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“We’re really doing this,” I say.
“Yeah,” Luke says, and leaves the door open behind us. “We really are.”
Chapter 10
The Doctor
LUKE
The night after we open the nursery door, I’m back on nights.
I leave the brownstone at 21:15 – Preston on the couch, drafting opinions about which crib “photographs best,” as though the crib will have a publicist – and clock in at 22:00, where the evening attending hands me the board with the words “quiet so far.” Out loud. Inside the building. Every doctor knows what that costs. If Preston were here, he’d have slapped the man. Open palm, no warning.
The BQE makes me pay for it before midnight. Seven patients in two hours, which means somewhere out there in the dark, physics won an argument with four cars at once.
By 02:10 the board is red from top to bottom and the department has found its bad-night rhythm – the one nobody teaches you, the one you only learn by standing in it. Trauma one has the rollover. Trauma two has the guy who was texting. I move between them in a loop I don’t have to think about anymore. Chest, belly, pelvis, long bones. Airway first, always, forever. The night is loud, but it’s loud in a language I’m fluent in.
I’m the attending now, which means all of it is mine. Every decision on this floor tonight either came out of my mouth or is about to be corrected by it.
“Dr. Silva.” Nowak, second-year, good hands, bad poker face. “Bay two’s sat is dropping. Eighty-eight on fifteen litres.”
“Breath sounds?”
“Diminished on the left. Trachea’s midline. I think–”
“Don’t think it. Say it.”
“Hemopneumothorax. He needs a chest tube.”
“Then he needs a chest tube.” I’m already walking. “Who’s up?”
Nowak hesitates and I follow her eyes to Lopez. First-year. Six months in. He’s gowned and gloved at the patient’s left side, tray open, and his posture is best-man-at-the-podium: upright, prepared, and freshly aware the speech is still in the car. The procedure was easy on the mannequin. Now there’s a living chest under his hands and his brain has just thought the one thing it should never do mid-procedure: what happens if I mess this up?
His hands are shaking.
I don’t shout. I come around the table, stand at his shoulder, and drop my voice to the register I’d use to tell someone the coffee’s ready.
“Lopez. Walk me through your landmark.”
“Fifth intercostal space.” His voice is steadier than his hands. Good sign. “Anterior axillary line.”
“Show me.”
He puts two fingers on the chest wall. Right place.
“Then the hard part’s over. He can’t feel you. The only person in this room who can feel anything right now is you, and you don’t count.” I nod at the tray. “Blade. Over the rib, never under.”
He makes the incision. It’s shallow. They’re always shallow the first time; the body has opinions about cutting people even when the medical licence says otherwise.
“Again. Commit this time. Like you mean it.”
He commits, and slices deeper this time.
“Kelly clamp. Three layers are going to argue with you, and then they’re going to stop arguing. That’s the pleura. That’s your door.”
He advances the clamp. Stops. The shake moves from his hands into his forearms, and for one second I watch him stand at the exact spot where this job breaks the ones it breaks.
I put my hand over his. Not taking the clamp. Just weight.
