Your good friend,
Vi Landers
My good friend, he thought. If we weren't short of private-duty nurses, like everything else, I'd lose my good friend quick. My good friend must be about forty-one or forty-two now, and she'll never pick a winner. She's got a nice body, or used to have, and about fifteen years ago it was interns and then residents and then young doctors and now patients. You're trying to speed a patient's recovery and she's holding it down. You're trying to get him to believe in himself, and she's trying to get him to depend on her.
"Have you Billed this yet?" he wrote in pencil at the top of the letter, and then he encircled the letterhead.
He picked up a postcard and glanced at the aerial photo of the modern white concrete and glass hotel on the beach. Turning it over, he saw the Miami, Florida, postmark and he read the scrawled writing: "Down here to give Father some of this wonderful sunshine. He's feeling fine and we both send you our thanks again. Best, Isabel Damon."
She's the one, he thought, who came in here after the operation complaining that Father had lost so much weight that his gums shrank and now they had to get him new dentures and could I please take something off the Bill? So I tell Carrie to take $200 off, and they're nice people and appreciate everything I did for Father and now they want me to know they're thinking of me while they're having their good time in Miami. They forget it's my money they're having this good time on, but Carrie won't forget. Carrie just drops it in here, but she'll hit me with it.
The next letter was on pale yellow folded stationery, with a small purple orchid in the upper left-hand comer. Although it had been lying open for probably twenty-four hours a slight odor of perfume still came off it, and he recognized the handwriting in the purple ink.
My dear Doctor Carter—I bet you'll be surprised to hear from me again so soon. I know you're busy (you always are!) but I imagine you like to take a few moments off and relax and read letters from friends (I should say patients, but I consider myself your friend.)
I am feeling much better since you reassured me, and I hope Dr. Berman won't mind waiting for my money. I got a Bill from him for $40 (!) I didn't think it would be that much as this very young doctor, maybe a student, got to practice on me so I thought maybe it wouldn't cost so much. Anyway . . .
Why do I get hooked by all these neurotics? he thought, putting the letter on top of the other three he had read. You feel sorry for people, and they abuse it. This kind of stuff is all right for Jaffrey, who needs these hypochondriacs as much as they need him, but I don't have to be involved with every. . .
He heard the outside door open and close. He looked at his watch and saw it was 8:35, too early for Carrie, and then she walked in.
"What are you doing here?" she said, looking at him and making a show of surprise.
"What are you doing here?" he said.
"Listen, I've got work to catch up, but you have an 8 o'clock."
"Delayed."
"Mr. Scheller?"
"Right."
"Not poor Mr. Scheller. You know we had to postpone him once because we couldn't get him a bed. What's the matter over there?"
"They've got a traffic jam. I'll do him at 10 or 10:30."
"Well, at least you're looking at the mail. Honestly, some of it has been lying there since . . ."
"I'm not looking at it any more. I've retired."
"Oh, for John's sake, Matt."
"I'll go over it when I get back."
"You can't. You and Rob are going to be crazy from 5 o'clock on. You've got the biggest patient load in weeks."
"Never mind. Call what's-his-name over at University and tell him I can't make the conference at 1. I'm delayed."
"You know you have a mitral there at 2."
"That reminds me," he said. "See if you can get Mrs. Scheller on the phone, or her son. Tell them I'll be doing him around 10 or 10:30, so if they can get over there, they can see him for a while now."
"Honestly," he heard her saying, walking to her desk and talking to herself. "Poor Mr. Scheller. That place is getting worse all the time."
You can't buy them like Carrie, he thought She and Rob and I get on one another's nerves once in a while, but she's right about the mail and she's right with the patients. They come in here feeling sorry for themselves and she mothers them, and I'll bet she gets Christmas cards from some we cured ten years ago. She's therapeutic. Mother Carrie.
"Good morning," he heard her saying, and he knew she was talking with the answering service. "Well, that's because I'm full of vim today. What have you got? All right. That's all?
"Matt," she said, hanging up. "Dr. Fineman has been trying to reach you. He's waiting for your call."
"Who?"
"Dr. Fineman."
"Call him," he said, "and look up his first name."
"It's Harry," she said, dialing. "Hello, Dr. Fineman? Dr. Carter's office. Dr. Carter will talk with you now."
"Hello, Harry?" he said, feeling the split-second guilt from the familiarity he knew that Fineman, whom he had never seen, would expect. "How are you?"
"Good," Fineman said. "You?"
"Okay. What's your problem?"
