The Sandman (2 page)

Debby laughed and helped Dios and the other nurse get Lorraine Bell onto the operating table. Peter went back to his work, his pulse beating faster.

“Cross? Dr. Cross?”

“Yes?”

“How we coming?”

“Fine, just checking the vaporizer.”

Cross poured a 150-cc. bottle of enflurane into the vaporizer, then turned and opened his armamentarium and began laying out his drugs—the 10-cc. syringe of sodium pentothal with 250 milligrams of the drug which would first induce Lorraine Bell to sleep, the 5-cc. syringe filled with 100 milligrams of succinylcholine which would relax her muscles, the 5-cc. syringe of curare used to maintain relaxation, and another syringe which he found himself reaching for as if he were in a dream, a 5-cc. syringe in which he placed 2.5 milligrams of neostigmine. He was barely aware of what he was doing. He began to shudder a bit … and laid out the atropine, 1.2 milligrams in a 3-cc. syringe. His tongue was dry, and he felt a cold chill come up his back. Across the room Debby Hunter talked with Dios, but he felt as though he were looking at her through a fog.

“Cross, Dr. Cross?”

“Yes. I’m coming.”

He laid out the endotracheal tube, tested the rubber cuff on it by inflating and deflating the balloon. He then inserted the stylet into the end of the tube which would remain outside of Lorraine Bell’s mouth. He lubricated it, softly rubbing the steel, rubbing it round and round, feeling, as he did it, clean and fast as though he were breaking out of a trance. He then checked out the laryngoscope to see if the light worked. He laid out oral and nasal airways and several tongue depressors to help the patient breathe. He wanted her to breathe for him. He wanted to feel her breath on his wrist. He checked her blood pressure chart again: 100 over 60. Still very very bad. Then he nodded to the nurse and let her know he was ready. He put on the blood pressure cuff, hooked on the leads for the cardiac monitor, made sure the IV was running properly. Lorraine Bell was now receiving her 5 percent dextrose and normal saline.

Quietly, fluidly, in a voice which sounded strange to him—it was that calm and peaceful—he said to Dios, “When she’s asleep, I’ll put in a central venous pressure line.” Dios nodded and Peter took her blood pressure again. It registered as it had on the chart, 100 over 60, and her heart rate was 100, but irregularly irregular, which meant she was suffering from atrial fibrillation. In short, her heart was very weak, and he must be careful. Not too much anesthesia.

When he thought that, it was as if his mind had cleared and he was himself again—he felt brilliant, logical, scientific—the room had become all hard-edged chrome, steel, and tile, and the ecstasy and strangeness that had encircled him a moment ago were now gone. He felt “normal,” though he didn’t know exactly what that meant. But he did know that he kept right on feeling normal until the moment he put the 150 milligrams of sodium pentothal into the IV line. Then, out of the corner of his eye, he once again saw her mouth and he began to feel the fog sweeping over him.

Quickly he picked up the mask, put it over her face, and continued to hand-ventilate her with the bag. He watched as she went deeper, then he injected 60 milligrams of succinylcholine, and he watched as her muscles began their fasciculations, the fluttering of the eyelids, the rippling of the muscles in the arms and the knees, and finally the feet, jerking a little, then relaxing. He knew she was peaceful now, that all her pain was gone and that she was in the place beyond even dreams.

He inserted the laryngoscope into her mouth, exposed the larynx, and placed the endotracheal tube down through the vocal chords into the trachea. He then removed the steel stylet from the other end and hooked up the connector to the machine. Carefully pressing the bag, he inflated the endotracheal cuff, checked for leaks, and, once satisfied there were none, he turned on the nitrous oxide and enfluorane mixture, still checking her blood pressure and keeping an eye on the cardiac monitor (he couldn’t be too careful there).

He kept ventilating with the hand bag and secured the endotracheal tube with a loop of tape which went around her lips. When he touched them, something seemed to break inside of him, literally shatter, as though there were some delicate crystal goblet instead of organs inside his own body. But when it shattered, instead of pain, he seemed to be filled with a terrifically warm liquid, all at once clear and good, and he felt himself swimming in a kind of compassion.

