Noble Vision: A Novel

by Gen LaGreca

  The secretary’s eyes caught the approving nod of Governor Burrow.

  “So you see, private insurance also failed, and for the same reason,” the secretary continued with conviction. “The government stepped in to regulate the insurers so that they would act with kindness, not actuarial tables; with sensitivity, not statistics; with the same rates for all; with no one denied a policy; with every condition covered. But did the insurers comply? More concerned with the ticks of their stock than the tears of the needy, they curtailed care and canceled policies faster than we could pass enough laws to stop them.

  “The problem became a crisis. The solution was more management by the government. Finally, Governor Burrow, in his ardent compassion for the people, stepped in to save medicine with CareFree.”

  Like creatures stalking prey, television cameras covering the event fixed their lenses on the secretary.

  “CareFree proudly is concerned not with finance, but with feeling; not with profit, but with pity; not with amount tendered, but with compassion rendered.”

  The secretary raised his head, his face imbued with a religious fervor. The governor looked confident that the secretary was the right man for his campaign.

  “Our opponents claim that our ideal has been tried before and it failed. However, it was not the ideal that failed but the people entrusted with it. If a rocket could soar to Mars but unscrupulous people filled the fuel tank with sand, should we blame the rocket or the saboteurs? Unfortunately, some practitioners have failed in their responsibility to comply with our new program. They break the rules and overload the system with expenses!” He bristled, as if hitting a sore point. “I want to assure all New Yorkers that we will strictly enforce our guidelines for the medical profession! Let this be a warning: I will not allow malcontents to dump sand into our engine!”

  A disturbing stillness fell on the room, most quickly on the doctors in the audience. They sat frozen, their eyes darting nervously. The governor’s smile faded, and panic covered the secretary’s face. Sensing that a change in course was needed to avoid crashing his rocket, the secretary quickly scanned his mind for a remedy. He noticed that the waiters had placed a glass of champagne before each person, so he picked up his and smiled.

  “But let us return to our purpose,” he said, his tone lighter. “Let us toast that which ended centuries of misery, transforming human existence from pain, suffering, and early death to health, happiness, and long life. A toast to modern medicine.”

  He raised his glass high and waited for the guests to follow suit.

  “And a toast to the man who harnessed medicine to serve the public, the man who will be reelected in November. A toast to Governor Malcolm Burrow!”

  Eight hundred gulps reverberated through the room.

  * * * * *

  David Lang’s car hit the bridge to Manhattan with a loud thump, but his foot did not lighten on the gas pedal. The procedure would be a normal event of his life—he was called, he came, he worked, he left—except for one thing: This time he was angry.

  A hot fuse of disturbing facts burned through his mind. Fact one: Bentley said the hemorrhage was subdural, below the dura, one of the layers of tissue between the skull and brain. David expected such a bleed to be from a vein, which flowed more slowly than an artery, providing time for diagnosis and treatment. Bentley said that the patient had sought medical attention prior to her emergency. Why did the problem remain undetected for days after the patient had seen her doctor? Fact two: The brain was sending warning signals with the worsening headaches. A blow to the head followed by progressively severe headaches, he thought, was a neon advertisement of trouble early on. Why had this symptom been preposterously misdiagnosed as migraines? And why had a scan apparently been delayed until so much blood and pressure mounted that the brain became a kettle about to blow its lid? Fact three: The patient was taking an anticoagulant, a blood thinner, for treatment of a clot in her leg. She had just given birth, and because pregnancy can worsen varicose veins and thrombosis, anticoagulants are sometimes prescribed. But any medical student knows that people taking blood thinners run a higher risk of hemorrhage after injury because their blood can fail to clot normally. Why was the anticoagulant apparently continued after the head injury and onset of headaches while the possibility of hemorrhage was ignored? He swore aloud; the prospect of senseless death was increasing the pressure on his own brain.

