A Dark Anesthesia Story: Mistake on the First Day
This has been linked on DeviantArt already but I figure I'll post it here, too.
To the extent that some of my writing is author self-insert, this is a situation I don't really want to find myself in.... but which I find fascinating nonetheless.
Warning: while this story is only slightly explicit, it does deal with some unsettling subject matter, and is not a hopeful or positive story. You have been warned.
Because it's ambiguous these days I'll also add that none of this is AI, if that matters to you.
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The snow fell everywhere.
Itâd been falling since well before dawn. By the time Alex found the flat brick building, the sign for Treeline Surgical Care was half buried. Alex did his best to navigate the maze of snowdrifts and find a parking space between the partially covered cars that had arrived before him.
He found a space, but it wasnât close to the building. Alex opened his door to a rush of cold. He stepped out and hurried towards the entrance. He bent forward against a gust of wind, hunching down into his coat as best he could. Even with his jacketâs lapels up, the blowing snow found plenty of gaps; sliding down his collar, into his dress shoes, up his pant legs, down into his socks. Snow crusted his eyebrows and hair. By the time he reached the double doors to the lobby, he was chilled and soaking.
The double doors slid open onto the lobby, and Alex quickly stepped inside, almost stumbling but grateful to find shelter from the storm. He stood for a moment, dripping onto scuffed linoleum. The lobby was unremarkable; faded green walls that once might have been chosen to seem professional or medicinal but not repainted for decades. One of the bare fluorescent tubes overhead was buzzing and flickering wildly, an obvious annoyance nobody had fixed. But it wasnât snowing inside, so it was an improvement. The doors sighed closed behind him.
The lobby was not calm. Two phones at the reception desk were ringing constantly, but not being answered by either of the women who sat there. They ignored the noise, frantically moving papers from one pile to another. Two other women in scrubs hurried by the desk, their arms full of paperwork and folders, arguing in loud fragments about charts and a whiteboard. A man in a puffy coat was sitting in a chair, talking loudly into a cell phone, dripping melting slow onto the seat.
One of the receptionists looked up at Alex as he approached, glancing at his coat and tie, and the snow that had accumulated on him. âIâm Alex Mitchell, starting as a new adminâŠâ
Without waiting for him to finish, the receptionist looked back down at her papers and pointed down the hallway to her right.
âHR,â she said, and didnât react at all when Alex thanked her. The two phones kept ringing.
Alex went where she pointed, leaving the incessant ringing behind. The hallway smelled faintly of bleach. The green walls bore small signs printed in some industrial font: Billing, Records, two bathrooms, Staff Break Room. Alex passed a door labeled âITâ, and heard angry voices inside. Finally, at the end of the hall, HR. The door was propped half open.
âMr. Mitchell?â The voice came before Alex saw the speaker. âYouâre late.â
Linda Hartwell stepped into the hallway, a clipboard tucked under her arm, and extended her hand for a brisk handshake. She was in her late 40s, her brown hair pulled back in a bun, a neat blouse, and reading glasses pushed up on her nose. Alex could feel her look him up and down, and felt like she was judging his posture.
âThe storm,â Alex began.
âYes, I see that.â Linda said. âCome in. Donât worry about the floor.â
She turned crisply and disappeared back into her office, leaving Alex to follow. The office was small and crowded; beige metal cabinets along one wall, chairs scattered near the door and the desk, a single small window in back with a view of overcast sky and blowing snow. Lindaâs desk itself, though, was obsessively clean, a pen, a stapler and the clipboard she placed squarely in the center. Alex could see the cover sheet was labeled âMitchell, A.â.
Snow slid off Alexâs coat onto the floor as Alex sat down in the chair that looked appropriate. He could feel melted snow trickling down his back. Linda didnât comment and began to turn pages of the clipboard.
âI-9, good. W-4 for withholding, Confidentiality agreement, looks fineâŠâ she flipped through the paperwork methodically, going down a mental checklist sheâd obviously used a hundred times. âHIPAA training acknowledgement, Computer use policyâŠâ she looked up âWeâre having some computer problems today, so weâll have to get you onboarded to the system when we get it back up.â Alex nodded as Linda went back to her checklist.
âEmergency contact⊠you didnât complete the second page.â She slid the form across to him. âSignature here, initial here,â handing him a pen. Alex fumbled for a moment then signed and slid it back.
âEverything looks in order, except for your medical form. Iâll need your physical results before I can issue you a badge.â
âOh,â Alex said. âI couldnât get to see my doctor in time. I can bring the form back before the end of the week.â
Linda set her pen down. âCompany policy requires a pre-employment physical and basic blood work before allowing access to patient areas. Youâll obviously need access to patient areas to run files.â
She sighed loudly, and Alex got the sense the frustration was with him and not with the policy. âIâll need you cleared before you can do your job.â
âLuckily⊠because of the storm, I think we can do this.â Linda said. She pushed her glasses up her nose with a knuckle. âHalf of our scheduled procedures cancelled this morning. Patients arenât coming in, and more than a few staff arenât either. The storm has left us short-handed. But I think with the gaps, a physical and a blood draw a well within our capabilities.â
âI donât want to be any trouble.â
âItâs not any trouble, itâs efficient. Thereâs no sense sending you away for something we can handle.â Linda slid the clipboard to the side, a gesture of closure. âOne of our nurse practitioners can see you between other patients. Youâll be in and out, and we can get you working before lunch. We need the hands today of all days, with the computers out.â
Alex opened his mouth, probably to argue. Heâd prefer his own doctor, and the impression heâd gotten of this office so far wasnât a good one. Heâd expected to have an easy first day, learning the computer and file system and basics of billing and so forth. That was not what heâd gotten. But Linda was already rising from her chair, and Alex closed his mouth without objecting further.
âYouâve started on not our best day. The storm has made everything worse,â she said, roughly echoing his thoughts. âBut we can get back on track. Follow me.â Alex wasnât happy with this situation, but it was clear the decision had been made.
Linda led him back into the corridor, walking quickly, assuming heâd keep up.
They walked back towards the ringing phones, and then took a sharp turn, through a set of doors that swung on stiff hinges. Behind the doors was another pale green corridor. This one was wider, and more chaos was immediately visible. A janitor mopped melted snow off the floor. A cart of folded linens had been abandoned in the middle of the hallway, and a technician hunched nearby tapping on a laptop that didnât seem to be working, muttering to himself. An intercom crackled overhead; a womanâs voice, compressed and barely intelligible, calling a name Alex couldnât understand.
The hallway took a bend, and Linda pressed on through another pair of swinging doors, which only opened when Linda scanned her ID badge. This door was marked âStaff And Patients Onlyâ. Alex figured that he was staff already.
