamp is one of the only things in an OR that does not change between incision and closure.
That is part of why I trust it. That is part of why it scares me.
The door behind me opens.
My eyes stay on the lit table below. I check the bone curettes again — three; small, medium, large. The footstep is heavy and unhurried, claiming the room without announcement, taking the long way around the gallery to the rail before it stops at the corner where the brass turns into the side wall.
"Rossi."
Low, even, the same as always.
I turn. Dr. Romanov is in navy scrubs cut by a tailor I will never afford, and the white attending coat over them with NIKOLAI ROMANOV, M. D. / CHIEF OF SURGERY embroidered in navy at the breast. The silver at his temples catches the gallery's low light. The pale gray of his eyes does not.
"Dr. Romanov."
He nods once. He stays planted in the corner. The right thumb of his right hand briefly touches the crown of the watch at his wrist — a fraction of a second; you would miss it if you were not looking — and then it is gone. His gaze moves from the table below us to the Mayo stand, and then to me.
"You count well."
That is all. The line lands bare — no softening, no warming, none of the small joke a man at this rank usually adds when he has noticed a junior nurse standing alone in a gallery before a case. He says it as he reads a vital. You count well. The same flat shelf of fact.
"Thank you, Doctor."
"Rossi."
He goes the same way he came in. The door closes as it opened — the latch finding the strike plate without a click.
The gallery is quiet. The brass lamp's pool of yellow over the fourteen instruments has not changed. The rail is cool under my forearm.
He saw me count. He saw me count and he named what I had done and he walked out without taking it from me. I had not understood, before this moment, how much I had been bracing for it to be taken.
I am being seen. By whom, I am uncertain. By whom, I know. The name stays behind my teeth.
---
The femur fix takes three hours and the patient lives.
That is the sentence I think when the senior attending steps back from the table and the resident closes the last of the lateral incision and the brass lamp's pool of light moves a quarter-inch as the table is rotated for the dressing.
The patient lives. He will go to PACU and to the floor and to home and to walking by Thanksgiving, on a leg he had given up on.
The lamp stays oblivious. The lamp stays the same. I change.
I have been at the rail for three hours and my breathing is even. The room outside the pool is no longer black.
Now.
Now I touch it. Pad of the right index finger, through the V of the scrub top, against the medallion at my sternum.
One press. One breath. The angel's hairline-cracked wing is under my finger.
The chain is warm. The medallion holds more heat than the chain.
I am here, I tell Saint Raphael, somatic and small. The patient lives. I am here.
I take the finger away.
That is the first.
There will be one more, tonight, when I have come home.
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