Three Weeks in Spring

Chapter 16

Wednesday, April 23

They woke her very early for surgery. She was calm. Resigned. Not a lamb to slaughter. Simply one ready for what was to come. She was not frightened. Valium, do your stuff, she thought. But her calmness was more than just resignation. It was a kind of eagerness too. As she had wanted to come to the hospital Sunday, so now she wanted to get on with the surgery. I have to come out of the other end of the tunnel. I have to get on with my life after this day and this surgery. She wanted to begin that life. She wanted to get to a point of certainty. To know if she’d live.

She got up and did her face. Lipstick, blusher, eye makeup, mascara, eye liner. Her nails were done. She brushed her hair. She was very careful with her hair. Dr. Eliopoulos was quite a nice-looking man.

Norah came in and gave her a shot. “Just some medication to make you drowsy. Won’t put you to sleep. Just make it easier for us to get you asleep in the OR.”

Things did get a little drowsy then. Two nurses, Norah and Eunie, came in and shaved her chest.

“I don’t want to spoil this,” Joan said. “But I don’t have any hair on my chest.”

“We do it routinely,” Norah said. “It’s silly, but we always do it.”

They put long white surgical stockings on her. Like my mother used to wear, she thought. But they only came to your knees. Nice. Just like knee socks. Maybe I can keep these and wear them later. No, maybe not. Probably don’t look good playing tennis in surgical stockings.

One of the nurses said something about nail polish.

“What?”

“You’ll have to remove your nail polish,” the nurse said. Joan wasn’t quite clear which nurse it was.

“Why,” Joan said. “Why is that?”

“Oh, just take it off.” The nurse handed her some polish remover.

“But I like it on there. I think it looks kind of neat.”

“Well, the thing is they want to be able to tell if your nails turn blue. They have to be able to see that.”

“Christ, I wish I hadn’t asked,” Joan said.

“And the makeup,” someone said. A tissue appeared. “Okay, wipe it off.”

Joan removed the makeup. The nurse washed her face.

Then she was moving. The bed was wheeled into the corridor. Benny was there, “You’re going to be okay, okay.” And into the elevator and down. Very down and then out into what seemed like a basement. Cinder-block walls painted bright green. A long corridor, other beds along the wall now and then. Nurses in green uniforms with skullcaps, and a strong sense of being deep underground. Windowless and silent. A different world right here on Lynnfield Street, next to the Shop Kwik Market that was always open. Even Christmas Day. And quite busy down there. The bed was parked next to the wall and Grace was there, a neighbor, but only a casual acquaintance. “Hi, Grace,” and Grace startled. It’s my hat. I’ve got on one of the goddamned hats, and poor Grace doesn’t know who the hell I am. Do I have on a hat? “Grace, it is I, Joan Hall Parker.”

And Grace, an operating-room assistant who cleans up, standing with her broom and saying, “Joan, what are you doing here?”

Good one, Grace. “I’m having some surgery, Grace. How’ve you been?”

Talk like they would have if they met over the potato bin at Star Market. “Good Joan, I’ve been good.”

Then Helen Walsh was there, looking different with her hat and her stethoscope. She stayed. Joan was interested now. Asking questions. What was the IV for?

“In case we need to plug blood in right off, we can. We can keep a steady solution dripping in there. We can have access to your bloodstream instantly that way. Very handy.”

“It is very bizarre,” Joan said, “being down here. Very odd to think of the traffic going by right outside and people going to work and the children walking past to school, and down below here, with the white lights and the green walls.”

“Oh, now, it’s not that bad,” Helen said.

“No, I don’t mean it’s bad. It’s just so basementy otherworldly.”

“I suppose it is,” Helen Walsh said. “I get used to it. To me it’s very routine. When we go into the OR I’ll give you medication through the IV. You’ll go to sleep almost instantly. You’ll wake up in the recovery room and it will seem to you, you just went to sleep. I’ll be there with you through the operation and I’ll be with you when you wake up. I’ll be right there with you and whatever needs to be done I’ll see to it.”

“I’m all right,” Joan said. “I’m ready for whatever. It’s okay.” They passed the time. They talked about Joan’s teaching, about the Le Boyer birth-without-violence method. In the operating room there were big medical lights. What makes them look medical The indirectness? But they do. The room seemed vaguely not square to her. Eliopoulos was there in his surgery suit. Several nurses. Helen Walsh near her head.

“Start counting backward from one hundred,” Helen said.

“One hundred,” Joan said.

“Good night,” Helen said.

“Ninety-eight, ninety-seven...”