The doors opened into a long, rectangular room filled with the sound of voices and beeps of machines. A nurseâs station sat directly in front of them, along with a large, rolling whiteboard. The whiteboard was enormous, nearly floor to ceiling, and had been divided into rows and columns with black electrical tape. What sounded like room names or locations ran down the leftmost column; Bays and ORs organized by number. 30 minute timeslots ran along the top. Patient names and medical abbreviations filled less than half the slots in four different colors. Many had been poorly erased or crossed out, leaving multicolored smudges. A nurse in pale blue scrubs was working with an eraser in one hand and a marker in the other, and Alex watched as she wrote a name in a space, OR 2 at 11:30.
âSee?â Linda said, pausing in front of the board. âHalf the schedule gone today. Some patients calling but most just not showing up, maybe stuck on the highway. But itâs a mercy because more than half of the staff didnât make it, too.â
The nurse at the whiteboard glanced at them without interest, and turned back to her task.
Linda turned away from the board and the nurseâs station. The room had been divided along both long walls into narrow bays, each one curtained off with a heavy mint-green fabric hanging from a track along the ceiling. Some of the curtains were pulled shut; filled with patients waiting or being examined. But others were open and obviously empty, with white gurneys made up waiting for patients that hadnât shown. Nurses in matching sky-blue scrubs moved between the bays, disappearing behind the curtains with clipboards or plastic basins in their hands. None of them looked at him or Linda; there were not a lot of nurses relative to the number of bays and they all seemed busy.
Linda led Alex down the long axis of the room, scanning the numbers stenciled on little signs above each curtain. She stopped at one marked 14. She drew the fabric back on its track with a rattle.
âHere we are, Bay 14.â The bay was small; barely big enough for the furniture inside. A narrow gurney was pushed up against the wall with a folded hospital gown laid crisply on the white pillow. A plastic chair sat nearby, near a small metal tray-table and a small electronic scale. A rolling cart with an apparently inoperative computer monitor was crammed into the corner.
âCoat on the hook,â Linda pointed to a hook on the wall. âGown on, the ties go in the back. The NP will be along.â
Alex looked skeptically at the gown. It was a pale off-white, like every other medical gown heâd ever seen. It was patterned faintly with tiny blue diamonds. âIs the gown really⊠?â He trailed off.
âItâs nothing we all havenât seen,â Linda gave him a smile that somehow seemed condescending. âAnd youâre soaked through, Mr. Mitchell. Take off those wet clothes.â She was already turning, half out of the bay. âIâll track down one of the NPs and get her over here. Sit tight.â
The curtain swept closed behind her with a rattle.
Alex stood for a long moment in front of the gurney. But Linda was right; he was soaked. And there was no point in being demure here, even in the unexpected situation he found himself. He didnât really want to do this, but better to get through it and get to work properly.
Shrugging out of his coat, Alex hung the heavy, damp garment on the hook as heâd been instructed. He methodically removed his layers; he peeled off his shirt and tie, his undershirt, and his pants. He took out his phone and his wallet and left them on the chair, then folded everything and made a small pile. He wanted to give his new coworkers a good impression in this odd situation, and made sure the pile of his wet clothes looked neat and orderly. He pulled off both his socks and shoes, leaving damp footprints on the green floor. After a minuteâs hesitation, he removed his underwear, too. He was already feeling fairly vulnerable, and he wasnât sure if he was supposed to, but they were soaked through.
Taking the gown from the gurney, he shook it open, sliding his arms into it. The short-sleeved gown hung down to his knees. Reaching behind himself, he fumbled with the ties and was relived when he managed to secure two of them. Only a small gap was still open down his back, a far better result than heâd feared.
Alex turned and sat down on the side of the gurney to wait.
And waited. He spent a few minutes listening to the sounds beyond the curtain. It still sounded busy out there, with plenty of footsteps going by every few seconds. Somewhere an alarm pinged. A womanâs voice was reassuring someone in a neighboring bay, too faint to fully make out the worlds. Nurses loudly discussing time slots with a shorthand he could hear clearly, but didnât understand. More footsteps and a rolling cart went past.
Minutes passed. Five, ten, more.
Finally, the curtain twitched aside. A woman in wrinkled scrubs peered in. She was stocky and solid, maybe in her forties, and carried a noticeably large pile of folders. She had the tired eyes of someone who had been on her feet since the early morning.
âOh, hon,â she said, surveying him. âBeen waiting long?â
âA little while,â Alex said.
She frowned. She glanced at the files she was holding, frowned harder, and stepped over to the dark computer cart beside the gurney. She tapped a key. Tapped it again. The screen stayed dark and unhelpful.
âSystemâs still down,â she explained, as if this wasnât obvious. âLord give me strength.â
âBay 14, Bay 14. Okay. Weâll get you.â She glanced up at him and smiled a small, tired, reassuring smile. âSorry for the delay. Stormâs got us all sideways. Someoneâs coming.â
Alex opened his mouth, to ask how much longer until the NP was available, but she was already stepping back out of the bay. He heard her raise her voice, yelling down to the nurse's station.
âAshley! Honey! You got a minute? I got Bay 14 still sitting here. Can you get him handled?â
Somewhere beyond the curtain, a cheerful voice answered. âSure, Iâm free now!â
More footsteps and then the curtain swept back on its track again. A woman came through, holding a clipboard and a plastic tub of supplies. She was wearing the same light blue scrubs that Alex had seen on other nurses. Around her neck was a black stethoscope, and on her head she wore a bright orange scrub cap, patterned in cartoon cats. Her skin was a warm brown and her face was round and encouraging. Alex smiled to match the smile the new nurse had on her face. Alex found the cheerful cap and her smile reassuring.
âOh, Iâm so sorry for the wait,â she said, a slight southern accent, more noticeable than the other people Alex had interacted with today. She pulled the curtain closed behind her in a practiced, one-handed motion. âIt is absolutely wild out there today. The storm, the computers, the schedule, donât even get me started. But Iâm here now and weâre gonna get you squared away, all right?â
âAre you a nurse practitioner?â Alex started. âI think I was supposed toâŠâ
âIâm Ashley,â she said, already moving about her tasks. She set the tub and clipboard down on the tray-table and flipped through the top two pages with one quick thumb. âAll of the nurses who made it in are running flat-out this morning. Weâll have you taken care of in no time.â
âLet me see,â Ashley said, glancing up from her form at him for a moment, then back down. âCan you tell me your name and date of birth, please?â
He gave them. Rather than check his information against the dark, nonfunctional computer, Ashley wrote them down in small tidy block letters across the top of the first page.
