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  THE CANONICAL (DIVINE) HOURS

  HOUR

  TIME

  OTHER NAMES

  Matins

  Midnight

  Vigils, Nocturns

  Lauds

  3:00 a.m.

  Dawn prayer

  Prime

  6:00 a.m.

  First hour

  Terce

  9:00 a.m.

  Third hour

  Sext

  Noon

  Sixth hour

  Nones

  3:00 p.m.

  Ninth hour

  Vespers

  6:00 p.m.

  Evening prayer

  Compline

  9:00 p.m.

  Night prayer

  PART I

  EMPATHY

  The problem with being a neurosurgeon is that when the telephone rings, you have to answer it. When the phone by my bed went off at 3:00 a.m. I went straight from sleep to standing. The emergency room attending sounded like he was having a bad night.

  “Dr. Trovato? Dr. Green here, Area A. We’ve got an old lady with a cerebellar hemorrhage—she’s unresponsive, and the CT scan looks nasty. How soon can you get in?”

  “Eight minutes. Call the OR.”

  The pocket of skull housing the cerebellum is a dangerously small space with rigid walls; there is no room for an explosion of blood. The consequence is disaster—the brain gets pushed in the only direction possible: down through the foramen magnum, the big hole in the bottom of the skull, crushing the brain stem, the control center for all basic life functions. Unless a surgeon gets there in time. I drove to the hospital in the dark, planning my approach. Amsterdam Avenue was quiet, with a few yellow cabs roaming for nonexistent fares. I pushed my speed to hit all the green lights.

  I scrubbed in at the vast stainless-steel sink and backed into the OR through the double doors. Linney, my favorite anesthesiologist, took her place at the patient’s head opposite me while I pulled on surgical gloves. The anesthesiologist’s job is to monitor every breath, heartbeat, and rush of blood pressure through the vessels. Linney, smooth and quiet, signaled to me—OK to cut. I looked at the back of the patient’s neck: innocent, slightly wrinkled, hiding the catastrophe beneath. I made a quick incision on the back of the scalp, a few inches behind her ear, then running down the back of her neck. Down through skin, then muscle, then picking up the craniotome, I sawed through bone. I sliced through the dura, exposed the cerebellum . . . there. As I scooped out the fresh clot, I felt suddenly short of breath. For a moment I was drowning, flailing for the surface.

  “Linney,” I gasped, “is there a problem with the vent?” Linney looked up at me, startled, and then at the monitors. Three seconds later, a long three seconds, the alarms started ringing.

  It was nearly noon before the patient opened her eyes, and by late afternoon she was awake and holding her daughter’s hand. I headed to the locker room to change.

  “Beatrice, lunchtime,” Linney said as we stripped off our gowns and shoe covers. I followed her to the staff cafeteria. Linney did not have conversations like other people. If I called her up and said, “Hi, how are you?,” she’d say, “Get to the point.” We sat across from each other at a white melamine table. The cafeteria had aspirations of greatness it did not quite achieve. A letterpress sign read ARTISANAL BREAD SELECTION, suspended over a basket of plastic-wrapped rolls, and the chef’s suggestion of the day was unintentionally thrice-baked ziti. I had an apple.

  “Beatrice, how did you know that woman was hypoxic?”

  “I felt like I couldn’t breathe,” I said, “but I knew it was the patient.” I hadn’t realized this until I said it out loud.

  “So what you are saying, Dr. Trovato”—I knew I was in trouble now, since we were no longer on a first name basis—“is that you just knew?”

  “I just knew,” I said.

  “You should have had more than an apple,” Linney replied, changing the subject with her usual abruptness. “We’ve got five more cases today.” She got up from the table, leaving me holding the apple core.

