I
It was called the Cage; likely it had gained the nickname by the three walls of wire-enforced windows that allowed to charge nurse to overlook all of the bustling activity of the surgery floor. Dean's knock on the open door of the Cage didn't seem to catch the charge nurse's attention, so he repeated it.
"Yes," Chuck said, not taking his eyes from the computer screen or turning around, "Kevin was supposed to be in that room. Dr. Novak requested you instead." Chuck hit the enter key with force and then twisted in his chair. "Given his tendency towards outright disrespect for every other tech I've ever assigned to his room, I'm going to take this as a good sign that I might somehow be able to cobble together some sort of team he can work with, and that I won't have to tell the OR manager that our only vascular surgeon is a completely antisocial dickwad who no one wants to tech for."
Dean blinked. "That, uh, wasn't my question. You've got me working next week, and I asked for it off months ago." He furrowed his brow. "Dr. Novakrequested me?"
"Ducked his head in about ten minutes ago." Chuck leveled a finger at Dean. "You keep him happy. We can't afford to lose the OR hours he has booked with us if management decides he's more trouble than he's worth."
Holding up his hands, Dean tried to look supplicant. "I'll try. Next week…?"
"Right. I'll fix the schedule. All week?"
"Please."
"Consider it done. Oh, and check your case cart – there should be a new instrument set on it, and if it's not, let me know and I'll get on Materials Management's case." The phone rang and Chuck reached to answer it, leaving Dean to slip back out into the corridor and begin his day.
II
"Still not checked in yet?"
Bobby shook his head in response to Dean's question. "Note here says the front desk called the patient and got no answer."
Dean grimaced. "Doc's going to throw a fit."
"What do you want me to do about it?" Bobby asked irritably, crossing his arms and glaring at the computer screen.
"Nothing, but I'm not opening until the patient checks in," Dean replied, crossing his own arms and leaning against the wall. "I'm not gonna waste money if we end up having to cancel."
"Good call," Ellen said behind him. "Just don't disappear – we're going to rush her through pre-op and we'll need you ready."
"I'm not going anywhere," Dean assured her.
There was a thud as the doors to the room were pushed inward to admit Dr. Novak, eyes hard as he glanced around the room. "Would anyone care to tell me what is going on, and why we're just standing around?"
"Your patient isn't here yet," Ellen said quickly in a challenging tone. "The room's ready for her whenever she decides to show up."
"It doesn't look very ready," Dr. Novak retorted, eyes landing on the undraped back table and the unopened supplies on the wire case cart. Even without a mask, he resembled the placid man at the edge of the pond last week only in stature; even his voice was harder, his posture more akin to a coiled spring than a lounging cat.
"This'll take me fifteen minutes at most," Dean said firmly, "and I don't want nine hundred dollars of supplies to be made useless if I open them and your patient cancels. I'm at least waiting until she checks in."
"She's not canceling. Get the case open now or I'll open it myself." Dr. Novak reached for the plastic dust cover of the package sitting on the table. Dean stepped swiftly in front of him.
"Doc. I got this. Trust me." Dean met Dr. Novak's stubborn gaze with one of his own, ignoring the incongruous step sideways his heart took in his chest as Dr. Novak's eyes narrowed.
"Patient just checked in," Bobby announced into the crackling tension. "Just in case anyone isn't too busy posturing to care."
Dr. Novak's eyes didn't leave Dean's. "How long until she's through pre-op?"
"Forty minutes at the least," Ellen responded.
Dean desperately wanted to swallow. It really wasn't fair, how piercing Dr. Novak could make his eyes, and they took on the hue of the scrubs they wore to appear an even colder blue than they naturally were.
"Page me if the room is ready before eight thirty," the surgeon said finally, stepping aside. "I'll go wait for the patient in pre-op."
Breathing freely once again, Dean first allowed himself a quiet sigh of relief before he reached out to grab something from the cart. "Hey, Doc! This might cheer you up."
