Harvest

by Tess Gerritsen

  This was Abby’s chance to flee the boat talk. She slipped away from Mark and went to join the Levis.

  “Mrs. Levi? It’s so nice to see you again.”

  Elaine returned a smile of recognition. “It’s . . . Abby, isn’t it?”

  “Yes, Abby DiMatteo. I think we met at the residents’ picnic.”

  “Oh yes, that’s right. There are so many residents, I have trouble keeping you all straight. But I do remember you.”

  Abby laughed. “With only three women in the surgery program, we do stick out.”

  “It’s a lot better than the old days, when there were no women at all. Which rotation are you on now?”

  “I start thoracic surgery tomorrow.”

  “Then you’ll be working with Aaron.”

  “If I’m lucky enough to scrub on any transplants.”

  “You’re bound to. The team’s been so busy lately. They’re even getting referrals from Massachusetts General, which tickles Aaron pink.” Elaine leaned toward Abby. “They turned him down for a fellowship years ago. Now they’re sending him patients.”

  “The only thing Mass Gen has over Bayside is their Harvard mystique,” said Abby. “You know Vivian Chao, don’t you? Our chief resident?”

  “Of course.”

  “She graduated top ten at Harvard Med. But when it came time to apply for residency, Bayside was her number one choice.”

  Elaine turned to her husband. “Aaron, did you hear that?”

  Reluctantly he looked up from his drink. “Hear what?”

  “Vivian Chao picked Bayside over Mass Gen. Really, Aaron, you’re already at the top here. Why would you want to leave?”

  “Leave?” Abby looked at Aaron, but the cardiologist was glaring at his wife. Their sudden silence was what puzzled Abby most. From across the lawn came the sound of laughter, the echoing drifts of conversation, but in this corner of the garden, nothing was said.

  Aaron cleared his throat. “It’s just something I’ve toyed with,” he said. “You know. Getting away from the city. Moving to a small town. Everyone daydreams about small towns, but no one really wants to move there.”

  “I don’t,” said Elaine.

  “I grew up in a small town,” said Abby. “Belfast, Maine. I couldn’t wait to get out.”

  “That’s how I imagine it would be,” said Elaine. “Everyone clawing to get to civilization.”

  “Well, it wasn’t that bad.”

  “But you’re not going back. Are you?”

  Abby hesitated. “My parents are dead. And both my sisters have moved out of state. So I don’t have any reason to go back. But I have a lot of reasons to stay here.”

  “It was just a fantasy,” said Aaron, and he took a deep gulp of his drink. “I wasn’t really thinking about it.”

  In the odd silence that followed, Abby heard her name called. She turned and saw Mark waving to her.

  “Excuse me,” she said, and crossed the lawn to join him.

  “Archer’s giving the tour of his inner sanctum,” said Mark.

  “What inner sanctum?”

  “Come on. You’ll see.” He took her hand and led her across the terrace and into the house. They climbed the staircase to the second floor. Only once before had Abby been upstairs in the Archer house, and that was to view the oil paintings hung in the gallery.

  Tonight was the first time she’d been invited into the room at the end of the hall.

  Archer was already waiting inside. In a grouping of leather chairs were seated Drs. Frank Zwick and Raj Mohandas. But Abby scarcely noticed the people; it was the room itself that commanded her attention.

  She was standing in a museum of antique medical instruments. In display cases were exhibited a variety of tools both fascinating and frightening. Scalpels and bloodletting basins. Leech jars. Obstetrical forceps with jaws that could crush an infant’s skull. Over the fireplace hung an oil painting: the battle between Death and the Physician over the life of a young woman. A Brandenburg Concerto was playing on the stereo.

  Archer turned down the volume, and the room suddenly seemed very quiet, with only the whisper of music in the background.

  “Isn’t Aaron coming?” asked Archer.

  “He knows about it. He’ll be on his way up,” said Mark.

  “Good.” Archer smiled at Abby. “What do you think of my little collection?”

  She studied the contents of a display case. “This is fascinating. I can’t even tell you what some of these things are.”

