My wife once told me the most scared she’d ever been was after her D&C. That’s where they go into your uterus to scrape out excess tissue with a spoon. In her case, leftovers from an early miscarriage.
It’s a creepy experience, the way she tells it—lying unconscious in nothing but a bedsheet, practically roofied, while strangers fiddle with your most intimate parts. Who knew what the doctor might do to you when you’re under?
I told her she was being ridiculous. There were four people in the room. All surgeons, like me. Professionals.
When I picked her up after the surgery, she leaned away from me, her head on the car window. But that’s just it, she said. It’s worse when you think all of them could be in on it. Each one diddling with you like you’re nothing but a corpse. Nobody would ever know.
Surgery always takes something from you. A clot, the hint of a fetus, a sweep of smooth, uninterrupted skin. One swift slice, and the damage is done. But what you never think of is how surgery also fills you back up. With blood, with pain, invisible aches that linger. The way my wife described it, it was a flood. A tightness in her womb, bloating up her cavities like a balloon.
She’d woken in a recovery bed soaked through with her blood. The clock on her phone told her she’d been unconscious for three hours. She didn’t stop bleeding until later that night.
I guess I couldn’t blame her, being scared.
•••
After any cut, the first thing the body does is bleed. Then comes clotting, drying, hardening into a scab. A scar. You can always differentiate scar tissue from regular skin—it’s a smooth, parallel line interrupting normal tissue and its intricate cross-weave. At least that’s what it looks like from the outside.
I spotted the tell-tale signs on Mrs. Waverly’s neck, the ghost of a surgery some twenty years gone. A benign lump, her records told me. She was trying to hide it, but her silk shawl slipped.
“Don’t worry, Mrs. Waverly.” I smiled at her, her liver-spotted fingers clutching a purse like it was a totem. “I’ve done this procedure countless times before. You’ll have the best hands in the county on you.” The only hands in the county.
She was a fragile thing, pinching her lips at me. Terrified, like most patients, but also too terrified to admit it. The pain giving her a pathetic hunchback that wasn’t just age, I remember.
You always remember your first.
“What you’ll have is a standard gallbladder removal, nothing to worry about.” I swiveled my chair over to the shelves cramming up the space.
Exam rooms make people anxious. Knees vibrating up and down. Eyes darting to the doorknob, to the grass-swept hills out the window. Straining to hide just how much they want to bolt.
I knew the feeling.
I snatched off my trusty diagram of a gallbladder, sliced down the middle like a secret nobody asked for. From the way her lip curled, might as well have been a xenomorph.
“It’s called a cholecystectomy. Minimally invasive. We’ll make three small incisions around your gallbladder, one at your navel.” Pointing with my pinkie. “I’ll go in and I’ll be able to see everything with my camera. Just a few seconds—snip, snap—no more pesky gallstones. You’ll walk out pain-free. A new woman. Only downside is that there’ll be no terrible scars to brag about to your friends.”
If she knew I’d made a joke, she didn’t show it. Her grip shifted to the shawl around her neck. “You look about old as my grandson,” she said.
I gave her my best broadcaster smile, the smile that said I was the purest man alive, don’t you forget it. “Why thank you, Mrs. Waverly. I can assure you I’m fully qualified. Finished residency years ago.”
“Not that many years,” she said.
“Look.” I lifted my hand. “Sure and steady as a board.”
The doctor-patient relationship is a weird one. You smile at them in a white room with your gecko-green scrubs and say Mrs. So-and-so, it’s a pleasure to tell you that your surgery was a success and pretend that, not one hour earlier, you hadn’t been elbow deep in their abdominal cavity, intestines hooked up to a metal rack like a boa constrictor.
It’s messed up.
And before the surgery, well, you do everything to keep them calm, reassure them.
I kept looking at the shawl, thinking I’d seen it before.
“You know, my wife has a shawl just like that.”
I couldn’t remember if that was true. Sounded true. Just the kind of shawl she’d pick up in some artisanal crochet shop, because it made her feel cultured or French or I don’t know.
