by Robin Cook
George again knocked Thomas’s hand away. “Don’t touch me like that,” he snapped.
“Gentlemen,” said Ballantine, stepping between them.
“I’m not sure Thomas knows what the word means,” said George.
“Listen, you little shithead,” snarled Thomas, reaching around Ballantine and grabbing a handful of George’s shirt. “You’re making a mockery of our program with the cases you’re dredging up just to keep the so-called teaching schedule full.”
“You’d better let go of my shirt,” warned George, his face suffused with color.
“Enough,” shouted Ballantine, pulling Thomas’s hand away.
“Our job is to save lives,” said George through gritted teeth, “not make judgments about who is more worthy. That’s up to God to decide.”
“That’s just it,” said Thomas. “You’re so stupid you don’t even realize that you are making judgments about who should live. The trouble is your judgment stinks. Every time you deny me OR space another potentially healthy patient is condemned to death.”
Thomas spun on his heels and strode from the room.
George took a deep breath, then adjusted his disheveled shirt.
“God! Kingsley is such a prig.”
“He is arrogant,” agreed Ballantine. “But he is such a damn good surgeon. Are you all right?”
“I’m fine,” said George. “I must admit I came close to slugging him. You know, I think he’s going to be trouble. I hope he doesn’t get suspicious.”
“In that sense his arrogance will be a help.”
“We’ve been lucky. By the way, have you ever noticed Thomas’s tremor?”
“No,” said Ballantine with surprise. “What tremor?”
“It’s on and off,” said George. “I’ve noticed it for about a month, mainly because he was always so steady. I even noticed it today when he was doing his presentation.”
“Lots of people are nervous in front of groups.”
“Yeah,” said George, “but it was the same as when I was talking to him about the Wilkinson death.”
“I’d rather not talk about Wilkinson,” said Ballantine, glancing around at the slowly emptying amphitheater. He smiled at an acquaintance. “Thomas is probably just tense.”
“Maybe,” said George, not convinced. “I still think he’s going to be trouble.”
Cassi dressed for her visit to Patricia as if it were the first time they were to meet. With great care she chose a dark blue wool skirt with a matching jacket to go over one of her high-necked white blouses. Just as she was about to leave, she noticed the atrocious state of her nails and thankfully postponed the visit while she removed her old polish and applied a new coat. When that was dry, she decided she didn’t like her hair, so she took it down and put it back up again.
Finally having run out of reasons to delay, she crossed the courtyard between the house and the garage. It was freezing out. Ringing Patricia’s bell, Cassi could see her breath in the crisp air. There was no answer. Standing on tiptoes, she looked through a small window in the door, but all she could see was a flight of stairs. She tried the bell again, and this time saw her mother-in-law slowly descend the stairs and peer out through the glass. “What is it, Cassandra?” she called.
Nonplussed that Patricia didn’t open the door, Cassi was silent for a minute. Under the circumstances she didn’t feel like shouting her reason for visiting. Finally she said: “I want to talk to you about Thomas.”
Even with that explanation there was a long enough pause for Cassi to wonder if Patricia had heard her. Then several bolts snapped aside and the door opened. For a moment the two women eyed each other.
“Yes,” said Patricia finally.
“I’m sorry to bother you,” began Cassi. She let her sentence trail off.
“You’re not bothering me,” said Patricia.
“Could I come in?” asked Cassi.
“I suppose,” said Patricia, starting up the stairs. “Be sure and close the door.”
Cassi was glad to close the door on the cold, damp morning. Then she climbed after Patricia and found herself in a small apartment sumptuously furnished in Victorian red velvet and white lace.
“This room is beautiful,” said Cassi.
“Thank you,” said Patricia. “Thomas’s favorite color is red.”
“Oh?” said Cassi, who had always thought Thomas partial to blue.
“I spend a lot of time here,” said Patricia. “I wanted it comfortable and warm.”
