But even though odds of survival are good, most closet visitors do suffer post-op trauma. On occasion, an important medical reason prompts paralyzing patients without putting them to sleep, but most of the time it happens by mistake. Which is why Janwar labels his syringes so carefully.
Using a scissor-shaped controller, Victor inflates Mrs. Bradford’s abdomen with carbon dioxide like a tennis dome. Once he can see what’s going on under the dome, he dissects the gallbladder away from the liver, removing it tidily in a little pouch through a hole near Mrs. Bradford’s navel.
Victor and Mildred take off their masks when the operation is over. Janwar puts Victor’s age around forty-five and Mildred five years younger. The two surgeons depart, and Janwar administers the various drugs needed to return Mrs. Bradford to wakefulness. All proceeds according to plan, until, as Janwar is bringing her back to consciousness, blood rushes out of Mrs. Bradford’s nose. She opens her eyes and registers the masked faces, the red slick on the pillowcase.
“You were supposed to operate on my gall bladder.” Mrs. Bradford looks more disappointed than anything else. “Why is there blood on my pillowcase?” She licks her upper lip and draws a smear of blood into her mouth. Her eyes widen. “And on my face? Doctor? Did you do the wrong operation?” The mountainous line on the EKG quakes.
Mrs. Bradford is still under the influence of Janwar’s anaesthetic cocktail. The nurses are trying not to laugh: a vein throbs in Henry’s forehead and José’s chest heaves.
Janwar places his hand on the woman’s bony shoulder. “Don’t worry, Mrs. Bradford. We didn’t touch your face. You had a nosebleed as I was waking you.”
He motions to Henry, who applies pressure to the bridge of her nose with his latexed fingers as Janwar injects a dose of a mild sedative into the IV. Henry’s scrub sleeve rides up and Janwar can see a large tattoo, but he can’t make out the design on the nurse’s dark skin. Mrs. Bradford relaxes and smiles at Henry’s touch.
“Zwillinge clean you up and have you heraus of here in no time,” Henry says, and now it’s José’s turn to hold up his hand for a high-five.
“Nicely done,” José says.
Carla removes her cap and mask and shakes her platinum-blond hair out of its operating configuration. Her hair is very long, far longer than Janwar often sees on middle-aged women, but it’s healthy and, because she’s tall, only a few inches shorter than Janwar, it looks good on her.
“Good work, Janwar.”
“Thank you, Dr. Welrod.”
“Carla.”
“Thank you, Carla.”
“One thing? Not something you did wrong, but something you should know. At the moment, we’re all using lidocaine instead of ketamine as the coinduction agent. There’s a bit of a supply problem.”
Janwar thanks her. These things happen. With so many orders going through the hospital, sometimes a shipment ends up in the wrong place and takes a while to track down. A hospital is a bureaucracy like any other. And sometimes it’s not even the hospital’s fault. The market doesn’t incentivize producing certain drugs at scale, or there’s a problem at a manufacturing facility, or there are regulatory issues.
“Any questions?” Carla is looking straight into his eyes. Hers are battleship grey. Maybe if Janwar were into sexy older ladies his heart rate would have spiked like Mrs. Bradford’s, but he isn’t. Janwar’s dream girls have always been strictly same age level, which means he watched some material in the early days of peer-to-peer file sharing, circa age thirteen, for which he still feels guilty.
He wants to ask if José’s and Henry’s behaviour was a test. Was there a real nursing rebellion or not? The two men are gone, so he can ask now, but he’s blanking on how to phrase it without sounding paranoid. He’ll start with a less important question and hope his subconscious grinds out a solution before Carla departs.
“I’m used to scrub pants with ties, not elastic.” Janwar tugs at his waistband, which sags under the weight of his Leatherman Raptor paramedic shears, which he carries always, because you never know when you’ll need to remove somebody’s clothes quickly: Janwar sure wishes it was more often. “How do you get them to stay up with stuff in your pockets?” Janwar asks.
Carla tucks a thumb into the elastic waistband of her scrub pants, revealing a second pair of scrub pants underneath.
