At the Scent of Water (10 page)

He nodded and stood to leave.

He jotted a note on the chart of the child with the botched repair.
Yes. I’ll see the child,
he scribbled. Perhaps it was hopeless, but he would see what he could do.

He headed toward the PICU for rounds.

****

It was only seven, yet his office was in full swing. The telephones were ringing, patients checking in. He crossed the hallway and saw the cluster of doctors and students hovering around a tiny bed. They would visit each patient in the unit. Sam joined them, quickly checking today’s lab reports and numbers. He listened to the others’ comments, then added his own. He carefully controlled his thoughts, refusing to think of these tiny patients as infants, children, connected to tubes and monitors. He narrowed his vision to their status, to formulating his recommendations for the plan of action.

They paused long at the bed of Evan Ridgeway, a three-month-old boy who had never known life outside the PICU of this hospital. His heart had begun to fail even before he was born. Another complex malformation. His heart was an inefficient sponge, vessels and chambers perversely and randomly placed. His only hope was a transplant, and that seemed remote now, as he had turned septic. He would be taken off the transplant list unless his condition improved, which was unlikely. The resident ran down each failing system.

“I’ll talk to the parents about withdrawing support,” the resident said.

The rest nodded. Sam clenched his jaw. Barney gave him a quick glance, then flicked his eyes back to the chart in front of him.

Rounds were finally finished. He went to surgery. He hung his suit carefully in his locker, put on his scrubs, took off his watch, and set it on the shelf. He stared at his bare ring finger for a moment, then closed the locker and spun the lock. He went into the surgeon’s lounge, put on his cap, mask, booties, loupe glasses, his fiber-optic headset, then went into the washroom to scrub. He worked methodically. Each finger, four sides, three minutes. Up, down. In between. Now his forearms. He scrubbed without haste, with thorough method. His mind was narrowing down, sealing itself off to the world beyond, the day outside, the hall outside, even to any part of himself that wouldn’t be needed in the next hours. He didn’t speak, and no one spoke to him. They knew not to. When it was time to do a surgery, he entered into a special universe that had room for only two people. Himself and the child on the table.

He thought about what he would do for the TGA repair. Rehearsed it. In the normal heart the two sides worked in beautiful symbiosis. The right side took blood returning from the body, full of carbon dioxide and depleted of oxygen, and pumped it via the pulmonary arteries to the lungs, where the blood swapped carbon dioxide for oxygen. It then returned to the left side of the heart via the pulmonary veins, where it was pumped out into the aorta and through the body.

In the case of the child who awaited him, a three-day-old girl named Elise Sanders, the pumps were connected in reverse. The aorta emerged from the right side of the heart, causing the poorly oxygenated blood to be circulated to the body instead of the lungs. The pulmonary arteries took the oxygenated blood back to the lungs instead of to the body. She was a beautiful child and had looked deceptively normal at birth, not showing her distress until the normal newborn opening between the chambers of the heart had closed, preventing even the minimal mixing of oxygen-poor blood and oxygen-rich blood. In Elise’s case the cardiologists had created a new hole in the cardiac catheterization lab, using a tiny balloon to pop a hole in the septum. Sam would repair this today, as well.

He entered the theater, hands held up at the elbows, dripping. The chief surgical fellow and his physician’s assistant had already opened and exposed the heart. His eyes scanned the operating theater. The child was ventilated, lines in the jugular vein, the foot, the arm. Blood was hanging. The perfusionist was ready with the heart-lung machine, the magical invention that allowed the heart to quit pumping so Sam could do his work. They were an odd-looking group, he supposed, only their eyes showing. Everything else was covered by hospital aqua. Anything that spoke of individuality was gone. For the next few hours they were extensions of him. His extra hands and eyes.

The circulating nurse handed him a sterile towel, helped him into a gown, held out his gloves. He walked toward the table, his mind in the other realm. His operating theater was silent. There was no music. No chitchat. He went over the operating plan he had devised in his mind. He greeted his team with a nod. They didn’t expect more.

He went to work. He marked where he would attach the coronary arteries onto the pulmonary artery, then inserted the bypass cannula. The machine began, its soft shushing taking over the frenetic beat of the infant’s heart. The anesthesiologist gave the heart a dose of potassium solution, and it stopped beating. For a moment Sam’s stopped, as well.

There it was again. That hesitation.
What am I doing?
a part of him screamed, looking at the tiny, still organ waiting for his blade. He breathed deeply and began to work.

He cut the aorta, sliced it clean through. He cut off the coronary arteries. He cut the pulmonary arteries, and then absurdly remembering his mother’s kitchen and the group of hens who stitched quilts, he began to sew. The coronary arteries onto the pulmonary. The pulmonary onto the aorta. He made a neat repair of the hole they’d made in the septum, taking care with his stitches, remembering hearing what his mother had said to Annie and his sister. “Make your stitches even, girls. Too loose and everything will flop every which a way. Too tight and it will pucker up.” Well, it was the same here. He worked quietly, swiftly. He finished.