“It is that,” admitted Cassi, seeing for the first time a rocking horse, a kiddy car, and other toys.
Patricia, as if following Cassi’s glance, explained: “Those are some of Thomas’s old toys. I think they’re rather decorative, don’t you?”
“I do,” said Cassi. She thought the toys did have a certain appeal but looked a little out of place in the lavish setting.
“How about some tea?” suggested Patricia.
Suddenly Cassi realized that Patricia was as uncomfortable as she was.
“Tea would be very nice,” said Cassi, feeling more at ease herself.
Patricia’s kitchen was utilitarian, with white metal cabinets, an old refrigerator, and a small gas stove. Patricia put on the kettle and got out her china. From the top of the refrigerator she produced a wooden tray.
“Milk or lemon?” asked Patricia.
“Milk,” said Cassi.
Watching her mother-in-law search for a creamer, Cassi realized how few visitors the older woman saw. With a touch of guilt Cassi wondered why they hadn’t become better friends. She tried to bring up Thomas’s problem, but the rift that had always existed between them silenced her. It wasn’t until they’d seated themselves in the living room with full teacups that Cassi finally got the courage to begin. “The reason I came over here this morning was to talk to you about Thomas.”
“That’s what you said,” replied Patricia pleasantly. The old woman had warmed considerably and seemed to be enjoying the visit.
Cassi sighed and put her teacup down on the coffee table. “I’m concerned about Thomas. I think he is pushing himself too hard and…”
“He’s been that way since he was a toddler,” interrupted Patricia. “That boy was a hyperactive high achiever from the day he was born. And I tell you it was a twenty-four-hour-a-day job keeping him in line. Even before he could walk he was his own boss, and I had a devil of a time disciplining him. In fact from the day I brought him home from the hospital…”
Listening to Patricia’s stories, Cassi realized exactly how central Thomas still was to the older woman’s world. It finally made sense to her why Patricia insisted on living where she did, even though it was so isolated. Watching her mother-in-law pause to sip her tea, Cassi noted how strongly Thomas resembled Patricia. Her face was thinner and more delicate, but there was the same aristocratic angularity.
Cassi smiled. When Patricia put her cup back down, Cassi said, “Sounds like Thomas hasn’t changed much.”
“I don’t think he’s changed at all,” said Patricia. Then with a laugh she added, “He’s been the same boy all his life. He’s needed a lot of attention.”
“What I was hoping,” said Cassi, “is that you might help Thomas now.”
“Oh?” said Patricia.
Cassi could see the newly gained intimacy rapidly revert to the old suspiciousness. But she forged on. “Thomas listens to you and…”
“Of course he listens to me. I’m his mother. What exactly are you leading up to, Cassandra?”
“I have reason to suspect that Thomas may be taking drugs,” said Cassi. It was a relief to finally get it out. “I’ve suspected it for a few months but hoped the problem would just go away.”
Patricia’s blue eyes became cold. “Thomas has never taken drugs,” she said.
“Patricia, please understand me. I’m not just criticizing. I’m worried, and I think you might be able to help. He does what you tell him to do.”
“If Thomas need
s my help, then he should come and ask for it himself. After all, he chose you over me.” Patricia stood up. As far as she was concerned, the little tête-à-tête was over.
So that was it. Patricia was still jealous that her little boy had grown up enough to take a wife.
“Thomas didn’t choose me over you, Patricia,” said Cassi evenly. “He was looking for a different relationship.”
“If it is such a different relationship, where are the children?”
Cassi could feel her strength of will drain away. The whole issue of children was a sensitive and emotional one for her, since juvenile diabetics were cautioned against the risk of pregnancy. She looked down at her tea, realizing she never should have tried speaking to her mother-in-law.
“There won’t be any children,” said Patricia, answering her own question. “And I know why not. Because of your illness. You know it’s a tragedy for Thomas to be childless. And he tells me you’ve been sleeping apart lately.”
