Most of them took place at night—the battles we sometimes lost but always survived. It’s not that we wanted to be up all night or that we could breathe easier once the sun came up and the outcome seemed inevitable; we simply had no control over when the phone rang. We went without sleep, oblivious to everything, living in a world where we knew it was morning when the hospital cafeteria was serving eggs. Time reset again and again whenever a phone rang in the night.
That’s what brought Ellen Hutchinson and me together on a winter’s night in 1983. The phone rang at different times in different places but for the same reason. It pulled us from our beds and sent us into the night, both afraid and expectant.
I’d been training in Pittsburgh for nearly two years by then. My car had caught fire that summer, and the divorce had taken whatever cash I might have had, but if I was careful, I could make it on my bike from the apartment on Marchand Street to the hospital in less than 20 minutes even in winter. At work, I stored my bike in the morgue because I knew a girl who worked there and it was safe.
The night I went to meet Ellen Hutchinson was a Sunday. I remember the day because of the smell in the air as I turned off O’Hara and pedaled up Desoto. It was a pungent mix of the odors from an electrical short circuit and the coal-smoke from my grandmother’s stove. It was inescapable, even in the filtered air of the operating rooms. I most associated that smell with Pittsburgh winters, when a featureless gray blanket blotted the sky and grew impenetrable through the night. It became more evocative of where I was than the sounds of sirens coming up Fifth Avenue or the image of ambulances parked outside the ER.
I asked about it my first week in town. We were just getting started on a transplant surgery that would take us nearly two days to complete. Chester was the scrub tech that Sunday night. I found him in the operating room, laying out the instruments on a large table.
“What’s that smell, Chester?”
He stopped stacking instrument trays and looked at me with his head cocked. “Smell?” he asked.
“Yeah. It’s in the air at night on weekends,“ I said. “Take a deep breath. You can even smell it in here.”
“Oh, that.” He opened a packet of sterile gloves and laid them on the table. “That’s the coke furnaces, Doc,” he said. “You’re in the steel city now.”
Someone said they cleaned the furnaces on Sunday.
“But not till night,” Chester claimed. “Not till after the Steelers game when everyone’s too drunk to care.”
Now, on another Sunday night, I rode down glassy black streets through coke furnace smog and parked my bike in the morgue. I was supposed to give Mrs. Ellen Hutchinson a new liver. That’s what I told her husband. He signed the piece of paper that said he understood all the other things that could happen, but I think we both figured it was just a formality.
“Legal stuff,” he probably told his neighbors back in Aliquippa when they asked him about it later, after he’d buried Ellen and given away her shoes and hats.
I’d seen people die during surgery over the years, but I was never in charge then. Someone else was—someone older and more experienced, someone whose position or title or credentials (if not always his presence) gave me asylum and an alibi.
Eventually, I worked them out, the deaths in the operating room. Most of the time, I looked for something about the patient: maybe if he’d taken better care of himself, stopped smoking or drinking so much; or if she’d come in earlier, before things got bad; or if he wasn’t so old. Sometimes I told myself I was the only one who could have saved the patient, and if I couldn’t do it, well, then. … That one was harder to pull off; it fell apart the moment I considered the possibility that someone else, someone smarter or more experienced or just better than I, maybe even someone I knew, would have done what I should have done. Then I wouldn’t have ended up with blood on my hands and soaking through to my underwear.
I have to keep in mind that no one else was available when Ellen Hutchinson’s time came. The real surgeons were out of town at a meeting, off to Venice or Kyoto or Boca Raton or wherever they all went that time. I was still just a fellow in training. I had to get special permission, emergency operating privileges, to do Ellen’s transplant.
The truth is I knew what I was doing. I’d operated alone more than enough to know everything would be fine, which is what I told Mr. Hutchinson when I went to see him and Ellen in the holding area before the surgery.
“How old are you?” he asked.
I told him I was 32 years old.