“Clever. I can requisition another pair of scrubs?”
“Sure can.” Carla looks at her Rolex, which probably cost more than Janwar’s Toyota back in Vancouver. “Okay, I’ve got to go. See you at the next operation.”
Janwar is putting away his equipment on the anaesthesia cart when someone taps him on the shoulder. He turns. A white-haired, white-bearded man with blue eyes that are almost too bright to believe is smiling at him. His hand is out for Janwar to shake. Janwar shakes it. This handshake says that they are professional men who respect each other.
“Dr. Llewellyn Cadwaladr. The dean of anaesthesiology.” Dr. Cadwaladr speaks with a mellifluous Welsh accent befitting his name.
“Janwar Gupta—”
“The new intern. I’ve been looking forward to meeting you, boyo.”
“This is all very exciting,” Janwar says. The man’s name is familiar.
“I should tell you, boyo. This is the teaching OR. We scheduled this operation here for a reason.” Dr. Cadwaladr gestures at the mirror. “This is a two-way mirror. Students can watch the operation without distracting anyone.”
As this is Janwar’s first operation at the hospital, he doesn’t find it unreasonable that an administrator observed him without his knowledge or consent. Janwar has been observed his whole life by teachers at school and his parents at home. The main reason he does any of the things that make him a human being is the knowledge that someone could be watching him at any time. His brief foray into living alone one unemployed summer, and his apartment’s rapid takeover by empty cans of organic chili, as well as his almost instantaneous descent into constant nudity and excessive daytime masturbation, taught him that.
For that reason, his dependence on being watched to know where he ends and the world begins, Janwar isn’t going to get upset about it now that he is on a placement with life-and-death-type responsibilities.
And meeting expectations with respect to those responsibilities: that Janwar’s first impulse was to mix his induction agents, as well as his sticking with his plan despite the flak from both nurses, impresses Dr. Cadwaladr deeply.
“You’re a dab hand, boyo. I knew you for a born Mixer.” Dr. Cadwaladr claps Janwar on the shoulder. “Maybe it’s too early to say this, but I hope you consider the University of Ottawa when the time comes for you to apply for your residency.”
A pinpoint of light roves around behind the mirror and then goes out. An absent-minded student looking for keys, maybe. A door shuts.
“Thank you, sir,” Janwar says. He remembers where he knows the name from—Dr. Cadwaladr signed the letter offering him the internship.
Heels click down the checkered hallway flooring.
“We’ll have none of that ‘sir’ business, boyo. Call me Llew.”
Janwar says he will, but also that he isn’t sure what Llew means by “born Mixer.”
“Ah, I botched that. I thought someone would have told you already. We believe that blending drugs in one syringe is the best induction method in all cases. So we call ourselves the Mixers.”
“Shoot ’em all and let the patient sort ’em out.”
Llew laughs. “There you are, then! Any other questions, boyo?”
“Yeah, if mixing is the position of the department, why are the nurses so negative about it?”
“It’s not the whole department who are Mixers. Just a few of us. Some of the others are more traditional. Most of the nurses are as well.” He waves them off.
Henry and José weren’t only messing with Janwar, then; their animosity toward his mixing was a serious position, even though as nurses they don’t get to make those kinds of decisions.
/> Nurses, especially male nurses, are often jealous of doctors, but most of the time they are happy to leave the decision-making to their higher-paid and more-sleep-deprived colleagues. The rivalry isn’t anywhere near as intense as the surgery-anaesthesiology conflict.
“I’m happy to be on the side of experimentation, Llew,” Janwar says. One of Janwar’s greatest strengths is in understanding how drugs interact, according to all his instructors at UBC. If he has to choose between “always be mixing” and “never be mixing,” he’ll choose the former.
Janwar wrings an operation’s worth of sweat out of his bandana into the metal sink and reties the Batman-print fabric. His hair is thinning at the top, but it started from a level of such luxuriant thickness that the thinning now, at age twenty-five, is still unnoticeable to others. He takes off his glasses, careful to lift the titanium earpieces using the same amount of force with each hand, and wipes his face with the bandana.
