Chapter 1
The Sterile Field
Maxwell
The heart is a dramatic organ.
It is a fist of muscle, a battery of electrical impulses, a fragile vessel that decides, sixty to one hundred times a minute, whether a human being continues to exist or becomes a memory.
I prefer it when the heart is silent.
"Clamp."
The word is barely a breath, but in the hyper-pressurized silence of Operating Room 3, it sounds like a gavel strike. A scrub nurse, her eyes visible only above a tightly fitted mask, slaps the hemostat into my outstretched gloved hand. She doesn't speak. In my OR, nobody speaks unless the patient is dying, and my patients do not die.
I adjust my grip. I look down into the open chest cavity of the fifty-five-year-old senator lying on the table. The bypass is complete. The sutures are microscopic works of art, the kind ofstitching that should be hung in a gallery, not buried under layers of fascia and skin.
"Releasing cross-clamp," I announce.
This is the moment. The terrifying, suspended second where the heart, cold and still for the last two hours, has to remember its purpose.
I wait. I don't pray—God has nothing to do with the precision of a vascular anastomosis—but I do hum. It’s a subconscious tick, a low, vibrating thrum in the back of my throat. Bach.Cello Suite No. 1 in G Major.The prelude.
Thump.
A single, sluggish contraction.
"Sinus rhythm returning," Dr. Sato drones from the head of the table. He sounds bored, which is the highest compliment an anesthesiologist can pay a surgeon.
Thump-thump.
The monitor picks up the beat, transforming the silence into a rhythmic, reassuringwhoosh-hiss. The blood begins to flow, pink and oxygenated, surging through the new vessels I have constructed. It is perfect. It is mechanical poetry.
"Flow is excellent," I say, keeping my voice flat. "Closing."
I don't smile. A York doesn't smile for doing the job he was bred to do. I step back from the table, peeling off my bloody outer gloves with a snap, leaving the closing to my senior resident.
"Dr. York?" Indira asks, her voice trembling slightly. "Do you want to check the drain placement?"
"If you can't place a drain by your fifth year, Dr. Singh, you should consider a career in dermatology," I say. I don't look at her. I walk to the scrub sink, the adrenaline of the surgery already receding, replaced by the familiar, cold hollowness that lives in my chest.
I scrub out, the ritualistic washing of hands that strips awaythe blood and the responsibility. I check my reflection in the steel mirror. Not a hair out of place. My black hair is slicked back, immobile. My pale blue eyes are clear behind my rimless glasses. I look exactly like my father. I look exactly like the statue of my grandfather in the lobby.
I look like a machine.
I dry my hands and check my watch.11:45 AM.I have a department meeting at noon, followed by rounds, followed by a donor dinner my mother is forcing me to attend.
I push through the double doors of the surgical wing, expecting the hushed, carpeted serenity of the Cardiothoracic Department.
Instead, I walk into a construction site.
A plastic tarp hangs from the ceiling, flapping in the draft of the ventilation system. The smell of drywall dust overpowers the scent of antiseptic. The waiting area—usually a sanctuary of beige leather and muted abstract art—is gone. In its place is a gaping hole in the wall and two men in hard hats eating sandwiches on a stack of drywall.
I stop dead. A piece of tinsel, cheap and silver, has been taped to the plastic tarp.Merry Christmas, it mocks.
"Dr. York!"
I turn to see my administrative assistant, a woman who usually possesses the calm demeanour of a bomb disposal expert, looking frantic. She is holding a cardboard box.
