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That's how it had started--a sick teenage girl who was taken to the operating room because the surgeon suspected a ruptured appendix. When he'd opened her up he had found a perfectly normal appendix but a decidedly inflamed and torsed ovary. Now, any general surgeon worth his salt could have removed an ovary, but the rules of the game call for a specialist in gynecological surgery to be called in to perform the task.
Though Angel wasn't precisely a gynecological surgeon, she was an M.D. in the family practice residency at Fielding Medical Center and as part of her training she had pushed to learn gynecological surgery. This would not have been the first ovary she had removed, and she felt perfectly capable of doing it in the present instance.
What was so galling was that Dr. Williams, her supervisor, had been perfectly willing to let her do the surgery until the maniac with the black hair had glared at him and said, "Not in my operating room, she won't. No one has proved to me yet that a family practice resident knows how to do proper gynecological surgery and until they do she can hold a retractor."
Williams wasn't supposed to back down under that kind of pressure, of course. The man was a wimp as far as Angel was concerned. She had said quitefirmly, "I've removed several ovaries before, Dr. Lenzini."
"Well, you're not doing it on my patient," he informed her bluntly. And Williams had just let him get away with that nonsense.
The family practice residency was not quite a year old at Fielding, but the other doctors already showed some respect for it. Not Lenzini. You'd have thought Angel was a medical student from his attitude. He stood away from the operating table, his wild hair barely contained by the scrub hat, his mouth and nose covered with a mask that merely heightened the effect of his demanding eyes and disordered eyebrows. Lenzini watched every movement Williams made, and looked as though he wouldn't hesitate to criticize even though the older man probably had twenty years of experience more than he did.
Angel wasn't sure why the male doctors found it necessary to make remarks about their unconscious female patients. Possibly it was to embarrass the females in the operating room--including doctors, nurses and technicians. Possibly it was to make themselves seem more in charge. But it was a very annoying habit which she had noticed more than once on the gynecological service. Dr. Williams had not seemed particularly egregious on other occasions, but perhaps he felt it incumbent on him now, under Lenzini's glare, to be one of the boys.
For whatever reason, he said, "These girls are so stupid to get pelvic inflammatory disease."
Before she could slip a rein on her tongue, Angel heard herself saying, "Men think with their dicks."
Williams stopped what he was doing and stared at her. In his coldest, most hostile voice he said, "I beg your pardon."
Something strange was happening to Angel. Though she would have bitten her tongue to prevent the remark, now that she had made it she refused to take it back. "I said," she said, remembering that it should have been her operation, "men think with their dicks."
There was a muffled snort from Dr. Lenzini which might have been amusement or fury. Angel didn't know or care which it was. Everyone else in the room seemed frozen in place. After a lengthy pause, Dr. Williams bent to his task again, saying, "You can't talk like that during surgery."
"Well, I thought that's what was expected," Angel remarked sweetly. "Making sexist comments. I've been feeling a little guilty about not joining in when I scrub on gyn operations."
"I don't make sexist comments," Williams snapped. "We'll discuss this later."
This was supposed to intimidate her, of course. As a resident, she had to cater to all the doctors higher up, the attendings and the people in her department. If they didn't like the way a resident talked to them, or disagreed with them, they could write her up and give her a bad evaluation. Angel was amazed that anyone came away from being a medical student and a resident with an ounce of backbone left. She had begun to feel her own backbone soften over the years and recently it had begun to seriously worry her.
Williams was finished with removal of the ovary and, stripping off his gloves, he turned to Lenzini. "If you'll close, I'd like to have a word with Angel."
"Angel." The behemoth laughed and cocked his head at her. "Now there's an inappropriate name." When she turned to leave he said, "No, don't go. I'm going to let you close. I want to see if you're as good with your hands as you are with your mouth."
Sexual innuendo was as rampant as sexism in the medical world. "Men think with their dicks," Angel muttered, stepping back to the table.
