The Chairmen

by Robert I. Katz

  The

  Chairmen

  A Kurtz and Barent Mystery

  Also by Robert I. Katz

  Edward Maret: A Novel of the Future

  The Cannibal’s Feast

  The Kurtz and Barent Mystery Series:

  Surgical Risk

  The Anatomy Lesson

  Seizure

  The Chronicles of the Second Interstellar Empire of Mankind:

  The Game Players of Meridien

  The City of Ashes

  The Empire of Dust (forthcoming)

  The

  Chairmen

  A Kurtz and Barent Mystery

  by

  Robert I. Katz

  The Chairmen

  A Kurtz and Barent Mystery

  Copyright © 2018 by Robert I. Katz

  This is a work of fiction. Any resemblance to any person, living or dead, is strictly coincidental.

  All rights reserved, including the right to reproduce this book, or portions thereof, in any form, without written permission except in the case of brief quotations embodied in critical articles or reviews.

  Cover design by Steven A. Katz

  To

  Jeff Palmer, Alan Santos and Peter Glass

  Contents

  Prologue

  Chapter 1

  Chapter 2

  Chapter 3

  Chapter 4

  Chapter 5

  Chapter 6

  Chapter 7

  Chapter 8

  Chapter 9

  Chapter 10

  Chapter 11

  Chapter 12

  Chapter 13

  Chapter 14

  Chapter 15

  Chapter 16

  Chapter 17

  Chapter 18

  Chapter 19

  Chapter 20

  Chapter 21

  Chapter 22

  Chapter 23

  Chapter 24

  Chapter 25

  Chapter 26

  Chapter 27

  Epilogue

  —The End—

  Information About the Author

  Prologue

  The letters were simple, crude and child-like, written in black crayon:

  You don’t know who I am but I know you. I’ve been watching you. I know where you live. I know where you work. I’ve waited a long time for this. I’ve had patience but my patience is at an end. Wounds heal slowly, by degrees. I’ll be coming for you. Soon.

  He took one last look, folded the sheet of paper neatly in half, slid it into a brown envelope, sealed the envelope, and sipped his coffee. He had been mulling this over for months, not seriously, not at first, just toying with the idea, not really intending to go through with it, and now, suddenly, here it was, his decision made, the thought of turning back suddenly, finally unthinkable.

  He smiled as he imagined the look on her face as she opened it. She would glance at it, frown, then most likely drop it into the wastebasket and do her best to forget it, but the next one would not be dismissed so lightly. She would look at the next one and ponder and begin to worry. Oh, yes she would.

  He enjoyed thinking about. He savored it. Anticipation, he thought, was like a fine wine. Enjoy it while it lasts.

  Bitch.

  Carefully, he picked up the letter.

  Tomorrow, he thought. Tomorrow, it begins.

  Chapter 1

  “Why me?” Kurtz asked.

  Sean Brody smiled. It was a jolly smile, an easy, happy and confident smile, a smile befitting the Chairman of the Department of Surgery at one of New York’s premier teaching hospitals. “Why not you?”

  “I’m busy?”

  “We’re all busy. Nevertheless, we have responsibilities to the institution, and somebody has to do it.”

  “I’m a voluntary member of the faculty,” Kurtz said, “I take care of patients. I don’t do research. What makes me equipped to evaluate the credentials of an academic superstar?”

  Brody made a rude noise. “Actually, it’s policy to have at least one private practitioner on all the chairman searches. It keeps the air from getting too thin at the top of the ivory tower.”

  “Oh,” Kurtz said. “I didn’t know that.”

  “And the Dean likes you.”

  “He does? That can’t be right.”

  “No accounting for taste.” Brody smiled again and handed him a folder. “Look this over. The Committee will have its first meeting at 3:00 PM next Tuesday. Be there.”

  “Shit,” Kurtz said mournfully.

  Brody shrugged.

  Kurtz sat at his desk, leaned back in his chair and glanced down at the file folder in his lap. A neatly placed sticker on the cover said, “Department of Cardiac Surgery, Staunton College of Medicine.” Copies of the folder had been distributed to the Search Committee. Others would be mailed out to prospective applicants for the position.

