‘How are you feeling?’ asked the head nurse.
‘Fine, thank you,’ Laura replied.
‘I was asking Miss Fels, Dr Castellano,’ she retorted.
‘Oh,’ said Laura, trying to hide her embarrassment.
‘I’m okay,’ the patient answered.
The head nurse smiled. ‘If you need anything, just holler.’
‘Can’t you do something about these damned contractions?’
‘Stay loose, Marion,’ Laura interposed, ‘we’ll be able to give you some medication very soon.’
‘Yes,’ the head nurse confirmed, ‘we’ve got you scheduled for a saddle block.’
Florence Nightingale withdrew her smirking face from the doorway. Laura thought to herself, Isn’t it wonderful to be getting such support from the teammates of my gender, who resent my wearing a white coat instead of a white hat. Please, Walter, eat that damn sandwich before this woman is fully dilated!
She tried to regain the patient’s confidence by taking her blood pressure and then checking her cervix, which – to her alarm – had dilated to nearly eight centimeters. The labor was progressing more rapidly than anyone had expected.
As soon as the patient’s contraction ended, Laura asked her gently, ‘Did I hear her call you “Miss”?’
Marion smiled wanly and replied with some difficulty. ‘Yeah. I didn’t want to marry him – mainly because he was married to someone else. Still, I’m not getting any younger and I wanted to have a kid before it was too late.’
‘What do you do?’ Laura asked.
‘Work for The Globe. I was so busy being successful that I didn’t take a look at the biological clock. Are you married, Doctor?’
‘Please call me Laura. And the answer’s “Not yet.”’
Suddenly Marion blurted, ‘Quick, Laura, your hand!’
As Marion moaned and squeezed her hand tightly, Laura murmured, ‘Relax. Try to breathe normally. It’ll be over soon.’
When she caught her breath, Marion inquired, ‘How much more of this till I get my baby?’
‘Not much,’ Laura replied reassuringly, inwardly praying that Walter was already speeding back along the Fenway. ‘I’ll just check you again.’
To her consternation she discovered that the cervix was fully dilated and the baby was at the plus two station.
Christ, it was first down with goal to go! She rang for the nurse.
‘This is it,’ Laura whispered to Marion.
‘Thank God, these contractions are starting to kill me.’
A squad of nurses bustled in and began to wheel the mother-to-be to the delivery room. In a split second Marion was gone.
Suddenly a voice behind Laura whispered unctuously, ‘Hadn’t you better scrub up?’
Shit, it was the friendly head nurse.
‘Yes, of course,’ she responded in a state of mounting panic. ‘Uh – when Doctor Hewlett comes back, be sure and tell him where I am.’
‘Of course, doctor.’
Laura sprinted down the hall, stopped at the sink outside the delivery room, and began to scrub.
All the while she struggled to control the rapid beating of her heart.
She pushed open the door and entered the O.R., where a second nurse was waiting to help her into a sterile gown and gloves.
From a distance she could hear Marion groan with pain.
‘Where’s the anesthesiologist?’ she asked. ‘He’s supposed to be giving her a saddle block.’
‘Nico’s just been called on a Code Blue. He may be quite a while.’
Oh God, Laura thought to herself, I ought to call him back on a Code Blue—’cause I don’t think I can keep breathing on my own. And I know I can’t do the anesthesia on my own.
She stood motionless, trying to remember what a real obstetrician would do in a situation like this. He would administer a pudendal. She had observed a few of those procedures, but had never actually done one.
Now she had no choice – Laura took a deep breath and walked into the brighter lights that flooded the operating room.
Then suddenly the miracle occurred. To her astonishment she was no longer shaking. She found herself moving calmly toward the table, where Marion’s legs had been strapped into the stirrups for delivery, her abdomen draped with sterile towels and sheets. The head nurse stood nearby at a small table on which she had tidily arranged the surgical instruments.
Laura rapidly rehearsed all the instructions she had memorized. First and foremost, do not hasten delivery or you might cause serious damage to the mother and child.
Depress the perineum to stretch it and let the newborn’s head clear the opening of the vagina.
