Michael Palmer - The Society

Goshtigian, dry-mouthed and groggy from the pre-op meds, smiled up weakly and patted Will on the arm.

“You’re just excited about getting to muck around with my innards,” he said.

“We’re going to get that cancer out of you, Kurt, and you’re going to be as good as goo.”

“You mean new.”

“Pardon?”

“You said goo when you mean new .”

Will had no idea what the man was talking about. Probably the pre-op meds, he decided.

“Yes,” he said. “Well, if you’re ready, I’m going to go scrub in. My partner Dr. Cameron is there in waiting for you. I’ll be in soon.”

Will replaced his mask and headed back into the scrub area. The wonderfully pleasant sense of well-being and connection to his world had, if anything, grown more intense. He was halfway through a four-minute scrub when he realized that he had broken his routine again, this time by taking the hexachlorophene-impregnated brush to his right arm and hand before his left. Strange. No big deal, but strange just the same . When he backed out through the scrub-room door and then into the OR, Kurt Goshtigian’s abdomen was already washed, shaved, prepped with an antiinfective, and covered with sterile drapes. Carrie Patel, the best anesthesiologist on the staff, was in the process of putting him to sleep. With a nurse’s help, Will slipped into a gown, had it tied behind him, then drove his hands one at a time into latex gloves, taking pains to do the left hand first. As usual, Gordo was talking almost nonstop.

“So, lad, are ye all boned up on the Whipple? The man’s first name was Allen, you know. Allen Whipple. Now, there’s a piece of trivia for you. . ”

Beneath his mask, Will smiled at his partner, even though he realized he wasn’t picking up everything Gordo was rambling on about. It was always good to work with him in the OR. For one thing, he was skilled and quick as a surgeon and intuitive as an assistant, and for another, his demeanor kept the team loose and upbeat, even through the most grueling cases.

The initial laparoscopic evaluation went smoothly and showed what Will had prayed it would-no evidence for spread of cancer into the organs adjacent to the pancreas. Throughout the procedure, though, Will sensed a very mild fuzziness to his thinking, and he also noticed that, on and off, especially with fine movements, his hands shook ever so slightly. Low blood sugar? he wondered. He had eaten as usual, so the possibility seemed remote. A virus of some sort? No symptoms to go along with the mild light-headedness. In fact, on the whole, he still felt upbeat and positive.

“Ready, everyone? Well, okay. Number-ten blade, please, Beth.”

“Again, please?” the scrub nurse asked.

Will felt a spark of irritation.

“I called for a ten, a number-ten blade.”

There was more of an edge to his voice than he had intended. The nurse in turn, glaring at him from above her mask, slapped the blade into his palm with more force than usual for her. Across the table from Will, Cameron immediately reacted to the rocky start.

“Okay, Willy,” he said, “a-cutting we shall go.”

The incision Will made, though quite large, was precisely the length he had planned. After bleeders were clamped and cauterized, he sliced open the peritoneal membrane, exposing the structures beneath. So far so good, except that Will was beginning to sense things weren’t good at all. He was feeling nauseated now, and his light-headedness was more constant. For the first time, he wondered if he was going to be able to continue with the operation.

Using large clamps and retractors, he and Cameron pulled the margins of the incision wide apart. The intestines, arrayed just beneath where the peritoneum had been, were moved aside with damp towels, exposing the blood-tinged structures of the operative field, glistening under the harsh saucer lights overhead.

Will’s mouth now felt desert dry. He peered down at the organs-pancreas, stomach, liver, gallbladder-and at the arteries, veins, nerves, and ducts servicing each one. In his mind, he had mapped out almost every second of this procedure. Now he couldn’t remember where he was to start.

“Everything okay, there, Willy?” Cameron asked.

Will glanced up at him from over his mask.

“I. . all of a sudden. . I’m not feeling so good.”

“You need a basin?. . Need to step away?”

“Huh?”

“Will, look over at me. Kara, take those glasses off him. Let me see his eyes. . ”

“I’m. . okay. . just. . need. . moment to. .”

Will felt the light-headedness intensify and a profound dizziness set in as well. His knees became rubbery, and his vision began to darken. He tried to speak, but only guttural sounds emerged from beneath his mask. Clutching at the sterile drape, he lurched to one side, then pitched forward heavily, landing facedown in the gaping incision.

The inestimable blackness was pierced by sound-garbled voices captured by Will’s gradually increasing consciousness. Next came the ghastly sensation of choking-a tube the size of a redwood, clogging his throat.

Will tried to move his arms but met immediate resistance at the wrists. From his earliest days as a med student in the hospital, he had watched patients be intubated and put on a ventilator-some comatose, some semiconscious-and wondered what it could possibly have felt like. He had even asked some of them after they were on the way to recovery and had concluded that the degree of helplessness, pain, and horror of the situation was a function purely of how much medication they had received. From time to time, especially with emphysema cases, the relief of being able to get in enough air made the breathing tube tolerable. But mostly, the discomfort was quite frightening, especially in the initial hours, before there was any chance to learn to cope.

Will knew he would never again have to ask a patient about the sensation.

He thrust his tongue against the hard rubber airway that had been slipped into his mouth next to the tube and then taped in place to keep him from biting down. Awareness was rapidly returning, along with swirling memories of becoming sick, terribly sick, in the OR. He must have stopped breathing, or come damn close. The fact that the discomfort and panic seemed manageable suggested he was being medicated. Was this the first time he had been awake? With no little effort, he forced his eyelids apart. Even before his focus sharpened, he knew that he was in the ICU. The fluorescent lights over him were midday bright. Across the cubicle, two nurses were talking.

Was it a stroke, he wondered? Is that what had happened to him? A cerebral hemorrhage of some sort? Methodically, he tested his hands and arms, then his feet and legs. No problem moving anything.

The incision! He had gotten horribly dizzy and toppled over into the incision. He could envision the blood and the coils of intestine as he pitched downward toward them. But there the images stopped.

How long had he been out? What happened to his patient?

He opened his eyes wider. As his consciousness grew, so did the suffocating discomfort in his throat. He also became aware of another unpleasant sensation-the desperate need to pee. Easy, easy, he told himself. There was no way he could have been unconscious on a respirator in the ICU and not have had a catheter inserted to drain his bladder. Easy. The pressure and urgency was almost as dreadful as the tube. He had never been a hospitalized patient before. Now he wondered if he had been sympathetic enough with those who were.

The nurses were two whom he knew well, Anne Hajjar and Donna Lee. He banged the back of his hand against the guardrail.