  Archer pointed to an odd contraption of gears and pulleys. “That device over there is interesting. It was meant to generate a weak electrical current, which was applied to various parts of the body. Said to be helpful for anything from female troubles to diabetes. Funny, isn’t it? The nonsense medical science would have us believe?”

  Abby stopped before the oil painting and gazed at the black-robed image of Death. Doctor as hero, Doctor as conqueror, she thought. And of course the object of rescue is a woman. A beautiful woman.

  The door opened.

  “Here he is,” said Mark. “We wondered if you’d forgotten about it, Aaron.”

  Aaron came into the room. He said nothing, only nodded as he sat down in a chair.

  “Can I refill your drink, Abby?” said Archer, gesturing to her glass.

  “I’m fine.”

  “Just a splash of brandy? Mark’s driving, right?”

  Abby smiled. “All right. Thanks.”

  Archer touched up Abby’s drink and handed it back to her. The room had fallen strangely quiet, as though everyone was waiting for this formality to be completed. It struck her then: she was the only resident in the room. Bill Archer threw this sort of party every few months, to welcome another batch of house staff to the thoracic and trauma rotations. At this moment, there were six other surgical residents circulating downstairs in the garden. But here, in Archer’s private retreat, there was only the transplant team.

  And Abby.

  She sat down on the couch next to Mark and sipped her drink. Already she was feeling the brandy’s heat, and the warmth of this special attention. As an intern, she’d viewed these five men with awe, had felt privileged just to assist in the same OR with Archer and Mohandas. Though her relationship with Mark had brought her into their social circle, she never forgot who these men were. Nor did she forget the power they held over her career.

  Archer sat down across from her. “I’ve been hearing some good things about you, Abby. From the General. Before he left tonight, he paid you some wonderful compliments.”

  “Dr. Wettig did?” Abby couldn’t help a surprised laugh. “To be honest, I’m never quite sure what he thinks about my performance.”

  “Well, that’s just the General’s way. Spreading a little insecurity around in the world.”

  The other men laughed. Abby did too.

  “I do respect Colin’s judgment,” said Archer. “And I know he thinks you’re one of the best Level Two residents in the program. I’ve worked with you, so I know he’s right.”

  Abby shifted uneasily on the couch. Mark reached for her hand and gave it a squeeze. That gesture was not missed by Archer, who smiled.

  “Obviously, Mark thinks you’re pretty special. And that’s part of the reason we thought we should have this discussion. I know it may seem a little premature, but we’re long-range planners, Abby. We think it never hurts to scout out the territory in advance.”

  “I’m afraid I don’t quite follow you,” said Abby.

  Archer reached for the brandy decanter and poured himself a scant refill. “Our transplant team’s interested in only the best. The best credentials, the best performance. We’re always looking over the residents for fellowship material. Oh, we have a selfish motive, of course. We’re grooming people for the team.” He paused. “And we were wondering if you might have an interest in transplant surgery.”

  Abby flashed Mark a startled look. He nodded.

  “It’s not something you have to decide a
nytime soon,” said Archer. “But we want you to think about it. We have the next few years to get to know each other. By then, you may not even want a fellowship. It may turn out transplant surgery’s not something you’re even vaguely interested in.”

  “But it is.” She leaned forward, her face flushing with enthusiasm. “I guess I’m just . . . surprised by this. And flattered. There are so many good residents in the program. Vivian Chao, for instance.”

  “Yes, Vivian is good.”

  “I think she’ll be looking for a fellowship next year.”

  Mohandas said, “There’s no question that Dr. Chao’s surgical technique is outstanding. I can think of several residents with excellent technique. But you have heard the saying? One can teach a monkey how to operate. The trick is teaching him when to operate.”

  “I think what Raj is trying to say is, we’re looking for good clinical judgment,” said Archer. “And a sense of teamwork. We see you as someone who works well with a team. Not at cross-purposes. That’s something we insist on, Abby, teamwork. When you’re sweating it out in the OR, all sorts of things can go wrong. Equipment fails. Scalpels slip. The heart gets lost in transit. We have to be able to pull together, come hell or high water. And we do.”