The dean lopes toward the OR door, each step causing his upper body to dip by several inches. Janwar almost laughs: Dr. Cadwaladr walks like a sine wave.
“Drop by my office sharpish when you’re off-duty, boyo,” Llew says. “It’s in the department. B309. I’ll be here till seven. We’ll have coffee and chat about how things work here. I’ve got a blend that could stop your heart.”
Janwar appreciates Llew’s comments and fatherly presence more than he wants to let on.
Despite his confidence during the operation, once Victor stitched Mrs. Bradford back up and the nurses wheeled her off, Janwar began to second-guess his judgment in mixing.
Once in a while, Janwar experiences what his therapist, Dr. Marilyn Brank, calls “chthonic breakthroughs.” She added the word chthonic, meaning “concerning, belonging to, or inhabiting the underworld,” to separate them from the “good” kind of breakthroughs, which happen when a patient escapes a matrix of negative thoughts. Chthonic breakthroughs are instead more of a “return of the repressed” thing, Marilyn says.
Janwar’s breakthroughs often start with him questioning his judgment in a recent situation, such as whether the sweater he bought fit properly, or whether he jaywalked at a safe time, or whether he performed the appropriate steps when injecting drugs into a real live human being. This mistrust spreads like a black net to encompass the entire universe, leaving Janwar leached of any emotion but fear, stuck in his own boogeyman’s closet.
Janwar didn’t get all the way to a full chthonic breakthrough this time, and his normal perspective has returned. Llew’s praise pulled him out of the closet. Janwar is a talented prospective anaesthesiologist and an all-round charming and likeable person. He is successful at most things he attempts.
Janwar’s mother told him, in a context Janwar cannot remember now, that she was glad to see tiny Janwar find some tasks difficult. Take playing basketball: as a point guard for the Glenlyon Norfolk School Grade 4 B-team, he had an embarrassing double-dribble problem. One opposing player memorably celebrated Janwar’s fifth double-dribble call in one game by performing the “suck it” gesture in front of the entire gymnasium. Garati, in the stands, had been happy to see the ball taken away from her son and used to score on a breakaway because she was afraid that Janwar was so successful at everything he’d tried by age nine that in the future he’d be unable to cope with failure.
But Janwar had failed at a number of other things in his life no matter how hard he tried, like being in a serious romantic relationship before age twenty, so Janwar figures Garati’s fears were unfounded.
Janwar is filling up his mug with fair-trade Colombian in the cafeteria, the Tulip Cafe, when Dr. Fang Jin, the newest resident in the anaesthesiology department, introduces herself.
“It’s nice to meet you, too, Fang.” The stream of coffee stops with Janwar’s mug only two-thirds full and, after a couple of attempts to get the last remaining drops from the container, Janwar moves his cup over to the Ethiopian tap and finishes pouring. “And Llew too. He seems pretty down to earth for an administrator.”
“Did you know before he took his admin job with the university, he was a genius anaesthesiologist?”
Janwar didn’t know this. The Tulip Cafe, much newer than the rest of the hospital, is decorated in brown and black, with halogen spotlights scattered throughout instead of overhead fluorescents, which makes it feel more like a high-efficiency bistro than an institutional cafeteria. Janwar isn’t sure if he finds the pools of darkness comforting or creepy. As he walks past the entrance to the kitchen, he feels the fryer oil in the air glom onto his lungs.
“Lleweyville Slugger, the Sultan of Sedation,” Fang says. “He was a fucking baller with GHB before most doctors switched away from it because sedation lasted so long. The staff put up cut-outs of him at Christmas parties because he worked so hard on improving his technique that he’d never leave the hospital. Man deserves his break.”
Janwar smiles. Fang smiles back, and one side of her mouth rises higher than the other, but the overall impression Janwar gets is of sincerity, and he feels that they would make good colleagues.
“It’s pretty pimp here,” Fang says. “You’ll like it.” She shakes out her bangs.
“Pimp?”
“Oh. You went to University of Alberta, right?”
“UBC. Grew up in Victoria, then moved to Vancouver for school.”
