فصل 13

13

She stopped. Worry flashed across her face. Without a word, she got up and ran into Elena’s room, then burst back out, grabbed the phone, and paged Melissa. A minute later, Melissa arrived, bleary-eyed, glanced at the strips, and rushed into the patient’s room, with me trailing behind. She flipped open her cellphone and called the attending, rapidly talking in a jargon I only partially understood. The twins were in distress, I gathered, and their only shot at survival was an emergency C-section.

I was carried along with the commotion into the operating room. They got Elena supine on the table, drugs running into her veins. A nurse frantically painted the woman’s swollen abdomen with an antiseptic solution, while the attending, the resident, and I splashed alcohol cleanser on our hands and forearms. I mimicked their urgent strokes, standing silently as they cursed under their breath. The anesthesiologists intubated the patient while the senior surgeon, the attending, fidgeted.

“C’mon,” he said. “We don’t have a lot of time. We need to move faster!”

I was standing next to the attending as he sliced open the woman’s belly, making a single long curvilinear incision beneath her belly button, just below the apex of her protuberant womb. I tried to follow every movement, digging in my brain for textbook anatomical sketches. The skin slid apart at the scalpel’s touch. He sliced confidently through the tough white rectus fascia covering the muscle, then split the fascia and the underlying muscle with his hands, revealing the first glimpse of the melon-like uterus. He sliced that open as well, and a small face appeared, then disappeared amid the blood. In plunged the doctor’s hands, pulling out one, then two purple babies, barely moving, eyes fused shut, like tiny birds fallen too soon from a nest. With their bones visible through translucent skin, they looked more like the preparatory sketches of children than children themselves. Too small to cradle, not much bigger than the surgeon’s hands, they were rapidly passed to the waiting neonatal intensivists, who rushed them to the neonatal ICU.

With the immediate danger averted, the pace of the operation slowed, frenzy turning to something resembling calm. The odor of burnt flesh wafted up as the cautery arrested little spurts of blood. The uterus was sutured back together, the stitches like a row of teeth, biting closed the open wound.

“Professor, do you want the peritoneum closed?” Melissa asked. “I read recently that it doesn’t need to be.”

“Let no man put asunder what God has joined,” the attending said. “At least, no more than temporarily. I like to leave things the way I found them—let’s sew it back up.”

The peritoneum is a membrane that surrounds the abdominal cavity. Somehow I had completely missed its opening, and I couldn’t see it at all now. To me, the wound looked like a mass of disorganized tissue, yet to the surgeons it had an appreciable order, like a block of marble to a sculptor.

Melissa called for the peritoneal stitch, reached her forceps into the wound, and pulled up a transparent layer of tissue between the muscle and the uterus. Suddenly the peritoneum, and the gaping hole in it, was clear. She sewed it closed and moved on to the muscle and fascia, putting them back together with a large needle and a few big looping stitches. The attending left, and finally the skin was sutured together. Melissa asked me if I wanted to place the last two stitches.

My hands shook as I passed the needle through the subcutaneous tissue. As I tightened down the suture, I saw that the needle was slightly bent. The skin had come together lopsided, a glob of fat poking through.

Melissa sighed. “That’s uneven,” she said. “You have to just catch the dermal layer—you see this thin white stripe?”

I did. Not only would my mind have to be trained, my eyes would, too.

“Scissors!” Melissa cut out my amateur knots, resutured the wound, applied the dressing, and the patient was taken to recovery.