Asher
Imposter syndrome is a saboteur. The more we learn, the more we realize how much we still don’t know. Be kind to yourself.
Focus on the things you’ve done right, and reframe your mistakes as opportunities for growth.
—My Therapist
“I’m going to have to sleep her,” Joss says a week after the tattoo prank.
From the other side of the OR, my head jerks up. No.
No. No. No.
I’ve been expecting Joss to retaliate with some sort of practical joke, so surely this is it, right? She’s totally faking
me out right now. The spinal anesthesia went in fine. She doesn’t need to sleep the patient. Not this patient. This very high-risk patient.
Searching her face makes my stomach curl up on itself. No silliness or mischief to be found. Just contrition.
“No spinal?” My voice is remarkably even. Light.
My insides turn to lead.
The portion of Jocelyn’s face that’s visible above her mask scrunches, and she shakes her head. She knows I’ve been dreading
today’s C-section for the past week. This is the patient’s sixth section. She had so much scar tissue during her previous
one—with a different surgeon—that she wound up with a bowel resection, a severe hemorrhage and a post-op infection.
I asked Dr. White for an assist today, and he practically laughed in my face.
Can’t do it on your own, Foley? Need me to hold your hand?
Sometimes I hate that guy. Viscerally.
This C-section is not one I want to do under general anesthesia. Instead of taking my time, I’ll have to go faster. Propofol
crosses the placenta. Propofol makes humans stop breathing.
Broadly speaking, I like babies to breathe when they’re born. It’s just a thing I like. Helps them be alive and such. Especially
since there are no neonatologists at this hospital to limit any potential damage. Safely digging through all that scar tissue
will only increase baby’s exposure to the drug.
Must go fast for baby.
Must go slow for mom.
Must balance the two and keep both alive.
Must stop being a pussy and man up.
Ack. Find replacement word for pussy.
Need Tums.
“I tried,” Joss says. “The anatomy is difficult.”
The patient, Hannah, turns toward me and grimaces, mouthing I’m sorry.
We’ve talked about this exact outcome no less than seven times.
She knows what she risked when she became pregnant again.
She trusted me to handle any complications that arose.
I will not let her down. Despite what people may or may not think—still not sure in this regard—I’m a good surgeon, and I’ll get all of us safely to the other side.
Smiling with reassurance at Hannah, I remind her it’s not her fault, then glance at Gabriela, the resident who planned to
help me today. “Can you go get the hospitalist? Tell her it’s an emergency.”
While the nurses position Hannah and prepare for surgery, I lock on to Joss. We’re both masked. Her Don’t Be Extra scrub cap hides most of her blond hair. Even with only her eyes visible, the silent support and encouragement bolsters me.
The uncomfortable tightness beneath my ribs eases slightly.
She turns away and draws up the drugs, then prepares for intubation.
The harried OB hospitalist, Evie O’Hara, steps into the OR. “What’ve we got?”
Besides their numerous other duties, the hospitalists help the private docs with difficult C-sections. I give her a quick
rundown of the current situation, and she whistles.
“Right.” She slips a ring off her index finger. “Let’s go scrub.”
Ten minutes later, I’m standing on the right side of Hannah’s OR table, a scalpel in my hand. Evie is across from me. Jocelyn’s
induction of anesthesia is fast, followed by a masterful intubation.
“All right, Doctor Foley,” Joss says. “Go.”
So I do.
I perform the surgery I’ve performed hundreds of times, and it’s just as much of a nightmare as I imagined. The good thing
about scar tissue: it doesn’t bleed. But there’s so much of it. Layers and layers of distorted anatomy and missing landmarks.
Sweat gathers beneath my scrub cap, fogging my eye mask. Evie and I work as a team, snipping, bluntly dissecting.
Guessing.
And that’s when the bleeding starts.
Aberrant arteries. Oozing veins. Snipped muscle between layers of tissue that looks like—but isn’t—fascia. This woman’s body
uses scar tissue like the US Army uses tanks—as offensive weaponry. By the time I reach the uterus—too many minutes later—there
isn’t enough room to extract the baby.
We do our best. Tugging. Cutting. Avoiding bowel like it’s Covid.
I think there’s enough room, so I open the uterus and elevate the baby’s head.
There is not enough room.
So now we’re in a deep, dark cave of an abdomen full of blood where nothing is visible. I’m operating by feel alone. Elbow-deep
in a woman’s body.
“I need a vacuum!” I yell.
The device is thrown into my field of vision, and I shove it into the cave. Thanks to the sheer quantity of blood, the vacuum
pops off four times before the suction takes.
A head of dark, bloody hair becomes visible in the hole.
And the vacuum pops off again. Each pop sprays blood across the OR. It’s on my face. Dripping down my neck. Obscuring my vision
through the eye mask.
