Dean’s Monday began like any other: it began with the boards.
Even hospitals that had switched completely to LCD screens still called them boards, harkening back to the days when the schedule for the operating suites was painstakingly written on dry erase boards every morning. There was a great deal of information to be found on the boards; the shape of the entire day rested in the color-coded lines and columns. Dean’s eyes scanned until they found his name and room assignment.
His stomach dropped.
“Oh,” another tech, Jo, said sympathetically, shoving her ponytail underneath a scrub cap. “Have you worked with him yet?”
Dean shook his head. “But his reputation precedes him.” He turned his head to look at her. “Have you?”
“Last Monday.” Jo made a face. “His reputation does him justice.”
A glance at the clock reassured Dean that he had plenty of time before he needed to clock in. “Any tips?”
“No talking,” Jo replied. “I’m serious. No talking, no music. He doesn’t even like having a tech there. By the end of the day I was setting up my table and letting him just grab what he wanted.”
Dismayed, Dean looked at the others assigned to his room. Anesthesia was Bobby and Ellen was the circulating nurse; normally that kind of room combination would mean a day of lighthearted ribbing and laughter. “And what’s he like?”
“I don’t really know,” Jo admitted. “I didn’t really get the measure of him. He snapped a lot.” She peered around the hallway to make sure the surgeon in question was not within earshot. “He’s a bit of an asshole.”
“Like, Zachariah brand asshole or Angeles brand asshole?”
Jo shrugged. “I think we’re going to have to just call it Novak brand asshole.”
“Great.” Dean heaved a sigh as he hitched his bag higher on his shoulder. “I’m gonna need some coffee.”
“Oh, great. You’re the tech today?”
Grin hidden by the mask he was tying on, Dean rolled his eyes. “Had I known I was in your room today, I’d have called in.”
“Yeah, right. You haven’t called in a single day since you got here,” Bobby scoffed. “The doc’s here and wants to get started. Ellen’s doing the pre-op right now.”
“What?” Dean gestured furiously at the cart of supplies and instruments, and then at his bare table. “Bobby, I haven’t even opened yet. It’s not even a quarter after. Patient’s not set to roll in until seven thirty.”
“I know.” Bobby tore into an airway mask with more force than necessary. “Them’s the breaks. Open fast and I’ll move slow, all right?”
“Dammit,” Dean muttered, eyes scanning the contents of the cart. “Everything better be here, then,” he conceded, reaching for the first package.
It was, thankfully, not a large case; a vein stripping was remarkably straightforward, though he did have to pull his own suture from the racks, keenly aware of the seconds slipping by as he scanned over the boxes of suture to find the ones he was looking for. He hastily popped the packages open onto his table and surveyed the haphazard mound of supplies. He hadn’t had time to open in anything even approximating an orderly fashion; the best that could be said of his back table at the moment was that everything was still sterile and nothing was in immediate danger of sliding to the floor.
“You good for me to bring the patient?” Bobby asked, heading for the door.
“Yeah,” Dean replied, though he still felt like something was missing as he took a mental inventory. Gowns. Gloves. Towels. Vascular instrument set. Suture. Sponges and drapes were in the vascular supply pack, the first thing he’d opened. Everything should be -
“Weitlaners,” he said aloud to the empty room. “Fuck.”
He dashed into the core, where supplies and instruments were stored, and rifled through the container where single-pack weitlaners were kept. “Who do I have to suck off to get goddamn four inch weitlaners when I need them?” he mumbled to himself. “Garth!” he called, peering between the wire shelves. “Do you have any weeties smaller than my head?”
“Room five has them all,” the sterile supply manager called back. “They’re doing parathyroids all day. The ones in your set not good enough?”
Dean swore under his breath as he emerged from the shelving. “Doc’s preference card specifically says four-inch weitlaners. They’re sixes and eights in the set.”
“Well, doc’s in for some bad news,” Garth said apologetically. “Let him know we’ve got them on order for his custom set. Sorry, man.”
“No worries.” Not technically true; Dean didn’t know exactly how the doctor would react to not having the specific instruments he’d requested, or if he’d even notice. Some doctors didn’t, and were just happy with whatever the tech handed over if it did the job. Hoping without much conviction that would be the case, Dean returned to his room.
Bobby had returned from the pre-op holding area already and was helping Ellen slide the patient from the gurney to the operating table. Ellen shot his back table a venomous look and Dean held up his hands innocently.
“I’m gonna go scrub,” he said. “You good here?”