From beyond her field of vision, Laura heard one of the nurses cry, ‘Look, the baby’s crowning.’
With an icy calm Laura instructed the Head Nurse to fill a syringe with ten cc’s of Xylocaine.
As she was waiting, she inserted her left hand past the baby’s head and felt for Marion’s ischial spine. Then, with her finger on the pudendal nerve, she asked for a ‘trumpet’, a metal tube that she inserted to guide her eight-inch needle. Taking the syringe with her other hand, she put it through the trumpet till she felt the tissue at the side wall of the vagina. She then withdrew the needle slightly to be sure there was no blood. And finally injected the painkiller.
At that moment Marion had another excruciating contraction.
‘Shit,’ she gasped. ‘The goddamn drug’s not working!’
Laura answered in what she hoped would be reassuring tones. ‘Xylocaine needs about two or three minutes to take effect, Marion.’
Indeed, less than five minutes later, all was well – for Marion, at least. Laura was able to perform an episiotomy. With a pair of straight Mayo’s scissors she made a three-inch cut from the base of the vagina toward the rectum to facilitate the baby’s grand entrance.
And Marion did not experience the slightest twinge.
Yet now things seemed less clear. A torrent of blood and mucus was pouring everywhere. But somehow Laura’s hands found the infant and she gently helped it clear. Its face and chin – and then the neck.
Functioning like an airplane on automatic pilot, Laura carefully rotated the infant and disengaged its shoulders from the mother’s pelvic inlet.
Slowly (every movement must be slow, she kept reminding herself) she turned the baby so that its face pointed downward. Now the second shoulder was free. The rest would be a cinch. But don’t hurry, Laura, goddammit. Your heart can go as fast as it wants, but keep removing the baby gradually and gently.
An instant later she was holding an entire infant in her hands. At least it would look like one when all the vernix, blood, mucus, and other matter were washed off. Christ, it was slippery. What if I drop it? No, I’m holding it the right way – by the back of its heels. Then someone cried – or was it a wail? In any case it was the first utterance of the newest arrival to the world.
Laura looked at the gravy-coated being she was appropriately holding like a chicken and called out, ‘It’s a girl. Marion, you’ve got a girl!’
She placed the baby on her mother’s stomach, as the nurses wrapped it in warm towels. As soon as the cord ceased to pulsate Laura clamped it, cut it, and tied it.
Just then a tall, stoop-shouldered doctor in an ill-fitting white coat entered the room. It was Nico, the anesthesia resident. ‘I’m sorry, Laura. But a code’s a code. Shall we get this show on the road?’
‘Sorry, Nico,’ Laura said with a breeziness born of relief, ‘I’m afraid the show’s over.’
‘What did you use for anesthesia?’
‘I did a pudendal.’
‘Yourself?’
‘No, my fairy godmother helped.’
Nico looked at the mother communing peacefully with her new baby, then glanced at Laura.
‘Hey, Castellano, not bad.’
He took a final glance at her patient and then about-faced to return to his code.
Laura started to sleepwalk
toward the exit.
‘Wait, Doctor,’ she heard the head nurse cry out. ‘Don’t forget the placenta.’ Laura returned to the table and, like an automaton, awaited the arrival of the afterbirth, and closed the episiotomy cut with chromic catgut.
Finally, she checked Marion’s general condition. The bleeding was slight. There were no lacerations or cervical damage.
‘You’re okay, Marion,’ she murmured.
To which the ecstatic mother replied, ‘You’re okay yourself, Laura. Thanks.’
Even after they had wheeled her patient out, Laura stood alone in the empty operating room, her feelings of relief now changing to pride. And then to jealousy. Marion really had things in the right perspective.
It suddenly seemed to Laura that for a woman the greatest joy was to hold a baby in her arms.
And now she realized that however much she wanted to succeed, she wanted that, too.
Barney was proud to be operating with the First Team, though he knew the best he could hope for was to be called upon to hold a clamp.
At least he would be watching Thomas Aubrey (‘the surgeon’s surgeon’) and anesthesiologist Conrad Nagy (‘the best gas-passer in Christendom’) do their stuff.
