CHAPTER 1

The overhead lights, blinding like the dentist’s, hovered like UFOs then descended in formation. The room was all action, ants too busy to follow. The scene was blurred from the premedication that had dripped into his intravenous line minutes ago. He knew what he was seeing would simply vanish from his memory after the operation—the green uniforms of nurses and anesthesiologists; the hum of circulators; and the high intensity, cool, bright lighting he saw every day—any recall extinguished because of the fast-acting medicines.
He knew the slightly acidic yet sweet smell of back-ground gases well, the pleasing aroma of the disinfectant on the floor that made the wintry air seem fresh and clean, the beeps and buzzing of monitors, the whispers. He recognized them all. The extra breeze of oxygen on his face and the warmth under toasty blankets in this arctic room of blue tile and icy air, the vents active with a deep chill, gave him a feeling of peace and let him nestle in for a sleep.
His right lower quadrant abdominal pain that had led him to the Emergency Room only an hour ago wasn’t even present now. The narcotic floating through his veins and numbing his brain had replaced his constant ache and kidney-punch nausea with euphoria. He knew he had appendicitis when he woke up that morning. He had all of the classic signs he learned as a resident in surgery: dull aching around his navel last night, more localized pain to the right of his navel when he climbed out of bed, queasiness deep inside his stomach. When he pressed his hand into the area of his appendix and buckled to his knees, he was absolutely certain. Still, he confirmed it in the emergency room with a CT scan.
“Are you doing okay, Dr. Miller?” The voice drifted through his consciousness.
His facemask, balanced over his mouth and nose and held in place only by the plastic tubing attached to the anesthesia machine, was delivering a slow flow of oxygen. He nodded.
“It won’t be long now!”
He recognized Jenny’s voice. She was his nurse anesthetist for the morning and had worked with him for years. When he first came to Tuscaloosa as a cardiac surgeon, she was working in an intensive care unit. However, as an excellent nurse on the floor, she was able to go to Nurse Anesthesia School to become an anesthetist. It seemed that all nurse anesthetists were attentive, competent and attractive, and Jenny was no exception. Her green eyes peered over her mask, checking everything. The breathing tube was ready when the anesthesia kicked in completely, and the drugs to achieve total anesthesia were in syringes, marked and ready for the anesthesiologist. The intravenous lines were all running, and the machine had been checked and all monitors were working.
“Alright, Grant!” said a not-so-gentle voice. It be-longed to Quan, his anesthesiologist, who was second-generation Chinese-American, brilliant, and a body builder. “What you doing on your back?” Moving like a ghost, he was above Dr. Miller at the head of the table before Grant could open his eyes. “You supposed to have two hearts to do today! You play hooky?” His laugh was as strong as his hand.
“Ha, ha, ha.” He picked up the syringes that Jenny had prepared and fired them into the intravenous setup. “You have good sleep, Grant!” His hands were magical, the fingers working with serpentine precision, almost as if without joints. Everything was rapid. Everything was precise. Everything was dependable. Quan didn’t waste time. His life and work had always been tactical. Nothing was different here, not even with a fellow physician.
Grant Miller, M.D., was out. He was scheduled to perform two coronary bypass operations today, both cancelled now. Like every day of his professional career, the unexpected was expected. He had survived training at Texas Heart working 25 hours a day, 8 days a week. He had lived in the surgical ICU for six months, never emerging for fresh air or to see daylight. He had endured six years of general surgery residency and three years of cardiac surgical training, never asking for relief and never complaining about the hours. Now was his chance to rest.
He was always responsible for his patients, always at the hospital, always the captain of the ship, the one to blame or the one to praise. But today, he rested, confident that his surgical team was able to perform a routine appendectomy without incident.
The nurses worked in concert now, two shaving his abdomen and another placing a urinary catheter and then painting his abdomen and right groin with antiseptic. Finally, as though the rest of his body had no importance, they placed drapes in a square, isolating his abdomen and excluding every body part that was not necessary for the procedure.
“Scalpel!” Jack Wade, Grant’s buddy, had entered the room as the last drape was placed. He was in residency training at Houston with Grant and had returned to Tuscaloosa as a general surgeon instead of spending extra years in training.
“For a sissy, this ol’ boy sure has tough skin!” He used a number 10 blade, pressing firmly on Grant’s umbilicus. The carbon-infused steel popped through Grant’s skin, leaving a blush of red behind. Next he pushed a rounded tube with a metal point into the hole. More pressure and he felt the resistance end as the trocar slipped into Grant’s abdomen.
“Fifteen millimeters of pressure,” Jack said as he sprayed carbon dioxide through the tube and into Grant’s abdomen, expanding the insides for better visibility and to avoid sticking additional trocars into the intestines. Two more stabs and he inserted other tubes in a triangular pattern to the left of midline.
“Hey, Jack!” Quan looked over the drapes separating the anesthesia domain from the surgeon’s sterile field. “How many surgeon it take to change a light bulb?”