They exited the OR to scrub in preparation for the surgery. Barnes joined Billings at the wide metal sink, grabbed a scrub brush, and broke open the plastic package. Inside, an iodine and chemical solution created a brown froth. Billings held the brush under the running water of a faucet, then, in the presurgery ritual practiced by all in their profession, methodically rubbed the plastic spicules along his fingers, scrubbing every surface again and again, before advancing to the palms and backs of his hands, then the wrists and forearms. Barnes was doing the same.
“Just so you remember,” Billings reiterated as they scrubbed, “I make the rules around here . . . I know you’re used to being the boss in the OR when you’re chief surgeon, but not today. If you give me any lip, I’ll . . . throw you out. Understand?”
“Yeah.” For a moment he resented Billings, his slow authoritative manner, but the man had a point. You can’t have two chief surgeons. “I hear you,” he added. “Just remind me if I forget.”
“Don’t worry. I will.”
Barnes entered the OR behind Billings, and they gowned and gloved with the assistance of a nurse. Everything was already in place: the anesthesiologist with all of his equipment, the perfusionist with the heart-lung machine, and the nurses with their trays of instruments, including scalpels, a saw, electrocautery, and numerous hemostats, scissors, retractors, and other specially designed instruments. The patient, a youthful forty-six-year-old Caucasian woman, had already been prepped and sterilely draped.
“She’s under,” announced the anesthesiologist, writing vital signs and other notes on a sheet of paper attached to a clipboard near Mrs. Rigsby’s head. “You can start whenever you’re ready.”
“Scalpel,” Barnes and Billings said in unison, and scrub nurses picked up the instruments from a sterile tray. Barnes held out his right hand, palm up, and felt the handle of the scalpel slapped into it.
“Here we go,” he said. For a moment he hesitated, wondering whom he was about to cut into, knowing only that it was a female who looked too young to be having coronary artery disease. She should be at home playing with her children, or maybe doing paperwork in an office in the financial district. Anywhere but on this table. Most of Barnes’s patients were much older, the majority men, and all of them he knew well from their hospital charts and office visits. Yet he identified with this woman, this complete stranger, more than with any of his other patients. Through forces beyond her control, she had ended up on this table, and she had probably never seen it coming.
If all went well, this patient would leave the hospital a cured woman. Maybe her arteries would eventually clog again, but for a while at least, she could return to her role of mother or wife or businesswoman. Back to normal.
Barnes made an incision down the center of the chest, from just above the top of the sternum to the abdomen, extending an inch below the xiphoid process at the bottom of the sternum. At the same time, Billings was working on the leg. Barnes didn’t even notice. He focused solely on the chest, maintaining a dry operative field by electrically cauterizing even the small bleeders while Findley retracted the skin. At this point, the patient was simply an object, a chest, and the resident and medical students across the table were merely pairs of hands. Almost. Findley was also a reminder of Barnes’s status as an assistant—every few minutes the resident updated Billings on exactly what Barnes was doing.
Barnes cut through the sternum lengthwise with an electric saw and opened the chest with a sternal spreading retractor, exposing the beating heart. He’d done this more times than he could count, but it never failed to inject him with a rush of adrenaline. Denny always said it was like lifting a skirt over the hips of a woman, and Denny had a similar analogy for touching the organ, but to Barnes the experience was more spiritual. To him, it was an opportunity to preserve the soul. The human brain holds that—our very essence—but it’s dead without a heart. The heart keeps everything alive. Even when the brain dies, the heart can prevent the rest of the body from shutting down.
The fate of such an incredible organ shouldn’t be entrusted to anyone but the most skilled surgeons. That’s why Barnes didn’t trust medical students, or even most residents, to do anything except minor procedures—and that’s why medical students and residents resented him. They didn’t appreciate his reverence for the organ, or the magnitude of their obligation to the patient. They viewed this woman as a teaching tool, not a desperately ill person entrusting them with her life.
Barnes examined the heart through magnifying surgical glasses, as it beat, inspecting the outside of the coronary arteries. Next he would lower the temperature of the heart with a cold potassium solution and would work together with Billings to reroute the blood flow through it.
A radio on the far counter played classical music, and this, along with Findley’s intermittent updates to Billings, reminded Barnes that someone else was the chief surgeon. Had he been in charge, rock ’n’ roll would have filled the air. Classical music was too sedate for open-heart surgery. But it seemed fitting for Billings. The man, like the music, was clearly different.
Barnes could no longer remember the chain of events that had led him to assist in this surgery, yet he was pretty sure Billings was doing him a favor, rather than the other way around. The man might have had an ulterior motive, but right now Barnes didn’t care.
“You remember what you’re doing?” Billings asked, breaking his train of thought.
“Hysterectomy,” Barnes replied.
Billings was right to ask, but Barnes didn’t need any help, at least not yet.
“Double bypass,” Billings said, obviously not in the mood to make light of the situation. He moved from the patient’s leg up to the chest, beside Barnes. “I’ll show you which vessels.”