Today’s procedure was a cholecystectomy. What would usually be the routine removal of a gallbladder was this time made a ‘little more interesting,’ as Aubrey put it, ‘because our patient, Mr Abrahamian – as you will have read in his notes – has had a complex childhood history that included rheumatic fever, and practically every allergy you can think of. We have to be alert for surprises.
‘Doctor Nagy has administered atropine as a pre-op, induced anesthesia with sixty milligrams of methohexitone, and used salcuranium for good neuromuscular harmony. To keep the patient asleep he is using nitrous oxide and oxygen in a 70:30 ratio.
‘So much for prologue, now we open the curtain.’
Holding the scalpel like a cellist’s bow, Aubrey made a Kocher incision, then beckoned to a nurse on his right and another on his left to come forward and hold the abdominal drains. Aubrey put his right hand into the wound to move the liver and thereby expose the gallbladder. He grasped the organ with a ring clamp and lifted it toward the surface.
His first assistant, Dr Lipson, kept the opening wide with a broad-bladed Deever retractor. He then signaled to Barney to take a narrow-bladed retractor and place it under the costal margin – the bottom edge of the rib cage.
‘Now, gentlemen,’ Aubrey announced, ‘we have maximum exposure. A careful surgeon must take his time in inspecting the entire area he has exposed.’
He took them on a guided tour of the duct system and arterial supply before removing the gallbladder. Thereafter he led his intrepid explorers in a search for any possible bleeding points that he had not already tied. At this point he turned the show over to Dr Lipson to close the wound while Aubrey continued to narrate.
‘Please note that Doctor Lipson is carefully avoiding the capsule of the liver, since sutures passing through that organ would cause bleeding. When all is ready, we will insert the drain—’
Suddenly, the anesthesiologist broke the spell of placid pedagogy.
‘Problems, Tom,’ he said, an unmistakable edge of worry in his voice.
‘What’s up?’ the surgeon asked calmly.
‘This guy’s sizzling. Blood pressure’s sky-high. Pulse is one-eighty.’
Dr Aubrey quietly ordered, ‘Somebody get a rectal temperature.’
Barney stood mesmerized, as one of the nurses inserted a thermometer. He began to sweat, yet did not dare wipe his brow for fear of losing his concentration on the retractor he was holding. He glanced at Nagy. The anesthesiologist’s forehead was furrowed and his eyes broadcast anxiety. Aubrey’s attention remained riveted on the open wound as if dissociated from the panic all around him.
After what seemed an eternity, the nurse removed the thermometer.
‘My God!’ she gasped.
‘Just read it, Helen,’ Aubrey ordered in quiet clipped tones.
‘It’s almost a hundred and eight, doctor.’
‘Shit,’ Nagy cried out, ‘malignant hyperthermia. Let’s get some ice, stat.’
Barney heard footsteps racing toward the door. He felt that he, too, should be reacting to this emergency, but how? Frightened and confused, he turned to the chief surgeon.
‘Should I help them get ice, doctor?’
‘Did I give you any orders, young man?’ Aubrey snapped in his first display of emotion. ‘Just keep holding that retractor and stay out of the way.’
At this moment the anesthesiologist blurted, ‘Tom, the EKG is going crazy.’
Aubrey ripped off a glove and reached for the patient’s groin to feel for the femoral pulse. Barney could tell from the expression above his mask that he had found none.
‘No heartbeat,’ another voice called out.
‘EKG flat,’ Nagy announced. ‘He’s dead.’
There was a sudden flood of silence. No one dared speak until Dr Aubrey decided on a course of action.
At last he ordered, ‘Doctor Nagy, continue aerating the lungs.’
The anesthesiologist nodded and obeyed.
Why the hell is he doing that? Barney wondered. This poor bastard’s dead.
The surgeon then tapped his assistant’s shoulder. Lipson understood and moved aside, ceding the task of suturing Mr Abrahamian to the swift and dextrous hands of the chief surgeon.
Barney watched in growing disbelief. Why the hell is he sewing so carefully – sewing at all, actually? They’re only going to reopen the guy for a postmortem.
By now Barney had removed the retractor and was merely a helpless and confused bystander as oxygen continued to inflate the dead man’s lungs.