"I know," he said. "It's only when you forget that you get in trouble."
Angel refused to look at him. The door closed behind Dr. Williams and she accepted the suture the scrub nurse held out for her. Dr. Lenzini stood close beside Angel, watching every move with hawk eyes. When she had finished, he shrugged. "Not bad. Of course, any general surgery intern could do that."
Angel snapped off her gloves and struggled to remove her surgical gown on which the larger men, like Lenzini, merely hunched their shoulders to break the seals. He seemed about to lend her a hand when the circulating nurse deftly stripped her of the disposable item and tossed it in the waiting plastic bag.
"Thanks, everyone," Lenzini said, as if it were his ritual close.
And a nice ritual, Angel thought, not remembering ever having heard someone say it before. Somehow it made them feel like a closer team, and appreciated. She would have to remember it for when she was in a position to be in charge of an operating room.
"Not so fast," Lenzini ordered, catching up with her as she started down the hall. He was truly a large man, six four or five, with more the build of an orthopedic surgeon/former football star than a general surgeon. He had not removed the scrub hat, but his mask was gone and Angel was confronted with what she could only describe as a smirk. "I think, since I was captain of the ship, that I should get to be there when Williams bawls you out."
"I doubt if he'll want an audience," she said, pulling off her own scrub cap. The women almost always chose the bubble caps which left their hair relatively unscathed. Angel gave her head a slight shake and her auburn tresses flowed down to her shoulders. She'd been on call the night before and had gotten almost no sleep. Her body ached with tiredness, which only intensified after having to be particularly alert during the oophorectomy just now. She wanted nothing more than to find a bed and fall into it, but Beth, the circulating nurse, had whispered that Dr. Williams expected her to meet him in the residents' lounge. "And you probably have a lot better things to do than follow me around," she added to Lenzini.
Dr. Lenzini seemed unimpressed with her attempt to shoo him off. He strode along beside her at a pace that showed he was attempting, barely, to match her stride and not overtake her in his usual impatience to get where he was going. "I don't have another operation until this afternoon and I can't think of anything I'd rather do than watch him try to ream you out."
Angel wasn't sure how to take this, so she said nothing. The residents' lounge was deserted except for Dr. Williams, who stood in front of a set of windows that glared with March sunshine. Angel had almost forgotten that it was turning spring outside in the real San Francisco world. Williams looked disconcerted by the appearance of Dr. Lenzini behind her, but the younger doctor just grinned and said cheekily, "Thought I should see how an old pro handles this kind of situation." He immediately plopped down on one of the two orange plastic sofas and cocked his head attentively.
After waving her to the far end of the other sofa, Dr. Williams adopted one of those hurt, puzzled expressions people use when they're trying to pretend they aren't madder than hell. He marched back and forth across the room in front of the glaring windows.
"I can't believe you did something that stupid," he began. "That was just plain nuts, saying something like that. You know what hospitals are. It will be all over the place before noon."
Angel knew that was quite likely. She also knew he thought he'd look like a fool if he let her get away with it. Lenzini merely regarded her inquiringly. But Angel wasn't ready to say anything.
"I don't think you understand how serious this is," Williams insisted. Probably not serious enough, on the face of it, to throw her out of the program, especially since it was March and most of her evaluations for the year had been excellent.
"Sure I do," she said. "Day after day I get to stand there and hear women abused by the male doctors. If I know what's good for me, I keep my mouth shut. Of course the doctors aren't aiming any of this abuse at me. They're just making routine comments about how inferior women are, which I shouldn't take personally, even if I am one. Because of course they don't mean it about me, or any of the other women in the room, or even any women they may be married to or associated with. Men think with their dicks."
"Stop saying that! It's a crude, childish, abusive thing to say."
"Then why are you saying it?"
"Because it's the kind of thing I hear all the time. See one, do one, teach one."
Lenzini laughed. "She's got you there, Williams."