“Is Dr. Starzl here yet?”
Dr. Thomas E. Starzl was the acknowledged father of liver transplantation, and in less than two years after his arrival, Pittsburgh had become the center of the transplant world.
I told him Dr. Starzl was out of town. “He travels a lot,” I said.
“We came here for Dr. Starzl,” he said.
I explained that Dr. Starzl had trained me. Ellen was lying on her back, looking up at the ceiling while I probed her abdomen with my hand. Her liver was huge and hard and came down almost to her hip. Mr. Hutchinson leaned over so his wife could see his face.
“I’ve been doing most of the transplants,” I said.
Mr. Hutchinson wouldn’t look at me.
“For three, four months now.” I didn’t mention my missing mentors because I didn’t believe it mattered.
Ellen Hutchinson stared at her husband’s face without turning her head. Her eyes, yellow-stained, were sunk deep into her skull. Mr. Hutchinson brushed a tuft of frizzled gray hair off her forehead. He was missing a finger on that hand.
Afterward, I found Mr. Hutchinson in the waiting room by himself. He was reading Ladies’ Home Journal. That’s what they had in our waiting room, that and Good Housekeeping. Some volunteer—a widow, maybe—brought them from home.
He stood and waited for me to come to him. It was early morning, 5 or 5:30, I think. A janitor was wrestling with a floor polisher by the vending machines.
I don’t remember exactly what I said. I’m sure that in medical school, they tried to teach us how to tell someone a loved one has died, as if that’s the same as telling a man you’ve killed his wife.
I asked him to sit down, but he didn’t. He just waited in silence, and when I told him Ellen was dead, he dropped to the chair and sat there for a moment, then started shaking his head and twisting the magazine into a tighter and tighter roll. I started to sit in the chair bedside him, but he rose to his feet again and came toward me.
“You told me she’d be fine,” he said, poking me in the sternum with his middle finger. It was his index finger that was missing.
I wanted to tell him what I thought went wrong. We didn’t have the A-team for anesthesia, I’d say. I’d never had confidence in that guy, and when everything started going to hell, he didn’t seem to have a clue what to do, and by the time they called for help and our best anesthesia guy showed up … well, it was too late. I wanted to tell him that we pumped on her chest, off and on, for more than an hour, losing her then getting her back. I wanted to tell him that when Luigi, poor old Luigi, who’d come from Italy to learn from Dr. Starzl, stopped pumping and looked up at me from across the table with his tired gray eyes and asked if it was finished, I pushed him out of the way and did it myself and kept going and going until I finally saw that everyone was standing back, staring at me, and I knew then we weren’t getting her back.
Mr. Hutchinson paced back and forth, shaking his head, talking to himself, now and then slapping the magazine against his thigh. The floor polisher was coming closer and closer, and I couldn’t make out what he was saying above the noise of it. I took one step toward him, thinking maybe I should touch his arm or something.
“What am I supposed to do?” he yelled at me.
The janitor was having trouble with the polisher. He’d have it bumping serenely along when, all of a sudden, it would skitter across the floor and crash into a chair or the Pepsi machine.
I asked Mr. Hutchinson if I should call someone, maybe someone in his family.
“Family?” he shouted. “Family? You want to know if I have a family?”
He put his head down, and I thought he was going to start pacing again, but then there he was, right in front of me and breathing hard.
“You just killed my family, son.” He wasn’t shouting anymore. “She was all I had. Now she’s gone. Thanks to you.” He backed away and stumbled into a chair and sat down. The janitor had left the polisher in the middle of the room. He’d probably gone for help. I really wanted to finish for him. It didn’t look that hard.
Mr. Hutchinson sat staring at the magazine open in his lap. I sat facing him. I leaned forward with my elbows across my knees, maybe trying to get him to look up at me but hoping he wouldn’t.
He rolled up the magazine again and held it across his lap like a nightstick.
“We’ll need the name of a funeral home,” I said.