Now he put in the oral airway, using a tongue depressor, and placed in an esophageal stethoscope which allowed him to listen to the patient’s heartbeat and breathing. He checked the heart rate and noticed that during the induction it had gone up from 100 to 126, but now it was returning to normal. The blood pressure had dropped slightly, to 90, but he checked the intravenous line, inserted it, and took the pressure. He found it acceptable—”acceptable”—another word like “professional.” Suddenly that word, too, made him feel wretched, and he began to breathe deeply. God, don’t let anyone notice.

He put the manometer on the line—it read 9 centimeters of water pressure and was fluctuating well. She was ready now, and the circulating nurse prepped the patient’s stomach with iodine soap. Debby handed the surgeon the sterile drapes and towels, and Dios draped Lorraine Bell. He did it quickly, professionally, and Cross felt as he always did when the patient was draped—cut off, removed from the operation. He had heard other anesthesiologists complain about it, especially Harry: “We get them all ready, we control it, and then they take over with their big egos and they get all the credit.” With Harry it was all a game of power. Harry was sorry he hadn’t been able to “cut it” in surgery. Dios now turned to Cross and nodded.

“May I begin?”

“Certainly,” Cross said, and he liked the sound of his voice when he said it. Crisp, in control.

Dios wasted no time. He accepted the scalpel from Debby and made the first incision on the belly. His assistant, Dr. Black, clamped the skin off, and the operation was underway. It would take a while to find the obstruction in Lorraine’s bowel. Since she couldn’t tell them where she hurt, the obstruction could be practically anywhere. Dios had made the incision where another incision had already been made. Cross thought of the old adage he’d learned in medical school: “See an abdominal scar; think of obstruction due to adhesions.” Surgery from the world of the blind. The patients knew nothing, the surgeon little more.

Cross was certain that Dios hadn’t bothered to tell Lorraine Bell’s children, if she had any, or if they had bothered to ask him. Probably they had not. Probably they had sent her off to a nursing home years ago, going out every week at first, then every couple of weeks, and finally once a month. By the second year they would call on her birthday and talk to a nurse, who would tell them she was doing quite well and “had taken her medication. Wouldn’t it be a shame to wake her?” And, of course, they would agree … it would be too bad … ridiculous to wake a now senile woman out of a good dreamy sleep. And so she would waste away until one day when everything had fallen in—her cheeks, her nose, her eyes, one vast sag of wrinkles—everything gone except the mouth, as if it were fighting the battle all by itself, the battle to remain young and beautiful. Such a futile battle it was, too. Cross knew that. He was only thirty-five, but already in himself he could see the signs of decay. He stared over at Debby Hunter. God, she was beautiful.

He watched Dios and his assistant, Black, kneading Lorraine Bell’s intestines, looking for fluid or gas trapped in the loops of the distended bowel. He watched as they shook their heads.

“It’s not there,” Dios said.

“I don’t see any adhesions,” Black said.

“This is so frustrating,” Dios said. “If we can’t find it, we’ll have to open her up again.”

“I know,” said Black wearily, as if he had already given up hope.

Cross watched as she lay there; then he checked her heart, her blood pressure, her breathing. All okay, but then there was a sickening stench and the scrub nurse held her fingers over her nose.

“God,” she said, “she’s done it. She smells like dead fish.”

The room reeked of Lorraine Bell’s shit, and the circulating nurse, Mrs. Martin, looked as though she were going to pass out.

Now they were working on her abdominal wall, Dr. Black using the rakes and Kocher clamps to keep the wall open. Cross watched, still stunned, his left hand preparing to inject her with a slight taste more of anesthetic, this time curare if she became too light and began feeling the pain. (And also to allow her to stay at that great place he had put her. Yes, he was growing excited again, reaching for the syringe labeled Curare.) He watched as they freed the small bowel from the anterior abdominal wall, dividing the adhesions which they found with dissecting scissors.

“Maybe these are it,” said Dios. “Two adhesions. God, the last guy butchered her with the stitching …”

“Yeah,” said Black, “but it didn’t stop her from butchering us. Christ, that odor.”