Dr. Williams glared at him but addressed Angel. "Don't be flip. Do you really feel that way about men?"
"Well, no, but then every man I've ever heard say something sexist has assured me that he isn't a sexist. Apparently you don't have to be sexist to say sexist things."
"It's a matter of opinion, what's a sexist remark."
"Yeah," Lenzini chimed in, mocking one or the other of them. Angel couldn't be sure which. He lounged easily on the orange plastic, making it squeak as he shifted his long legs. "Some women are too sensitive."
Dr. Williams, ripe with avuncular sorrow, moved away from the windows and came to loom over Angel. "I've invested a lot of time in your career, Angel. I thought you were serious about medicine."
Angel refused to take that bait. He wanted her to grovel and she wasn't having any of it. She was overworked, underappreciated and regularly humbled. For this she should apologize? No way! Behind Williams she could see Lenzini, who grinned at her, raised his eyebrows and winked. Really, the man was impossible.
The tension in the room increased as her silence lengthened. Color rose from Dr. Williams's neck to his face and he looked as though he were about to explode. Just as he opened his mouth to speak, Lenzini rose and said, "That's the problem with letting women into the operating room. They think they should be treated fairly. Where did they get an idea like that? Tell me, Angel, why you think women should be treated fairly in the operating room?"
Angel didn't know if it helped that he was making a mockery of the whole subject. Williams looked ready to throttle him and she had no simple answer to such a ridiculous question. Lenzini watched her patiently, thrusting a hand into the back pocket of his scrub pants and withdrawing a stick of chewing gum, which he proceeded to unwrap and stuff into his mouth. After a minute he said, "Well, I can understand your hesitancy. There isn't any reason we should treat women fairly in the operating room, is there? They aren't treated fairly anywhere else. Why should we be the exception?"
Lenzini snorted. "Angel is just the only one who's spoken up. Of course your program is sexist. Mine is." He bowed in Angel's direction. "It's not, young woman, that we intend them to be sexist, it's just a long line of tradition in medicine. It's changing, but slowly. And having most of the women buy into it doesn't help."
"Blame the victims," she retorted. "You're asking the women to be stronger than the men."
"Hell, it's for their benefit."
"It's for everyone's benefit."
Lenzini shrugged. "Maybe." He turned to Dr. Williams and said, "Let's forget it, shall we?" Peering at Angel's name tag he added, "Dr. Crawford made a joke in the operating room. We misunderstood her."
Williams frowned. "We can't have the residents trying to make fools of us. The whole system would break down."
"I don't think Dr. Crawford is capable of making a fool of me," Lenzini protested. "Or you either," he added as an afterthought. "Bet she was on call last night."
"I would have said it if I hadn't been," Angel insisted.
Lenzini laughed. "Sure you would have. Come on. I'm taking you to lunch in the cafeteria."
"Because then it will be obvious to everyone that I knew you were joking and that I forgive you."
"Oh, wow. That's really generous of you."
"Just smart," he replied, reaching down to grasp her hand. "You coming, Williams?"
"No." Dr. Williams still wore a prodigious frown. "I hope you realize we've been lenient with you this time, Angel. A repeat of this kind of behavior could be damaging to your career."
Threats always rubbed Angel wrong. But Lenzini had a firm grip on her hand as he pulled her out of the mushy sofa and his eyes challenged her to make a wrong move.
"Yes, Dr. Williams," she sighed, pulling her hand from Lenzini's grip. "I understand."
"Good. Don't forget to look in on our patient this afternoon."
"I won't, Dr. Williams."
Satisfied, the older doctor left the room and Angel stood staring after him.
"You can stick your tongue out if you like," Lenzini offered. "I won't snitch."
Angel would have liked to tell him to go to hell, but his suggestion of being seen with her at lunch was actually eminently sensible. "You're all heart."