He looked up and said something just as the polisher started up again.
“I’m sorry,” I said. “I couldn’t hear.” I pointed over my shoulder toward the noise.
“Sheffield,” he said. He opened the magazine and smoothed it with his palm. “The one in Aliquippa, out on Franklin.”
I left him in the chair. A different man was running the polisher now. He ran it gracefully, back and forth, in great sweeping arcs, moving toward Mr. Hutchinson’s corner of the room.
Ellen Hutchinson’s cadaver lay naked and drained on the operating table. They’d taken away the blue surgical drapes and turned off the room lights, but the huge operating lights were still on her, and she looked sculpted from alabaster. I walked over and stood in the same place where I’d spent most of the night. The incision I’d made was shaped like the arms of a Mercedes hood ornament, and it was huge. I’d left the others to close it with big looping sutures. They’d been sloppy, and I regretted trusting them with someone they never knew.
Chester came in and walked to the back of the room and stood staring at the metal table on which they’d piled all the surgery instruments in a stainless steel basket.
“Fuck,” he said and shook his head. He picked up a big right-angle retractor blade with the tips of his fingers then dropped it back into the basket. “Jesus, fuck.”
Dried blood caked nearly everything in the basket, and brown streaks ran down the side of the table. Chester looked down at the blood pooled on the floor, black and shiny. He backed up suddenly, picking up his feet like someone who’d stepped in dogshit. He didn’t notice Ellen Hutchinson or me.
“Where is everyone?” I asked.
Chester jumped. “Jesus, don’t do that!” He shielded his eyes with his hand and squinted through the light. “Oh, it’s you.”
Chester found some plastic gloves and pulled them on. “Fuck if I know, Doc.” He grabbed hold of the instrument table with a hand on each side. “Probably another trauma. They sent me to fetch this shit is all I know.”
I watched him push the instruments out the back entrance, and as the door swung shut, I saw a man sitting on the floor behind it. He was asleep with his head lying on his arms across his knees. He still had on his surgical mask, and I wondered if he thought it protected him.
“Luigi?” I whispered over the cadaver and across the room. I walked over to make sure.
“Hey, Luigi.” I had to shake him. “What are you doing?”
He looked confused at first. He was an old man, and he’d been up all night with me. He was a famous professor in Milan. He had no business sleeping on the floor.
He smiled at me.
I felt very tired.
I went back to the table. They’d washed the body. They’d also removed all the tubes from her, and I worried about that. They should have left them in for the autopsy. A white plastic sheet and a roll of flat white twine lay on the floor beneath the operating table, along with a folder of papers. The Death Kit. They must have left in a hurry.
Luigi was across the table from me, still with his mask up. I reached over and pulled it down and looked at his mouth and asked him if he knew where to find a gurney. He nodded and left.
I stood beside Ellen Hutchinson’s body and thought about all there was to do: tie the hands together across her body with the twine, wrap the body in the white plastic, put it on a gurney, fill out all the forms in the Death Kit and put a name on why she died. Then cover the gurney with a white sheet and roll it down to the elevator, to the tunnels, to the morgue, and then get on my bike and ride away, because someone is going to need this room to do some regular surgery, the kind where the patient–a poor old woman from Aliquippa, the only family a man had—doesn’t die because someone doesn’t know what he’s doing.
Luigi came back and said he couldn’t find a goony.
“Gurney,” I said. “We call it a gurney.”
Luigi watched me knot the string I’d looped around the hands. He looked exhausted.
“Go home,” I said. “I can get this.”
Luigi came over and stood beside me. He was maybe 5 feet 4 inches tall, and his hair was gray, and I thought then he might actually be over 70, and I was at least a foot taller and half his age. He came closer, and I felt his hand on my shoulder. I clenched my jaw, but tears flooded my eyes, and my legs buckled. I staggered backward, away from Ellen Hutchinson. Luigi tried to hold me up, but we both fell to the floor.