The Patient

by Michael Palmer

  “The deep sensitivity and empathy intrinsic to most women will make you that much better a physician regardless of the specialty you choose. But those same qualities will make medicine harder on you than on most men … especially if you choose a specialty like oncology, or critical care, or certain branches of surgery, where a fair percentage of your patients are going to suffer and die in spite of everything you can do for them.”

  Jessie’s office was a lilliputian, one-window cubicle, made to feel even smaller by dark cherry paneling. A desk, two chairs, a locked filing cabinet for patient records and journal articles, and a set of shoulder-to-ceiling bookshelves on one wall all but filled the room, although she had managed to personalize the space with a couple of small watercolors, some framed photos from her rafting trip down the Colorado, and a planter.

  Narda Woolard’s words were echoing in Jessie’s head as she sank into her chair. She did five uninspired minutes of Tetris and set a timer for fifteen minutes. Then she put her feet up on the desk, leaned back, and closed her eyes. Usually even fifteen minutes was long enough for her to drift off, enter some sort of REM sleep, and awaken rejuvenated. This time, her thoughts refused to slow. Early on in her internship, a cynical resident, already in advanced burnout, first exposed her to what he called Fox’s Immutable Laws of Medicine: Good guys get cancer. Trash survives. Who Fox was, the resident never explained. But Jessie had seen the laws hold too many times ever to ignore them. And Sara Devereau was an exceedingly good guy.

  Could Sara have been cured by a properly aggressive initial operation? Jessie had wondered this many times. Had Carl Gilbride even given the case much thought? How would he have felt if he had been to Sara’s house? Met her husband? Her kids? Would he have spent an extra hour or two at the operating table? Gone after those few extra tumor cells? Fat chance. Throughout her experience with the man, Jessie had never heard him admit to so much as a shortcoming, let alone an actual mistake—and there had been many over the years.…

  What difference does it make now, anyway? Tomorrow morning Sara would have her last shot at a surgical miracle. The envelope was going to have to be pushed and pushed some more. Walking, sight, arm use, speech … there was no telling what would have to be risked—even sacrificed—in the interest of getting all the tumor. And there was no predicting what was going to be left of Sara after the operation was done.

  Go to hell, Fox, whoever you are!

  “Jess?”

  Emily had opened the office door and was peering in. Jessie realized that she’d been out cold, tilted back in her chair, orbiting Neptune. Her timer, which she had apparently shut off, was clutched tightly in her lap. Forty-five minutes had passed.

  “Whoa,” she said, shaking the cobwebs loose, brushing some wisps of hair away from her eyes, and fumbling for her glasses on the desk. “I don’t think we’re in Kansas anymore, Toto.”

  “You okay?”

  “Let’s just say I needed the rest.”

  “I’m glad you got some. Ready to finish rounds?”

  “I am.”

  “It shouldn’t take too long. Oh, before I forget, there was a call for you at the nurses’ station just a little while ago from Dr. Mark Naehring.”

  “The shrink?”

  “Exactly. Remember that show he put on at grand rounds?”

  “Who could forget it? That poor woman.”

  Naehring was a psychopharmacologist. In front of an amphitheater filled with two hundred or so physicians and other practitioners, he had used a combination of drugs to rapidly and very effectively hypnotize a middle-aged woman with profound emotional illness. He then extracted, for the first time, a terrifyingly vivid description of childhood sexual abuse at the hands of her father and his brother, at times both at once. Naehring then used more medication and posthypnotic suggestion to remove all memory of his patient having shared anything. He would introduce her revelations gradually in their therapy sessions, making use of a video where needed.

  “Hopefully, the breakthrough helped her in the long run,” Emily said.

  “Do you have any idea what he wanted?”

  “I do. He’s heard about the functional MRIs we’re doing to map patients’ brains while they’re awake during surgery, and he wondered if he could come into the OR sometime and watch you do it. He believes some of the drug combinations he’s been using might be useful in keeping patients sedated but completely responsive.”