“We’re fine,” Ellen said pointedly, looking at his table again. “Go scrub.”
The water pressure in the scrub sink was, of course, more suited to subduing mobs than washing hands; the front of Dean’s scrubs were soaked with the spray within seconds. Watching the second hand on the clock make its way around the face, Dean almost didn’t notice the man tying a mask to his face as he strode into the operating room, not even bothering to spare a glance for Dean at the scrub sink.
“Hey, Doc,” Dean muttered under his breath, scrubbing a little harder with the brush to spread the yellow iodine suds around. “Good to meet you. I’m Dean, your surg tech today. Not that you give a rat’s ass.”
“I’m Ellen Harvelle, circulating nurse,” Ellen announced to the room in a rehearsed tone, holding up a sheet of paper. “And this is Victoria Wilson, patient record number A571942.”
“Correct,” Bobby confirmed from the head of the bed, behind the surgical drape.
“Victoria has consented to a left saphenous vein stripping by Dr. Novak. The consent is signed, witnessed, and dated. She’s had a gram of cefazolin that just finished a few minutes ago, she has a sequential compression stocking on her non-operative side, and her grounding pad is on. Do we all agree to the side, site, and procedure?” She paused for a split-second for the murmurs of assent before turning to Dean. “Dean?”
“Dean Winchester, surgical technologist,” Dean recited. “I have all the instrumentation needed for this case, with additional outside the room should we need it. On the field I have twenty cc’s of quarter percent plain Marcaine, and initial counts have been established. Bobby?”
“Bobby Singer, CRNA,” Bobby’s voice issued from behind the drape. “Victoria’s a reasonably healthy individual with no allergies or comorbidities to speak of, other than a bit of dementia. She’s had her gram of Ancef. Risk of fire is minimal. She’ll get Toradol at the end of the case for pain and she’s got her granddaughter waiting to take her home. I don’t have any other perioperative concerns. Doc?”
“Cas Novak, surgeon,” the doctor said, adjusting a glove. “We’re doing a left saphenous vein stripping, it’s routine, patient should go home today. I don’t anticipate any unusual blood loss. Any additional safety concerns?” He didn’t wait for anyone’s response, instead reaching out to Dean’s back table.
“Need something, Doc?” Dean asked pointedly.
After some time in the operating room, it becomes easy to read facial expressions even if only the surgeon’s eyes are visible. Even so, it was remarkable how much exasperation Dr. Novak seemed to be able to express with just his eyes.
“Just put everything where I can get to it when I need it. Please,” the surgeon added, almost as an afterthought.
Dean nodded. “Everything but my sharps.” He’d placed the red sharps container near his end of the table on purpose.
The blue eyes above the face mask hardened. Dean matched the glare with an even, stubborn look of his own.
“Local,” Dr. Novak said, voice flat.
Dean uncapped the needle and passed the syringe. “Quarter plain Marcaine,” he announced – practically chirped – with exaggerated enthusiasm. He was sure he was supposed to see how the doctor rolled his eyes, even if he ducked his head as he did it.
“Sharp back. Knife.”
Dean was already waiting with the knife; Dr. Novak took it without a word. Dean recapped the needle and watched out of the corner of his eye as he picked up his second knife. As soon as Dr. Novak looked to be done with the incision, Dean cleared his throat.
“I’ve got a fresh blade for you here, Doc. Can I have the skin knife back, please?”
Dr. Novak looked up, blade in his hand hovering over the incision. “You’re one of those, are you?”
“One of those,” Dean agreed amiably.
Without a word, Dr. Novak held out the knife. Surprised at the lack of resistance, Dean handed him the new knife as he took the other. Perhaps this wouldn’t be that bad after all, he mused as he replaced the blade on the knife handle with a fresh one.
“Knife back.” Dr. Novak held it out as he peered at the instruments Dean had laid out. “Do you have weitlanders?”
Dean grit his teeth, as much at the incorrect pronunciation as at the request. “Edge of the pan, on the right,” he said.
“Those are huge,” Dr. Novak said dismissively. “This isn’t a triple-A. Anything reasonably sized?”
“‘Fraid not, Doc,” Dean replied as neutrally as he could. “We don’t have many baby weeties and they’re already open in another room. CS has some on order for your custom set.”
“And that will be fantastic, when they get here,” Dr. Novak said icily, “but does very little to help me right now.” He heaved a sigh as he reached into the pan. “Senns will have to work. Here.”
