Public Anatomy (2 page)

So far, so good.

Throughout the procedure, Liza narrated each step for SurgCast’s audience. She described the robotic instrument, how it worked, and how robotic surgery was so much better for the patient than traditional surgery performed through a gaping incision. She described how this patient suffered from a diseased uterus, the bleeding and pain, and how much better she would feel after the operation.

During this final portion of the operation, Liza looked up from her console, curious to see if the video cameras still focused on her. Glad to see one camera seeking a full facial shot, she winked over her mask and gave a quick head shake so her silver loop earrings would jangle and flash. The camera panned down, lingering ever so briefly at her waistline, and continued to the floor. Liza glanced at the monitor to see her naked feet.

“This is an important part of the robotic controls,” she said. “With the foot pedal, I can manipulate two instruments at once.”

She had anticipated that the cameraman might want to show this portion of the apparatus, so she’d prepared for it with a pre-op pedicure from her favorite salon. Her toenails were painted a glossy brown with a little yellow smiley face on each nail. She checked the monitor and wiggled her toes, the little faces performing a wavy dance.

Dr. French’s narration, along with her camera-friendly intraoperative flair, created a logjam of viewer e-mails. The company’s advertising specialist estimated the number of communications-per-episode to be up by 50 percent, a veritable windfall for the company. At first, the film crew kept up with each question received at “command central,” a techno-modified work bench with a computer in the corner of the operating room. From this vantage point the whole filming process was controlled, from camera angles to audio control to an open phone line connected to company headquarters, where external image transmission was continuously monitored.

Most of the questions came from interested patients.

Should I have a hysterectomy?

Does the robot procedure cost more?

How do I make an appointment?

After screening for appropriate content, chief resident Greenway read each e-mailed question aloud for all viewers to hear. For a moment, the film crew focused on him. At six foot three, his athletic build and tanned face were attractive features for the camera, even though mostly hidden by surgical garb. The resident answered the questions as best he could, with additional color commentary added by Liza French. Each unanswered e-mail was catalogued and archived for a later individual response.

The release of tension toward the procedure’s completion let a bit of frivolity seep into the room, and the rigid e-mail screening process relaxed.

“We have time for one more e-mail,” Greenway announced, and he read the last question verbatim.

“My wife wants to have this operation and I was wondering if it changes the way, you know, how we make love.”

After a moment’s hesitation, the resident finished the message.

“She was the one who told me to ask the doctors.”

Except for a few muffled laughs, the room fell quiet, then gave way to audio-detectable snickering.

Poised and waiting for the next prompt, SurgCast’s crew hoped to move forward from this entertaining but awkward moment.

Dr. French brought the focus back to the operation at hand.

“The final step before closure will be removal of the already detached uterus itself.”

She directed the chief resident to clamp the dangling organ and remove it. Then she returned to the viewer’s e-mailed concern.

“I appreciate your question. Your wife will be the same woman she was before. I hope that’s what you want.”

After that last comment, Greenway shot her a wide-eyed glare.

Liza shrugged, temporarily pulled down her mask, and mouthed back, “Well?”

To complete the operation, Greenway began to remove the robotic instruments from the patient’s abdomen.

During the distraction, Cate, the medical student, began watching her mentors instead of the telescopic camera she was holding. She accidentally banged the resident’s uterine clamp with her instrument.

Cate quickly readjusted the camera. The resident readjusted his clamp, their rapid movements brushing against the sterile drapes.

Liza twisted inside the console to see what was happening at the operating table. Her bare foot slipped off the pedal. When she looked back at her screen, a pulsating geyser of arterial blood covered the field.

“What the hell?”

The SurgCast crew kept filming. A precipitous decline of the monitor’s tone indicated the patient’s heart rate was plummeting.

The anesthesiologist, quiet the entire procedure, announced, “I’m losing her pressure up here.”

Cate scrambled to reposition the camera, again. But the lens was submerged in a sea of blood.

With no visualization of the abdominal cavity, Liza stared, paralyzed, at red waves splashing her screen.

“She’s bleeding out,” Greenway yelled. “We have to open her.”

Nurses scrambled to get blood for transfusion.

The last words the online viewers heard were Dr. French’s. “Cut the damn cameras.”

She dashed to the operating table and watched her resident grab the scalpel, cut a long skin incision, and turn an elective, highly publicized operation into a last-ditch effort to save the woman’s life.

Throughout the nation and around the world, each viewer’s computer screen faded from red to black.

“Dr. Branch?”

Silence.

“Dr. Eli Branch? Are you in here?”

Eli Branch squinted at a bright column of light filtering around a large figure in the doorway.

“You-hoooooo, Dr. Branch.”

The call room was big enough for only a bed and a nightstand. The bed was a gurney he had rolled in from one of the exam rooms. He just hoped the sheets had been changed since the last patient. Before sneaking away from the nurse’s desk for a few minutes of sleep, Branch had cranked the thermostat way down. In contrast to the sizzling one hundred degree temps that had plagued the River City for over a week, the sheets, dirty or not, were now icy cold.

The heat wave, combined with a sixty-year record drought, tested the civility of Memphis citizens, their dispositions often frazzled on the best of days. Adding more burn to the heat, the city’s sanitation workers decided to strike, leaving heaps of festering garbage along the curb of every apartment complex, residential community, and restaurant across the city. Hot, dry, and putrid were not the top three descriptors that the Chamber of Commerce would have chosen to advertise the metropolitan center of the Mid-South. More than forty years ago, the city had witnessed the tragic climax of its first sanitation workers strike: an assassination on the balcony of the Lorraine Hotel that sent the nation into turmoil. At the moment, Eli wished to ignore all this, as well as the nurse at the door, but as sure as the rain would stay away, she would not.