  “Interesting. Did you invite him to observe Sara’s operation?”

  “I did. He’ll be at a conference all day tomorrow. He said to please call him next time.”

  “Terrific. Hey, maybe he can use some of those meds on me,” Jessie said. “He can probe me to find out how I could have turned out the way I have with a mother who spent years grooming me to be the perfect happy home-maker for some lucky guy.”

  “What a failure she’s been. Imagine having to live with your daughter growing up to be one of the finest neurosurgeons around.”

  “Okay, okay, you can have that raise. Now, how’s our service doing?”

  “Not bad, actually. I’ve seen everyone but Dave Scolari.”

  “Any problems with the others?”

  “Let’s see. Mrs. Kinchley wants to change rooms because Mrs. Weiss snores. Mr. Emspak wants to pull the shunt out of his head and go home because he has tickets to the ball game this weekend. Mrs. Davidoff is in her sixth day without a bowel movement. She won’t let us discharge her until she has one. I told the nurses that whoever gets her emptied out wins dinner for two at the Top of the Hub.”

  “Courtesy of her HMO. Anything else?”

  “Dr. Gilbride’s patient, Larry Kelleher, has a fever. I couldn’t find much, so I ordered blood cultures and the usual tests.”

  “Carl’s patient with a post-op fever? Not possible!”

  “I know. I know. I couldn’t believe it myself.”

  They were still trading digs at their department chief when they entered room 717. New England Patriots linebacker Dave Scolari looked up at them impassively. He was a beautiful man—twenty-six years old, six foot three, with a 250-pound body that could have been chiseled from granite. He was also paralyzed from the neck down as the result of a fluke helmet-to-helmet hit. Surgery had stabilized his cervical fracture, and he had gotten back some movement in his hands, but the outlook for major recovery was guarded. Scolari, a fearless warrior on the field, had all but given up.

  “Something funny?” he asked.

  Jessie apologized, silently cursing herself and Emily for not regaining their composure before going in to see a patient—especially Dave. One of her coverage partners had done the surgery on Dave’s neck, then had gone on safari, so over the intervening weeks, she had spent a fair amount of time with him. Initially, he had responded to her, teasing her about looking too young to be a neurosurgeon, even calling her Doogie Howser. But as the reality of his situation and his prognosis hit home, his enthusiasm began to wane. Now, though he tried being civil and went through the motions with his therapists, it was obvious to everyone that the spark was gone.

  “More cards,” she said, gesturing to the walls, which were virtually covered. “I’ll bet most of them are from beautiful women.”

  “I haven’t looked. The nurses hang them up.”

  Jessie took one down and studied the photo of a woman who had to be a professional model.

  “Maybe you should read them. This one gives her phone number.”

  She showed Dave the photo, but got little reaction.

  “Nice looking,” was all he said.

  Jessie conducted a quick but thorough exam. His grip seemed marginally less feeble than it had been.

  “Dave, I think there’s improvement here. I really do.”

  “Come on, Dr. Copeland. There’s been no change. You know that as well as I do.”

  “No, Dave, you don’t know that as well as I do. I love playing games, but not this kind. If I say you’re improving, you’re improving. You’ve got to sto
p this. The more negative you are, the less you’ll benefit from the therapy you’re getting, and the less your body will respond to any of those X-factors that go into the medical miracles we’re always hearing about. I’m sorry to sound so sharp. I hope you know that I’ll do anything I possibly can to help you. But you’ve got to help yourself.”

  Scolari looked away.

  “Sure,” he said. “Anything you say.”

  Jessie wondered how she would respond to having life as she knew it end with the ghastly suddenness his had. No more neurosurgery, no more walks, no more volleyball at the Y, maybe no more dressing herself, or even feeding herself. Did she have what it would take to retool? She knew there was no way she, or anyone else, could really answer that question until they were where Dave Scolari was now. She set her hand on his shoulder. The muscle tone was gone, and she knew that atrophy had already begun. But some bulk was still there.

