"Over my dead body, " Engleson said as he raced down the hall to the stairs. "No way do you open that woman up without my being there." In less than a minute, he had joined Nixon in the scrub room. "The nurses said Stone Hands was trying to find you, " the woman said. "I was just finishing up a case down the hall when Denise grabbed me. Do I have to stay?"
"You might want to learn from the master in there, " Engleson responded acidly, cleaning his fingernails with an orange stick. The intern smiled, nodded a thanks-but-no-thanks, and left him to finish his scrub.
"Order a peach and you get a pear, " was Bartholomew's comment on the change in assistants. He laughed merrily at his own humor and seemed not to notice the absence of response from around the room. With Engleson handling sponges and hemostats, Bartholomew used an electric scalpel to make an incision from just below Beverly Vitale's navel to her pubis.
The scalpel, buzzing and crackling like hot bacon grease, simultaneously sliced through the skin and cauterized bleeding vessels. Next, with the voltage turned up, he cut through a thin layer of saffron-colored fat to her peritoneum, the opaque membrane covering her abdominal cavity. A few snips with a Metzenbalim scissors, and the peritoneum parted, exposing her bowel, her bladder, and beneath those, her uterus. In a perfunctory manner, too perfunctory for Engleson's taste, the older surgeon explored the abdominal cavity with one hand. "Everything seems in order, " he announced to the room. "I think we can proceed with a hysterectomy."
"No! " Engleson said sharply. The room froze. "I mean, don't you think we should at least consider the possibility of ligating her hypogastric artery? " He wanted to add his feelings about rushing ahead with a hysterectomy in a thirty-year-old woman with no children, but held back.
Also unsaid, at least for the moment, was that the hypogastric ligation, while not always successful in stopping hemorrhaging, was certainly accepted practice in a case like this.
Bartholomew was still guided by the old school-the school that removed a uterus with the dispatch of a dermatologist removing a wart. D. K.
Bartholomew's pale blue eyes came up slowly and locked on Engleson's.
For five seconds, ten, an eerie silence held, impinged upon only by the wheeze of air into the vacuum apparatus. The tall resident held his ground, but he also held his breath. The outburst by the older surgeon now, and there would be a confrontation that could further jeopardize the life of Beverly Vitale. Then, moment by moment, Engleson saw the blaze in Bartholomew's eyes fade. "Thank you for the suggestion, doctor,
" the surgeon said distantly. "I think perhaps we should give it a try."
The relieved sighs from those in the room were muffled by their masks.
"You or me? " Engleson asked. "It… it's been a while since I did this procedure, " Bartholomew understated. "Don't worry, we'll do it together."
In minutes, the ligation was complete. Almost instantly, the bleeding from within the woman's uterus began to lessen. "While we're waiting to see if this works, " Engleson said, "would you mind if I got a better look at her tubes and ovaries?"
Bartholomew shrugged and shook his head. Engleson probed along the fallopian tubes, first to one ovary and then to the other. They did not feel at all right. Carefully, he withdrew the left ovary through the incision. It was half normal size, mottled gray, and quite firm. This time, it was his eyes that flashed. You said everything was in order.
Bartholomew sagged. There was a bewildered, vacant air about him, as if he had opened his eyes before a mirror and seen a painful truth. The woman's right ovary was identical to her left. "I don't think I've ever seen anything quite like this, " Engleson said. "Have you? " No, well, not exactly-, Pardon?"
"I said I hadn't either."
There was an uncertainty, a hesitation, in the older man's words.
He reached over and touched the ovary. "You sure? " Engleson prodded. "I … I may have felt one once. I'm trying to remember. Do you suggest a biopsy? " Engleson nodded. "A wedge section?"
Another nod. The man's confidence was obviously shaken. By the time the wedge biopsy was taken, the bleeding had slowed dramatically. As Engleson prepared to close the abdominal incision over the uterus he had just preserved, he sensed the irony of what was happening tighten in his gut. The uterus was saved, true. A fine piece of surgery. But if the pathology in Beverly Vitale's ovaries was as extensive as it appeared, the woman would never bear children anyhow. "Denise, " he said, "could you find out who's on for surgical path this month, both the resident and the staff person, okay?"
"Right away."
Engleson glanced at the peaceful face and tousled hair of the young cellist. Some women try for years to get pregnant, never knowing whether they can or not, he thought. At least you'll know. Glumly, he began to close. Twenty minutes later, the two surgeons shuffled into the doctor's locker room. "Dr. Bartholomew, have you been able to remember where you might have encountered ovarian pathology like this woman's?"
"Oh, yes, well, no. I… what I mean is I don't think I've ever seen anything like them."
"You look as if you want to say something more."
"I may have felt something like them once. That's all."
"When? On whom? " There was some excitement in Engleson's voice. D. K. Bartholomew, MD, Fellow of the American College of Surgeons and Diplomate of the American College of Obstetrics and Gynecology, shook his head. "I… I'm afraid I don't remember, " he said. "What are you talking about?"
"It was surgery for something else. Maybe removal of a fibroid tumor.
The ovaries felt like this woman's did today, but there was no one around to consult, and I think I had another case or two left to do and …"
"So you just ignored them and closed?"
"I felt they were probably a normal variant."
"Yeah, sure. Did you mention them on your operative note?"
"I… I don't remember. It might have been years ago."
The wall telephone began ringing. "Dr. Bartholomew, " Engleson said, allowing the jangle to continue. "I don't think you should operate anymore." With that he turned and snatched up the receiver. "Dr.
Engleson, it's Denise. I called pathology."
"Yes?"
"I couldn't find out who the resident is on surgicals, but the staff person is Dr. Bennett."
C'Good."
"Excuse me?"
"I just said that's good. Thanks, Denise."
"Thank you for what you did in there, Doctor. You made my day."
Kate's back was arched over the pillows beneath her hips as Jared knelt between her legs and used her buttocks to pull himself farther inside her. Again and again he sent jets of pleasure and pain deep into her gut and up into her throat. Her climax grew like the sound of an oncoming train-first a tingle, a vibration, next a hum, then a roar. With Jared helping, her body came off the pillows until only her heels and the back of her head were touching the carpet. Her muscles tightened on him and seemed to draw him in even deeper. He dug his fingers into the small of her back and cried out in a soft, child's voice. Then he came, his erection pulsing in counterpoint to her own contractions. "I love you," he whispered. "Oh, Katey, I love you so much." Gently, he worked his arms around her waist, and guided her onto her side, trying to stay within her as long as possible. For half an hour they lay on the soft living room carpet, their lover's sweat drying in the warmth from the nearby wood stove. From the kitchen, the aroma of percolating coffee, forgotten for over an hour, worked its way into the sweetness of the birch fire. A cashmere blanket, one of the plethora of wedding gifts from Jared's father, lay beside them. Kate pulled it over her sleeping husband and then slipped carefully from underneath. For a time, she knelt there studying the face of the man who had, five years before, arranged to have himself and a dozen roses wheeled under a sheet into her autopsy suite in order to convince her to reconsider a rebuffed dinner invitation. Five years. Years filled with so much change-so much growth for both of them. She had been a nervous, overworked junior faculty member then, and he had been the hotshot young attorney assigned by Minton/Samuels to handle beleaguered Metropolitan Hospital. The memory of him in those days-so eager and intense brought a faint smile.