Page 59 of Gone Before Goodbye
She marks the natural folds around the eye and then uses a curved size 15 blade to make the incisions. She removes excess skin, muscle, and fat and closes the wounds up. The sliding genioplasty, a very specific type of chin augmentation, is next. She cuts through the mandibular symphysis—in layman’s terms, the chin bone—and shifts it with her gloved hand. She harvests the fat from Oleg’s abdomen via liposuction and transfers it to the face. Then she molds and shapes and shifts until Oleg’s chin and jawline resemble the chin and jawline in the photographs.
Ivan Brovski is scrubbed and masked. He watches everything in silence. When he sees her close to finishing, he says, “Odd.”
“What?”
“You’re even better than your reputation.”
Maggie should be above feeling pleased by the flattery, but the truth is, she’s not. Maybe she would have been in the past. Not now. She closes up, and when she exits the operating room, Maggie sees that the total operating time on Oleg Ragoravich was three hours and fifteen minutes. Not bad. Maggie paces, feeling wired and jazzed. She can’t wait to get back in there. The operating room is soon ready for Nadia’s breast augmentation. Ivan Brovski is already there. Like before, she ignores him. Not out of malice or annoyance. She’s just in the zone. She doesn’t want anything interfering with that. If Brovski wants to watch, so be it. But she doesn’t feel the need to facilitate or hinder.
Focus. Stay in the moment.
As with most surgeries, intermittent pneumatic compressiondevices—think inflatable leg-squeezing machines or high-tech compression boots—are placed on the patient’s legs. This is to regulate blood flow and prevent deep vein thrombosis or again, layman’s terms, a blood clot. The Bovie pad is already stuck on Nadia’s upper thigh. Put simply, it’s a grounding pad used to channel electric currents away from the patient’s body.
Maggie would have wanted to go with the most cutting-edge method of breast augmentation—using a patient’s own fat—but Nadia didn’t have enough fat to donate, and that procedure would have been too subtle a change for what she (or Oleg) wanted. Instead, they were going with the aptly nicknamed, state-of-the-art “gummy bear” implants—solid gel breast implants known for shape retention and realistic consistency. If you slice traditional silicone breast implants in half, the material will leak out like honey. That’s not the case with the more solidified gummy bears.
Most people think they know how breast augmentation works: The surgeon makes the incision, creates a pocket behind the pectoral muscle, places the implant in the pocket, and then centers it behind the nipple. That’s all true, but for the best work, you need to strap the unconscious patient to the operating table so that at some point, you can sit them up in a Fowler position. It is really the only way to evaluate the breast shape and assess the placement. Think about it. Do you want them to look natural only when you’re lying down? Or do you care what they look like when you’re sitting or walking? Duh. To not have the patient cranked up to a seated position because of hemodynamic concerns that have pretty much been laid to rest in study after study is, in Maggie’s view, negligence.
The scrub nurse presses the operating table’s button, moving the strapped-in Nadia into an upright position. Maggie inserts the various sizers and then stands back to see which ones are most symmetrical and appropriate for Nadia’s frame. She has, as Brovski mentioned, the three sizes from which to choose. Dr. Deutsch, her mentor in thisprocedure, told her that when in doubt, go with the larger one because when it’s over, almost every woman he’s worked on says they wished they had gone a little bigger. Maggie keeps that in mind, but she also believes, perhaps wrongly, that Nadia is being somewhat coerced into doing this. In the end, the three hundred ccs, the smallest of the three sizes, provide the best aesthetic anyway, so Maggie goes with that.
At some point Ivan Brovski exits without a goodbye. Maggie idly wonders about that, but again this isn’t about him. It’s about the patient and the procedure.
A few minutes later, Maggie finishes up with sutures and steps back.
It’s over.
Except it most definitely is not.
The scrub nurse turns off the ESU or Electrical Surgical Unit. Then she pulls the Bovie pad off Nadia’s upper right quadricep.
And everything changes.
Maggie freezes and feels her world start to spiral.
“Doctor?”
Nadia has a tattoo on her leg. Maggie bends down for a closer look.
The tattoo is garish orange and purple. It’s a cartoonish image of a goofily smiling serpent with a halo and a silly wink.
“Doctor McCabe, are you okay?”
Maggie has seen only one tattoo like this before.
On Marc’s leg.
Maggie can’t move.
The scrub nurse says, “Doctor?”
Her eyes finally move off the tattoo and up to Nadia’s face. Nadia’s eyes are closed. It’ll be thirty to forty minutes before she’s awake and able to converse. Maggie’s gaze is drawn back to the tattoo.
There is no way this is a coincidence.
She thinks about that tattoo—how Marc regaled her with its college-spring-break origin story and how bad Marc was at handling his alcohol (which he was) and how his friends got him drunk (though it was his fault too, he’d admit) and how they stumbled down the French Quarter—and when he told the story, you could see the New Orleans night sky and feel the thick Creole humidity and touch the brick of the old buildings—and how he ended up in that small tattoo parlor and it was just a dare, no one thought Marc would go through with it, and how the artist, who was definitely drunk or stoned or worse, drew it in pen in mere seconds and that was it, it wouldn’t go any further than that, surely, just a pen drawing, and then the artist—his name was Agent or something like that—took out the needle, and ha, ha, okay it’s time to stop kidding around except no one did and it hurt like hell even with all the alcohol, and when he woke up, the area was all red and Marc thought it might be infected…
How can Nadia have that same tattoo?
“Doctor?”
