Andy stood over Cadell’s motionless body in the operating room as the anesthesiologist intubated him, threading a breathing tube down his throat. Her job was to stand there and observe until the section of his liver was removed, and then she would carry the graft to the OR where they were preparing Emily to receive it and assist with the transplant, there.
The surgical mask itched her face around the edges and over the nose, as always. She barely noticed it anymore.
Cadell’s inert body bothered her.
Other patients didn’t bother her. It was fine to see them prepared for a surgery that would save their life or the life of someone they loved. It was beautiful, really.
Cadell should move. He should make music, and that sexy, dark twinkle should shine in his eyes.
He shouldn’t lie there, limp like that. His black curls lay on the papery sheet, unmoving.
The sterile field on his tattooed abdomen was prepared. The surgeons were ready. Dr. Clea called the time and started dictating notes as she held the scalpel just below Cadell’s sternum in the center of his chest.
Andy glanced up at his face, looking for any sign that the anesthesia hadn’t worked, that he might be conscious under the paralytics and muscle relaxants that would have kept him immobile while he was fully awake and aware. Such a reaction was exceedingly rare, a minuscule fraction of a slice of a percent, but Cadell had been a heroin addict. His body might be more tolerant to opioids and anesthesia drugs than normal people.
Nothing. He wasn’t sweating. He wasn’t twitching. His eyes were not moving under his closed lids.
The surgeon lowered her scalpel toward his skin on the left side of Cadell’s still body. In living-donor liver transplants, if the recipient is an adult, part of the donor’s liver is taken from the right side of the body. If the recipient is a child, the segment is taken from the donor’s left side.
Correct angle. Correct place. Just inside the swirled black ink of one of his tribal tattoos. The ripples of his abs started just below the scalpel and proceeded down to the blue drape covering his reproductive organs.
Dr. Clea pushed the scalpel down, piercing Cadell’s skin.
Blood welled around the steel.
For the first time in her surgical career, Dr. Andy Kumar looked down at the cement floor and stared at the blue paper booties covering her shoes.
~~~~~
A short time later, Andy delivered the section of Cadell’s liver to the other surgical team that had prepped Emily. She held the steel bowl gingerly. Two lives were at risk due to this little piece of organ meat.
They say that people are beautiful inside and out, but most people rarely got to see the beauty inside a person. This lobe of Cadell’s liver was beautiful, dark rose and smooth and stunning, as healthy as if he had never taken a drink in his life, let alone what he had actually done to it.
The liver lying in a specimen dish beside Emily’s operating table was dark brown, pebbled, and diseased. While the PELD score is an accurate method for assessing the stage of liver disease, seeing a dying liver was always a shocking experience. No one should have such a monster living inside their body.
Emily Glynn was flayed open, her arteries and veins clamped off or rerouted, and tubes and tubing passed through her mouth, nose, and incisions in her skin.
Andy passed Cadell’s liver section to an OR nurse who placed it within the surgical equipment, and she caught a look from another of the OR nurses, a quick eye flicker of concern.
She stood across Emily’s body from Dr. Singh. Behind the clear shield, beads of sweat dotted the surgeon’s forehead, soaking through her cap that held back her black hair.
Andy asked, “Are you all right, Dr. Singh?”
The woman nodded, but Andy didn’t like the way that she was blowing her breath hard through her mask, the thin tissue popping in and out as the woman panted.
“Dr. Singh,” Andy said. “Are you sure that you’re capable of surgery today?”
The surgeon nodded and worked on closing the raw surfaces created when they had removed the diseased liver.
Behind the plastic shield, Dr. Singh’s eyes closed, and she swayed on her feet.
“Dr. Singh!”
The surgeon fell, face-first, toward the open cavity in Emily’s body.
Nurses reached, dropping steel instruments that clattered on metal trays.
Andy’s hands were right there, and she opened her hands like she was releasing a baby bird, catching Dr. Singh’s face right before she fell into Emily’s open body, which would have contaminated the whole surgical field and probably killed the child.
Andy shoved the surgeon backward, over Emily and to the floor on the opposite side. Her dead weight was heavy, but Andy pushed hard.
The nurses on the other side caught her before she hit the floor.
In front of Andy, the surgical field was wide open, uncontaminated, and in progress.
A nurse was staring at Andy, her deep brown eyes wide over her surgical mask and behind her face shield.
They were in the anhepatic stage of the surgery, where the diseased, native liver had been removed and the donor liver was not yet ready to be placed, the most sensitive part of the surgery. Most of the work inside had been done, but not all.
Time was of the essence. Speed determined how much damage the other organs incurred from lack of blood flow.
Andy held out her hand to the nurse. “Clamp.”
The nurse scrambled to the cart, found the one that Andy needed, and placed it handle-first in her palm.
Andy applied the clamp to a bleeding vein and began to methodically tie off the rest of the dissected area.
From the floor, a nurse said, “I can’t find a heartbeat. Call a Code Blue.”
Andy continued to perform the transplant. She had performed dozens of liver transplants on pediatric patients from first incision to epidermal sutures. She could do this.
She told one of the other nurses, “When Dr. Singh is removed from the OR, have someone notify Dr. Jackson that Dr. Singh has been incapacitated and that I am performing this surgery unassisted and unsupervised.”
Dr. Taneshia Jackson, one of the senior faculty, would scrub in as soon as she could.
Andy refused to look above the drape, where the anesthesiologist was monitoring the patient.