  “We help each other out, too,” said Frank Zwick. “Both in the OR and outside of it.”

  “Absolutely,” said Archer. He glanced at Aaron. “Wouldn’t you agree?”

  Aaron cleared his throat. “Yes, we help each other out. It’s one of the benefits of joining this team.”

  “One of the many benefits,” added Mohandas.

  For a moment no one spoke. The Brandenburg Concerto played softly in the background. Archer said, “I like this part,” and turned up the volume. As the sound of violins spilled from the speakers, Abby found herself gazing, once again, at Death versus the Physician. The battle for a patient’s life, a patient’s soul.

  “You mentioned there were . . . other benefits,” said Abby.

  “For example,” offered Mohandas, “when I completed my surgery residency, I had a number of student loans to pay off. So that was part of my recruitment package. Bayside helped me pay off my loans.”

  “Now that’s something we can talk about, Abby,” said Archer. “Ways we can make this attractive to you. Young surgeons nowadays, they come out of residency at thirty years old. Most of them are already married with maybe a kid or two. And they owe—what? A hundred thousand dollars in loans. They don’t even own a house yet! It’ll take ’em ten years just to get out of debt. By then they’re forty, and worried about college for their kids!” He shook his head. “I don’t know why anyone goes into medicine these days. Certainly not to make money.”

  “If anything,” agreed Abby, “it’s a hardship.”

  “It doesn’t have to be. That’s where Bayside can help. Mark mentioned to us that you were on financial aid all the way through medical school.”

  “A combination of scholarships and loans. Mostly loans.”

  “Ouch. That sounds painful.”

  Abby nodded ruefully. “I’m just beginning to feel the pain.”

  “College loans as well?”

  “Yes. My family had financial problems,” Abby admitted.

  “You make it sound like something to be ashamed of.”

  “It was more a case of . . . bad luck. My younger brother was hospitalized for a number of months and we weren’t insured. But then, in the town where I grew up, a lot of people weren’t insured.”

  “Which only confirms how hard you must have worked to beat the odds. Everyone here knows what that’s like. Raj here was an immigrant, didn’t speak English until he was ten. Me, I’m the first in my family to go to college. Believe me, there are no goddamn Boston Brahmins in this room. No rich daddies or handy little trust funds. We know about beating the odds because we’ve all done it. That’s the kind of drive we’re looking for in this team.”

  The music swelled to its finale. The last chord of trumpets and strings faded away. Archer shut off the stereo and looked at Abby.

  “Anyway. It’s something for you to think about,” he said. “We’re not making any firm offers, of course. It’s more like talking about a, uh . . .” Archer grinned at Mark. “First date.”

  “I understand,” said Abby.

  “One thing you should know. You’re the only resident we’ve approached. The only one we’re really considering. It would be wise if you didn’t mention this to the rest of the house staff. We don’t want to stir up any jealousy.”

  “Of course not.”

  “Good.” Archer looked around the room. “I think we’re all in agreement about this. Right, gentlemen?”

  There was a general nodding of heads.

  “We have consensus,” said Archer. And, smiling, he reached once again for the brandy decanter. “This is what I call a real team.”

  “So what do you think?” Mark asked as they drove home.

  Abby threw back her head and shouted deliriously. “I’m floating! God, what a night!”

  “You’re happy about it, huh?”

  “Are you kidding? I’m terrified.”

  “Terrified? Of what?”

  “That I’ll screw up. And blow it all.”

  He laughed and gave her knee a squeeze. “Hey, we’ve worked with all the other residents, okay? We know we’re recruiting the best.”

  “And just how much of this was your influence, Dr. Hodell?”

  “Oh, I put in my two cents’ worth. The others just happened to be in complete agreement.”

  “Right.”

  “It’s true. Believe me, Abby, you’re our number one choice. And I think you’d find it a terrific arrangement, too.”

