Chapter Ten
God, how Maggie has missed this.
In medical terms, the suffix plasty—as in rhinoplasty and blepharoplasty and genioplasty and mammoplasty—means “repair,” “restore,” “replace.” It comes from the Greek word “plastia,” which means “to mold”—and that is what it means to Maggie.
Mold. Repair. Restore. It’s science. It’s art.
The clay you create with is human flesh.
There is no greater honor or responsibility than being a surgeon.
For most of her career, Maggie dealt with soldiers and children with severe injuries and deformities.
With her own two hands, she had the ability to mold, repair, restore them.
Imagine that for a moment. Imagine what a privilege it is to do that kind of work, to make a living that way, to have people put that kind of trust in you and your abilities, to make them whole again.
How had she let herself betray that trust?
The obvious rationales—a butchered husband, a dead mother, whatever—none of that could ever excuse what she did. She had been given the greatest gift possible—the ability to heal through artistic creation—and she had squandered it.
Now she has been gifted this reprieve—for one day, at least.
Maggie goes through the same routine she’s gone through hundreds if not thousands of times before—wash the hands, don the scrubs, tie the mask over the nose and mouth, snap on the gloves—but there is nothing routine about it.
Not today. When she enters the surgical theater, emotions fly toward her hard and fast, nearly overwhelming her.
Tears come to her eyes. She holds steady.
She stops and takes a few deep breaths before approaching the table where Oleg Ragoravich lies unconscious.
Her support staff—that’s how she views them, as hers—are poised and ready.
This, Maggie knows, is where she belongs.
The operating room is her temple, her church, her sanctuary. Marc was home for her. She was home for Marc. But she and Marc both knew that here, in the cathedral they called an OR, was where they felt their most whole, their most complete.
She loved that about Marc. And he loved that about her.
They were the luckiest people in the world, weren’t they?
Once Maggie asks for a scalpel, once she makes the mid-columellar inverted-V incision to access the underlying cartilage, her heart rate slows down.
The calm enters her bloodstream. She settles back into this state of blissful creation.
She would curse herself for not appreciating this feeling, this reverence, this calling, but she’d always understood and appreciated how special and extraordinary it was to be a surgeon.
And she’d blown it anyway.
That’s what we stupid humans do. We carry the seeds of our own self-destruction.
She focuses now on the work to the point where she gets lost in it.
Time passes. She has no idea how much. There are TV-like monitors so she can watch—they are in most operating rooms now—but she almost never needs them.
It takes a little longer than she expects to clear away the nose cartilage so she can fit the marvel that is the artificial nose scaffold into place.
She had hurried down three hours ago and geeked out when the technician showed the artificial scaffold to her.
The material was, well, a nose—flimsy and stiff and malleable and brittle all at the same time.
She starts with this procedure because it is new and thus the most difficult.
But it goes smoothly. She then moves on to the eyelids.
She wants this feeling to last—to take her time, to remain in this state of pure contentment—but she knows it can’t.
It doesn’t work that way. Surgery has its own organic, quasi-circadian rhythm.
You can’t mess with it to please your own needs.
She marks the natural folds around the eye and then uses a curved size 15 blade to make the incisions.
She removes excess skin, muscle, and fat and closes the wounds up.
The sliding genioplasty, a very specific type of chin augmentation, is next.
She cuts through the mandibular symphysis—in layman’s terms, the chin bone—and shifts it with her gloved hand.
She harvests the fat from Oleg’s abdomen via liposuction and transfers it to the face.
Then she molds and shapes and shifts until Oleg’s chin and jawline resemble the chin and jawline in the photographs.
Ivan Brovski is scrubbed and masked. He watches everything in silence. When he sees her close to finishing, he says, “Odd.”
“What?”
“You’re even better than your reputation.”
Maggie should be above feeling pleased by the flattery, but the truth is, she’s not.
Maybe she would have been in the past. Not now.
She closes up, and when she exits the operating room, Maggie sees that the total operating time on Oleg Ragoravich was three hours and fifteen minutes.
Not bad. Maggie paces, feeling wired and jazzed.
She can’t wait to get back in there. The operating room is soon ready for Nadia’s breast augmentation.
Ivan Brovski is already there. Like before, she ignores him.
Not out of malice or annoyance. She’s just in the zone.
She doesn’t want anything interfering with that.
If Brovski wants to watch, so be it. But she doesn’t feel the need to facilitate or hinder.
Focus. Stay in the moment.
As with most surgeries, intermittent pneumatic compression devices—think inflatable leg-squeezing machines or high-tech compression boots—are placed on the patient’s legs.
This is to regulate blood flow and prevent deep vein thrombosis or again, layman’s terms, a blood clot.
The Bovie pad is already stuck on Nadia’s upper thigh.
Put simply, it’s a grounding pad used to channel electric currents away from the patient’s body.
Maggie would have wanted to go with the most cutting-edge method of breast augmentation—using a patient’s own fat—but Nadia didn’t have enough fat to donate, and that procedure would have been too subtle a change for what she (or Oleg) wanted.
Instead, they were going with the aptly nicknamed, state-of-the-art “gummy bear” implants—solid gel breast implants known for shape retention and realistic consistency.
If you slice traditional silicone breast implants in half, the material will leak out like honey.
That’s not the case with the more solidified gummy bears.
Most people think they know how breast augmentation works: The surgeon makes the incision, creates a pocket behind the pectoral muscle, places the implant in the pocket, and then centers it behind the nipple.
That’s all true, but for the best work, you need to strap the unconscious patient to the operating table so that at some point, you can sit them up in a Fowler position.
It is really the only way to evaluate the breast shape and assess the placement.
Think about it. Do you want them to look natural only when you’re lying down?
Or do you care what they look like when you’re sitting or walking?
Duh. To not have the patient cranked up to a seated position because of hemodynamic concerns that have pretty much been laid to rest in study after study is, in Maggie’s view, negligence.
The scrub nurse presses the operating table’s button, moving the strapped-in Nadia into an upright position.
Maggie inserts the various sizers and then stands back to see which ones are most symmetrical and appropriate for Nadia’s frame.
She has, as Brovski mentioned, the three sizes from which to choose.
Dr. Deutsch, her mentor in this procedure, told her that when in doubt, go with the larger one because when it’s over, almost every woman he’s worked on says they wished they had gone a little bigger.
Maggie keeps that in mind, but she also believes, perhaps wrongly, that Nadia is being somewhat coerced into doing this.
In the end, the three hundred ccs, the smallest of the three sizes, provide the best aesthetic anyway, so Maggie goes with that.
At some point Ivan Brovski exits without a goodbye. Maggie idly wonders about that, but again this isn’t about him. It’s about the patient and the procedure.
A few minutes later, Maggie finishes up with sutures and steps back.
It’s over.
Except it most definitely is not.
The scrub nurse turns off the ESU or Electrical Surgical Unit. Then she pulls the Bovie pad off Nadia’s upper right quadricep.
And everything changes.
Maggie freezes and feels her world start to spiral.
“Doctor?”
Nadia has a tattoo on her leg. Maggie bends down for a closer look.
The tattoo is garish orange and purple. It’s a cartoonish image of a goofily smiling serpent with a halo and a silly wink.
“Doctor McCabe, are you okay?”
Maggie has seen only one tattoo like this before.
On Marc’s leg.
Maggie can’t move.
The scrub nurse says, “Doctor?”
Her eyes finally move off the tattoo and up to Nadia’s face. Nadia’s eyes are closed. It’ll be thirty to forty minutes before she’s awake and able to converse. Maggie’s gaze is drawn back to the tattoo.
There is no way this is a coincidence.