“I’m sorry, Ma,” Valerie says again, keeping silent tally of her apologies.
“Well, you’re here now,” Jason says, flashing Rosemary his most captivating smile. It is no family secret that Jason is her favorite child, his homosexuality notwithstanding.
“And you,” Rosemary says, giving Jason a once-over that he would later joke to Valerie looked like a search for signs of AIDS. “You’re way too thin, honey.”
Jason drapes one arm over Rosemary’s shoulder, further charming her. “Oh, come on, Ma,” he says. “Look at this face. You know I look good.”
Valerie considers his statement and feels herself tense. Not so much because Jason is talking about his handsome, unscarred face, but because of the glance he shoots her afterward. It is a look of worry, of sympathy, of realizing that he, too, just said the wrong thing. Valerie knows this look of pity well and feels an ache in her heart that her son will now come to know it, too.
***
The following morning, while Charlie is still dozing, Dr. Russo comes to examine his hand. Valerie can tell right away that something is wrong despite his impassive expression and slow, deliberate movements.
“What’s wrong?” she says. “Tell me.”
He shakes his head and says, “It’s not looking good. His hand. There’s too much swelling . . .”
“Does he need surgery?” Valerie asks, steeling herself for bad news.
Dr. Russo nods and says, “Yeah. I think we need to go in there and release the pressure.”
Valerie feels her throat constrict at the thought of what “going in there” entails until he says, “Don’t worry. It’ll be fine. We just need to release the pressure and do a graft on his hand.”
“A graft?” she says.
“A skin graft, yes.”
“From where?”
“His leg—the thigh area. Just a little strip of skin is all we’ll need . . . Then we’ll put it in a meshing machine and expand it—and secure it to his hand using a few surgical staples.”
She can feel herself wince as he continues, telling her the whole graft will be nourished by a process called plasmatic imbibition—which means that the graft literally drinks plasma, then grows new blood vessels into the transplanted skin.
“You make it sound easy,” she says.
“It is pretty easy,” he says, nodding. “I’ve done thousands.”
“So there’s no risk?” she asks, wondering if there’s a judgment call involved, whether she should seek a second opinion.
“Not really. The main concern is fluid accumulation under the graft,” he continues. “To prevent this from happening, we’ll mesh the graft with tiny rows of short, interrupted cuts.” He makes a small cutting motion in the air and continues. “Then, each row will be offset by half a cut-length, like bricks in a wall. In addition to allowing for drainage, this allows the graft to both stretch and cover a larger area . . . and more closely approximate the contours of the hand.”
She nods, feeling queasy but reassured by the precise science of it all. “I’ll also be using VAC therapy—Vacuum Assisted Closure—which does pretty much what it sounds like it does. I’ll place a section of foam over the wound, then lay a perforated tube onto the foam, securing it with bandages. A vacuum unit then creates negative pressure, sealing the edges of the wound to the foam, and drawing out excess blood and fluids. This process helps to maintain cleanliness in the graft site, minimizes the risk of infection, and promotes the development of new skin while removing fluid and keeping the graft in place.”
“Okay,” she says, taking it all in.
“Sound good?” he asks.
“Yes,” she says, thinking she does not want a second opinion, that she trusts him completely. “And then what?”
“We’ll keep his hand immobilized in a splint for four or five days, then continue therapy and work on function.”
“So . . . you think he’ll be able to use it again?”
“His hand? Absolutely. I’m very optimistic. You should be, too.”
She looks at Dr. Russo, wondering if he can tell that optimism has never been her go-to emotion.
“Okay,” she says, resolving to change that.
“Are you ready?” he asks.
“You’re going to do the surgery nowT she asks nervously.
“If you’re ready,” he says.
“Yes,” she tells him. “I’m ready.”
Tessa