“She’s not my patient anymore,” said Abby. “I transferred her to Neurosurgery. They drained a subdural hematoma.”
Vivian just kept reading the chart.
“She’s only ten hours postop,” said Abby. “It seems a little early to be talking harvest.”
“No neurologic changes so far, I see.”
“No. But there’s a chance . . .”
“With a Glasgow Scale of three? I don’t think so.” Vivian slid the chart back into the rack and crossed to Bed 11.
Abby followed her.
From the cubicle doorway she stood and watched as Vivian briskly performed a physical exam. It was the same way Vivian performed in the OR, wasting no time or effort. During Abby’s first year—the year of her internship—she had often observed Vivian in surgery, and she had admired those small, swift hands, had watched in awe as those delicate fingers spun perfect knots. Abby felt clumsy by comparison. She had invested hours of practice and yards and yards of thread learning to tie surgical knots on the handles of her bureau drawers. Though she could manage the mechanics competently enough, she knew she would never have Vivian Chao’s magical hands.
Now, as she watched Vivian examine Karen Terrio, Abby found the efficiency of those hands profoundly chilling.
“No response to painful stimuli,” Vivian observed.
“It’s still early.”
“Maybe. Maybe not.” Vivian pulled a reflex hammer from her pocket and began tapping on tendons. “This is a stroke of luck.”
“I don’t see how you can call it that.”
“My patient in MICU is AB positive. He’s been waiting a year for a heart. This is the best match that’s come up for him.”
Abby looked at Karen Terrio and she remembered, once again, the blue and white blouse. She wondered what the woman had been thinking as she’d buttoned it up that last time. Mundane thoughts, perhaps. Certainly not mortal thoughts. Not thoughts of a hospital bed or IV tubes or machines pumping air into her lungs.
“I’d like to go ahead with the lymphocyte cross match. Make sure they’re compatible,” said Vivian. “And we might as well start HL-A typing for the other organs. The EEG’s been done, hasn’t it?”
“She’s not on my service,” said Abby. “And anyway, I think this is premature. No one’s even talked to the husband about it.”
“Someone’s going to have to.”
“She has kids. They’ll need time for this to sink in.”
“The organs don’t have a lot of time.”
“I know. I know it’s got to be done. But, as I said, she’s only ten hours postop.”
Vivian went to the sink and washed her hands. “You aren’t really expecting a miracle, are you?”
An SICU nurse appeared at the cubicle door. “The husband’s back with the kids. They’re waiting to visit. Will you be much longer?”
“I’m finished,” said Vivian. She tossed the crumpled paper towel into the trash can and walked out
“Can I send them in?” the nurse asked Abby.
Abby looked at Karen Terrio. In that instant she saw, with painful clarity, what a child would see gazing at that bed. “Wait,” said Abby. “Not yet.” She went to the bed and quickly smoothed out the blankets. She wet a paper towel in the sink and wiped away the flecks of dried mucus from the woman’s cheek. She transferred the bag of urine around to the side of the bed, where it would not be so visible. Then, stepping back, she took one last look at Karen Terrio. And she realized that nothing she could do, nothing anyone could do, would lessen the pain of what was to come for those children.
She sighed and nodded to the nurse. “They can come in now.”
* * *
By four-thirty that afternoon, Abby could barely concentrate on what she was writing, could barely keep her eyes focused. She had been on duty thirty-three and a half hours. Her afternoon rounds were completed. It was, at last, time to go home.
But as she closed the last chart, she found her gaze drawn, once again, to Bed 11. She stepped into the cubicle. There she lingered at the foot of the bed, gazing numbly at Karen Terrio. Trying to think of something else, anything else, that could be done.
She didn’t hear the footsteps approaching from behind.
Only when a voice said: “Hello, gorgeous,” did Abby turn and see brown-haired, blue-eyed Dr. Mark Hodell smiling at her. It was a smile meant only for Abby, a smile she’d sorely missed seeing today. On most days, Abby and Mark managed to share a quick lunch together or, at the very least, exchange a wave in passing. Today, though, they had missed seeing each other entirely, and the sight of him now gave her a quiet rush of joy. He bent to kiss her. Then, stepping back, he eyed her uncombed hair and wrinkled scrub suit. “Must’ve been a bad night,” he murmured sympathetically. “How much sleep did you get?”
