“That’s it. She’ll be fine after that?”
“That’s the hope, Meg.” I grinned confidently but I could tell my attempt at charming Lizzie’s mom was ineffective.
“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.”
I heard a cry from the waiting room. I watched as Meg, Lizzy’s mother, fell to the floor, sobbing. Somehow she knew; she could see we weren’t discussing good news.
I left my father, ran to her, and knelt by her side. “I’m sorry. I couldn’t . . . I tried.” Tears made their way to the front of my eyes and spilled over. I reached out and took her in my arms and rocked her back and forth for several moments while she screamed out, “No!” over and over in loud sobs.
When I felt Steve’s hands pulling me up, I looked into his tearstained eyes and said, “I’m so sorry.” My voice was trembling unprofessionally and laced with sadness and guilt.
He didn’t respond, he just pulled his shattered wife into his chest and walked out the door of the waiting room. I looked down to see my father still standing at the end of the hall, looking unemotional and stoic. I couldn’t face him.
I left the hospital and went to my apartment where I stayed for six days without speaking to a soul. My father rang the doorbell on a Sunday afternoon.
When I opened it, he gave me a pitying smile before walking past me into the living room. “It wasn’t entirely your fault, Nate.” I sunk down on the couch and watched him walk around, opening the blinds. “Son, you are the hardest-working person I know. Please don’t be discouraged. This is part of the deal. Every doctor makes mistakes and every doctor loses patients. We’re humans and we’re flawed. That girl needed a heart transplant, not percutaneous closure. Who knows if she would have made it long enough to get one.”
“You mean, if I hadn’t killed her?”
He stood over me as I stared at my fidgeting hands. “I put you in for leave.”
“What? Why?” I said with no expression on my face.
“I made an executive call. You were getting a little cocky, Nate.”
“You’re punishing me for losing a patient?”
He sat down next to me. “Look around this place. This is where you live? You’re almost thirty years old and you haven’t purchased any décor for a house you’ve lived in for five years, not even a television?”
“I’m never here.”
“You’re always at the hospital.”
“Your point being?”
“It’s not healthy.”
“Okay, so now what? You want me to take time off and decorate my apartment?”
“I called your Uncle Dale.”
“Why?”
“You’re taking a month off. I’ve got your patients covered. Son, look at me. . . .”
It was hard to look him in the eye because I knew he was right. I needed to get away but didn’t know what I’d do without the hospital. “What about Uncle Dale?” My father’s brother, a veterinarian, lived on a ranch in Montana, one that I had visited as a kid. The owners, Redman and Bea, were friends of my grandparents. We visited the Walker Ranch during the summers when I was a kid, but now my uncle lived there.
“Dale could use some help and they have the space. It’s beautiful there this time of year. You could fish. Remember how to do that?” He smiled.
“What, and help Dale deliver calves?”
“Something like that. You’re not above that, a
re you?” My father’s expression was one of disappointment. It was the first time I had seen that look in his eyes in a long while. The last time he seemed disappointed was when I was seventeen and I drove my mom’s car over her flowerbed in the front yard. That look made me feel small.
My jaw clenched. “No, Dad, I’m not. I’ll go.”
“That’s my boy.” He patted me on the back.
Even as reluctant as I was at the idea, two days later I was packed and ready to go. Frankie was going to live in my apartment and take care of my cat while I was gone. His brisk knock came promptly at six a.m.
“Hey, brother.” He gave me a sideways hug and dropped a large duffel bag in the entryway. He looked around and said, “Wow, you still haven’t decorated this place?”
“Haven’t had time.”
“You bring women back here?”
“Haven’t had time.”
“It’s not like it’s hard for you. You’re a doctor, and you look like . . .” He waved his hand around at me. “You look like that.”
“It hasn’t been on the top of my priority list.” My cat jumped onto the couch in front of us. “Anyway, that’s my girl.”
“Wrong kind of pussy, man. What’s her name again?”
“Gogo.”
He laughed. She went up to him, purring, and rubbed her back on his hip. He shooed her with his hand. “Go-go away.”
“You better be nice to her.”
“She’ll be fine. This situation is kind of pathetic; I don’t know why I agreed to stay here. This apartment and that cat are going to kill my sex life. You might as well get five cats now and just quit. Seriously, Nate, when was the last time you got laid?”
“I don’t know. Let’s go. Are you gonna take me to the airport or what?”
“Tell me.” He began moving toward me.
“A while,” I said, towering over Frankie’s five-foot-five frame.
“Jenny, that neonatal nurse told me that she would be willing to pay you to let her suck your dick,” he said, pointing at my crotch dramatically.
“Why are you telling me this?”
“Because you’re weird, man. You look like a model and women are lining up for you and you haven’t had sex since when? Tell me.”
“I don’t know. Olivia, I guess.”
“What?” His voice was high. “That was five fucking years ago at least. That is not normal.”
Shaking my head, I finally laughed. “Yeah. You’re probably right.”
I landed at Great Falls International Airport in the early afternoon. I had brought one small carry-on suitcase and my laptop—nothing else. When my aunt Trish pulled up to the curb, she rolled down the passenger-side window of her gray dually. I hadn’t seen her in eight years, but she looked exactly the same.
She lifted her sunglasses in a dramatic gesture and said, “Well, well, look at you, all grown up. Get in here, you handsome thing.”
Once I was inside the truck, she leaned over and kissed me on the cheek.
“Hi, Aunt Trish.”
As she pulled away from the curb she shook her head, her blond curls bouncing around. “It’s been too long, dammit. I know you and your pop have been busy but we miss you out here. Your uncle Dale misses your father so much.”
“It’s been hard to get away.”
She glanced over and pursed her lips. “Is that so?”
