by Urban, Ami
“So, what do we do?” he asked, exchanging glances between us.
“Best course of action is an osteochondral autograft transplantation. I’ll take cartilage from your rib and just stick it right between ya bones,” Brendon said.
“One moment.” I help my hands up. “Surely jumping to surgery is an overreaction, yes?”
“Yes.” Jack piped up. “And don’t call him Shirley.”
“This fucking guy.” Brendon pointed to him with a smile.
“No, no.” I continued. “We can just drill into the bone to stimulate natural cartilage growth. Why would we want to open up two spots when it’s not even necessary to open one?”
Brendon scrunched up his face. “If you want to use our drill, be my guest. But that thing only has two settings: hot and hotter. Do you really want to risk damaging more cartilage and possibly even bone?”
“But surgery would require debridement!” My voice was entering another decibel level before I could stop it.
“We’re gonna have to debride no matter what we do, Bunny.”
“Please don’t call me that.”
“Newbies can’t call the shots, Mama Reynolds.” Brendon turned toward Jack, putting both hands out like the scales of justice. “Hot drill in the leg that could possibly cause more damage or a nice, clean surgery that you’ll probably be able to walk out of.” His right hand went higher than his left. “Hot drill and more damage. Clean surgery with a walkout.” Both eyebrows were raised, as if awaiting his answer. I sighed then turned to Jack as well.
“What do you suggest, Babe?” he asked. He seemed surprised when I just shrugged my shoulders.
“I don’t know.” I side-eyed Brendon. “I’ve never seen a drill do as much damage as Dr. Rutherford has described and I’d rather not dress two surgical sites, but…” I paused. “I suppose a graft would be the quickest way about it.”
“Okay, then.” He tapped his index finger on his chin. “Surgery it is.”
An excited whoop left our companion. “And that’s how the game is played, Bunny.”
The look I gave him could’ve likely killed a horse. “Don’t—”
“Get used to it.” He didn’t allow me to finish, but his tone wasn’t mean.
“So, when’s my surgery, then?” Eagerness dripped from Jack’s words. I was sure he wanted to be able to walk pain-free again.
But Brendon’s eyebrows knitted together at his question. “Well, that’s where the problem lies. We have zero oscillating saws. Without a saw, I can’t graft anything.”
“Well, wait…” He straightened his back. “Why the hell did you offer it if you couldn’t do it?”
Brendon gazed at my husband as though he were looking at a small animal. “Don’t get your panties in a twist, Dyüd. I just have to find one.”
I shot a quizzical glance at the surgeon. I wasn’t sure what that word was he’d used. I’ve written it down to the best of my ability. The closest iteration of its meaning I could find is the Estonian word for “twice.” It still doesn’t make sense to me.
“So…what’s the plan for the meantime?” Jack asked, worry creasing into his face.
I thought for a moment. Brendon beat me to an answer. “Pain management, I suppose.”
“Any suggestions, doctor?”
He looked at me as though I’d just given him the greatest yet saddest compliment he’d ever received. “Drugs?”
I waited for him to elaborate but got nothing. “We keep treating him with Toradol?”
He shook his head, a lock of dark hair brushing one eyebrow. “I was thinking more like…Oxycontin. We have a ridiculous amount of preloaded hypos of it.”
Immediately, I put my hand up to stop him. “I do not prescribe opiates to my patients. There’s an epidemic.”
The strangest thing happened then. The two men turned to look at me very slowly. It was if time had slowed down to almost nothing. Then, I realized what I’d said.
“I apologize. Canned response.”
The two of them laughed.
“But I still do not prescribe them. They are far too addictive.”
“Well, you can only use so much Toradol.”
He was correct, of course. Toradol was a high dose anti-inflammatory. Adults will typically have to stop using it after a short period. “Can we find a saw in five days?” I asked.
Brendon sighed. “We’ve had teams out looking for supplies weekly. Every hospital does.”
“We’ll need daily searches.”
He pursed his lips but didn’t argue.