  Was Bentley the doctor who had treated the woman earlier in the week? With general practitioners pressured by CareFree to reduce referrals to specialists, patients increasingly flooded the ER, where they could see such doctors more easily. Bentley was the neurosurgery resident on call that week in the ER, and he had referred to the woman as “my patient.” Had Bentley examined her earlier and sent her home to take blood thinners, with a subdural bleed? He swore again. Stop it! he ordered himself as he reached Manhattan. He ran a red light and headed west.

  The air in the windowless waiting room of Riverview Hospital was hot and stale. Ten-year-old Billy Miller thought it was the stink of the hospital that made him sick to his stomach. A tall man in blue clothing, Dr. Bentley, was talking to his father. The doctor said that Eileen, his mother, was very sick, that her brain was bleeding, that a Dr. Lang was coming to operate. Billy could not take his eyes off the man’s face, waiting, hoping . . . but Dr. Bentley did not smile. Billy wondered why he had played baseball outside their brownstone after his mother had told him not to, after she had warned him that someone could get hurt. He wondered why she was falling asleep so much and wasn’t herself that week. Was it because his baseball had hit her that she was sick? Billy’s father and older sister sat holding hands, but the boy remained by himself.

  A door swung open in the operating room where Eileen Miller lay unconscious. The scrub nurse raised her eyebrows when Dr. Lang rushed in wearing street clothes. His eyes hit the shaved head on the operating table and the brain scans on the view box, and then he gasped.

  “Get me gloves!”

  “I’ll have these instruments laid out in a few minutes while you change and scrub, Doctor,” said the scrub nurse.

  “We don’t have a few minutes!”

  “I need to insert this catheter,” said the circulating nurse, trying to move around him.

  “Forget that!” he said.

  “I’ll tape these tubes down,” said the anesthesiologist, trying to get at the patient.

  “Not now,” said David, as the nurses threw a sterile gown over street clothes and sterile gloves over unwashed hands.

  Someone managed to place a mask and cap on him. Soon the buzz of a high-speed drill and the smell of scorched tissue hit the air.

  David had no time to question Tom Bentley, who was assisting him, because pieces of Eileen Miller’s brain were about to explode. Clumped blood from the hemorrhage pushed structures in the brain, causing pressure to rise. David ordered drugs to reduce the swelling while trying desperately to contain the brain tissue in the skull, to remove the mottled clumps of blood, and to find the source of the bleed in a sea of red.

  The brain David faced was raging. Spewing and clumping blood buried the normal pale color, gentle pulse, and delicate landscape of vessels and nerves. Somewhere near the red deluge was the center that controlled Eileen’s circulation and breathing. How much time would David have before the red menace reached the command post of the brain and began pushing and shoving critical areas? The threat haunted him. He evacuated the purple blotches at an alarming pace, with vital structures a hair’s width from flying instruments. Could David find the source of the bleed and stop it in time? How much good brain would be lost on the battlefield? And what would remain of Eileen Miller, wife and mother?

  * * * * *

  Aromas of cognac and coffee laced the air of the grand ballroom after the meal. The crystal chandeliers cast a jaundiced glow on Governor Malcolm Burrow, rising from the dais to speak. His hair was neither black nor white but a tangle of the two, as if undecided between youth and ol
d age. With thin legs and a paunch, he was both slim and chubby. His mouth smiled while his eyes drooped, his face seemingly unable to choose a mood. He wore cuff links handcrafted by an Iroquois descendant and a digital watch from a New York manufacturer. Malcolm Burrow was said to be all things to all people, an impression that he seemed to encourage, especially with an election looming. Television cameras followed him to the podium as the band played “Back Mack,” a tune created for his campaign.

  “Good evening, my fellow New Yorkers. I sincerely appreciate your generous support for my campaign. I see many among you who backed me four years ago in my first race for governor. I hope you all realize that your contributions helped us make history.