âAll right,â she said, brisk but warm. âLetâs do the boring stuff first. You mind hopping on that scale for me, sweetie?â
At the side of the bay was a small, electronic scale, not unlike the cheap one in Alexâs apartment. Alex stood up and stepped onto it, conscious of the gap at the back of his gown, the cool air on his spine. In a minute, the LCD flashed out the number. Ashley wrote a number down.
âThank you. Back on the bed for me.â She patted the gurney. âYouâre gonna feel a little squeeze here.â Alex saw that sheâd pulled on a pair of violet-colored gloves as heâd been on the scale, moving quickly.
She produced a blood pressure cuff from where it had been coiled in a stand on the bedâs headboard, opening its Velcro with a scraping rip, and wrapped it around his upper arm. Ashley took the stethoscope from her neck, and carefully positioned it in her ears and then on his arm. The cuff tightened around his biceps in slow increments until his pulse drummed loudly in her ears. Her eyes were on the analog gauge, and she let the cuff hiss back down.
âA little high,â she said, making a note, âbut thatâs to be expected, hon. Weather like this, new place, unusual situation, normal to be a little high. Nothing to worry about.â
She slid a plastic probe cover onto a digital thermometer and slipped the tip under his tongue. It beeped a few moments later with a quick chirp. She read it, wrote it down. She produced a pulse oximeter and clipped it onto the tip of his index finger, and watched the glowing red numbers settle. She wrote them down too. Each gesture was unhurried but quick, the result of having done this many times. It was more or less the same things that Alex had expected from his own doctor, and this reassured him.
âOpen wide for me, sweetie, and tilt your head back.â She produced a small penlight from a pocket of her scrub top and clicked it on. âJust going to take a look in your mouth. There we go.â
He opened his mouth. She leaned in, pointing the light. Alex wasnât sure what she was looking for, but this was easy enough, and he was eager to get this over with. Her gloved fingers pressed gently along the sides of his neck, palpating beneath his jaw.
âBeautiful,â she said, clicking the penlight off. âNice and clear. All right, Iâm gonna go ahead and get you an IV started. Just a little needle. You all right with needles? Some folks arenât.â
âIâm fine with needles,â Alex said. He watched her lay out more supplies from her plastic container. âIs that⊠I mean, blood work, right?â
âJust like that, â Ashley said, cheerfully, laying out a small clear adhesive square and setting it aside. Alex watched as she opened and staged a needle and a small plastic catheter. An alcohol prep pad came out of its packet, and she began swabbing the back of his left hand in slow concentric spirals.
âMake a fist for me, Alex?â Alex obeyed as the nurse picked up her small blue tourniquet.
The curtain scraped open before she could tie the tourniquet, and a younger nurse stepped half into the bay. She was slight, early twenties, with dark hair scraped back into a tight low ponytail and no makeup to speak of. Her scrubs were a slightly different color; a flat navy blue. The new nurseâs eyes seemed to slide over Alex, she focused entirely on Ashley.
âAsh,â the younger nurse said. âDr. Morenoâs stuck in that thing over in OR 1, the GI. Gonna be at least thirty minutes. OR 2âs done, though. Theyâre turning it over now.â
âGood,â Ashley said without looking up. âGives us a minute to breathe, at least.â She tightened the tourniquet around Alexâs forearm with a small snap.
The new nurse produced a syringe from a scrub pocket and held the syringe out. Something Ashley had forgotten, Alex assumed. Ashley took it without ceremony and set it on the edge of the tray beside the open, readied catheter.
âHi,â Alex said, uncertainly, drawing the new nurseâs attention for the first time.
âHi,â the young nurse said, and flashed him a quick, professional smile. âIâm Nicole. Iâll see you in a bit.â
Alex agreed; it was an odd way to meet his new coworkers but what first day isnât awkward? Nicole was already leaving. The curtain moved again behind her.
âOh, what a day,â Ashley said, clearly just to herself, and then, louder, to Alex: âLittle stick now. Deep breath.â
He breathed in. Ashley, with her purple-gloved fingers, pulled the skin taut with her thumb. The needle slid in with a small pinch. She advanced the plastic catheter, withdrew the needle, and with movements almost too quick for him to follow, she had an extension tube with a port pressed onto the hub and the transparent dressing pressed smooth over the site, holding it all in place. The blue elastic tourniquet came off with another small snap.
âAlmost done,â Ashley said. âYouâre doing great, hon.â
She picked up the small syringe that Nicole had left. She uncapped it and fitted it into the port on the IV and pressed the plunger down. Alex felt a faint coolness as the clear liquid flowed through the line. It took only two seconds, by all appearances a normal part of getting an IV working. She withdrew the empty syringe and dropped it into a red plastic sharps container on the wall.
âAll right, hon,â she said. She patted his knee through the gown. âYou go ahead and lie back. Nicoleâs gonna come get you in just a bit. Okay?â
For the first time, this seemed odd to Alex. Ashley hadnât taken any blood yet. Alex began to ask the nurse if she was forgetting to do it, but again Nurse Ashley was moving quick. Too quick. Ashley tucked the clipboard back under her arm, and hustled out of the bay, leaving him alone before he could finish the thought.
Alex sat on the edge of the gurney, the IV now taped into the back of his hand under the dressing. Ashley had done the whole exam but no vial had been drawn. Why was he not done? Was that why sheâd said Nicole was coming back?
The last few seconds didnât make any sense. Alex was starting to feel something was wrong. It occurred to him that heâd never actually explained why he was here. But Ashleyâs clipboard had his employment form on it, right?
But⊠he should just make sure they knew what he needed done, get the forms signed, and go find Linda again. He decided to follow Ashley; he could get up and go after his new coworker; even wearing the gown, he could just walk out and ask. He didnât really want to walk around in his half-dressed state, but he could swallow his embarrassment. Thatâd be the wisest thing to do.
He leaned forward on the gurney, making to stand up. But as he did, a wave of dizziness hit him. The green fabric around the bay seemed to rotate, as if heâd stood up too fast. He felt lightheaded. Alex paused, waiting for the feeling to pass. But it didnât pass. Instead, the room began to sway. The room tipped sideways a few inches, then tipped back the other way. Then the rotating got more intense.
And he couldnât remember what heâd been doing. Why had he wanted to go anywhere? The confusion brought with it a moment of fear; what was happening to him? But a second later, the fear and confusion seemed⊠softer. Everything seemed softer.
Next thing he knew the thin pillow was pressed against the back of his head, and he looked up at the ceiling. He had no memory of lying down, as if heâd fallen or teleported slightly backwards. This didnât concern him much, either. Someone had told him to lie down, hadnât they? He pulled his legs up onto the gurney. He had a deep sense that everything was alright. Heâd just take a little rest and then everything would start to make sense.