  I sat at the table for a few minutes after Linney had gone. Surgery seems so straightforward: open someone up, fix what’s wrong, close. But even working inside the body doesn’t necessarily get to the center of the problem. When I was training to be a neurosurgeon, I wanted to know whether a teenage girl’s headache was a symptom of a bad home situation, or a herald of a leaky brain aneurysm. I wanted to be sure that the depressed patient I sent home with pain medication for a brain tumor wouldn’t try to commit suicide by taking all of it at once. And I’ve always wished I could reach my patients silenced by loss of language or trapped in the blankness of coma, circling endlessly in their own internal darkness. I’d touched people’s brains with my hand, but I couldn’t know how it felt to actually be inside someone else’s head. Today, though, it seemed I had.

  * * *

  I’ve been orphaned twice. The first time was at birth, since I never knew my father, and my mother and twin sister died just after I was born. I was twin A, though I’m not sure whether that counts, now that there is only one of us. My brother, Benjamin, had just turned seventeen when he gained a little sister and lost a mother; he was transformed suddenly from brother into parent. I can’t imagine how he did it. All I know is his college education got postponed for a year; he didn’t say more.

  Ben told me Mom never bothered with finding fathers for her children. “A minute and a mother are all you need,” she used to say. I quoted that when I was a kid without really understanding it, and I got some very odd looks. Once I hit adolescence, I realized why. I never met Mom, unless you count being inside her as meeting her.

  All my nursery school classmates were jealous of my uni-parent. On Mother’s Day when the moms visited and got their irregular heart-shaped cards, Benjamin came to class dressed up in a polka-dot housedress, a blond wig, and pumps. He had just started studying microbiology, so he brought in cookies in the shape of microorganisms. I liked the viruses best because they looked like jewels. On Father’s Day he arrived wearing a double-breasted suit and a Groucho Marx mustache-nose-eyeglass combo. No one ever made fun of me for having neither a father nor a mother; they all wanted a Benjamin.

  For kindergarten, Ben enrolled me at the Franciscan St. James Academy, the natural choice for reasons of tradition and nostalgia; Ben had learned his letters and responsorial psalms there thirteen years before. There was a black-and-white photo of him on the wall in his role as the camel in the annual nativity skit—I used to stop and look at it on my way to Tuesday Mass. I got to play the Virgin Mary, but part of me wished I could have been the camel instead.

  While I was in elementary school, Benjamin put himself through graduate school twice: first microbiology, then medieval history. By the time I was dissecting my first fetal pig in ninth grade biology, he’d become an expert on the Plague, particularly as it applied to medieval Italy. Ben and I approached medicine from opposite directions. I went forward, straight to the patient, while he went back—to the past.

  Having a sibling really takes the pressure off trying to do too much—you just divide everything up. I became the physician, Benjamin the academic, so my scholarly side didn’t complain, and he never had to wonder whe
ther he should have become a doctor. I suppose it might have gone another way—we could have vied for excellence in the same domain—but competition never occurred to me. Neither did collaboration, until it was too late.

  When I was thirty, Ben followed a project to Siena, Italy, and fell in love—not with a person, but with the city.

  “Little B, I’m head over heels,” he wrote. “It’s like time travel but without losing all the amenities—medieval life plus hot showers and toilet paper. I’m set on buying a house big enough for family. Otherwise known as My Little Sister Beatrice.”

  I liked seeing the word family on paper, but I wasn’t used to letter writing. The last paper letter I’d turned out was at Girl Scout camp, on stationery decorated with mice curling their tails around an inkpot. But Ben was weird about email—I think the medieval scholar in him resisted the march of technology.

  Ben eventually bought his house in Siena, but three years later I still hadn’t made plans to go to Italy, and he hadn’t come back to New York. It was the longest we’d gone without seeing each other. We kept in touch with rare precious phone calls across time zones, and resorted the rest of the time to Ben’s favorite, if archaic, mode of communication. I had even gotten into the medieval spirit by digging up the old fountain pens I’d once used for calligraphy.

