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  The doors of the OR swished open, instantly breaking me out of my trance, and everyone got into position for transporting the patient over to the table. Once over, he was quickly prepped and draped for us to open. Bowers entered shortly after scrubbing in and gowned up to assist me. The anesthesiologist gave the green light to proceed and I inhaled a slow deep breath. With a steady exhale I called out, “IT,” indicating the incision time as I made the cut all the way from his xiphoid process down to the pubis to open his abdomen. The second I got into the peritoneum, a pool of bright red blood flooded the field and the scrub tech could barely keep up with suction.

  “If you can’t see, I can’t see,” I quietly reminded him. “Which unit is infusing?” This guy needed blood like a fish needs water.

  “This is the second unit of O-neg going in now,” the anesthesiologist replied.

  Once the majority of the blood was cleared, I isolated the site of the hemorrhage, and it was indeed the spleen.

  “Looks like we can add psychic abilities to the list of Dr. Fine’s talents,” Dr. Bowers joked under his mask.

  “This is not the time or place,” I responded curtly while clamping off a few problematic vessels before mobilizing the spleen. Dividing the ligamentous attachments, I was able to quickly determine that a complete splenectomy was in order. The bleeding wouldn’t get under control no matter what I did. He was losing blood faster than we could transfuse it in, and my stomach cramped at the thought of losing him.

  “He’s got a liver laceration too. Looks like grade two, approximately six centimeters long and…uh…two centimeters deep.” I mulled over what was priority. Bowers wanted to be the hero, and I needed a second set of hands. “Okay, Dr. Bowers, how about you suture this liver lac while I take care of the spleen. You should be able to use a three-oh chromic on a—”

  “I know what suture to use, Fine. You don’t need to instruct me like I’m a second year resident,” he interrupted, insulted.

  “Yes, of course. I apologize.”

  I hadn’t meant to tell him what to do. I was more or less thinking out loud. Talking myself through the procedure in my head was just how I did things. I visualized it all and took myself through the surgeries, step by step, like a recipe.

  I dissected and removed the spleen while Bowers worked on the liver laceration, which was always challenging. I was glad he was the one having to deal with it. Repairing a cut in the liver was a lot like trying to stitch together Jell-O Jigglers except there was blood everywhere and the more you lost, the closer your patient got to dying.

  With us both working with the Bovie cautery back and forth to clean up a few bleeders, our reassured mood was interrupted by the squeal of alarms sounding.

  “He’s hypotensive again,” the anesthesiologist announced. “Seventy over forty-two, and he’s got an arrhythmia.”

  Episodic arrhythmia. What are we missing? I thought.

  “Fifty-eight over thirty-six.”

  He’s still bleeding from somewhere. In his chest? His head? We never got a head CT.

  “He’s bradycardic.”

  I don’t see any other bleeding. We should put a chest tube in.

  “Get cardiothoracic in here,” I ordered.

  A circulating nurse to my right informed me that he was already scrubbing in.

  “Log in and pull up his labs, please,” I requested. “And everyone be quiet,” I shouted as the strangest feeling came over me. It was as if I was floating. No…not floating, more like in a tunnel where all the noises and sounds were echoed and my peripheral vision was darkened except for the light at the end.

  Am I about to pass out? What the hell is happening to me?

  The cardiothoracic surgeon, Dr. Coston, entered the room and gowned up, asking for an update on the patient’s condition. Bowers gave him the rundown on what he’d presented with, the code in the ER, what ultrasound showed, and what we had done so far in the operating room. Gloved and ready, he approached.

  “Got the labs,” the nurse announced.

  “Did he have enzymes drawn with his panel?” I was looking for something to explain the arrhythmia, and if his cardiac enzymes were out of whack, it could suggest…

  “Thinking a myocardial contusion, Dr. Fine?” the cardiac surgeon volunteered.

  “Yes sir. We’ve achieved hemostasis and can’t find any other source of bleeding but he’s still got a persistent arrhythmia,” I reported, feeling almost dizzy.