“Off bypass,” the perfusionist said. Sam held his breath. The moment of grace appeared. The heart quivered briefly, then began to beat. He let out his breath slowly. Everything was in order, he reassured himself, his eyes flicking quickly over the surgical site. Everything was where it should be. The right ventricle was now pumping blood to the lungs. The left ventricle to the aorta and to the body. He stared for a moment, silent, as if waiting to make sure it was not some cruel joke, that things would not suddenly come unglued. They did not.

“Thank you all,” he finally said, signifying the end.

They murmured back.

He shed his gown and left the OR, and it wasn’t until he was out in the corridor that he drew a deep, long breath. He felt the adrenaline drain out, leaving a sucking fatigue in its wake. It was at this point he used to thank the Almighty. He didn’t do so now but felt a surge of gratitude nonetheless that disaster hadn’t visited today.

He thought of the hundreds of surgeries he had done, of the relatively few complications, but he had the sense that his luck had run out years ago and he had been holding things together through sheer willpower. He recalled that once he had thought he was magic, charmed. Blessed. He had believed that he had healing in his hands and that everything he touched would be put right. Well, he knew better than that now, didn’t he? He turned the corner to the lobby to speak to the child’s parents, and the weariness became even deeper. They rose at his appearance, brought their hungry eyes to him, their gaping hearts.

“It went well,” he said.

“Is she all right?” the mother asked anxiously, her eyes red from crying. She clutched Sam’s hand, and he remembered how he used to touch his patients and their families. He used to look deep into their eyes, sending them some of his strength. “We’re in this together,” he would tell them. “You’re not alone.” He remembered giving distraught parents his home telephone number and taking their calls at all hours of the day or night. He recalled praying with them at bedside. He remembered going to funerals with them and sitting heavyhearted under the crushing awareness of his fallibility but still believing in the One who did all things well. He was conscious of the mother’s hand on his now, but his overriding emotion was a strong wish to have it gone.

“She’s fine,” he assured her. “We accomplished all we had hoped.”

They had more questions, more grasping, and suddenly their gaping mouths reminded him of fish on the bank, hooked and gasping. He dispersed his information, patted the mother’s moist hand, and gently pried it off his own.

He went back to the locker room and regowned and regloved. He had two more surgeries to do today.

Eight

“Make that sweet potato pie again,” Kirby said, his long hank of hair falling down over his wire-rimmed glasses. “And those huge biscuits. What did you call them?” he asked, knowing perfectly well.

“Cat heads,” Annie answered dryly.

“Yeah.” Kirby was grinning. Enjoying himself immensely at the hillbilly’s expense, northerner that he was. “Them was plumb good.”

“You’re so clever and entertaining,” Annie said.

“See you tonight.” He grinned again and went back to his work. She went to her desk and gathered up her box of belongings. Her space looked empty and bare. She looked around for someone to tell good-bye, but everyone was busy. On the phone, engaged in conversation, typing. Well, she would see them all tonight, she reassured herself.

It did not surprise her at all that Kirby had assigned her to make most of the food for her own going-away party. It was typical. He did the same at Christmas and Thanksgiving, inviting half the staff of
The Times
to his home, then assigning the entire menu to them. Annie was philosophical. She supposed it was a mutually beneficial situation, for she didn’t really mind baking and cooking. In fact, a part of her entered into the task with abandon and a sense of rightness that she felt at no other time. But it also stirred her up, and by the end of her time in the warm kitchen each holiday eve, she had an aching feeling, a hollow spot just beneath her ribs that no amount of nibbling on the freshly baked comfort foods could assuage. It awakened feelings and memories of that other life, and she had a sneaking suspicion that was exactly why Kirby always insisted she do it. He was always probing and stirring. Wanting her to talk. To make that oft-lauded move in the right direction.

She drove home, brought the box in, and placed it with the others. Her entire life had fit into seven cardboard containers, which she would load tomorrow morning into the back of her truck. She had said good-bye to Adrienne, who was back at her father’s for three and a half days. Tomorrow morning she would give Mrs. Larsen a hug and a kiss and the contents of her refrigerator. She had notified the power and phone companies she would be leaving tomorrow. Then she would drive to Los Angeles. She would stay in a motel for her first few weeks of work. Until she found an apartment, or maybe even a house, and furnished it. She would come back just long enough to be granted her divorce. She would do things right this time. She would make things permanent and real.

“Why don’t you leave your things here until you find a place?” Kirby had argued. “Fly down and look around, rent something, then come back and get your stuff. That’s how a normal person would do it.”