The green curtains rotating slowly around him started to look slightly gray. No, it was more than that; the whole world was starting to feel gray. The color reminded him of an overcast sky.
For a little bit, Alex didnât think of anything else. The gray world vibrated slightly, the room rotated, and his eyelids drooped. Everything was soft. Everything seemed alright.
Everything was not alright.
Outside the curtain, down the length of the room, Ashley paused at the large whiteboard. The name that had been written in Bay 14 was half-erased, a smudge, a smear. But luckily for her, the procedure abbreviation was still there. Ashley diligently copied it down onto Alexâs file on her clipboard. She picked up a blue marker and wrote, in her neat script, MITCHELL, A. Heâd already waited a long time, so she wrote his name in the very next time slot for OR 2.
Alex came awake slowly. He wasnât sure when heâd fallen asleep; he had no memory of that. He wasnât sure where he was, or why. This ambiguity didnât bother him. Nothing bothered him. The whole world was gray. His head felt light, and soft, and the whole world vibrated gently. He didnât feel any distress at that, either.
He registered that he was on a bed, but someone was talking to him. Maybe two people; he could see two figures backlit by the florescent light around him.
âThere you are,â a voice said, warm and low. Somehow, the voice sounded relaxing, playful. âI see youâre nice and relaxed. Having a nice little rest?â
Alex blinked. His eyelids moved slowly, heavy. They almost stayed shut and it took effort to make them open again.
If Alex had been able to focus, he wouldnât have recognized the woman who had spoken. She was in her mid-thirties, curvy, her hair hidden beneath a green disposable surgical cap. She wore dark blue scrubs, different than most of the nurses Alex had seen so far. A white surgical mask dangled from her neck.
âIâm Dr. Mary Fuentes,â she said. âYou can call me Mary. Iâm the anesthesiologist. Weâre doing things a little bit backwards today, but Iâm gonna be taking care of you, okay? Any allergies you forgot to mention?â Alex didnât understand the question; the whole world was too distant to comprehend. The words should have been terrifying, but they barely registered with Alex at all.
The doctor smiled. âWell, nothing in your file, so weâll deal with it as it comes. Okay, good.â Dr. Mary turned to the other figure. âMaybe a bit too much midazolam for this one, Nicole,â but the criticism has no heat.
Alex slowly registered the second figure was familiar; it was the nurse from before. Nicole. Her dark blue scrubs matched the new doctor, and like the doctor, her hair now was entirely hidden by a matching green bouffant cap. The outfits, taken together, felt a lot less cheerful and reassuring than that last nurse had.
âHi again, Mr. Mitchell,â Nicole said. âWeâre gonna get you moving.â
Alex gathered his focus. He wasnât sure what was going on, but remember he had to say something. âIâŠâ he said. âNeed to⊠to⊠work.â
It came out thick and barely intelligible, with long pauses between words as the room swayed. The softness in his head seem to fill his mouth, making it hard to use his tongue to shape words.
âI know, I know,â Dr. Mary said, without really listening. âYouâll be back at work soon.â
She had taken a clipboard from Nicole and was flicking through the paper. Her eyes moved down each page without pausing. âDonât you worry about a thing. Weâre gonna take real good care of you. Youâre in good hands, okay?â
âBlood⊠workâ Alex said, trying very hard to say something he thought had been important. The words came out in a strange shape, the consonants melted into the vowels, but it was understandable enough.
âI donât see any notes about your lab work. It should be fine,â Dr. Mary reassured, reading the file further. This statement confused Alex, but thatâs what heâd wanted, wasnât it? That was good. Alex felt re-assured. Had he ever felt not-assured? He wasnât sure.
Nicole had produced, from a shelf behind the gurney, a thin paper package. She tore the bag open and pulled out a thin bouffant cap, this one blue instead of the green both nurses wore. She shook the cap out until it was vaguely hat-shaped. She leaned over him and he felt her fingers gather the hair at his temples, felt her tuck it gently up and under the elastic, felt the light band of the cap settle around his forehead.
âThere you go,â she said, cheerfully. âJust one more thing.â
She picked up his right wrist, the one without the IV, and her gloved fingers held it as she fitted a narrow white plastic band around it. The band had a small adhesive clasp; she pressed the two ends together and smoothed them flat. Alex looked down at this with a vaguely detached curiosity. There was a name on the band. MITCHELL, ALEX. His date of birth. A number. A doctorâs name he didnât know. Some other letters organized into a medical-looking word that was a mystery. The letters blurred quite a bit; his eyes were not quite willing to hold focus. None of it meant anything to him anyways.
âI think weâre ready to go,â Dr. Mary said. âEverybody is way behind today, but weâll take you over now.â The explanation didnât explain anything to Alex. He heard a familiar soft sound as Mary pushed the curtain open its track, opening the bay up to the rest of the large room.
Nicole leaned across the base of the gurney and Alex felt, through the thin mattress, a pair of small mechanical thuds as she released the brakes with the side of her foot. The gurney shifted slightly and Nicole pulled it slightly away from the wall. Dr. Mary stepped around to the head of the bed and laid her hands on the bar there.
âHere we go, Mr. Mitchell,â she said. âShort little ride.â
The bay began to slide away, or rather the world outside began to move. Linearly this time, rather than around in a circle or back and forth. The green curtain slid away from him and the pre-op room opened overhead. Alex watched the ceiling tiles and fluorescent lights above him begin a slow procession, each long white panel sliding into view at his feet and traveling up out of sight past his forehead. One of them, he noticed with the limited focus that his current drugged state allowed him, was flickering as they went by.
They rolled past the Nurseâs Station. He could hear voices from a great distance, and they sounded familiar. He turned his head towards them. It seemed to take a long time, as if trying to move during a dream, as if he wasnât in charge of his own body anymore. He saw, at the edge of the stationâs counter, a woman in a neat cream blouse, her hair drawn back into a low bun, with reading glasses pushed up the bridge of her nose. She was talking on a phone. He had met her earlier, he was sure, but a name was slow in floating up.
â⊠how shorthanded we are,â the woman was saying, her voice clearly annoyed, âIâve been waiting for an NP to get here, and I have a new hire waitingâŠâ
The womanâs eyes passed over the gurney as it moved through her line of sight. They did not stop. She did not recognize the blue-capped figure, dressed in a patient gown and a patient wristband catching the light. He was just another patient going by. The gurney rolled on.
