“This was one we didn’t expect,” the nurse said.

“Could sure as hell do without it,” fat boy said. He gave the muscle-relaxant with a sleep dose of Pentothol, then he intubated the patient’s trachea and took over the job of the man’s breathing with a ventilator.

The intern came in, the tall sloppy-looking one Adam had seen in the Ward. Neither the anesthesiologist nor the nurse acknowledged his presence. He began to prep the abdomen, scrubbing it down with antiseptics. Adam watched with interest, wanting to see how things were done here. It looked as though the intern was using a single solution. In the Georgia hospital they had had to wash the field first with ether, then with alcohol, then a third time with Betadine. “I trust you have noted what a smooth-shaven man Mr. Peterson is,” the intern said. “A baby’s ass by comparison is a veritable forest.”

“Richard, as a surgeon you’re a fair barber,” fat boy said.

The one called Richard finished washing down the belly and began to cover the patient with sterile drapes, leaving exposed only a square foot of flesh framed in a field of cloth.

A surgeon came in. Meomartino, the Surgical Fellow, Adam supposed, but wasn’t certain because nobody said hello. A big man with a broken hawk’s-nose and an old, almost invisible scar on his cheek, who yawned and stretched, shuddering, “I was dreaming so very nicely,” he said. “How’s our perforated ulcer? Is he bleeding?”

“I don’t think so, Rafe,” fat boy said. “Heart rate 96. Respiration 30.”

“What’s his blood pressure?”

“Hundred-ten over 60.”

“Let’s go. I’ll bet it’s like a cigarette hole in there.”

Adam saw him take the scalpel from the nurse and make the right paramedian incision, a deliberate parting of flesh that created two lips where before there had been belly flab. Meomartino cut through the skin and the fatty yellow subcutaneous tissue and Adam saw with interest that the intern had been trained to stop the bleeding with sponges instead of clips, at the same time using the pressure of the sponge to spread the margin of the wound so that the glistening gray envelope of the fascia was revealed. That’s damned efficient, he thought; it had never occurred to them to do it that way in Georgia. For the first time he felt a flash of happiness; they have things to teach me here.

Meomartino had incised with slow care, but now he cut the fascia swift and clean. To do it that way, in one sure slash that would not cut into the rectus muscle just below, this man had had to do it well a great many times before, Adam knew. For one stupid moment he allowed himself to resent the Fellow for his easy skill. He half-stood to watch but the slob of an intern moved his head and shoulders over the operating field and he couldn’t see anything else.

He leaned back in the chair and closed his eyes in the dark and saw in his mind what the surgeon below would be doing: he would lift the fascia and undermine it with the sharp edge of the scalpel and then pry it away with the blunt edge, exposing the midline meeting of the rectus. Then he would elevate the muscle and retract it laterally and go through the peritoneum and into the belly.