Though it was shortly before noon the cafeteria was already crowded. Fielding Medical Center was a large complex and the cafeteria served a vast population, so there were extensive seating arrangements, indoors and out. To one side a segregated area for doctors and their guests was beginning to fill as well. Angel was still in her green scrubs and Dr. Lenzini in addition still had his scrub hat over his dark hair. She preceded him in the line for a choice of chicken or barbecue. Thinking he would choose the chicken, a much more medically correct choice, she picked up the barbecue. He followed suit, but in addition accumulated an extra potato salad, a square of cornbread and a piece of cherry pie.
"I'm a growing boy," he informed her lightly.
Angel paused at the cashier to present her card but Lenzini waved it aside, saying, "I'm getting both of these."
"Thanks, but I'd rather get it myself," she said, again presenting her card to the cashier, who, after a brief glance at Lenzini, accepted it.
"You women," he muttered. "What the hell am I supposed to do with all the money I make if I don't buy some poor house officer lunch every once in a while?"
"You could contribute something to a battered women's shelter."
"Actually..." But he changed his mind and nodded toward the doctors' dining area. "We'll be most effective over there, I think. That is, if you aren't going to object."
"I appreciate what you're doing," she replied, weaving her way behind him past a dozen tables.
"I love a grateful woman."
Lenzini surveyed the doctors' area carefully before edging toward a long table with three other people. One of them, Roger Feingold, had been the anesthesiologist on the case that morning. The other two were an older neurologist and a middle-aged orthopedic surgeon. As he set his tray down, Lenzini said, "I don't know if you all know Angel Crawford, a family practice resident here."
"We've just been hearing about her," the neurologist, Ben Taylor, admitted. "Roger was unfolding the saga for us. He tells a good story, Roger. Exaggerates sometimes."
Lenzini laughed. "Probably not this time."
The orthopedic surgeon, who had sat silent until now, demanded, "Did you really say men think with their dicks in an operating room? That sounds pretty uncalled for to me."
Angel had never met this man before but his disapproval was palpable. She intended to point out to him that Dr. Williams had called the teenager stupid for getting pelvic inflammatory disease but before she could open her mouth, she felt Lenzini nudge her toward a chair.
"I thought it was a really astute observation," Lenzini remarked as he claimed his own chair beside hers. He dug right into the potato salad. "You're a surgeon, Doug. And what do we say about surgeons? They've got to have balls, right? That's what we say."
"These days," Roger pointed out, "we say they have to have a fire in their bellies."
"Yeah, well, it's the same thing, isn't it?" Lenzini stabbed the air with his fork to make his point. "We're saying they have to be men, or think like men, or act like men. Now, Angel here is a woman. And it irritates her that we think only men can really be surgeons."
"Who thinks only men can be surgeons?" protested the orthopedic surgeon, Doug. "There are plenty of women surgeons. It's hard for them to be orthopedic surgeons, of course, because of the physical strength involved, but ..."
Lenzini and Roger burst out laughing.
Dr. Doug looked offended. "Well, it's true. When a woman tries to enter the program we point out to her the necessary physical force needed on some of our cases because she should know about that up front."
"So she'll know she has to get help from her techs once in a while, like everybody else," Lenzini concluded. "So even more often than most, so what?"
"What if there aren't any techs around?" Doug demanded. "What's she supposed to do then?"
"The same thing you'd do, Doug," Roger suggested. "Find one. Techs are everywhere."
Angel was taking this all in as she forced down her lunch. Apparently Dr. Lenzini wasn't going to make her defend herself. In fact, it looked as though he weren't going to let her speak for herself at all. She waited until she had his attention by smiling kindly at him, then asked, "So why wouldn't you let me operate, Dr. Lenzini?"