That womanâs name, Alex thought, slowly and dispassionately, was Linda. That was Linda, and she was looking for an NP. She still hadnât found one. That was⊠somehow⊠important to Alex.
The gurney turned. Alexâs train of thought was abandoned, unfinished.
They passed through a set of double doors that swung open before them, automatically, Alex thought. Beyond the doors, the air changed. It was colder here; he felt the chill slide over his bare calves under the gown. And the corridor was quieter, the alarms and ringing phones and low murmur of nurses cut off as the doors shut behind them. If Alex had looked over the side of the gurney, heâd have seen that the linoleum had a different sheen, less worn, more freshly mopped, reflecting the overhead fixtures in long bright smears.
âAlmost there,â Nicole said, and patted his shoulder through the thin gown. âYouâre doing fine.â
Alex tried to smile at her. He felt fine.
They turned a last corner, and the gurney rolled through another set of double doors. A small stenciled sign on the wall beside the door read Operating Room 2.
The room seemed brighter than the hallway. If Alex had been able to survey his surroundings heâd have seen that it was more modern than the rest of the facility. The tile floor had been refinished sometime this decade, a slightly darker shade of green, and the walls were an institutional off-white. At the center of the room, under a pair of massive surgical lights mounted on articulated arms, an operating table stood. It was covered with a clean surgical-blue pad, and awaited a patient.
Near one wall, a tall machine on wheels towered above the head of the table. It was as tall as a person, with vertical flowmeters and two different vaporizer canisters mounted on the front. Off the side hung ventilator bellows, a large CO2 absorbing cylinder and a pale green rebreathing bag, not yet inflated. A corrugated hose looped down to where a mask was already fitted, on a hook nearby. Two bright computer screens, these obviously working, were illuminated above the workstation.
On the machineâs flat top, various drug ampoules were lined up but not drawn, syringes and tubes laid out in their packaging, a laryngoscope not yet assembled. The anesthesia tech, whoâd have helped get these items ready, was off lost in the storm somewhere.
On the opposite side, near the foot of the table, a nurse was standing in front of a broad metal table. The scrub nurse was capped and fully masked, and she wore a long, smooth blue gown, which covered her from neck to almost her ankles. She was flipping out the corners of a surgical blue drape with small sharp snaps of her wrist. She did not look up when the gurney rolled in. Her hands were covered with long, white gloves, and they moved deliberately as she lifted instruments one by one from a nearby tray, placing them in rows on the draped table.
âHere we are,â Dr. Mary said, guiding the head of Alexâs gurney to align alongside the operating table. âWeâre gonna slide you over. Nice and easy.â
Another nurse had appeared; she was anonymous with her featureless blue gown, green cap and mask tied up. Together she and Nicole took hold of the sheet under him and lifted. The world swam for a moment and then he was on the table, narrower and firmer and colder against his back through the thin cloth he wore. The gurney, relieved of him, was rolled away and disappeared from his reality. For Alex, the whole world still seemed to be swaying back and forth. Despite feeling the literal cold of the padded table, his head felt warm.
âHeâs pretty snowed,â Dr. Mary said to the room, casual, almost amused. She had moved to the head of the table and was sorting and the items sheâd need; a few sizes of ET tubes, a coil of clear tubing, checking all the vials were correct. She glanced at his unfocused eyes and his loose jaw and made a small approving sound. âWe might as well go ahead and get him positioned. Heâs not gonna remember a thing and the other case is running behind. I still need to draw up meds.â
âMr. Mitchell,â Nicole said, leaning over him from the right side of the table. âI need you to scoot down for me. Just a little. Toward the end of the table. Can you do that?â
Alex did not know why she was asking. He did not have the focus, any longer, to form the question âwhyâ about anything going on around him. He planted his heels weakly against the padded table and wiggled a bit. His hips shifted a few inches downward along the table. Nicole and an anonymous nurse took hold of his waist through the gown and slid him a bit more, until his pelvis lay at a very specific spot on the table. Mary paused her preparations on the machine, and helped slide a U-shaped foam pillow under his neck and head. His head tilted back, up at the lights.
âGood job,â Nicole said softly. âPerfect.â
From the foot of the table two nurses produced a pair of stirrups. They were large and padded, made of black plastic and blue foam, big enough to cradle an entire calf and the sole of a foot. They were mounted on articulated arms that swung up from sockets in the tableâs frame and firmly locked into place with metallic clicks.
The nurses lifted his legs, one at a time, and fitted his calves into the boot-like cradles. The foam was cool against the back of his knee. They rotated his legs outward, in the same movement, and his thighs fell apart at an angle his body did not normally make. When both legs were lifted, a wide strap was drawn across each thigh and then tightened.
Somewhere underneath the forced relaxation and the softness of the drug, two alarming thoughts floated into Alexâs head. He started to recall, from very far away, that heâd needed an employment physical. He didnât think that the bodies of men undergoing an employment physical usually were arranged like this. But the two thoughts still felt separate, unrelated. The midazolam held them apart, at least for now.
âLetâs get that gown off you,â Nicoleâs voice. âWeâll get you a blanket instead.â Nicoleâs gloved hands dug under his back for a moment, but quickly found the knotted ties. They tugged loose with no resistance, and Nicole peeled the gown away from his shoulders. She lifted his arms, and pulled the gown all the way off him. Alex felt the air of the cool OR over the skin of his chest and belly and crotch now. He was aware, distantly, that he was naked except for the blue cap and the plastic name band around his wrist. Some sense of embarrassment should have made him uncomfortable, but the drugâs relaxation filled his head so completely he only registered it in the abstract, equal to the mild annoyance at the cold air.
One of the other nurses, anonymous behind her mask, unfolded a wide, blue sheet, draping over his hips and thighs. The act was meant to spare him some vulnerability as they continued their preparations, but Alex just couldnât care about anything very much. At the head of the table, Nicole was clamping two blue pads, one above each of Alexâs shoulders. He couldnât see them, but they attached to the frame of the surgical table and extended upwards just a few inches above its surface. Nicole adjusted them until they were gently touching just above Alexâs collarbone, making sure that the patient couldnât slide towards the head of the table at all.
âArms, now, My. Mitchell,â Nicole said, moving to her next task. âLetâs get these out for you.â Nicole had unfolded an armboard from somewhere under the right side of the table, clamping it in place perpendicular to his body. She walked to the other side of the table, disappearing out of Alex vision for a moment, and did the same on the left side. She patted the green surface of the left armrest.
âSlide your arm out here for me, please.â The instruction was too complicated for Alex, but he lifted his arm and Nicoleâs gloved hands took his wrist. His arm felt far away, like heâd left it outside, in his car, and itâd become numb in the cold. Nicole guided it out with gentle pressure, turning his wrist such that the IV in the back of his hand faced up. The padding was chilly where his palm touched it. Nicole reached up, and connected a coil of IV tubing from a hanging saline, which, after a moment, began to drip.