She had made a jibe back. She would do it as she had planned, for the truth was she felt that haste was imperative. That something was gaining on her and she didn’t dare slow down. Besides, she had some time, and she intended to sight-see. Kirby had replaced her position from within, and Jason Niles wasn’t expecting her at the
Times
until the end of July.

She took down her bowls and measuring cups. She assembled her ingredients, glad she knew the recipes by heart, for they had been left behind along with the rest of that life.

She could picture exactly where she had left them—stuffed in the aged metal box with scraps of paper and index cards on the top shelf of the old Hoosier cupboard in her kitchen. She hadn’t needed them even then, but she had treasured them, many of them written in Grandma Mamie’s own spidery hand. Her grandmother’s recipes were historical artifacts, though essentially useless unless you already knew how to make the dish. Mamie hadn’t bothered with measurements. Those kind of detailed instructions were for amateurs.

Aunt Lula’s Sweet Potato Pie,
one said.
First bake your pie crust,
she instructed, correctly assuming a skill Annie had been taught as soon as she could see over the table.
Then mix together your cooked sweet potato meat, your sugar and brown sugar, some allspice, two good-sized eggs, ginger, and some evaporated milk, put in some melted butter, and let it cook real good
.

She smiled for a moment, then went back to her task. She would make her sweet potato pie and some fried apples. Kirby’s wife, Suzanne, was making a main dish of some kind. Art, one of the photographers, would bring a ham. Rita, the arts and leisure columnist, would awe them all with something—she’d made lobster thermidor last Christmas, standing rib roast at Easter. Shirley, her own Shirley, probably busily slicing and dicing downstairs at this very moment, had confided she would contribute homemade sushi and stir fry with tofu this year, as usual. And she, Annie, the token southerner, would bring down-home foods, the kind that filled up your hollow spots with comfort. She had already made a coconut cake, and now she would mix up some cat-head biscuits, so named because they were as big as the aforementioned. She had a jar of honey she’d bought when she’d gone to a lavender farm in Sequim last summer on assignment. She had been saving it for some special occasion, and she supposed this qualified.

She measured and baked, and as much as she wished not to, she remembered her other life. She remembered him and how she had seen him then. Before. As a good man. Heroic. Bigger than life and able to keep her safe. That life they had shared had been idyllic and blissful, and she supposed she had known even then that anything raised up on a sacred altar could not last, but must, along with all other idols, be cast down.

Her mornings then had been different than they were now, and she twisted a smile at the understatement. She had arisen each day and cooked the eggs and grits he liked for breakfast. He was the one with important work to do. He was the one who must be taken care of.

“Don’t tell anyone,” he’d made her promise as she served him his food. “I’m supposed to be an example of healthy eating. My patients shouldn’t know I have heart attack on a plate every morning.” She had smiled and jokingly crossed her heart but had felt a quiver of dread. What would happen someday if his health failed? She couldn’t bear to think of what would happen if he were to— She never finished that sentence. She hadn’t been able to imagine life without him.

A morning stood out in her memory. It had been one of those shining, perfect moments. It had been in the early days of Sam’s career. She had not been working then. She had risen early to cook for him before he left. It had been a fine fall morning. The mountain air of home had been crisp and cool after the summer’s moist heat. The red dirt of the fields beyond their own was beautiful in the autumn light, the mountains smudged with daubs of gold and rust and flame. There had been something different about that autumn light, she decided. The slant, the shadows things cast had made them seem clearly outlined, crisp in their images. She remembered her deep contentment, her satisfaction with her lot. “The boundary lines have fallen for me in pleasant places,” she recited from somewhere in memory.

She browned a roast that morning and put it in the slow cooker, and while she prepared it she thought about her life. Some of her friends from college thought she was wasting it. They never said so, of course, but the implication was there, and she felt vaguely apologetic in their presence, as if she should make excuses. She consoled herself by recalling what Miss Loretta had said on that very subject at the ladies’ Bible study the week before. “Women who have careers serve an employer. They try to anticipate his or her needs and expectations and meet or exceed them for advancement or money or personal pride. The woman who serves her husband and family does honorable work, and her reward will be eternal. Don’t let the world tell you whom you may serve.” Annie had thought about that as she washed the dishes and put them to drain, as she fixed her husband’s breakfast and prepared their supper. Miss Loretta was right. She felt a warm thrust of joy as she went on with her work.

She heard his feet on the stairs. She took down the plate, one of her grandmother’s old Blue Willow plates, and scooped up the grits, slid the eggs off the pan, buttered the toast, and poured the coffee. She set it all on the table and put out the salt and pepper, the jar of blueberry jelly.

“Good morning,” he said. He came into the room and brought that sense of purpose and safety with him. He held her. He kissed her. She kissed him back and stroked his face, yet unlined with worry and strain.

