“‘. . See that pier out there,’ MacGregor says, ‘I built that pier. So, do they call me MacGregor-the-Pier-Builder? Noooo! And that shed over there. I built that, too. Do they call me MacGregor-the-Shed-Builder? Noooo! And. . and that stone wall out there? I set every single one of them stones in place myself. So am I known as MacGregor-the-Stone-Setter? Noooo! But fuck one lousy goat. .’ ”
Will joined in the laughter. Even though he had heard the joke enough to qualify as an expert on it, Cameron’s delivery was hilarious enough to make it fresh every time.
“Gordo, what are you doing here at this ungodly hour?”
“Kristin’s snoring woke me up. She swears it was me waking us both up, in addition to the neighbors and a bunch of them in the cemetery down the street, but I know better. Since the powers that be are about to put me on probation for not getting my discharge summaries dictated, and since I’m going to be spending twenty or thirty hours assisting you with that Whipple, I thought I would come on in and get caught up.”
“Kristin’s like a hundred and fifteen pounds,” Will told the crew. “Somehow, I can’t imagine her snoring any louder than a sparrow if she ever even snores at all. My money’s on the Scotsman here. Did you guys save me my jelly stick?”
“We practically had to pry it out of Dr. Cameron’s hands with a crowbar,” a nurse said, “but there it is.”
“Hey, Gordo, you know jelly stick’s my lucky doughnut. I can’t start a big case like this Whipple without having had one.”
“Mea culpa,” Cameron said, “but excuse me for pointing out that it’s the poor slob you’re operating on that needs the luck.”
“Good point.”
Will knew he wasn’t kidding himself about the jelly stick. For as long as he could remember, he had been a creature of lucky maneuvers and talismans, of lucky shirts and rituals. Although his superstitions didn’t run so deep as to paralyze him or even alter his life very much, he did cling to certain routines and clothing when playing poker with his friends in their monthly game or when preparing to do a case in the OR.
After fifteen minutes of small talk, and another Scottish joke, Cameron headed off to the dictation carrels in the record room and Will made his way to the medical library. The Whipple he was about to perform on Kurt Goshtigian was among the most complicated of surgical procedures. Developed in the thirties, the technique was necessitated because the pancreas is anatomically not clearly separated from the GI structures surrounding it-the gallbladder, the duodenum segment of the small intestine, the bile duct, and often the stomach, as well. After the cancerous head of the pancreas and parts of the other organs were removed, the remaining portions would be sutured back to the small intestine to restore continuity and function. Gordo’s sarcastic reference to Will’s painstaking, time-consuming technique in the OR notwithstanding, if things went well, the operation would take four to six hours, and the result would be a cure.
Will had performed or first assisted on fifteen or so Whipples over the years-certainly enough to feel confident about the procedure. Still, the technique and anatomy were complex and variable enough to warrant reviewing them before stepping into the arena. It was crucial before beginning the Whipple to examine the area thoroughly using a laparoscope in order to be as convinced as possible that there was no cancer outside the head of the pancreas. Evidence that the disease had spread to local organs or the inner wall of the abdomen would mean that it was essentially incurable and would strongly if not absolutely mitigate against a procedure as extensive as this one.
After forty minutes of review and actually performing the operation in his mind, Will felt energized and ready. He called the twins to wish them a good day and to review the plans for the rest of their weekend together. Then he made rounds on his three hospitalized patients and finally headed up to the OR suite in the east wing of the second floor.
Thanks to a huge gift from a grateful family’s trust, the surgeons’ dressing room, like the ORs, was state-of-the-art-plushly carpeted with three private showers and a steam room. Following a routine from which he seldom if ever varied, Will left his wallet and watch on the shelf of his locker, laced up his red Converse Chuck Taylors left foot first, pulled disposable shoe covers over them right foot first, tied on a hair cover, then a mask, and finally slipped on the glasses and magnifying loupes he only used in the OR. Next, for five minutes he sat, eyes closed, breathing deeply and slowly, making no real attempt at clearing extraneous thoughts from his mind, but willing himself to relax and thanking God for the opportunity and skill to be a surgeon. By the time he was ready to enter the scrub room, he was experiencing a most pleasant calmness and euphoria. They were sensations he had come to expect, although this one was even more intense than what he was accustomed to.
Kurt Goshtigian was just being wheeled up to the OR when Will entered the scrub room. Gordo, already scrubbed and gowned, was on the other side of the glass OR door, along with a surgical resident who would do the prep and drape on Goshtigian’s abdomen. Will hurried past the scrub sinks and out of the narrow room and caught up with his patient’s stretcher, actually bumping into it, just as it reached the OR. Goshtigian was a solid, weathered fifty-four-year-old with tattoos on his muscular forearms and over his deltoids. His coarse black hair was graying, and his silver stubble suggested he hadn’t shaved for a couple of days. Will pulled his mask down and apologized to the man for bashing into him.
“I’m pretty sure I’ve never done that before,” he said, wondering if maybe he shouldn’t have broken his routine by rushing out of the scrub room.
Goshtigian, dry-mouthed and groggy from the pre-op meds, smiled up weakly and patted Will on the arm.
“You’re just excited about getting to muck around with my innards,” he said.
“We’re going to get that cancer out of you, Kurt, and you’re going to be as good as goo.”
“You mean new.”
“Pardon?”
“You said goo when you mean new.”
Will had no idea what the man was talking about. Probably the pre-op meds, he decided.
“Yes,” he said. “Well, if you’re ready, I’m going to go scrub in. My partner Dr. Cameron is there in waiting for you. I’ll be in soon.”
Will replaced his mask and headed back into the scrub area. The wonderfully pleasant sense of well-being and connection to his world had, if anything, grown more intense. He was halfway through a four-minute scrub when he realized that he had broken his routine again, this time by taking the hexachlorophene-impregnated brush to his right arm and hand before his left. Strange. No big deal, but strange just the same. When he backed out through the scrub-room door and then into the OR, Kurt Goshtigian’s abdomen was already washed, shaved, prepped with an antiinfective, and covered with sterile drapes. Carrie Patel, the best anesthesiologist on the staff, was in the process of putting him to sleep. With a nurse’s help, Will slipped into a gown, had it tied behind him, then drove his hands one at a time into latex gloves, taking pains to do the left hand first. As usual, Gordo was talking almost nonstop.
“So, lad, are ye all boned up on the Whipple? The man’s first name was Allen, you know. Allen Whipple. Now, there’s a piece of trivia for you. . ”
Beneath his mask, Will smiled at his partner, even though he realized he wasn’t picking up everything Gordo was rambling on about. It was always good to work with him in the OR. For one thing, he was skilled and quick as a surgeon and intuitive as an assistant, and for another, his demeanor kept the team loose and upbeat, even through the most grueling cases.