  There were eighteen academic chairmen at Staunton, which included the Chairs of Physiology, Biochemistry and the other basic science departments, as well as the clinical departments, and another twelve, all of them clinical, at Easton, the school’s second largest teaching hospital. Since the average chairman served approximately five years before retiring or stepping down (or being fired…let’s not forget being fired), there were at least four or five searches going on at any one time. In the past year alone, the chairmen of radiation oncology, physiology, anesthesiology, rehabilitation medicine and neurosurgery had all been replaced. This was Kurtz’ first search and despite his half-hearted protest, he was just glad that he had not been drafted into any more of them.

  The folder contained little that Kurtz did not already know. The Department of Cardiac Surgery consisted of six surgeons: three assistant professors, two associate professors and one full professor in addition to Peter Reinhardt, Professor and Chairman. It was a small department, but in most schools, cardiac was a division of surgery, not a separate department. There were also four fellows, three physician’s assistants, two secretaries, two research assistants and an administrator, plus at least three residents from the Department of Surgery rotating through cardiac at any one time. The folder contained a summary of the departmental finances, which were excellent; a listing of research grants, ongoing projects and published papers, annotated by author and by year; an Excel spreadsheet with the surgical caseload; a listing of recent initiatives, which included a transplant program, an off-pump bypass program, an endovascular valve replacement program and a clinical protocol designed to reduce overall mortality, overall cost and length of hospital stay. Kurtz rolled his eyes at this last one. Pick two out of three, he thought. Maybe.

  The department’s caseload and research output had both stayed relatively constant for over ten years, until five years ago, when Dennis Cole, the only full professor other than Peter Reinhardt, had been recruited from Duke to be fellowship director. The obvious heir apparent, Dennis Cole had more than doubled the research funding, though he had done little to increase the caseload.

  Chairmen…

  Kurtz sat back in his seat and grimaced at the ceiling. Academic departments are not democracies. They’re not meant to be democracies. Academic departments are dictatorships, and in the general opinion of the faculty, most of whom liked to cherish the illusion that they were independent champions for their patients’ welfare rather than employees, chairmen are, at best, a necessary evil. The arrival of a new chairman, particularly a high-profile chairman, is always a time of both opportunity and justified concern, for both the department and the institution.

  It is a sad but inevitable fact of academic medicine that most chairmen fail, for the simple and obvious reason that the talents and skills necessary to acquire the job most often have nothing to do with the talents and skills needed to actually do the job. Physician
s who are good, really good, at patient care tend to do what they’re good at. They take care of patients. They become physicians that their colleagues admire and their patients love and their students and residents, if they choose to pursue a career in academia, respect. And that’s where they stay, content (sort of, most of them), with their chosen lot.

  But you take a surgeon who can’t tie knots, an internist who has no skill at diagnosis, a psychiatrist who sees nothing but his own neuroses when he looks at a patient, and the medical establishment is faced with a dilemma. What are you supposed to do with the guy? He’s an MD, after all. He’s a little clumsy or he tends to miss the forest for the trees or maybe he’s simply nuts, but he’s not stupid and he’s not lazy, even if he’s got no talent for the job that he’s been training for. You can’t just abandon him, not after four years of college and four years of medical school and at least three more years working his ass off in a residency program. The poor schmuck has debts to pay and maybe a family to support. So, you send him off to the lab, where he happily develops a career in research, killing rats and doing nobody any harm for the next twenty-five years.

  Unless, of course, he is stupid and lazy, in which case you fire his stupid, lazy ass.

  So how do you get to be a chairman? Well, first of all, you have to be famous, not famous like a movie star or a sports hero or even a politician, but famous among physicians. You can work on national committees, lobby congress and your state legislature on the issues that matter most to physicians, like managed care and governmental interference with physician autonomy. You can be a great clinician, so great that your expertise becomes universally acknowledged. But politics and clinical expertise will carry you only so far. Chairmen are in charge of academic departments and the academic mission most conspicuously includes advancing the science. No matter what else might account for your fame, if you want to be a chairman, you have to do research. For some, the research is a highlight to otherwise well-rounded careers, but for many, the research is all they know how to do. After twenty-five years, the guy who wasn’t good enough to be a doctor has a hundred papers to his credit. He’s well-known. He’s got a national reputation. He’s an expert on neuronal-glial interactions in the leach, or the effect of pepcid on bowel motility, or he’s developed a new chemotherapy regimen that produces zero point two per-cent better results than the old chemotherapy regimen. He’s famous.