  This is the weirdest feeling ever. It’s got to be the fatigue. I’m just tired.

  I reached my hand back into the abdomen, needing to feel grounded, dabbing into his abdominal cavity with a moist lap, but instead I almost felt like I had been shocked. A muted electricity, almost like a tingle of static, zapped through my hand, startling me out of my tunneled haze. The nurse started rattling off CK and troponin levels.

  “Let’s get echo in here,” Dr. Coston ordered, glancing at the telemetry monitor to review the strip. “I think you may be onto something with the contusion train of thought, Dr. Fine.”

  The anesthesiologist called out the heart rate and blood pressure and I exhaled since they were improving. A few minutes later, the echo team entered the OR, and while cardio inspected the heart and surrounding vessels, I worked on irrigation and approximation of the abdomen, closing the anterior fascia soon after. All my actions were steady and it was as if I was on autopilot, but the strange feeling was still present, loud and nagging. I wondered if I was getting a migraine, the sensations certainly aligning with others’ description of an aura-like feeling. I didn’t know firsthand, having never suffered from anything more than a tension headache. I just knew I needed to get out of there. Surgical sponge counts were completed and as soon as I was able to leave the rest of the case in the hands of Dr. Coston and Dr. Bowers, I excused myself.

  Standing at the scrub sink just outside the OR, I washed my hands and felt dazed, my eyes blurring and watering. I made my way to the closest bathroom, splashing water on my face and scooping handfuls into my mouth to drink. My pulse wasn’t fast and my skin didn’t feel diaphoretic, but I felt so weird.

  Get a grip, Andie, I coached myself.

  Retreating into a dictation station, I verbally recorded my operative note for my portion of the surgery and guzzled ice water as fast as I could. I had to be dehydrated or something; surely it was just that. I ate a banana and scooped peanut butter right out of the single-serving plastic cup I’d swiped from the patient nourishment room. It had been way too many hours since I’d eaten a decent meal. The very second I could leave, I was out of there.

  Chapter 3

  Andie

  I staggered through the front door of my modest four-bedroom house, tossing my keys into a basket on the bar, clanking them against other things that had junked up the receptacle, and then I made my way over to my fish bowl. Grabbing the container of food, I pinched out a few beads and took them over to the bowl, only to notice that my goldfish, Lucius, was floating at the surface belly up. I couldn’t even remember the last time I’d fed him and I felt awful, regretting not taking the pet store worker’s suggestion to purchase an automatic feeder. That was it—no more pets for me. I was never home anyway.

  Too exhausted to deal with a funeral ceremony for my dead googly-eyed fish right then, I pressed the message playback button on my answering machine.

  “Andie Leigh Fine, this is your mother. You can’t avoid me forever. Call me back as soon as you get this. It’s important.”

  I was dialing her home number before the message even finished playing, and my mother answered on the second ring, already chastising me.

  “Well, it’s about time. I was wondering if I needed to call the police and report you missing yet.”

  “Mom, you know I have a cell phone, right? Did you even try to call me on that number? Or page me? You know I’m never home.”

  “I refuse to page you. I’m not having a medical emergency, I just wanted to talk to my daughter.”

  �
�Well, if you’re not going to call my cell phone, I don’t know what to tell you. It’s always on me—you know that,” I insisted. It wasn’t that I wanted her to be blowing up my cell, but as a grown woman, I didn’t appreciate being reprimanded like I had just missed curfew. The whole idea of missing a curfew was a foreign concept anyway since I had lived one of the most sheltered childhoods of any kid around. My mother was a sweet woman who’d taught kindergarten for a few years before getting pregnant with me. Married to my father, a busy pathologist who worked long gruesome hours, they opted for her to quit teaching and stay home with their child, eventually electing to homeschool me.

  “I never know if you’re in surgery or not, and I hate to disturb you over some Brussels sprouts,” her mother admitted.

  “This is about Brussels sprouts?” I asked, annoyed and completely over the conversation.

  “Well, yes. They’re on sale at Tucker’s today and I wanted to roast some.”

