Noble Vision: A Novel

by Gen LaGreca

  “The hospital can transfer Carter’s grant to the next chief of neurosurgery.” Randy pulled a paper out of his briefcase. “This letter from the BOM outlines the terms of the research.” He slid the paper to his brother.

  David read a description of the abundance of animals permitted to John Carter, the money for laboratories and fellows, and the criteria for the grant, which fit his own project. David stared at the paper for a long moment after he had finished reading. Finally, he pushed it back across the desk to Randy, his hand moving slowly, as if forcing a heavy weight.

  “Don’t ask what you’re going to ask me, Randy, because I can’t do it,” he whispered painfully.

  “Why not?”

  “You know why.”

  “I’m offering a starving man a truckload of steaks.”

  “No.”

  “David, you’ll have all the animals you need and a crop of postgraduate fellows falling out of the trees like apples to assist you. Another year is all you’ll need. I know you’ll work day and night, you’ll answer all the remaining questions you have, you’ll polish your new procedure and be ready for human trials—before you have a chance to regret your decision to accept this opportunity.”

  “I can’t.”

  “And while you’re completing the animal studies, things could change. What if Mack Burrow loses the election and becomes a pimple on the nose of history? What if more hospitals fold and the people finally get fed up? What if the new governor is forced to abandon CareFree?”

  “Then he’ll invent FearFree or TearFree.”

  “But what if they’re finally forced to leave us alone? Then the way will be clear for our Institute for Neurological Research and Surgery. Have you forgotten the dream we’ve had since high school?” Randy leaned over the desk excitedly, trying to engage David, who sat back, crossing his arms skeptically against his chest. “Once such an institute is free to turn a profit, Riverview’s board of directors will fund it, and if they don’t, we’ll find other investors who’ll want to make a fortune. Leave that to me. With you as medical director and me as president, how can we fail? David, you’ll have patients begging for your new treatment; you’ll have doctors to train; you’ll have a research lab; you’ll have a dozen other projects you’ll want to start—”

  “Randy, please!”

  “The world will have a momentous medical breakthrough, your new treatment, which will launch the Institute for Neurological Research and Surgery. And I . . . I’ll get to leap out of bed every day, rushing to get to work, because I’ll have a hundred ideas that I’ll want to try, that I’ll be free to try. My work will be a story of progress and success, instead of . . .”—his eyes dropped—“well . . . never mind.”

  “I know you’re unhappy,” David said sadly.

  Randy ignored the comment. “With all that’s still possible, why won’t you accept the opportunity I’m throwing at you?”

  “Because in order to get the grant, I’d have to replace John Carter as the new department head, and that thought should scare you, not make you want to throw a party.” He gestured to the champagne bottle. “Besides, I’d never be accepted.”

  “With your clinical record, the surgeons will accept you in the chief’s post,” said Randy with conviction. “Oh, there’ll be some griping because some of them want the job, but that kind of politics can be handled. And although you’re young for the position at thirty-seven, your accomplishments, especially the separation of the twins, will silence any objections.”

  “But the board of directors would never approve of my other record, the one I have with CareFree. And they’d be smart not to, so let’s drop the matter.”

  “Believe it or not, David, the board is open to considering our star bank robber as its next chief of police.”

  “Then you must be twisting their minds out of whack.”

  “I’ve already been . . . well, campaigning on this. . . . I didn’t tell you, but—”

  “I don’t want you campaigning for me! It’s too risky for you.”

  “Nevertheless, I can get the board to approve you. Because I worked as a medical researcher before switching to hospital administration, I have the pull to recommend a clinical appointment.”

  “Does the board now endorse surgeons knifing inspectors?”

  “They don’t know about that, and they won’t find out. The BOM doesn’t want Senator Carlton getting curious about what really goes on. His niece is one patient who can get anything her doctor wants.”

  “I still wouldn’t be approved by the board. You’d have to be blackmailing the members.”

  “If I had anything on them, I would,” Randy said, smiling. “Actually, almost everyone on the board owes me a favor or two, and now’s my time to cash in. There’s just one condition you’d have to agree to. You’d have to address the board personally and assure them—convince them—that you have reformed. You must be very persuasive when you tell them that you’ll comply with the practice parameters, that you’ll never receive another fine from the BOM, and that you’ll conduct yourself in a way that will not embarrass the board or compromise the hospital.”

  “No.”

  “The board will approve you, David, if you promise to obey CareFree’s rules.”

  “No.”

  “Then how will you complete your experiments? You’ve already applied to every agency that deals with science, medicine, education, or research, and they’ve all turned you down. So what’s left? Are you going to throw away seven years of experiments—seven years of your life—and abandon your dream?”

  Randy’s blue eyes stared across the desk at David’s green ones.

  “This is your last chance, David. If your promise to the board is compelling, they’ll trust you.”

  “Will you, brother? Will you trust me?”

  Randy knew what David meant. A tinge of worry shaded the administrator’s face.

  “I’ve heard you say many times that you need to keep your job until the kids are through with college.”