Rhetorically he asided to Roger, "Have you ever encountered such an inappropriate name? Well, Angel, my guess is that there were three or four things at work here. First, I've never been much of an advocate of the family practice residency in a city like San Francisco. We're specialists here, not generalists. Second, Williams didn't stand up for you when I challenged him. That didn't say much for your experience. Third, I was annoyed that I'd misdiagnosed the kid as having appendicitis and wanted to take it out on someone. You were by far the easiest."
The neurologist shook his head. "I guess that about covers it. Too bad we can't have this much clarity on everything."
"Wait a minute, wait a minute," Lenzini protested. "I said there were four reasons."
The others regarded him with mock expectancy.
"And fourth, I remembered my own residency and how character building it had been. We tend to forget that," he told his fellow attending doctors. "Residency is a period in your life when just about anyone can dump on you and there's very little you can do about it. Isn't that so, Angel?"
Angel wiped barbecue sauce from her fingers. "Yes, that's true, Dr. Lenzini."
"You see?" he said triumphantly. "Now here was a perfect opportunity to build this young woman's character. She didn't avail herself of the opportunity, of course, but that may be because her character is already well enough developed. Who is to say? Well, perhaps Dr. Williams. Dr. Williams knows her better than we do. He told her that what she said was crude, childish and abusive, and she agreed with him. He demanded to know why she would say such a thing and she said, 'See one, do one, teach one.' He asked her if she really felt that way about men and she said sexists don't think they're sexist, or something like that. He said he'd invested a lot of time in her career."
His companions, unsure at first of where he was leading them, were now openly amused, except Dr. Doug who took these matters very seriously. Dr. Doug said, "It's a matter of opinion, what's a sexist remark."
The others howled. Lenzini confided, "That's what Williams told her. And I told her that women were too sensitive."
While the others laughed, Dr. Doug looked perplexed. "But that's true," he insisted. "Women read too much into casual remarks."
"Like men think with their dicks," Lenzini concluded. "It's all the same, isn't it? Hey, Roger, did you have to intubate Mrs. Helvici in the ICU?"
And the conversation about Angel was over. She didn't quite feel a part of their discussion of other hospital happenings but Lenzini turned to her occasionally to include her in the group or to learn if she'd heard a particular bit of gossip. As soon as she had finished eating, she excused herself, pleading pressing patient matters on the sixth floor. The men each acknowledged her departure with a nod or wave. Lenzini rose, his mouth curved ruefully. "Watch your step, Angel."
"I usually do, Dr. Lenzini." She turned to go but paused to say, "And thanks."
Angel received a number of censorious looks during the afternoon, but for the most part she was too busy to pay any heed to them. It could have been much worse, and probably would have been without Lenzini's assistance. She had five post-operative patients to see and three new admits on whom to do history and physicals, plus a trip to radiology to go over the results of a CT scan on an outpatient of hers. Several of the doctors and nurses teased her about what they'd heard, but she pretended surprise at their thinking it was anything more than a joke. At any moment she expected a call from the head of the department, but it never came and at seven she escaped to her flat two blocks from the hospital.
Exhausted, she climbed the two flights of stairs and leaned heavily against the door as she tried to unlock it. Her eyelids were so heavy she could hardly keep them open now that she was minutes away from her bed. The door opened into an entry hall which, like most of the rooms in the flat, had dark stained wood wainscoting and hardwood floors. If Angel had spent more time there, she would probably have made some effort to lighten the place up with spring flowers and colorful prints. As it was, she mostly slept when she was at home and the curtains were seldom even open on daylight for more than a few hours.
Her roommate, a resident in the neurology department, spent even less time in the flat, but only because she spent so much time with her male friend. Each of the women had her own bedroom; Angel's was in the back overlooking a scraggly garden two stories below. All three flats theoretically shared the back yard, but it got little use, perhaps as much because of the fog as that the tenants had so little spare time.