  She sat back, smiling. Imagining. Until tonight, she’d had only a fuzzy notion of where she’d be working in three and a half years. Toiling in an HMO, most likely. Private practice was in its dying days; she saw no future in it, at least, not in the city of Boston. And Boston was where she wanted to stay.

  Where Mark was.

  “I want this so badly,” she said. “I just hope I don’t disappoint you all.”

  “Not a chance. The team knows what it wants. We’re all together on this.”

  She fell silent for a moment. “Even Aaron Levi?” she asked.

  “Aaron? Why wouldn’t he be?”

  “I don’t know. I was talking to his wife tonight. Elaine. I got the feeling Aaron isn’t very happy. Did you know he was thinking of leaving?”

  “What?” Mark glanced at her in surprise.

  “Something about moving to a small town.”

  He laughed. “It’ll never happen. Elaine’s a Boston girl.”

  “It wasn’t Elaine. It was Aaron who was thinking about it.”

  For a while Mark drove without saying a word. “You must have misunderstood,” he said at last.

  She shrugged. “Maybe I did.”

  “Light, please,” said Abby.

  A nurse reached up and adjusted the overhead lamp, focusing the beam on the patient’s chest. The operative site had been drawn on the skin in black marker, two tiny X’s connected by a line tracing along the top of the fifth rib. It was a small chest, a small woman. Mary Allen, eighty-four years old and a widow, had been admitted to Bayside a week ago complaining of weight loss and severe headaches. A routine chest X ray had turned up an alarming find: multiple nodules in both lungs. For six days she’d been probed, scanned, and x-rayed. She’d had a bronchoscope down her throat, needles punched through her chest wall, and still the diagnosis was unclear.

  Today they’d know the answer.

  Dr. Wettig picked up the scalpel and stood with blade poised over the incision site. Abby waited for him to make the cut He didn’t Instead he looked at Abby, his eyes a hard, metallic blue over the mask.

  “How many open lung biopsies have you assisted on, DiMatteo?” he asked.

  “Five, I think.”

  “You’re familiar with this patient’s history? Her chest films?”


  “Yes, sir.”

  Wettig held out the scalpel. “This one’s yours, Doctor.”

  Abby looked in surprise at the scalpel glittering in his hand. The General seldom relinquished the blade, even to his upper-level residents.

  She took the scalpel, felt the weight of stainless steel settle comfortably in her grasp. With steady hands, she made her incision, stretching the skin taut as she sliced a line along the rib’s upper edge. The patient was thin, almost wasted; there was scant subcutaneous fat to obscure the landmarks. Another, slightly deeper incision parted the intercostal muscles.

  She was now in the pleural cavity.

  She slipped a finger through the incision and could feel the surface of the lung. Soft, spongy. “Everything all right?” she asked the anesthesiologist.

  “Doing fine.”

  “Okay, retract,” said Abby.

  The ribs were spread apart, widening the incision. The ventilator pumped another burst of air, and a small segment of lung tissue ballooned out of the incision. Abby clamped it, still inflated.

  Again she glanced at the anesthesiologist.

  “Okay?”

  “No problem.”

  Abby focused her attention on the exposed segment of lung tissue. It took only a glance to locate one of the nodules. She ran her fingers across it. “Feels pretty solid,” she said. “Not good.”

  “No surprise,” said Wettig. “She looked like a chemotherapy special on X ray. We’re just confirming cell type.”

  “The headache? Brain metastases?”

  Wettig nodded. “This one’s aggressive. Eight months ago she had a normal X ray. Now she’s a cancer farm.”

  “She’s eighty-four,” said one of the nurses. “At least she had a long life.”

  But what kind of life? wondered Abby as she resected the wedge of lung containing the nodule. Yesterday, she had met Mary Allen for the first time. She had found the woman sitting very quiet and still in her hospital room. The shades had been drawn, the bed cast in semidarkness. It was the headaches, Mary said. The sun hurts my eyes. Only when I sleep does the pain go away. So many different kinds of pain . . .