Strangers (10 page)

Parker stepped into the room. “Buddy? Are you all right? You were screaming. I could hear you clear out in the driveway.”

“A dream.”

“Must’ve been a lulu.”

“I can’t remember what it was,” Dom said, remaining on the floor, in the corner, too exhausted and weak-kneed to get up. “You’re a sight for sore eyes, Parker. But…what on earth are you doing here?”

Parker blinked. “Don’t you know? You phoned me. Not more than ten minutes ago. You were shouting for help. You said
they
were here and were going to get you. Then you hung up.”

Dom felt humiliation settle over him as if it were a painful burn.

“Ah, so you
did
make the call in your sleep,” the painter said. “Thought as much. You sounded…not yourself. Maybe I should’ve called the police, but I suspected this sleepwalking thing. Knew you wouldn’t want it brought into the open in front of strangers, a bunch of cops.”

“I’m out of control, Parker. Something’s…snapping inside me.”

“That’s enough of that crap. I won’t listen to any more of it.”

Dom felt like a helpless child. He was afraid he was going to cry. He bit his tongue, squeezed back the tears, cleared his throat, and said, “What time is it?”

“A few minutes after four. Middle of the night.” Parker looked toward the window and frowned.

Following the other man’s gaze, Dom saw that the draperies were drawn tight shut and that the highboy had been moved in front of the window, barring entrance by that route. He had been busy in his sleep.

“Oh, Christ,” Parker said, moving to the bed, where he stopped, a vivid expression of shock on his broad face. “This is no good, my friend. This is no good at all.”

Holding on to the wall, Dom rose shakily to his feet to see what Parker was talking about, but when he saw it, he wished he had remained on the floor. An arsenal was laid out on the bed: the .22 automatic that he usually kept in his nightstand; a butcher’s knife; two other meat knives; a cleaver; a hammer; the ax he used for splitting firewood and which, the last he remembered, had been in the garage.

Parker said, “What were you expecting—a Soviet invasion? What frightens you so?”

“I don’t know. Something in my nightmares.”

“So what do you dream about?”

“I don’t know.”

“You can’t remember any of it?”

“No.” He shivered again, violently.

Parker came to him, put a hand on his shoulder. “You better take a shower, get dressed. I’ll start rustling up some breakfast. Okay? Then I…I think we’d better pay a visit to that doctor of yours as soon as his office opens. I think he’s got to take a second look at you.”

Dominick nodded.

It was December 2.

DECEMBER 2–DECEMBER 16

1

Boston, Massachusetts

Viola Fletcher, a fifty-eight-year-old elementary-school teacher, mother of two daughters, wife of a devoted husband, a wry and witty woman with an infectious laugh, was silent now and still, lying on the operating table, unconscious, her life in Dr. Ginger Weiss’s hands.

Ginger’s entire life had been a funnel, focusing on this moment: for the first time, she was assuming the senior surgeon’s role in a major and complicated procedure. Years of arduous education, an immeasurable weight of hopes and dreams, lay behind her ascension to this moment. She had a prideful yet humbling sense of just how great a distance her journey had covered.

And she was half sick with dread.

Mrs. Fletcher had been anesthetized and draped in cool green sheets. None of the patient’s body was visible except that portion of her torso on which surgery would be performed, a neat square of flesh painted with iodine and framed by lime-colored cloth. Even her face was out of sight beneath tented sheeting, as an added precaution against airborne contamination of the wound that would shortly be made in her abdomen. The effect was to depersonalize the patient, and perhaps that was in part the
intent
of the draping, as well, thereby sparing the surgeon the need to look upon the human face of agony and death if, God forbid, his skill and education should fail him.

On Ginger’s right, Agatha Tandy, the surgical technician, stood ready with spreaders, rakes, hemostats, scalpels, and other instruments. On her left, a scrub nurse was prepared to assist. Another scrub nurse, the circulating nurse, the anesthesiologist, and his nurse also waited for the procedure to begin.

George Hannaby stood on the other side of the table, looking less like a doctor than like the former star fullback on a pro football team. His wife, Rita, had once talked him into playing Paul Bunyan in a comedy sketch for a hospital charity show, and he had appeared at home in woodsman’s boots, jeans, and a red plaid shirt. He brought with him an aura of strength, calmness, and competency that was most reassuring.