The building was a three-flat Victorian, newly painted in one of the three-color schemes that had become so popular in San Francisco. Angel herself doubted that the original paint job had been so flamboyant, but had to admit that the navy, burgundy and dark gray brought out the wonderful detail around the doors and windows and under the eaves. Convinced that she would one day have the time to properly decorate her own flat, she had originally bought plants which died from neglect and prints which were never framed. Instead she had learned to do the minimum in tidying of her own room, and managed to buy thick shades that made her bedroom perfectly dark even when the sun was still out. Not that it mattered. As soon as she hit the bed she was sound asleep, whether she had remembered to brush her teeth or not.
Unfortunately on this occasion when she walked into the flat her roommate Nan was standing in the arched entry to the living room eager to talk. Nan was a tall woman, two or three inches taller than Angel's five seven, and she had ash blond hair which she wore in a French braid pinned loosely to her head. Nan's eyes were dancing with humor when she confronted Angel.
"I've heard nothing but your antisocial remarks in the operating room since the middle of the day," she said. "At least half a dozen people who know we room together made sure I heard what had happened. Geez, Angel, were you trying to get kicked out of your program or just out of the OR?"
Angel slumped on the overstuffed sofa and let her backpack fall to the floor. "They didn't let me do the oophorectomy. I was tired. Williams said how stupid women were. I don't know. It just got to me."
"Who didn't let you do the oophorectomy? You've removed ovaries before."
"Yeah, I know. Well, Dr. Lenzini said I couldn't and Williams didn't argue with him. Both of them are jerks."
Nan laughed. "Hey, they're both surgeons. What do you expect?"
"Well, I'm going to be qualified to do some surgery, too, and I'm not going to be a jerk."
Nan's eyes twinkled. "I'm not sure that's possible, Angel."
It was a standard joke between the two of them, never more than lightly touched on. Non-surgeons thought surgeons were arrogant; surgeons thought non-surgeons were wimps who deliberated rather than acted. Neither could have done without the other, though both groups would have been willing to try. Neurologists were non-surgeons as were family practice doctors. But because family practice physicians had to know ob/gyn and its complications, some learned surgery, peripherally.
"I heard Dr. Lenzini took you to lunch with him."
Angel folded her arms on her chest and said crossly, "He wouldn't have had to if he'd behaved properly in the first place, would he?"
"He didn't have to anyhow." Nan dropped into an armchair opposite the sofa. "I've met him. Talk about arrogant. It probably whizzed him off to misdiagnose that patient as an appendectomy. He hates being wrong."
Curious, Angel asked, "How do you know?"
"I was doing a neurological exam on a patient who shared a room with one of his. He couldn't believe the woman was still on an IV a week after her cancer surgery. He walked out muttering about cutting the umbilical cord. I was in and out of the room a lot around that time and I want to tell you this woman gave the nurses no end of trouble about her pain after the IV was taken away because she'd had a patient-controlled analgesia machine with it. She got hysterical once, screaming until her roommate buried her head under the pillow, and no amount of medication seemed to calm her down. Lenzini was fit to be tied but he finally agreed to let her have the IV and the machine back."
"He was probably right to take it away in the first place. You have to wean patients at some point."
"So he said, at some length, to the patient. Who was not intimidated, by the way. I can't imagine why not, when here's this irate bear of a man with his hair springing out from under his scrub cap, his eyes snapping like electric sparks. I think they called him from surgery to placate her."
Angel shook her head. "I'm not surprised he has a temper. On the other hand, he obviously has a sense of humor. He thought my situation was funny as hell."
"But he tried to rescue you."
"Just another one of those surgeonly attributes--doctor to the rescue stuff." Angel picked up her backpack and rose from the sofa. "I'm exhausted, Nan. If I'm not in bed in two minutes I'll fall asleep right here."
"He's not married."
"Lenzini? No wonder."
"He lived with someone for a long time, years maybe. I don't know what happened with them."
"Did I ask? Do I care? The man is a jerk." Angel trooped to the hallway leading back toward the bedrooms. She turned to add, "A sexist jerk," before she disappeared into the rear of the flat.