Chapter 4 – Above the Table
Bellevue Hospital, Cardiothoracic OR 3 – 06:58 a.m.
The CTOR gallery is dark except for the glow of the monitors and the rectangle of blinding light that spills up from the operating table below.
Leo slips in through the heavy door at the top of the stairs, still smelling like the cafeteria's burnt coffee and Noah's threats. His hands are raw from scrubbing, but he's not allowed to touch anything today; just watch. Matteo's orders, delivered by a terrified circulating nurse: "Tell the intern he's gallery only. If he contaminates my field, I'll end him."
So Leo stands alone behind the glass, white coat swapped for a disposable bunny suit that makes him look like a nervous marshmallow.
Below, the patient is already draped in blue. Mr. Rivera, thirty-eight, father of three, STEMI two days ago, triple-vessel disease, LIMA to LAD, SVG to OM and PDA planned. The chart is burned into Leo's brain because he spent the last forty minutes looking it up on his phone so he wouldn't look stupid.
The door to the OR opens again.
Matteo walks in like he owns gravity. Hair tucked under a navy surgical cap, mask already in place, eyes the only thing visible (dark, focused, lethal). He doesn't look up at the gallery once.
The fellow, Dr. Priya Desai, follows. Then the PA. Then the perfusionist. The scrub tech lays out the instruments like a priest arranging communion: sternal saw, Finochietto retractor, 10-blade, Debakey forceps, the tiny needle holders that look like toys.
Anesthesia calls, "Paralyzed and ready."
Matteo finally speaks, voice low and calm through the intercom. "Music."
Someone hits play. Sinatra. Of course it's Sinatra.
"Time-out."
They do the time-out. Matteo's gloved finger points to each person as they state their name and role. When he gets to "student/observer in gallery," his eyes flick up for the first time.
Straight to Leo.
Even through mask and goggles, the look pins Leo to the glass.
Matteo's gaze lingers two full seconds, then drops back to the patient.
"Knife."
The 10-blade kisses skin. One smooth midline incision. Blood beads bright red.
Leo's heart is suddenly in his throat. He's seen videos. He's done cadaver lab. Nothing prepared him for how fast it happens when it's real.
Matteo's hands move like they're dancing with the tissue instead of cutting it. Bovie crackles. The sternal saw screams to life (that sound is pure nightmare fuel). The retractor goes in, cranked open with a series of metallic clunks that echo up into the gallery.
The heart appears, small and vulnerable, wrapped in golden fat, beating too fast under the lights.
Leo forgets to breathe.
Matteo's voice floats up, conversational, almost gentle. "Priya, show me the LIMA."
The fellow lifts the left internal mammary artery, tiny and perfect.
"Beautiful skeletonization. Don't fuck it up when you clip."
Sinatra croons about flying to the moon.
They harvest the LIMA. They cannulate. The perfusionist says, "On bypass," and the heart slows, then stops.
The room goes quieter than Leo thought possible. Just the hiss of the ventilator and the soft clink of instruments.
Matteo takes the tiny 7-0 Prolene, needle no bigger than an eyelash, and starts the anastomosis to the LAD.
His hands never shake. Not once.
Leo leans forward until his mask fogs the glass.
He doesn't realize he's whispered "Jesus Christ" until the circulating nurse glances up and smiles behind her mask.
Below, Matteo ties the last knot on the LIMA-LAD, then looks up again (directly at Leo).
He can't speak through the intercom without pressing the button, so he does something worse.
He lifts one blood-slick finger and taps his own chest, right over his heart.
Then points straight up at Leo.
The message is crystal clear:
One day this will be you down here.
Don't waste my time.
Leo's knees almost give out.
The rest of the case passes in a blur of vein grafts and tiny stitches and Sinatra lyrics Leo will never hear the same way again.
When they come off bypass, the heart stutters, then kicks into sinus rhythm like it's relieved to be alive.
Matteo doesn't cheer. He just nods once, satisfied, and starts closing sternum with thick wire that he twists like he's tying shoelaces on a child.
At 10:12 a.m. the patient rolls to the CVICU alive and Matteo finally pulls off his mask.
He looks exhausted and perfect and terrifying.
He hits the intercom button for the first time all morning.
"Kang."
Leo jolts. "Yes, sir?"
"Get down here."
Leo practically falls down the gallery stairs.
He bursts into the OR still in the bunny suit. The team is breaking down the sterile field.
Matteo is already at the sink, scrubbing out. He doesn't turn around.
"You watched the whole thing."
"Yes, sir."
"Good." Matteo's voice is softer now, almost human. "Next time you'll be holding the retractor. And the time after that, you'll be sewing."
Leo's mouth goes dry. "Yes, sir."
Matteo finally looks at him, water dripping from his forearms, eyes bloodshot but burning.
"Stop calling me sir. Makes me feel old." A pause. "It's Matteo."
Then he walks out, leaving Leo standing in the wreckage of his first open-heart case, heart racing faster than Mr. Rivera's ever did.
The scrub tech laughs. "Welcome to cardio, baby intern. You're his now."
Leo looks down at his shaking hands.
He's never wanted anything more.