CHAPTER 19 #2
The OR-3 trauma anesthesia cart is open at the head of the table when Nikolai sets me down. The on-call anesthesiologist is at the cart — a woman whose face I do not know well, a senior, blonde under the cap, hands fast. She has the mask on me at the second I am horizontal.
The mask hisses.
The first hiss belongs to the mask seal — soft, intimate, latex against cheekbone. I file the difference.
Then the regulator hisses.
I have heard this hiss since Day 1. The slow audible whisper from the emergency oxygen rack at trauma bay six — the regulator maintenance flagged two months before I started and never replaced — is not supposed to be in an operating room at all.
It is here because the first seven seconds are transport seconds: mask to face, Ambu bag in the anesthesiologist’s hand, cylinder at the foot while the wall hose is being seated.
The regulator under emergency demand is failing.
The gauge is dropping. The bag gives less than her hand asks for, breath by breath.
The hiss climbs. Higher pitch. Pressure leaking past the regulator’s failing diaphragm at a rate the gauge is now showing the anesthesiologist plain.
I hear it. Semi-conscious. Through the seal of the mask and the four-count Stefan is calling at my left ear, the hiss is the loudest thing in the room.
Stefan is calling: Regulator’s gone. Wall oxygen. New E-tank if the hose does not seat. Move.”
The senior anesthesiologist’s hands are already moving. One hand keeps the mask seal. The other snaps the green wall hose home. The Murmansk man is at her shoulder with the spare E-cylinder anyway, already turned to her grip.
I mark the seconds.
One. Two. Three. Four. The hiss is the only count I keep. Five. Six. The hiss climbs through six. The diaphragm is shot. Seven.
The seal of the new tank screws home at seven.
The mask fills.
The hiss stops.
Seven seconds. I have lost seven seconds. I am twenty-five years old and I have lost seven seconds I will spend the rest of my life adding to a count I have been keeping since I was nineteen on the wrong side of a window in NewYork-Presbyterian.
Sophia.
The name stays inside my skull where it lives.
She is on the table I am on. I am on the table she was on.
I am on the table she was on for forty-one minutes while a tall man whose face I never saw clearly worked her code and called time at eleven-forty-seven.
I am the one on the table now. I am the one watching from the gallery in reverse.
I have spent six years on the right side of every window I could find and I am the patient on the wrong side of the glass and I have a brother in the room.
I have four.
I mark the men in the room. The view is partial; the count is whole.
The man at my head — Stefan. The man at my hand — Nikolai, still, because his grip stays closed around my left hand even when he set me down, even when Stefan asked him to step back.
The man at my side scrubbing in fast — Alexei.
He is in faster than the trauma protocol allows.
He is going to operate. The fourth lives in the edge of the room my eyes have already lost.
Gabriel was at Lab A.
The fourth is coming.
The seven-second mark closes on the new cylinder.
The mask fills. Stefan's hand is on my forehead and the four-count is back in my ear.
The room is breathing in fours again. The senior anesthesiologist is calling the propofol.
I take the sequence: one. Two. Three. Four.
The IV at my right hand is cold then warmer then it is not anything and the lights begin to —
"Krasivaya. I have you. Color."
Alexei's voice at the edge of where the lights are going.
"Green."
I am bleeding. I am bleeding into my left flank and I say green because I have one syllable left and I want it to be the one that means I want to stay.
"Good," he says. "Stay with me. Three breaths and you sleep."
I take inventory.
One.
Two.
The articulated lamp arms above the table are three.
The underside of the lamp is a country I am visiting for the first time.
The light is yellow at the center bulb. The quadruple shadow is on me — on my chest, on the medallion at my sternum, on the cuff of Stefan's lab coat as he leans over my face, on Nikolai's right shoulder, planted there beside the table.
I map tiles between Alexei's hands as he sets the field.
Six. Seven. Eight. I map the OR-3 ceiling tiles I can see between his gloved fingers. Fourteen across. Fourteen across the visible band. Twenty-eight beyond. Forty-two total before the gallery glass cuts the view.
Forty-two.
The number I counted on the way to the chief's office Day 4.
Three.
I sleep.
---
There is a long stretch where I am not anywhere.
I have read in the literature — Stefan's literature, the cardiac stuff he leaves at the suite's writing desk — that propofol leaves the patient empty of the time it is on board.
