CHAPTER 4
Elena
◆
I dress in the dark at five-fifty because the apartment is colder than it should be in October.
I push the pencil through the knot at the nape of my neck — soft yellow, dulled at the lead from yesterday's chart corrections — and I drop the medallion under the scrub top.
It rests against my sternum as it always does. My ribs know where it sits.
The intercom catches me at my locker at seven-twenty-five.
"Rossi. Chief's office. Now."
The voice belongs to the unit clerk reading off a slip handed to her by someone on Floor 10. I close my locker. I take the south stairwell because the residents take it and because nothing said in a stairwell carries.
The chief's corridor is empty at seven-twenty-eight.
The walnut door at the southeast corner of Floor 10 is closed, and the brass plaque on it — NIKOLAI ROMANOV, M.
D. / CHIEF OF SURGERY — catches the corridor light at a slant I am learning.
I raise my hand to knock. The door opens before my knuckles connect.
"Come in. Sit."
He is at the desk. The desk is dark walnut, bookmatched grain, the kind of wood you do not see in hospital offices, and the surface is bare except for one folder, one closed pen, the small electric kettle on the credenza behind him, and a cobalt-blue tin with gold lettering at its waist. Earl Grey.
The kettle has just clicked. There are two Royal Doulton cups on a tray beside it — thin gold band at the rim — and a small silver tea spoon laid across the saucer of the cup nearest the desk.
The steam off the spout is the first thing I let myself look at; it curls up into the southeast light and the bergamot reaches me before I sit down. The room smells like a private library someone keeps for a man who reads at six in the morning and prefers to be left alone.
I map the windows because that is what I do when I have walked into a room whose geometry is still strange to me.
Eight. Two casements on the south wall facing First Avenue, the pale October sky cut into slats.
Two casements on the east wall above the credenza.
Four small clerestory panes set high on the west wall, opaque glass, daylight only.
The bookshelf along the east wall holds anatomy texts — I read the spines later, when I am not looking at him.
Seventy-two. Sabiston's. Two volumes of Maingot's. A leather roll on the third shelf at eye height that I know is a surgical kit because the buckles are positioned as they are positioned on the trays in OR-1. The kit is decoration. The instruments are real. I file that too.
"Sit."
I sit. The leather of the club chair smells faintly of pipe tobacco — a ghost scent, the wood has held it for years.
Aged oxblood, the seam at the right armrest worn shiny by a thumb that has been there for a very long time.
The room smells of leather, paper, and bergamot. The bergamot is winning by an inch.
He has dressed in civilian wool this morning — a charcoal merino crewneck and a white oxford open at the collar, the cuffs not yet buttoned, the tungsten watch dark on his left wrist — third strap, navy leather, the crown at his right thumb when he reaches for the folder on the desk.
He has the kind of stillness most men have only when they are asleep. His eyes track me anyway.
"Hayes has you in OR-1 at nine."
A statement, flat as the desk between us. I nod once.
"That schedule has been changed. You are not in OR-1 this week.
The OR nurse manager signed the temporary float at oh-six-thirty and Beatriz countersigned it because Beatriz signs what moves her people.
You are on the chief's surgical service as circulating support — OR-3 mornings, pharmacy witness at eleven, the library at fourteen hundred when there is no scheduled case, and back to OR-3 for the late-afternoon teaching board.
HR has the transfer file; Occupational Health has your titers; your access stays RN-only. Beatriz knows. I told her last night."
"Sir."
"That is the schedule. Do you have a question."
"No."
The watch moves an inch as he checks the time without looking at it. Pressure of the right thumb on the crown, a quarter-second, the only mannerism he has. Seven-thirty-one. He has been awake since five.
"There is a second matter. The cardiothoracic late case Aguilar signed you up for in OR-3 — twenty-one hundred, the post-bypass washout — has moved to OR-4.
Anesthesia approved the room swap at six forty-two; sterile processing moved the cart; no patient loses time.
OR-3 stays blocked for trauma and for a teaching round on the rocuronium-and-sugammadex pairing tray we keep stocked on the OR-3 cart — standard intubation, standard reversal, the pair lives together.
