Welcome back, pt 2

One. Two. Three. Four. Five. Six. Seven. Eight. Nine. Ten. One. Two. Three… she counted under her breath as the plastic bristles scraped her skin. Folding the sponge in half, she restarted her mantra, working on the spaces between her fingers. One last squeeze, watching the red soap ooze around her thumbs, and then she dropped the sponge into the sink. Fingertips hovering just under the faucet, she let the warm water rinse the suds away. Hands lifted in front of her chest, water dripped onto the floor from her elbows. She backed into the door, executing a half-spin into the room. She laughed when she heard the music playing overhead.




“Back in the saddle again, Marsha?” She reached out with one damp hand to take the blue towel offered by a fully gowned and gloved Mrs. Lucas.




“Just a little mood music.” Beverley deftly dried both hands, turning to drop the towel into the soiled linen bin. Mrs. Lucas held open a paper gown as Marsha moved behind her. Carefully placing her hands into the sleeves, she bent slightly to allow the material to drape comfortably over her shoulders. Marsha secured the ties, first at Beverley’s back, then her neck. Beverley’s fingertips were just barely visible beyond the loose fabric cuffs of the ballooning sleeves. Mrs. Lucas stretched open a right-handed surgical glove that Beverley’s hand dove into automatically.




“Are these my usual gloves? They feel a little different.” Her now-gloved middle and ring fingers grabbed the lip of the now-proffered left glove making the opening just a bit wider as she ensconced her bare hand.




Ms. Lucas leaned in to whisper as she grasped the tabbed strap at Beverley’s waist. “These are hypo-allergenic. I thought you might want to try them, I know people’s skin can get a little sensitive after…, well, after…. Now, shall we dance?”




Beverley spun around and grabbed the final tie from Mrs. Lucas’s hand, tying it snugly at her waist. She placed her hand on the woman’s forearm. “Thanks, Karen.”




“It’s good to have you back.”




“How about we get some drapes on Mrs. Ackmann here?”



The pair made quick work of preparing the operative field. A very nervous intern came into the room as they were working. “Dr. Shipley? I’m Emily. Simon sent me.”



“Welcome, Dr. Hyngstrom, tell Marsha what size gloves you wear and go scrub. You gave your pager to Simon?”



“Yes, ma’am.” The young woman murmured to Marsha and then left the room. Beverley grinned as she watched her scrubbing methodically through the window.



“I hear good things about her. What about you guys?” Mrs. Lucas was holding a telescoped plastic sleeve into which Marsha dropped the gamma probe. Careful not to disturb the sterile field, Marsha pulled the ends of the tube, ensheathing the probe and its wire.



Mrs. Lucas was securing the head of the probe with elastic bands. “She’s good people.”



Marsha wheeled the base of the gamma counter closer to the table, flipping a few switches and knobs. “The recovery room nurses love her.”



Beverley laughed as she took the probe and began scanning, “So all hope is not lost?”



“Not yet.”



Beverley began her questions as the nurses were getting Emily into her gown and gloves. “Emily, what can you tell me about sentinel node biopsy?”



“The sentinel node should be the first possible lymph node that cancer can spread to.”



“Why do we biopsy it?”



“If there is no cancer in the sentinel node, we can presume that the cancer hasn’t spread.”



Emily stood prepared for surgery and Beverley motioned for her to stand above Mrs. Ackmann’s outstretched right arm. “How often is that presumption correct?”



“Umm..."



“It’s okay. Don’t panic. I don’t bite.” Beverley placed the head of the probe over the scar from the patient’s previous breast biopsy and it began chirping loudly. “Now this is where we injected the radionuclide earlier this morning. Where should I start looking for the sentinel node?”



“It will usually be in the axilla, but rarely, it can track to the supraclavicular nodes or internal mammary.”



“Very good.” Beverley moved the probe into the woman’s armpit, twisting and turning the probe, catching faint beeps until she finally elicited a steady raucous stream. “Let’s check those other basins just to be sure we’re not dealing with more than one hot spot.” She moved the probe over the patient’s collarbone and over her breastbone, failing to elicit even a single tone from the counter.



“I know I called you in here without much preparation. What can you tell me about this patient?”



“Jane Ackmann, late forties, microcalcifications picked up on mammogram two months ago. Needle-localized excisional biopsy done one month ago, diagnosed with invasive ductal carcinoma.”



Beverley looked up at Mrs. Lucas who gave her a knowing nod. She held out her hand, “Marking pen.” The older woman uncapped the purple marker and gave it to her. As she pinched Jane’s skin to find a natural fold that would camouflage her scar, she lifted her eyes to address Emily. “That’s a lot to know, her chart has been in here with her the entire time.”



“I assisted on her biopsy last month with Dr. Jacobs.”



"I know..." Beverley made a few more marks, then capped the pen and returned it to Mrs. Lucas. “…. 10 blade.”



The scalpel’s handle was slapped into her hand with a purposeful thwack. Her fingers curled around it out of well-honed instinct. The procedure moved along, her attention glued to the mass of fatty tissue she was exploring. Her eyes never left the field. She knew she would never have to doubt the instrument being given to her. She and Mrs. Lucas had a familiar rhythm, an innate perception, sometimes she didn’t even have to ask, she just had to lift her hand and the instrument she needed would be there.



Before too much time had passed, the sentinel node was out and on its way to pathology. The entire team changed their gloves. “Five percent.” Emily’s wrinkled forehead signaled her confusion. “The false negative rate for sentinel lymph node biopsy. Five percent of the time we think it hasn’t spread, but it has.” Beverley turned her attention to the woman’s breast and asked again for the marking pen. “Dr. Jacobs let you close?”



“Yes, ma’am.”



She carefully drew an ellipse around the scar, bringing Emily’s focus to the field. “See how this edge puckered a little when it healed? You were a little too tight on that end, but this looks really good.”



“Thank you.”



Beverley returned the pen to Mrs. Lucas and she held eye contact with her as she spoke to Emily. “Emily, switch places with me.” Mrs. Lucas gave her a brief nod and the corners of her eyes crinkled with her hidden smile. The three danced around each other, maintaining sterility by clutching their gloved hands to their chests. “Mrs. Lucas, 10 blade to Dr. Hyngstrom.” Beverley reached down and stretched the skin tight, making the incision easier for Emily to control. Marsha caught her eye and grinned. Dr. Shipley was back.