2. Chapter 2
Julian
It's four forty in the morning and I'm standing at the kitchen counter eating eggs because sitting down feels like a commitment I don't have time for.
The espresso machine hisses behind me. My socks slide on the oak when I reach across for the salt, and through the terrace door I can see the tomato planters I built in the spring.
My mother's recipe box sits on the shelf above the stove.
I don't open it much. I just like knowing where it is.
I rinse the pan, leave it in the rack, pull on my shoes by the door. The walk to Lakeshore Memorial takes nine minutes if the lights are with me, eleven if they're not. At this hour they're always with me.
By six fifty-five I'm at the scrub sink outside OR four, brush moving under my nails, and my father comes to the sink beside mine without a word.
He's sixty-four. He's been chief of cardiothoracic surgery in this building since I was in high school, and he scrubs exactly how he did when I was a resident watching from the hall.
Thirty seconds a hand. Elbows last. He does it the same every single time, like a man who decided once how something should be done and never revisited it.
"You reviewed her echo again last night?" he says, eyes on his own hands.
"Twice."
"And?"
"Annulus measures twenty-three. I'd go with the twenty-five valve. There's calcium in the outflow tract the imaging is underselling."
He shuts the water off with his elbow. "We'll see."
That's as close as he gets to agreeing with me before I've been proven right.
The patient's name is Lorraine. Seventy-one years old.
She raised four kids on a school cafeteria salary, and yesterday in pre-op she told me she just wants to make it to her granddaughter's graduation in the spring.
Aortic valve calcified to near stone, and we're replacing it this morning.
My father takes the lead. I take the right side of the table, and for the next three hours this room is the only place in my life where everything runs exactly the way it should.
The perfusionist calls numbers. The cross clamp goes on at seven fifty-two.
The valve comes out in pieces, and there's calcium in the outflow tract, more than the imaging suggested, more than most people would've called.
My father looks up at me over his loupes for half a second.
He doesn't say a word. That's all I need.
I'm sewing in the new valve when he leans in over my hands.
"Redo that one."
I look at the stitch. The spacing is off by less than a millimeter.
I redo it without saying anything.
The cross clamp comes off at eight fifty-six.
Her heart takes one slow roll, like it's deciding, then picks itself up and gets back to work.
The rhythm strip settles. Steady. There's no feeling in my life that touches this one, and I've stopped trying to explain it to people who haven't stood at this table.
We close. My father steps back, strips his gloves, tells the room good work in the flat tone he uses that means exactly what it says, and walks out already pulling off his gown.
I find Lorraine's family. Her daughter stands up so fast her coffee nearly goes over.
"She did great," I tell her. "The valve's in, her heart's happy. She'll be awake this afternoon and complaining about the food by tonight."
The daughter laughs and cries at the same time, one hand pressed over her mouth. Then her eyes narrow at me, the way people's eyes do when they're trying to place something. "Wait. You're the one from the magazine. At the grocery store. By the gum."
"That's the rumor."
"Can I get a picture? My sister will lose her mind."
"Let's get one with your mom instead, when she's awake. Better-looking subject."
Noon. The staff lounge. A sandwich Derek picked while I was still writing post-op orders, because that's what Derek does.
Derek Okafor has been putting my patients to sleep for six years, and he's been putting me to sleep with stories about his daughter's swim lessons for five of them.
He's the best anesthesiologist in this building.
"By the gum," he says, when I tell him. He sets his sandwich down to enjoy the story with his full body. "The new face of cardiac surgery. Next to the gum."
"Premium placement."
"You know what's actually funny? You paid a lot of money for that apartment and I've eaten dinner there twice. Twice, Julian." He points at me. "Gorgeous kitchen. Owner unreachable. The magazine should've led with that."
"I cook every morning."
"Eggs in the dark alone. That's surviving." He peels back his sandwich wrapper. "Camille keeps asking when you're coming over. She made a list. It's laminated."
"Tell her I'm honored."
The lounge door opens. Dianna from development comes in scanning the room until she locks onto me, tablet against her chest, the donor smile already on.
"There he is." She walks straight toward my end of the table. "Headliner."
"Dianna."
"Don't Dianna me. Tux fitting tomorrow at two, the shop on Erie Street, they already have your measurements. I need your bio approved by tonight, the event firm's printing programs this week." She swipes the tablet awake and holds the screen out to me. "I wrote it. Just say it's fine."
The bio calls me a rising star. It says devoted son. It says the auction's most anticipated bachelor.
"I'm not doing this," I say.
"You are."
"Dianna. I'm a surgeon. I'm not standing on a stage while people bid on a dinner with me like I'm a vacation package."
"It's a lake house, a private chef dinner, and your company, and last year the headliner package alone funded two ECMO circuits for the peds unit." She pulls the tablet back. "Also your father already RSVP'd for you both at the board meeting. So..."
Derek tips his head back and laughs.
"He did what?" I ask.
"Front table. He's introducing the auction." She's already moving toward the door. "Talk to him, not me. Erie Street, two o'clock. Wear real shoes."
My pager goes off at one forty.
Type A aortic dissection. Male, sixty, outside hospital in Rockford. Already on the helicopter.
A dissection means the inner wall of the aorta has torn, and the man's own blood pressure is now peeling that artery apart from the inside, working toward his heart.
Half the people this happens to never reach a hospital.
The other half lose roughly one percent survival per hour.
When the page comes in, you don't finish your coffee. You move.
I meet the CT images before I meet the patient. The tear starts just above the valve and runs up through the arch. My father is already at the monitor when I get there, glasses on, arms folded, reading the scan top to bottom.
