I stand from the sofa and go to the kitchen for coffee. It’s been a long time since I’ve pulled an all-nighter but a good night’s sleep is not in the cards for me. I fill the Keurig’s water reservoir, replace it on the unit and let it warm, checking my phone to see if I missed a call or a text from Jake. It’s ten thirty-five at night. I don’t know why he isn’t home.
Jake saw patients in his office today. These days tend to be his shorter days because there’s a predictability about them. Patients come in for consults or pre-op appointments. They have set appointment times, which may run over a few minutes if a patient is late or Jake gets behind, but never by more than a few minutes. The rest of the time, Jake spends these days catching up on paperwork. If anything, he’s said, nonsurgery days are boring. Jake prefers being in surgery because that’s when he’s at his best.
Despite that, the days he performs surgeries are astonishingly long. He wakes up at four thirty in the morning when the alarm goes off on his watch. The workday starts just after dawn with rounds, prechecks and discussing patients on his list with the rest of the surgical team. They end sometimes as late as nine or ten o’clock. Surgery days are the most unpredictable too. While surgeries are sometimes planned, like removing a tumor, sometimes, like last week, a patient comes in with a gunshot wound to the head and Jake has to spend unanticipated hours trying to save a life. That gunshot victim died. She was practically dead to begin with. That’s how Jake phrased it. There is a detachment in the way he speaks of his patients because there has to be. He can’t get all emotional about it, otherwise he wouldn’t be a good surgeon. There is a whole psychology about how doctors like him get through the day. It started in med school for Jake, where he referred to cadavers as things, not people, so he could cut into them more easily. For most people, seeing a dead body is a defining moment in their life; for Jake, it’s frequent.
With this gunshot victim, Jake said that, even before she landed on his operating table, before he cut into her, she was fucked. Her odds of survival were infinitesimal, something like 5 percent, with even smaller odds of her having a good quality of life if she survived.
“That must have been hard for you, then, knowing she was likely to die and still doing the surgery anyway. It must feel futile,” I’d said, trying to be empathetic because there’s been a rift between Jake and me these past few months. He says it’s my fault, and I’ve been trying so hard to be present in the moment, to not be distracted by other things when I’m with Jake.
He was drinking a whiskey sour. He lowered it to the table, his eyes watching me intensely over the glass. I think he took offense at what I’d said. I wasn’t trying to suggest that what he did for a living was futile, but that was what he heard. What I did often felt futile too: talking for hours to students who were half-asleep and not listening.
“How could you be so sure she wouldn’t survive?” I asked.
“With gunshot wounds, it depends mostly on the location and trajectory of the bullet,” Jake said, sounding smart. “This bullet entered her head at the anterior temporal lobe. It traveled from one side of the brain to the other, crossing the midline, which is not ideal,” he said, as if there was an ideal way for a bullet to travel in one’s brain. “The bullet went in, but it didn’t come out. It tore through both hemispheres, all four lobes of the brain before getting lodged in there.”
“Did she die in surgery?”
“After.”
“How?”
“Brain stem death.”
“What does that mean?”
“The brain stem.” I could see him thinking in his head how to dumb this down for me. I was grateful, not offended. Sometimes he throws out words like globulus pallidus and acoustic neuromas as if I should know what they mean. He’s so used to tossing them around with ease among colleagues, he forgets I’m not one of them, that I didn’t go to med school for years. “It’s responsible for all the things that keep us alive. Breathing. Blood circulation. Digesting food. When the brain stem is dead, you are too.”
“Like being in a vegetative state?” I’d asked.
“No,” he said. He took a sip of his whiskey sour while I waited for an explanation. “It’s different, because a person in a vegetative state still shows signs of brain stem function.”
“How old was she?”
“Twenty-nine.”
“Who shot her?”
“Her husband.”
I wished I hadn’t asked. I didn’t want to know any of it. Unlike Jake, I couldn’t be detached. I thought about it for the next twenty-four hours at least, wondering what happened between them to precipitate her husband shooting her in the head.
On surgery days, there is never any telling when Jake will be home. If an emergency surgery comes in, he stays until it’s done. But today isn’t a surgery day. He should have been home hours ago. I try calling him now, but Jake’s phone is off or dead because it routes straight to voice mail. It’s not like Jake to let his phone die. I leave a voice mail for when he has a chance to charge it, keeping it light, asking him to call me when he can. I don’t say that I’m worried or that I’m wondering where he is because maybe I’ve mixed up my days and today was a surgery day after all. I’ve been distracted lately. My mother’s health is failing. She’s going blind and then, if that wasn’t bad enough, the doctors recently found a mass in her left breast. We need to do a biopsy and see if it’s malignant or benign. I’m a pessimist and so, in my head, I’ve already decided. It’s malignant. If that’s the case, we will have to decide what to do: keep the breast or get rid of it. My mother can’t make a decision to save her life, which leaves all the decision-making to me. She’s not that old to be going through all this but both things, macular degeneration and breast cancer, are in her genes, which means they’re in my genes too. The doctor’s appointments are endless: the general practitioner, mammographer, ophthalmologist and soon, a surgical oncologist. I’ve had to take days off work for them. The appointments fill the hours when I’m not teaching and, when I’m not with my mother, I’m thinking about and worrying about her, obsessing over decisions like lumpectomy or mastectomy, knowing if I make the wrong choice when the time comes, my mother will die for it.
Because of it, Jake and I have grown distant from each other. It was the impetus for last night’s fight, how I care about everyone and everything but him. It’s not true. But I can see why he would think it. Except that last night I’d turned it around on him. I devalued his feelings and made him feel bad for the way he felt. After screaming at each other, Jake took his pillow and slept on the sofa. He left this morning after hardly speaking to me and without really saying goodbye. Now he’s not home and he’s not answering his phone, and I’m worried I know why.
CHRISTIAN
In the middle of the night, Lily is crying.
“What is it, baby? What’s wrong?” I ask, curling myself around her. Her crying is a quiet whimper that she tries to suppress. But I’m a light sleeper. It doesn’t take much to wake me. I hear her cry, but more than that, I feel the vibration of her body against mine.
Lily is turned away from me in bed. Her back is pressed into me. She doesn’t tell me what’s wrong. “Bad dream?” I ask, feeling the back of her head nod against my chest. “Here,” I say, “let me get you some water,” pushing against the weight of the quilt, which levels us in bed.
“No,” Lily says, reaching for my hand. “Please just stay here, Christian. Just stay with me.”
I lower my head to the pillow. I sink back into bed and wrap my arm around her.
If I didn’t know any better, I’d think Lily was scared.