  “My administration launched CareFree, the greatest public entitlement program ever attempted in New York. We’re the first state to guarantee health care to all citizens. The president of the United States himself hailed CareFree as a model system. So now every other state in the nation is scrambling to copy what we’ve already accomplished here in New York!”

  The audience cheered.

  “Now, I’m going to ask you to make history with me again,” continued the governor. “I have only one campaign promise this time, but accomplishing it will be another milestone. First, let me say that I was as shocked as everyone by the recent . . . questions . . . concerning one of our colleagues.”

  Burrow’s tone softened. The lieutenant governor, conspicuously absent from the evening’s event, was under investigation for accepting gifts and payments from construction companies awarded government contracts, and many voices were urging Burrow to choose a new running mate.

  “We are thoroughly investigating the matter involving the lieutenant governor. Once the facts are known, I will act accordingly.”

  Burrow waved his hand as if to shoo away the scandal blackening the front pages of every newspaper in the state in recent weeks. Cameras panned to the secretary of medicine, the leading contender for the governor’s running mate should the lieutenant governor be forced off the ticket. Prominent citizens lauded the secretary as a “man of honor,” “pillar of morality,” “impassioned servant of the people.”

  “This brings me to my promise to you and to all New Yorkers,” Burrow continued. “I pledge that my administration will serve no cause other than the people’s welfare. We will make history again, this time by having the most honorable government ever to serve the people. The public interest will be our only beacon!”

  The governor’s voice was a distant drone to alcohol-mellowed Marie Lang, sipping cognac and watching the waiter pour coffee.

  “This coffee’s stale,” said the partner who managed Reliant Care’s clinical staff, the tinge of petulance in his manner becoming more pronounced after the evening’s drinks. He raised his hand to signal the waiter, and then lowered it. “Aw, what’s the use complaining? Nobody listens.”

  The financial officer tasted his coffee, and then glanced around the room. “It’s stale, but no one else is complaining. Who are we to go against the majority?”

  “This is typical,” said the head of marketing, tasting the contents of his cup disapprovingly. “The hotel makes a killing on the banquet, then serves us these dregs. There ought to be a law.”

  “I have just the thing,” said Marie. She poured some of her cognac into the complaining partner’s coffee. “How’s that?”

  “Actually, very good!” said the partner, sipping the brew.

  Paul Eastman smiled. “That’s a fifty-year-old cognac you just poured into stale coffee, my dear. One could say you ruined the cognac.”

  “Or one could say I improved the coffee.”

  “I’d say Marie’s bent on making things work, even if it takes a little defiling,” said the head of the clinical staff approvingly.

  “The way Reliant’s growing, we’ll need to take on another partner.” Eastman tapped Marie’s hand. “Let’s talk.”

  “Let’s do, Paul,” she replied.

  Marie’s silky hair bounced as she tossed her head back in enjoyment of the moment. Affixed to the thin strap of her gown was a gold pin. In the creamy light of the chandelier, one could read the engraving: Dr. Marie Lang, Distinguished Caregiver.

  * * * * *

  Disinfectants and sweat hung in the heavy air of the OR. Fluids that had been sucked out of Eileen Miller’s brain filled a plastic container. Bloody gauze pads lay in neat rows on a blue cloth after a nurse triple-checked that every one put into the patient’s brain had been retrieved. Bentley finished bandaging the patient’s head. While David Lang shed a surgical gown resembling a butcher’s apron after a day’s work, the anesthesiologist removed the respiratory tube. David’s eyes froze on Eileen Miller’s still body. What would her lungs do? Within moments, her chest rose and fell in even breaths, an auspicious sign! Smile lines, the first of the evening, livened David’s face.

  He accompanied Eileen into the recovery room. Standing over her listless form, he waited for her to awaken. Would she? No device existed to spare him the anguished moments after surgery when only the limp body before him knew whether his best effort had been good enough. He waited for Eileen’s body to confide in him its secret. Interminable minutes passed. Then Eileen Miller opened her eyes.

