Into Thin Air
DEBORAH ROGERS
1
The first thing Dr. Julia Norris notices is how black the lung is. Black with tar and other impurities. Fifty years of smoking will do that. It’s a miracle the patient can breathe at all. Julia leans closer and slips her fingers inside the patient’s chest, cradling the lung in the palm of her hand. Center right, tucked behind the lung, the heart pulsates in a pool of liquid.
The lung belongs to Mrs. Tammy Keller, a seventy-two-year-old San Francisco native who presented three days ago with severe breathing difficulties. Julia’s initial thoughts were pleurisy, but a chest X-ray showed a spontaneous pneumothorax, aka punctured lung. The likely cause was the rupture of a blister on diseased lung tissue, causing air to leak into the pleural space. Mrs. Keller had been traveling with her daughter in Asia, and Julia’s calculated guess was that a blister had burst midair due to the pressurized cabin air.
With the tip of her gloved thumb, Julia feels the underside of Mrs. Keller’s lung for the abnormality. Next to her, Paul Sweeny, the twenty-six-year-old resident who’s on his surgical rotation, shifts uncomfortably on his feet. He’s shivering. Julia feels bad. She’d forgotten to tell him to wear long sleeves. Theater is cold. The temperature is set at a strict sixty-six degrees Fahrenheit, mainly to inhibit blood loss in the patient, but also to keep the surgeons alert.
Paul lets out a breath, rubs his nose with his forefinger. Some people never get used to the smell of warm blood.
“Okay?” says Julia.
“Absolutely.”
Julia nods, then hitches up her surgical mask, flicks on the electrocautery tool, and delicately cauterizes a membrane to separate the lung for a better vantage point.
“There,” she says, thumbing the large blister. “You see that?”
Paul leans over. Julia smells garlic and onions even though he’s wearing a mask.
“Yeah, I do.”
“Now we staple and cut. The plan is the lung will seal and become fully functional again.” She looks up at Sue, the scrub nurse. “May I have the 60mm endo-stapler with 4.8 staples and peristrips, please, Sue?”
“Yes, Jules, that I can surely do,” says Sue, winking at Julia.
Julia smiles under her mask. Only Sue could get away with that. She is the oldest teenager Julia’s ever met. A forty-two-year-old serial-dater and over-sharer, forever trying to lure Julia onto Plenty of Fish. You’re only thirty-seven, Jules, she had said the last time they’d met for coffee, there are ninety-year-olds on Tinder having more fun than you.
Julia cuts and seals the lung with the endo-stapler then drops the dissected lump of tissue into a steel kidney dish for disposal. The entire procedure is over in less than ten seconds.
Julia looks at Paul. “You can go ahead and do the internal sutures if you like.”
His eyes widen. “But I’m only meant to observe.”
Julia smiles warmly. “You’ll do fine, Paul. I’m here if you need me.”
“I’m not sure I know how,” he says, perspiration sprouting on his forehead.
Julia glances over her shoulder at Sue. “Suture kit, please, Sue, if you wouldn’t mind.” She turns back to Paul. “Deep dermal sutures, Paul, just like you would have been shown in med school.”
He lets out a breath. “Okay. Deep dermal. I got it.”
Sue passes Paul a pre-threaded surgical needle, shaped like a large C, which he nearly drops into the open cavity of Mrs. Keller’s chest.
“You can do this, Paul,” says Julia.
“Yes,” he says, licking his lips. “Yes, I can.”
He swallows deeply and goes in for the first stitch, hands trembling.
“You’re doing great, Paul,” she says. “Keep it neat. Even. That’s it.”
When he’s finished, he stands back and holds up his hands.
“Terrific job,” she says. And she means it. He’s done extremely well.
His face lights up. “Thank you, Dr. Norris.”
“You very welcome, Paul. We’ll make a surgeon out of you yet.”
2
Julia’s bone tired. She always is after surgery. The responsibility of having someone else’s life in your hands never gets easier. It doesn’t help that she’s had surgery nine days in a row. Two coronary artery bypasses. One bilobectomy. Two lobectomies. Repair of a congenital heart defect. Removal of a cyst. An excise of a tumor. There’s a shortage of cardiothoracic surgeons in the bay area, and now with her colleague Rod Johnson out on paternity leave, it’s probably only going to get worse.
On the way home, she calls into her neighborhood grocery store, because despite Sue’s best endeavors to entice Julia out on a blind date with her brother’s best friend, it’s a night in for Julia. Opting for a fresh, ready-made quinoa salad for one and a generous-sized salmon steak, she’s out of the store in less than ten minutes and angling her silver Toyota Prius in front of her apartment just before 7 p.m.
When she opens her front door, Bishop jumps down from the windowsill where he’s been basking in the last rays of sun and pads over to greet her.
“Hey, cat,” says Julia, bending to stroke him with her free hand.
He purrs loudly. “Oh, I know what you want,” she says. “Come on, let’s get you some dinner.”
Julia heads for the kitchen, Bishop mewing and figure-eighting her calves as she goes.
“Boy, you’re one pushy feline, aren’t you?”
Setting the groceries down on the counter, she shakes some dry cat food into Bishop’s bowl and watches him demolish the lot in less than a minute. She feels a pang, remembering the day she and Leo went to collect Bishop from the animal shelter. The poor thing had been dumped in a trash bag in a creek with eleven of its siblings. Only three had survived. Leo had wanted to take them all home but Julia had put her foot down: one pet to look after was plenty enough.
She shakes off the memory. Trips down memory lane never got anyone anywhere. She pours herself a glass of red wine and carries it over to the living room, where she takes a seat on
