Unforgivable Ties

Chapter 20

Stephanie

I t was another day at the mafia warehouse. I should study, because it was slow and I needed to study for my pathology final, but I was too busy wallowing in self pity.

When I was doing Vincenzo’s laundry, one of his shirts had been covered in sparkles and cheap floral perfume. I knew I had no claim over him, especially after denying his offer to sleep with him, but I was still devastated. I broke down sobbing on his bedroom floor for an hour before I pulled myself together.

Even though I knew I shouldn’t, I wanted it to be me who he touched, kissed, whispered sweet nothings to at night. The idea of him sleeping with a different woman made me sick. The thought brought a wave of bitter jealousy that soured like vinegar in my heart.

Would things have been different if I slept with him? Maybe he would only want to be with me. Perhaps the sparkles and cheap perfume wouldn’t be littering his clothes.

It would probably be the same. I hadn’t known him for long, but Vincenzo didn’t seem like a man who would commit to one woman. I would have been just another notch in his belt, a name on a long list of women he had slept with and discarded. Our night together would have been a mere blip in his memory, fading into obscurity like countless others before me.

And even though I knew it was logical for me to stop thinking about him, and stop wallowing in pity, my heart didn’t listen. I played with one of the pencils I had sitting on the table, trying to hold back fresh tears.

Suddenly, Cesare burst into the room.

“We have a critical patient on the way,” he said, grabbing some scrubs to put on over his normal clothes.

Oh, it really was serious. Cesare barely bothered with those garments unless it was a life-or-death situation. I quickly wiped away any remnants of tears, shuffled my textbooks aside, and moved to get ready.

I quickly threw on a set of my own, washing my hands before covering them in sanitizer. Cesare had hastily thrown an operating bed together and was now preparing the surgical tools.

Two men I hadn’t seen before burst through the doors, carrying a younger man who was unconscious and covered in blood. They placed him on the operating bed, where Cesare quickly got to work, his hands moving with a dexterity that came from years of experience.

I was always way out of my element in these situations. All I did was pass Cesare what he needed and helped with the most basic of tasks, should they arise.

The man had been shot three times in the chest, and it wasn’t looking good. Looking at him, I guessed the bullets had pierced his pulmonary arteries and possibly his coronary arteries as well, leading to massive internal bleeding.

His heart rate was just a blip on the monitor, each beat weaker than the last, and the oxygen saturation level rapidly declining. Cesare worked in a desperate frenzy, his gloved hands firm yet gentle as he tried to stabilize the man.

Things were going well. Cesare had almost stopped the bleeding and was patching the patient up, all the while I passed him things he needed.

Then he flatlined.

“Intubate him,” Cesare said, not looking up from his work.

Grabbing the laryngoscope, I opened the man’s mouth and guided the endotracheal tube down his throat. My hands were shaking, because I hadn’t done this without Cesare’s help before, but I was in a medical school for a reason. I wanted to save as many lives as possible. Even if those lives belonged to mafiosos who made questionable decisions.

The line stayed flat.

“Administer Epinephrine,” Cesare commanded, still not looking up from his work.

Epinephrine was a drug used to stimulate the heart and increase blood flow to vital organs. We couldn’t use a defibrillator on him, because there was no sign of electrical activity in his heart.

I fed the IV line into him and delivered the dose swiftly yet steadily. His heart rate was still nonexistent. It seemed like I could feel my own pulse pounding in my ears.

It had been ten minutes, and nothing was happening. The man’s heartbeat hadn’t restarted.

“Time to call it,” Cesare said, stepping away from the man.

He said it so casually, like he was talking about the weather. Not like he was talking about how we failed to save someone else’s life.

“B-but, he’s...” I couldn’t finish my sentence.

Cesare and I had other critical patients come in like this, but we had always saved their lives. Things were stressful, and it took a lot of work, but we had always saved them.

“Ah. First time?” Cesare stripped off his gloves. “It is unfortunate, isn’t it? But, it’s a cold reality in life. People die.”

His words were harsh, but his tone wasn’t unkind. It was a tone of resignation, of acceptance of a fact that was as bitter as it was inevitable.

“And one that you must come to terms with very soon into this profession.”

It was as though I had swallowed a bitter pill, one that was hard to digest.

“Yeah...” I said quietly.

Seeing death was so much different from all the media I had consumed in school. I had read books, watched videos, and dissected pigs, but nothing had prepared me for the real thing.

It didn’t feel real; it wasn’t supposed to be like this. This wasn’t supposed to end with the patient dying on the table, and us unable to do anything about it. I stared at the lifeless body beneath us, unable to comprehend what had just happened.

