Rupture Read online

  A six-foot-long steel tub, positioned at waist level by four metal legs with wheels, hugged the opposite wall. A blue felt blanket covered the bin like a flag over a casket.Only in Pathology would they park the customers so close to the front door.

  Mixed with the odor of formalin was a pleasing aroma, rich and alive. Behind the reception desk, on top of a file cabinet, a half-full carafe of coffee rested on a hot plate. Eli tested it with his knuckles and found it still hot.

  He filled a Styrofoam cup and looked in the drawer for cream, but decided he was pushing his luck. His stomach felt irritated from the late-night beer and no breakfast. It growled as he sipped the coffee. A clock radio, the old kind with rotary numbers, buzzed, then flipped to 7:13.

  The only sound in the room was a remote hum, like the drill of a dentist, underwater. He walked to the metal tub.Surely it’s empty, just parked here, waiting for the next mortal pickup. Eli peeled back the corner of the felt blanket.

  Not empty.

  “Anybody you know?”

  Eli flipped the cover back and patted it smooth, as though making a bed. Mrs. Conch, he presumed, occupied the doorway, five foot tall, just as wide, squinting at him through dark-rimmed glasses.

  “I was just —”

  “Who you here to see?” The woman crossed the floor and squared up behind her desk, a mother elephant claiming territory.

  Eli hesitated, assessing the situation. “Autopsy. Gaston’s the name.”

  “Done started.” Mrs. Conch pointed down a narrow hallway. “Probably got him peeled back like an oyster by now.” She flicked her wrist as if cracking a shell. “You the surgeon?”

  “Not exactly. I was asked to —”

  “Good. Got some paperwork for you to sign.” She produced a legal-sized document three pages thick, carbon paper between each sheet.

  Since Eli had pronounced the time of death, he was left the duty of signing the death certificate, which required the immediate cause of death and the correct diagnoses leading up to the event. But Eli had not had contact with Gaston since leaving medical school for surgical residency, and he had no idea of Gaston’s health during those eight years.

  “Isn’t it the law that the death certificate has to be signed before the autopsy starts?” Eli was trying to delay what he knew was inevitable.

  “Well, technically yes, but . . .” Ms. Conch hesitated and looked back toward the autopsy room. “This new doctor, Daily, she don’t exactly follow the rules, best I can tell.”

  Guess not, Eli thought. Who starts an autopsy before 7 A.M.?

  Eli gave it one more try. “His actual surgeon is James Korinsky. He’s the one who —”

  “Look doctorrrr . . .” She squinted to see the name embroidered on his coat, “Branch.” She emphasized the “ch” as if it ended a hard sneeze. “We don’t want no legal trouble now, do we? Just put something down here and sign it.” She scooted the form across her desk and drew out a long “Pleeeease.”

  Eli removed a pen from his coat pocket and leaned over the form. Ms. Conch’s stubby hand held firm to the corner of the page. He surmised by the presence of an endograft that Gaston had suffered an aortic aneurysm, although there was so much blood that the aortic wall could not be visualized. Landers had been correct; the leak seemed to be at both the upper and lower edges of the aortic graft. Eli pressed hard against the page with his pen:

  Events Leading to Death–Abdominal Aortic Aneurysm

  Immediate Cause of Death–Aortic Device Failure

  “There you go,” Eli said, and released the pages.

  “Thank you, Dr. Eli Branch.” Ms. Conch swiveled in her chair toward a file cabinet. “How’s my coffee?”

  She was all smiles now.

  Eli looked down at the black syrupy brew. With Ms. Conch’s raw oyster visual still in mind, Eli raised the cup as if toasting. “Best I’ve had in a while.” He used the cup to gesture in the direction of the autopsy room.

  “Sure, go on back.”

  Eli hung his change of clothes on the handle of a filing cabinet. He paused by the body bin, out of respect and a bit of curiosity.

  “Don’t worry,” Ms. Conch said, smiling like a witch. “He’ll keep me company.”

  The drilling sound became louder as he parted a set of swinging doors, and a cold front hit him as if he’d entered a meat packing plant. Eli passed four deep metal chambers, with a handle on the front of each. Lined up on shelves were sealed opaque plastic buckets holding tissue specimens floating in juice, like a chunky fish stew.