"I've got a woman," Fineman said, "the wife of an attorney, and last night she was eating a hamburger, and a piece of meat or a sliver of bone got caught in her throat. She says it's been making her cough, so it must be in her trachea or bronchi. She called me at 8 this morning, so I've been trying to get you. Have you got time to take care of her?"
"I'll make time," he said. "I'd better bronchoscope her. I've got a friend whose eighty-two-year-old mother, a couple of months ago, did something like this with a chicken bone. She neglected it, and the bone perforated into the mediastinum and she died."
"But don't tell this woman that. She's the nervous type, and it'll scare her to death."
"Of course not. I'm telling you. When did she eat last?"
"Last night. The hamburger."
"Then we can bronchoscope her right away. How long will it take her to get to Mercy?"
"She can be there in a half-hour. She can take a cab."
"Okay. What's her name?"
"Louise Brower. She's fifty-three."
"All right. Hold a minute, and I'll turn you back to Miss McKeen, and she'll book her into the hospital."
He put his hand over the mouthpiece of the phone.
"Carrie? Pick up Dr. Fineman on three. He's got a woman with a piece of meat stuck somewhere and I'm bronchoscoping her. She'll be at the hospital in a half-hour."
"How in heaven's name are you going to do her this morning?" Carrie said. "You've got Mr. Scheller."
"They won't be ready for him yet. I can do this in ten minutes. Pick up three."
So the first thing he tells me is that she's a woman, he thought, and the second thing he tells me in a nice offhand manner is that her husband is a lawyer. The shysters have us all scared, and now he's clear and I've got the ball. I'd do this woman, whatever her name is, anyway. I'd do her if her husband were a bank robber, but it's something the way they always let you know now if there's a lawyer in the family or somewhere in the shrubbery. The shysters have us on the defensive and the shame of it all is that every day now you have to order a lot of unnecessary tests. You overload the labs, which are too busy anyway, just to play it safe on the legal side and the public gets stuck with rising hospital costs. Too many insurance companies are settling out of court, too, and that's another reason we're all stuck with rising rates.
"I've got a woman swallowed a piece of meat or a bone the wrong way," he heard Carrie saying, talking to the hospital. "She'll be there in a half-hour. Mrs. Louise Brower. B-r-o-w-e-r. No, give her a private room, if you've got one. She'll be out by late afternoon."
"A general anesthetic," he said, walking out to Carrie's desk. "Pentothal."
"Pentothal," Carrie said, into the phone. "Okay."
"I'll go over now," he said, when she had hung up. "I'll call you later."
"Wait a min
ute," she said. "Are you and Marion going to that dinner party tonight?"
"What?" he said, and then remembering, "I forgot. I should go to the Academy. I missed the last meeting."
"I know."
"I could go to the Academy, and pick Marion up at the party about 10:30."
"Didn't she talk to you about it last night?"
"No. I got home late and she was still asleep this morning. Call her about 10, and see what she thinks."
"I know what she thinks. She's been to the last two alone. She thinks she hasn't got a husband."
"Is it formal?"
"Yes, and that's why I want to know. Your two shirts are still at the laundry, and if you're going to dress here, I'll have to go out and buy you another one."
"Do that, and call Marion and tell her I'll see her there at 8 o'clock."
"Pick her up at home."
"All right. Good-bye."
"One other thing," Carrie said, but the phone was ringing, and she picked it up. "Dr. Carter's office."
As he opened the door to the court the postman was about to push the bell. He said hello to him and took the mail, holding it in both hands, and closed the door again with his shoulder. He carried the mail back into Carrie's office, a dozen or more flat envelopes and a couple fat with samples of sedatives or antacid pI'lls for which he had no use, glossy brochures from equipment houses, at least one of them a new one putting the last of its economic resources into this advertising, a square cardboard box with samples of a new suture material, a copy of Newsweek, a copy of Life.
"That's all right, Mrs. Mossman," she was saying on the phone but shaking her head at him. "Dr. Carter or Dr. Robinson will be able to see you on Friday. I'm putting you down for 4:30. All right?"
"Enjoy yourself," he said, turning.
"Listen, Matt," she said, hanging up the phone. "One more thing."
"I'll call you," he said.
One more thing, he thought, walking to the car, and then another. Maybe I am really starting to get old, but the only place I get any peace these days is in the operating room. That's the way it should be, I suppose, because that's the only place where I really have something to contribute anyway. The O.R. has become my only sanctuary, and I don't know how those general practitioners and internists can stand it without it. Nothing can get at you in the O.R., nothing or nobody. It is really an only sanctuary.
8:58 A.M.
III
The receptionist saw him as soon as he came through the door, and smiled at him.
"Good morning," he said. "How's everything?"
"Just fine."