“Well, let’s take this learning opportunity.” Cesare said, tearing me from my thoughts.

“Huh?”

I hadn’t even had time to process the cold reality of death and Cesare was throwing this at me.

“Let’s perform an autopsy. School always takes too long to teach the hands on things.” Cesare launched into a long-winded rant about his days in medical school, and how they needed fewer concepts and more practice.

I felt my stomach churn at the thought. “Now?”

“In this line of work, death doesn’t wait for you to process your feelings.”

Cesare was right, as much as I didn’t want to admit it. I looked back at the patient on the table, his skin already turning an unnatural shade; this was no time for me to wallow in my feelings.

“So you make the Y incision, which we won’t be able to do perfectly given his injuries.”

Cesare took a scalpel and started to make the cut, his hands steady as ever. The sharp blade of the scalpel split the pale skin with ease, revealing the organs beneath, a world I had witnessed countless times in textbooks and on screens, but never in its raw, unfiltered state.

“Alright,” he said. “Let’s see what’s available to save.”

My stomach twisted in nervous knots. We weren’t in a hospital; there was no reason for us to try and save the organs for removal.

“Uh, Cesare...” I said, inching away from him. “There’s no reason for us to do that here.”

“It’s training,” he said sternly, looking directly at me. “It doesn’t matter if they get tossed after; we’re pretending like they need to be preserved.”

I nodded, trying to keep my face passive. Cesare was right, after all. This was a training exercise, and I was supposed to learn from it.

I hesitated a bit before stepping up to him. The scent of blood and death was overwhelming, but Cesare seemed immune to it. He looked at me expectantly. I swallowed down my apprehension, took a deep breath, and watched what he was doing.

“His heart won’t be salvageable. Neither will the left lung,” Cesare said, motioning to the organs that had been pierced by the bullet. “Now, we need to clamp the blood vessels.”

His hands moved confidently and without hesitation, grabbing a pair of hemostats from the tray beside him. With precision guided by years of practice, he located the major arteries and veins and clamped them off.

A chill ran through my body. At first, I thought it was from experiencing the harsh reality of death. But then I realized the A/C had definitely gotten chillier. The warehouse was quite old, and the electrical wiring was most likely malfunctioning.

“And then remove them one by one. Be careful with where you make the cuts.”

I leaned in closer to see the small, delicate cuts he was making in the tissue. His technique was flawless, each incision precise and deft. The scalpel was an extension of his hand, a tool that made the gruesome act almost seem like an art form. I marveled at the level of focus he demonstrated, so deep in his zone that the world around us seemed to fall away.

He set the right lung on a tray behind him and continued his work.

“And some need to be flushed with preservation solution,” he said, taking out a kidney.

I watched him flush the organ, his movements swift and efficient. Then, he gently sat it down next to the lung on the tray.

Cesare narrated his process while I watched in silence. Once again, seeing something in real life was so much different from what was taught in school. The sheen and texture of organs, the slick and visceral feel of them, was something that couldn’t be captured in a video or written on paper.

Teaching couldn’t convey the iron scent of blood mixed with the preservation solution, nor the soft gurgle as the solution flushed through the various arteries and veins.

“I’ll finish up here,” Cesare said. “You can go home.”

“Are you sure you don’t need help? Normally I clean up.”

He waved me off. “I’m sure Vincenzo is waiting. It’s past one thirty am.”

Vincenzo. At least the night had distracted me from the heartbreak I was experiencing. But now, it was time to go home and try not to burst into tears when I looked at him.

“Alright.”

I wished him goodnight before walking out of the operating room. As I removed my gloves and scrubs, I longed for the ability to do the same to my heart.

After packing up my things, I walked into the hall. Suddenly, I was hit with an intense wave of nausea. It was as if all my emotions from the night had suppressed themselves, and were now bubbling to the surface.

Instead of taking a right and heading towards the front of the warehouse where Vincenzo would be waiting, I took a left and ran out the back door. I barely made it outside before vomiting on the concrete below me.

We failed. We didn’t save the man’s life, and afterwards used him as a training lesson, without taking a minute to remember his life. He was a man with a family, but we just cut him open like it was just another Saturday.

I was ashamed the medical profession I loved made me feel this way. Was this even the profession I loved anymore? Or had I strayed too far deep in with the mafia, treating lives like they didn’t matter?

When I finally was done, I took a deep breath and wiped my mouth with the back of my hand.

I was fine. This would be fine.