'One thing you should know. You're the only resident we've approached. The only one we're really considering. It would be wise if you didn't mention this to the rest of the house staff. We don't want to stir up any jealousy.'
'Of course not.'
'Good.' Archer looked around the room. 'I think we're all in agreement about this. Right, gentlemen?'
There was a general nodding of heads.
'We have consensus,' said Archer. And, smiling, he reached once again for the brandy decanter. 'This is what I call a real team.'
'So what do you think?' Mark asked as they drove home.
Abby threw back her head and shouted deliriously. 'I'm floating! God, what a night!'
'You're happy about it, huh?'
'Are you kidding? I'm terrified.'
'Terrified? Of what?'
'That I'll screw up. And blow it all.'
He laughed and gave her knee a squeeze. 'Hey, we've worked with all the other residents, OIL> We know we're recruiting the best.'
'And just how much of this was your influence, Dr. Hodell?'
'Oh, I put in my two cents' worth. The others just happened to be in complete agreement.'
'Right.'
'It's true. Believe me, Abby, you're our number one choice. And I think you'd find it a terrific arrangement, too.'
She sat back, smiling. Imagining. Until tonight, she'd had only a fuzzy notion of where she'd be working in three and a half years. Toiling in an HMO, most likely. Private practice was in its dying days; she saw no future in it, at least, not in the city of Boston. And Boston was where she wanted to stay. Where Mark was.
'I want this so badly,' she said. 'I just hope I don't disappoint you all.'
'Not a chance. The team knows what it wants. We're all together on this.'
She fell silent for a moment. 'Even Aaron Levi?' she asked. 'Aaron? Why wouldn't he be?'
'I don't know. I was talking to his wife tonight. Elaine. I got the feeling Aaron isn't very happy. Did you know he was thinking of leaving?'
'What?' Mark glanced at her in surprise.
'Something about moving to a small town.'
He laughed. 'It'll never happen. Elaine's a Boston girl.'
'It wasn't Elaine. It was Aaron who was thinking about it.'
For a while Mark drove without saying a word. 'You must have misunderstood,' he said at last.
She shrugged. 'Maybe I did.'
'Light, please,' said Abby.
A nurse reached up and adjusted the overhead lamp, focusing the beam on the patient's chest. The operative site had been drawn on the skin in black marker, two tiny x's connected by a line tracing along the top of the fifth rib. It was a small chest, a small woman. Mary Allen, eighty-four years old and a widow, had been admitted to Bayside a week ago complaining of weight loss and severe headaches. A routine chest x-ray had turned up an alarming find: multiple nodules in both lungs. For six days she'd been probed, scanned, and x-rayed. She'd had a bronchoscope down her throat, needles punched through her chest wall, and still the diagnosis was unclear.
Today they'd know the answer.
Dr. Wetfig picked up the scalpel and stood with blade poised over the incision site. Abby waited for him to make the cut. He didn't. Instead he looked at Abby, his eyes a hard, metallic blue over the mask.
'How many open lung biopsies have you assisted on, DiMatteo?' he asked.
'Five, I think.'
'You're familiar with this patient's history? Her chest films?'
'Yes, sir.'
Wetfig held out the scalpel. 'This one's yours, Doctor.'
Abby looked in surprise at the scalpel, glittering in his hand. The General seldom relinquished the blade, even to his upper level residents.
She took the scalpel, felt the weight of stainless steel settle comfortably in her grasp. With steady hands, she made her incision, stretching the skin taut as she sliced a line along the rib's upper edge. The patient was thin, almost wasted; there was scant subcutaneous fat to obscure the landmarks. Another, slightly deeper incision parted the intercostal muscles.
She was now in the pleural cavity.
She slipped a finger through the incision and could feel the surface of the lung. Soft, spongy. 'Everything all right?' she asked the anaesthesiologist.
'Doing fine.'
'OK, retract,' said Abby.
The ribs were spread apart, widening the incision. The ventilator pumped another burst of air, and a small segment of lung tissue ballooned out of the incision. Abby clamped it, still inflated. Again she glanced at the anaesthesiologist. 'OK?'
'No problem.'
Abby focused her attention on the exposed segment of lung tissue. It took only a glance to locate one of the nodules. She ran her fingers across it. 'Feels pretty solid,' she said. 'Not good.'
'No surprise,' said Wettig. 'She looked like a chemotherapy special on x-ray. We're just confirming cell type.'
'The headache? Brain metastases?'
Wetfig nodded. 'This one's aggressive. Eight months ago she had a normal chest x-ray. Now she's a cancer farm.'
'She's eighty-four,' said one of the nurses. 'At least she had a long life.'
But what kind of life? wondered Abby as she resected the wedge of lung containing the nodule. Yesterday, she had met Mary Allen for the first time. She had found the woman sitting very quiet and still in her hospital room. The shades had been drawn, the bed cast in semidarkness. It was the headaches, Mary said. The sun hurts my eyes. Only when I sleep does the pain go away. So many different kinds of pain…
Please, doctor, couldn't I have a stronger sleeping pill?
Abby completed the resection and sutured the cut edge of lung. Wetfig offered no comment. He merely watched her work, his gaze as chilly as ever. The silence was compliment enough; she'd learned long ago that just to escape the General's criticism was a triumph.
At last, the chest closed, the drain tube in place, Abby stripped off her bloodied gloves and deposited them in the bin labelled: contaminated.
'Now comes the hard part,' she said, as the nurses wheeled the patient out of the OR. 'Telling her the bad news.'
'She knows,' said Wettig. 'They always do.'
They followed the squeak of the gurney wheels to Recovery. Four post-op patients in various states of consciousness occupied the currained stalls. Mary Allen, in the last stall, was just beginning to stir. She moved her foot. Moaned. Tried to pull her hand free of the restraint.
With her stethoscope, Abby took a quick listen to the patient's lungs, then said: 'Give her five milligrammes of morphine, IV.'
The nurse injected an IV bolus of morphine sulphate. Just enough to dull the pain, yet allow a gentle return to consciousness. Mary's groaning ceased. The tracing on the heart monitor remained steady and regular.
'Post-op orders, Dr. Wettig?' the nurse asked.
There was a moment's silence. Abby glanced at Wetfig, who said, 'Dr. DiMatteo's in charge here.' And he left the room.
The nurses looked at each other. Wetfig always wrote his own post-op orders. This was another vote of confidence for Abby.