  Dear Ben,

  I know I need to visit you soon, and meet your new girlfriend, I mean, hometown. But I can’t imagine getting out of here right now. I spend twelve hours a day looking at three square inches of someone’s body, willing my hands to do exactly the right thing. One little mistake, and it’s blindness, or left-sided weakness, or death, just like that. I’ve got one day off every seven, not really enough to get me to Siena and back. But soon, OK? The OR has been more intense than usual—I feel like my usual self-protective doctor’s reserve is wearing a little thin and I need an antidote to all this surgeon stuff. What time of year is best to come?

  Love, Beatrice

  The OR had been more intense than usual, and not in a good way. The day before, Linney and I had scrubbed in on a far-gone basal cell carcinoma case. Skin cancer doesn’t usually involve a neurosurgeon, but in this case the patient had kept pulling her wig down over the slowly growing lesion on her forehead. Fifteen years later, the wig was so low over her eyes she couldn’t see. By the time she got to us, the cancer had eaten through her skin and skull, and she had a quarter-size hole between her eyebrows through which we could see the dural membrane covering the brain. The sight made me cringe when I saw her in the office. I have seen dura plenty of times—just never outside of surgery.

  In the OR things took a downturn quickly. Just after I made the first incision, the heart monitors registered ventricular tachycardia—a dangerously fast rhythm that can deteriorate, preventing blood from going where it’s supposed to. Not good. I took a quick look at the monitors—blood pressure was holding, but that might not last. Out of the corner of my eye I could see Linney moving quickly, asking for procainamide. Then, suddenly, I heard a hum in my ears, and after that, incongruously, the sound of my brother Ben’s voice. My vision grayed, and then my heart and head filled with the fear of losing him.

  * * *

  Benjamin didn’t tell me about his heart until I was in medical school. I’d reacted badly.

  “Ventricular tachycardia? For God’s sake, you’re a walking time bomb!”

  “My cardiologist says it’s under control. In the meantime, please avoid doing anything shocking or sudden in my presence. . . .” He grinned lopsidedly while I fumed to cover the panic I felt.

  “Why didn’t you tell me before?”

  “You were a kid—my kid, basically. I didn’t think you needed to know. Now you’re a big girl.”

  I hit him. He deserved it. Ben grunted, then started over.

  “You’re a big doctor, I mean. . . .”

  “That’s better.”

  “And I thought it was time you knew me from a grown-up perspective. It’s been years; I’m fine.”

  I tried to incorporate this new frailty into my image of indestructible Ben. My own heart was pounding, though, in sympathy. I don’t want to lose him.

  “How about a hug, Little B,” he said, “like the old days?”

  I buried my head in his wool sweater and listened to his heart beating, slow and steady.

  * * *

  The next thing I knew Linney was whispering harshly in my ear. “Beatrice, blood pressure is stable, she’s back in sinus rhythm. What’s going on?” I wasn’t sure what was going on, but it wasn’t something that could happen again. There is no time for drifty emotional lapses when you’ve got a scalpel in your hand.

  “I’m OK,” I said. But I wasn’t.

  Siena, May 2

  Hey Little B: What do you mean the OR is much more intense than usual? If you look up intense in the dictionary I bet you’d find NEUROSURGEON right at the top of the page. I like thinking of you taking people apart and (ideally) putting them back together again. I try to get into people’s heads too, but my subjects are already dead. You might say I’m a forensic pathologist of the distant past. I can imagine you saying “Come ON Benj, spare me the convoluted metaphors.” I love it when you say stuff like that. Hey, happy almost birthday, Big Girl.

  I have some news, to the extent that any medieval historian could be said to have “news.” There is something funny about the Plague and Siena. I’ve got my hands on some sources that explain why Siena did so badly during the Plague, and it will make a big splash when I’m ready to publish. In fact I think I might already have made a splash—I dropped hints at a conference of Tuscan medievalists, and a few “colleagues” got worked up about what I was suggesting.