Dean watched in quiet dismay as the surgeon placed one handheld retractor in either side of the incision. No. Surely he wasn’t going to make Dean hold the incision open for the entire case.
“Here,” Dr. Novak said again, nodding towards the retractors.
Resigned to his fate, Dean took hold of the retractors, contorting his torso to make the most of the awkward positioning. He could only hope that this surgeon was a fast one.
“You can come out with those,” Dr. Novak said absently, tapping one of the retractors. Not losing a moment, Dean withdrew the retractors and put them back down in the instrument pan, then immediately tried to repair some of the havoc the surgeon had wreaked upon his back table. Dean was not an intrinsically neat and tidy person – any glance into the trunk of his car would prove that – but the sight of the black silk strands and hemostats and scissors heaped without any regard to the order of his table had been setting his teeth on edge. For the last twenty minutes he had stood, helplessly holding the retractors, as Dr. Novak had laid waste to the orderly rows of instruments.
Even now, as Dean attempted to set the instruments back as they should be, Dr. Novak was reaching around Dean’s hands and grabbing a handful of hemostats, not appearing to care that he upset the entire rack of instruments as he did so. Dean grit his teeth and added two more hemostats to the hoard that Dr. Novak had amassed up by the patient’s leg, in the hopes that if he had all of them, he wouldn’t rifle around on Dean’s table anymore.
Dean’s hand was already moving before he even had the chance to register what the order had been. He turned and placed the knife into Dr. Novak’s waiting hand.
“I want to keep this up here. I’m going to be using it a lot and I can’t just wait for you every time. Give me an emesis basin or something to put it in.”
Dean opened his mouth to argue before realizing that he really didn’t care anymore. If it was in a basin, it at least wouldn’t cut through the drapes, and would be visible enough for Dean and the doctor to avoid sticking themselves, and that was all that Dean really cared about. He plunked the kidney-shaped basin next to Dr. Novak’s collection of hemostats and moved his hand just in time to avoid being stuck with the blade as Dr. Novak tossed it in.
Thus began the tedious repetition of vein stripping, a procedure only slightly more interesting than watching grass grow. Dean watched, shifting from one foot to the other, as Dr. Novak made an incision, reached in with the curved vein hook, and withdrew enough vein to clamp with a hemostat. Twisting it until the end he’d cut previously came out of the incision, he’d cut the vein, unclamp it, and then move an inch down the path of the vein in the leg to do it again. Dean noted the multitude of purple ink from the surgical marking pen, where Dr. Novak had mapped out the vein and where he would be stripping, and held back a bitter sigh as he calculated in his head just how much more time they were going to be spending there.
An abrupt, frantic movement, very unlike the deliberate and competent movements the surgeon had displayed so far, forcibly drew Dean’s attention back to what Dr. Novak was doing just in time for him to hear the quiet metallic clatter of an instrument falling to the floor. Immediately Dean’s eyes swept the field, surveying what had fallen, and his heart sank as he realized the casualty simultaneously with Dr. Novak’s “Ellen, can you open another vein hook please?”
“There’s only the one,” Dean said disconsolately, halting Ellen as she turned to go search for one in the core.
Dean felt the surgeon’s incredulous gaze turn to him just as much as he saw it. “What do you mean, only one?”
“We only have one vein hook,” Dean repeated. “It’s not even ours. We’re borrowing it from St. Luke’s. We never did vein stripping here before you came.” He took a breath, but Dr. Novak interrupted before he could continue.
“This is unacceptable.” Dr. Novak took a step back and crossed his arms. “One vein hook? Is sterile supply just incompetent?”
“There are more on order,” Dean interjected smoothly, confident that was the case, “and we can flash this one now.”
“And how long is that going to take?” Dr. Novak demanded.
“Forty minutes, max,” Dean promised, sincerely hoping he was right. “We’ve got an ultrasonic right there in the core. We don’t even have to send it anywhere.”
“And so we’re just going to stand around in the meantime?”
“Doc, you can yell at me ‘til you’re blue as your scrubs while we wait, if it makes you happy,” Dean snapped, “but for the love of God would you please just kick the damn thing behind you so Ellen can get it into the ultrasonic and we can get on with our lives.”
For a crackling, tension-filled moment, Dean worried he’d gone too far; Dr. Novak was glaring at him with open animosity, and from the corner of his eye he could see Bobby standing up to peer over the top of the drape at the head of the bed to see for himself what was about to happen.