“I don’t know. Half an hour.”
“I heard rumors you batted a thousand with the General this morning.”
She shrugged. “Let’s just say he didn’t use me to wipe the floor.”
“That qualifies as a triumph.”
She smiled. Then her gaze shifted back to Bed 11 and her smile faded. Karen Terrio was lost in all that equipment. The ventilator, the infusion pumps. The suction tubes and monitors for EKG and blood pressure and intracranial pressure. A gadget to measure every bodily function. In this new age of technology, why bother to feel for a pulse, to lay hands on a chest? What use were doctors when machines could do all the work?
“I admitted her last night,” said Abby. “Thirty-four years old. A husband and two kids. Twin girls. They were here. I saw them just a little while ago. And it’s strange, Mark, how they wouldn’t touch her. They stood looking. Just looking at her. But they wouldn’t touch her. I kept thinking, you have to. You have to touch her now because it could be your last chance. The last chance you’ll ever have. But they wouldn’t. And I think, someday, they’re going to wish . . .” She shook her head. Quickly she ran her hand across her eyes. “I hear the other guy was driving the wrong way, drunk. You know what pisses me off, Mark? And it really pisses me off. He’ll survive. Right now he’s sitting upstairs in the orthopedic ward, whining about a few fucking broken bones.” Abby took another deep breath and with the sigh that followed, all her anger seemed to dissipate. “Jesus, I’m supposed to save lives. And here I am wishing that guy was smeared all over the highway.” She turned from the bed. “It must be time to go home.”
Mark ran his hand down her back, a gesture of both comfort and possession. “Come on,” he said. “I’ll walk you out.”
They left the SICU and stepped onto the elevator. As the doors slid shut, she felt herself wobble and melt against him. At once he took her into the warm and familiar circle of his arms. It was a place where she felt safe, where she’d always felt safe.
A year ago, Mark Hodell had seemed a far from reassuring presence. Abby had been an intern. Mark had been a thoracic surgery attending—not just any attending physician, but a key surgeon on the Bayside cardiac transplant team. They’d met in the OR over a trauma case. The patient, a ten-year-old boy, had been rushed in by ambulance with an arrow protruding from his chest—the result of a sibling argument combined with a bad choice in birthday presents. Mark had already been scrubbed and gowned when Abby entered the OR. It was only her first week as an intern, and she’d been nervous, intimidated by the thought of assisting the distinguished Dr. Hodell. She’d stepped up to the table. Shyly she’d glanced at the man standing across from her. What she saw, above his mask, was a broad, intelligent forehead and a pair of beautiful blue eyes. Very direct. Very inquisitive.
Together they operated. The kid survived.
A month later, Mark asked Abby for a date. She turned him down twice. Not because she didn’t want to go out with him, but because she didn’t think she should go out with him.
A month went by. He asked her out again. This time temptation won out. She accepted.
Five and a half months ago, Abby moved into Mark’s Cambridge home. It hadn’t
been easy at first, learning to live with a forty-one-year-old bachelor who’d never before shared his life—or his home—with a woman. But now, as she felt Mark holding her, supporting her, she could not imagine living with, or loving, anyone else.
“Poor baby,” he murmured, his breath warm in her hair. “Brutal, isn’t it?”
“I’m not cut out for this. What the hell do I think I’m doing here?”
“You’re doing what you always dreamed about. That’s what you told me.”
“I don’t even remember what the dream was anymore. I keep losing sight of it.”
“I believe it had something to do with saving lives?”
“Right. And here I am wishing that drunk in the other car was dead.” She shook her head in self-disgust.
“Abby, you’re going through the worst of it now. You’ve got two more days on trauma. You just have to survive two more days.”
“Big deal. Then I start thoracic—”
“A piece of cake in comparison. Trauma’s always been the killer. Tough it out like everyone else.”
