Sharon rolled her eyes. “Anything else I can get for you gentlemen?” she asked, trying to back away.
“Yes,” Bill said. “Yes, there is.” He put his right hand over his heart. “We can’t go on like this, you and I, pretending we don’t care for each other. Take me,” he said. “Take all of me.”
Jack nodded. “Yeah, Sharon, except for the gas problem and the snoring, he’s really quite a catch.”
“Let me get your check,” Sharon said.
“Oh, good,” Patti said as I came in the back door, “I was worried you were going to miss dinner. What took you so long?”
“Another rough day at work,” I said, giving her a kiss.
“Phew! You don’t usually come home from work smelling like that.”
“Well,” I said, “after we finished our biomechanics final we played golf.”
“Where, in a brewery?”
“Well, you know how Jack and Frank and Bill are. They said we had to stop at Tinkler’s on the way home.”
“Oh, those big bullies dragged my little Mikie into a bar and poured beer down his throat.”
“Something like that.”
“Well, sit down. I’m glad you’re home.”
When dinner was over, and the dishes were done, I put the girls in their pajamas, said their prayers with them, and tucked them in bed. As I closed the bedroom door, the house was quiet. Patti was curled up on the couch listening to Carole King on the stereo. I slid her feet over and sat next to her.
“How are you feeling, hon?” I asked as I slipped an arm around her.
“Better.”
“Is the baby still kicking a lot?”
“He sure is an active little thing. He’s always poking me right here.” She pointed to a spot low on the left side.
“Well, at least you’ve got Eileen and Mary Kate to do the housework for you.”
“While I lie around taking bubble baths and eating bonbons.”
“You know,” I said, “in my next life I want to come back as a resident’s wife.”
She sat up, folded her hands, and looked at the ceiling. “Oh, please, God, please grant this fool’s wish.”
We laughed. I pulled her head against me and began running my hand through her hair. “You have the nicest hair,” I said, burying my face in it. We sat like that for several minutes.
“Well, hon,” I said finally, “tomorrow I go back to the real world—this time as a senior resident.”
She sighed. “And I get to be a widow again.”
I had spent a lot of time with Patti and the kids the past six months. We ate dinner together almost every night. We took the kids to the petting zoo at Oxbow Park, and to the pool at Silver Lake. We took them on long walks at Mayowood, telling them stories about their grandfathers during the war, and their foremothers during the Chicago Fire and the Potato Famine. The girls taught me how to play Round and Round the Garden and Creep Mousie. I taught them how to play Something’s Coming for Your Armpit.
It had been a wonderful six months, but Patti knew I was anxious to get back to work. She asked whose service I had been assigned to.
“Bill Kramer’s.”
“Is that good?”
“Well, Bill’s new on staff, so there won’t be a lot of action on his service, but they never assign the new senior residents to one of the busier services like Romero, or Hale, or Cuv.”
“Well, that’s good,” she said, looking up at me. “At least you’ll be home once in a while, right?”
I couldn’t wait to begin my senior residency, but at that moment, sitting with my arms around Patti, I found myself wishing I were home all the time.
Year Three
Chapter Twenty-Six
August
Sarah Berenson was the girl I swore I would never forget. She was young, she was beautiful, and she was going to die if we couldn’t help her.
I met Sarah during my second month on Bill Kramer’s service. Bill was the youngest of the three orthopedic oncologists at Mayo. I had been leery about working with him. I was nervous not only about being a senior resident, but also about working in oncology. Oncology was the antithesis of orthopedics. In ortho, we generally dealt with healthy people and solvable problems. People came to us with torn cartilages—we removed them and they were better. People came to us with broken legs—we set them and they were better. People came to us with arthritic hips—we replaced them and they were better. I loved orthopedics. I loved going to work each day and fixing things. I loved the incredible feeling of accomplishment in what we did.