  “You could just go get them, Mom,” I suggested with sarcastic mocking in my tone.

  “You know I can’t do that, Andie. I’m…well, I’m working on it,” she faintly verbalized, embarrassed. My mother was an extreme social recluse and diagnosed agoraphobic. She had always had some degree of social anxiety, but once Dad passed away, it progressed into complete agoraphobia. I only knew her as someone who seldom left the house for any reason, but I often wondered how she had been before. How was she ever a teacher? And of kindergarten, no less? All those little snot-nosed, high-energy kids surrounding her all day—it was incomprehensible to me.

  “Yeah, listen, I’m sorry, but your sprouts are going to have to wait a little longer,” I declared, receiving a disappointed sigh in response. Starving, I popped some grapes from the refrigerator into my mouth as I talked to her. “I’ve been at the hospital for the last forty-eight hours working a double shift from hell, my fish is dead, and I need sleep. I can’t even see straight anymore.”

  “You have a fish?” she questioned in disgust.

  “Had. I had a fish.”

  “Well, no wonder you’re still single. You can’t even keep a fish alive, much less nurture a man.”

  “Oh, for Pete’s sake, Mom. Really? We’re doing this right now?”

  “Never mind,” Mom relented. “Get some rest. You’re working yourself like a dog, just like your father.”

  “I’ll call you later.”

  “Okay, dear. Sweet dreams.”

  The dig about my father was a low blow, but she was pretty spot-on. He had been a workaholic, and the stress and demand of his work was eventually his undoing. Jacksonville was a huge city with nearly nine hundred thousand people, and at one time, he was the premier pathologist in the metropolitan area. He eventually branched more and more into the forensics side of the field, working directly for the medical examiner’s office and hand in hand with law enforcement for any homicide investigations or suspicions of foul play. He couldn’t relieve stress with alcohol since he was pretty much always on call and thus had to be sober in case something happened and his services were needed, so he coped with the stress of his work with a horrible diet, eventually dying of a massive heart attack at the age of fifty-one. I was in the second year of my surgical residency at Emory University, assisting in an emergent paracentesis at Grady Memorial in Atlanta when I got the call from my mother, and just like that, my best friend was gone.

  I was a daddy’s girl through and through but had a unique relationship with my father. He was quirky, eccentric, and brilliant. From the moment I could talk, I was asking questions. Curious, intrigued by the simplest thing, I wanted to know everything about everything. He figured anything I was curious about and had the guts to ask about, he would answer it. Better for me to get the answers from him than seek them elsewhere and get misinformation. So, when I asked about what Daddy did for his job, he told me—in an age-appropriate way, of course. As I grew older, the answers to my questions got more detailed as I demonstrated my ability to handle the knowledge. I remember when he got home late one evening and tried to sneak into my bedroom to kiss my forehead. Instead of finding a peaceful sleeping seven-year-old child, he caught me awake in my bed looking at his hardback edition of Gray’s Anatomy with my flashlight under the covers. I thought I was dead meat, but he later told me it was a tremendous moment of pride for him.

  “So, I see you’ve found my anatomy book?”

  “I’m sorry, Daddy. It’s just so beautiful. Did you know we have six hundred and forty muscles in our bodies? Look at these pictures!”

  “Actually, many of those muscles consist of multiple parts, and those can be divided further, up to eight hundred fifty individual muscles,” he replied enthusiastically.

  “Wow! That’s amazing.”

  “It is amazing. God made us into masterpieces.”

  “He sure did. I can’t believe it.”

  “Sweet girl, I’m so pleased to see you excited about learning, but it’s well past your bedtime. Let’s close this book and save some for tomorrow, during daylight hours, okay?”

  “Okay, Daddy.”

  “And next time you want to look at my books, just ask me. You don’t ever have to be sneaky. We don’t keep secrets from each other, right?”

  “Right. Never ever. I’m sorry.”

