“Dr. Claflin,” he said, knife poised over the belly, “what are the layers of the abdominal wall? I forget them. I’d dearly like to know what they are, though, before I cut through them. I hate to cut in ignorance.” Jemma smothered an urge to put her face in her hands, and told him the information he already knew. It was a favorite question, one she’d been asked dozens of times in her clerkship, and always the surgeon pretended not to know the answer. Jemma rattled off the layers with minimum effort, aided by a mnemonic: surgeons climax if stimulated expertly in the rectum.
“Ah yes,” said Dr. Walnut. “That’s it. Now we can proceed.” He lowered his knife. Dolores brought the suction up in what looked to Jemma like a quick salute, then she brought it down to hover just behind the knife blade. As Dr. Walnut cut she sucked up the blood behind him. The skin sprang apart under the knife, and tiny beads of blood collected in the mouth of the suction. After he’d opened the skin, Dr. Walnut cut the rest of the way with the electrocautery. It sang a shrieking, keening note as it cut, and sent up acrid twirls of smoke that Dolores sucked out of the air before they could reach and offend Dr. Walnut’s pointy nose. What wafted toward Jemma she let go, so Jemma got smoke in her eyes. In her clerkship she’d become overly familiar with it, because she was a klutz with the suction, and could never capture all the smoke from the air. Sometimes, when the patient was very fat, it was like standing at a barbecue, and Jemma once or twice nearly passed out from holding her breath, trying and failing not to be carried on the clouds of smoke back to Calvin’s burnt black body.
“Retractors!” Dolores said imperiously. When the nurse handed them to her, she took one for herself and handed the other to Jemma. Jemma had never seen retractors so small before — these were about as big as chopsticks. Hooked on both ends, used to pull skin and muscle and fat out of the way of the surgeon’s hands, they were familiar to every medical student, as retracting was their primary duty, after being humiliated and before wielding the suction. Jemma had retracted for hours and hours before, so at the end of the surgery she was unable to feel her hands, and surgeries became contests of will between her and the fat. She’d fallen asleep once, during a four a.m. appendectomy, pulling back on a crowbar-sized retractor, in the attitude of a water-skier. The surgeon, when she noticed that Jemma was asleep, had used her greasy finger to flip the retractor out from under a shelf of fat, and Jemma had fallen straight down on her back. Jemma had woken to laughter, and the shadows of masked faces under the surgical lights, and had wanted so badly for it all to be a horrible nightmare. Now she shifted her weight back and forth from one foot to the other, trying to stay awake. Everywhere she looked she saw comfortable places to fall asleep: under the various carts, curled up in the corner, in the cabinets full of gloves and towels. She thought of all the places she’d found her father asleep, when she was a child. In his car, in the bushes, folded over the kitchen counter, on top of the dining-room table; he could fall asleep anywhere, and it had always made her feel very grown up and somehow indispensable, to settle a blanket over him, wherever she happened to find him. She stared longingly at the blanket warmer. Surely the angel could warm a blanket, too — lengths of warm blanket billowed in her head, pouring out of the replicator to cover her on her bed.
“Too hard!” said Dolores, and then, “Too soft!” Jemma adjusted the pressure on her retractor, but Dolores continued to scold, like a fat, crabby, perpetually dissatisfied Goldilocks. Dr. Walnut was rummaging delicately in the belly of the baby, leaning over the surgical wound every few moments and exclaiming, “Smell that rot!” He walked along the intestines with his fingers, seeking out the dead gut. What his fingers passed over, he pulled out onto the drape, so as he walked deeper and deeper, neatly placed loops of bowel grew up in a pile on the sterile drape.
“Eureka!” he said, finally. He held the sick bowel up for all of them to see; it was purple, except where it was mottled black, a stark contrast to the earthworm-pink healthy bowel. “Five, seven, fifteen centimeters, I think, and the valve, too. Ah, poor short-gut baby! Dr. Claflin, would you like to make the first cut?”
“No thank you,” Jemma said politely. But Dr. Walnut insisted. He placed the clamps and directed the scissors, miming the cut with his two fingers.
“But wait a moment, it’s too dark. Dr. Dickens, would you adjust the light?” Rob reached above them to move the surgical lights. There were six of them suspended by as many triple-jointed arms above their heads. For five minutes Rob made adjustments, but Dr. Walnut was hard to satisfy. “Well, that’s fine for the left side of the field, but look on the right. What’s that? Stygian gloom!” Another three or four minutes passed. Dr. Wood peeked over his curtain and asked if everything was all right. “Just fine,” Dr. Walnut said. “We just need a little more right here.” He pointed with his finger at a spot inside the child. Rob reached for the sixth light, the one that was furthest away from him, and brought it around. As he set it in position, and Dr. Walnut exclaimed, “Perfect!” there was a noise Jemma recognized from her childhood: a violin string breaking, a strong, refined ping. The perfect light vanished. She felt a rush of air at her back, like a bus had just zoomed by her, and heard another childhood noise, a pumpkin smashing. She turned just in time to see Rob stuck on the far wall. He hung there a moment, then peeled away, head, chest, belly and legs, leaving a silhouette of blood on the clean white paint in the shape of his head. He fell to the ground and lay like a sleeper, his hat in place, blood expanding in a wet stain on his mask, and blood pouring from his ear.
29
“I told you,” she said to his swollen purple face in the PICU. “I told you this would happen.” She spoke out loud, but really she was talking to herself, because she never had told him why she had run so halfheartedly from his courtship. When he asked why she had been so jittery, back at the beginning, she said not, “Because I was afraid something absolutely fucking awful would happen to you,” but instead, “I guess I have a hard time trusting people.” For the longest time she’d only told him she loved him in the throes of an orgasmic tizzy; she’d shout it in utter distraction and then wonder, during the after, if she could take it back. Then, after practicing on houseplants and the neighbors’ pets, and seeing how they came to no harm, she’d woken him one blue pre-morning to say it, premeditated and deliberate. “Don’t I know it?” he’d asked her sleepily, and drawn her to him. She’d folded into him, limb over limb, until she felt like a ball wedged against his belly and under his ribs. Now she imagined the roach, afloat at some far latitude, scraping its legs at her and broadcasting reproach on its antennae: I told you, didn’t I?
She said it again, though—“I love you”—not able to help herself, or convince herself or fate or the furies or God that she had only been kidding, the whole time. She said it to the baby crying in his crib, and the boy weeping outside his house because he thought his family had moved away without him, and the adolescent weeping over the father he never met, and the man weeping for the drowned world. She was in love with every one of them, and she spoke the words to all of them like a fatal wedding vow.
Dolores had proved herself a champ. “I’ll get it,” she’d said to Dr. Walnut, as if Rob were a ringing telephone, and not a dying body. Before Jemma had unfrozen out of her horror, she’d stabilized his neck, rolled him over, and caught the laryngoscope and ET tube tossed across the room by the anesthesiologist. Jemma by then had crossed the room, ignoring Dr. Walnut’s cry to come back, come back and retract. “I’ve got it,” Dolores said, looking deep into Rob Dickens’ throat. She tubed him on the first try and hooked up a bag. “Get back to the table,” she said. Jemma, her tongue already turning to stone, said softly, lamely, “He’s my fiancé.”