The literature is right and partly right.
The surgery itself is gone. I remember a count Stefan is calling.
I remember the medallion at my sternum being lifted once on a gloved knuckle and set back down at the hollow beneath the chain.
The gloved knuckle is wide and warm through the latex. Alexei. The chain stays clasped at the nape. He tucks the medallion at the hollow beneath the chain where it will live outside his field, the angel kept on his patient.
The keeping reaches me through the blur.
The medallion has been at my sternum since I was eighteen.
The chain has been broken and resoldered twice.
The angel has a hairline crack, and now the crack rests on the pad of Alexei's glove for one warm second before he sets the chain down where it belongs.
He keeps it on me.
I sleep again.
---
Voices. Nikolai's voice. He is at the head of the table. Stefan is in the gut, the laparotomy is open, the field has been called. Nikolai is standing at the head of the table at the patient's head — which is mine, my head — and he is doing what the chief does in a trauma case. He is calling.
"Volkov. Status."
Alexei. Surgical-pace. "Splenic. Hilum bleeder. Going in."
"Pressure ninety over sixty. Drop."
The senior anesthesiologist's voice. Crisp.
"Hold here. Three."
Nikolai's count. A three, in his cadence — sharper than Stefan's four, set to the trauma rhythm. He is the chief. He commands. The last command of his I heard was three weeks ago in his office: sit. He commands now. The room moves around the three.
"Pressure ninety-two."
"Continue. Bystro, Volkov. Splenectomy."
"On it. Forceps. Suture. Hilum. Clamping the splenic artery now."
Splenectomy. The word lands inside me semi-conscious.
He is taking the spleen. The round did not exit.
It drove upward under the lower ribs, glanced off the eleventh rib the way the entry wound predicted, and tore the splenic hilum on the way in.
The spleen has to come. Alexei is fast. Alexei is left-handed and he is fast.
"Vessel control. Splenic artery clamped."
"Confirm."
"Confirmed. Vein next. Short gastrics."
I follow breaths. I follow the breaths the ventilator is doing for me. Four. Eight. Twelve.
"Specimen out."
The weight of me on the table changes by the weight of a spleen.
The change is below sensation. I file the file of it.
My grandmother's word in Sicilian for the spleen — la milza — surfaces in the half-second of half-sleep for reasons my body knows ahead of my head.
She has been dead since 2017; she lives in the medallion.
The medallion is at the hollow beneath the chain where Alexei tucked it.
I name men. The man at the head is Nikolai. The man in the gut is Alexei. The man at the suction and the four-count is Stefan. The man at the door is —
The man at the door is at the door.
Gabriel.
My eyes have lost the gallery glass; my skin has him at it.
He is at the gallery glass — the kind of presence you feel as a hand on a shoulder you cannot see.
He has come from Lab A — twelve flights down, two corridors, the West Annex elevator he keys with the strap.
He is at the glass. He has been there for the close. He has been watching.
I am the one being watched from the gallery now.
Sophia was the one being watched from the gallery.
I was the one watching from a NICU window across the lightwell.
The geometry has inverted. I am the patient.
He is the watcher. He is a watcher who loves me.
Sophia had only me — me on the wrong side of the glass, alone at the NICU window, the love of her not enough to reach through wire-glass to her room.
She has me. I am hers and on the table. I am the witness in the room. I would like to stay in it.
I sleep without counting.
---
OR-3 closes at thirteen hundred. The closing time arrives in my head secondhand, hours afterward. I am told.
I am told by Stefan in the PACU.
I am awake at sixteen-twenty by the wall clock. Wrong: I am awake at sixteen-twenty by the wall clock in PACU. The PACU is the holding room until they move me to the suite. The suite is two corridors east. I have been told this. The rest waits behind Stefan's mouth.
Stefan is sitting on a stool to my right with his palms open. The braided leather cord on his left wrist is across my right wrist. The Littmann is on his neck. The dark crescents under his eyes are the receipts for the hours it took me to bleed.
"Doll."
The voice is somewhere south of my throat. I try. "Stefan."
"Doll. Give me the honest color. The word means today what it means in the room. Green only if the body agrees with you. I will take the truth gently."
"Yellow."
"Thank you. The pain is at four?"
"Six."
"Six. We will go to four before you sleep again."