Aubrey tied a locking half-stich, which squared the last knot. ‘All right,’ he said quietly, ‘take him to the recovery room. I’ll be there in a few moments.’
As the late Mr Abrahamian was wheeled off, Aubrey turned and strode coolly back to what must have been the star’s dressing room.
Lipson re-entered from post-op and saw Barney rooted to the ground. ‘What’s up?’ he asked.
‘I don’t understand what I just saw,’ he answered.
‘Which part?’
‘The guy was dead and they still—’
‘Oh that,’ Lipson answered. ‘How much surgery have you been in on?’
‘This is the first week of my rotation,’ Barney replied, and then demanded, ‘Now will you please explain to me why the hell you pumped air into a guy who’s so dead he had no pulse or heartbeat?’
‘Calm out, amigo,’ said the young doctor, ‘you’ve just learned why no patient ever dies on Dr Aubrey’s operating table. Thanks to the balloon work of Aubrey’s gas-passer, Mr Abrahamian will be pronounced dead after the operation by somebody in the recovery room.’
‘You mean just for Aubrey’s ego?’ Barney replied with astonishment.
‘No,’ Lipson protested, ‘Tom’s a bigger man than that. But you can’t imagine how much paperwork he’s saved – even though I usually do it for him. All the damn certificates, hospital papers, insurance forms – that bureaucratic crap takes hours. Now it’ll be a job for the boys in post-op. So you’ve learned something today, eh, amigo?’
‘Yeah,’ said Barney, ‘I’ve learned that I don’t want to be a surgeon.’
Just before their fourth and final year, Second Lieutenant Palmer Talbot flew into Boston from California – military rate – on United Airlines. A week later he could have winged home without a plane, so inebriated was he by the heady wine of Laura’s newly affectionate behavior.
For her part, Laura was delighted at having a Stage Door Johnny outside the operating theater – a man whose qualities she respected, who treated her like something other than a sexual brass ring on the medical carousel.
Palmer had determined to make his Army years an educational experience. He had been accepted by the Army Language School in Monterey and had begun the study of Chine
se. It would mean a commitment to the military for an additional year. But it had seemed worth it, especially when Laura had been so cold and indifferent to him.
Now he had a Laura who preferred sitting by a fire in the living room of his Beacon Street house and talking about everything – as long as it was nothing to do with medicine.
She told herself she had forgotten how well read he was, what a good listener – and how loving. There was no one in the world, she convinced herself, who cared for her as much as Palmer Talbot. What a fool she had been to risk losing him in the smug confidence that she was yet to meet ‘Mr Right’. For she had now decided that it could never be ‘Doctor Right’.
She tried not to burden him with the deep hurt she still felt at the disintegration of her family. The separation had become all the more definitive when earlier in 1961 – in January to be exact – the United States government completely severed diplomatic ties with the Castro government. And then the Bay of Pigs invasion, launched by exiled Cubans from Miami intent on ‘liberating’ their homeland, reduced relations between the two countries from absolutely nothing to overt hostility.
‘Now I couldn’t see Luis even if I wanted to,’ Laura commented wryly.
‘Well, actually you could,’ Palmer offered. ‘It’s still possible to go to Mexico and fly over from there.’
Laura looked at him and tried to sound resolute when she pronounced, ‘I’ve no desire to visit Cuba, Fidel, or my father.’
‘Haven’t you had any contact at all since he left?’
‘A few crummy letters. I didn’t even bother to answer them. I mean, the guy’s more than un poco loco to be a revolutionary at his age. He claims his greatest aim in life is for me to join him in Cuba and be a doctor there.’
Palmer shook his head. ‘I read somewhere about men doing outlandish things at his age – sort of menopausal madness. Even if you wanted to, I wouldn’t let you follow him.’
‘Don’t worry, there’s no risk of that. Or of my joining my mother in her religious retreat.’
‘How is she, by the way?’
‘Oh, we’ve spoken on the phone a few times. She claims she’s happier than she’s ever been since she “found her calling” – as she so piously put it. I think she expects me to visit her, but I’m in no mood to see a mother who would rather be a “sister.”’