She burrowed deeper into his arms. “If I switched to psychiatry, would you lose all respect for me?”
“All respect. No doubt about it.”
“You’re such a jerk.”
Laughing, he kissed the top of her head. “Many people think it, but you’re the only one allowed to say it.”
They stepped off on the first floor and walked out of the hospital. It was autumn already, but Boston was sweltering in the sixth day of a late-September heat wave. As they crossed the parking lot, she could feel her last reserves of strength wilting away. By the time they reached her car, she was scarcely able to drag her feet across the pavement. This is what it does to us, she thought. It’s the fire we walk through to become surgeons. The long days, the mental and emotional abuse, the hours of pushing onward while bits and pieces of our lives peel away from us. She knew it was simply a winnowing process, ruthless and necessary. Mark had survived it; so would she.
He gave her another hug, another kiss. “Sure you’re safe driving home?” he asked.
“I’ll just put the car on automatic pilot.”
“I’ll be home in an hour. Shall I pick up a pizza?”
Yawning, she slid behind the wheel. “None for me.”
“Don’t you want supper?”
She started the engine. “All I want tonight,” she sighed, “is a bed.”
3
In the night it came to her like the gentlest of whispers or the brush of fairy wings across her face: I am dying. That realization did not frighten Nina Voss. For weeks, through the changing shifts of three private duty nurses, through the daily visits of Dr. Morissey with his ever-higher doses of furosemide, Nina had maintained her serenity. And why should she not be serene? Her life had been rich with blessings. She had known love, and joy, and wonder. In her forty-six years she had seen the sun rise over the temples of Karnak, had wandered the twilight ruins of Delphi, and climbed the foothills of Nepal. And she had known the peace of mind that comes with the acceptance of one’s place in God’s universe. She was left with only two regrets in her life. One was that she had never held a child of her own.
The other was that Victor would be alone.
All night her husband had maintained his vigil at her bedside, had held her hand through the long hours of labored breaths and coughing, through the changing of the oxygen tanks and the visits of Dr. Morissey. Even in her sleep she had felt Victor’s presence. Sometime near dawn, through the haze of her dreams, she heard him say: She is so young. So very young. Can’t something else, anything else, be done?
Something! Anything! That was Victor. He did not believe in the inevitable.
But Nina did.
She opened her eyes and saw that night had finally passed, and that sunlight was shining through her bedroom window. Beyond that window was a sweeping view of her beloved Rhode Island Sound. In the days before her illness, before the cardiomyopathy had drained her strength, dawn would usually find Nina awake and dressed. She would step out onto their bedroom balcony and watch the sun rise. Even on mornings when fog cloaked the Sound, when the water seemed little more than a silvery tremor in the mist, she would stand and feel the earth tilting, the day spilling toward her. As it did today.
So many dawns have I known. I thank you, Lord, for every one of them.
“Good morning, darling,” whispered Victor.
Nina focused on her husband’s face smiling down at her. Some who looked at Victor Voss saw the face of authority. Some saw genius or ruthlessness. But this morning, as Nina gazed at her husband, she saw only love. And weariness.
She reached out for his hand. He took it and pressed it to his lips. “You must get some sleep, Victor,” she said.
“I’m not tired.”
“But I can see you are.”
“No I’m not” He kissed her hand again, his lips warm against her chilled skin. They looked at each other for a moment. Oxygen hissed softly through the tubes in her nostrils. From the open window came the sound of ocean waves sluicing across the rocks.
She closed her eyes. “Remember the time . . .” Her voice faded as she paused to catch her breath.
“Which time?” he prompted gently.
“The day I . . . broke my leg . . .” She smiled.
It was the week they’d met, in Gstaad. He told her later that he’d first spotted her schussing down a double black diamond, had pursued her down the mountain, back up in the lift, and down the mountain again. That was twenty-five years ago.
Since then they had been together every day of their lives.
“I knew,” she whispered. “In that hospital . . . when you stayed by my bed. I knew.”
“Knew what, darling?”