Dr. Novak turned, and Dean held up the blue-wrapped box that very plainly had "DR. NOVAK'S VEIN STRIPPING EXTRAS" scrawled across the striped indicator tape. Dr. Novak stared for a moment, his eyes flickering between Dean and the box, before a very small smile quirked the corner of his mouth.
"It's about time," he said, but the words had no real edge to them. "See you in forty."
III
Time-out completed, Dr. Novak held out a hand. "Local."
"Quarter Marcaine with epi," Dean said as he handed over the syringe, uncapping the hypodermic needle as he went.
"Sharp down. Fifteen blade."
Dean handed the surgeon the knife, carefully sliding the hypodermic needle back into its cap to rest beside the red sharps container until it was needed again.
"Sharp down. Pickups and Bovie, please."
Dean blinked, but his hands were moving before his mind caught up with the commands, passing Dr. Novak the forceps and shaking the electrocautery pencil free of excess cord before placing it in the surgeon's waiting hand.
The characteristic scent of cauterized flesh began to permeate the air, detectable even through Dean's mask; at one point the smell had made Dean swear off Corn Nuts for the rest of his life, but now it just made him vaguely crave barbeque. One really could grow accustomed to anything, Dean supposed.
"Small weitlander," Dr. Novak said, jerking Dean out of his momentary reverie.
"Weitlaner," Dean corrected automatically, his mouth taking initiative before checking with his brain to determine whether this was a wise course of action. He suppressed a grimace as he held out the retractor.
"Excuse me?" Dr. Novak asked, not taking the retractor.
"It's 'weitlaner.' No d." Dean wanted to squirm under the puzzled scrutiny. "Sorry. Pet peeve. Carry on."
"Weitlaner," Dr. Novak said musingly as he took the retractor and positioned it to hold the incision open. "That name makes even less sense. Debakeys and Metz."
Dean had passed the smoother forceps and the tissue scissors before it occurred to him that Dr. Novak had even asked. Bemused, he looked across to Ellen, who hadn't seemed to notice anything.
"How many instruments do techs even know?" Dr. Novak asked as he dissected down further to reach the deep vein.
Dean considered for a moment. "Hundreds," he replied. "Maybe even one or two thousand. Some of them have several names. Kochers can also be Oschners or Rochesters, depending on the coast the doctor is from."
"Hmmm. Snap."
Thoroughly suspicious now, Dean handed Dr. Novak the hemostat, and on a hunch, readied himself with another. Sure enough, Dr. Novak's second call of "snap" came a few seconds later, followed closely by "tie."
"Free or on a passer?" Dean asked. He'd loaded several strands of the silk onto small hemostats already, in preparation for Dr. Novak taking over his table as he had last time, but Dean got the distinct feeling that today was going to progress somewhat differently.
"Free is fine. Can you hold that?" Dr. Novak indicated one of the hemostats he was holding; Dean passed off the length of silk and took the hemostat, holding it while the surgeon tied the silk tightly around the vessel it was clamping. "Thanks. Come off now and cut that – leave two millimeters on the tails. Pickups back."
Dean handed Dr. Novak the forceps with his free hand while he unclamped the hemostat with the other, then grabbed the scissors and cut the excess ends of the silk. This time when he looked up at Ellen she was watching with disbelief. He shrugged as he set the hemostat back on his table with the others and palmed the scissors; it looked like he was actually going to be useful today.
IV
Dr. Novak worked silently for several minutes before clearing his throat. "So Gabriel told me that you two had an interesting conversation last week."
Heat rushed to the tips of Dean's ears, and he resisted coughing guiltily. "I was more of a captive audience. Dr. Angeles likes to hear himself talk."
Dr. Novak didn't laugh, but Dean could see the crinkles at the edge of his eyes that either meant a smile or a grimace. "That is a very accurate statement. Snap."
The hemostat changed hands again. "So you knew him in college?" Dean asked politely.
Dr. Novak looked up as he held his hand out in wordless request for another hemostat. "Didn't buy the fraternity story, did you?"
Feeling significantly more at ease, Dean handed the surgeon another hemostat. "He does tend to make up a lot of things from whole cloth. I didn't actually believe he had a wife until I met her."
