The last surgery of the day should be easy. Routine. Enough experience between them—they could perform it with blindfolds on. They won’t, but in their mind they’re already on their way out. Already searching the fridge for something to cook for dinner, yelling at children, or putting on heels to go out. The time between now and then, thin as an operating theatre drape.

But when they make the incision, it’s nothing like what they prepared for. The resident lets out a yelp. The attending surgeon’s spine curves, first forward, then back. The soundtrack fades. Exposed before them, an alien neon-blue growth that must have eluded the MRI. Octopus-shaped. It’s wrapped itself around the patient’s heart like a fist. Pushed the lungs upward into the throat.

The attending has seen this just once before, back when she was an intern. What she saw then was smaller, less bright. She bends her neck and studies the red and blue landscape inside the body cavity, full of awe. She is not ready to say anything, though the whole operating room is waiting. She thinks of the red jellyfish she swam with in the Aegean as a kid. The same red and azure, filling her field of vision, inviting her in. How she caressed the burn on her thigh for months after. She looks up. The seconds hand speeds on the clock on the wall.

The intern wipes sweat off his forehead. She finally clears her voice.

‘Most of you haven’t seen this before,’ she says. ‘Most doctors never do—The American Dream metastasized.’ Somebody sighs, maybe her resident, or maybe they all let out anxious air at the same time. It’s her job to navigate them through this. She points to the dream’s gooey tissue with her scalpel. It’s so rare, she has to make it a teaching moment. Point out the probable starting point, there in the upper gut.

‘We know too little about the mechanisms that make it invade its host. What makes them snap, so to speak.’ Somebody drops a pen on the floor, she waits for the echo to end. ‘We all have a few of these blue cells. We ingest or inhale them most of the time without knowing, and usually they just sit there without doing damage.’

She hopes there won’t be any questions, that it’s clear there’s nothing to be done for the patient. But her whole team just stands there, blue in their faces from light reflected from the dream they all carry. Even the anesthesiologist has lost the jaded look on his face.

 She doesn’t ask for a scalpel or gauze. She doesn’t try the impossible feat of removing it all, making a case she could publish in one of the journals. When she gives the sign, the resident closes the incision with all his skill, the nurses count all the pieces on the tray afterwards, as if someone’s life depended on it.

Later, when she walks home, there’s a whiff of fireplace and mulled wine on every corner. Scents full of hope, dreams for sale. There’s a bar she used to go to for warmth after a long shift. After her divorce, before the last war.

She looks down on her hands, red from scrubbing and this week’s cold snap. The purple vein, still visible—despite the temperature. Down the street an ambulance, its cold blue light pulsating into the night. Her eyes flutter for a while with the blue. Then she closes them firmly.