  Suddenly, a chairman decides to retire, and the Dean appoints a Search Committee. And who’s on the Search Committee? First and foremost, a representative sample of the faculty of the medical school, many of whom are basic scientists: anatomists, physiologists, biochemists, pharmacologists—people who’ve never taken care of a patient in their lives, people whose sole criteria for evaluating excellence…is research. And so it goes. The guy who wasn’t good enough to be a doctor is now the boss, telling all the real doctors how to do their jobs.

  That, at least, is the worst-case scenario. Often, of course, you get lucky. You pick a guy who’s got some common sense and maybe even knows his way around a patient. Maybe he went into research because he really liked research. Maybe he is competent. Maybe he’s not out of his mind.

  So it was with Peter Reinhardt.

  Peter Reinhardt’s grandfather had been a great supporter of German nationalism. He had won the Iron Cross during World War I and changed the family name from Stein to the more Germanic Reinhardt, none of which had impressed the Nazis. Peter Reinhardt was still Jewish. He spent a year in Dachau and was nearing death from starvation when the Allies finally liberated the camp. His father, mother and two older sisters did not survive. He was taken in by an uncle, became a physician and moved to America, doing a surgical residency at Bellevue, then moved on to Cornell for his cardiac fellowship and was recruited by Shumway to do transplant work at Stanford. He published his hundred papers. He became famous. He married a nice woman who thought he was God’s gift to humanity and he in turn was fond of her and their three children. When the chair at Staunton became vacant he applied and was accepted.

  Reinhardt’s department did not love him but they did respect him. He was pompous and wishy-washy and vacillating but his heart—mostly—was in the right place. He was good with figures and he kept meticulous records and he never ran in the red. He cared about his people, he didn’t hold a grudge and he stayed out of trouble. And if his department was well-known for nothing in particular, it nevertheless took good care of its patients and also produced no scandals. It was enough. Peter Reinhardt was successful.

  And in his seventy-sixth year of life and his nineteenth year as Chairman of Cardiovascular Surgery at the Staunton College of Medicine, Peter Reinhardt chose at last to retire.

  Two weeks had passed. Three notes had been sent. He was enjoying this. He sipped a brandy after dinner and thought about the future. Should he wait a little longer? Should he let the anticipation build? He had come to realize that the dance between predator and prey is a delicate one, anticipation on both their parts making the process all the sweeter. He smiled at the thought. Sweeter for him, at least.

  He toyed with the idea of waiting but then shook his head. No, it was too soon to back off. Time enough later on to play with the timing, to let the fear die down, just a little, before stimulating it once again. Intermittent reinforcement, he had read, is always best. Never let it become routine, never let the subjects get their bearings. Never let them think that they know what to expect and when to expect it.

  Smiling, he picked up a crayon (red, this time…) and began to write.

  Chapter 2

  It was 11 o’clock in the morning and Kurtz had his hands in an abdomen full of pus. “Give me a drain,” Kurtz said.

  The patient was a construction worker named Larry Reed, who had come into the ER complaining of abdominal pain. The pain had been building for almost a week. The patient had fever, rebound tenderness and was guarding the lower right quadrant—an obvious appendix.

  A burst appendix, as it turned out. A burst appendix that had walled off into an abscess, which was the only thing that had kept Larry Reed alive. An abscess, while bad, is not as bad as acute, disseminated peritonitis. Unfortunately, an abscess, just as often as not, goes on to become acute, disseminated peritonitis.

  Levine handed him a drain, frowned down at the abscess, gave a tiny shake of his head and wrinkled his nose. He didn’t say anything but his posture radiated disapproval.