At that, Mrs. Waverly sat up, shaving off years with a blush. “My husband gave it to me many years ago. Before he died. He was the type, you know, loved giving gifts, more than getting them.”
You can’t help but love that special kind of forgetting reserved for dead men. Almost looks like pride.
“It’s beautiful,” I said.
Her smile would’ve been the answer I was looking for, except it split into gritted teeth. Pain cut through, bowled her over into the hunchback. The pain, that great amnesiac, doing its job. Smothering any fear remaining in her.
•••
I used to love giving gifts, too. For our second anniversary I gave my wife a scorpion necklace. Suited her personality, I’d told her with a drained grin.
It’d been just a few months after we’d moved to the highlands. To escape the stress of the city, we’d thought. But we never really settled in. You know how moving to a new place is. Packing. Unpacking. Huge blisters of goddamn bubble wrap everywhere. Mattress that sits on your floor for weeks, a sad altarpiece to the horde of half-emptied cardboard boxes of memories you’re too chickenshit to throw away.
And the town. More like a ghost town in the making, really. Most people of working age had left a while back. Now it was all seniors and stubborn farmers who only went to the doctor when they had to get something extracted.
Then there were the families from the city who’d decided to try their hand at homesteading. The type of town perfect for raising kids, or for dying, so I guess we were getting ready for one of those.
That anniversary, a week after we moved in, that was the last time we did gifts on special days. Instead, we switched to every couple months. It was modern, or so my wife said.
We never did Valentine’s.
She wore the necklace every day for a while. Kept losing it wherever we went—on hikes, at the pool, the hardware store. Would only find it after a full half-hour of us both sniffing around like mad dogs. She was always careless like that. After the seventh time on our hands and knees, past midnight in the basement, I stopped yelling at her. If she didn’t care about it, why should I?
Then she left and scorpions took on a whole new depth of evil for me.
It’d been a month. She said she needed space and walked out the door. And me—the way when you’re trying to have a baby, you see them everywhere? I’d see Scorpio birthday cards passing the window of a New Age shop. Scorpions with teeth, on the battle boots of a goth girl in some TV show. On a teenager’s shirt as he was rolled into the E.R. At least that one was ripped, stained.
•••
I cut one of my ex-girlfriends once.
It was an accident.
Of course, she didn’t buy that.
The pre-med student, with a steak knife, in the college cafeteria. We’d been having a fight, one of those quiet, so-low-it’s-almost-a-growl fights. Because we were one of forty tables, each a pack of grinning students.
I still remember her face blooming with surprise, hardening into anger. Contracting like a Venus flytrap. Jaw clenched, going white-hot.
I’d jabbed the knife at her plate and grazed her arm, the slightest stripe of pink. The type of cut that you’d think would heal up without a thought, fold back into memory. But there was always a little evidence of it. Like the tail of a comet, a trace of what’s already long gone. For months after, I’d see her rubbing it every so often, stroking it white, stroking it into a habit. I’d always feel guilty but also a bit proud.
I wonder if she remembers how she got it. If she thinks of me whenever her eyes fall on it. Maybe she got a tattoo to cover it up. I wonder if she tells her boyfriend or her husband how she got it, or if she lies. Maybe she says, “I got it working in the yard.” Or maybe she tells the story, proudly, of the time her crazy ex stabbed her in a college cafeteria.
I would.
•••
Mrs. Waverly came in for surgery on a Wednesday.
I remember her eyes, just before she went under. A bit lost. Glassy. When I’d asked her if she had a ride home after her recuperation, she’d muttered something about taking a taxi, not to worry.
I hated that.
In the O.R., she was so pale and lifeless. We’d stuck her with four trocars—these hollow cylinders—where we could slip in surgical equipment without opening her whole chest up. Three by her gallbladder, one up her navel where the nurse was blowing up her abdomen. She looked like a sea urchin that had lost most of its prickles.
Looked about as undignified as that, too.