Barnes gave him some room but said nothing. He’d never deferred to another surgeon in the OR, not since his days as a resident.
He couldn’t decide whether to be annoyed or grateful.
Chapter 31
After checking on Barnes, Billings focused on dissecting around the greater saphenous, the longest vein in the human body. He’d done the procedure enough times that it was like brushing his teeth, but a sense of urgency still tugged at him. The patient’s life rested in his hands, and he felt uneasy having that power. For most surgeons it was a rush. Not for him.
He knew that with Findley keeping an eye on things, he could rely on Barnes to manage the other half of the surgery. The son of a bitch had the best survival record in the history of the hospital, despite taking the most complicated cases. That had been a major consideration in letting him assist—having Barnes instead of a resident was in the patient’s best interest.
But Barnes was abrasive and arrogant. Why should anyone help a jerk like that? If things had been reversed and Billings needed help, would Barnes have offered to let him assist? Not a chance.
On the other hand, Barnes’s illness and the death of his wife had reduced him to a manageable state. Not surprising, considering that either of those tragedies would prompt any normal person to take stock of his life and change his attitude and priorities.
Barnes did have redeeming qualities, Billings conceded, but then so did almost everyone if you looked hard enough. It would take more than that to make working with him palatable. Of course, this might be their first and last time as a team. If Barnes behaved the way Barnes usually did, Billings wouldn’t invite him back.
Too bad the man didn’t have any real friends to help him, but that’s not surprising when you treat everyone as though they’re inferior to you. What had Elizabeth ever seen in him? Billings had liked her, despite her poor choice in a husband. Unlike Barnes, she would say hello to him and sometimes chat with him when their paths crossed on rounds or outside the operating rooms. Of course nothing could be done to help Elizabeth, but certainly she would have wanted him to help her husband. Maybe he could do that, in part, for her.
And there was one other thing—Denny Houston. Houston was a bigot, and you
could bet he’d be infuriated to see his former friend working under the direction of a black man.
Billings had endured racism nearly every day of his life, much of it subtle or hidden. He especially hated that type, where people act collegial but block your promotion or pay raise, act neighborly but try to keep you from buying a house in their white district. His father told him not to resent those people, to look past the injustices, but Billings couldn’t help it. His father had been an associate professor of political science. For thirty years the man taught classes, conducted research, and wrote papers, but he never got promoted to full professor. Bad luck? Billings didn’t think so. More like the wrong skin color. His father had since retired and now received a pension, but it was less than he deserved.
Despite the unfairness, though, his father enjoyed retirement while Billings staved off an ulcer. Maybe there was a lesson in that. Maybe he should spend a little less time working and a little more time enjoying life outside the hospital, with Priscilla—his wife of sixteen years—and their daughter, Maria, who was rapidly growing up without enough of his guidance. She’d just turned fifteen and already had acquired her mother’s charm, ethereal beauty, and self-confidence. Against his better judgment, she’d started dating, and in another year she would be asking to borrow the car. At least he didn’t drive a Mercedes or a Jaguar like most of his colleagues. He would feel a lot better letting Maria borrow the three-year-old Buick.
Billings suddenly felt sorry for Barnes. More likely than not, the man would never know the joy of having a family—never see a child’s eyes light up when he came home from work, never have a little girl or boy call him “Daddy.”
Billings glanced over at him again. Barnes seemed intent upon his work. He would help save this patient’s life, but in a few hours he wouldn’t remember anything about it. Yet Billings knew this was important to Barnes. Maybe on some primitive level he would learn from his experiences, even if he couldn’t remember them. Or maybe he would learn to compensate. The brain sometimes has a miraculous ability to adapt. Billings had seen patients recover from worse.
He knew all about Barnes’s condition. So did everyone else at the hospital. It’s hard to keep a secret when the story is printed in every major newspaper in North America. He didn’t know the full extent of Barnes’s memory impairment, but he’d read that the domoic acid in the shellfish preferentially destroys the temporal lobe regions of the brain, and he knew the ramifications of that.
Helping Barnes wasn’t easy, but it was the right thing to do. His father would be proud of him. That alone might be reason enough to do it. But there was a more compelling reason that he chose not to contemplate—a humiliation he’d endured for most of his life.
Damn Barnes for making him think of that. Some things you should be able to put out of your mind. Some things are best forgotten.
He forced his focus back on the patient.
Chapter 32
Barnes and Billings emerged from OR 9, the surgery completed. Barnes had already forgotten most of what they’d done, but he had been surprised by Billings’s skill in handling the greater saphenous vein. They’d worked together in attaching portions of the vein to the coronary arteries, wearing magnifying glasses to see while they sutured the small vessels. None of the segments of the grafts appeared kinked, twisted, or stretched, and Barnes knew the patient would likely recover without complications.
“That went all right,” he said as they walked down the corridor to the surgeons’ lounge. They’d left Findley and the medical students to accompany the patient to the recovery room and write the orders for her nursing care.
“You’re welcome,” replied Billings. “I assume that’s your way of saying thank you.”
“I probably need a little practice with that,” he admitted.