Joan was strapped to the table. They draped her with sheets, leaving open only the area on the left side of her chest. One sheet was draped vertically from a bar above her chest and acted as a sterile partition. At her head, behind the partition, Helen Walsh watched Joan closely. When the sheets were in place she administered 2 cc of Pentothal intravenously. It was a test dose. The room was quiet. Eliopoulos and the scrub nurse stood back a little, away from the table, in green caps and gowns, masked and sterile.

Joan’s response to the test dose of Pentothal was right, and Helen Walsh gave her 400 milligrams. Joan lay motionless on the table. Helen brushed her eyelashes to see if there was reflex. There was none. With the circulating nurse standing by, Helen gave her pure oxygen through a face mask, watching the attached bag billow and shrink, and monitored her blood pressure, EKG, and other vital signs. The tiny blip on the display screen showed Joan’s heartbeat steady. The room was quiet and the small beep of the monitor was loud, against the rush of the exhaust fan. Helen remembered surgery in ORs without the fans, when everyone was getting giddy from the anesthesia by the end of the surgery.

“She’s fine,” Helen murmured to the circulating nurse. She added halothane to the oxygen. The heart remained steady, the bag inflated and decreased with Joan’s regular breath. If it became shallow Helen would assist by squeezing the bag. The circulating nurse washed the area of surgery with PhisoHex. Joan’s left arm was stretched out and placed on a padded board. Her right arm the same with the IV tube in place and the blood-pressure cuff attached. Helen nodded at Eliopoulos.

Sterilized instruments on a sterilized surgical table stood ready. Before Joan had been wheeled in, the scrub nurse had laid them out, following the procedures card indexed for breast biopsy. Now John Eliopoulos took a surgical knife and made a two-inch incision in the skin of Joan’s left breast above the lump, following the grain of the skin. After he made the cut he put the knife aside. The skin was assumed to be nonsterile and therefore the skin knife was no longer sterile. He used a pair of clamps to hold the lump and, guided by the feel through the new knife, he carefully cut out the lump. It appeared no different from the surrounding tissue. Joan’s vital signs remained normal. Every five minutes Helen Walsh charted blood pressure, pulse, EKG. She was careful to remain behind the sterile barrier.

Eliopoulos took the small piece of tissue on a piece of gauze to the door of the room. He dropped it into the pathologist’s tray. The pathologist took it to the lab for a frozen section. In the OR animation was largely suspended. Eliopoulos took two temporary stitches in the incision on Joan’s breast to close it. He was the only man in the room.

It is always, Helen Walsh thought, a kind of sisterly experience on a breast biopsy. There was a real sense of rooting for the patient.

The circulating nurse said, “What do you think?”

Eliopoulos shook his head. “We’ll wait for the pathologist.”

As the biopsy stretched out, the tension built. Five minutes is sufficient for a frozen section. It was already seven. The longer the wait the more probable the cancer.

In nine minutes the pathologist was back. He spoke to Eliopoulos at the door. Eliopoulos turned to Helen and the nurses and shook his head. “Positive,” he said. “We’ll take the breast.”

One of the nurses said, “Shit.”

They began all over. A new set of instruments was laid out by the scrub nurse. A second surgeon, standing by to assist, was paged. Another scrub nurse came in. They removed all of the wrappings from Joan’s inert form and put new ones in their place.

Helen Walsh gave Joan a shot of Anectine through the IV tube. It paralyzed her for about three minutes. She then put a tube down Joan’s throat. At the end of the tube was a kind of balloon which could be inflated, so Helen could control Joan’s breathing. Helen was now completely responsible for Joan’s life maintenance. Eliopoulos looked at Helen. Helen nodded. Eliopoulos made a neat careful incision with the skin knife on either side of the breast, cutting toward the center. Then with a new knife he began slowly to cut away a little at a time the subcutaneous tissue. One of the scrub nurses held the skin back with retractors. Anything suspicious was sent to pathology for a frozen section. As he cut he tried to avoid as much as possible the muscle tissue. Periodically the other nurse cleaned out the surgical area as blood collected. She used a clear plastic tube with a stainless steel tip like a pencil which vacuumed any area at which it was pointed. As they went on, the assisting surgeon cauterized small blood vessels and sutured the larger ones. As he cut, Eliopoulos was careful to take some lymph nodes for pathology.

There was no talk now, merely the sounds of the work and the humming of the life-support and gas systems behind Helen and of the exhaust fans above. The moving blip of Joan’s heartbeat displayed on a scope was a steady punctuation.

The breast came out finally, in one piece, and went to pathology. The skin was folded carefully back in place and Eliopoulos began to stitch. As he did so the second surgeon inserted the drain. Eliopoulos stitched carefully in small tight stitches, his large hands steady and clever as he moved. When he finished, a large pressure bandage went over the incision, the drapings began to come off, and Helen began to wake Joan up.

