A White Coat Is My Closet (34 page)

Dr. Klein was standing next to the operating table opposite him. “I’m sorry, Carlos,” he said, addressing Dr. Alfredo. “This is going to be a long procedure, and I sprained my ankle this weekend. I think I’m going to have to sit. Go ahead and begin but,” he said as he turned to Maggie, “I’m going to need a stool.”

“Right away, Doctor. There’s one right here in the corner.” Maggie’s tone was efficient and accommodating. She’d had plenty of experience working with Dr. Klein. In addition to trying to anticipate his needs, when he said jump, the requisite response was “How high?” She brought the stool over and centered it behind him. “There you are, Doctor.”

Rather than acknowledge her effort, Dr. Klein spoke to Dr. Alfredo. “Okay, Carlos, you’re lead on this one. I’m just here to make sure you don’t make any mistakes.” He chuckled under his mask.

Dr. Alfredo simply answered, “Thank you, Maggie, we all have a big job ahead of us.” With that, he placed the edge of his scalpel against Christopher’s skin and made a six-inch incision.

Maggie looked at the clock and spoke to Dr. Zoryan, who was writing in the surgical log. “Official start time, 2:54.”

The surgery was laborious. The tumor was large and was encroaching on numerous essential nerves and blood vessels. The surgeons worked meticulously and efficiently. Conversation was limited only to the exchange of essential information. Though caustic, Dr. Klein was talented, and Dr. Alfredo had the reputation of being one of the best pediatric surgeons on the West Coast. Christopher was undoubtedly in good hands, but watching the procedure only heightened my anxiety. It was one thing to see a tumor on an MRI. It was quite another to look at it consuming the bulk of Christopher’s small abdomen. My heart sank. The likelihood that he could recover from such a devastating disease seemed even more impossible.

Two hours into the operation, Maggie temporarily left the room. Moses stood next to Dr. Klein and passed instruments. The surgical resident was next to Dr. Alfredo. He was holding a suction catheter in one hand and a retractor in the other. His job was to keep the area where the surgeons were working free of blood and in clear view. I was watching from a platform eight inches off the floor. Because I was just over Dr. Alfredo’s shoulder, I had an unobstructed view of the area in which they were operating. The only sound was the soft gurgle of the suction and instruments clattering on the tray. The silence was interrupted when Dr. Klein complained that he was now too far away from the table to clearly see.

In an attempt to prevent Dr. Klein from having to endure even the slightest inconvenience, Moses quickly volunteered, “Maggie just left the room, but I think I can push in your stool.”

Dr. Klein briefly diverted his eyes away from the suture he was in the process of tying and looked at Moses disdainfully. “That’s a proposition I never want to hear coming from someone like you.” His voice was replete with contempt. “Where the hell is Maggie?”

It took everyone a second to understand the inference of his comment, and the room fell into an uncomfortable silence. Between his mask and the edge of his surgical cap, I could see Moses’s forehead burn red with embarrassment. Initially, I was in a state of momentary shock, but as I recovered, I felt nauseous. A flurry of emotions overwhelmed me. Outrage, anger, self-consciousness, and fear. Once again, one of Dr. Klein’s homophobic slurs had brought all my insecurities to the surface. In one respect, I was incensed that Moses would be subjected to such a demeaning comment. In another, I was hugely apprehensive that I was precariously close to being painted with the same brush. I hung my head in shame. The biggest indignity of the whole experience was my silence. Finally, probably also at a loss for an appropriate response, Dr. Alfredo interjected. “Let’s all just stay focused on the patient. He deserves our full attention.” Then, without looking up, he added, “And just for the record, Moses, I’ve always found working with you to be a pleasure. There are many children alive today who have greatly benefited from your caring and professionalism.”

He withdrew a small square of gauze from the incision with a pair of tweezers, then held open his empty hand. “Mosquito forceps.”

Moses put the instrument in his hand with practiced precision and echoed, “Mosquito forceps.” His voice softened as he said, “And thank you.”