As a general surgeon, it fell on me to take up all those pathologies that specialists shied away from. Liver, intestine, pancreas, thyroid–all those lovely secreting organs and odorous bits. We’ve been called masochists, but that’s more for the long hours. Masochist, altruist—I guess taking away pain from another person means you take it into yourself, one way or another.
My wife never understood that.
“From the look of her knees, Dr. Evans, I’d say less than six months.” Jason the nurse and I made bets on how long before we’d see a patient on the table again.
I slipped the laparoscope up her navel tube, carefully edged it up to her gallbladder. Watching its journey on the monitor. Sliding into that internal world with its leeched-out colors, its twists and turns—weirdly the same in every person. If you don’t know, if you’re looking without seeing, it looks like a mess.
You’re a real fucking mess, Waylon.
I came out by the liver. Grasping the forceps, I pinned back the gallbladder and clipped off the main artery and duct. I was dropping them into the tiny specimen bag, my eyes glued to the monitor, when my hand slipped.
Scraped Mrs. Waverly on her liver.
Left a mark.
God knows it’s not the first time a surgeon had slipped, but it was a deeper mistake than I’d ever made before. A brisk line of mud red, a shade darker than blood. It started flooding in, spots percolating to the surface.
My eyes cut to Jason. He was checking the drip from the I.V.
The anesthesiologist wasn’t due back for another fifteen minutes.
The assistant busy with an appendectomy down the hall.
Nobody had noticed.
The worst part of any surgery is afterward, in the recovery room. You can always tell the ones who don’t have anyone waiting for them in the parking lot. Who’ll go home and sit by the window, still aching from where you cut them open. Belly bloated, feeling their worst. Wondering if the pain will ever stop. Wondering, but not really believing it ever will.
I think about that a lot.
I repositioned the scissors in a better grip and made another cut. The two together made the tiniest of cross-cuts on the underfolds of her liver. A place that would never be seen, hardly ever felt.
You know when you make cross cuts in an orange, to stab cloves in at Christmas?
X marks the spot.
And whenever I remembered that little X, it made me feel closer to her. It was like a tiny promise, like I was still taking care of her, well after she left my O.R.
I wondered if she ever felt it. If she still feels it. A tiny ache, barely perceptible. Inexplicable. A slight pulse with no source, no reason. Maybe she brushes it off as age, yet another senior thing she has to deal with. Maybe she blames having slept on it funny.
Part of me wanted to tell her, in the recovery room. If she knew, then maybe she’d be a little less afraid.
But that would’ve been stupid.
•••
There was this guy with varicose veins. About a week after Mrs. Waverly. Untreated for so long he had ulcerations on his lower legs. Purplish, like a hunk of that moldy cheese my wife obsesses over. He couldn’t stop giggling from nerves, which made everyone—me, my assistant, tech—giggle too and the whole room was a manic giggle fest until the anesthesiologist came.
Later, while the assistant was extracting ulceration tissue for the lab, I slipped in with my scalpel. Slit into the man’s subcutaneous fat. A stupid, microscopic triangle. To thank him for the laugh, I guess.
Another time, a woman came in with gastrointestinal trauma. She’d tried to drown herself in a swimming pool. Turns out, she’d sat on an uncovered drain and the suction force–hundreds of pounds of pressure–eviscerated a tiny part of her intestine. Took four hours and a laparotomy to patch her up.
I carved a little heart on the outside of her pylorus valve because I felt sorry for her. The worst part was even though she lived, her eight-year-old son who dove in after her didn’t. He’d panicked and swallowed a lungful of chlorine.
•••
My wife cut herself a few months ago.
We’d gotten into a huge fight, and out bled savage honesty, more werewolf than anything. Death by a thousand cuts of intimacy. So she locked herself in her studio and colored in her fury with a nail file.
A tiny hook on the end made the cuts. Slight pressure from her finger to keep the marks steady, even. Left a runway of skin unfurling, like the wake of a boat.
“I cut myself,” she said sheepishly when I asked her what the hell happened.