First she turned down the halothane dosage, then turned off the nitrous oxide. In about five minutes Joan began to stir. Helen removed the tube from her throat and administered pure oxygen. One of the nurses removed the EKG monitor. Another removed the blood-pressure cuff. Helen wheeled her out of the OR and into the recovery room, staying always near her head, ready to turn her if she vomited. In the recovery room Joan’s records were handed to the recovery room nurse.

“Her name’s Joan,” Helen said. “She’s had a modified radical mastectomy of the left breast. She expected it, I think, and was pretty well acclimated. I don’t think it will be a big shock when she comes to.”

For Joan the recovery room was fragmented and barely real. Helen Walsh was there. A nurse was there as well. Maybe Eliopoulos. Was he there? She didn’t know. Then Judy Marsh, and she realized she was in her room. She could not remember asking and being told, but she knew with her first coherent consciousness that her breast was gone. Hello, Jude. “Hello, Jude.” She felt the bandages on her left side. No great mounds of swaddled wrappings, just some gauze and some adhesive. The bandage extended over the breast area and around under her arm. It was not a very impressive bandage. She remembered Dan and his appendectomy and how insignificant a bandage he had come up from surgery with. She drifted in and out of sleep.

“Jude,” she said. “You know what?”

“What, Joan?”

She slept. She woke.

“Jude, is that you, Jude? You know what?”

“What, Joan?”

She went back to sleep. During one moment of awakeness she heard Judy say, “I’m going down and get your chart and see what the medication schedule is. I’ll be right back.”

“Okay, Jude. Take your time. I’m fine.” As she drifted off again she was like a drunk trying to be sober, trying to speak lucidly and intelligently and no one should know that she was zonked. The phone rang. Isn’t it good I got a phone, she thought. I can call anyone, and they can call me. But they aren’t supposed to call in now. I don’t think. I think the switchboard is supposed to intercept after surgery. Hello. “Hello?”

“Joan? This is Judy.”

“Bullshit, Judy just went down the hall. Who is this?”

“Judy Martin, Joan.”

“Well who the fuck is it, Judy Marsh or Judy Martin?”

“Joan, its Judy Martin. From Endicott. How was your surgery? Did they have to take the breast?”

“Yep. The bastards took it.”

“Oh, Joan, I’m sorry...” Joan let the phone drop and went to sleep. Judy Marsh came back to find it dangling at the end of its cord, humming its high-pitched warning. She hung it up. Joan never remembered the conversation. When she learned that Judy Martin had called in and that she, Joan, had used foul language, she was appalled. Judy Martin would never tell her what she’d said, but Joan knew no one less ready to admire the richness of her foul mouth than Judy Martin.

Judy Marsh sat and watched her sleep, on her back. The IV was still attached to her left hand, the needle in the vein.

Joan woke up. “And she drinks like a fish, Jude. A goddamned fish.”

“Who?”

Joan slept again.

A half hour after she was up from surgery Ace came in. He came through the half-open door, walking quietly. Unsure of what he would see. Joan was asleep, Judy was there, small and blond in her white uniform.

“How is she?” he said, softly.

“In and out. She’s asleep for a while and then awake, and asleep. There’s no pain.”

“She know she lost the breast?”

“Oh, yes. She’s been awake. She knows.”

He stood silently at the foot of the bed, looking at her. Above him high on the wall the television was on, but the sound was down.

“I’ll stay a while with her, in case she wakes up,” he said. “If you want to take a break or anything.”

“Okay. She’s not going to be awake very long and very coherently today. She’s very foolish. Ten minutes ago she woke up and said, ‘She drinks like a goddamned fish’ and went back to sleep.”

“When David was born,” he said, looking at Joan as he talked, “she was scared and had a lot of anesthesia and I came to see her right after the doctor called. I went in, twenty-six years old, the new father, and she was lying there on her back like that with her eyes closed. And I said, ‘How are you feeling?’ and she opened her eyes and looked at me and said ‘Lousy’ and rolled over and went to sleep. And I stood around with my thumb in my ear for about twenty minutes and went out and got myself some fried shrimp at Dill’s. And many beers.”

“I’ll leave you for a few minutes,” Judy said.

And she left him alone in the room. He felt her loss. He felt nervous without her. Christ, he thought, she’s so small you could mail her first class for thirteen cents, and I’m scared when she leaves me alone. He looked at his wife. She looks just the same as she always does when she sleeps. She had on lipstick. He wondered if she’d left it on during the surgery or put it on afterward. Probably the first thing she did when she woke up. With the hospital johnny on she looked no different. He couldn’t see any meaningful bandages. She looked as she had yesterday. She woke up briefly and they spoke. She went back to sleep and still he stood looking at her. He felt the strong craving in his chest and arms. He wanted to lie on the bed with her and put his arms around her. But he knew he should not. Yet.

In a while, Judy came back in and he went home.