“Prednisone?” I glanced at Jack, but he only shrugged.
Brendon tapped a finger on his chin. “Hmm… What about corticosteroid injections? We’d have to put him out, but we can use Propofol and do it right here in his room.”
I nodded. A solid idea, indeed. “I like it. Jack?”
He almost seemed startled by his name. “I mean…sure.”
“Great!” Brendon clapped his hands together and rubbed them back and forth. “Let’s prep.”
***
“Okay, Jack, you might feel a rush of warmth as I push the anesthetic into your IV.” I pushed down the syringe’s plunger, releasing the medication into the IV tube.
“Yeah. I got this. I’ve done it before.” He smiled at me. That smile still warmed my heart.
“Uh-huh.” Brendon came around the table from checking vitals. “We’ve all been there, cherry pie, but saying it over and over again is called protocol.”
“I think I’ve heard of that.”
Brendon smirked, then checked the IV. “Done this before?”
“Yes.” I answered his question without asking if it was directed at me in the first place.
“If she can…cut off a leg…she can do…anyth…” Jack’s eyelids began to droop.
“Anything?” Brendon finished the sentence as Jack nodded. “Any last words?”
“Mm… I love…spoon.” He was out.
Brendon looked up at me. “And I thought I came up with odd nicknames.”
“It’s not a nickname. It’s a product of the anesthetic.” I turned to my tools and picked up the syringe, ready to hand it over to him.
“Oh, Bunny…” The pity in Brendon’s voice made me stop. “That’s what we call a joke.”
“I’m familiar with the concept.”
We began our work. Brendon was brilliant. He did all the right things with style and grace I’d never seen from a surgeon. It was almost as if he were inside my head the entire time.
“So, what’s your story?”
“What do you mean?” I didn’t look up from watching him work.
“You know…” He paused, finishing with one injection and putting out a hand for the next. “Like…where are you from? How’d you meet your other half? How’d you survive the apocalypse. The same old stuff.”
“I think it’s fairly obvious how we survived.”
“Okay.” The sentence was paired with Brendon’s hand around my wrist, causing me to glance up at him. “You’ve been short this whole time. You got SRI? Wanna talk about it?”
I offered a tight smile. “It’s really nothing.”
“I love ya, Mama Reynolds, but I don’t got all day.” He looked up at me, handing over the second to last empty syringe. “Spill it.”
I hesitated for a moment, wondering if I could trust this new person with familial information. There wasn’t much of a reason not to, but I still had to tread lightly.
I handed him the last injection. “Raychel made me promise to take care of Jack while he’s anesthetized.”
“His sister? Man, she’s a hottie.”
“How professional of you.”
He chuckled.
I shrugged. “Anyway, I haven’t had a moment to sort it out yet.”
“What does that mean?”
“It means I’m perfectly capable of controlling my own emotions and evaluating which ones are pertinent. And I haven’t had a moment to delve into the subject of he
r statement.”
“That’s a fancy way of saying you have no clue.”
“Indeed.”
From the desk of Dr. Lisa Reynolds – February 7
I cannot express how exhilarating it was being a doctor again. Working in a hospital had been a dream of mine my entire life. My work at Tehachapi never went unnoticed. It was the happiest I’d ever been.
Until I’d met Jack. I hadn’t even realized my life was missing something until he stumbled into it. And now, I was doing what I loved while happy in my personal life. Were things perfect? I didn’t quite believe in that, but, yes. Yes, they were.
And that morning, I’d been standing at the white board, erasing and updating the schedule for hours. And having fun. Because whoever had been making it was severely underutilizing the entire staff of surgeons. Granted, up until a week prior, it’d only been Brendon performing said surgeries.
I was on the last day of the week when I heard singing in the hallway behind me. I checked the clock on the wall. Did he normally show up for work at nine in the morning?