Cross watched as they began to cut through the adhesions. He knew that these two adhesions wouldn’t be the last of Lorraine Bell’s problems. Sure, they got rid of them, but from the looks of her, some young resident had been practicing carving turkey on her. How many more adhesions did she have inside the loops of bowel that Dios and Black didn’t bother to plunge into because of the smell? It was clear from the speed at which they worked that they were doing their best to get out as fast as possible. Not that they were bad doctors—Dios was a bit of a hacker, but he was by no means the worst—it was just that everyone felt the same way. One had only so much time, stamina, and strength to waste on a gomer. Everyone knew she would be better off dead. So, given that premise,
anything
one did was sort of a bonus for her. Cross watched as the two surgeons started the Noble Plication, and he suddenly felt tears come to his eyes. God, don’t let them notice. What was happening to him? Was he having some kind of crackup? He didn’t understand it. But the moment he had seen her, something had clicked, and so now, as her body began to jerk a little from them tugging on her mesentery, he felt a cold chill come down his back.

He reached for the curare, with its pale green label, only he didn’t pick it up. His hand reached for the neostigmine, and he had almost injected the drug into the IV when he noticed … My God, the wrong drug … or was it wrong … Lord, don’t let them see. Slowly, he put back the neostigmine, picked up the curare, and shot it into the IV. Six millimeters of it. Almost immediately Lorraine Bell began to relax. The doctors resumed stitching up the mesentery. The patient bucked, and now he felt a strange calmness descending over him. All the shakes and fears were gone.

He felt himself pulling away from everything, and he found his hand reaching for the neostigmine, the syringe with 2.5 milligrams in it, reaching behind the curtain where no one could see him (but then they couldn’t see him anyway, for somehow they were no longer in the room, it was just he and Lorraine Bell, oh, yes, and he felt good … all of a piece, not split or unsure of himself anymore) and he stuck the 2-millimeter syringe into the IV, shooting the drug into it, then replaced it with the empty curare syringe, so if anybody looked, they would see nothing unusual, nothing unusual at all … and he heard his mother, Lila Lee, saying to him, “If I could just sleep through it … If I could only sleep through the pain … Petey … I could bear it if I could just sleep through the pain.”

He checked her blood pressure. Christ, it was happening already. Her pulse rate had dropped off from 100 to 90 and was rapidly descending. Her blood pressure had dropped from 100 to 80 and was going down fast. Peter watched and felt the faintest sense of fear, a chill, but the chill seemed to be changed into something else, a rush of excitement, a spreading of happiness which poured through his veins.

Suddenly, Dios spoke up sharply: “Hey, Peter, there isn’t much bleeding.”

Peter turned and looked at the monitors (turned coolly, as if he had been preparing for this all his life).

“My God,” he said, hearing his voice register a wonderfully accurate degree of shock and dismay. “Her blood pressure is down to sixty and her heart rate is down to fifty-five … and dropping … I don’t know what the hell is going on! Stop the operation until I can get her stable.”

Oh, he had done it. Just the right amount of “professional” concern.

Black’s voice was urgent: “Her heart … ventricular heartbeats … now it seems … Christ, she’s going into ventricular tachycardia … Shit … It’s happening too quick … What the hell is it … she’s going into V-fib …”

Dios nodded and yelled. (Though Cross couldn’t hear him, he felt as if he had turned to gold. Never had there been anything like this. He had been waiting for this moment.) “All right, I’m starting external cardiac massage … Get the crash cart … We’ve got to get the pads on her.”

Dios began to pump up and down on the heart, harder and harder, and Peter, feeling as though he were watching himself perform, began to give Lorraine 1.2 milligrams of atropine, which ordinarily would increase the heart rate, but he knew now that he had been successful. He had waited too long. The atropine would get to her too late … Oh, yes, as would the sodium bicarbonate, 50 milliequivalents worth he pumped into her, and finally the one milligram of epinephrine used to stimulate the pulse rate.

“It’s not working,” Peter said. “Nothing’s working at all.”

“It’s no fucking good,” said Dios.

“My God,” said Debby. She turned her long, beautiful back to Peter and held her hair with her hands, like someone gripping the edge of a building. Peter watched her and felt another jolt go through him. He wanted to go over to her, put his arm around her, hold her face and tell her it was all right. Everything was going to be just fine.

He stood there, hands limp at his sides, the glare of the hot lights reflecting off his glasses. He watched, deeply moved, as they wheeled the corpse into the hall.

He walked through his living room, hearing the sound of his stockinged feet as they glided over the fake Oriental rug. In his hand was a Scotch and soda, and the sounds of the ice cubes clicking sounded like the roll of dice on a back alley in Baltimore.