  “You just do your best,” she said, clearing a rasp from her voice. “Whatever hand you’re dealt, fair or not, is going to be your hand. Just try to do your best, Dave, and chances are some good things will happen. Say, listen. I’ve got an idea. Do you think you could handle having a quadriplegic friend of mine come and visit you? His name’s Luis Velasco, and he’s quite an incredible person.… Dave?”

  “Whatever.”

  “I’ll take that as a yes. I’ll call Luis tonight. Hang in there, pal.”

  Jessie followed Emily out of the room.

  “Let’s intensify his therapy,” she said. “Make sure they’re doing enough electrostimulation.”

  “You really think he’s getting stuff back?”

  “I’m sure of it. Not a breakthrough, but definitely something. Dave’s just too depressed right now to accept the change and work with it. That’s understandable, too. When your idea of activity is knocking someone’s block off on a football field, a little flicker of a couple of fingers just doesn’t cut it. We can’t let up on him, though. Any guy who thinks I look too young to be a neurosurgeon is definitely worth saving.”

  Emily took Scolari’s chart off a rolling rack and wrote orders for the intensified therapy. Then she and Jessie headed for room 710, a double that, for the past few days, had been occupied by only one patient—thirteen-year-old Tamika Bing. Before they reached the room, Jessie stopped and flipped through the girl’s chart.

  Seven days had passed since Jessie performed the excision of a glioblastoma infiltrating deep on the left side of Tamika’s brain. The operation had gone as well as she could have hoped, given the nature of the problem. Tamika’s motor function, a major concern, had been completely preserved. But the teen’s ability to connect with words appeared to have been lost. With that realization had come a devastating depression and an inertia even more disabling than Dave Scolari’s. Only the threat of tubes down her nose had gotten her to eat anything. And getting her to leave her room and take a walk was out of the question.

  Friends, family, nurses, social workers, psychiatrists, Jessie—no one had made a dent.

  “What am I going to see in there?” Jessie asked now.

  “Guess,” Emily replied.

  “Any ideas?”

  “The shrink wants to start her on an antidepressant.”

  “Ugh. As if having her brain messed with surgically isn’t enough. Well, I guess we don’t have another option. Has she used the laptop her mother brought in?”

  “Nope. Her mom says she was on it all the time at home, and even took it to school. Apparently it was her prized possession. She won’t touch it.”

  “Poor baby.”

  Tamika’s half of the room was as cheerful as the nurses and her mother could possibly make it, filled with cards, letters, pictures, stuffed animals, candy, magazines, and a portable CD player with headphones. In the middle of the comfortable clutter, propped in bed at almost ninety degrees, the girl sat, her wide, dark eyes staring straight ahead at nothing in particular.

  Fox’s laws.

  “Hi, Tamik,” Jessie said. “How’re you doing?”

  The two of them had gotten along well—very well—right up until the surgery. Since then, the teen hadn’t acknowledged her at all. This moment was no different.

  “I see you haven’t opened the CD I brought you,” she said, holding up the rap album she had picked out for the girl. “Want me to put it on?”

  Nothing.

  “Come on, Tamika. At least write me something—anything. Type it if you want.”

  Jessie centered the portable computer on the Formica tray table across Tamika’s lap.

  Nothing.

  She looked to Emily for guidance, but the nurse only shrugged. A quick exam, a final try to get some sort of response from their patient, and they turned to go. Carl Gilbride was standing in the doorway, watching them.

  The neurosurgical chief was, as always, impeccably dressed and groomed—tan suit, silk tie, wing tips, gold Rolex, starched and pressed lab coat, perfectly straight name tag—Carl W. Gilbride, Jr., M.D.; Chief of Neurosurgery. His wavy brown salon-cut hair and his round, rimless glasses helped produce an image that reminded Jessie of an SS interrogator in a grade B war movie.

  “Carl, hi,” she said lightly. “I thought you were going to be off lecturing for the day.”

  He stood motionless in the doorway, glaring at her.

  “What in the hell did I just hear about you doing a case with ARTIE in the operating room?” he said, giving no indication he cared about the girl in the bed behind her. “Just who the fuck do you think you are?”