Ginger held out her right hand.

Agatha put a scalpel in it.

A keen, thin, bright curve of light outlined the razor-sharp edge of the instrument.

Hand poised over the score lines on the patient’s torso, Ginger hesitated and took a deep breath.

George’s stereo tape deck stood on a small table in the corner, and familiar strains of Bach issued from the speakers.

She was remembering the ophthalmoscope, the shiny black gloves….

However, as frightening as those incidents had been, they had not utterly destroyed her self-confidence. She had felt fine ever since the most recent attack: strong, alert, energetic. If she had noticed the slightest weariness or fuzzy-mindedness, she would have canceled this procedure. On the other hand, she had not acquired her education, had not worked seven days a week all these years, only to throw away her future because of two aberrant moments of stress-related hysteria. Everything was going to be fine, just fine.

The wall clock said seven-forty-two. Time to get on with it.

She made the first cut. With hemostats and clamps and a faultless skill that always surprised her, she moved deeper, constructing a shaft through skin, fat, and muscle, into the center of the patient’s belly. Soon the incision was large enough to accommodate both her hands and those of her assisting physician, George Hannaby, if his help should be required. The scrub nurses moved close to the table, one on each side, grasped the sculpted handles of the retractors, and pulled back gently on them, drawing apart the walls of the wound.

Agatha Tandy picked up a fluffy, absorbent cloth and quickly blotted Ginger’s forehead, careful to avoid the jeweler’s lenses that protruded from her operating glasses.

Above his mask, George’s eyes squinted in a smile.
He
was not sweating. He seldom did.

Ginger swiftly tied off bleeders and removed clamps, and Agatha ordered new supplies from the circulating nurse.

In the brief blank spaces between Bach’s concertos and in the silence at the end of the tape before it was turned over, the loudest sounds in the tile-walled room were the sibilant exhalations and groaning inhalations of the artificial lung machine that breathed for Viola Fletcher. The patient could not breathe for herself because she was paralyzed by a curare-derived muscle relaxant. Though entirely mechanical, those sounds possessed a haunting quality that made it impossible for Ginger to overcome her apprehension.

On other days, when George cut, there was more talk. He traded quips with the nurses and the assisting resident, using light banter to reduce the tension without also reducing concentration on the vital task at hand. Ginger was simply not up to that sort of dazzling performance, which seemed akin to playing basketball, chewing gum, and solving difficult mathematical problems at the same time.

Having completed the excursion into the belly, she ran the colon with both hands and determined that it was healthy. With damp gauze pads provided by Agatha, Ginger cradled the intestines, placed the hoe-like blades of the retractors against them, and turned them over to the scrub nurses, who held them out of the way, thus exposing the aorta, the main trunkline of the body’s arterial system.

From the chest, the aorta entered the belly through the diaphragm, running parallel to the spine. Immediately above the groin, it split into two iliac arteries leading to the femoral arteries in the legs.

“There it is,” Ginger said. “An aneurysm. Just like in the X-rays.” As if to confirm it, she glanced at the patient’s X-ray that was fixed on the light screen, on the wall at the foot of the operating table. “A dissecting aneurysm, just above the aortic saddle.”

Agatha blotted Ginger’s forehead.

The aneurysm, a weakness in the wall of the aorta, had permitted the artery to bulge outward on both sides, forming a dumbbell-shaped extrusion full of blood, which beat like a second heart. This condition caused difficulty in swallowing, extreme shortness of breath, severe coughing, and chest pains; and if the bulging vessel burst, death followed swiftly.

As Ginger stared at the pulsing aneurysm, an almost religious sense of mystery overcame her, a profound awe, as if she had stepped out of the real world into a mystic sphere, where the very meaning of life was soon to be revealed to her. Her feeling of power, of transcendence, rose from the realization that she could do battle with death—and win. Death was lurking there in the body of her patient right now, in the form of the
throbbing aneurysm, a dark bud waiting to flower, but she had the skill and training to banish it.

From a sterile package, Agatha Tandy had taken a section of artificial aorta—a thick, ribbed tube that split into two smaller tubes, the iliac arteries. It was woven entirely of Dacron. Ginger positioned it over the wound, trimmed it to fit with a pair of small sharp scissors, and returned it to the technician. Agatha put the white graft in a shallow stainless-steel tray that already contained some of the patient’s blood, and swished it back and forth to wet it thoroughly.

