CHAPTER 3
Elena
◆
I check laps before I take anything else apart.
Four in the basin on the back table. The count for the case is four; we are clean.
I say it out loud because Beatriz is at my left elbow and Beatriz likes counts audible.
Four laps. Two clamps. One needle driver.
The case is a laparoscopic cholecystectomy and I am circulating, which means my hands stay clean of the field and my eyes do the work of three.
The anesthesiologist hums under his breath behind the drape.
The cautery has not been switched on yet; the room still smells of chlorhexidine and the cleaner stainless burn of trays just out of the autoclave.
Ceil-blue scrubs Beatriz handed me three days ago.
The white lab coat with the pediatric pin still on the lanyard — a small enamel teddy bear with a red stethoscope, Sister Mary Catherine's first-day-on-the-pediatric-floor gift.
I have not taken the pin off. I have not yet decided whether removing it would be a promotion or a desertion.
The Saint Raphael medallion is at my sternum, cold against the skin until the body warms it; the chain has been resoldered twice; the angel has a hairline crack across one wing.
The patient is forty-two, female, BMI of twenty-six, allergic to sulfa. Her gallbladder will be in a kidney basin inside forty minutes. I have read her chart twice. Twice is my floor for any chart that crosses my hands.
Dr. Hayes pushes through the anteroom door at seven fifty-two.
He is eight minutes early for a seven-fifty-six skin time.
The surgeon of record on this case is a second-year fellow who came down from OR-5 with the scope tray; Hayes is the senior attending floating cases this morning, and he likes to be visible.
He nods at the anesthesiologist. He nods at the fellow.
His chin passes me as if I am part of the wall.
He goes to the scrub sink.
I am at the door checking the case cart for the lap count one more time, because my Catholic-recovered mind says the third count is the one God hears, and Beatriz has gone to the front to take a call.
The room is quiet in the way rooms get quiet when the people in them are working alone next to each other.
Hayes uncaps his fountain pen.
The pen registers now, for the first time, because of the sound — a small dense click, brass against brass, the click of something expensive being closed and opened deliberately.
Montblanc, probably, the black one with the white star.
Louder than a Bic. Louder than a Pilot G-2. It is the sound of money being held.
He writes something on a clipboard. He caps it. The cap-click goes off in the small room like a small dry-fired round.
Then he caps it a second time, deliberately, as if the first had not been enough.
He puts the pen back in his pocket.
He turns.
He says, "Rossi."
I say, "Dr. Hayes."
The watch has moved on. He has the kind of blue eyes the donors find warm.
He says, "Elena."
The first name belongs to my mother's kitchen and my sister's voicemails.
I am at work. I am in scrubs. I am thirty seconds from a case.
The first name is the brush against the back of the hand done with the voice, and I clock it the same way I clocked the click.
He used my last name once and my first name once.
The first name is the one he wanted to use. He has been practicing.
He smiles.
"I was going to ask if you wanted to scrub in on a Whipple this afternoon. Hayes case. I requested you specifically. The pediatric service spoke very highly of you. I've read your file."
A senior attending saves that sentence for a circulating nurse he knows. This sentence carries three small lies. I name the lies because I have to count something. My left ear wants to be tucked behind my hair. I keep my hands at the cart. The tell stays inside the body where I built it.
He takes one step toward me.
I take one step back. The step is reflex, not performance — the body takes it as you take a step away from a hot stove, before the mind has finished narrating — and my heel finds the metal kick-plate of the cart behind me with a small clean ring, and I know I am at a wall.
He reaches.
The back of his knuckles brushes the back of my hand from the second metacarpal up to the wrist. One inch of contact. A quarter of a second. Deniable. I have spent a career flinching from quarter-second touches and they have all been deniable. They have all been the same touch.
It registers in my sternum, not my thigh.
I have been touched without consent by men before.
I have training. I take one beat — the controlled breath of a nurse who has put her hand into more than one ER room she did not want to be in — and I step back a second time.
I do it cleanly. My eyes go to his face and stay there.
The brushed hand keeps working the cart handle, a clinical reflex, as if it belongs to someone competent in another room.
I say, "Dr. Hayes. I'm circulating OR-1 today. Whipples are over my pay grade."
