Under The Knife

The small and perfect footprints you leave in the sand.

In remembrance there are no endings.

And so you lie there, now and always, by the sea.

You open your eyes. You touch me.

The sun is in your fingertips.

And I am healed.

I am healed.

CHAPTER ONE (#ulink_9d3b9754-f0bd-5d48-84ea-a54c63073a1b)

WITH A STEADY HAND, Dr. Kate Chesne injected two hundred milligrams of sodium Pentothal into her patient’s intravenous line. As the column of pale yellow liquid drifted lazily through the plastic tubing, Kate murmured, “You should start to feel sleepy soon, Ellen. Close your eyes. Let go….”

“I don’t feel anything yet.”

“It will take a minute or so.” Kate squeezed Ellen’s shoulder in a silent gesture of reassurance. The small things were what made a patient feel safe. A touch. A quiet voice. “Let yourself float,” Kate whispered. “Think of the sky…clouds….”

Ellen gave her a calm and drowsy smile. Beneath the harsh operating-room lights, every freckle, every flaw stood out cruelly on her face. No one, not even Ellen O’Brien, was beautiful on the operating table. “Funny,” she murmured. “I’m not afraid. Not in the least….”

“You don’t have to be. I’ll take care of everything.”

“I know. I know you will.” Ellen reached out for Kate’s hand. It was only a touch, a brief mingling of fingers. The warmth of Ellen’s skin against hers was one more reminder that not just a body, but a woman, a friend, was lying on this table.

The door swung open and the surgeon walked in. Dr. Guy Santini was as big as a bear and he looked faintly ridiculous in his flowered paper cap. “How we doing in here, Kate?”

“Pentothal’s going in now.”

Guy moved to the table and squeezed the patient’s hand. “Still with us, Ellen?”

She smiled. “For better or worse. But on the whole, I’d rather be in Philadelphia.”

Guy laughed. “You’ll get there. But minus your gallbladder.”

“I don’t know…. I was getting kinda…fond of the thing….” Ellen’s eyelids sagged. “Remember, Guy,” she whispered. “You promised. No scar….”

“Did I?”

“Yes…you did…..”

Guy winked at Kate. “Didn’t I tell you? Nurses make the worst patients. Demanding broads!”

“Watch it, Doc!” one of the O.R. nurses snapped. “One of these days we’ll get you up on that table.”

“Now that’s a terrifying thought,” remarked Guy.

Kate watched as her patient’s jaw at last fell slack. She called softly: “Ellen?” She brushed her finger across Ellen’s eyelashes. There was no response. Kate nodded at Guy. “She’s under.”

“Ah, Katie, my darlin’,” he said, “you do such good work for a—”

“For a girl. Yeah, yeah. I know.”

“Well, let’s get this show on the road,” he said, heading out to scrub. “All her labs look okay?”

“Blood work’s perfect.”

“EKG?”

“I ran it last night. Normal.”

Guy gave her an admiring salute from the doorway. “With you around, Kate, a man doesn’t even have to think. Oh, and ladies?” He called to the two O.R. nurses who were laying out the instruments. “A word of warning. Our intern’s a lefty.”

The scrub nurse glanced up with sudden interest. “Is he cute?”

Guy winked. “A real dreamboat, Cindy. I’ll tell him you asked.” Laughing, he vanished out the door.

Cindy sighed. “How does his wife stand him, anyway?”

For the next ten minutes, everything proceeded like clockwork. Kate went about her tasks with her usual efficiency. She inserted the endotracheal tube and connected the respirator. She adjusted the flow of oxygen and added the proper proportions of forane and nitrous oxide. She was Ellen’s lifeline. Each step, though automatic, required double-checking, even triple-checking. When the patient was someone she knew and liked, being sure of all her moves took on even more urgency. An anesthesiologist’s job is often called ninety-nine percent boredom and one percent sheer terror; it was that one percent that Kate was always anticipating, always guarding against. When complications arose, they could happen in the blink of an eye.

But today she fully expected everything to go smoothly. Ellen O’Brien was only forty-one. Except for a gallstone, she was in perfect health.

Guy returned to the O.R., his freshly scrubbed arms dripping wet. He was followed by the “dreamboat” lefty intern, who appeared to be a staggering five-feet-six in his elevator shoes. They proceeded on to the ritual donning of sterile gowns and gloves, a ceremony punctuated by the brisk snap of latex.

As the team took its place around the operating table, Kate’s gaze traveled the circle of masked faces. Except for the intern, they were all comfortably familiar. There was the circulating nurse, Ann Richter, with her ash blond hair tucked neatly beneath a blue surgical cap. She was a coolheaded professional who never mixed business with pleasure. Crack a joke in the O.R. and she was likely to flash you a look of disapproval.

Next there was Guy, homely and affable, his brown eyes distorted by thick bottle-lens glasses. It was hard to believe anyone so clumsy could be a surgeon. But put a scalpel in his hand and he could work miracles.

Opposite Guy stood the intern with the woeful misfortune of having been born left-handed.

And last there was Cindy, the scrub nurse, a dark-eyed nymph with an easy laugh. Today she was sporting a brilliant new eye shadow called Oriental Malachite, which gave her a look reminiscent of a tropical fish.

“Nice eye shadow, Cindy,” noted Guy as he held his hand out for a scalpel.

“Why thank you, Dr. Santini,” she replied, slapping the instrument into his palm.

“I like it a lot better than that other one, Spanish Slime.”

“Spanish Moss.”

“This one’s really, really striking, don’t you think?” he asked the intern who, wisely, said nothing. “Yeah,” Guy continued. “Reminds me of my favorite color. I think it’s called Comet cleanser.”

The intern giggled. Cindy flashed him a dirty look. So much for the dreamboat’s chances.

Guy made the first incision. As a line of scarlet oozed to the surface of the abdominal wall, the intern automatically dabbed away the blood with a sponge. Their hands worked automatically and in concert, like pianists playing a duet.