Dr. Klein did little more than to clench his teeth. He was completely unaccustomed to being even subtly contradicted, but because he and Dr. Alfredo shared similar stature in the hospital hierarchy, he undoubtedly recognized there could potentially be consequences were he to continue his verbal assault. “Let’s just see if we can wrap this up.”

I too breathed a silent acknowledgment of thanks to Dr. Alfredo. I was so appreciative that he had come to Moses’s defense. Always the diplomat, he probably knew he’d run the risk of having the situation escalate if he challenged Dr. Klein directly. But at the same time, he was unwilling to let such a derogatory comment pass without somehow invalidating it. At least someone in the room had the balls to speak up. I wished it had been me. In reality, though, it was impossible for me to ever imagine having the courage to stand up to a bully whose opinion of me might somehow influence my career. I felt pathetic.

Four hours after having made the initial incision, Dr. Alfredo finished closing the wound. He looked tired but optimistic. They had succeeded in removing the vast majority of the tumor, and it was in a specimen container on its way to the pathology department for more extensive study. In addition, they had been able to save Christopher’s left kidney and were relatively confident its function had been mostly preserved. Finally, though the tumor had been pressing against his spine, there didn’t appear to be any permanent nerve damage.

Dr. Alfredo thanked everyone individually for their exceptional efforts, starting with Dr. Klein. “Steven, you have a phenomenal set of hands. It’s a real privilege to operate with you. Thank you for your help.” Dr. Klein grunted an almost unintelligible response and walked out the door. When I thought about it, I admired Dr. Alfredo’s ability to emphasize a person’s positive attributes.

He then turned his attention to the surgical resident. “Justin, keep up the good work. You show great promise. You have the potential to be an outstanding surgeon.” He smiled. “It might be a good idea for you to review which arteries in the abdomen go where, but overall, a very good job.”

Justin answered. “Thanks a lot, Dr. Alfredo. I really hope to have the opportunity to do a full rotation with you. I really learned a lot from you and appreciate your teaching style. It’s refreshing to be able to work on a big case and not be made to feel like an idiot.” The innuendo hung in the air, but no one ventured to elaborate. Justin gave Moses an apologetic nod, then turned back to Dr. Alfredo. “Anyway, thanks again. I’m on call tonight, so I’ll be checking on Christopher frequently. I’ll keep you apprised of any changes in his condition.”

“I’d appreciate that.” Dr. Alfredo raised his voice and directed it across the room. “Moses, Maggie, as always, a stellar performance. Thank you both for your outstanding work.” He then walked across the room and intentionally shook Moses’s hand. “Young man, you can operate with me anytime.”

Moses blushed again, but this time from welcome embarrassment. “I appreciate that, Dr. Alfredo. I consider it a real honor to work with someone who has both exemplary ability and integrity. It’s a privilege. Truly, it is.”

Always the gentleman, Dr. Alfredo responded, “In my experience, it’s you nurses who make us surgeons look good.”

Finally, Dr. Alfredo turned to me. “Zack, Christopher is going to be in the recovery room for at least five or six hours. I want to make sure that he’s fully awake, that he’s making good urine, and that he’s able to move his legs without difficulty. Would you like to accompany me to give his parents what is, in this situation, anyway, the best possible news?” The lines on his face deepened. “While the surgery was technically a success, I wish having that tumor out significantly changed the prognosis. I’m not sure it does. It’s evident from being in there that he has an extremely aggressive disease. I felt like I was watching the tumor grow even as we were trying to cut it out. Also, there’s the fact that it’s already spread to the liver and the lymph nodes. It’s frequently humbling to witness how ineffective we are at battling Mother Nature when she chooses to show us her ugly side.” He patted my shoulder. “But, for today, anyway, the parents get a little piece of good news. We accomplished what we’d hoped to, and the outcome was better than we’d anticipated. I fear most of the news they’ll be getting with regard to Christopher’s overall condition will be discouraging. Let’s try to make today’s surgery represent a bright spot, as brief as that bright spot might be.”

