Chicago
Saint Francis Hospital

It had been years since Dr. Claire Antonelli had scrubbed up alongside chief of surgery Dr. Jackson Miles. Ever since she started her own private practice her hospital visits were limited to visiting recovering patients and delivering a baby now and then. She wasn’t a surgeon. She recognized her limitations and appreciated her strengths. An exploratory laparotomy was not one of her strengths.

Vera Schroder had not been pleased. Her husband had never had surgery in his life, had never spent a night in the hospital until now.

“Markus takes very good care of himself,” she had told Claire, offering it as further reason that all of this had to be some horrible mistake.

“He has an infection somewhere in his body,” Claire had tried to calmly explain to Vera while right next to them Markus stared out with red eyes and unblinking but droopy eyelids. In just two days his face had taken on an expressionless mask, the facial muscles drooped as if the tissue was disconnecting. There was little indication that he was listening to them. Claire worried that he had already started slipping away.

To make matters worse, Vera answered all the questions, not waiting for her husband. She touched his hand and swept his thin hair from his forehead, not expecting him to respond to the questions or to her touch. Claire had noticed early on that even when Markus had been alert and lucid this was the relationship between the two—Vera did the talking, the gesturing, the patting and caressing while Markus simply stood or sat by.

“There may be an inflammation or an abscess,” Claire had persisted. “Perhaps even a perforation in the intestine that isn’t showing up on our tests.”

“You think it’s cancer, don’t you?” Vera had asked in a whisper.

Claire had never believed in being anything less than straightforward with her patients. She didn’t want to alarm Vera Schroder, but she wouldn’t sugarcoat it, either. She told her they weren’t ruling out anything. They simply needed a better picture of what might be going on inside Markus. Finally Vera had no comeback. She wanted her husband back home. She wanted things back to normal.

Now Claire watched Dr. Miles make the abdominal incision and she hoped they would find an answer, the answer, something that could explain why a perfectly healthy forty-five-year-old man had suddenly turned into a vomiting and feverish zombie.

“We’ll do a checklist,” Dr. Miles said without looking up, his large fingers gentle and confident. “We’ll start with the gallbladder, appendix, pancreas, liver.”

His voice was deep, calm, smooth and reassuring. Claire was reminded of the image she had of him when she was a resident, the image that they all had of him. He was a larger-than-life father figure and even his voice was like that of God’s. If Dr. Jackson Miles couldn’t find what was wrong with Markus Schroder, then no one could.

“Pancreas looks normal,” he continued. “There doesn’t appear to be anything taking a ride on it.”

Claire dabbed sponge laps at the blood while Miles’s surgical nurse, a young Asian man named Urie, readjusted the suction. Blood continued to ooze up. More dabs from Claire. Urie applied clotting gel. Another small, wiry nurse reached up on tiptoe and swiped the sweat from Miles’s brow. He added a hemo clip to the incision. Then he added another.

The incision filled up with blood again.

Usually during surgery the blood vessels the surgeon cuts through will clot up. Additional bleeding can be clamped off or gelled to stop. Periodically the wound and incision need to be suctioned. But that wasn’t the case here. Something was very wrong.

Miles waited for Claire to dab again, but her sponges became soaked with blood faster than she could change them out. Same for Urie. As soon as he would apply more clotting gel, the blood would overtake the application. The other nurse added her hands, dabbing and collecting blood-soaked sponges. Even the anesthesiologist looked ready to jump in.

Miles’s eyes met Claire’s, avoiding the rest of the surgical team. There was a flicker of uncertainty that she had never seen before. Claire found herself thinking, It’s like seeing God worried. Recognizing the alarm in Miles’s face made her stomach take a brief plunge.

Urie suctioned off more blood while Miles tried to pinch off the blood vessels with another clamp. Claire continued to soak sponge laps. Nothing seemed to work. Markus Schroder’s abdomen continue to fill up with blood. Claire couldn’t help thinking it was like scooping sand out of a hole in the beach. As soon as you pulled up a handful the sand walls caved in, filling the hole as quickly as you could dig.

“This isn’t good,” Miles finally said. “Let me cut a piece of tissue then let’s get out of here.”

He did the biopsy quickly, which was amazing to Claire, who could no longer differentiate anything through all the blood. Miles handed the sample off to the nurse. Then he and Claire began closing up, suturing quickly as Urie suctioned and dabbed.

Finally finished, the entire team of six stood back and exchanged looks. No one said anything. Claire could feel the sweat trickle down her back as she watched a stream slide down Miles’s face. At one point his black eyes held Claire’s and there was as much question and concern as there was alarm.

Urie was the one who broke the silence. “That dude’s got some serious problems.”