  Levine believed in aggressive treatment. Levine was still young.

  Kurtz believed in treating an abscess gingerly and with great respect. It was an old and still unresolved controversy: irrigate or drain? You irrigated the abdomen with about twenty liters of antibiotic saline, and maybe you could wash out all the pus and kill off all the germs that were left. Or maybe by trying, you just spread the stuff around and made the transition from abscess to peritonitis inevitable. Kurtz did not irrigate. Kurtz preferred to put drains into the center of the abscess, administer antibiotics and close.

  Usually it worked. Sometimes, no matter what you did, the patient died.

  “Sandra,” Kurtz said, “would you please stand a little more to the side?” Sandra Jafari was one of five medical students currently on service. She was holding a retractor with her left hand, her body turned at an angle so that Kurtz could reach into the incision. Unfortunately for Sandra, in this position she could barely see the operation.

  “So, Sandy,” Levine said, “who invented rubber gloves?”

  Sandra, a thin girl with a pale face and short brown hair, frowned uncertainly behind her mask. “Halstead?” She had a barely discernible accent. Something Eastern European, Kurtz thought.

  “Very good,” Kurtz said. “Most of the students don’t know that.”

  “And why did he invent them?” Levine asked.

  Sandra frowned. “To prevent infections?”

  “Nope. Supposedly, he invented them because his girlfriend, who was an OR nurse, had a skin allergy.”

  “That’
s probably just a story,” Kurtz said. “I don’t think it’s true.”

  “It’s a good story,” Levine said. “It should be true.”

  Kurtz rolled his eyes and Levine grinned behind his mask. “So, Sandy,” Levine said, “what is the most common cause of appendicitis?”

  “I don’t know,” Sandra said. She sounded worried.

  “Neither does anyone else.” Kurtz frowned at Levine, who shrugged. “Every once in awhile, you find a bit of food or something stuck inside. The appendix can’t drain. It gets inflamed. Most of the time, you never do find a reason.”

  The anesthesiologist, Vinnie Steinberg, suddenly popped his head up over the drapes, looked at the abdomen and nodded. His head disappeared as he sat back down on his stool. Steinberg, thought Kurtz, looked glum.

  “What’s happening, Vinnie?” Kurtz asked.

  Steinberg grunted from the other side of the drapes. “You hear Reinhardt is retiring?”

  “Yeah, actually. What about it?”

  “I’m worried,” Steinberg said.

  Kurtz didn’t have to ask what he meant. A chairman retired, a new chairman came in, and suddenly the very next day, everything is different. In order to attract the right candidate, the Dean would have to give him at least some of what he wanted, and the first thing that every new chairman wanted was control: control of the hiring and firing, control of the curriculum, a significant say in the operation of the school, maybe his own institute funded by institution funds. Most of all, control of the money.

  Say in his urge to exert control, the new chairman wants to bring in his own team of anesthesiologists, or even worse, wants to split the anesthesiologists who do cardiac off from the Department of Anesthesiology and make them a part of the Department of Cardiothoracic Surgery. That way, he not only gets control, he also gets to keep the money that the cardiac anesthesiologists bring in. Unlikely that the Dean would agree to that, but it could happen. For the anesthesia staff, it was worth worrying about. But more likely, the new Chairman of Cardiac Surgery would try to come in with a splash, do something to increase the prestige of his new department. The simplest way to do that was to do more cases. More cases meant more work for anesthesia, which, in the abstract, was a good thing. But the OR schedule was full. There were only three ways to do more cases. The first was to take time away from somebody else. This was possible but politically risky. The second was to build new OR’s, also possible but time consuming and expensive. The most likely solution was to turn into a “twenty-four-hour” hospital. You let the guy work at night and on the weekends or even around the clock. You want to do a case? Sure, you can do a case. Oh, it’s three in the morning? We have to pay overtime to the nurses and the pump techs and the lab boys? No problem. Nothing’s too good for our new chairman, at least until the honeymoon is over and you start to piss off the wrong people. Anesthesiologists, like most normal human beings, do not like to work at three in the morning. A new surgical chairman was always cause for the anesthesia staff to worry.