“Sorry you’re going, Doctor Cutter. I was looking forward to being on your service,” a first-year resident said as they prepped for surgery in the OR.
Alex tossed the surgical towel he just dried his hands with into the linen bucket. “I’m going to miss teaching you guys almost as much as I’ll miss the muffulettas.”
“Seeing’s how this is your last case, you get the honor of picking the music,” Cole called from the other side of the surgical drape.
He thought back to his first case here at Baptist, the patient with the cerebellar tumor, and remembered the music Cole played. “How about the Bob Seger disc with ‘Hollywood Nights’ and ‘Against The Wind.’ That is, if you brought it today.” Cole always carried a black nylon CD wallet into the OR with twenty or so discs and his boom box.
“Figured you might want that one.” Cole laughed. “You always did like it. Especially the line ‘working on mysteries without any clues.’”
Alex finished gowning by knotting the stays around his waist. “Yeah, it’s one of my favorites.” Then he said to the resident, “Pay attention. Here’s how I drape and prepare my field.”
Chuck Stevens, gowned and gloved, stood on the step of the overhead table, ready to hand off the sky-blue surgical drape. “All set?”
“I am.”
In one fluid movement, Chuck passed the head-end of the drape while peeling off the protective cover of the transparent adhesive barrier. Alex accepted the drape, smoothed the sticky, transparent surface over the incision line he’d marked on the scalp with a Sharpie, and pulled out the wrinkles, funneling the drainage system into the sterile suction bag at the bottom of the drape.
Minutes later they were quickly progressing through the opening, Alex doing it instead of having the new resident muddle through. Besides, this was the resident’s first—and only—day on his service, and the standing rule was to observe the first case before being allowed the privilege of taking the scalpel. Chuck and Alex worked flawlessly as a team, having done so many openings together that Chuck had the next instrument ready before Alex asked for it, now wordlessly passing instruments back and forth, Alex’s hands moving with deft precision, the only sounds in the room the respirator, the heart monitor, the gurgling suction, and Bob Seger’s Silver Bullet Band.
“Where you from, Trevor?” Alex asked the resident.
“Chicago.”
Alex bent slightly for a better view before slipping the dural elevator through the burr holes to strip dura from the undersurface of the skull. “Chicago. Huh!” It was a city home to several residencies. “Why come all the way down here?”
“Wanted a change. Grew up there and went to Northwestern.”
“Well, you certainly got what you wanted, didn’t you?”
“Uh-huh.”
“Craniotome.”
Chuck handed him the air-powered side-cutting drill. Alex pressed the footplate against the tip of his finger and squeezed the trigger. The drill responded with the high-speed whine of an air-driven motor similar to a dentist drill. Alex let it run a few seconds to make sure the footplate didn’t heat up, which would happen if the drill wasn’t perfectly seated. Just one more precaution to make sure to stay out of trouble. As much as he trusted Chuck, he always double-checked. Just like Chuck double-checked him.
“Irrigate the blade while I cut,” he instructed the resident.
Chuck passed the resident the bulb irrigator filled with saline to squirt over the skull where Alex worked.
As Alex began to cut between the burr holes to lift the square piece of skull away, several emotions surged inside. This, he realized, could very well be his last craniotomy. Ever. After today his surgical career would likely end. He would miss some aspects of practice, the intense camaraderie being one. He felt strong bonds to the OR team, the floor nurses, his colleagues. He suspected this bond was similar to what policemen or soldiers felt toward each other. They shared common stresses and joys and the inherent difficulties and triumphs of their emotionally taxing professions. He could explain a difficult case to Lisa, but she never really understood the daily stress or the complex issues he was forced to deal with. Perhaps this is the reason she had some difficulty understanding his decision to abandon a profession he’d worked so hard to obtain. Fourteen years of training would essentially vanish the moment he walked out the OR door in a few hours.
Also, he was off call now. No sense catching a case if you wouldn’t be around to handle the post-op care. At seven o’clock this morning, at the official termination of his last night on call, an incredible weightlessness came over him, as if the soles of his Nikes barely grazed the floor. A chronic burden pressing on him for years simply vanished, leaving him almost giddy with relief. Gone were the anxiety-provoking, sleep-stealing, middle-of-the-night calls about post-op fevers. No more early morning summonses to the trauma center. Yes, he’d miss the camaraderie, but the emotional price he paid for it no longer seemed worth it. He would find similar relationships in his new job, perhaps starting with Levine and Slater.
Suddenly, he realized the music had stopped. Glancing up, he saw Cole smile at him.
“What?” Alex asked. Something wrong? Panic seized his gut.
“Hail to The Chief” filled the room from the boom box, the volume now up.
“What the hell?” he asked, glancing around.
Chuck stood at attention. So did the resident at his side. Then through the swinging doors marched the two chief residents. “Ten hut!” called Chuck.
The two chief residents, Steve Stein and Rene Coumaux, marched to within a foot of Alex and stopped, as if soldiers. “Doctor Cutter,” Stein said, “by the powers vested in me by the residents of this university, I award you the medal of the Silver Scalpel for Excellence in Teaching.” He paused. “I’d pin it on you, but then you’d have to regown and reglove, so I’ll just set it over here next to your loupes.”
Misty-eyed, Alex scanned the crowd pouring into the operating room—scrub techs, circulating nurses, Ellen, Betsy Lou, other residents who’d scrubbed out of their cases. A lump formed in his throat, causing him to croak a response. “Thanks … guess I … better get back to work before you guys contaminate the field and this patient gets an infection, ’cause then I’d have to stick around to take care of it.”
Two hours later as Alex knotted a suture—a quick instrument tie rather than using his fingers, a final bit of flash to finish the case—he glanced at the new resident. “One last question.”
The resident reached in with the scissors to snip the suture tails. “Yeah, what’s that?”
“What would you say if I told you Humpty Dumpty was pushed?”
The resident laughed and replied without missing a beat. “Everyone loves a scandal.”
Alex glanced toward Cole. Cole’s eyes came up over the top of the drape, twinkling. “Goddamn!”
“Knew someone would eventually get it,” Chuck added.
Alex shook his head. “Yeah, but it took a goddamn Yankee to figure it out.”