  “Good evening, Eileen! Squeeze my hand.”

  Five frail fingers made the journey around the summoning hand. David felt a weak but discernible pressure.

  “Good! Now squeeze my other hand. . . . Wiggle your toes. . . . Very good! . . . Now follow my finger with your eyes. . . . What year is it, Eileen?”

  Although groggy and confused, Eileen responded normally to his various neurological tests. David laughed in exhaustion, relief, and triumph. But his laughter died when Bentley entered the room.

  David stepped away from the bed and whispered to the resident: “Was a brain scan done on this patient before tonight?”

  “No, Doctor.”

  “Do you know that a patient taking anticoagulants is predisposed to hemorrhage after trauma?”

  “Yes, Doctor.”

  “Do you also know that persistent headaches after a head injury are a neurological sign to take seriously?”

  “Of course,” Bentley replied, confused.

  “What has been done all week to treat this woman?”

  “She was given a painkiller for migraines.”

  “Do you know the difference between a migraine and an intracranial hemorrhage?”

  “Why, yes.”

  “Is this what I’m teaching you to do, Bentley?”

  “Oh,” Bentley said in sudden understanding. “But—”

  “To observe symptoms and not to test?”

  “But Dr. Lang—”

  “To send a patient home to die! Is that what you’re learning here?” David’s fists tightened.

  “But Doctor, I—”

  “Excuse me, Dr. Lang.” A nurse had approached them, pointing to a man and two children standing at the doorway. “The Millers made their way back here. Shall I ask them to wait?”

  David saw six desperate eyes staring at him.

  “No, I’ll talk to them right away.” Glancing at Bentley, he added coolly, “I’ll be back.”

  Despite the exhaustion apparent in his puffy eyes, David’s handshake was firm. “Hello, Mr. Miller. I’m David Lang. I just operated on Eileen.”

  “You’re smiling, Dr. Lang. Does that mean we . . . have reason . . . to . . . hope?”

  “I think Eileen is going to be fine.”

  His words transformed three despondent figures into human beings. Mr. Miller jubilantly embraced his daughter. He paused to look for a small presence standing apart, watching them.

  “Come here, son. Everything’s going to be all right.”

  Billy tentatively walked toward them. The father and sister threw their arms around the little bundle, clutching him until the biting sadness lifted its grip on his small face.

  David allowed them to talk to Eileen. He watched with a quiet thrill as they kisse
d the limp form with the bandaged head. He stood apart, allowing them intimacy, yet he could not avert his eyes, knowing he was part of that moment.

  “Dr. Lang, forgive me—I haven’t thanked you yet,” Mr. Miller said when they left the patient. “You see, I’m still stunned. Eileen seemed fine. She complained of headaches earlier in the week, but they weren’t bad at first.”

  “These conditions sometimes worsen, even though she might have seemed okay when you brought her to the hospital earlier this week.”

  “We never brought her to the hospital.”

  “You didn’t come to the ER?”

  “Why, no, we didn’t think there was an emergency—until tonight when we couldn’t arouse her from a nap.”

  “I guess I assumed you brought her here.”

  “We’ve never been to Riverview Hospital before tonight, except when Eileen gave birth.”

  “I was napping when Dr. Bentley called me this evening. I thought he treated her earlier this week.”

  “We never met Dr. Bentley until tonight.”

  “Oh, I see!” David said, relieved to owe Bentley an apology. He liked the resident. Then the fuse within him reignited, searching for the proper target to strike. “Who treated your wife?”

  “She saw our general practitioner at the office as soon as the headaches started, the same physician who has been treating her varicose veins. We also telephoned our doctor when the headaches were worsening. We were told they were migraines and nothing to worry about.”

  “Who is this doctor?”

  “Well, that’s what we were wondering.”

  “What do you mean?”

  “We were curious.”

  “About what?”