  An observation window to his left revealed the procedure in progress. Gaston lay naked on a metal bench, rectangular and dipping toward the corners, an eerie pool table collecting fluid in the pockets. The corpse’s legs were bluish white, with the knots of his knees falling back disjointed against steel. Between Eli and the old man’s face stood the pathologist, back toward him, leaning near the head. A line of sprayed bone spat against the table. The buzz of the Stryker saw stopped and a gloved hand lifted the skull like a halved coconut suspended by long gray hair. Placed on the table, sideways, it rolled forward like a bowl.

  Eli stepped closer to see Gaston’s head supported by a wooden block under his shoulders, neck extended as though hanging off a table. The glistening inner surface of his scalp was peeled down and sagged on his face in redundant pockets, a ghoulish Halloween mask.

  As if aware of his presence, the pathologist turned to face Eli in a graceful pirouette. Not the awkward butcher he had expected. Her face was protected by clear plastic, like a welder’s shield. A paper mask had been pulled tight across her nose. In this room of cold, mottled flesh, the only promise of life was condensed and magnified in her brown eyes.

  She held a knife of sorts, long and blunted at the end, and with two quick flicks she motioned for him to enter. She turned again toward her patient and Eli kept his eyes on the twist of a gathered white smock, tied in the small of her back just above a perfect pair of tight blue scrubs.

  “Gown and mask, please. On the corner table.”

  Eli removed his white coat and slipped his arms through a yellow protective gown. She watched him for a brief but intense moment.

  As a surgeon, he was comfortable with warm bodies lying on the table. But here, Eli felt strangely out of place, even though as a boy he was familiar with the dead lying cold. He tied his mask and approached the corpse sprawled between them.

  With the top half of the skull removed, Gaston’s brain lay exposed revealing fissures and deep ridges like a shelled pecan. The pathologist pressed the brain posteriorly to expose the cranial nerves at the skull base. With a pair of Metzenbaum scissors, she clipped the slender white cords. They popped, like tight ribbons on a Christmas present, as the distal nerve ends retracted into the neck. Swiftly, she divided both vertebral arteries and delivered Gaston’s brain, seventy years of wisdom and pain plopped into a metal pan.

  “I saved the abdomen,” she told Eli. “Figured you’d been there.”

  Eli glanced at Gaston’s ashen face. A contorted left cheek pulled his upper lip in a snarl.

  “Thanks.”

  “Dr. Branch, I presume.”

  “Yes. Eli. Please.”

  “Most surgeons just read the report.” She looked up for his reaction. “We don’t get many visitors down here.”

  “In the dungeon?” He hoped for familiarity, then wondered if she considered it an insult.

  Above her mask, barely perceptible, the brown eyes narrowed in a playful squint. “Yeah, the dungeon.”

  Behind his mask, Eli smiled, as though he had broken through the code. Then he looked down at Gaston and Eli’s transient delight evaporated. Gaston’s torso had been opened with a V -shaped incision that started at the shoulders and came to a point at the bottom of his breastbone. The ribs were cut on both sides, the marrow-filled ends sticking out like a rack of barbecue. The chest plate had been removed to expose the lungs, two large sponges framing a lifeless heart.

  “And you are—?�
�� he asked.

  She extended her gloved hand across Gaston’s chest and Eli accepted it with an impersonal, latex-on-latex shake.

  “Meg Daily.” She quickly retracted her hand and cupped it around Gaston’s heart as though holding the head of an infant. With a pair of scissors, she zipped open the pericardial sac.

  The silence grew louder as he pretended to look around the room.

  “You don’t have much help here, do you?”

  Dr. Daily continued her examination, now dissecting the descending coronary artery off its groove in the cardiac tissue.

  “The muscle is intact,” she said calling out her findings as she went, “but bruised.”

  Eli thought of his cardiac massage and the damage it must have done in a futile attempt to force blood to Gaston’s brain.

  “There’s a tiny puncture mark in the left ventricle. Did he have an intracardiac injection?”