"Root and ascending," he says. "Arch is involved."
"I'd do the hemiarch and reassess the valve once we're in. The leaflets might be spared."
"They won't be."
"They look clean on this cut."
"They won't be." He's already walking. "You'll take the root. Don't make me regret saying that."
The patient's name is Walter. His wife is in a chair outside the elevator, and I get ninety seconds with her, so I crouch down next to her.
His aorta has torn. We're going in to fix it.
The surgery is long, it's serious, and it's also his only option.
I'll come find you myself the minute we're done.
She takes my hand in both of hers and doesn't say a word. Her hands are shaking. Mine can't be.
The repair takes the rest of the day. To fix the arch we cool Walter's body to eighteen degrees and stop his circulation entirely, which means that for thirty-one minutes there is a man on our table with no heartbeat, no blood moving anywhere in him, dead by every definition except the one that matters, which is that we can reverse it.
The room gets quiet during circulatory arrest in a way I've never found anywhere else.
Everyone speaks in single words. The only clock that matters is the one the perfusionist calls every five minutes, and my father's hands move through that half hour at the same pace they move through a routine procedure.
No faster. Faster is how you lose the man you're trying to save.
The valve can't be spared. He doesn't say anything when we see it. He doesn't have to.
We come off bypass the first time at six fifteen.
There's bleeding behind the graft. We go back on.
The second time it holds. Dry field, good pressures, a heart squeezing on the monitor the way hearts are supposed to.
By the time we close it's past eight and I've been in this room since two in the afternoon.
I find Walter's wife in the family room on two. Same chair, same untouched vending machine coffee from hours ago going cold in her hands. She stands when she sees my face and her whole expression starts to crumple before I can even open my mouth, so I say it fast.
"He made it. The repair's done. He's in the ICU and you can see him within the hour."
She sits back down hard, all at once, and then she's crying into one palm and reaching the other one out toward me.
I hold it for a while in the doorway, this stranger's hand, while the vending machine hums. Some days this job is a magazine cover.
Most days it's holding a woman's hand while she finds out her husband is still alive.
This is the part I'd keep if I could only keep one.
In the locker room my father sits on the bench in his scrub pants and undershirt, turning his wedding ring with his thumb while he reads the post-op labs off his phone. He still wears it. Seven years next spring since my mother died, and he still wears it.
"Your anastomosis was clean today," he says, not looking up.
From him, that's everything.
"Thanks, Dad."
"Don't thank me. Do it again tomorrow."
Derek is by the elevators with his coat on. "One beer. Costello's. You look like a man who's about to go home and stand in his kitchen in the dark. Let's go."
Costello's is two blocks from the hospital, half full on a weeknight, a bartender named Patrick who knows the whole cardiothoracic floor by first name and has for years.
We take two stools near the door. Derek is one beer into a story about his daughter's backstroke when his phone lights up on the bar, his wife's face on the screen, and when he picks up, his daughter is wrapped in a towel with her hair soaked, waving at the camera with her whole arm.
"That's me." He drains the glass, claps my shoulder once, and points at me on his way out. "Laminated list. Think about it."
I should go. I'm reaching for my wallet when I turn toward the door to check the rain, and that's when I see her.
End stool. Last seat at the bar. Blonde hair down, red wine in front of her, phone face-down beside it. She's closing a laptop, sliding it into a bag, and I don't fully process the sequence of what I do next. I'm just suddenly off my stool with my beer in my hand, already moving.
Six years. And I knew it was her before I even saw her face.
"Long time no see."
She turns. Her eyes move up from my chest to my face and I watch it happen, the recognition, one full second where everything opens. Then it's gone. Closed down completely.
"Julian."
I sit on the empty stool before she can tell me not to. Patrick drifts toward us. She covers her glass with her hand and he reads it, drifts back.
"You look good." I mean it more than I want to.
She looks at me, completely flat. "I know."
That's it. No softening, no thank you. Just I know, like it's a fact she's tired of confirming.
I turn toward her. "So what are you doing these days? Last I knew you were headed toward running a cardiac floor somewhere."
"I keep busy."
"Doing what?"
"Things." She turns the stem of her glass. "How's the career."
She says it the way you'd say how's the weather. Flat and deliberate.
"Good. I'm at Lakeshore. With my dad." I watch the side of her face. She doesn't react, but she also doesn't look away from her glass. "You saw the magazine?"
"The whole city saw it." She finally turns her head, and I'd forgotten what it's like to have all of her attention at once. The bar noise keeps going around us, and I can't hear any of it. "Six years," she says. "And now you're talking to me like were best friends."
"I panicked."
"You don't panic, Julian. I watched you take a practical exam with a proctor two inches from your ear." Her chin lifts slightly. "You saw a woman sitting alone."
"I saw you."
She holds my eyes for a second past comfortable. She feels it. I know she does, the same way I always knew, the same way nothing about that has changed in six years. She's the one who looks away first.
I should leave it there. Any man with any sense leaves it there.
"Have dinner with me," I say. "Not tonight, whenever. Or I can cook. I'm ten minutes from here, I still make that pasta you used to like."
"Stop."
She slides off the stool and stands, pulling her coat off the back of it, taking her time with every button. I sit there with my beer going warm and watch her do it.
"It was good to see you." She sets a twenty on the bar even though Patrick never brought her a tab.
Then she picks up her bag and looks at me one more time.
Not warm. Not cold either. Just honest. "But the last time I had drinks with you it cost me more than I should've paid. I'm not doing that again."
She walks out. The door opens to rain and traffic noise, then swings shut.