I could tell by her offbeat smile she was proud of herself. Proud of the proof she now had, that my toxicity was driving her mad. It wouldn’t save our marriage, but we both already knew that. What did she expect? It didn’t even draw blood.
It did leave marks, though. Little faint red lines in between her arm hair. If you weren’t looking for them, you’d miss them.
Did she wear short sleeves more after that? I didn’t ask. But I’d look, remember that fight we’d had. Not what it was about—who remembers that? Just the emotion of it, the sheer rage. Calling her a bitch. Comparing her to my crazy mom. I remember her screaming at me—you’re a real fucking mess, Waylon—all that pent-up rancor erupting with the force of an arterial stream.
This kind of truth was the only way we connected anymore.
It was like the scar solidified our emotions, no matter how fleeting, no matter if we made up and pressed lips and lies—that scar was that harsh-bright thing that made us flesh, made us real.
•••
I don’t know if I’m explaining it well. It was like it was a silent oath to my patients, that everything would be all right. And some part, some small part of them, knew it, felt it, where it’s dark, where it’s deep.
They were walking around, talking, smiling, picking up their kids from daycare—because of me. They didn’t know it, but I was the common thread between them all.
Like some big, happy, weird family.
I know this all sounds crazy.
But—come on.
It’s not like I was leaving my signature.
I tried different shapes. Circle. Hexagon. On Billy, the old Satanist from Portland, I left a pentagram. Thought he’d appreciate that. Tried a graduation cap on a college kid home for spring break, but kind of botched it. Not proud of that one.
Once I tried to leave a Christmas tree.
This man came in with a hemangioma. Tumor on the liver. Benign, in his case. Came in complaining about palpitations and, before you know it, lying flat under my knife.
I forget why the tree. Maybe because he was dropping “Christ Almighty” and “Sweet Jesus” a lot during our pre-op. Scared as a rabbit, that one.
Some organs are more fragile than others. With livers, for example, you’re just one sweaty slip away from a puncture. But we had this new argon beam from the city, so I was eager to try it out. An electrical current passes through a stream of argon gas to get to the organ. I’d used one before, though not for a few years. Probably easy enough to pick up again.
I was all eyes on the monitor, my laparoscope off to one side, one hand gripping the laser. Carving around the tumor, mending my marks with the beam as I went. It was on the small size, smaller than my wife’s fist, and in less than twenty minutes I had it bagged. Started shooting the surface of his liver like I was repairing the damage I’d made. It was tricky, that tree. The kind preschoolers draw—three triangles stuck on each side, a rectangle on the bottom. But I’d never been much of an artist, and it was a slippery canvas.
I’d just finished one side, when a voice jolted me. Out of instinct, I flipped the laparoscope away from my art. So it wouldn’t show on camera.
“This friend of mine from out of town,” Jason was saying. He tapped the IV with one finger. “I had her over for dinner the other day and she had the craziest story.”
Fucking Jason and his stories.
I didn’t worry too much about Jason. A few failed job opportunities and medical school loans meant he was stuck at his parents’ house, and ten years in the same job, same town, had made him bored and inattentive. Spent a good chunk of his break gelling his hair. Liked swapping stories over a comatose patient much as the next guy.
I squinted, like I was concentrating on the laser. Blasted in the tree pot.
“She was telling me about a time she went for a massage,” he was saying, “and the guy working on her, he was about thirty minutes into her session, kneading away, right? When all a sudden he announces to her that he’s got HPV.”
My fingers slipped a bit, from the sweat.
Shit. Botched a triangle.
Shouldn’t he be checking oxygen levels?
He sat on a stool, watching my face. Grabbed a sterile rag and started cleaning blood off the Mayo scissors I’d used to make an incision.
“And he was feeling, like, real bitter about it, you know. He’s got HPV and these genital warts that keep coming back. So he tells her, all the time while he’s working her, that his goal in life was to sleep around and spread it to as many people as he could. And the whole time he’s telling her this, he’s massaging her, kneading all of this into her. Like she could get infected, just by the story.”
I stared at the lines in front of me. Realized I’d been clenching my jaw. My hand. Cramping up.