  “No sweat, baby girl. Close your eyes now. Take a slow deep breath and picture that diaphragm contracting, compressing your abdominal cavity and expanding your thoracic cavity. Picture all of those intercostal muscles working in a perfect rhythm to draw air into your lungs. Hold it in for a few seconds—three…two…one—to absorb all the oxygen you can and then let go, nice and slow. Picture your heart pumping and try to make it slow down. Calm your whole body down. Inhale…hold it…three…two…one…release.”

  It had become my lullaby, and I still did it as an adult to calm myself down when my mind was racing. When I knew I would only be able to catch an hour or two of sleep before the next trauma but my mind was running a mile a minute, I remembered. I would start with my heart, picturing it pumping strong and steady, seeing the blood flowing through my vessels. I would visualize my diaphragm contracting, the dome-shaped muscle pushing up like a rainbow rising higher in the sky with determination, the air filling my lungs and branching out into all of my little alveoli. I would hold it, just as he instructed, and count down three slow seconds, feeling my body relax. I would calm my toes, and then my legs, all the way up to my chest like a wave of peace sweeping over me, and I would rest.

  And yet, even with my tried-and-true relaxation technique, I couldn’t shake the unease within my body since that last trauma case. I had thought it was fatigue at first, or hunger, maybe even dehydration, but something about it—about him—felt different. Never before had I felt such a bizarre connection—if you even want to call it that—with a patient before. An energy, or pull…something was peculiar about him. I hadn’t even gotten his name. They’re all John Does to me until I’m out of the OR anyway.

  I didn’t wake up until the following morning, getting many hours of much needed sleep, and I awoke thinking of my father. I knew he would have been proud of me but I hated that I couldn’t just call him up and talk to him anymore. I was starting to forget his voice. Little by little, it wasn’t as loud in my head, not quite as clear. I arose and stumbled to the bathroom to relieve my bladder then splashed my face with cold water after washing my hands. Looking into my mirror, I sighed at how tired I looked, thinking that getting serious about my skincare regimen—or current lack thereof—was probably a good idea.

  Walking over to my closet, I retrieved a box from my overhead shelf. Placing it on my bed, I lifted the lid to find some of my most treasured memories from and of my father. I immediately found a picture of my dad and me in his lab, dressed up in gowns and hats, donning gloves. I looked to be around nine or ten years old, and I remembered that specific day well. He often took me to work with him for “educational observation”, as he would put it. Really, he just wanted to hang out wi
th me, which was fine with me since I loved learning and seeing the human body in all its glory right in front of me.

  That day was the first day I got to see a dead body in person. He always brought home pictures of anything unique or especially interesting. He would capture it on film to show me and once the roll had reached its twenty-four shots, he would drop it off at the local drugstore for developing. Those were the best days ever, when he would come home with a new envelope of pictures. I saw everything from a body riddled with cancer and flayed open for autopsy to severed limbs from accidents. My birds-and-bees instruction was a conversation that began about a picture of a placenta. He showed me the perfection of the umbilical artery and umbilical veins encased in a thick cord, branching out like a beautiful tree of vessels into the chorionic plate. From that picture came the questions. I vaguely remembered not being able to grasp the concept of sex and the romantic notion of intercourse, but I knew the science behind it all. I learned the biology, and it was fascinating to me.

  The day that picture was taken of Dad and me together in his lab was one of the best days I could remember. Mom had a hair appointment and the sitter canceled at the last minute. Dad had calmly said, “Great, you can just come hang out at work with me for a few hours.” Mom refused immediately, saying it was the last place a child should be. She was adamant that a kid shouldn’t have to see such gruesome things, but to my father and me alike, they weren’t gruesome things at all. It was simply reality, life and death, the biology of how miraculously our bodies were made and how fragile they were, with the potential to abruptly cease to function at any moment. He reassured her he didn’t have any cases scheduled that day, only pathology specimens to analyze. “Lumps and bumps in jars, honey,” he insisted. “Nothing gross or traumatic, I promise.” She finally relented, knowing she would only be a few hours and I could always go watch TV in his office if there was some sort of emergency.