He burst through the double doors to the OR, not even acknowledging my presence as he went on. “Well, I’ve had a splittin’ headache from my eyebrows to my backbone. Arthritis, appendicitis, Bright’s disease and gall stones. Bleedin’ ulcers, ingrown toe nails, swollen adenoids. The Asian flu a time or two and inflamed vocal chords. I’ve had a toothache so severe my jawbone split in two. But nothing’s ever hurt me half as bad as losing you.” When he opened his eyes and saw me standing at the board, a smile lit up his face. “Well, hello, Bunny! Bright and early, I see.”
“I’ve been here for three hours already.”
His face sank. “Oh.”
“And I’ve updated the schedule.” I turned back to the board. “You’ll find that your days start earlier, but they also end with plenty of time in the evenings.”
“You…you gave me my weekends back?” His voice was behind me.
“Yes, I—”
“And I’m your attending?”
I whirled around. His eyes were almost misted over. In what? Adoration? Idolization? I hoped not. “No, I’m your attending. I’m not a surgeon. Besides, I’m confident you and I are the only doctors capable of performing any procedure in this hospital.”
Both his eyebrows shot up, a dark lock of hair brushing the left one. “Huh.” He pulled the black plastic-framed glasses from the collar of his scrubs. “I guess you could say…” He put the glasses on. “We are the champions!” He made a big show of turning in a circle as he sang Queen’s most famous words.
Without even thinking about it, I blurted, “Beep beep, Richie.”
Upon turning back to face me, Brendon let out a laugh. “A lot of people in my life have told me to shut the feck up, but that’s the first time I’ve ever been compared to Trash Mouth Tozier.”
“I am so sorry about that.” I almost couldn’t believe myself.
“Hey!” He spread his hands. “It’s better than getting called Henry Bowers.”
That was true.
“Hey, like a surgeon! Cuttin’ for the very first time!” Brendon sang the verse in tune with Madonna’s Like a Virgin, then hummed the rest as we scrubbed in for the first procedure of the day. It was an appendectomy – one of the simplest surgeries in my book.
I legitimately chuckled to myself at his song. “That’s funny.”
“Wish I could say I made it up.” He continued to hum the song while scrubbing his fingernails hard. He was almost as meticulous as I about hygiene before a surgery. Admiration bloomed inside me over such a simple task. At that moment, I felt conceit. I’d just silently bonded with someone because they performed tasks in the almost obsessive way I did. It was rather silly. I scolded myself.
He still managed to impress me during the procedure. While boisterous in social situations, he was serious and wise in the operating room. As if he’d spent as many years as I had studying.
Once the patient was prepped and Brendon had the scalpel in hand, he paused. The silence went on for a bit longer than I deemed necessary.
“Is everything okay?” I asked from my spot near the patient’s head.
Brendon looked up at me, his eyes almost startled behind the magnified loupes on his face. “I forgot you were here.” He chuckled behind his surgical mask. “I was just trying to figure out what type of incision I wanted to make.”
All that deliberation over the first incision? I was enjoying his work more and more by the minute.
“Think I’ll do a McBurney-McArthur incision.”
“Walk me through your procedure, please, doctor,” I said, feeling as though I were just sitting down to a new film I’d been anticipating for months.
“For sure.” He nodded while staring at the patient’s abdomen. “I’m going to make an incision at the right anterior superior iliac spine to the umbilicus… Say that ten times fast.”
I likely had at some point. Meanwhile, he didn’t even have to look at a book. Sometimes even I had to look at a book.
“Have you put any thought into how we can reduce hospital errors?” It may have seemed like a random question, but the silence since his last words had been deafening.
“I’ve put thought into the steak dinner waiting for me at home,” he said, continuing his work. I found it odd he’d elongated the first word of his sentence.
“I need the Bovie.” He almost said this to himself. I handed him the electrocautery device which he seemed surprise to have happen. “Thanks.” He let out a chuff of humor as he glanced at me. “You’re definitely gonna come in handy.” There was a smile behind his dark eyes. I nodded, and he went back to work. “Incising through both the Camper and Scarpa fascia.”