In the doctors' lounge he pushed the light button next to his name. He looked at his watch and saw it was 8:58, and signed in on the registry. He was starting toward the elevators when he became aware of the lighted coffee shop and heard the low sound from it coming out of the open glass door. He walked in and sat down at the counter.
"Hello, Doctor."
"Why, Mac!" he said, seeing her two stools away. "I didn't expect to see you here."
Mary MacGowan was in her street clothes, a dark blue coat over her shoulders, her overnight bag at the foot of the stool. She was all of five feet, one inch, and about a hundred pounds, about fifty years old now, her hair going all gray but her complexion still smooth and young.
"I know," she said, smiling. "I didn't expect to be here."
"I saw you on the 4 to midnight with my Mrs. Kirk," he said, sitting down next to her.
"That's right. She's a lovely lady."
"She is."
"I'm sorry about her. I'm sorry you couldn't do something for her."
"I'm sorry, too. That kind make you feel so helpless."
"Not you, Doctor. You should never feel that way."
"You know her husband is that TV newscaster."
"I know. I watch him when I'm home."
The Puerto Rican counter girl was wiping the counter in front of him with a paper napkin.
"Coffee, black," he said to her, "and a piece of coffee cake. Mac?"
"No, thank you. I have to be going."
"So you did a double shift?"
"They're short-handed again, so I had your Mr. Davies on the midnight to 8."
"How was he when you came off duty?"
"He was sleeping again. He was restless about 6 and complained of a little discomfort but I noted you didn't want him to have any more morphine. Dr. Bronson said he'd checked with you about that."
"That's right. The patient's family is coming in, and they want him alert. Hell be all right for a while."
"Both his wife and his daughter called this morning," she said. "They seemed very disturbed."
"They can't accept it," he said. "How are your two kids?"
"Fine. Annie's finishing up business college, and John made the dean's list again last semester."
"He'll be an engineer before you know it."
"In one more year."
"What will you do when you haven't any more educations to pay for? Buy another duplex?"
"Not on your life," she said, standing up. "You know what I'm going to do right now?"
"You're going home and sleep until 3."
"I'm going home and leave this," she said, picking up the overnight case, "and I'm going to take my tool box and take a bus up to the apartments and replace a fuse."
"You're kidding."
"No, I'm not. You won't believe this, but last night one of my tenants—this woman married to an oaf—called the Private Duty Office and insisted on talking to me. They called me off Mrs. Kirk and I phoned her back. She said: 'Mrs. MacGowan, you've got to come up here right away and fix the lights. They won't light in the living room or the dining room.' I said: Then it's a fuse. Have your husband go down in the basement and the new fuses are right on top of the fuse box.' You know what she said?"
"I might guess."
"She said: 'My husband doesn't know how to change a fuse, and he's afraid of being electrocuted.' He must be six feet two and weighs over two hundred pounds, and that's God's truth."
"I believe you," he said and then, thinking the rest to himself: and that one you married must have been like that and the kindest thing he ever did was leave you and the two kids.
"The God's truth," she was repeating.
"So you really have a tool box now?" he said.
"I do. Two dollars and fifty-eight cents from Sears, Roebuck. Now I've even learned how to rewire a lamp and change a washer in a faucet."
"Good. The next time I need a plumber at the office I'll call you. Last month it took us two days to get one."
"Anytime," she said, smiling, "but right now I'm about to fall asleep on my feet. I'll be back for Mrs. Kirk at 4."
"You're the best, Mac," he said, "and thanks for everything."
And she really is the best, he thought, having his coffee and cake. She may fall asleep on her feet, but if she does it won't be while she's on duty. You won't walk in and find her asleep in the chair like I did dear old Vi Landers, my good friend.
It had happened about five years before. The patient was in terminal condition. He was an old Italian landscape gardener with no money but with his grown kids all kicking in to give Pop the best, including private nursing around the clock. It was about 7:15 in the morning, and dear old Vi was sitting by the window, her head down and asleep.
When he took the patient's wrist to feel for the pulse, there was none.
He pressed the back of the hand with his thumb and, when he released the pressure, the thumb mark stayed white and he quietly picked up dear old Vi's stethoscope and put it over the heart and then took it off and put it on the foot of the bed.
"Why, good morning, Doctor," she said, obviously thinking he had just walked in.
"Good morning," he said. "How's the patient?"
"He seems to be quite comfortable," she said.
"I know," he said. "Has he had any liquid lately?"
"Not for several hours."
'Try to get him to take some rig
ht now," he said.
She took the water glass with the bent glass tube in it. She put her right arm behind the patient's back, lifting him.
"Now," she said to him, "it's time. . ."
The surgeon Page 3