But oncology is a different story. Oncology means cancer, and cancer usually wins. Pity the poor oncologist, I thought, losing many more battles than she wins; no grateful patients thanking her every day, no tangible results affirming her competence, no happy endings. A lifetime spent signing death certificates, not op reports. Oncologists, I concluded, were better people, stronger people, than I. They did their job, they treated their patients, but they reaped none of the adulation we orthopods took for granted.
Sarah was an eighteen-year-old girl with osteogenic sarcoma of the left ilium. She had been referred to Mayo by her family doctor in Los Angeles. He told Sarah she had “a growth,” it might be bad, and she needed to go to the Mayo Clinic “right away.” We were left to tell her it was indeed bad, and that her only hope was a radical operation called a hemipelvectomy, in which we would remove not only the entire leg, but half the pelvis as well. Even with this mutilating surgery, Sarah’s chances of survival were not good.
Sarah was a vibrant, beautiful, young woman with a perfectly proportioned body, and eyes that radiated innocence and trust. This is the Mayo Clinic, her eyes said. You will cure me. Before we had done a thing her eyes were thanking us.
Part of me liked being thanked by this beautiful young woman. It was an acknowledgment of our power, our skill. But I was uncomfortable, too. Her thanks, her trust, placed upon us a burden I wasn’t sure we could shoulder. This was my first rotation as a senior resident and I was still naive enough to want to fight every bad guy, and to win every fight—but I knew the statistics, too. Sarah had osteogenic sarcoma of the ilium. The five-year survival rate was less than five percent.
But I wouldn’t listen to the voice that tried to reason with me. I preferred to listen to Sarah’s voice telling me how wonderful I was. I envisioned her arms around me, her wet tears on my neck as she thanked me for saving her life.
I was attracted to Sarah—but in a way I found hard to define. I wanted to be everything to her. I wanted to be her brother, her doctor, her lover—but mostly I wanted to cure her. I wanted to say, “We’re going to beat this thing, Sarah, you and me.” (Well, mostly me. I was going to beat it for her. It was to be my gift to her.) Cancer was the big bully forcing itself on this beautiful, virginal creature, and I was the guy who was going to stop it. We were going to drop the gloves and go at it. “Let’s go, shit head. Right now. You want Sarah? Well, you’ll have to come through me first.”
Yeah, right. After cancer had beaten me to a pulp a dozen times in a row I would learn to keep my emotional mouth shut.
I went to Sarah’s room the night before surgery. I didn’t usually do that, and I didn’t attempt to explain to myself why I did it that night. Five percent five-year survival, I was telling myself. That’s five percent, not zero percent. That means some people make it. Sarah has to be one of those people.
It was after ten by the time I got to her room. Her parents had already left. Sarah was lying in bed, her blond hair splayed across the pillow. Her eyes lit up as I entered the room.
I started to smile, then looked away. I flipped through her chart for several seconds, then closed it. I looked at Sarah, then opened the chart once again and pretended to read something. Finally I laid the chart down and asked Sarah how she was feeling.
“Okay,” she replied.
I went through the usual pre-op instructions. I told Sarah she should not eat or drink anything after midnight. I reminde
d her that the orderly would come for her at six o’clock the next morning. Then I asked if she had any questions. Sarah seemed confused. She seemed not to know what she was supposed to say. She shook her head and said she had no questions.
I noticed a little card in front of her and asked what it was. She showed it to me. In a neat, feminine script she had written the word “hemipelvectomy.” I remembered her asking me earlier in the day what the name of her operation was and I noticed her copying it down.
“It’s not in the dictionary,” she said. “I looked.”
No, I didn’t suppose it would be.
“Can you tell me again what it means?”
I wasn’t sure how to explain it to her. It had been easier to hide behind the technical terminology. It was easier to obscure the truth than to illuminate it.
I tried to act casual, as though I were asked about hemipelvectomies all the time. “Hemi,” I began, “is from the Greek. It means half. Ectomy means to remove something. So hemipelvectomy means to remove half the pelvis.”
Sarah frowned in confusion. “But I thought you were going to remove…my leg.”
“Well, we are, Sarah. Your pelvis and your leg.”