The smell of burnt flesh wafted briefly through the OR. It was something I’d grown accustomed to long ago. I helped hold the incision open with Kelly clamps.
“Jack’s last name was still missing from his chart this morning. So, I had to write it in.” I paused but Brendon didn’t look up. “In Sharpie.” Again nothing. “Because we have no pencils.”
Finally, I got a response. But it wasn’t the one I was looking for. Instead, he let out a thin giggle under his surgical mask. “Sounds about right.”
“Don’t you think we should do something about that?”
He shrugged.
Why was he being so evasive? “Should we digitize them? We have all those computers sitting there doing nothing.”
“Isn’t that the kind of stuff nurses and hospital administrators do?” He turned to collect his next tool.
“Well, yes, but we should all be working toge—”
“Why don’t you just take the Chief of Medicine title? Then you can delegate whatever tasks you want to your slaves.” There was a smile in his voice, but I hardly had time to focus on it.
“You…” My stutter caused him to pause the procedure. “You want me to run the hospital?”
He blinked. “I don’t know. I guess?”
I couldn’t help it; my hand flew to my chest. Maybe it was an attempt to slow my heart rate. He wanted me to run the place?
“Of course, I’ll do it.”
“‘Kay.” He went back to work. “External oblique aponeurosis is exposed. Can you…” He gestured to me while looking down. “Can you do a blunt split for me?”
“Of course, doctor.” I complied, smiling.
“Ugh, that is so much better.”
I helped suction excess blood from the area.
“I gave you blood, blood, gallons of the stuff…” He sang to himself in a quiet tone. “I gave you all that you can drink and it has never been enough.”
A bit gruesome, but I went along with it until we had visualization of the transversalis fascia and the peritoneum. Brendon made an incision on the peritoneum in a craniocaudal direction.
“I now have access to the peritoneal cavity,” he said.
“Which approach are you using?”
“I came here to perform an antegrade appendect
omy and chew bubble gum.” He looked up at me again. “And I’m all outa gum.”
Amusing.
“But what if the appendix is retroperitoneal?”
He stopped, his hands hovering above the incision. “Is it?”
“No, but it’s good to remember these things,” I said.
He made a show of wiping his brow with the back of one hand. “Whew. You had me sweatin’ there.” He went back to work. “Alrighty. I see the ascending colon and the taeniae coli.”
“Doctor, it’s actually pronounced tee-nee-uh. Not tay-nee-uh.” While a sliver of guilt ribboned through me at my interruption, Brendon seemed alright with being corrected.
“My bad,” he said simply. “Tee-nee-uh coli.”
I nodded, and he went back to work.
“Performing ligation of mesoappendix. Can you hold this, please?”
I took the scalpel he handed me, placing it back on the tray. I clamped just proximal to the distal ligature, avoiding any inadvertent contamination.
“Danke schoen, Bunny. I am now cauterizing the exposed mucosa of the appendix.” That same burning smell filled the room once more. Once the appendix was successfully removed, Brendon tossed his instruments back on the tray, picked up the infected organ with one hand, lifted it in the air and spiked it in the biohazard bin across the room. “Fifty points!” He began performing a sort of touchdown dance.
“Great job. I’ll close up the patient.”
Before I could begin, a knock behind us startled me. I whipped around to see a tall, dark-complexioned man staring in at me. I had no idea my brain could gasp until that moment. Brendon and I exchanged glances.
“You know this guy?”
My smile widened. “I do.” Then, I gestured toward the patient. “Can you finish up here while I speak to him?”
“Aye, aye, Mama Reynolds.”
I stepped out into the scrubbing area, removing my surgical mask. Happiness bubbled into my chest at seeing the man again. Jack had suggested both were dead, but one of them was in my hospital now.
“Hello, Dr. Wood,” I said.
“Greetings, Dr. Reynolds. It’s good to see you again.” While his words showed a positivity about him, they were emotionless. “Is there a place we can talk?”
