The surgeon

by Wilfred Charles Heinz

  still holding him she turned, and she looked like the old man had just slapped her across the face.

  "Why!" she said. "He's dead!"

  "I know," he said, and he made the notation on the chart, with the time, and walked out.

  Damn, he had thought then, they are paying for nurses because they did not want the old man ever to be alone again. He went easily and it made no difference to him, but he was alone.

  Now he stood up at the counter and picked up his check and paid the cashier. In the hall he pushed the button for the elevator and waited.

  "Good morning, Doctor," the elevator boy said. "O.R.?"

  "Yes," he said. "Good morning."

  The elevator stopped at the second floor. A young Negro girl in the green uniform of a ward maid was waiting for it, and she started to get in.

  "You going down?" the elevator boy said.

  "No," she said, surprised and hesitating. "I'm going up."

  "So am I," the elevator boy said, laughing. "Get in."

  "Honest," the girl said, getting in. "That all you got to do?"

  "You know me," the elevator boy said.

  "I know you all right," the girl said. "That's the last time you'll do that to me. Now, if it's not too much bother, would you mind letting me off on seven?"

  "Anything you want," the elevator boy said, still enjoying it. "O.R., Doctor."

  When he got off he walked across to the glassed-in nurses' station. There was just the faintest, light, sweet-sharp odor of ether in the air, but he had long ago become insensitive to it, unaware of it even on his person when they were using it almost exclusively and, hours later, he would come home and his wife would detect it immediately.

  "How's my gal Sal now?" he said, when she turned from showing the other nurse something in the schedule book.

  "Do you really want to know?" Sarah Wheeler said, looking up at him over the tops of her glasses, and then standing up.

  "You'll handle it," he said.

  "I don't think we can get you into Room Three until about 11:30."

  "Stan is still having trouble?"

  "He's on his fourth pint of O-Negative. After last night the blood bank may be hollering for help."

  "He'll work his way out of it," he said. "Have you seen my invaluable associate?"

  "I called him after I called you, but I haven't seen him."

  "Dr. Robinson was here a while ago," the other nurse said. "He said to tell you he's seeing patients."

  "Thanks," he said, and then to Sarah Wheeler: "I suppose I'll have to do my bronchoscopy down in Emergency."

  "Unless you want to do it out on Walker Avenue," she said.

  "It's too cold out there, and they'd give me a parking ticket. I've got two already that Carrie has to answer."

  "I got one myself the other day."

  "While I think of it," he said, "I want to be sure they've got the polyethylene tubing in three sizes in my kit today."

  "If you called for it, it'll be there. You know we're efficiency plus."

  "I'll be down on Four seeing patients for about twenty minutes," he said. "Then I'll be down in Emergency."

  "Enjoy yourself," she said. "I'm leaving on my yacht for the Bahamas."

  On the way down the stairs he took out the slip of memo paper on which, the evening before at the office, he had written down the names while he and Bob Robinson had divided up their rounds. Rob had put his in his little black book, carefully writing down, after each cancer case: "Patient knows. Wife doesn't." Or: "Patient, no. Wife, no. Son, yes."

  "God, Matt," Rob had said to him, going over the in-hospital cases about a month after he had joined him. "I don't know how you can keep them all straight."

  "Keep what straight?" he had said.

  "Who we're telling what. I walked in this afternoon to see that case we did four days ago, that Mr. Isaacson with the cancer of the left lung ..."

  "We told him because he asked, and he took it all right."

  "I know, but I thought his wife knew."

  "No."

  "That's what I found out. She walked me out in the hall and started to question me about his recovery and I said: 'Well, you have to remember he had a cancer. . .'"

  "What happened?"

  "She went into hysterics. I had to get a nurse, and it took me about ten minutes to get her back to normal. I finally got her to listen and I told her we got it all out."

  "We did."

  "But I don't know how you remember who knows what."

