"So you're going to take a cranial graft?" asked Halls.
As the conversation drifted from surgeries to Michael Moore's "Sicko," the doctors' main courses arrived.
By now, the Scripps OR was a familiar place for Ana, even as she dozed under the warming blankets and sedatives. The bright lights overhead were like starry planets.
She and Fran had driven down the day before. She had stayed up late watching as many "Friday the 13th" movies as she could, making it through the fourth installment. She was tired.
In the car, she and Fran talked about the surgery. Ana just wanted it to be over.
"There're lots of things I don't like," said Fran, who had recently been diagnosed with colon cancer. "I've even thought of quitting my chemo."
"If you quit," Ana said, "then I'll quit my surgeries for sure."
"Then I guess we'll just have to continue," Fran said.
Batra finished washing her face with Betadine. Halls began injecting lidocaine and epinephrine, and the tiger started to twitch its tail.
As Kikkawa began exposing the lower part of the left eye socket, Batra gently lifted back the scalp and identified a site, about four inches above Ana's left ear, where he would harvest bone for the graft. He marked it with a purple pen and started to trace the outline with a small pencil-like saw with a diamond tip. Its high-pitched whine sounded like a drill in a dental office.
The cranium comprises two layers of bone, the outer table and the inner table, separated by marrow. Removing a small piece from the outer table is as tricky as trying to cut a small piece of veneer from a sheet of plywood without chipping the surrounding wood or damaging the other layers.
Once the outline had been cut, an incision no more than an eighth of an inch deep and barely as wide, Batra tried to pry the bone free.
He angled the edge of a small chisel-like tool into the incision and began tapping it with a hammer.
"Do you have a sharper, thinner osteotome?"
"Not a curved one."
The risk was that he would pry up the inner table as well, exposing the dura mater of the brain. The tapping grew louder and louder.
Perhaps they were trying for too large a piece, Batra thought. He asked for the saw, divided the square into thirds and tried again.