As soon as the arm had been positioned, Dr. Mary appeared and slid a pulse oximeter onto his pointer-finger. A monitor on the anesthesia cart above him began to beep, slow and regular.
On the right, the anonymous nurse took his other arm, coaxing it into the same extended position. Both arms stuck out at right angles now, cruciform. Alex wasnât sure he liked the feeling but the room still vibrated, still seemed warm and far away, and any concern still belonged to someone else. Nicole appeared again with a blood pressure cuff, which went around Alexâs right arm. He vaguely recalled a nurse named Ashley taking his blood pressure some time ago, and this one began to squeeze just like that had. The memory nagged at him, almost reminding him of something that seemed important, or maybe alarming. He couldnât figure out the words but he made a noise of confusion.
âShh,â said Nicole. She smoothed a hand over the blue cap on his head. âItâs okay.â Alex believed her and let the memory go for now.
Dr. Mary loomed above his head. She was masked now. She ripped open a packet, peeled out five round white electrode pads, and pressed them each to his chest and abdomen. âThere we go,â she said, as she pressed the fifth electrode just beneath his left ribcage, then snapped the leads onto the pads, one by one.
Nicole drew a wide black strap up from underneath the armboard, and laid it across his right wrist. She brought the two ends of the strap together and drew it snug, tucking the IV line clear of the closure before pressing the Velcro closure flat. On his left, an anonymous nurse did the same. The straps were not uncomfortable. They were just there, the way everything going on around him was, but something in his subconscious made him try to pull his right arm back a few inches. The strap prevented it.
âDonât worry about those,â Nicole had noticed the movement. âWe just need to make sure you donât get your hands caught when weâre adjusting the table. Which weâre going to do now, all right?â Nicole didnât wait for Alexâs consent but nodded to a nurse nearby.
There was a mechanical hum from the table, low and vibrating through the padding and into his spine. The head of the table began to tilt downward, slowly, a few degrees at a time. At first, Alex didnât really perceive the move; after all, the whole world was swaying back and forth. But after a few moments, he could feel the gravity shift; a new heaviness in his head that had nothing to do with his sedation. The shoulder pads pressed gently against his collarbones, holding him in place against the new angle.
Then something happened at his feet. Or rather, below his feet. A nurse pressed a control, and then the lower portion of the table simply fell away. It hinged downward and away from his legs, leaving nothing beneath his thighs and calfs but air. The stirrups held his legs up and apart, cradling them in their padded boots, but everything below his pelvis now hung suspended over empty space.
This situation should have been terrifying under normal circumstances. But with the sedation filling Alexâs head this all seemed distant. It was confusing, but only when he tried to concentrate.
The door to the operating room swung open with a loud sigh of moving air. For some reason, Alex expected Linda, the HR lady, looking for him. But instead, Alex saw a new woman. A new nurse, with deep blue scrubs. She stood in the doorway and didnât quite step through.
âDr. Merenoâs still working on other case,â she said. The mask she held over her mouth muffled her voice only slightly. âMaybe 20 more minutes, but she says you can induce.â
âCopy that,â Dr. Mary said, without turning or looking up. She sounded annoyed. She was unwrapping syringes from their plastic packages on top of the anesthesia cart. The door sighed shut.
Alex, flat on his back on the narrow padded table, tried to hold the words in his head long enough to examine them. Doctor⊠Moreno⊠working. Twenty minutes? Can Induce. Each word he knew, and he had heard them in order, but when he tried to hold them all at once, they began to sway and became distant and blurry, just like everything else.
âI donât really want to extend anesthesia time that much,â Dr. Mary was talking thing to Nicole. âI think heâs relaxed enough to get the urinary catheter and drape now, donât you?â
Nicole looked down at Alexâs slack face, and agreed.
Even through the soft grey that lay between him and the entire world, Alex wasnât sure that that sounded good. Slowly, deliberately, Alex started to re-assemble the two thoughts heâd had before.
He needed a physical exam, for his first day.
You didnât position someone in an OR for a physical exam.
For the first time, the two thoughts related to each other, and related to him.
Something was wrong. He was sure now.
Above him, the enormous disk of the surgical lights were being tilted into position by a gloved hand, and both lights blazed suddenly into full brightness, two small suns pointed at his lower body. He squinted, momentarily distracted from his newfound certainty.
âAlright, Alexâ Dr. Maryâs face resolved only partially as she leaned into his field of view. Her surgical mask was up over her nose and mouth, but her eyes were visible, warm and unbothered. âWeâre going to start getting ready for you, and you might feel some pressure, alright?â
Alex moved his mouth. He wasnât sure what to say, but he was starting to understand he had to say something. Heâd explain. It was his first day.
âFirst⊠day,â he managed. The words were, to his surprise, completely understandable. Heâd said it! He felt a moment of triumph. Heâd done it!
But Dr. Mary ignored him, turning away, reaching for something on her tray.
âDonât worry, Mr. Mitchell,â Nicole leaned in from his left side. Above her mask, her alert young eyes crinkled into a small indulgent smile. âItâs not our first day, hon. Weâve done dozens of prostatectomies this way. Dozens and dozens. Youâre in good hands.â
âProsâŠtateâŠectomies?â Alex slurred, confused. That wasnât the word for a physical exam. That seemed wrong. Alex took a moment to try to understand.
Dr. Mary had turned back. In her purple-gloved hand, she held a clear plastic anesthesia mask, hollowed to fit the architecture of a human face. A length of corrugated tubing in translucent plastic trailed from its port back toward the large anesthesia machine at his head. She held the mask up so he could see it.
âJust a mask,â she said. âIâm gonna place it over your nose and mouth. I need you to breathe some oxygen for me, nice and easy.â
The clear plastic rim settled against the bridge of his nose and along the soft edge of his chin, and the cushion sealed tightly against his face. The smell was the smell of new plastic. He could feel and see, through the clear vault of it, her purple-gloved fingers spread on either side of the seal, pressing the mask down gently, but firmly. With her other hand, Dr. Mary drew four plastic straps from the foam pillow, up to the sides of the mask and secured them, one by one.
He remembered something was wrong. He turned his head. It was a small movement, a weak shift to the side. The mask moved with him, the harness holding it on.
âDonât fight it,â Dr. Mary said. Her voice reassuring. âItâs just oxygen. Breathe normal for me while we finish getting ready. Thatâs all you have to do.â
Nicoleâs hand came down on his shoulder. The pressure of her gloved palm flat against his shoulder. Her thumb stroked once, twice, along his collarbone in a slow reassuring arc.
