4. Chapter 4
Nick
She's at the nurses' station at six-fourteen in the morning with three charts open and her hair in that tight bun, and I know she's been here since six because Rosa told me before I asked.
"The new one came in before me," Rosa said, holding out my list. "She'd already seen your Walter. Brought him a real coffee from the lobby. He proposed."
"Of course he did."
"She said no. He respected it. Told her she should wait for someone who earns her." Rosa looks at me over the top of the list a little too long. "Anyway. 412 held pressure all night."
I've known Rosa six years. She reads this unit the way other people read the sky, and I have never once gotten anything past her, so I decide right there to be extremely boring around her for the rest of the year.
I take my list and go the long way to the physicians' lounge to keep from passing the station. That's my whole plan now. Choosing hallways. Eleven years of training, chief of the department at thirty-eight, and my strategy for the year is dodging one resident like a kid avoiding a locker.
It worked yesterday for ninety minutes, then I heard her laughing in Walter's room and walked in anyway.
It never happened. I should be grateful for the terms. The terms are the only thing making this survivable. A chief and his own resident is not a gray area. It's a complaint waiting for a date stamp, her transfer burned down in the first month over something I started at a bar.
Pre-rounds are at seven. She presents her three patients, and she's over-prepared, which I expected, and quick, which I did not.
She runs through Walter's ribs, his pain plan, his breathing numbers, and a plan to get him up walking that she already cleared with physical therapy at six-forty in the morning.
I go looking for something to correct, because that's the job.
"His daughter," I say.
"Wasn't in the chart, so I asked him. She's in Phoenix, they haven't spoken in three years, and he says it's nobody's business, which tells me it's the whole business." She closes the chart. "He's healing fine. He's also alone. Those are two problems, and we're only writing orders for one of them."
The team writes it down. Theo, the third-year, watches her like she fell out of the sky.
"Adequate," I say, and behind the team Rosa walks past with an armful of IV bags and makes a sound that might be a cough.
At nine-forty the pager takes the day. Motor vehicle collision, two coming in, one bad, a driver in her forties, unrestrained, blood in her belly on the scan.
I'm scrubbed and standing in the trauma bay when they roll her through, and the resident on my board today is Mitchell, because I built this schedule last week before the universe decided to be funny about it.
Her name is Carla Reyes. I know that because she's telling everyone, loudly, the whole time.
"I need my phone. Where's my phone. Sir. I had forty dollars cash and a phone, and I need the phone."
"Ma'am, we need you to hold still—"
"My daughter gets out of school at three, and if I don't text her she walks to the library, and the library closes at five, so somebody find my phone."
Her pressure's dropping while she organizes her daughter's afternoon. Sarah steps in at her shoulder, bends close to her ear, and takes her hand.
"Carla. Look at me. What's your daughter's name?"
"Bree."
"Bree. Does Bree have a grandmother, an aunt, anybody with a key?"
"My sister. Yolanda."
"Then here's the deal. You're going to sleep for a while so we can fix your stomach, and my first phone call when we're done is Yolanda. Bree will never make it to that library. I'm telling you so you can stop running her schedule and let us run yours."
Carla stares up at her. Her hand tightens on Sarah's until the knuckles go white. "You'll call her?"
"First call. I promise."
"Okay." She lets her head sink back. "Okay. Don't let them lose the forty dollars."
We're in the operating room nine minutes later. Her spleen is in pieces, there's more blood than I can see around, and I call the resident off the retractor and onto the field because I need hands right now, so Sarah steps up across the table from me.
Nobody warns you that wanting someone doesn't check the room first. It finds you anywhere, even here, over an open abdomen, and it isn't the dress or the river now, it's her hands.
They're steady and quick and already where I need them a half second before I say it.
I ask for the clamp and it's turning toward me.
I ask for suction and the field goes clean.
Two hours in, we've stopped speaking in whole sentences because we don't need them, and at one point the anesthesiologist looks back and forth between us like he's double-checking his own machines.
The spleen comes out. The bleeding stops.
Carla's numbers climb back up while I close, and across the table, above her mask, Sarah's eyes have that particular brightness that only shows up in this room, the kind you can't describe to anyone at a dinner party, so I look at her one second longer than the work calls for.
Eleven years. I've operated with hundreds of people, and it has never felt like this.
"Nice work," I tell everyone in the room.
She scrubs out ahead of me. Through the window into the scrub room I watch her pull her mask down and shut her eyes for a second under the light, then she takes out her phone and dials, and I don't have to hear a word to know Yolanda's phone is ringing, because Bree gets out at three.
Walter has opinions about my afternoon rounds.
"You look terrible," he says. "Worse than me, and I came off a ladder."
"Your ladder story changes every day, Walter."