There is also a vecuronium ampoule at the back of that tray that ought not to be there.
I will be addressing it. The room will have a junior anesthesiology resident and the night charge.
I would like you on it. Bring your own pen. Twenty-one thirty. My office."
The watch again. Half a second. Twenty-one thirty.
"Yes, sir."
"Is there anything else."
"No, sir."
"Then I will see you in the morning at OR-3. Bystro, Rossi. The case board will not wait."
He says bystro with the flat finish of a knife sliding back into its tray — flat, precise, finished.
The trauma textbook used the word for emphasis.
He uses it for closure. I am out of the chair and the door is closing behind me and I am twelve steps down the corridor before I notice my hand has gone to the medallion at my sternum and is still there.
I put it down. I shape my breaths from the elevator to OR-3.
Four.
*
I am at OR-3 at seven-fifty-four. The operating lamp is on, its three articulated arms set wide for the morning's first case, the center bulb yellowed.
I register the chief through the gallery glass at eight-oh-two — he is on the catwalk, a folder open against the brass rail, his pale eyes tracking the floor below and the residents already scrubbing in.
His gaze stays on the floor. He has registered me already. I file that too.
The morning proceeds as mornings do when a chief has restructured your week without explaining why. I move. I check instruments. I lay out the sponge counts twice because I always lay them out twice. I call back the lap count exactly on the second the third-year resident calls it forward.
At eleven I am at the pharmacy on Floor 8 counting the controlled-substance cabinet inventory with the Lab B pharmacist, a small man whose handwriting is the neatest I have seen in a hospital and whose count is sixty seconds slower than mine.
Fentanyl, midazolam, ketamine, propofol, succinylcholine, sugammadex, rocuronium, morphine, hydromorphone.
The cabinet's double key is heavier than it looks. I file that too.
I think of Sophia at the pharmacy door before I turn the second key.
She comes to me where she comes to me — the reason stays opaque.
The trauma attending whose face I never saw clearly was a tall man in scrub-green who called time at eleven-forty-seven and walked out of OR-2 with his gloves still on.
He had done the math the room was permitted to do and he had lost. He was a competent man at the edge of his stamina.
He was tired. I have spent six years thinking about the difference between the men who walk out of those rooms tired and the men who walk out tired in as the body knows a wrong tired.
The chief upstairs counts as I take inventory.
He counted my windows before he sat down.
He counted the sponges through the gallery glass at eight-oh-two while the residents thought he was reading.
He is the opposite shape of that tired man.
Be careful, Elena. The thought arrives in my own voice and I keep walking.
At fourteen-hundred I am in the hospital library on Floor 7 with the cath-lab custom-dilution protocols open across the long table.
The pages are dense. The math is clean. A man is at the back table with a stack of journals; even seated his shoulders are above the head of the chair, his hair black and tied back, his coat the long one — the research coat, not a surgical coat.
His eyes stay on the page. Mine stay on mine.
We are reading. He is one of them. Which one stays a question for tomorrow.
At sixteen-thirty the drizzle starts. I am in the residents' workroom restocking the pen drawer when the window changes color above the alley — slate to silver to slate again — and the pressure drops.
Beatriz catches me at the door on her way to OR-1 for the four-thirty turnover. She lays one warm hand on my elbow.
"You good, mija?"
"I'm good."
"The chief moved you off my board for the late case. I do not ask him why and he does not tell me; you do not ask him either. You walk careful and you tell me tomorrow whether you slept."
"Beatriz."
"Mija. Co?o. Walk careful."
She is gone before I can answer. I sit at the workstation and I chart for an hour and I do not think about twenty-one thirty until twenty minutes before twenty-one thirty.
*
The chief's corridor at twenty-one-twenty-five is darker than it is in the morning. The overhead is dimmed; the wall sconces throw small ovals of warm yellow against the walnut wainscoting; the door at the southeast corner is half-open. The man coming out of it is Stefan.
Mikhailov closes the door behind him without looking at it, with the ease of someone who has known the door for years.
He is in hunter-green scrubs and the white attending coat he keeps buttoned, the braided leather cord at his left wrist a thin band against his cuff.
His face is the warmest of any face I have seen in this hospital and the most tired.