  Eli studied the muscle closely.Oh, she’s good, Eli thought as he tried to find the tiny hole created by his needle when drawing blood.She’s very good.

  Meg moved to the lungs and began to open the left pulmonary artery, totally absorbed in her work. Two long minutes of silence passed.

  “Ms. Conch, she seems nice,” he said, hoping this would engage her again, maybe get a laugh.

  Dr. Daily looked up at him. “It’s quiet and lonely down here, just like I like it. Can get my work done. Usually.”

  With this, Eli focused his attention on Gaston. He imagined the man at his work, hovering over the medical students, calling attention to every detail. And now he was a cadaver, a delegate to medical science. Just like those bodies he had attended in Anatomy Hall for all those years.

  Eli looked at the hasty closure of the old man’s abdomen, whip-stitched together with thick sutures that cut through edematous tissue. He removed a pair of trauma sheers from the instrument tray and cut the first stitch just beneath the breastbone. Then the second. The third snip was followed by a ripping sound, and tissue burst open like an over-ripe melon.

  Meg Daily stood with her arms crossed, watching him.

  He cut the remaining sutures, extracting the ends with a pair of heavy forceps. With the incision fully opened, Eli slid a finger inside to separate a film of congealed blood that covered loops of cold intestine.

  “Here,” Daily said, presenting a self-retaining retractor to Branch.

  Eli inserted the finger-like metal hooks along each side of the abdominal wall. He spread the instrument with a ratcheting force that transformed the linear incision into the shape of a diamond, a move that allowed the abdominal organs to be viewed at once.

  “Thanks.”

  “You’re welcome.”

  He felt a current pass through him, light and rapid, like the fluttering of moths. He tried to ignore it but looked at her again. Something about her eyes, a sadness that beckoned and suggested to him sorrow in her life, just as there was in his. He had come to the autopsy in search of closure in the life of this man, Gaston. Not only to learn the cause of his death but to bury the memory of his impropriety with the dead. Now, over Gaston’s body, Eli tried to resist a slight, untimely attraction he felt for Meg Daily, despite her removing, at that moment, clots of old blood from the abdominal cavity.

  “Ruptured aortic aneurysm?” she ventured.

  “I wish it was that simple.” Eli was beginning to mobilize the sheath of small intestine, a move that would expose the exact cause of death.

  They moved in tandem, a preordained rhythm of hands searching violent lands, perfect pressure on tissue, giving, taking, vying for command, then submission, an electric brush of knowing, experienced fingers retracting from illicit contact, but wanting more as they pushed deeper toward a synchronous destination.

  There it was. A perfectly cylindrical tube interposed in the aorta, expandable mesh cage intact and structurally competent.

  “The endograft looks fine,” Daily said, her fingers spread and stretched over mounds of clot to hold the exposure. “Don’t you think?”

  “Appears to be.”

  Above and below the graft, where the native glistening white aorta should have been, Eli saw only shards of tissue, like the aftermath of a grenade. “But,” he added, “the aorta’s blown to hell.”

  “Hold this,” she said as she released her hold on a shelf of clot and Eli slid his hand over hers.

  Tiny electric shocks.

  “It’s moth-eaten,” she said.

  Eli looked at her but saw her focused elsewhere. “Come again?”

  “Little holes, everywhere.” With DeBakey forceps, Daily lifted from the wound a torn portion of vessel wall, like a flat noodle, and held it at a mutual focal point between them. “See?”

  “Okay,” Eli said, studying the tissue. “Moth-eaten.”

  Unaware of time, until now, Eli found a clock on the wall.

  “Damn it,” he said, “sorry.”

  “What? Damn it, sorry.”

  The clock read 9:06. Eli removed his hands from Gaston’s belly as if it were on fire and ripped off his gloves. “I’m late.”

  Dr. Daily looked up and Eli sensed a hint of disappointment at his leaving.

  “Operating room?”

  “No, worse,” Eli said and held his arms above his head to mimic an imposing figure. “Chairman of the Department of Surgery.”

