Routine
Colin Adams

Kim was bored. As per her routine, she drove in the dark from her house, through the snow, to the parking garage. Her car hadn’t even warmed up when she arrived. She could still see her frosty breath fog up her window. She swiped her hospital ID, barely allowing enough room for the yellow and black bar to rise above her car before driving through. It was so familiar as to be unwelcoming. As usual, she parked her car in the staff-parking area behind the concrete pillar on the north-most side. Kim was bored.

She couldn’t remember how long it had been since something interesting had happened at the hospital. Her ER shifts used to be fun and exciting. She used to enjoy when a gangbanger got stabbed and she would have to stitch him up, but even those cases got dull. When she wasn’t in the ER, Kim mostly sat around while she prepared for her next operation. But by this point, she had performed so many surgeries that the planning— and the operation itself—required little to no effort.

Like many doctors, Kim was funneled to medical school by her parents. Although not explicitly told to do so, it was expected. After all, both of her parents were doctors. So, like a good, obedient child, she studied hard in high school, ended up at a well-respected university (Rice), did well on her MCATs, and went straight into medical school at the University of California at San Francisco. She liked San Francisco—she fit in there more than in Texas. In medical school, she chose to specialize in heart surgery, thinking that it would be both challenging and rewarding. She would have to solve life and death problems on the fly, and she would get to work with her hands. There was also a strange feeling holding someone’s heart in your hand. After the first time she had done this, Kim became hooked. Kim controlled their life in the operating room; for all intents and purposes, she was their god.

But like all things, playing god got old too. She never really questioned this path, telling herself that this is what she wanted, until after the thousands and thousands of dollars the bank gave her had been signed for and not yet paid. And after that, her life was essentially fixed with little room to deviate. So, she stepped through life in intervals of how many stents she put in FAPPs (fat and pathetic persons) to keep their almost-useless hearts beating. But FAPPs usually had insurance, and insurance paid the bills around here, so she tolerated their existence. Even so, their existence still made her depressed. Maybe that’s why she started drinking before work. Or, maybe it was to make the boredom a little less boring. Either way, she opened her glove box and pulled outa bottle of gin and took a drink that would make André the Giant cringe. Then she poured the gin until it filled her half-empty Gatorade bottle until it reached the brim. She sipped the top so it wouldn’t spill, returned the gin, grabbed her backpack, her lunch (an apple), and got out of the car.

As Kim walked to work, hands deep in pockets, her chest still warm from the gin, she briefly considered going to a meeting for alcoholics. She knew she was one, she was at least that honest with herself. She wasn’t a sloppy drunk who dragged down society. She was still a valuable member in her community. Yet, Kim didn’t like the term “high-functioning alcoholic.” It’s not that she denied being one—she knew that she hit most of the red flags—but rather she didn’t think any alcoholic could be high-functioning; those terms fundamentally clashed with one another. Instead, she described herself as a ‘professionally presentable alcoholic’ (PPA). Some of her hospital friends—men and women—were PPAs, too. Kim would rotate between them, but the routine was the same: after work,
they would go out to eatand drink afew bottles of wineat the table. Usually, they would then go back to Kim’s place and drink some more. They’d almost always fuck too. But, by this point, even the fucking tended to be an anti-climactic routine for Kim; she used the sex more so her fellow PPAs would keep drinking with her regularly. As she entered the hospital, she nodded to Jim the security
guard (she had fucked him a few times before: he was sloppy, boorish, and boring) and she decided not to start attending any AA meetings this week. She never had gone and never really planned on going. The meetings that were closest to her apartment met on Mondays which is when she got dinner with Barbara—her most reliable drinking buddy—and Barbara could only drink on Mondays because that’s when her husband, a nurse, worked the graveyard shift. So, the AA meetings weren’t practical for Kim. Maybe she’d buy a self-help book instead. Satisfied with this, she pushed alcoholism out from her head and decided to focus on the surgeries that she had on her plate. She knew she had to perform an angioplasty or an atherectomy today. Or was it a stent placement? Shit. She couldn’t remember. She’d just play it by ear. It’ll be fine, she thought. It always was.

After going up the stairs, Kim finally reached her office. She closed the door, set down her backpack and lunch, sat down, and exhaled loudly. She reached under her desk, searching for a secret shelf on the backside of one of her drawers. She felt around until she found the leather flask with a British flag pressed into it (her father’s). She grabbed it. It felt almost empty. She’d have to buy more soon. The flask was for her bad days. She decided to finish it off. Tequila. God, how she hated tequila. But it did what it needed to: she felt a little more awake. She put the flask back on the secret shelf. She didn’t want anyone to smell the alcohol on her breath, so she pulled out a fresh bag of salt and vinegar chips from her backpack. She usually ate this for her post-drink breakfast, and she hated herself for what this habit was probably doing to her own pulmonary artery—and her liver. She compared herself to a FAPP. She shuddered and shrugged off the thought.

***

Knocks stirred Kim from her sleep. A small puddle of drool had formed on her fore-arm and a little pooled on the desk. Louder knocks. How long had she slept? It didn’t matter. She briskly walked over to the door and opened it. “Yes?” she said. Two doctors were impatiently waiting at her door. One was an old, gray-haired colleague named Greg Peck who mostly did knee surgeries; he was good too. Unfortunately, he was so damn whiny. The other was some blond-haired kid fresh out of medical school, with his tie too tight and hair too neat. Kim couldn’t remember his name, but she remembered making a bet with one of the PPAs on whether or not he was a Mormon and/or believed in gay conversion therapy. The bet was ongoing.