I tried to smile, but the effort never reached my lips. “Thanks, Dr. Alfredo. I learn something from you every time I work with you. Not so much about surgery, but about compassion. And for me, anyway, I suspect that’s a more important lesson.”

Dr. Alfredo patted me affectionately. “I’m not so sure, Zack. I’ve been at this game a lot longer than you have, but I’ve been watching you with patients. As far as compassion goes, I feel like you’re the one who has been giving me a refresher course.” He started walking toward the door. “Let’s go talk to his parents. Knowing exactly what to say isn’t going to be easy. Straddling that line can be a real challenge. In this situation, how does a physician encourage genuine hope while at the same time not contribute to unrealistic expectations? I’ve been wrestling with what I was going to say to them from the moment I placed my scalpel on their son’s skin.” He stopped, shook his head for a second, and looked legitimately perplexed. “To tell you the truth, I’m still not exactly sure what it’s going to be.” He paused and patted my shoulder one more time. “What do you say to helping me wing it?”

T
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next few weeks were a blur. Comparatively speaking, Christopher’s overall condition improved. Though Dr. Herbert was apprehensive about stopping his chemotherapy temporarily, the consensus was that he should be given an opportunity to at least partially recover from his surgery before proceeding. He had endured an extensive operation, and initiating chemo too soon would significantly compromise his ability to adequately heal. So, though we knew his tumor could potentially continue to proliferate, we felt we had few alternatives. The upside was that during his chemo hiatus, Christopher’s energy began to slowly return, as did his appetite. We once again began to see remnants of a vitality-filled little boy. He and I worked on more puzzles, played more games, and conquered more villains. In fact, after a shift, if Sergio was working, rather than going directly to the gym, I would frequently remain in the hospital for an additional hour just to spend time with him. On weekends, Sergio and I would even haunt secondhand stores to find vintage Superman videos. The classics were Christopher’s favorites.

In addition, Sergio and I were spending most of our free time together. Despite significant conflicts in our schedules, we did whatever we could to ensure we’d be able to see each other. We laughed, we joked, we challenged one another, we argued, and we relished in the process of getting to know one another. Sometimes, if he was working a number of consecutive nights in a row, just so I’d be able to see him, I would leave the back door unlocked when I went to bed. After he closed up the restaurant, he would drive over to my house, sneak in the back door, and slide into bed next to me. Even if he were to awaken me out of a sound sleep, the excitement of having him in bed with me would invariably result in quick but satisfying sex. Afterward, I would again fall unconscious. Such escapades would sometimes make it difficult for me to haul my ass out of bed in the morning, but they were well worth it. What I suffered in fatigue was compensated for by being energized by spending time with Sergio. The other metamorphosis occurring was my beginning to feel a genuine sense of happiness.

Because Sergio slept at my apartment more often than I slept in his, when I did spend the night at his place, I sometimes awakened from a deep sleep feeling slightly disoriented. It was initially bewildering to find myself in unfamiliar surroundings. Such was the situation one morning when I found myself coming slowing awake before the alarm went off. The shadows on the wall looked strange to me. I rolled to my left side, expecting to see a faint light streaming in through the curtains, but instead was confronted by the indistinct shape of a dresser covered with an array of framed pictures and a trio of glass vases. The vases were different sizes and shapes, but even in subdued light I could appreciate that each was a clear vibrant orange. As my eyes began to slowly adjust to what was just the early glow of dawn, I kept my gaze fixed on the vases. I felt my brain slowly lifting from the fog of sleep, and I was confident I would soon remember why I wasn’t in my own bed. I let my fading dream swirl around the colors in the vases. Red and yellow flashes mixed delicately throughout the orange, but each vase boasted its own unique pattern. Later, I learned they had been hand-blown on the island of Murano, near Venice. I was impressed that such a simple addition to the top of a dresser could create such a beautiful focal point. It occurred to me that to an impartial observer, my bedroom probably looked like a college dorm.
Damn, I’ve got to do something other than work.