“And somewhere, for decades now, there’s been that guy out there, spreading his disease to all the hapless girls and boys. You know. Like he’s fucking Santa.”
My eyes cut to his then.
He knew.
I flipped off the laser and straightened. Shoulders square to his.
“Hey,” he said, palms up.
“What’s it to you?” I asked with an edge.
“Nothing. No biggie. I know you’re nothing like that guy. Just been noticing some things.”
“It’ll heal up.”
“Yeah, I get it. I actually get it, trust me. It’s no secret you’ve been stressed out. It’s a wild outlet, but ok. Easy access. Disappears after a while. Wasn’t going to say anything.”
I glared at him. “But you did.”
“Man…I’m worried about you. I know Madison left you. Ran into her the other day. She’s been staying at the Owl Inn, over by Fourth. Across the street where I live.”
Every fucking word tensed me up even more.
“You talk to her?”
“Just a bit. She doesn’t look good. Tired. Stressed out. Like you.”
Had he seen her scars? I went hot thinking she’d shown him.
“Look, it’s really none of my business, but she asked about you. I told her you were stuck at work, day and night. Stressed out.”
I never finished that tree. It was the last time I tried leaving a mark with an argon beam. Problem is, they’re too efficient. The damage fades in a week or two. I stuck to scalpels after that.
•••
When I say I hate my wife, what I mean is, I hate how she leaves her socks in our bedroom doorway, the way she interrupts me constantly. The way she tiptoes down the hall to her studio, where she paints all goddamn day, acting like it’s because she doesn’t want to wake me. Which, I guess, is true. In a way. Less time together means less time wasted arguing. When she started closing the door behind her, it was a relief.
Of course, maybe you’re in a happy marriage. Maybe you’re both bigger than your problems. But if you’re like most people, your marriage is just a cold meat platter of unhappy moments.
One day you wake up, and those things—the things that used to disappoint you, used to make you grit your teeth, used to make you want to scream into your pillow—slide off you like hot butter. When “I’m fed up” and “I’m tired” become household names. You try and try and try—until one day you just don’t, you know?
And one day, we didn’t.
It’d been a month since she’d left. My lower back tensing up whenever I heard the phone ring. Hating that. Hating that my body was waiting for her to call me.
That whole month, she never did.
But then, just the day after Jason told me he’d seen her, there she was. In my hospital. She never liked attention, my wife. But I couldn’t take my eyes off her. Nobody could, the way the EMTs were rolling her up to me on a stretcher. Her belly carved open with a knife. Like she’d been looking for something.
•••
My wife, the way she was sleeping, her damp hair plastered to her face like seaweed. Like a mermaid.
Of course, she was always damp because of her nightmares. I used to wake her when I heard her whimper, her breath dropping into irregular clots. Used to hold her close to me until we both fell asleep. That was before we started fighting. A little at first, then every night. After a while, I’d pass out from sheer exhaustion, and then I’d just sleep through her nightmares.
But from the bags under her eyes, I could tell she still had them.
She was passed out from the drugs the EMTs had administered. As they rolled her in, one of them whispered to me. “I’m sorry, Waylon. It looks—it looks like a suicide attempt.”
They wanted to call another surgeon, from the next town over. Two hours’ drive.
Fuck that.
She’d stabbed herself in the abdomen, two, three times. An inch and three quarters. Not crazy deep. Around the base of her lower rib, like she’d been digging for something.
She’d aimed for the stomach. I knew, because of those nightmares. She’d be lying in our bed, stretched out to the four corners of our queen-size, making an X. A sword dangling above her, her very own sword of Damocles. Stirring in the breeze. Sometimes the sword would plunge down, pierce her right through her stomach. Whenever she woke up, she said, she could still feel it, stabbed into her side.
Looks like it finally got you, I told the damp curls on her forehead.
“You good?”
Jason was drawing a sample of her blood, glancing over, nervous that he might have to be more active than usual.
I nodded, and his relief was audible.
