Chapter One
The Attending Wife
Thirty-Four Days
"Clamp's at eleven minutes," Petra says. "For the room."
"For the room."
Nobody in this room needs it. She says it every case.
The vessel above the old graft is thin. Below it, scarred and thick. It's the thin part that'll tear, and it'll tear while I'm up at the other end being pleased with myself.
"Suture."
"Which one?"
"The one I'm going to ask for in four seconds."
"I love this game," Petra says, and puts it in my hand before I've finished the sentence, and it's the right one.
This is a reintervention. You go back in on your own work. There's no kinder word for it and I've watched a lot of people hunt for one in front of a family.
She's seventy-one. She was mine four years ago and she's mine again this morning, and everything that's different is in the tissue.
"Pressure's eighty-two," the anesthetist says.
"Give it a minute."
"Doctor, it's eighty-two."
"Give it a minute and then tell me eighty-two again."
He's new. He tells me twice more and stops. By nine he's telling me things I want to know, which is faster than most of them get there.
I get the proximal seal I want. The thin part holds, because tissue is a liar in both directions and this morning it lies in my favor.
"Off the clamp."
"Off," Petra says. "Thirty-one minutes. Nice."
"It isn't nice, it's thirty-one minutes."
"It's nice for thirty-one minutes."
She takes a pen out of her scrub top and writes a line in a small book that isn't the chart. Then she asks the circulator where the second set of clips went.
I close. Closing is the part I do slowest and I've stopped apologizing for it.
In the lounge there are two coffees to make. I'm making one for myself. The other is already made. Half a packet of sugar, spoon left in.
I look at it a second.
Then I take it up to the chair's office. His door's shut and he's on a call, so I leave it on the desk. There's nothing else to do with a coffee once you've made it.
Nineteen years is a long time to learn one drink.
The clinic list on my phone is forty-one names long for an afternoon that has room for maybe twenty-eight of them.
"You people," Okonjo says.
He's still standing. He's got his coat over his arm and he hasn't looked at the chair.
"Mr. Okonjo—"
"No. Thirty-four days. In thirty-four days I have had one phone call and it was a machine asking me to rate my visit."
"Sit down."
"I'll stand."
"Sit down anyway. I can't feel anything on a man who's standing."
He sits down hard enough that I'm meant to hear it. Fifty-something, forearms on him, a good watch, and none of that tells me one thing I need.
"Four days ago," he says.
"Tell me."
"Four days ago somebody opened me up again. At night. I came in here at eleven o'clock at night with my belly on fire and by morning I had another operation in me, and I went home Sunday, and nobody has said one word to me since."
"Who did it?"
"I don't know."
"You don't remember a name."
"It was night," he says. "There were two of them and one of them was very young and I was busy."
I wash my hands. I take longer than I need to, because I need the extra seconds to keep what I know off my face before I turn around.
"I'm going to feel your belly."
"Feel it."
His skin is cold. Every clinic room is a degree colder than a person expects, and I never got maintenance to care.
Here's what I know before I know anything. I did this man's repair thirty-four days ago. His neck was straightforward. The iliac side cost me forty minutes, calcified end to end into a piece of pipe, and I remember standing there talking to it. Now there's hardware in him that I didn't put there.
There's a fullness low on the left with no business existing in a man I sealed.
That's all it is. I know. Knowing isn't a document.
"Say something," he says.
"You had a cuff placed. An extra piece, put in above the first one, to close a leak."
"A leak."
"Blood was getting where I didn't want it. Someone fixed it. They fixed it correctly, from what I can feel."
"So why are you making that face?"
"I'm not making a face."
"You're making the face my mother made about my wife."
I pull the post-op scan from four days ago and turn the screen so he can see it. It's all there. A cuff, four days old, sitting exactly where I'd have put one.
"There," I say. "That's the new piece."
"And nobody called you either."
"No."
He looks at me for a while. He isn't stupid.
"You're the surgeon," he says.
"I am."
"You're the surgeon and you're finding out in a room with me."
"Yes."
"Why?"
"I don't know."
"That's not an answer."
"It's the only one I've got right now."
He puts his coat on and takes his time with the buttons. I let him. The other option is filling the quiet with something reassuring, and he'd hear it.
"Mr. Okonjo. Can I call you? Not the office. Me."
"You didn't the first time," he says, and goes.
The trial's ninety-day table is published, which means anyone with an account can read it, which means for four years I haven't.
The ninety-day window is the whole game. Anything that happens to a patient inside ninety days of the implant belongs to the device. Day ninety-one, it's just life.
Okonjo is on the list. Enrollment number, site, implant date. Then a column for reinterventions inside the window and a column for adverse events.
Both of them are clean.
Not pending. Not flagged for query. Not blank.
No reintervention. No adverse event.
I read it three times. There's nothing to read. It's five words wide and it says a man I examined this afternoon is a man nothing happened to.
I put two fingers on my own wrist. Habit, picked up from a resident twenty years ago. Sixty-six, and completely uninterested.
Grant is home before me, which happens twice a year.
"There she is." He's at the island with his laptop and a glass of wine he isn't drinking. "Sit down, I've got news and it's good news, so brace yourself."
"I'm braced."
"They're putting you at the head table. At the dinner."
"I don't want to be at the head table."
"Nobody wants the head table. I know." He turns the laptop around and turns it back without showing me anything. "I asked for it. Six weeks out and they had it seated already, and I made a nuisance of myself, and Simone, you should have heard me. I was shameless."
"You're always shameless."
"I'm strategically shameless." He kisses the top of my head on his way to the fridge. Asks if I ate. I say yes and he says liar and starts making me something.
I could say it right now. He's eight feet away with his back to me and a knife in his hand and he would put the knife down.
Here's how it goes. I say your ninety-day table is wrong about my patient. He says which patient. I tell him. He says leave it with me.
Thursday there's a query. Friday a data manager I've never met sends an apology with three people copied. Next month he tells it at a meeting, warmly, the one about his wife catching a coding error six paid monitors missed. Everybody laughs. I get thanked for my diligence in front of people who'll remember only that I needed thanking.
He'd fix it. That's the thing. He'd fix it inside a week and I'd have nothing at all.
"Eat," he says, and puts a plate in front of me, and it's good, because he's a better cook than I am and always has been.
Upstairs I write it in the notebook. Initials, date, what was done, what actually happened. Four lines, fountain pen, same as every night for longer than I can remember. This year's is navy and half full.
Then I open the laptop and go back into the table. This time I don't search for a patient.
I search for me.
Three of my own went back on the table within that window. I reopened all three myself. I know the dates and I know what I dictated afterward, and in about ninety seconds I'm going to be looking at three more clean columns.
Somebody's data manager is having a terrible year.