The Watchmaker’s Hand

She happened to glance at the car’s clock, which sat to the right of the amp gauge and above the oil.

The time was 8:50.

An hour until the next attack.

And where, Sachs wondered, would that be?

36

On the eighth floor of St. Francis hospital, in a room midway along Ward S, Dr. Anita Gomez is calling, “Almost there,” reassuring sweaty MaryJeanne McAllister, who is huffing and grunting in pain. “Eight centimeters. Won’t be long. You’re doing fine.” Labor started early; her husband is out of town, hurrying back, and MaryJeanne is on the phone with him. Apparently, he’s concerned about the sounds issuing from his wife’s mouth. MaryJeanne says, “He wants you to give me some meds. There’s too much pain.” Dr. Gomez refrains from explaining that the level of pain MaryJeanne is experiencing seems perfectly normal. Plus, her patient didn’t want an epidermal or spinal, afraid, wrongly, that it might affect the baby and Dr. Gomez tells her this. “He wants...” A grunt. “Holy shit!... To talk to you.” And offers the phone. The doctor takes it, shuts it off and drops it on a table. “No!” the patient rages. But then she falls silent, apart from the breathing. Both women frown. They hear a curious noise. Low in pitch, from outside. What is that? Dr. Gomez wonders, but then it’s obscured by the mother’s unearthly wail. She hits nine centimeters. “Call my husband,” she rages. Dr. Gomez cheerfully replies, “Get ready to push.”

On the seventh floor, directly below ob-gyn delivery, neurosurgeon Carla DiVito is preparing to repair an aneurysm in the brain of Tyler Sanford in surgical suite 11. The patient presented with what he described as a searing headache, the “worst he’d ever experienced.” Tests of the condition — the swelling of a vessel in the brain — revealed it had not yet ruptured, but the ballooning was sizable. DiVito, the anesthesiologist, two nurses and a resident are present in the room that is, of course, spotless and sterile, but is tiled in the bile green that designers in the 1960s felt, for some unearthly reason, that patients and physicians preferred. Sanford is unconscious and a small portion of his skull has been removed — the burnt smell from the saw lingering unpleasantly as always. Since the aneurysm is large, Dr. DiVito will be using a flow diverter rather than clipping off the vessel. “How do you like it?” a nurse asks. He is nodding toward the Aesculap Aeos robotic microscope hovering over the open brain. “Heaven,” the doctor replies. In the past, most neurosurgeons suffered significant ergometric problems — back pain, primarily — from bending over a patient for hours. The microscope allows her to remain upright and view the incision and procedure on a vertical 4K screen. Whereas she could only do one such procedure a day, now she can easily do two. She glances up to her team briefly. “Let’s get started.”

On the sixth floor, directly under suite 11, is recovery room 3E. The wife and adult son of Henry Moskowitz are sitting beside the bed. “We can have it in the pavilion,” the son, David, says. He’s raised the topic of the venue for his daughter’s sixteenth birthday party, eight months away, not because it must be planned now, but because it will, he hopes, distract his mother from her husband’s condition. She’s always on board for party planning, as he well knows. She considers. “The pavilion’s good. They didn’t trim the grass very well for Edna’s.” “No,” her son agrees. They both stare at the unconscious man, the wealth of machinery around him. The surgeon has assured them that the quadruple bypass went well, and he should be coming out of the anesthetic soon. David now cocks his head, hearing some groaning from outside. Thunder? No, the day is clear. But the brief sound put him in mind of the party venue. “We should see what size tents they have. October can be rainy.” “Yes,” his mother says. “It can.”

On each of these three floors — and for that matter, every floor in this building — near the middle is a room roughly twenty by twenty. The doors are double-locked and covered by large signs: FIRE HAZARD and No Smoking, the latter of which, of course, dated to a different era, but had remained, perhaps because the message still imparted a historical, almost genetic, urgency. Inside these rooms are scores of tanks of oxygen, carbon dioxide, nitrogen, nitrous oxide and regular air. Some of these are stored, some fitted to hoses that feed into wall sockets. Also present are tanks of sevoflurane, an anesthetic. While nonflammable in itself, fires and explosions can occur when this gas reacts with an absorbent used in anesthesia procedures, barium hydroxide lime, of which there are several containers here as well. In addition, here are receptacles of cyclopropane, divinyl ethel, ethyl chloride and ethylene. These facilities are known among staff as the Dynamite Rooms.