The Scribe of Siena
Melodie Winawer
PART I
EMPATHY
The problem with being a neurosurgeon is that when the telephone rings, you have to answer it. When the phone by my bed went off at 3:00 a.m. I went straight from sleep to standing. The emergency room attending sounded like he was having a bad night.
“Dr. Trovato? Dr. Green here, Area A. We’ve got an old lady with a cerebellar hemorrhage—she’s unresponsive, and the CT scan looks nasty. How soon can you get in?”
“Eight minutes. Call the OR.”
The pocket of skull housing the cerebellum is a dangerously small space with rigid walls; there is no room for an explosion of blood. The consequence is disaster—the brain gets pushed in the only direction possible: down through the foramen magnum, the big hole in the bottom of the skull, crushing the brain stem, the control center for all basic life functions. Unless a surgeon gets there in time. I drove to the hospital in the dark, planning my approach. Amsterdam Avenue was quiet, with a few yellow cabs roaming for nonexistent fares. I pushed my speed to hit all the green lights.
I scrubbed in at the vast stainless-steel sink and backed into the OR through the double doors. Linney, my favorite anesthesiologist, took her place at the patient’s head opposite me while I pulled on surgical gloves. The anesthesiologist’s job is to monitor every breath, heartbeat, and rush of blood pressure through the vessels. Linney, smooth and quiet, signaled to me—OK to cut. I looked at the back of the patient’s neck: innocent, slightly wrinkled, hiding the catastrophe beneath. I made a quick incision on the back of the scalp, a few inches behind her ear, then running down the back of her neck. Down through skin, then muscle, then picking up the craniotome, I sawed through bone. I sliced through the dura, exposed the cerebellum . . . there. As I scooped out the fresh clot, I felt suddenly short of breath. For a moment I was drowning, flailing for the surface.
“Linney,” I gasped, “is there a problem with the vent?” Linney looked up at me, startled, and then at the monitors. Three seconds later, a long three seconds, the alarms started ringing.
It was nearly noon before the patient opened her eyes, and by late afternoon she was awake and holding her daughter’s hand. I headed to the locker room to change.
“Beatrice, lunchtime,” Linney said as we stripped off our gowns and shoe covers. I followed her to the staff cafeteria. Linney did not have conversations like other people. If I called her up and said, “Hi, how are you?,” she’d say, “Get to the point.” We sat across from each other at a white melamine table. The cafeteria had aspirations of greatness it did not quite achieve. A letterpress sign read ARTISANAL BREAD SELECTION, suspended over a basket of plastic-wrapped rolls, and the chef’s suggestion of the day was unintentionally thrice-baked ziti. I had an apple.
“Beatrice, how did you know that woman was hypoxic?”
“I felt like I couldn’t breathe,” I said, “but I knew it was the patient.” I hadn’t realized this until I said it out loud.
“So what you are saying, Dr. Trovato”—I knew I was in trouble now, since we were no longer on a first name basis—“is that you just knew?”
“I just knew,” I said.
“You should have had more than an apple,” Linney replied, changing the subject with her usual abruptness. “We’ve got five more cases today.” She got up from the table, leaving me holding the apple core.
I sat at the table for a few minutes after Linney had gone. Surgery seems so straightforward: open someone up, fix what’s wrong, close. But even working inside the body doesn’t necessarily get to the center of the problem. When I was training to be a neurosurgeon, I wanted to know whether a teenage girl’s headache was a symptom of a bad home situation, or a herald of a leaky brain aneurysm. I wanted to be sure that the depressed patient I sent home with pain medication for a brain tumor wouldn’t try to commit suicide by taking all of it at once. And I’ve always wished I could reach my patients silenced by loss of language or trapped in the blankness of coma, circling endlessly in their own internal darkness. I’d touched people’s brains with my hand, but I couldn’t know how it felt to actually be inside someone else’s head. Today, though, it seemed I had.
* * *
I’ve been orphaned twice. The first time was at birth, since I never knew my father, and my mother and twin sister died just after I was born. I was twin A, though I’m not sure whether that counts, now that there is only one of us. My brother, Benjamin, had just turned seventeen when he gained a little sister and lost a mother; he was transformed suddenly from brother into parent. I can’t imagine how he did it. All I know is his college education got postponed for a year; he didn’t say more.
Ben told me Mom never bothered with finding fathers for her children. “A minute and a mother are all you need,” she used to say. I quoted that when I was a kid without really understanding it, and I got some very odd looks. Once I hit adolescence, I realized why. I never met Mom, unless you count being inside her as meeting her.
All my nursery school classmates were jealous of my uni-parent. On Mother’s Day when the moms visited and got their irregular heart-shaped cards, Benjamin came to class dressed up in a polka-dot housedress, a blond wig, and pumps. He had just started studying microbiology, so he brought in cookies in the shape of microorganisms. I liked the viruses best because they looked like jewels. On Father’s Day he arrived wearing a double-breasted suit and a Groucho Marx mustache-nose-eyeglass combo. No one ever made fun of me for having neither a father nor a mother; they all wanted a Benjamin.
For kindergarten, Ben enrolled me at the Franciscan St. James Academy, the natural choice for reasons of tradition and nostalgia; Ben had learned his letters and responsorial psalms there thirteen years before. There was a black-and-white photo of him on the wall in his role as the camel in the annual nativity skit—I used to stop and look at it on my way to Tuesday Mass. I got to play the Virgin Mary, but part of me wished I could have been the camel instead.