âRelax, Mr. Mitchell,â she said. âEverythingâs fine. You just breathe for us. Weâre taking care of you.â
Alex breathed because he did not know what else to do, and because the women had told him to. The faintly plastic-scented air flowed into his mouth and down the back of his throat, and his chest rose and fell. On Dr. Maryâs machine, the rebreathing bag inflated and deflated in time with him. But he remembered his two thoughts again. Something was wrong.
Suddenly, there was a flash of cold. The drape over his pelvis had been removed. The scrub nurse was there, at the foot of the table, between his spread legs. He felt something cold and wet press against the skin between his thighs. The cold spread in slow deliberate strokes; she was painting circles of antiseptic across the sensitive skin in places he really didnât want anyone touching, even through the grey haze.
His right hand wanted, suddenly, very much to come up to his face. He wanted to push the mask off, so he could talk, even if he still wasnât sure exactly what to say. He tried to lift it. The strap across his forearm held. He tried the left hand. No better. His fingers curled weakly and uncurled. He tried again. No.
âHold still, Alex,â Nicole said, using his first name for the first time. Her hand on his shoulder increased its pressure. âYou need to hold still for us. Donât pull on that.â
A small stirring of real alarm had begun, deep within his chest. Even if it was hard to hold onto his thoughts, he knew he wanted his arms free. He knew he wanted his legs free. He knew he wanted the mask off. He pulled, he twisted, he tried to turn his head. None of it worked, but his body tensed and jerked on the table.
âMary.â Nicoleâs voice had sharpened slightly. âHeâs getting a little agitated.â
âI see it.â Dr. Mary was already reaching up above his head. âI think we can make this experience a little less scary.â
Dr. Mary reached over to her tall machine at the head of the table. Her gloved fingers adjusted two knobs on the front, adjusting the oxygen and starting the flow of nitrous oxide.
The bag on the machine inflated and then collapsed as Dr. Mary gently squeezed it, once, twice. As Alex tried to weakly struggle, the mask filled with the new gas, filling his lungs as she massaged the green bag. There was nowhere to go; the harness held the mask on tight. Alexâs thoughts, already difficult to hold through the grey of the midazolam, rapidly were obscured with a harsh fuzz.
âEasy, Alex,â Nicole comforted. âJust breathe easy.â Alex pulled again. His wrists strained against the straps, the Velcro holding firm, unyielding, the padding beneath it barely shifting. He pulled harder. The muscles in his forearms tensed and trembled but the straps were too strong, and besides, his body wasnât responding right. Mustering all this effort was difficult through the grey. Both arm stayed where they were, pinned flat to the boards.
He thought about his legs, splayed above him. He tried to move his legs. The stirrups cradled his calves in their foam boots and the straps across his thighs were wide and snug. He pushed with his heels, tried to draw his knees together, but the blue stirrups held his legs apart at an unnatural angle and the muscles of his thighs simply trembled without producing any real movement. The shoulder pads above his collarbones prevented him from even pushing his body downwards.
And the whole time that he was struggling, he was breathing. A deep whooshing noise started, not in the room but in his head. It was the sound of the wind, blowing the fuzz into his head. The sound of blowing snow. The noise grew louder with each breath. He knew something was wrong, and that he had to get loose. But he took another breath, and there was too much wind and fuzz in his head to remember why. The mask, the mask was a problem. He tried to concentrate on moving his head away from the mask. He twisted his head to the right, the motion slow and uncoordinated. The mask followed, the four straps pulling taut against the back of his skull, the soft plastic rim tightening slightly against the bridge of his nose but never breaking its seal. He twisted left. The same. The cushioned edge of the mask simply rode with him, molded to the contours of his face.
The noise in his head got louder. It had been hard to think with the midazolam making the room move, making the world distant. With the addition of the nitrous, the sound of the wind, and the fuzz, no, the snow in his head made thinking impossible.
When Dr. Mary leaned into his vision again, all he could concentrate on was her white surgical mask. It seemed to glow in a sea of falling snow. How heâd gotten here, his concern, any memory of a physical exam, heâd known a few seconds ago. But now⊠they were lost in the storm.
The scrub nurse had finished the skin preparation between his legs. Alex had completely forgotten her. Sheâd finished applying antiseptic and had moved on to her next task. He could have almost seen what she was doing, because of the angle of the table, but he didnât remember to look. He felt something cold and slick, pressed against him, being inserted where heâd never had anything inserted before.
His hips twitched, but with the restraints and the sedation it was only a small move, and it was barely discomfort. The scrub nurseâs gloved hand advanced the catheter inside him, and the pressure increased, a slow steady advance, the lubricated tip sliding into him. Sheâd done this a thousand times before. Even through the nitrous he felt it travel deeper, a thin foreign presence somewhere unfamiliar and unwelcome. But not painful.
âAlmost done down here,â the scrub nurse said, not to him but to the room. It didnât matter. The wind in his head was so loud.
The scrub nurse inflated the foleyâs balloon, settling it deep within his bladder. She gave the tube a small tug, gently, pleased that the catheter stayed in position. His bladder began emptying without his permission, without his effort, the urine flowing by gravity into a collection bag that the nurse had hung from the side of the table frame.
âFoleyâs in,â the scrub nurse announced.
âGood,â Nicoleâs voice, from somewhere above and to his left. âThank you.â
The snow in Alexâs head fell thicker. He was breathing steadily now. He looked up at the surgical lights and tried to think. All he could think of was of snow. The snow was completely filling his head now. It was piling up, forming large drifts behind his eyes.
Somewhere, distantly, his legs shifted in the stirrups. He felt the foam pads flex against the backs of his knees and felt his ankles push inward and outward once or twice in small, purposeless motions. The blood pressure cuff on his arm squeezed again. He couldnât remember what the feeling was.
The scrub nurse was draping blue blankets over him now; one over each leg. The heavy blue fabric settled over his shins, his knees, draping the stirrups themselves. Another drape went across his lower abdomen, its edge folded precisely just below his navel. The nurseâs gloved hands smoothed each layer flat, tucking edges under the foam of the stirrup boots, clipping the corners to the frame with small metal clips that clicked into place. The addition of these blankets might have been reassuring if he wasnât so far away, but the nurse didnât cover the spaces between his legs, and that might have been concerning.
These motions were happening, he was aware, but they were happening to a body he was currently only loosely attached to. The armboards held his arms out in their crucifix pose, his head tilted down, his pelvis exposed. But it didnât matter. Nothing that happened around him mattered.
