"I appreciate it." Briefly, Wynter trailed her fingertips over the top of Pearce's hand. "I just might take you up on it. Thanks."

"You're welcome." Pearce's eyes cleared and she grinned. "Come on, I'll show you a shortcut to the OR."

Wynter took a deep breath and plunged after her as Pearce bounded out the door. It occurred to her that this hospital was Pearce's own private playground, and she was being introduced to the neighborhood by the kid who ruled it. She realized something else as well. She very much wanted to be worthy of playing on Pearce's team.

"Pearce," Wynter called, "stop for a minute."

"What's the matter?" Pearce said with a laugh, turning to face Wynter but continuing to walk backward down the hall. Somehow, she managed to miss running into the people coming in her direction, or perhaps they simply parted for her like the Red Sea before Moses.

"Tired already?"

"Not on your life, Rifkin," Wynter snapped, yanking her beeper off her pants and peering at it. "What's 5136?"

Pearce's expression immediately grew serious. "The ICU." She was tempted to take the call herself, but Wynter was a senior resident and it was about time they both got a sense of what she could handle.

She pointed to a wall phone next to the elevator and leaned against the wall while Wynter dialed.

"Dr. Thompson," Wynter said when a ward clerk answered the phone. She pulled her list from her pocket and anchored the phone between her shoulder and ear while she unfolded it. "I was paged.

Uh-huh. Uh-huh. Wait a minute, who...Gilbert, uh-huh...how much fluid?"

Pearce tensed. It was all she could do not to grab the phone and ask the nurse what the problem was, but she forced herself to stand still and just listen. She needed to find out just how far Wynter could be trusted alone.

"No," Wynter said firmly. "Leave the bandage in place, soak it with saline, and make sure she's had a CBC and electrolytes drawn today. We'll be right there. Oh, and make sure she doesn't eat or drink anything."

"What's up?" Pearce asked as soon as Wynter hung up.

"Mrs. Gilbert complained that she was leaking."

"Leaking. As in...?"

"As in," Wynter informed her as they hurried down the hall, "her gown and bed seemed to be covered with cranberry juice."

"Fuck."

"That was my thought too. She's what, three days post gastric bypass?" Wynter took a look at her list. "Yeah. And her last hemoglobin was 12, so it's not likely she had a big postop hematoma that no one noticed. Too soon for that to drain anyhow."

"I agree," Pearce said darkly. "If she bled after surgery, her blood count would be lower, and even if that were the case and we missed it, it's too soon for a collection of blood to drain. Did they get her out of bed today?"

"I don't know," Wynter said, pushing the button for the elevator.

"But apparently, the patient had a coughing episode just before she noticed the leaking."

"Dandy. So what are you thinking?"

They stepped into the elevator and moved to the rear, where Wynter said in a voice too low for the other passengers to hear, "I'm thinking that Mrs. Gilbert has a dehiscence. Aren't you?"

"Yeah, that's exactly what I'm thinking."

"Is she yours?" Wynter asked as they maneuvered their way through the crush of people and into yet another hallway. It was a touchy question, and she half expected Pearce to lose her temper. No one liked to have a complication, especially a surgeon. And a technical complication, one that might have been avoided had the surgeon performed the procedure differently, was the hardest thing for a surgeon to accept or, sometimes, even to admit to. She had a feeling that Pearce did not like to have complications.

"No. Dzubrow...one of the other fourth-years...did it with the chief." There was no satisfaction in her voice. The double doors to the ICU were closed, so she swiped her ID through the card lock and punched in the code. "3442," she said for Wynter's benefit.

"Got it."

The doors swung open and they entered the controlled chaos of the surgical intensive care unit. Twelve beds were lined up along the far wall, separated only by curtains and the minimum amount of room to allow a nurse to move in between them. Tables at the foot of each bed were covered with charts and graphs and lab reports. Flexible plastic tubes connected ventilators to many of the motionless patients in the beds. The lights were too bright, the beeping and clatter of machines too loud, and the atmosphere far too impersonal for the severity of the illnesses housed within.

It looked exactly like every other SICU that Wynter had ever been in. "Which one is she?"

"Bed five."