  CHAPTER 4

  “CARL, PLEASE. TAKE A DEEP BREATH AND TRY TO stop snarling at me like I just shot a white rhino. I didn’t hurt anyone or do anything wrong. At least I don’t think I did. Pete Roslanski was dead. A cadaver! He and his family wanted his body to serve some purpose beyond fertilizing the north forty of some cemetery. You were away. I couldn’t have asked your permission even if I wanted to.”

  Jessie and Gilbride confronted each other across the table in one of the examining rooms on Surgical Seven. She had managed to curtail his tirade in Tamika Bing’s room before it got any more abusive, and to lead him down the hall. The teenager, who had surely overheard what was said, had reacted not at all. She merely lay there as she always did, propped up in whatever position the nurses had chosen for her, staring straight ahead at nothing.

  Gilbride’s fury had only marginally receded. He still looked like a bullfrog being squeezed tightly from below. Over the years Jessie had served in his residency and worked in his lab, he had lost his temper with her any number of times. Enduring his explosions went with the territory. And in truth, she really wasn’t treated much differently from any of the others who were on his B list. His A list consisted of those who never expressed a viewpoint or treatment approach different from his. And that sort of obsequiousness she was simply incapable of displaying—or even faking, as most of those who were on the A list did.

  She suspected that merely having two X chromosomes would have also been enough to disqualify her from the A’s. She had been the first—and to this point the last—female resident Gilbride had taken into his program, and the only woman on the neurosurgical faculty. It took just a few months of her residency—and of his snide, offensive, at times near-illegal asides—for her to understand how desperately the man must have needed her technical expertise in his robotics lab to have accepted her. There was even a rumor that he had once let slip his belief that she would wash out of the program before a year was out, and end up working full-time on his research.

  But on the plus side, she wasn’t playing the résumé-and-wait game every year in a field dominated by XYs, and she had a damn good job in a hospital that had risen to near the top of neurosurgery programs. She had friends like Emily and Hans Pfeffer, almost universal respect from her colleagues at EMMC, and at last count was the busiest surgeon in the department, next to the bullfrog himself. And finally, she had ARTIE, which, although technically Gilbride’s, was a child she was determined
to see into adulthood.

  In the interest of continuing her work, she could handle whatever Gilbride dished out, as long as he didn’t demand she compromise her beliefs too much. But the scene in Tamika’s room had represented a clear-cut escalation in the tension between them. Gilbride had never chastised her in front of a patient before, let alone so harshly.

  She took pains to maintain eye contact with the man and focused on two objectives: first, to defuse his anger before he said something irreparable, and then, to try to find out exactly why he was so steamed over what she had done. The clock over Gilbride’s left shoulder read almost six-thirty. Her chances of making it to the Cavendish Club in time for the bridge game were almost as remote as the chances of her playing well now even if she did.

  “Carl, I’m sorry,” she began, not completely certain for what she was apologizing.

  “You should be. What right did you have to tie up an entire operating room team, plus the radiologists, without clearing it with me?”

  “Bill Wellman had canceled his OR case. The team was just waiting around for their next case, and Pete Roslan—”

  “Dammit, Copeland, I’m not done talking. Why is it you always have the bullshit ready before anyone even has a shovel?”

  “Sorry.”

  “You know, I carry a beeper just like you do. You could have paged me.”

  Jessie could have enumerated the many times Gilbride had gone ballistic because she or one of the other B-listers had paged him for something less than a nuclear spill on Surgical Seven. Instead, she muttered another apology. This fire was simply going to have to burn itself out.

  “You’ve done good work in the lab,” he went on. “I have no complaints about that. But I think you tend to forget that I had started developing ARTIE before you ever came on board here. Those grants that pay for you, Skip, and all that equipment are my grants. The patents on ARTIE have my name on them. You aren’t his adopted mother, you’re his nursemaid and his tutor. If you forget that fact, you’ll be history around here. I promise you that.”