Without breaking eye contact, Dr. Novak shifted his weight, and with one foot sent the vein hook skittering across the floor behind him. Ellen stooped to pick it up with a gloved hand and slipped from the room with an approving backwards glance at Dean.
“Give me the three-oh Vicryl,” Dr. Novak said at last, his tone studiously neutral as he stepped back up to the patient’s side. “I’ll close the groin incision while we wait, and finish the rest when the hook comes back.”
Praising whichever god had prompted him to open all his sutures before the case instead of waiting for Ellen to open them at the end, Dean loaded the needle onto the driver and passed it off, sharing a look of relief with Bobby as the apparently placated surgeon set to sewing.
“That was the worst of it,” Dean finished, taking a long swig of his beer. “Didn’t apologize when we finally finished, just stormed off to the dictation room. Left me and Ellen to clean and dress the three or four million little puncture incisions he made. And then he basically ignored me completely during the AV fistula later.”
“He’s only there once a week, though, right?” Dean’s brother Sam twisted the lid off his own beer and tossed it to the coffee table.
“Yeah, Mondays. And next Monday is Labor Day, so no one will have to deal with him since we’re closed.” Dean shook his head. “Good thing, too. I can only stand so much arrogant bastard per week.”
“Speaking of the long weekend,” Sam said, leaning forward slightly, “I…have a favor to ask.”
“Yeah? Shoot.” Interest piqued, Dean leaned forward as well.
“You’ve got good taste in jewelry.”
Dean glanced at his bare hands before furrowing his brow. “Obviously.”
“And you’re pretty good friends with Jess, and you know the kind of stuff she likes.” Sam took a deep breath. “I’m gonna start shopping for a ring for Jess this weekend. Was hoping you’d give me a few pointers.” Sam coughed. “I mean, since you already scoped out most of the stores around here.”
Dean shifted in surprise. “Well, I mean – that was three years ago. Half of those stores are gone. But yeah. Of course.” He grinned suddenly. “Finally gonna make the plunge, huh?”
“Dean, we bought this house,” Sam pointed out. “We’ve already well and truly plunged.”
“Yeah, but – all official-like.” Dean reached out and clapped his brother on the shoulder. “Congratulations, man. It’s about time. You’ve been dating for what, fifty years now?”
“Ten,” Sam scoffed, lifting the bottle of beer to his mouth. “But now that I’m finally nearly done with my residency…” He shrugged as he took a drink. “And it took me a while to save up for anything worthwhile.”
“I hear you.” Dean nodded. “Ring I bought – nearly bought, anyway – I hadn’t ever paid so much for anything that didn’t have an engine.”
“You ever hear from her?” Sam asked, entirely too casually.
Dean shrugged. “From time to time. She’s at your hospital. You probably see her more often than I do.”
“Nah. I don’t spend much time in surgery.”
Nodding thoughtfully, Dean picked at the corner of the label on his bottle. “Her taste was a bit different from Jess’s,” he said absently. “You’ll still probably want something that’s pretty from the side, though, so she can wear it around her neck when she scrubs and it’ll still look nice. If the main metal’s gold, have them line it with something that won’t scratch on a chain. Might want a setting that doesn’t stick out, so it doesn’t catch on the neck of the gown. Of course,” Dean amended, “that’s assuming she’s scrubbing forever. I know she was looking at nursing school.”
“She is,” Sam confirmed. “I think she was waiting until I finished up.”
Dean forced another smile to his face. “You two are going to make each other so happy it makes me sick.”
Sam wasn’t fooled; it was nearly impossible to fool his brother. “Hey. You’ll find someone who will put up with you too.”
“Me? Hah.” Dean leaned back and finished the last of his beer with a cavalier swig. “This is Kansas. Not the friendliest place to be openly…whatever. Not straight.”
Sam coughed. “I know it’s rough, man. I wish I could do something to make it easier.”
“Easy? I don’t want easy.” Dean shook his head forcefully. “Easy would have been marrying Cassie and pretending. Hell, she’d probably still say yes if I went and asked her right now. But the easy way was wrong and…” Dean trailed off, then shrugged. “This may not be great, but I’d be miserable pretending, and so would any girl I subjected to that.”
“At least you know now,” Sam offered weakly.
“However much good that does me,” Dean replied darkly. He shook his head. “Sorry. Didn’t mean to bring you down. There’s a really good jeweler on the Missouri side of downtown. I’ll give him a call and tell him to expect us on Saturday.” He smiled, and it was mostly genuine, even if the corners of it drooped as he tossed the empty beer bottle into the garbage and started up the stairs to his room.