  "I may have a fair memory. I don't know. As long as I'm treating them I remember them, but if a patient I cured five or six years ago walks up to me on the street, I won't have the vaguest idea who he is. He'll be walking around with my big incision on him, but I won't recognize him. If I saw his chest X-rays again I could tell you everything about him— occupation, family, everything—but his face means nothing. You'll get like that."

  "I'll have to start keeping a little notebook," Rob had said, and then: "but I don't like it."

  "None of us like it," he said, "but we have to face it. Curing a difficult surgical problem is a pleasure, and that's why we chose surgery. Treating a difficult mental or emotional problem, unless you're a psychiatrist, is, to put it succinctly, a pain, but it has to be done."

  "I know, but I'm no good at lying."

  "I wasn't either, but today I'm one of the world's biggest liars. For a long time I was ashamed of myself. I used to hate myself, but you get over it. I don't mean you'll ever enjoy it."

  "You can bet I won't."

  "You worry too much about it. In the time you've been around, how many patients have come right out and asked you if they had cancer?"

  "Damn few."

  "You'll find that ninety per cent never ask the question. If they ask, you're morally obligated to give them the truth, eventually, but you can see it coming, and if the time isn't right you can take the play away until it is."

  "Have you ever had a situation where the patient said: 'Tell me, but don't tell my wife' and then the wife says: 'Tell me, but don't tell my husband'?"

  "Yes, I've had that, too. Somebody in the family, close to the patient, if not the patient, has to know. You figure out who it is, remembering it's the patient that you're treating."

  He had gotten up then, and gone out to the small refrigerator in the back room and poured a bourbon for Rob and a vodka for himself.

  "A few years ago," he said when he came back, "I had a case that proved to me that I was right. He was an intellectual—a college professor —who came into town to see me on a Thanksgiving vacation. When I examined him he talked pleasantly enough, but I knew he was scared. He had a fast pulse, he was perspiring, and his skin was cold.

  "Anyway, the next day I bronchoscoped him and when the biopsy report came back I called his wife at the hospital. She'd been in the office with him, an intelligent woman, and I told her it was cancer. She said on the phone: 'Well, we've always been very close, and I think he should be told.' I said: 'All right, but when I examined your husband and again while they prepared him for the bronchoscopy, I found him apprehensive. Let me tell him in my own way in my own time.' She agreed.

  "The next morning I read about it in the paper. He was dead. He'd jumped out of the window of their hotel room. Later on I found out that about 11 o'clock that night, after she'd talked to me, she had said to him: 'The doctor wasn't sure you should be told right away, but you have cancer.' When she went into the bathroom a few minutes later, he went out the window."

  "Damn," Rob had said.

  "I'd have told him, because she wanted him told, that the tumor was not large, that it was easily removable, that there was small operative risk and a high prospect of cure. All that would have been the truth, too."

  "I read a paper not long ago by somebody who doesn't hold with this. He says he tells them, at least ninety or ninety-five per cent of them."

  "I know, I've read those papers and listened to them on panels, and they may be right. If they are, they
're treating a different race of human beings than I am. They say that they tell their patients, and their patients thank them. If we're honest men, it's easier to tell the truth than to lie. Also, we all like to be thanked, but after you've told a patient you couldn't get all the cancer out and he thanks you for being so honest and goes home, something happens to him. He lies there at night, the only one awake in the house, and in his mind, if not in fact, you've pronounced the death sentence on him. Then he begins to feel pain, either real or imagined, and this now is not the same man you told three weeks or three months before, and who thanked you. This is a different man and, whether he'd admit it or not, I'll bet he wouldn't thank you again."

  Now, walking down the stairs and looking at the list on the memo paper in his hand, he saw there were six names on it, and he realized that he couldn't see more than three or four before the bronchoscopy. Coming out of the stairwell onto the floor he walked to the nurses' station and saw two of the newer ones sitting and talking with their backs to the desk.

  "—and then," one of them was saying, "Jackie Cooper gets this chance to take this temporary assignment in Hawaii. He wants to go, but he doesn't dare tell her, so . . ."

  "Oh, hello, Doctor," the other one said.

  "Hello," he said. "Did he go to Hawaii?"