“Don’t think I can’t see you under those covers.”

She shifted in the doorway, and the slender column of light switched from one side of her to the other.

A digital clock on the nightstand read 2:34 a.m. Five hours to go in his twelve-hour shift. Branch was accustomed to waking up for surgical emergencies at Gates Memorial—gunshot wounds, a perforated bowel—but since his scalpel-induced hand injury just a few weeks ago, he had been forced to take ER call in this small community hospital in White-haven, just south of the downtown medical center. It provided his only income.

Middle of the night
, he thought.
No telling what this could be
. Something serious like a myocardial infarction, or fleeting like gas pains. Or suicidal ideations, a middle-of-the-night death wish. He could only hope it was something surgical, like a deep, nasty laceration.

“Don’t make me come tickle you out the bed.”

This brought him bolt upright.

“Yes, I’m here,” he told the nurse.

“Sorry to wake you, doc, but we’ve got a walk-in.”

Eli was fully awake now. He flipped on the bedside lamp and checked his pager. No calls missed.

“I don’t use pagers. Easier to come knock on your door.”

“What is it?”

“Male, early sixties, says the top of his head is crawling.”

Eli ran a hand through his hair. “What?”
Top of his head crawling?

The nurse stepped back and let the door start to close. “I don’t know, doc. Probably some nut case.”

“Okay, be right there.”

She left, and Eli rubbed his face and stood. A month ago he was the new hotshot recruit at the University of the Mid-South Medical Center. An academic surgeon poised to rise to the top. Now, he was the doctor of choice for nocturnal crazies that roamed south Memphis.

Branch pulled a white coat over his wrinkled scrubs and threaded his splinted hand through the sleeve. Squinting under bright fluorescent lights, he approached the examination area. Outside curtain three, the charge nurse handed him a clipboard. He read the name.

Norman Felts.

“Do we know him?”

“Norman? He’s here at least once a week.”

Eli scanned the sheet and found a list of psychiatric meds. “Once a week?”

“Yeah, but we don’t call him Norman.”

Playing her game, Eli asked. “What do we call him?”

“He’s known to the staff here as Tobogganhead.”

Eli gave her an odd look. “Toboggan? As in wool cap?”

“You’ll see.”

He brushed the curtain back to see Norman sitting on the gurney, legs dangling, a blue stocking cap pulled low over his ears. The day before, the temperature had topped out at one hundred and three degrees. Today’s prediction was a Memphis cool front, dropping to ninety-nine. Eli couldn’t imagine anyone wearing a wool toboggan.

Eli extended his hand. “I’m Dr. Branch.”

“He is?” Norman looked at the nurse. “And handsome too.” Rather than shake Eli’s hand, Norman ran his fingers across Eli’s palm, as though reading the lines.

“Just tell him what’s wrong, Norman,” the nurse said.

“I’m getting to that, Janice.” He said her name loudly, then looked Eli up and down. “He’s new, isn’t he?”

“Yes, this is my first night here,” Eli said, hoping to speed up the process. “Why don’t you tell me—”

Norman interrupted. “What kind of doctor is he?”

Confused by Norman’s odd questions in third person, Eli noticed that Janice was thoroughly amused. She leaned forward with both hands on the bed, a stethoscope dangling from her shoulders like a necklace framing full-chested blue scrubs.

“You’re lucky, Norman. Dr. Branch is a surgeon.”

Norman spoke directly to Eli. “A surgeon. Oh my. I need a surgeon, yes I do. You do specialize in surgery of the neuroconnective tissue, don’t you?”

Janice covered a silent laugh with her hand.

Eli looked at his patient. It was middle of the night, the place was
quiet, deserted practically, yet Norman was somewhat charming in an odd sort of way.

“Yes. In fact, I’m a neuroconnective specialist.”

“Well goody,” Norman said, “because it feels like the top of my head is crawling off.”

“Let me take a look,” Eli said, reaching to remove the wool cap with his right hand. He held his left close to his side in a splint.

Norman pulled back. “What’s wrong with your hand?”

Eli raised his arm and examined the splint as though for the first time. The scar down his forearm peeked through the support, the flesh still red and angry. He’d wondered how patients would react to his injury. Now he knew. Eli decided there was no reason to hide the truth.

“I was on the wrong end of a knife fight.” He noticed that the nurse perked up, listening intently.

“A knife fight? Like in a bar?”

“No, not exactly. In the operating room. A scalpel, actually.”

Norman thought about this. “So that’s why you’re here, taking ER call,” he said. “You can’t operate anymore.”

Eli nodded. “Severed most of the tendons.” He raised his hand and watched a flicker movement of his fingertips. “With rehab, I’m getting a little back.”

Norman grimaced. “I’m sorry, doc.”

Eli squeezed Norman’s knee, then reached to remove his cap. “Let’s take care of you, shall we?”

But Norman pulled away again.

Eli looked to Janice for assistance.

“He’s never let us take it off before,” she said.

Norman confirmed this. “I never take my cap off in public.”

Eli’s first impulse was to say,
How the hell do you expect me to help you?
He hesitated, calculated his words. “You’re going to have to trust me.” Eli reached for Norman’s toboggan.

The edge of the cap was stuck as though sealed to his forehead. When Eli broke the seal, a tiny white flake, like a piece of skin, fell out and stuck to the bed sheet. Janice stepped back.

But rather than stick there, the white flake began to move, then wiggled to a crawl along the linen’s surface.

“It’s a maggot!” Janice’s voice held both clinical objectivity and a touch of horror.

Eli peeled the cap back and slung it to the corner, a shower of white larvae following in its wake.