“If you want to operate again tomorrow, stop by before my first case.”
“Really?” Barnes had figured it would be a one-shot deal.
“No, I’m just being polite. I figure . . . you’ll forget in a few minutes.”
“Very funny.” Under different circumstances he would have told Billings to screw himself, but that wasn’t an option if he wanted to get back into the OR.
“You can assist,” Billings said, “as long as you do exactly what I tell you . . . and treat everyone with respect.”
“I can do that.” Then he added, “Can you remind me about this later when I’ve got a pen to write it down?”
“I’ll stick a note in your locker.”
They had reached the surgeons’ lounge, and Barnes felt like his old self—ready to take on whatever anyone could throw at him. He pushed through the door ahead of Billings.
“. . . bricks short of a full load! He doesn’t deserve a break!”
Apparently he’d walked into a heated debate, but the conversation abruptly halted. Then he realized why—they were talking about him. Carl Milligan, the chairman of surgery, had just hurled the insult. The old jarhead had been talking to Denny Houston and Ralph Manning, another surgeon. The only question was who, if anyone, had defended him.
Milligan cleared his throat and collected himself. Nodding an acknowledgment, he said, “Hey, Chris, Nate.” Then he turned back to Denny and Ralph and said, “I’ll catch you two later.” And he hurried out.
Billings headed back to the locker room, shaking his head. Manning joined him. Barnes stayed behind in the lounge and asked Houston, “What was that about?”
“Nothing. Milligan’s just being an ass. You know how he is. You just come from the OR?”
“Yeah. I did a case with Nate.”
“Nate?”
“Yeah, Nate Billings.”
Houston shook his head. “I’m surprised at you, buddy, working with that guy. He’s not in your league.”
“I’ll take what I can get.” He could recall only fragments of the procedure yet sensed it had gone well. All he knew for sure was that he wanted to do it again. “Don’t judge Billings till you’ve shared a case with him.”
“I wouldn’t share a case of beer with him.”
“You wouldn’t share a case of beer with anyone,” Barnes said. “Sharing’s not something you do.”
“Horse shit. What about that nurse, Kitty what’s-her-name?”
“That was seven years ago, Denny. Can’t you think of anything more recent?”
Barnes could see Houston’s jaw clench. Then Denny said, “That’s beside the point. The point is you don’t belong with Billings.”
Barnes shrugged him off. “I’m going to get changed. If you’re still here when I get back, I’ll talk to you then.” He started for the locker room.
Houston called after him, “You can do better than Billings.”
Opening his locker, Barnes saw a note scribbled on a piece of paper wedged in the door: You’re scrubbing with me tomorrow at 7 a.m. Signed Nate. Putting the note into his pants pocket, he remembered that Billings had offered to let him assist. Billings. Who would have thought?
He changed back into street clothes and put on his watch and wedding ring. As the gold band slid onto his finger, it brought back memories of Elizabeth—his marriage proposal to her. He’d popped the question at the end of the Hyannis Port breakwater, the longest rock jetty on the Cape. They’d hiked out there at low tide, climbing over massive boulders that had shifted and fallen from years of pummeling by ocean waves. Standing on the last rock in the late-afternoon sun, surrounded by glistening waters and curious seagulls, he’d pulled a diamond engagement ring out of the pocket of his swim trunks.
He held it out to her. “This is for you.”
“Oh, Christopher.” She looked at him with disbelief.
“Will you marry me?”
For a moment she said nothing, just looked into his eyes. Then, “Do you really want to be with me forever?”
“Longer. If you can tolerate me.”
As if in slow motion, she took the ring. “Yes. I’ll marry you.”
He might not remember anythi
ng now from one day to the next, or even one hour to the next, but he would never forget that afternoon, that proposal to Elizabeth.
He glanced at his watch to see the time, and the inscription on the face reminded him to check the list in his pocket. He unfolded that paper, and the first item jumped out at him: Elizabeth murdered . . .
It wasn’t as much of a shock as it should have been. Some part of him must have remembered. That would explain why he’d thought of the marriage proposal. In the back of his mind, he knew she was gone. What he’d learned about Elizabeth, and even some of the morning’s events, must have left impressions, however faint. Was this an improvement over the day before? Most likely. And tomorrow, or the day after that, should be even better.
He read through his notes. Nothing shed light on what had happened to Elizabeth. There wasn’t much about Denny, either, at least nothing good. No mention of the atherosclerosis research the two of them had done together. Barnes wondered what was happening with that. He vaguely recalled having seen Denny in the surgeons’ lounge. That could have been hours ago, but it was worth checking out. He finished getting changed, then threw his scrubs into a hamper and headed to the lounge.
Denny was sitting on the far end of the long couch, smoking a cigarette and reading a newspaper.
“Hey, Denny?” Barnes said.
Houston looked up, then back at the newspaper. “Yeah.”
Barnes sat beside him and took out a pen and paper. “Can you give me any insight into what happened to Elizabeth?”
“All I know is what was on the news.” He put the newspaper on the arm of the sofa and took a drag on his cigarette.
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