“That you were the only one for me.” She opened her eyes and smiled at him again. Only then did she see the tear trickle down his cheek. Oh, but Victor did not cry! She had never seen him cry, not once in their twenty-five years together. She had always thought of Victor as the strong one, the brave one. Now, as she looked at his face, she realized how very wrong she had been.
“Victor,” she said and clasped his hand in hers. “You mustn’t be afraid.”
Quickly, almost angrily, he mopped his hand across his face. “I won’t let this happen. I won’t lose you.”
“You never will.”
“No. That’s not enough! I want you here on this earth. With me. With me.”
“Victor, if there’s one thing . . . one thing I know . . .” She took a deep breath, a gasp for air. “It’s that this time . . . we have here . . . is a very small part . . . of our existence.”
She felt him stiffen with impatience, felt him withdraw. He rose from the chair and paced to the window, where he stood gazing out at the Sound. She felt the warmth of his hand fade from her skin. Felt the chill return.
“I’ll take care of this, Nina,” he said.
“There are things . . . in this life . . . we cannot change.”
“I’ve already taken steps.”
“But Victor . . .”
He turned and looked at her. His shoulders, framed by the window, seemed to blot out the light of dawn. “It will all be taken care of, darling,” he said. “Don’t you worry about a thing.”
It was one of those warm and perfect evenings, the sun just setting, ice cubes clinking in glasses, perfumed ladies floating past in silk and voile. It seemed to Abby, standing in the walled garden of Dr. Bill Archer, that the air itself was magical. Clematis and roses arched across a latticed pergola. Drifts of flowers swept broad strokes of color across the expanse of lawn. The garden was the pride and joy of Marilee Archer, whose loud contralto could be heard booming out botanical names as she shepherded the other doctors’ wives from flowerbed to flowerbed.
Archer, standing on the patio with highball in hand, laughed. “Marilee knows more goddamn Latin than I do.”
“I took three years of it in college,” said Mark. “All I remember i
s what I learned in medical school.”
They were gathered next to the brick barbecue, Bill Archer, Mark, the General, and two surgical residents. Abby was the only woman in that circle. It was something she’d never grown accustomed to, being the lone female in a group. She might lose sight of it for a moment or two, but then she would glance around a room where surgeons were gathered, and she’d experience that familiar flash of discomfort with the realization that she was surrounded by men.
Tonight there were wives at Archer’s house party, of course, but they seemed to move in a parallel universe seldom intersecting with that of their husbands. Abby, standing with the surgeons, would occasionally hear far-off snippets from the wives’ conversations. Talk of damask roses, of trips to Paris, and meals savored. She would feel pulled both ways, as though she stood straddling the divide between men and women, belonging to neither universe, yet drawn to both.
It was Mark who anchored her in this circle of men. He and Bill Archer, also a thoracic surgeon, were close colleagues. Archer, chief of the cardiac transplant team, had been one of the doctors who’d recruited Mark to Bayside seven years ago. It wasn’t surprising the two men got along so well. Both of them were hard-driving, athletic, and fiercely competitive. In the OR they worked together as a team, but out of the hospital, their friendly rivalry extended from the ski slopes of Vermont to the waters of Massachusetts Bay. Both men kept their J-35 sailboats moored at Marblehead Marina, and so far this season, the racing score stood at six to five, Archer’s Red Eye versus Mark’s Gimme Shelter. Mark planned to even the score this weekend. He’d already recruited Rob Lessing, the other second-year resident, as crew.
What was it about men and boats? wondered Abby. This was gizmo talk, men and their sailing machines, high-tech conversation fueled by testosterone. In this circle, center stage belonged to the men with graying hair. To Archer, with his silver-threaded mane. To Colin Wettig, already a distinguished gray. And to Mark, who at forty-one was just starting to turn silver at the temples.
As the conversation veered toward hull maintenance and keel design and the outrageous price of spinnakers, Abby’s attention drifted. That’s when she noticed two late arrivals: Dr. Aaron Levi and his wife, Elaine. Aaron, the transplant team cardiologist, was a painfully shy man. Already he had retreated with his drink to a far comer of the lawn, where he stood stoop-shouldered and silent. Elaine was glancing around in search of a conversational beachhead.