“Dr. Joh? Where have you been? We’ve been trying reach you.” Kim looked down at her belt and saw her pager was dead. “Apparently, it’s out of battery. What’s the problem, Dr. Peck? What do you need? I was about to eat lunch.” She still felt buzzed from breakfast but was far from drunk. She knew it probably didn’t show. She had been doing this for long enough to know when she was sloppy. She was not even close to that point. If anything, she wasn’t drunk enough. The headache would hit soon unless she got another drink. Kim hated the fucking headaches.

Dr. Peck was speaking fast in his characteristically shrill (and fucking annoying) voice, “We just got a patient who had a massive cardiac arrest. Luckily, someone nearby knew CPR and they had a defibrillator in the building. He’s very lucky to be alive. But the cardiologist who looked at him after found that he also has heart disease. It’s bad too. The cardiologist is worried another heart attack would kill him. He thinks we need a quadruple bypass surgery to avoid further issues. He might not survive another heart attack.” Kim stared at Peck with fury. All of her plans just went poof. She’d have to cancel her PPA date. She shifted her anger to Mormon boy. Why was he even here? He was just standing there like a fucking cabbage.

The silence grew. Then, Mormon boy decided to snap out of his meek, vegetative state and speak, “Um, uh, Dr. Joh. You’re the best heart surgeon we got. Your record is impeccable. We, uh, you should, uh, be the lead surgeon on this.” More silence. Mormon boy shifted his gaze from hers.

“When is this happening?”

“As soon as possible, Dr. Joh. Um, I mean, as soon as, uh, you’re ready,” said the cabbage.

“Okay. I’ll reshuffle some things. I’ll be down in a few. Let me splash water on my face and I’ll meet you by the lobby.” Kim closed the door and silently tapped her forehead against it. Fuck me, she thought. She’d miss Barbara tonight. Kim let out a quiet yet forceful groan. The headache was coming. She went to her desk and grabbed the flask; it was empty, she already knew, but she just wanted her tongue to taste any residual tequila that it could. She managed to catch a drop. She looked at her father’s initials hand carved at the bottom: ‘T.J.’ She moved her thumb over them, but she couldn’t feel them. They were too shallow. She stashed the flask away.

***

After Kim donned her white lab coat and splashed her face with lukewarm faucet water, she walked down the stairs to meet Dr. Peck and Mormon Boy. As they walked, they were telling her some of the details of the patient’s history but she wasn’t listening. The headache was coming and crushed her temple with each pulse. She needed booze. Quadruple bypasses were always a pain in the ass. The heart is stopped and blood is rerouted using a heart-lung bypass machine that supplies oxygen to the blood and pumps it around the body. The blood vessel in the heart that is blocked needs to be bypassed, meaning the blood needs to flow around that blood vessel until the plaque is cleaned out:a slow and tedious process. That’s a bypass surgery. Naturally, it’s understandable why Kim especially hated performing a quadruple bypass surgery.

***

Kim was in her blue surgical scrubs. She had just finished washing her hands and was ready to enter the operating room. Unfortunately, she felt completely sober, a fact that her pounding headache confirmed for her.

She walked in and saw the team around her. She nodded to them, signaling that things were ready to begin. Everyone took their appropriate places. Kim walked over the man who was chemically put to sleep. He was a huge man. A true FAPP. He probably weighed as much as a literal farm pig at slaughter. If she had to guess, Kim would say he was slightly below average height although it’s hard to tell when they’re laying down and it’s even harder with a FAPP. His chest was stained with iodine and
underneath was already a large scar running down his sternum. Kim asked the physician assistant his medical history.

“The patient has had open-heart surgery before, for heart disease. He was doing well with his recovery before, uh, the cardiac arrest earlier.” This really pissed off Kim. Here is this fucking FAPP who had heart disease before and apparently made no changes to his lifestyle afterwards. He had clogged his arteries again with donuts and milkshakes and hot dogs and whatever-the-fucking-else he
eats while he twiddles his fat thumbs. Kim clenched her jaw in rage. “Let’s begin,” she said to the team.

Kim took a scalpel and made an incision the length ofa pint glass down the sternum. Then Kim asked for the oscillating saw to break through the sternum. This is always a bit messy but it’s interesting if anything goes wrong. After, Kim slowly spread each half of the ribcage giving her easy access to the lifeless heart. The real operation began.

***

Each bypass went without incident, as usual, as always. Another checked box. All that was left was to sew this FAPP up. But before she did, Kim stared at the still aorta, the lifeless veins and arteries. She thought about the FAPP. Wouldn’t he just eat Krispy Kreme to the operating table again? He would just be here again, taking up more hospital resources. He kept her from her gin now. Would he
do it again? She hated him.

Kim looked around the room. Everyone was exhausted. They just wanted to stitch him up again and go home and sleep. Nobody was paying attention. Kim calmly picked up a scalpel. Her chest shook with each blood-banked thud of her own heart. If she made a small incision in the aorta, when they let the heart start beating again, soon the pressure from the blood would cause the aorta to
rupture, and, by that point, it would be too late. He would almost certainly die. A FAPP with along history of heart problems dies of a heart problem after having open-heart surgery to fix a heart problem—would anyone really be surprised? She stared at the still heart. Kim felt adrenaline.

***

“Okay everyone. Let’s get this guy out of here,” Kim yelled out. Kim’s headache was gone. They took the FAPP off the bypass machine causing his heart to beat again, sewed his ribs up with wire and stitched him up. As they rolled him out of the operating room, the EKG was sending out steady, periodic pulses into the room. Then there weren’t. There was just a high-pitched whine. Scrambling and shouts followed. Under her surgical mask, Kim smiled. This was new.
​

Born in Colorado, living in California, Colin enjoys books, running, physics, and other things.