Cassi lifted her head, shocked that he would reveal such intimate matters. “I know Thomas and I have our problems,” she said. “But that’s not the issue. I’m afraid he is taking a drug called Dexedrine and that he has probably been taking it for some time. Even though he does it just to work harder, it can be dangerous both to him and his patients.”
“Are you accusing my son of being an addict?” snapped Patricia.
“No,” said Cassi, unable to explain further.
“Well, I should hope not,” said Patricia. “Lots of people take a pill now and then. And for Thomas it is understandable. After all, he’s been driven from his own bed. I think your relationship is the real problem.”
Cassi didn’t have the strength to fight back. She sat silently wondering if Patricia was right.
“Furthermore I think you should go,” said Patricia, reaching across and taking Cassi’s cup.
Without another word Cassi got up, descended the stairs, and let herself out.
Patricia collected the teacups and carried them into the kitchen. She had tried to tell Thomas that marrying that girl was a mistake. If only he had listened.
Back in the living room Patricia sat down at the telephone and called Thomas’s exchange. She left a message for him to call his mother as soon as possible.
Thomas’s patients were inconveniently sprinkled on all three surgical floors. After Grand Rounds he’d taken the elevator to the eighteenth to work his way down. Normally on Saturdays, he liked to make rounds before the conference and before visiting hours. But today he’d arrived at the hospital late and consequently lost a lot of time reassuring nervous families. They would follow him out of the room and stand asking questions in the hall until in desperation he cut them off to examine his next patient only to be further delayed by that person’s relatives.
It was a relief to reach the ICU where visitors were rarely allowed. As he pushed through the door he allowed himself to think about the regrettable episode with George Sherman. As understandable as his reaction was, Thomas was surprised and disappointed in himself.
In the ICU, Thomas checked on the three patients he’d operated on the day before. All were fine. They’d been extubated and had taken something by mouth. EKGs, blood pressures, and all other vital signs were stable and normal. Mr. Campbell had had a few brief episodes of an irregular cardiac rhythm but that had been controlled when an astute resident found some unrelieved gastric dilation. Thomas got the fellow’s name. He wanted to compliment him next time he had the opportunity.
Thomas walked over to Mr. Campbell’s bed. The man smiled weakly. Then he started to speak.
Thomas bent over. “What did you say, Mr. Campbell?”
“I have to urinate,” said Mr. Campbell softly.
“You have a catheter in your bladder,” said Thomas.
“I still have to urinate,” said Mr. Campbell.
Thomas gave up. He’d let the nursing staff argue with Mr. Campbell.
As he turned to leave, he glanced at the sorry case in the bed next to Mr. Campbell. It was one of Ballantine’s disasters. The patient had embolized air to the brain during the operation and now was no more than a living vegetable totally dependent on a breathing machine, but with the quality of the nursing care at the Memorial, he could be expected to live indefinitely.
Thomas felt an arm on his shoulder. He turned and was surprised to find George Sherman.
“Thomas,” began George. “I think it is healthy that we have disagreements if only because it might force us to examine our own positions. But it upsets me to think there has to be animosity.”
“I was embarrassed at my own behavior,” said Thomas. That was as close as he could come to an apology.
“I got a bit hot under the collar myself,” admitted George. He let his eyes leave Thomas’s face, noticing which bed Thomas had stopped at. “Poor Mr. Harwick. Talk about a shortage of beds. Here’s another one we could use.”
Thomas smiled in spite of himself.
“Trouble is,” added George, “Mr. Harwick is going to be here for a long time unless…”
“Unless what?” asked Thomas.
“Unless we pull the plug, as they say,” George smiled.
Thomas tried to leave, but George gently restrained him.
Thomas wondered why the man felt obligated to touch him all the time.
“Tell me,” asked George. “Would you have the courage to pull the plug?”