Dr. Mary had turned aside. On her stainless tray she was finishing drawing her drugs into syringes. The last one had an especially large barrel, and she drew it full of a milky white substance. White like snow. She capped the needle and set the propofol down on the anesthesia cart.
The room settled into a strange quiet, as everyone waited. The beeping of the pulse oximeter marked time in slow, even intervals. The surgical lights blazed above him, twin white suns far above the snow storm that was still happening in his head.
But maybe the midazolam was starting to wear off a bit, or maybe the quiet and stillness let him start to think again.
Because again, he was trying to remember. He was trying very hard.
There had been a reason. A reason he was here.
It was⊠his first day. Heâd needed a form signed. Linda. A woman named Linda.
The thought dissolved. The snow covered it over, smooth and white as if nothing had ever been there at all.
But⊠he tried again. Linda⊠he had to talk to Linda.
The table was cold beneath his shoulder blades, cold, like snow. He was on a table, exposed, legs apart, arms out, tilted uncomfortably. An operating table. He wasnât supposed to be here, was he? His lips moved behind the mask, shaping air into something that might have been a new objection, but it was no more coherent than his thoughts. And it was too quiet for anyone to hear over the steady mechanical hissing of the machine above his head.
Dr. Mary had moved away from the head of the table. He could hear her voice somewhere behind him and above, talking to someone; to Nicole, perhaps. Alex couldnât see her, either. He started to feel very alone, despite the figures moving around him.
Time passed. He was almost certain time passed, because the beeping continued its count, and the bag breathed, and the background hum of the room did not change. The blood pressure cuff squeezed his arm again. And again. But how much time it was, he could not say. A minute. Ten minutes. An hour. The snow in his head made all durations equal.
The door opened again. He heard the pneumatic sigh of the seal breaking, the shift in air pressure that against the exposed skin of his chest. Alexâs eyes moved toward the sound, a glacial rotation of his skull against the foam pillow. Through the snow in his head, through the white roar and the sweet plastic smell of the mask, he saw a figure in the doorway.
He knew it was Linda. Sheâd found him, he thought. He couldnât remember why but knew he wanted this; it was what he needed. Sheâd come. He could talk to her, figure out what was going on. Sheâd found him, and sheâd explain⊠something⊠about his first day. An employment physical.
The figure stepped forward and Alex could see it was not Linda.
It was a nurse. Another nurse, anonymous, blue scrubs and a mask. âDr. Morenoâs ready,â the nurse said. Her voice was clipped, efficient. âOR 1 just closed. Sheâs scrubbing now.â
âFinally,â Dr. Mary said. The word came from behind him, above him. âOkay. Tell her weâre ready to go in here. Patientâs been positioned and on nitrous for longer than Iâd like, honestly. Letâs get this show on the road.â
The door nurse disappeared. The OR door shut.
Dr. Maryâs face appeared above him, inverted, framed by the bright lights, her eyes the only visible feature between her green cap and white mask.
âOkay, Alex.â Her voice had changed. It was quieter now, more deliberate, the casual friendliness replaced by something practiced and cold. âYouâve done great and now itâs time for lights out.â
Alex looked up at her and felt real fear. He couldnât totally explain why, but he didnât want this. But it was too late. Dr. Mary reached for something above his head. Then her hand came back into view holding the large syringe, filled with the milky white propofol. Nicole was above his left hand and Mary handed her the syringe.
âNicole is going to give you some medicine through your IV now,â Dr. Mary leaned down. âItâs going to feel cold going in, and then youâre going to fall asleep. Nice and fast. When you wake up, everything will be done.â
âNoâŠâ Alex thought, but the words didnât make it out of his mouth.
Nicole took the syringe in her own purple hand; everything else was white; the bright white of the syringe was like the bright white lights above him and the white snow that filled his head. She uncapped it, and fitted its tip into the small port on the extension tubing of his IV line, the one that looped off the armboard and trailed up towards the hanging bag of saline and she braced her thumb on the plunger.Alex watched her through the haze. Nicole smiled behind her bright white mask; Alex could see it in her eyes.
Nicole pressed the plunger.
The bitter cold began at the back of his hand. Ice; it was the feeling of ice. The sensation traveled up the inside of his forearm; ice water running up his vein. Alex shuddered. He tried to pull his arm away, but it was ineffectual, because it was already inside him.
âYouâre doing great, Alex.â Nicoleâs voice was low, sweet, like honey. Her free hand stroked the length of his forearm above the IV site, a slow petting motion, warm through her purple glove. âAlmost there. Almost there. You have a nice sleep, okay? When you wake up your surgery will be all over. You wonât feel a thing.â
The ice water climbed past the crook of his elbow and fanned out along the inside of his upper arm, into his shoulder, running to his heart. From there, itâd be pumped to his brain.
He tried hard to think again, to remember, maybe to protest, mustering all the willpower he could. His mouth opened, loosely. A sound came out of it. The sound was a soft moan and it did not make any sense as a word at all.
Nicoleâs face floated above him, smiling gently behind her mask, her eyes showing a sort of professional kindness. Above him, Dr. Mary loomed, backlit by the surgical lights. The propofol syringe was empty.
A third face moved into his vision above him.
It appeared on his right, a woman, scrubbed and gowned in blue, with long white gloves pulled up over the cuffs. Her surgical mask and cap hid everything except her eyes, which were dark and sharp. She held her white-gloved hands high, to keep them sterile. Just from her eyes, Alex knew this was the surgeon.
She looked down at him, then her gaze moved over his body without particular interest, checking to make sure all was ready for her blade. âThe GI case ran long,â the surgeon said, her voice clipped and flat, directed somewhere above Alexâs head. âBleeding wouldnât stop. But this oneâs straightforward, and the perineal approach will be quick.â
Her eyes flicked down to his face once more. The surgeon had, of course, previously met the patient that was supposed to be here. Sheâd discussed that patientâs reason theyâd needed the surgery, all the possible complications, all the ways it would effect their life afterwards. Now there was a patient in front of her, prepped and positioned and being sent to sleep. There was no reason for her to even consider one patient was not the other. Even if sheâd wondered, with the computers down, his wristband matched the file and thatâs all that mattered.
She moved away. She stepped toward the foot of the table, toward the space between his legs where the surgical lights were focused, that the drapes exposed, where the tube was already inside him. Where her work would start just in a few seconds.
Alex, his arms strapped to their boards and his legs in their stirrups and the milky white of the propofol already in his brain, felt a moment of profound dizziness. The surgical lights above him blurred into one bright smear, and the faces softened, and the softness expanded until there was white everywhere. The white of snow.
There was snow everywhere.
Then there was nothing at all.