The graft would be allowed to soak until it had clotted a bit. Once it was installed in the patient, Ginger would run some blood through it, clamp it, allow that blood to clot a bit more, then flush it out before actually sewing it in place. The thin layer of clotted blood would help prevent seepage, and in time the steady flow of blood would form a neointima, a leak-proof new lining virtually indistinguishable from that in a real artery. The amazing thing was that the Dacron vessel was not merely an adequate substitute for the damaged section of aorta but was, in fact, actually superior to what nature had provided; five hundred years from now, when nothing remained of Viola Fletcher but dust and time-worn bones, the Dacron graft would still be intact, still flexible and strong.

Agatha blotted Ginger’s forehead.

“How do you feel?” George asked.

“Fine,” Ginger said.

“Tense?”

“Not really,” she lied.

He said, “It’s a genuine pleasure watching you work, Doctor.”

“I’ll second that,” said one of the scrub nurses.

“Me, too,” the other said.

“Thanks,” Ginger said, surprised and pleased.

George said, “You have a certain grace in surgery, a lightness of touch, a splendid sensitivity of hand and eye that is, I’m sorry to say, not at all common in the profession.”

Ginger knew that he never gave voice to an insincere compliment, but coming from such a stern taskmaster, this bordered on excessive flattery. By God, George Hannaby was
proud
of her! That realization flooded her with warm emotion. If she had been anywhere but in an operating room, tears would have come to her eyes, but here she kept a tighter rein on her feelings. However, the intensity of her reaction to his words made her aware of how completely he had filled the role of father-figure in her life; she took nearly as much satisfaction from his praise as she would have taken if it had come from Jacob Weiss himself.

Ginger proceeded with the operation in better spirits. The disturbing
possibility of a seizure slowly receded from her thoughts, and greater confidence allowed her to work with even more grace than before. Nothing could go wrong now.

She set about methodically controlling the flow of blood through the aorta, carefully exposing and temporarily clamping all branching vessels, using thin elastic loops of extremely pliable plastic tubing to valve off the smaller vessels, placing mosquito clamps and bulldog clamps on the larger arteries, including the iliacs and the aorta itself. In little less than an hour, she had stopped all blood flow through the aorta to the patient’s legs, and the throbbing aneurysm had ceased its mocking imitation of the heart.

With a small scalpel, she punctured the aneurysm, releasing a pool of blood; the aorta deflated. She sliced it open along its anterior wall. At that moment, the patient was without an aorta, more helpless and more dependent upon the surgeon than at any other time. There was no going back now. From this point on, the operation must be conducted not only with the greatest care but with the most prudent speed.

A hush had fallen on the surgical team. What little conversation there had been now ceased. The Bach tape had reached the end again, and no one moved to turn it over. Time was measured by the wheezing and sucking of the artificial lung machine and by the beeping of the EKG.

Ginger removed the Dacron graft from the steel tray, where it had been soaking up blood and clotting precisely as desired. She sewed the top of it into the aortal trunk, using an extremely fine thread. Then, with the top of the graft sewn in place and the unattached bottom clamped off, Ginger filled it with blood to let it clot again.

Throughout these steps of the operation, it had not been necessary for Ginger to have the sweat blotted from her forehead. She hoped that George noticed her new dryness—she was sure he did.

Without needing to be told that it was once again time for music, the circulating nurse reset the Bach tape.

Hours of work lay ahead of Ginger, but she pressed on without the least weariness. She moved down the draped body, folding back the green sheets, revealing both of the patient’s thighs. With the help of the circulating nurse, Agatha had replenished the instrument tray and was ready now with everything that Ginger needed to make two more incisions, one in each of the patient’s legs, below the inguineal creases, where the legs attached to the body trunk. Clamping and tying off vessels, Ginger eventually exposed and separated the femoral arteries. As with the aorta before, she used thin elastic tubing and a variety of clamps to valve off the blood flow through these vascular fields, then opened both arteries where the bifurcated legs of the graft would attach to them. A couple of
times she caught herself humming along happily with the music, and the ease with which she worked made it seem almost as if she had been a surgeon in an earlier life, now reincarnated into the elite brotherhood of the caduceus, predestined for this labor.