And Grace, an operating-room assistant who cleans up, standing with her broom and saying, “Joan, what are you doing here?”
Good one, Grace. “I’m having some surgery, Grace. How’ve you been?”
Talk like they would have if they met over the potato bin at Star Market. “Good Joan, I’ve been good.”
Then Helen Walsh was there, looking different with her hat and her stethoscope. She stayed. Joan was interested now. Asking questions. What was the IV for?
“In case we need to plug blood in right off, we can. We can keep a steady solution dripping in there. We can have access to your bloodstream instantly that way. Very handy.”
“It is very bizarre,” Joan said, “being down here. Very odd to think of the traffic going by right outside and people going to work and the children walking past to school, and down below here, with the white lights and the green walls.”
“Oh, now, it’s not that bad,” Helen said.
“No, I don’t mean it’s bad. It’s just so basementy otherworldly.”
“I suppose it is,” Helen Walsh said. “I get used to it. To me it’s very routine. When we go into the OR I’ll give you medication through the IV. You’ll go to sleep almost instantly. You’ll wake up in the recovery room and it will seem to you, you just went to sleep. I’ll be there with you through the operation and I’ll be with you when you wake up. I’ll be right there with you and whatever needs to be done I’ll see to it.”
“I’m all right,” Joan said. “I’m ready for whatever. It’s okay.” They passed the time. They talked about Joan’s teaching, about the Le Boyer birth-without-violence method. In the operating room there were big medical lights. What makes them look medical The indirectness? But they do. The room seemed vaguely not square to her. Eliopoulos was there in his surgery suit. Several nurses. Helen Walsh near her head.
“Start counting backward from one hundred,” Helen said.
“One hundred,” Joan said.
“Good night,” Helen said.
“Ninety-eight, ninety-seven...”
Joan was strapped to the table. They draped her with sheets, leaving open only the area on the left side of her chest. One sheet was draped vertically from a bar above her chest and acted as a sterile partition. At her head, behind the partition, Helen Walsh watched Joan closely. When the sheets were in place she administered 2 cc of Pentothal intravenously. It was a test dose. The room was quiet. Eliopoulos and the scrub nurse stood back a little, away from the table, in green caps and gowns, masked and sterile.
Joan’s response to the test dose of Pentothal was right, and Helen Walsh gave her 400 milligrams. Joan lay motionless on the table. Helen brushed her eyelashes to see if there was reflex. There was none. With the circulating nurse standing by, Helen gave her pure oxygen through a face mask, watching the attached bag billow and shrink, and monitored her blood pressure, EKG, and other vital signs. The tiny blip on the display screen showed Joan’s heartbeat steady. The room was quiet and the small beep of the monitor was loud, against the rush of the exhaust fan. Helen remembered surgery in ORs without the fans, when everyone was getting giddy from the anesthesia by the end of the surgery.
“She’s fine,” Helen murmured to the circulating nurse. She added halothane to the oxygen. The heart remained steady, the bag inflated and decreased with Joan’s regular breath. If it became shallow Helen would assist by squeezing the bag. The circulating nurse washed the area of surgery with PhisoHex. Joan’s left arm was stretched out and placed on a padded board. Her right arm the same with the IV tube in place and the blood-pressure cuff attached. Helen nodded at Eliopoulos.
Sterilized instruments on a sterilized surgical table stood ready. Before Joan had been wheeled in, the scrub nurse had laid them out, following the procedures card indexed for breast biopsy. Now John Eliopoulos took a surgical knife and made a two-inch incision in the skin of Joan’s left breast above the lump, following the grain of the skin. After he made the cut he put the knife aside. The skin was assumed to be nonsterile and therefore the skin knife was no longer sterile. He used a pair of clamps to hold the lump and, guided by the feel through the new knife, he carefully cut out the lump. It appeared no different from the surrounding tissue. Joan’s vital signs remained normal. Every five minutes Helen Walsh charted blood pressure, pulse, EKG. She was careful to remain behind the sterile barrier.
Eliopoulos took the small piece of tissue on a piece of gauze to the door of the room. He dropped it into the pathologist’s tray. The pathologist took it to the lab for a frozen section. In the OR animation was largely suspended. Eliopoulos took two temporary stitches in the incision on Joan’s breast to close it. He was the only man in the room.
It is always, Helen Walsh thought, a kind of sisterly experience on a breast biopsy. There was a real sense of rooting for the patient.
The circulating nurse said, “What do you think?”
Eliopoulos shook his head. “We’ll wait for the pathologist.”
As the biopsy stretched out, the tension built. Five minutes is sufficient for a frozen section. It was already seven. The longer the wait the more probable the cancer.
In nine minutes the pathologist was back. He spoke to Eliopoulos at the door. Eliopoulos turned to Helen and the nurses and shook his head. “Positive,” he said. “We’ll take the breast.”
One of the nurses said, “Shit.”
They began all over. A new set of instruments was laid out by the scrub nurse. A second surgeon, standing by to assist, was paged. Another scrub nurse came in. They removed all of the wrappings from Joan’s inert form and put new ones in their place.
Helen Walsh gave Joan a shot of Anectine through the IV tube. It paralyzed her for about three minutes. She then put a tube down Joan’s throat. At the end of the tube was a kind of balloon which could be inflated, so Helen could control Joan’s breathing. Helen was now completely responsible for Joan’s life maintenance. Eliopoulos looked at Helen. Helen nodded. Eliopoulos made a neat careful incision with the skin knife on either side of the breast, cutting toward the center. Then with a new knife he began slowly to cut away a little at a time the subcutaneous tissue. One of the scrub nurses held the skin back with retractors. Anything suspicious was sent to pathology for a frozen section. As he cut he tried to avoid as much as possible the muscle tissue. Periodically the other nurse cleaned out the surgical area as blood collected. She used a clear plastic tube with a stainless steel tip like a pencil which vacuumed any area at which it was pointed. As they went on, the assisting surgeon cauterized small blood vessels and sutured the larger ones. As he cut, Eliopoulos was careful to take some lymph nodes for pathology.
There was no talk now, merely the sounds of the work and the humming of the life-support and gas systems behind Helen and of the exhaust fans above. The moving blip of Joan’s heartbeat displayed on a scope was a steady punctuation.
The breast came out finally, in one piece, and went to pathology. The skin was folded carefully back in place and Eliopoulos began to stitch. As he did so the second surgeon inserted the drain. Eliopoulos stitched carefully in small tight stitches, his large hands steady and clever as he moved. When he finished, a large pressure bandage went over the incision, the drapings began to come off, and Helen began to wake Joan up.