  Randy and his wife had three gifted children whose artistic and scholarly talents were nurtured through special lessons and private schooling and whose college tuitions were looming. Both parents worked; however, Randy’s job provided the larger income to support the children’s futures.

  “Now you want to walk a tightrope with me,” David continued. “What are you going to tell your kids—my two nieces and nephew—if I pull you down with me when I crash?”

  “You can’t allow that, David. For your own sake, you can’t . . . crash.”

  “I don’t want you running any fan clubs for me. In fact, I’d feel a lot better if you joined my critics.”

  “For the sake of your research, for your career, for everything you love, for our dream, for Pete’s sake, David, give in! You can’t fight them; they’re too strong. You have to compromise.”

  David had no reply.

  “Please, David, accept this opportunity and learn to do things differently. Before you see a patient, be sure you’re allowed to. Before you order tests, get approval. Before you admit a patient, study the rules. Before you drill a hole in somebody’s skull, read the guidelines. Before you make adjustments, ask. Learn to hit the ball on your knees. You can’t wallop it over the fence. The game doesn’t exist on that scale anymore. Either you play by the new rules or spend your career in the dugout. Damn it, brother, I’m offering you a chance to run around the bases! Won’t you be smart and accept it?”

  David stared across the desk at his own features framed in blond hair, but it was not Randy that he was seeing. Two sights forced their way into his awareness: He remembered the first rats that he had operated on unsuccessfully seven years ago, when he had nothing more than a hunch to try, and he saw the final cats that he had operated on just months ago, proving at last that his hunch was right and leaving him with a burning desire to operate on a hundred more animals, a hundred at once, at that very moment, because he could not sleep or eat or even wait until the next
morning to unravel the amazing puzzle that had held him spellbound for seven years. But he had no clearance to proceed, only a roadblock to frustrate him.

  “David.” His brother’s whisper was like a hidden voice from his own consciousness. “I know you want to accept. Couldn’t you find a way?”

  David pushed aside the glass containing his untouched champagne. “No, Randy, I can’t. Besides, my brother would despise me if I did.”

  * * * * *

  That night a strong wind hissed through the fragrant shrubs of a garden, warning of a thunderstorm. The gust blew through opened French doors and into a lit study. David sat at his desk, the pages of a notebook crackling in the wind. He kept a collection of notes and drawings of his surgeries. Like the pages of a detective thriller, his entries chronicled the absorbing dramas of his life: the tales of diagnosis, treatment, and results. That night in his home, he sketched the brain of Eileen Miller, the patient he had saved when his wife was attending the banquet for the governor. He drew the woman’s brain as he had first seen it—distorted, swollen, wild with blood; then he drew it again as he had left it—calm, clean, restored.

  He began writing his notes: “A subdural hemorrhage in the posterior fossa—” But his mind kept wandering to his conversation with Randy, as it had all day. Against his will, his mind was searching for a way to accept the unacceptable. No, he told himself, forcing his attention back to his task.

  He raised his head when he heard footsteps approaching. He saw Marie standing at his half-opened door, wearing a silk dressing gown and high-heeled slippers. The scent of her perfume floated through the air as she entered the room. She took a seat facing him, the rich tan of her slender legs a provocative contrast to her white silk robe. He looked at her with the purity of a monk.

  “How long are you going to be angry, David?”

  “She almost died, Marie.”

  “It wasn’t my fault.”

  “You were her doctor.”

  “Eileen Miller only said she had a headache. She didn’t think to tell me that a baseball hit her on the head.”

  “Why didn’t you think? Why didn’t you ask? Why didn’t you take a better history?”

  “I can’t send every patient who has headaches for a brain scan, David. No one can fault me for that—except you, of course.”

  “You probably didn’t spend more than five minutes with her, so you could zip on to the next poor slob.”

  “Why don’t you try understanding for a change, instead of launching one of your self-righteous attacks?”

  “All hell was breaking loose in her head. Were you waiting for a coma before you did anything?”

  “You always have to be right, don’t you? Hindsight is great!”

  “It’s not hindsight, Marie. Anticoagulants, trauma, and bleeding paint a picture any med student would see.”

  “Any med student would also know that migraines explain headaches much more often than hemorrhages.”

  “Not in Eileen Miller’s case. She had a head injury!” He could feel his voice rising.

  “Why can’t you leave me alone? You always have to find fault!”

  “You treated a migraine headache that she didn’t have and missed a cerebral hemorrhage that nearly killed her. Don’t you find fault with yourself?”

  “Everybody misjudges a patient occasionally. Even you, David.”

  “It’s not occasionally with you. What about Charles McIntyre?”

  “Are you going to throw that in my face again?”

  “You sent him for physical therapy, which he could have had till doomsday without correcting the weakness in his legs. If he hadn’t crawled into my office and I hadn’t removed the ruptured disc fragment pressing on his spinal cord, your patient, who’s normal today, could have become a paraplegic.”

  “I did what I could. I spent hours preparing his case for quality assurance review, but the committee wouldn’t approve a referral to a neurosurgeon. They wanted to try physical therapy first.”

  “So you did what a committee that never met your patient told you to do. But was it right?”