I apply it once more, and finally, finally, the head delivers, followed by a limp body.
The baby doesn’t cry. Doesn’t move.
With a clamp and a quick cut, she’s detached from her cord and handed off to the nursing staff.
And I pause.
Because I hate this. These conceivably avoidable situations. These OB nightmares that keep me awake wondering . . . what if? Is it not enough
to have one life in my hands? No, I have two. I chose OB-GYN because it’s the happiest specialty.
But it can also be the saddest.
Did I fuck up? Would this have gone smoother with a different surgeon? A better surgeon? Am I a total fucking fraud?
“I need a new mask,” I say, then head back into the bloody cave.
Miraculously, there are no organ injuries. About eight minutes after delivery, the baby gives her first cry. Eventually, Evie
and I have Hannah closed up and ready to form new scar tissue.
Breathing is suddenly easier.
Did someone turn down the oxygen in the room just for the surgery or something? Not good form.
Evie’s gloved hand touches mine, and I meet her eyes. “Good work, Doctor,” she says.
“And to you.”
We share a silent moment of understanding, a commiseration that only people who’ve suffered the same trenches can comprehend.
Yes, surgeries like this suck, but everyone is alive. Probably because of Evie’s help and a dash of luck. But still.
As soon as that thought occurs, my therapist’s voice rises from the depths of my brain. Try not to attribute your successes to external factors.
Yeah, yeah.
Behind the sterile blue drape, Jocelyn raises an eyebrow at me, then points at all the blood spatter around the room. “You
went full Dexter.”
“No judgment allowed.” I snap my gloves off and slide the soiled surgical gown off my body. “Everyone lived. You’re welcome.”
Blood soaked through the gown and stains my right arm nearly to my elbow. The mirror in the physician locker room is a bit
of a shock. I’ve had a serial killer makeover. Blood on my face, my neck—anywhere that was exposed—but a quick shower erases
the evidence.
Dressed in clean scrubs, I’m towel-drying my hair when someone knocks on the door. “Asher?”
I throw the towel down and lean around the lockers to see the door. “Joss?”
“Is anyone else in here?”
“Um. No—”
She launches into the room and attacks me with a bear hug.
“This is the men’s locker room, sugar bee.”
“I don’t care. You did awesome, and you need a reward hug.”
I laugh. “If you say so.”
The door opens again, and Joss gasps. She leaps into the wet shower I’ve just vacated and slides the curtain closed. A laugh
bursts out of me. “I feel like hiding is somehow worse than being caught in here.”
“Shhhh.”
“Doctor Foley.” The resident, Ashesh, peeks around the corner. He’s obviously confused who I’m talking to, but I don’t bother
explaining. “Heard that was one hell of a section.”
“Yeah. Shit show galore.”
He laughs. “Surprised Doctor White didn’t help you.”
I fight the frown, but seriously? What the hell. Even residents doubt my abilities now? “He was otherwise engaged.”
A sneer I wasn’t expecting pulls up Ashesh’s top lip, and he snorts. Is that . . . derision I detect? “Probably had a tee time he couldn’t miss, right?”
And I’m off-kilter. Because that—that sounded like judgment against Dr. White. Not me.
“But you didn’t need him, I guess.” Ashesh raises a hand for a bro high five, which I supply with a smile.
Little boost feels quite nice. Will it last?
Focus on the positive. Reframe the negative.
“Anyway, I saw one of your patients in triage,” he says. “She thinks she’s in labor.”
“Is she contracting?”
“No.”
“Is she dilated?”
“Nope.” Ashesh smirks. “Closed like Kmart.”
“Sounds like she’s just pregnant. Send her home.”
Once he’s gone, Jocelyn pokes her head out of the shower. “White really wouldn’t help you? Dick move.”
“You know how he is. Egomaniac. He probably would’ve helped if I’d sufficiently humiliated myself by begging, but I couldn’t
quite reach that level.”
She grins. “Nothing wrong with a little shameless begging.”
“I didn’t need to beg, though.” I throw my arms wide, faking confidence. “I am a surgical god.”
Her smile falls. “There was another reason I came in here. The second instrument count was off. Missing a towel clamp. They
want you to look at the X-ray.”
“What?” I nearly laugh. “I don’t use towel clamps.”
She shrugs, and my mind goes wild. Thoughts tumble deep into chaotic disarray.
No. It can’t be. Towel clamps aren’t even in C-section surgical sets.
But . . .
What if . . .
I follow Joss back to the OR on numb legs. Cynthia, the nurse in the wash station outside the room, has an image pulled up
on her portable rollie computer—a plain film of my patient’s abdomen with a towel clamp right in the center.
No way. Is this for real?
I move closer. “I don’t understand. I didn’t use towel clamps.”