“Oh.”
We were silent for a few moments.
“Will it hurt much?” she asked.
“You won’t feel a thing during the operation since you’ll be asleep.” I spoke with the casual ease of an experienced surgeon. “But most patients do have some pain afterward.”
Shut up, you asshole, I screamed at myself. You’ve never even seen a hemipelvectomy.
I just stood there, squeezing her chart until I couldn’t stand it any longer. I turned and started to walk away, then turned back. “Sarah,” I said finally, “I…Well, I’ll do everything I can for you.”
She looked at me and smiled kindly. Now it was she who was providing the care. She was a mother comforting her little boy. She reached out, touched my forearm, and said simply, “I know you will. Thank you.” She was so confident, so trusting. This was the Mayo Clinic. We would save her.
I wondered later who was more naive, Sarah or me. But, of course, it was no sin for Sarah to be naive…
Sarah was the first case, so the orderly came for her at 6:00 A.M. Her parents followed behind. I was waiting for them when they arrived at the surgical holding area. At the door the orderly stopped so Sarah could kiss her parents good-bye. Her father leaned forward and kissed Sarah on the cheek. He squeezed her shoulder, then quickly turned away, hiding his face from her. Her mother stepped forward, her eyes filled with tears. Sarah struggled to sit up. They tried to embrace, but the IV kept getting in the way.
“I love you, Sarah,” her mother said.
“I love you, too, Mom.”
They continued to reach for each other as the orderly pushed Sarah through the double doors into the brightly lit holding area. Sarah’s mom kept her arm extended toward her daughter as the doors swung shut with a gasp of compressed air.
I helped the orderly wheel Sarah into the corner where I introduced her to another orderly, Luella, who was going to do the prep. While the pre-op nurse was attaching a bag of antibiotic solution to the IV, Luella explained that she was going to scrub and shave Sarah’s leg. I sat at the desk as Luella swung the curtains around Sarah’s cart.
I could hear Luella tear open the surgical scrub sponge and begin the prep. “I even have to get up around your private area, honey,” Luella said. “Can you raise your bottom a little?” I could see the shadow on the curtain as Luella had Sarah bend her knees and spread her legs. Every bit of her pubic hair had to be shaved away.
Five minutes later Luella asked Sarah if she had ever had a catheter.
“No,” Sarah replied in a barely audible voice.
“The catheter goes into your bladder,” Luella told her. “That way whenever you need to pee it will just come out through the tube.”
Sarah was told to spread her legs again. Luella washed her with a warm, soapy solution, then painted her with betadine.
“This might hurt a little,” Luella said.
Sarah gave a brief gasp.
“There, now,” Luella said. “All done. Let me get a blanket from the warmer.” Luella was back in a few seconds. She tucked a warm blanket under Sarah’s chin, then tore back the curtain. “Bye, honey,” she said, patting Sarah on the shoulder. “Anything else I could get for you?”
“No,” Sarah whispered.
An anesthesiologist came in and talked to her about the procedure. He said once she was asleep he was going to put a breathing tube in her mouth. He also said she might be given some blood during the surgery. He asked if she had any questions.
Sarah, who seemed not to have heard a thing he said, answered, “No.”
She lay quietly, watching the nurses scurrying back and forth between patients, starting IVs, hanging antibiotics, taking blood pressures and temperatures.
Finally I went over to her. “Sarah, have you had anything to eat or drink since midnight?” I asked.
She shook her head. “No,” she said.
“Okay then, Sarah, it’s time to go.”
I unlocked the cart and swung it out from the stall. We passed through a series of double doors before finally entering the OR. As always, it was cold, and intensely lit. As we entered, I pulled up the mask that had been hanging below my chin. I docked the cart next to the narrow, black operating table and asked her to “scoot over.” The circulating nurse whisked Sarah’s blanket away and Sarah gasped at the cold. As she started to move to the OR table her gown rode up to the top of her thigh. Sarah had been told not to wear panties and she blushed as she tried to tug her gown back down. One of the nurses helped her, then covered her with a warm blanket.