"Oh, trust me. I know his fondness for a good, believable lie better than anyone." Dr. Novak placed the handles of the hemostat into Dean's waiting hand as he took the black silk, threading it around the vessel and knotting it with dexterous fingers. "But that wasn't whole cloth. We were PhiDE brothers." Once again, he held the ends up for Dean to cut.
"Wait. You were in a frat?" Ellen asked, turning her head from the computer where she sat.
"Everyone is always so surprised," Dr. Novak said with a wry air. "Vein hook and skin knife. Is it really that hard to believe?"
"Yes," Dean and Ellen said simultaneously.
"Well." Dr. Novak shook his head, and Dean was almost certain that the wrinkles around his eyes were from a grin. "Assume that anything Gabe tells you is at least based on a grain of truth."
"Even the tattoo?" Bobby asked from behind the drapes, adding his voice for the first time.
"The tattoo story is possibly slightly exaggerated," Dr. Novak conceded.
"How so?" Ellen asked with interest, but at that exact moment, Dr. Novak's vein hook brought up a fragment of saphenous vein that was very determined to drain itself.
"Shit. Snap!"
It was no danger, simply messy; the blood pooling on the field would clot if Dean didn't do something about it, and that wasn't pleasant for anyone. While Dr. Novak continued excising small fragments of vein, Dean busied himself with mopping up the blood and keeping up with the surgeon's puzzling requests for instruments. The requests themselves were not puzzling – hemostat, scissors, vein hook, all in a simple pattern that Dean had memorized the last time Dr. Novak had performed this surgery with him.
What struck Dean as so puzzling was that for no reason that he could tell, Dr. Novak was no longer averse to using a tech.
V
The bottle of enzyme treatment spray was empty. For a short moment Dean considered leaving his instruments in the dumbwaiter without spraying them, then looked again at the blood that was beginning to dry in gummy brown splashes on every item in his instrument pans and he sighed. Garth would give him an earful if he sent down bloody instruments again. He and the new central sterile supply manager were only just beginning to get along; the last thing Dean needed was a petty workplace feud.
With a heavy sigh, Dean reached up to grab the gallon jug of the enzyme treatment solution. The sweet chemical odor of it made his eyes water as he carefully decanted it into the neck of the spray bottle.
The door to the dirty utility room opened, clattering loudly against the cart full of Dean's instruments and knocking one of the full suction canisters to the floor. The lid, thankfully, held, and the canister rolled into a corner as Ellen stuck her head into the tiny room.
"Dean? You in here?"
"Back here," Dean said, looking balefully down at the copious amount of enzyme treatment fluid he'd slopped down his front at the sudden noise.
Ellen squeezed the rest of the way into the room and stooped to pick up the canister, depositing it into one of the biohazard collection bins. "What the hell did you do?"
"Come again?" Dean asked, furrowing his brow as he screwed the cap back onto the gallon jug. Now appropriately armed with a full spray bottle, he began to spray his instruments with the chemical that would break down the thick residue of blood and tissue.
"Dean, I've been the circulator in that room since he got here five weeks ago. He doesn't like techs. He doesn't use techs. He made Jo cry because she was getting in his way. Seriously, what did you do?"
Dean grunted. "Look, Ellen, I know you love Jo like a daughter, but you've circulated with her. She's not fast. She's hideously smart and she knows her shit, but she takes her sweet time. Dr. Novak used to be on a heart team. He's used to getting things he wanted yesterday. Most techs who get jobs in outpatient surgery…" Dean shrugged. "We've got our own pace. Nothing wrong with that. But now that I know what makes the Doc tick, I'm gonna do my best to give him what he wants and keep him happy. And if that means being the kind of tech you'll find in the big hospitals, then…"
"It's not just that," Ellen insisted. "He was downright jovial today. The only time I've heard him use that many words at once was when he was heaping abuse on Bobby for not keeping the patient under deep enough."
"Don't know what to tell you there," Dean said, tossing his sharps container into the larger sharps collection bin. "Maybe try talking to him like a human instead of a human-shaped asshole. It worked for me."