“Well, when I was in med school at U of T, anything good was ‘pimp’ and anything bad was ‘fail.’ All the young doctors talk like that here, too.”
“Maybe it’s Ontario slang. At UBC we all said that good things were ‘beastly’ and bad things were ‘rough.’ Like, ‘Alejandro is beastly at induction.’ Or, ‘That suture job is fucking rough.’ Pardon my language.”
Fang laughs. “I don’t know where you BC guys get your slang. Sounds like some backwoods shit to me.”
“It may be backwoods, but it’s grammatically correct.”
“Where I was going with all this, before we went off the rails,” Fang says, “was that this is a good place to be, and we’re glad to have you. I heard about how you fucking crushed it with Mrs. Bradford.”
“Thanks.” Janwar pauses. “It was—what’s the word? Means that it could have been otherwise.” He shakes his head. “Whatever. You get the idea. But it went the way it did. I’m glad it worked out.”
“You’re too humble.”
Mrs.Bradford could still have died as a result of Janwar’s mixing—even out of the chthonic breakthrough, Janwar is careful to acknowledge that to himself—but she also could have died as a result of following the traditional one-drug-per-injection process. Or she could have died without anybody’s interference.
“Anyway. You guys do seem pretty pimp,” Janwar says.
“You got it.” Fang smiles again and holds up a hand for a high-five. “Civic Hospital Mixers, what’s up!”
Something that could have been otherwise is contingent, Janwar remembers now. He has to learn so many new medical terms every day that less-critical words and memories drift away like the lingering euphoria after shooting a propofol bolus. He tells friends he can’t remember anything before age eighteen, though that’s an exaggeration he admits when pushed: he can remember back to about age seven, when he fell into a pond during a school field trip. That’s still late for a first memory, as most people he knows can remember back to at least kindergarten, but it’s also not quite into Hollywood amnesia territory.
Janwar hopes his memory loss won’t get to that point, the fog creeping inexorably forward, swallowing up history tests about the Iroquois and their penchant for causing acute pain to missionaries without anaesthetic; field trips to Science World where he and his classmates got to mix chemicals together to make fun gooey reactions; his first sexual encounter in a school stairwell with Lucy Kaufman, after which she claimed to feel “strangely tranquil”; trombone performances in the pit orchestra for the musicals Evita and Les Misérables where sometimes he snuck in harmonies that weren’t in the sheet music because, with a head ful
l of music theory, they made more sense that way; his Grade 11 citizenship award for being the nicest person out of a class of 150 (“the person you most want to be your neighbour,” headmaster Buddy Rainier said about the prize; “a real social butterfly who blends in well in any situation,” Head Boy Yu-hao “Howard” Chen said about its being awarded to Janwar); discussions about his future with his parents, Garati and Ajay Gupta, BA (Hons), JD, and BSc, MSc, PhD, respectively—the amnesia maybe even reaching a point one day, far into his career, where he’ll go to bed one night and wake up the next and the only thing he can remember from the past is that he is an anaesthesiologist and he has to be at work at 6 a.m....
Janwar anaesthetizes two more patients before the end of the day: Mr. Nakamura and Ms. Burton. Carla sits in the corner with her tablet, constantly swiping left across the screen. Both procedures take place in operating rooms without mirrors, rooms I and III. Carla could report back to Llew, so whether Janwar is being observed in a sub rosa manner or not is moot, but now that Janwar knows that such mirrors exist he can’t help but look for them.
Mr. Nakamura needs a precancerous tumour removed from his right shoulder blade. He is healthy and has no blood-pressure problems or drug contraindications, so Janwar might not normally have mixed his induction drugs in one syringe. But Llew had welcomed Janwar into the group of Mixers under the impression that drug mixing was in his blood, so now is the time to commit.
Janwar unlocks the anaesthesia cart by launching the cart vendor’s app on his tablet, pressing his thumb against the biometric reader to activate it, showing that, yes, he’s Janwar Aashish Gupta and he should be allowed to open these drawers. He holds the tablet in front of the sensor on the cart until the door snicks open.
Death and the Intern Page 2