“Your breakfast is getting cold,” she finally murmured.

He kissed her again, then they went to the table. She had a piece of toast, drank her coffee, and listened to him tell about the day before him. He would see patients in the hospital this morning, in the office this afternoon. And of course, what she knew without saying was that there would be a late afternoon consultation or two. A parent who needed encouragement. A sick child who’d been looking forward to a visit from Doctor Sam. No money would change hands, but he would be late home to supper, and tomorrow would be even worse. Tomorrow he had surgery, and who knew when he would be home on surgery day. Tomorrow she would make supper and make the drive to take it to him. If she was lucky and his schedule permitted, they would eat in the small kitchen off the doctors’ lounge.

Sam, his brother, his father, his great-uncle, his great-grandfather, way on back to the first one who had come over on the boat from England, had all been physicians. She watched her husband eat and thought about that, the fact that he was part of a heritage, a lineage, a noble calling. She didn’t feel envy, only respect, and she never begrudged the time or energy his work required of him. She never saw it as taking from her. His work was part of who he was. Part of what she loved about him. And she knew who she was, as well. No matter what anyone else might say, she knew the part she played in making his work possible. The part her mother-in-law and all the Truelove women before them had played. Perhaps she didn’t prescribe the medicine or hold the scalpel, but she had a role in making him the doctor and the man he was. She knew her husband well, and she knew herself.

“What are you going to do today?” he asked her.

“I’m going to put a roast on to cook,” she said. “And then I’m going to clean out the garden. I’m going to take Aunt Bessie to the grocery store and help her pick her apples.”

He leaned back and looked at her, smiled, as if he was well pleased with her plans, as if it gave him pleasure to hear her talk about them. He held out his hand, and she took it. She looked at the competent, strong fingers, and she tried to imagine their skill and dexterity as they mended the hurting children who came to him for help. They closed over hers, and they began this day the way they began all others.

“Lord Jesus, thank you for this day,” Sam said in his firm resonant voice. “Thank you for the work you’ve given us to do. Thank you for your provision, for your bounty. Thank you for coming and dying for us so that we might have life. Help us, Lord, to walk in a manner worthy of our calling.”

“Amen,” she said softly, and everything in her heart settled into one sweet harmonious note as she whispered the words.

“Amen.”

She stared down at her hands now as she prepared the food for her party and tried to recall that other golden time. That shining mirage that had been her life. There in that small town perched in a cove of the mountains. It had been a blissful dream. Not permanent. Not real. She had not known that the veil was about to tear.

They had gone to church. The same church her mother-in-law and father-in-law, her brother-in-law and sister-in-law, and a horde of their cousins and aunts and uncles attended. She went to the ladies’ Bible study on Wednesday mornings. She went to the baby showers and socials and made a quilt a year to sell at the Christmas bazaar. And she remembered Sam courting her right there on that wide lawn as they sat and ate dinner on the ground, as their great-great-ancestors had probably done. It had been a small society, kindly and sustaining. She’d planted and tended a huge garden every year. She’d wanted to have a large family. Seven children. Maybe eight, and she had imagined them playing in the yard, swinging on the swing, splashing in the creek as she had done. She stopped her memories there. She felt as if something might swallow her up.

She stared at her empty kitchen wall now, then shook her head forcefully to bring herself around. She remembered the question Kirby had asked her. “Are you headed in the right direction?” And she remembered those halfway moments before great mistakes. She could almost feel herself teetering, balancing between the past and an irrevocable future.

She felt annoyed at the uncertainty, that the question still mocked her, unanswered. She picked up an apple and began slashing at it furiously, the peelings falling and sticking to the white porcelain sink.

****

She finished her cooking and baking by five, then loaded all the food she had made into the cab of the truck, as well as the good-bye gifts she had bought for Kirby and his family. She had given Shirley hers already, a book on natural healing remedies, which Shirley had immediately used to brew a horrible tea, from who knew what, that she had insisted Annie drink. It had reminded her of the smell of the sheep pens at home.

She drove to Kirby’s house. He lived in north Seattle in an old neighborhood near a small college. Many of the houses were Craftsman bungalows, and she had read that in the twenties Sears Roebuck had sold the kits to make them for seven hundred dollars and delivered them on a railroad flatcar. She tried to imagine what it would be like to sit there surrounded by all the pieces of a house and yet have no idea where to begin to assemble it. She didn’t have to try very hard.

She gazed now beyond those neat square houses and green lawns, past the rhododendron bushes and Douglas firs and cedars. She looked past the line of cars parked along the narrow streets, the telephone and power poles, the cracked sidewalks and misty gray sky, and instead she saw a bumpy ridge of mountains enfolded in smoky blue mist. She closed her eyes to make the scene go away. It worked after a fashion, and then she had arrived at Kirby’s house.