When they reached the bedside, Pearce leaned over the bed rail and smiled at the anxious woman in the bed. "Hi, Mrs. Gilbert. What's going on?"

"I think I sprang a leak, dear."

"This is Dr. Thompson. She's going to check you out." Pearce eased away from the bed and signaled Wynter to move closer. "See what you think."

Wynter pulled on latex gloves and lifted the sheet. "Mrs. Gilbert, I'm going to remove your dressings so I can get a look at the incision.

"Are you having any pain?"

"It's sore. No worse than this morning, though."

"Did this happen while you were coughing?" Wynter lifted one corner of the sterile gauze that covered the midabdominal incision as she talked. A little conversation often helped to distract the patient during the examination.

"Right after that, I think. They told me coughing was good for my lungs. Do you think I shouldn't have done it?"

"No, I think it's important to keep your lungs clear after surgery.

You did fine." Wynter had a good idea of what she would find, and she wasn't surprised to see a glistening pink loop of bowel protruding through the central portion of Mrs. Gilbert's abdominal incision. She gently replaced the bandage.

"Dr. Rifkin and I are going to talk for a minute, and then we'll be right back," she said and turned away. She met Pearce's gaze. "Did you see it?"

"Yep. Looks like we're going to have to do a little repair job. I'll call the chief. You get her ready to go."

"Okay." Wynter turned back to explain to Mrs. Gilbert that her incision had partially opened and that they would need to go back to the operating room to reclose it. She didn't tell her any more, because it wouldn't change the procedure to be done and would only frighten her.

Although it looked gruesome, it wasn't a serious situation as long as they took care of it before infection set in or the bowel was injured. By the time she had the consent signed, Pearce was finishing on the phone.

"Are we all set?"

"Well, the chief is in the middle of the aneurysm, and after that he's got a colon resection waiting."

"She shouldn't sit around here for a few hours," Wynter said quietly.

"That's what I said."

Wynter waited, catching the glint in Pearce's eyes. "And...?"

"Looks like it's you and me, Doc."

Doc. No one else had ever called her that with quite the same mixture of teasing and respect. Wynter smiled.

"Well then, let's go do it."


CHAPTER SIX

"What have you got?" Ambrose Rifkin asked as he backed through the swinging door of the operating room, his gloved hands held at chest level. He'd shed his gown and used gloves after the last case, but kept his freshly gloved hands uncontaminated before he scrubbed again. It allowed him to cut down his time between cases.

Pearce waited several feet away from the operating table, already gowned and gloved, while Wynter prepped the patient's abdomen with Betadine, taking care to avoid the surface of the exposed loop of bowel with the caustic solution. "Mrs. Gilbert, a sixty-three-year-old female, three days post gastric bypass. She dehisced her wound about forty-five minutes ago."

"Any precipitating event?"

"Probably coughing."

"Huh." He walked to within three feet of the table, took one quick glance at the patient's abdomen, and then swept an eye over the monitors at the head of the table. He nodded to the anesthesiologist.

"Everything okay, Jerry?"

"She's fine, Am."

Pearce's father regarded Wynter across the table. "What's your plan here, Dr. Thompson?"

Putting a resident on the spot by asking them to outline a procedure that in all likelihood they would not do was a tried-and-true technique that quickly identified lazy or inferior candidates. It was axiomatic that a resident never came to the operating room without understanding both the problem and the solution, even when they did not expect to be performing the surgery.

Surprised that the chairman even remembered her name, Wynter made a last swipe over the stomach with the prep solution. "We need to extend the incision and do a thorough intra-abdominal washout as well as a visual inspection of the gastric plication." As she stripped off her prep gloves and extended her arms for the sterile gown which the scrub nurse held out to her, she continued, "We ought to culture the wound too."

"What makes you suspect infection?"

The chairman's tone was level, but his inflection suggested that he disagreed with her.

She shrugged, snapping on her sterile gloves. "I don't. But we're here, and it's a simple test to do, and if we miss an early necrotizing fasciitis we're going to look pretty stupid tomorrow."

He laughed. "And we wouldn't want that, would we."

"I don't know about you, sir," Wynter's eyes sparkled above her mask, "but I wouldn't like it."