"My ladder story gains detail. That's memory." He mutes his cooking show with the remote. "The new one. Mitchell. She was here before the sun. You know what she did? She sat down. Five minutes, morning and night. You know the last doctor who sat down in this room?"
"Let me guess."
"Nobody. That's who." He points the remote at me like a gavel.
"My Edith was a nurse thirty years. She used to say you can teach a person hands, you can't teach them to sit down.
So whatever that sitting-down doctor needs in this hospital, you get it for her, because those ones burn out or get taken, and either way the patients are the ones who pay. "
"I'll keep it in mind."
"Keep it in more than that." He turns the show back on, then, without looking at me, "She's not married, you know."
"Goodnight, Walter."
"I'm reporting facts. I run a tight operation from this bed."
I check his incision, change nothing because there's nothing to change, since his doctor already handled it at six in the morning, and I get out before Walter can recruit me into whatever he's building.
The day ends the way trauma days end, all at once and two hours late.
By nine the unit's gone quiet, and my office is the last lit room on the administrative hall.
I'm signing operative notes when a knock lands on the doorframe, and she's standing there in her coat with her bag on her shoulder, and every reasonable part of me files an objection.
"Carla Reyes," she says. "Evening labs look good. Yolanda picked up Bree, they came by at seven, and the forty dollars is in the belongings safe, which I've now personally confirmed twice, because I was told there would be consequences."
"You could've texted the team that."
"I could have." She stays in the doorway.
There's a line she's drawn for herself right at my threshold, and I watch her stand on it and not cross it.
"I wanted to say it to your face. What we did this morning, I've been in a lot of operating rooms, and that was the best surgery of my life. So thank you. That's the whole speech."
"It wasn't me. You were ready before I asked. Every time."
"I know," she says. "It was both of us. That's what made it the best one."
The true thing just sits there in the quiet office, nine o'clock, nobody left on the hall, so I set my pen down because my signature has stopped looking like mine.
"Sarah."
"Stop." She says it fast and low. "Whatever you're about to say, don't, because I'm holding this together with both hands, and I need you to let me."
"You should go home."
"I should." She glances past me, around the office, at the diplomas I never look at and the folded blanket on the couch that tells anyone paying attention how often I sleep here, then her eyes come back to me and her voice drops.
"This would be easier if you were a terrible surgeon.
Or mean to the nurses. Or stupid. I keep waiting for you to be one bad thing, just one, all day, and you keep not being it, and then you go sit with Walter when you think nobody's watching. "
"You want a list of my faults? Rosa keeps one. It's alphabetized."
"There it is." She lifts one hand toward me, toward my face and whatever it's doing.
"That. At the bar I thought, fine, he's handsome, the city's full of handsome men.
It's that you're funny quietly, like you're letting a person in on something, and it makes them feel like the only one who heard it. "
Nobody has said a thing like that to me in years, and maybe not ever. I'm up out of the chair before I decide to be, so she takes one step back into the hallway and puts the distance back, this trade we keep making on nothing but the honor system.
"House rules," she says, and her voice isn't steady. "Your building this time. Say goodnight, Dr. Calloway."
"It was one night," I say. "That was the deal. One night, strangers by morning, and I've kept it two days."
"I know. I was there for both of them."
"I'm going to keep keeping it. Your residency is worth more than this, and there's no version of the year where I'm the reason you lose it.
" I come around the desk, and she holds her ground in the hall with her chin up and her eyes level, so I stop at the threshold.
"But you should hear the truth if we're going to get through the year.
It wasn't one night for me. I stood in your kitchen at five in the morning arguing with a pen because everything in me wanted to write down your number. "
Her lips part. She looks at my mouth, then looks away, down the hall toward the dark windows.
"The pen won," she says.
"The pen won. I've regretted it since the stairs."
She nods slowly, like she's putting it somewhere she'll have to carry. Then she shifts her bag higher on her shoulder and steps back, one, then two, walking backward down the hallway with her eyes still on me.
"Goodnight, Dr. Calloway."
"Goodnight, Dr. Mitchell."
She turns and walks toward the elevators, and I stand in my doorway and watch her the whole way, and she knows it the whole way, and neither of us bothers to pretend otherwise, because that's the one lie we can't seem to pull off.
The elevator takes her. I go back to my desk and the operative notes, my signature still not looking like mine, so I sit back in the chair and stare at the ceiling of the office I sleep in too often.
Three hundred and sixty-three days left in her residency year.
I've held pressure on a torn artery for forty minutes with my bare hand. I've run eleven-hour surgeries on no sleep, then told a mother her son didn't make it, then gone back in for the next patient an hour later. I don't break.
She asked the kid's name, though, and she was ready before I asked, every single time, so I sit there and do the arithmetic I've been avoiding all day.
Three hundred and sixty-three days. God help me, I'm going to count every one of them.