I smiled sheepishly.
“Well, you’re here now. Redman and Bea and your uncle will be thrilled to see you.”
We drove across miles of land as the sun slowly sank toward the horizon. I looked out the passenger window toward a field and saw a few pronghorn antelope grazing.
“Stunning creatures,” I said.
“Yes, they’re gorgeous.”
“God, it’s really beautiful out here, isn’t it?”
“You’ve been trapped in that concrete jungle for too long. You’ll feel more alive out here. The clean air gets into your bloodstream.” A beatific smile etched across her face. “You’ve changed a lot since the last time I saw you.”
“How’s that?” I asked.
“You’re thinner.”
“I work out.”
She chuckled. “You do that L.A. kind of workin’ out. I see those muscles, honey, but those are skinny muscles. We’re gonna beef you up out here.”
I laughed. “Okay, Aunt Trish.”
“When we get to the ranch, I’ll show you around and introduce you to the other folks we have there with us. We’re puttin’ you to work—you know that, right?” She looked over and winked.
I looked down at my smooth, hairless hands. Prized surgeon hands were not meant to shovel shit on a ranch but I smiled at her anyway. “Who lives there with you all now?”
“It’s just Redman, Bea, Dale, me, and Caleb. He’s a young guy, like you. He’s been doin’ the ranch thing most of his life. He works hard. I’d say you two will get along but Caleb can be a little, well . . . he’s a bit of the macho type, and you’re more like . . . what do they call it out there? Metrosexual?”
“What?” I laughed in surprise. “I’m not metrosexual.” Her own laugh rang out.
“Well, you look pretty well groomed to me, and aside from that mess of hair on the top of your head, it looks like you wax every inch of your body.”
“Aunt Trish!” I scolded her playfully.
“But I’m your auntie so I don’t really need to know ’bout any of that.”
After we fell into a few moments of companionable silence, she said, “Anyway, Avelina is still with us. She’s a hard worker, that girl, but she keeps to herself.”
I remembered hearing a story of a man who killed himself on the ranch. I was pretty sure that the woman my aunt spoke of was the man’s wife, but I knew very little other than that. “Avelina is the woman who . . .”
“Yes.” She stared ahead and sighed. “So young to be a widow. It’s been four years since she lost Jake.” My aunt shook her head. “Like I said, she keeps to herself, but she’ll help you with the horses. She’s extremely skilled with the animals. Not so skilled with humans anymore, though.”
“Hmm.” For the rest of the hour-and-a-half drive to the ranch, I thought about how my aunt described Avelina and wondered if I was lacking some social graces as well. Had my career taken such a hold of me that I had lost sight of why I wanted to be a heart surgeon in the first place: to help people live their lives more fully? Yet lately, I hadn’t considered my patients much at all beyond the unconscious bodies on the operating table. It took losing one, so vibrant and young, to wake me up.
“Here we are,” she said, turning the truck up a long dirt road. As we approached the barn, cabins, and main house, the ranch appeared like a photo taken right from my childhood memory. Little had changed. The ranch house had a wide wraparound porch, and sitting there in wooden rockers, the picture of cowboy nostalgia, were Bea and Redman, smiling from ear to ear.
I hopped out of the truck and headed toward them. “Get up here so I can smack you!” Bea yelled, still smiling. Redman and Bea were like alternate grandparents for me.
Redman stood up and hugged me first and then held me out from the shoulders and scanned my face thoroughly. “You’re skinny. We can fix that, but what in God’s name are you wearing on your feet?” he asked, staring at my shoes.
“They’re Converse.”
He ignored me and turned to Bea. “We have something lying around for this kid so we can put him to work?”
She stared at me adoringly. “I’m sure we can find something suitable.” Skirting around Redman, she took me in her arms. “Hello, Nathanial. We’ve missed you.” I could tell by her voice that she was on the edge of tears.
“I’ve missed you, too.”
Someone walked up behind me and put a hand on my shoulder. “Nate,” a male voice said.
I turned. “Uncle Dale, good to see you.” We hugged.
“Glad you decided to come out. Wish I could get your father out here more.” His smile was guar
ded. He was a much quieter man than my father but just as compassionate and the best in his field of veterinary medicine. He, my father, and I shared the same dark hair and light eyes. When the three of us were together there was no question we were related.
“Let’s get your stuff into your room, honey,” Bea said. “And then we’ll show you around and refresh your memory.”
I followed her into the main house, down the long hall, and past a grand fireplace made of river rock. The guest room was small with a queen-size bed covered in a simple blue comforter. The nightstand was full of framed pictures and the desk on the other side of the room had a small task lamp. I studied a picture of my father and Dale, standing in front of the main house and outfitted for fly-fishing. I could see myself in the background, maybe five years old at most. I looked as though I didn’t have a care in the world. I loved the ranch as a kid; it was like Disneyland to me.
The window in the guest bedroom looked out on the front yard toward the barn, stables, and corrals. Far beyond them were the majestic mountains of Montana. Some in the very far distance were still capped with snow.
Bea stood in the doorway. “Will this do for you, honey?”
“Of course, Bea.” Redman walked up and stood behind her.
“Thank you so much, both of you, for having me. This will be wonderful.”
Redman laughed. “Don’t be mistaken—you’re here to work, son,” he said before walking away.
“Get settled and relax for a bit and come out when you’re ready. We’ll have dinner at the big table around six thirty. I’m making shepherd’s pie. Is that still your favorite?”
“Yes. Thank you, that sounds delicious,” I lied. I had been a vegetarian for years but the pure love and hospitality I felt from Bea was touching—and, frankly, something I hadn’t felt in a long time. Back in L.A., even my mother had stopped asking me over for dinner because I constantly turned her down to stay at the hospital.