“Okay smart guy, how many times have you done this?” Meg asked.
“Four times, and I’ve assisted and observed a similar procedure on a patient of the same age. It’s textbook, and there’s little risk of complication. But, keep in mind, that doesn’t mean there’s no risk.” I went to Lizzy’s bedside and observed her vitals. “We can schedule the procedure for this afternoon.”
“I trust you, Doc,” she said, “even though I still think you look too young.”
I finally smiled at her. “You’re going to be fine . . . better than before.”
Her eyes sparkled as she smiled back. I wondered briefly what she would look like in ten years. A vision flashed through my mind of her in a wedding dress and then another of her holding an infant. Struck by my uncharacteristically sentimental reaction, I shook my head in an attempt to eliminate the thought.
“What?” Lizzy said.
“Nothing.” I offered a short nod to Lizzy’s parents, left the room, and gave my instructions to arrange the surgery.
Later that day in the operating room, as my surgical team and I watched the X-ray screen and fed the line up from Lizzy’s leg, her pressure started to drop. A few moments passed as I calmly ordered the administration of medicines and gave instructions to the other surgeons and nurses, but her blood pressure continued to plummet. The anesthesiologist looked at me intently, waiting for me to make a decision.
There is something to be said about knowledge and experience in the medical field. You can know every fact and read every case study, but when you have less than ten seconds to make a decision your experience is mainly what is tested. Your ability to be confident in your answers comes from knowing the positive outcomes in study and the negative outcomes from your own goddam mistakes.
“We have to open her up,” I said.
Every nurse and doctor went into motion the moment the words came out of my mouth. Within seconds trays were shoved in front of me with surgical instruments of every kind. The smell of iodine was heavy in the room, even through my mask. The sound of the saw piercing Lizzy’s sternum was like nails on a chalkboard. I had never had an emotional reaction to the gruesomeness of surgery until that moment. Everything about what I was doing seemed wrong. Cranking the spreaders to pull her bone and tissue apart took more effort than usual, and I had to cauterize several leaking ends from the breastbones. I gagged behind my mask at the smell of the vaporized blood and bone. Lizzy’s beautiful chest was peeled apart and spread open, revealing a nightmare about to unfold.
To my absolute shock and horror, her entire chest cavity was full of blood. Like in a dream, my hands and arms moved slower than my brain. “Suction!” I kept yelling, but I couldn’t find the source of the bleeding. Seconds felt like days. “Fuck! Suction, goddammit!”
“She’s crashing,” someone said calmly.
“I’m trying,” I said through gritted teeth. I was doing everything right. I couldn’t understand what was happening and why it was happening so fast. I began running through long procedural lists in my head. Had I checked every possible source, I wondered? I continued barking orders at the team.
Twenty minutes later, a fellow surgeon told me it was over. I called the time of death with Lizzy’s heart still warm in my hands.
The first face I saw when I left the operating room was my father’s. He put his hands on his hips, which forced his overweight Hawaiian-print-clad belly to protrude from his lab coat. He pointed to the waiting room at the end of the hall and said, “Go tell the mother and then meet me in my office.”
Was he mad? I had just lost my first patient, a beautiful fifteen-year-old girl who’d had the rest of her life ahead of her.
I swallowed back anger. “You’re not going to apologize to me?”
“Apologize for what?”
“This is fucking tragic,” I said in a frantic voice.
“Keep your voice down,” he barked back at me, but it was too late. I had already gotten the attention of Lizzy’s mother, who was watching me through a wall of glass from the waiting room. My father leaned over and in a quiet and calm voice said, “It wasn’t a tragedy, it was a mistake—that you made. I read the chart. You misdiagnosed her.”
Shocked, I stared blankly at the wall behind him. I couldn’t blink my eyes. They were dried out and stuck open, and my heart was beating out of my chest. Thoughts began swirling frantically in my head. I was a terrible surgeon. I was a fuckup. I was a murderer.
“Why didn’t you stop me?” I whispered. I still couldn’t look him in the eye.
“Because you were so goddam anxious to get in that O.R., I didn’t have the time.”