  “You did what they told you not to do. You operated on him without authorization, and instead of getting paid, you got fined. Was that right, David?”

  He did not know why he wanted to press on, to convince Marie, when an inner voice warned him that it was futile. “Was it right to tell Helen Pennington that she, too, had migraines, when her headaches and temporary paralysis resulted from a blocked carotid artery about to cause a stroke?”

  Marie’s face reddened. “Sometimes migraines can cause temporary paralysis. Was it right to examine my patient without my permission? Was it right to rush her to the hospital, to demand that the technicians test without authorization? Was it right to throw a temper tantrum, to do the damn test yourself, then to rush her to surgery to open the artery without consulting anyone, without asking, without explaining your case to the certifications officer?”

  “Was the main artery to her brain ninety-eight percent blocked or not?”

  “There has to be a better way to make your point.”

  “Was Helen Pennington going to have a massive stroke at any minute or not?”

  “Why do you have to make enemies everywhere you go?”

  “Was it right to save her life or not?”

  “Was it right to embarrass me with your hotheaded attitude, with your uncivilized behavior, with the way you practice medicine?”

  “The way I practice embarrasses you?”

  “What would you have me do, David? Become a misfit, too?”

  “Those patients of yours needed surgery, Marie, not aspirins and sweet words.”

  “But my hands were tied! Their treatment was fixed by the guidelines.”

  “But is it right, Marie?” he asked quietly.

  “Is it right to perform those surgeries without permission?”

  “I got permission—from the patients.”

  “A lot of good that did you!” she laughed mirthlessly. “Tell me if you got paid!”

  He did not answer.

  “In fact, you paid the state. And you’re lucky that fines are the worst penalty you’ve gotten so far. It’s bad enough that you’re destroying your career, but now you want to drag me down, too. You want me to practice the way you do, to ignore the rules, to do unapproved tests, to make unauthorized referrals, to stick my neck out. Soon you’ll be paying out more in fines than you’re getting from surgery. Then who will pay the bills? Who’s paying most of them now?”

  He had no answer.

  “David, I’m doing the best I can. It’s not as if I have a choice in the matter. Do you think I do?”

  A wave of guilt overpowered him. It was true, wasn’t it? She had no real choice, did she?

  “It’s hard for me. I’m under a lot of pressure. You can’t imagine!”

  He knew there were demands on her. Surely she did not like the situation any more than he did. How could he blame her for the way she bore the unbearable? What did he want from her, anyway?

  “Why are you making things worse for me?” she asked, echoing his thoughts. “You’re so protective of your brother. You want Randy to walk a straight line and never break the rules or get in trouble. Then why do you want me to?”

  It was true, he had to admit to himself. But an inner voice warned him that somehow Marie and Randy were different.

  “Your demands on me aren’t fair, David.”

  It was true, he thought; he was not being fair. He was causing the heated arguments burning a hole through their marriage. He wondered about the strange circuit of anger and guilt that he could not break. He rubbed his eyes, as if trying to erase the bloody image of Eileen Miller.

  “All right, Marie,” he said softly. “I understand that you didn’t have a choice.”

  “There, that’s better now,” she whispered calmly.

  The wind filled the curtains of the French doors, blowing them into the room like starched white sails. Reaching her rob
e, the gentle breeze lifted it to reveal more of her legs. She rose and walked behind his chair. Sweet scents from the garden mixed with her perfume. She threw her arms around him, her hands touching his chest, her face leaning over him, her mouth brushing his hair. She had always been drawn to the tall, muscular body, the striking features, and the subtle sensuality of the man who was her husband. She wanted him in a way that went beyond the raw need that his body stirred in hers. She somehow wanted to unleash in him a feeling that he could not control, to see him helplessly in her power, even if just for a few convulsive moments, as a kind of victory over him, over something in him that she could not reach.

  “David,” she whispered, “let’s have a drink on the porch and watch the storm.”

  She sat on the desk, facing him. She waited for the signs she knew well—eager eyes that traveled over her, exquisitely sensitive hands that caressed her, a warm mouth that covered hers. She saw none of them.

  “I just want to finish my work and go to sleep.”

  “In the guest room again?” she stood up abruptly. “Maybe the trouble with our marriage isn’t what I’m doing in my office, but—”

  “If that’s all, Marie—”

  “How long can you hold a grudge? Don’t you want to do something for pleasure?”

  “I am,” he said, and gestured to the journal, lifting his pen to resume his work.

  Instead of leaving, Marie returned to her seat, circling the desk slowly, as if trying to dissipate her anger. “Actually, David, I wanted to talk to you about something else—about John Carter’s post being up for grabs.”

  So that explained her visit, he realized. Surely she had not come to discuss Eileen Miller, a subject that she had avoided all weekend.

  “I think that being chief of neurosurgery at Riverview will be very good for you. It’ll put your career back on track, and that’ll help us get along better. If you want John Carter’s position, surely Randy can pull strings to get you approved.”

  “It would allow me to finish my research, but—”

  “Your research? Are you still chasing that windmill?”

  “Isn’t that why you mentioned John Carter’s post?”

  “What does that have to do with your research?”