“Not unless I talked with Rodney Stoddard first,” said Thomas sarcastically. “What about you, George? You seem willing to do most anything to get more beds.”
George laughed and withdrew his arm. “We all have our secrets, don’t we? I never expected you to say that you’d talk to Rodney. That’s a good one.” George gave Thomas another of his little taps and walked away, waving good-bye to the ICU nurses.
Thomas watched him, then glanced back at the patient, thinking over George’s comments. From time to time a brain-dead patient was taken off his life support system, but neither doctors nor nurses acknowledged the fact.
“Dr. Kingsley?”
Thomas turned to face one of the ICU clerks.
“Your service is on the line.”
Giving Ballantine’s patient one last glance, Thomas walked over to the central desk wondering how he could get Ballantine to refer his difficult cases. Thomas was confident these “unanticipated” and “unavoidable” tragedies would not happen if he did the surgery.
Thomas answered the phone with undisguised irritation. Invariably when the answering service looked for him it meant bad news. This time, however, the operator just said that he should call his mother as soon as he could.
Perplexed, Thomas made the call. His mother never called him during the day unless it was something important.
“Sorry to bother you, dear,” said Patricia.
“What is it?” asked Thomas.
“It’s about your wife.”
There was a pause. Thomas could feel his patience evaporating.
“Mother, I happen to be rather busy.”
“Your wife paid me a visit this morning.”
For a fleeting moment Thomas thought that Cassi might have mentioned his impotence. Then he realized that was absurd. But his mother’s next statement was even more alarming.
“She was suggesting you were some kind of addict. Dexedrine, I think she said.”
Thomas was so angry he could barely speak.
“Wha-what else did she say?” he finally stammered.
“I think that’s rather enough, don’t you? She said you were abusing drugs. I warned you about this girl, but you wouldn’t listen to me. Oh, no. You knew better…”
“I’ll have to talk to you tonight,” said Thomas, disconnecting the line with his index finger.
Still gripping the receiver, Thomas struggled to control his rage. Of course he took a pill now and then. Everybody did. How dared Cassi betray him by making a big deal of the fact to his mother? Abusing drugs! My God, an occasional pill didn’
t mean he was an addict.
Impulsively Thomas dialed Doris at home. She answered on the third ring out of breath.
“How about a little company?” asked Thomas.
“When?” asked Doris enthusiastically.
“In a few minutes. I’m at the hospital.”
“I’d love it,” said Doris. “I’m glad you caught me. I was just on my way upstairs.”
Thomas hung up. He felt a twinge of fear. What if the same thing happened with Doris as happened last night with Cassi? Knowing it was better not to think about it, Thomas hurried through the rest of his rounds.
Doris lived only a couple of blocks from the hospital on Bay State Road. As Thomas walked to her apartment, he could not stop thinking about what Cassi had done. Why would she want to provoke him like that? It didn’t make sense. Did she really think he wouldn’t find out? Maybe she was trying to get back at him in some illogical way. Thomas sighed. Being married to Cassi had not been the dream he’d envisioned. He’d thought she was going to be such an asset. So many people had swooned over her that he’d been convinced she was something special. Even George had been crazy for her, wanting to marry her after a handful of dates.
Doris’s voice mixed with static greeted him over the intercom when he pushed her bell. He started up the stairs and heard her door open.
“What a nice surprise,” she called as he rounded the first landing. She was dressed in a skimpy jogging outfit of shorts and a T-shirt that barely covered her navel. Her hair was loose and seemed incredibly thick and shiny.
As she led him inside and closed the door, Thomas glanced around the apartment. He hadn’t been there for months, but not much had changed. The living room was tiny, with a single couch facing a small fireplace. At the end of the room was a bay window that overlooked the street. On the coffee table were a decanter and two glasses. Doris walked up to Thomas and leaned against him. “Did you want to dictate a little?” she teased, running her hands down his back. Thomas’s fears about his potency quickly vanished.