Two arm boards were swung out from the side of the table and Sarah lay with her arms extended to either side. The anesthesiologist wrapped a blood pressure cuff around her right arm while one of the nurses adjusted the IV in her left. Another nurse returned with two more blankets from the warmer. Sarah tried to shrink beneath them.
Just as she was starting to warm up, the anesthesiologist pulled the blankets away and calmly mentioned he had to “place some leads.” Sarah blushed again as he reached under her gown and placed several cold, sticky patches above and below her breasts. As soon as he replaced the blanket another nurse said in a cheerful voice, “Cold, sticky pad!” She slapped a large, cold pad on Sarah’s right thigh. A clear electrical wire ran from the pad to a machine next to the table. “That’s your grounding pad,” the nurse said. Sarah smiled and nodded as if she knew what a grounding pad was.
I could see Sarah’s eyes begin to glaze over. “I have just given you a little something in your IV to relax you,” the anesthesiologist said. I stood next to her, leaned over. “Are you cold, Sarah?” I asked as I tucked the warm blanket under her chin.
“Please,” she said, her voice raspy and small. Her eyes welled up with tears. She struggled to sit up. “Please don’t…”
As the anesthesia began to take effect she sank back down and closed her eyes. “Don’t worry, Sarah,” I said. “We’ll take good care of you.”
The anesthesiologist told Sarah to take a couple big, deep breaths…
From start to finish it was a horrible operation. Oh, nothing went wrong from a technical sense, but the whole thing was so wrong, so unfair. For the first time I began to wonder if we were part of Sarah’s problem rather than part of her salvation. Even the prep and drape seemed obscene. We turned Sarah on her right side, and prepped her from the low back to the knee. We then covered everything except her left leg with sterile drapes. Sarah had now disappeared, buried under a mound of blue drapes. We were no longer operating on a person. We were operating on a tumorous appendage emerging from a blue hole.
Bill took the sterile marking pen and outlined his incision. I held Sarah’s leg high in the air and watched in awe as the purple line skirted her labia, swung up almost to the lower abdomen and then dipped back and around
the upper buttock. When he had finished he dropped the marking pen on the Mayo stand and held out his hand.
“Scalpel.”
It was a long, bloody operation. I was constantly clamping and cauterizing and placing retractors, trying to give Bill the best exposure. As the operation progressed, Bill and the anesthesiologist conversed frequently, deciding when to give the next unit of blood or fresh frozen plasma. There was a steady flow of blood products going in her arm and oozing out her surgical wound.
Every move we made caused more bleeding. Blood pumped and oozed and leaked and squirted. We soon became oblivious to it. Our gloves became tacky and thick with it. Blood spread up our sleeves and coated the front of our gowns. Blood seeped into the surgical sheets and spread down the side of the drapes. Blood dripped on our shoes and soaked into the blankets the nurses had cast on the floor in front of us.
Slowly, over several hours we began to separate Sarah’s long, shapely leg from the rest of her body. The two edges of the incision grew farther and farther apart. When we finally severed the iliac bone, the leg dangled obscenely from a few posterior tendons. These Bill quickly severed and the leg was free.
I lifted the leg, the gaping wound at the top still oozing blood, and slid it into a sterile, plastic bag the circulating nurse held for me. As the leg dropped into the bag the nurse couldn’t hold it and it fell to the floor. One of the other nurses came forward and helped wrap the leg. I glanced briefly over my shoulder as the circulator, carrying her burden in front of her, exited the room and headed to Surgical Path.
Bill and I still had another couple hours of work to do. There was a question of how many sacral nerves we could spare. If we took too few, we would increase the chance of tumor recurrence. If we took too many, Sarah’s bladder and perhaps her and sphincter wouldn’t work.
I stared into her huge open wound and saw virtually nothing familiar. It was all virgin territory to me. I had assisted on plenty of hip operations, but had never seen the inside of the pelvis like this.
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