It was easy work for me. All things considered, the cuts, though clumsy, were clean, missed all the organs. I couldn’t have done it better. If you ask me, it was almost on purpose. I went in with forceps and suction. Checking the tissue around the wound for inflammation. I removed a flap of nonviable tissue that was barely hanging on. She’d have scars in the surrounding tissue for the rest of her life. Made to mend, made to ache.
Jason was glued to the monitor. Hadn’t said anything during the entire surgery.
“Get out,” I muttered, and he didn’t argue. He cleaned up and left.
I’d heard about this science experiment once, where they wrote different words on many bottles of water. One bottle: tranquil; another: joy. Then words like sadness or fear. Left them to stand for some time. When they examined the water crystals under a microscope, those from the positive words were symmetrical. Beautiful. Like snowflakes.
Wouldn’t it be something if organs could absorb words like that, in the same way?
My wife’s belly was open, fascia latched back with forceps, a carnivorous flower. I glanced at the monitor. All I had to do was close the incision.
But something in the monitor made me stop.
Was that a cut, there on the bottom rib?
I craned my neck closer to the monitor. Gently pushed her stomach away, so I could be sure of what I was seeing.
Two tiny letters, carved right into my wife’s lower rib bone.
W, E.
•••
When I say I love my wife, what I mean is, I love the way she laughs at dad jokes. How she licks ranch dressing off her fingers. The way she forgets to do laundry because she’s painting or hanging up stupid papier-mâché masks. And the way she was caressing the bandages on her torso in the recovery room, like she was marveling over the work that’d been done on her.
I didn’t need to see her crinkled face to know she was hurting. She’s been hurting ever since we met. When I walked up to her, her face melted into a smile I didn’t know I’d missed. I felt my gut leap in response, like she’d probably been waiting for.
I grimaced. “The knife went in deep.”
“Thanks,” was all she said. Then her smile and her gaze slipped downward.
“You should stay here overnight, make sure you’re stable.” I wanted to ask her where she’d been all this month, but she just looked at me with that strange, sheepish grin, like a shy schoolgirl.
“You…you saw—” she started, paused.
Neither of us needed to finish the thought. She knew I’d seen it.
I didn’t even have to ask why.
It was a promise, a dare.
Try, try again.
It was past midnight. Staff had all gone home. And there she sat, looking like the wet mermaid she was.
I wheeled over the small table that held my tools, pumped the stool I was sitting on higher, so she could reach. Curled up the green scrubs past the knee and plunged a syringe of local anesthesia into my calf. Because the truth was I still loved giving gifts. A slice from the scalpel was all it took to peel back the flesh, and I watched it crinkle like someone else’s, like I’d done a thousand times before.
I was breathing fast, in deep gulps. “Take it,” I said, offering the scalpel to her.
Her eyes widened, but she understood right away. God, she’s always been like that. Understood so much, without me telling her. That’s something that just doesn’t come around so often. Nothing can replace that, right? The kind of love it takes to keep on digging in, past all the bullshit? To the real meat. I don’t think people get it, how rare it really is.
She leaned over with a grimace, leaned into her pain, making it a memory, and found the tibia. Hesitated a bit, as if she were thinking what to carve. Maybe an image, maybe a name? But I knew what it’d be, even before she did. Two letters. She pressed the sides of her white French tips around my knee as she worked. First the M, then the E. Madison Evans.
Initials for initials.
She made sure to curve the arches so it’d take a bit longer. And the pressure, it shot from her fingers deep into my marrow, made me bite down on a cotton wad. There was only so much anesthesia could do to block out her sting.
When she was done, she kissed me there. Right in the meat.
God.
“You’re going to need a whole case of antibiotics,” she joked then, her lips red, and that cut me up in all these new, invisible ways.
I tried to sew the wound up, but my hands were shaking. So while I dabbed gauze onto the wound, she sewed me up in mini cross stitches. And when strands of her mermaid hair brushed against my knee, it tickled.
This is how it works. A little bit of me in her, a little of her in me. It’s how she’ll find herself in me, whenever she looks for it.
X marks the spot.