  They’re probably upset because they wanted to get there first, but not only am I first, I’ve also got something they haven’t—and it’s something juicy. I wish you were around to puzzle over this stuff with me, the way you used to when you were a kid. I can still imagine the nine-year-old you, your straight black hair around your serious little face. Even then you had that laser focus; all you could see was the few fascinating inches right in front of you. I should have guessed you’d become a surgeon. For a while I thought you might turn out to be a historian like me, but you went for the knife instead. “Taking a history,” you doctors always say, in that proprietary way doctors have. We historians prefer to call it “borrowing,” since it’s not ours to take.

  You’d love Siena, and it’s crazy that you’ve never seen the house. You should take a vacation and come help me with my little mystery. You don’t want to be in the hospital in July anyway when the new residents come and you have to teach them not to kill people.

  It’s a great time to visit. The two Palios—the horse races that have taken over the city every summer for seven hundred years—are coming, and everyone is revving up for the event. We can read manuscripts together—medieval Italian is close enough to modern that you’d be able to manage. Good thing I took your Italian upbringing so seriously, right? There is no way that Beatrice Alessandra Trovato was going to grow up without learning how to speak and write her mother tongue. Maybe Dante was a funny way to learn it, but you can’t do better really.

  Let me know. I’ll change the sheets on the spare bed just for you.

  I love you, Little B.

  Ben

  * * *

  After I got Benjamin’s letter I did something wildly uncharacteristic—I acted on impulse. It was after midnight when I finished reading, but I went online and searched for flights to Siena. The forty-eight-hour cancellation policy made me reckless, and I clicked on the “reserve now” button for an irresistibly affordable flight. Ben would be just waking up by now, so I picked up the phone and dialed.

  “Ben, I bought a plane ticket. I’m coming to visit.”

  “For real?”

  “I’ll be there in three weeks.” I imagined Ben’s face with his habitual day’s growth of beard, receiver pressed against his ear.

  “I’ll have
to buy laundry detergent, but you’re worth it. Send me your details, and I’ll pick you up from the airport.”

  “Great. And hey—I love you.”

  “I love you too, Little B. Now go to bed. You have to get up soon.”

  As I fell asleep, I imagined poring over old manuscripts the way we used to when I was a kid. But it didn’t work out that way.

  * * *

  I was orphaned for the second time a week later. The first time I had Benjamin; the second time I was on my own. The call from Ben’s lawyer in Siena came the day after I’d renewed my passport, and the strange echo of the international call made me hear every word twice. Once was almost more than I could bear.

  There was no way I could have imagined Ben’s death—that moment when my one source of unconditional love collapsed into nothing and winked out like a dying star. Years before, when I’d first learned about Ben’s heart, I’d thought: I’ll go crazy if I lose him; I won’t survive it. But now that he was gone, now that I had gone from having a brother to having none, I did not go crazy. Or perhaps I did go crazy for those few seconds, as the world I knew tilted vertiginously sideways, and my legs slid out from under me. From the floor, I tipped my head back to look up at the haloed brightness of the hall light. One bulb is out, I thought, seeing the single bright circle where two should have been, how strange that I hadn’t noticed until now. One minute Ben had been there, and now he was not. Had I gone crazy, it might have lessened the agony of understanding the truth. But my mind did not allow me that relief.

  * * *

  The used bookstore around the corner from my apartment has served as my second home for years. It’s the kind of place that rarely exists anymore, with narrow aisles and big worn leather chairs where you can sit for hours getting lost in an out-of-print edition of some obscure writer’s first novel. I have the dubious distinction of adoring authors whose books are mostly out of print, so I spend as much of my little free time there as I can. That’s where I first met Nathaniel, who owns the bookstore and imbues it with unusual literary magic. Every time I go there I get lost in a book and look up hours later, having missed a meal, or the change from daylight to darkness. I’m cautious about who I get recommendations from, but Nathaniel knows how to pick a book, at least for me.