He smiles wider.
"I bet very little is over your pay grade."
He says it to the doorframe over my shoulder. He says it to the corridor he hopes will hear. The voice is doing the work the hand was doing.
I open my mouth to say something I will later be grateful I did not say.
Beatriz walks in.
She walks in with a chart she does not need and a cup of coffee she has not touched, and she walks the corridor between Hayes and me without a single second of hesitation, and her body is between his and mine before her sentence finishes.
"Dr. Hayes. " Her voice is the calm Bronx alto of a charge nurse who has been on the floor for thirty-two years; the salt-and-pepper bob at her jaw does not move.
"OR-5 is paging you. They're not happy with as the scope cart was set. "
His gaze moves from her to me.
"Beatriz. You're a treasure. Excuse me. " He nods. His chin passes over my shoulder a second time. He brushes past her on the way out and the door catches on its strike plate as he goes.
Beatriz waits two beats.
"Mija, listen."
"Yes."
"He brushed your hand."
"Yes."
"I wrote it down before I walked in. I'll have it on Aguilar paper before lunch and on chief's paper before five. You did everything right. You're scrubbed mentally in this case in two minutes and you are not going to think about him for the next four hours. Tell me you heard me."
"I heard you."
"Good."
She turns to the cart. She picks up the lap basin without looking at it. She has done my count for me, and her count is the count that wins.
Nikolai is at the OR-3 corridor window the whole time and I miss him entirely.
He stands at the glass that runs the length of the corridor — the chief's window for watching his ORs without going in — and he has been there for at least the cap-click and probably the brush, and Beatriz knows this and I will not, not yet.
The temperature in OR-1 drops the way air goes when a thing has been registered somewhere it cannot be undone.
Language for it will arrive later. Today it is only a colder draft along the cart.
The case takes thirty-eight minutes.
The fellow is fast. The gallbladder comes out in the bag.
The patient is stable on closure. The anesthesiologist hums one more time at the end as he reverses, the same tune as before; I think it is a Russian children's song but I do not ask.
The fellow thanks me. He calls me Elena, as the residents who like a circulating nurse call her.
I take the count one more time. Four laps. Two clamps. One needle driver. Clean.
We break.
In the corridor outside OR-1 the autoclaves are coming up to cycle and the corridor smells as it smells at change of shift — the chamber-cycle whistle behind the wall and the hiss of pressure release that lives somewhere between cooking and grief.
I stop. I listen through the hisses. Four.
I mark them again. Still four. The jury is out on whether four is my number or only mine for this hospital.
I walk to the chief's corridor.
I have no chart to deliver and twenty-two minutes before I am due anywhere.
I walk because my body wants to be moving and because Beatriz said the chief had seen Hayes brush my hand and the verb she used was saw.
I would like to know what saw looks like at this distance. I would like a small data point.
The chief's corridor is the southeast quadrant of Floor Ten.
The walls are warmer than the surgical floors, more wood, a Persian runner that has been here longer than I have been alive.
The walnut blinds on his window are half-drawn.
The kettle is dark on the credenza. The air carries only floor wax and old paper, no bergamot.
The door is closed.
I stand outside it for one breath. My hand goes to the medallion at my sternum without my asking it to.
The pad of my right index finger finds the silver and the silver is colder than the skin under it, and what I do is closer to naming a witness than to prayer — Saint Raphael, patron of healers, patron of safe travel, patron of looking the right way at a man at a closed door.
The medallion warms. The corridor air keeps its chill.
This feeling is new in a corridor, and I file it for later.
I move on.
I have controlled-substance counts to run at the eighth-floor pharmacy.
The pharmacist signs in first. I scan my badge after hers. I press my right thumb against the reader. WITNESS ONLY appears in green on the cabinet screen. She turns the primary key; I turn the second. The cabinet clicks open.
I take inventory.
Fentanyl ampoules. Two hundred and fifty mcg per ampoule. The blister sleeves come in tens; working stock is three sleeves; I have one, two, three. Thirty ampoules. The number matches the ledger. I initial.
Hydromorphone. Two-milligram ampoules. Working stock two sleeves. One sleeve, two sleeves. Twenty ampoules. Matches. I initial.