  CHAPTER SIX

  MID-SOUTH MEDICAL CENTER

  SOUTH CAMPUS

  FRANKLIN ADMINISTRATION BUILDING

  Eli pushed the button to the seventh floor three times, rapid fire. He would have taken the stairs but he was already winded after a brisk four-block run from the Pathology building to the administrative offices of Medical Center South. He needed a moment to collect himself. Eli buttoned his white coat to conceal his scrubs, but this seemed only to highlight a fan of black hairs on his chest. He pictured his starched shirt and tie hanging next to Ms. Conch’s desk and glanced at his watch for the tenth time. 9:14.

  Scrubs and fifteen minutes late were definitely better than a tie and twenty-five.

  The elevator opened to a reception desk and a face that Eli remembered from his recruitment interviews. The young woman wrinkled her forehead in a sympathetic gesture. She looked at Eli like she was watching a car about to crash. “You better go straight back,” she said. “He’s kind of waiting.”

  Of all the times Eli had waited patiently to meet with senior staff, this had to be the day when all appointments were running smoothly and on time. The secretary closed the door behind him.

  “Dr. Fisher, I’m sorry.”

  “Have a seat.”

  Eli knew this wasn’t a request; it was an order. Karl Fisher was a large man with shoulders that started somewhere on his back and rounded over like the hood of a Volkswagen Beetle. No neck. And from the looks of his reddened face, he’d been idling on simmer. Eli settled immediately into the straight-backed chair.

  Centered on the wall, above a thick mahogany desk, hung the chairman’s prize kill—the head of a rhinoceros. Eli let his eyes fall along the curve of its slick head, downward, until Fisher occupied his view. The resemblance was striking.

  “Been operating this morning, have you?” Fisher asked, eyeing Eli’s scrubs.

  Their last interaction had been at a recruitment dinner earlier in the spring. Fisher had smoked a Partagas cigar, drunk straight Kentucky rye whisky, and laughed like jolly Saint Nick. It was a joyous, carefree night.

  Deceptive as hell.

  Fisher hunched over Eli’s personnel folder. Eli knew immediately this was a bad sign. He wished he had a fifth of Kentucky’s best to serve Fisher, to lubricate the next few minutes.

  Fisher flipped a page and began to recount Eli’s academic pedigree.

  “Summa cum laude from the University of Mississippi.” He cleared his throat, pretentiously. “Ole Miss.”

  He continued.

  “Accepted to a prestigious comparative anatomy fellowship at University College London.” He glanced up at E
li as if to confirm this account. Beefy eyes peered over a set of diminutive glasses, perfectly balanced on his horn.

  Eli nodded in affirmation but remained silent. The chairman of surgery went on. “Ranked number three out of a hundred nineteen students in an exceptional medical school class. Chief administrative resident, Vanderbilt University.”

  Fisher’s voice was gaining speed like the charge of a rhino.

  “Sixteen peer reviewed publications on Matrix Metallo—blah, blah, blah, and a teaching award from the sweet little medical students in Nashville.”

  He ripped off the glasses and flung the chart across his desk. “What the hell is going on?”

  Eli had been lulled into the singsong verse of all his accomplishments. He tried to rebound from Fisher’s sudden change.

  “Sir?”

  Fisher released a lung full of air. “James Korinsky called me at six this morning.”

  Eli said nothing. He had no idea what this was about, but the tone of his superior suggested it wasn’t in his favor.

  “Look, Eli.” The big man folded his hands over his abdomen like he had just finished a large meal. “I like you. We rolled out the red carpet for you. I can’t remember recruiting someone harder.” Fisher picked up a pen and sawed it across his thumb, like he was cutting a steak. “I mean, dinner at Folk’s Folly, a Lakers’ game at the Forum.”

  He stopped and tilted to one side as if passing inaudible gas.

  “This is not a good start. All you really need to do is show up when called, do your operations, and publish some papers out of your lab. Can you do that?”

  “Yes, sir.” Eli still didn’t know where he was going with this. “I don’t understand.”

  Fisher rolled forward. “Korinsky said he called you to assist. You didn’t answer your beeper for almost an hour and then complained like a wimp that you weren’t on call. When you finally came in, you insulted the nurses and the brand-new intern.”