  "Who?" the one who had been listening said.

  "Jackie Cooper."

  "Oh," the first one, the talker, said, "that was just a television show, Doctor."

  "But did he go?"

  "Yes, sir."

  "Good. How are all my chest patients?"

  "No complaints, Doctor."

  "All right, but now I'm going to have to check up on you. See if I've got the rooms right."

  "Yes, sir," the listener said.

  "Benjamin Davies, 410."

  "That's right," the listener said, referring to her list.

  "Grace Cowan, 415, and Lynn Cummings, 417."

  "Correct."

  "Mrs. Elizabeth Kirk, 412. Anthony Trusco, 414; and Bernard Waterman, 418."

  "All correct."

  "Now I'd better look at Mr. Benjamin Davies' chart first."

  The talker went to the chart rack and took it out and handed it to him. He scanned it quickly and saw that the temperature was 101, the respiration was 36, and the pulse 110.

  His respiration is rapid because it hurts him to breath deeply, he thought, and his pulse is fast because of the pain. Morphine will bring his respiration back to about 24 and his pulse down to 90. At least the blood pressure is 130 over 85, which is normal for a man his age, but it doesn't mean a damn thing when Benjamin Davies is dying.

  IV

  Although, if anyone had asked him now, he could not have told him exactly when it had been, he had first seen Benjamin Davies twenty-seven months before. Benjamin Davies's secretary had called and talked to Carrie McKeen and said that Mr. Davies was sending some X-rays over by messenger and that he wanted Dr. Carter to look at them and call him. In fact, Mr. Davies hoped Dr. Carter would be able to call him the next morning, as on the next afternoon he would be leaving town for two days.

  "Good God, Matt!" Bob Robinson had said to him, after he had slapped the plates up under the clips on the light panel in the office, "this guy inhaled a golf ball!"

  That is exactly what it looked like. The shadow in the root of the right lung was the size of a golf ball, and as perfectly round. The rest of the right lung was clear, but in the upper lobe of the left lung there was another and smaller shadow.

  "I'd say your golf ball was benign," he said, "except for one thing."

  "The other lung?"

  "That's right. When you see a single tumor as round and clean and self-contained as this, the chances are nine out of ten that it's benign. If that's a tumor in the other lung as well, your odds go the other way."

  "How long has he been walking around with this?" Rob said, still looking at the plates and fascinated.

  "I don't know. I've never seen anything on him before."

  "You can almost read the Top-Flite trade mark on it," Rob said.

  The next morning Carrie called Benjamin Davies. She never got through to Mr. Davies, but Mr. Davies's secretary said that Mr. Davies would be in to see Dr. Carter three days later, at 6:15 in the evening.

  At exactly 6:15 on that evening Benjamin Davies appeared, and Rob did the preliminary examination: chief complaint, present I'llness, past history, marital history, family history, systemic review from the texture of his hair—graying black, dry, coarse—to the reflexes of his knees-right: normal; left: torn medial meniscus ligament but normal reflex in the quadriceps, the muscles that run down along the front of the thigh.

  "For John's sake, Matt!" Carrie said, when he finally arrived in the office. "Get in with Mr. Davies. You're the one he wants, and I don't think he takes to Rob."

  By the time he had changed into his white smock and walked into the examination room, Rob had just about finished with the work-up on Benjamin Davies, and Benjamin Davies was standing there with his trousers back on, but still stripped to the waist. Benjamin Davies was fifty-nine years old, six feet one inch, 220 pounds and not much of it fat.

  "Good evening," he had said, shaking hands with Benjamin Davies. "I'm Matt Carter."

  He has the look of class, he thought, Harvard or Yale, Class of '22 or '23.

  "I thought I had an appointment with you," Benjamin Davies said, big and looking right at him.

  "You did. I'm sorry to be late. I had an extended operation and I had several hospital patients to check on before I could get over here."

  "All you doctors are alike, aren't you?"

  "I don't know about that, but Dr. Robinson is as fully capable as I am of conducting an examination."

  He had taken the work-up sheets from Rob, and was checking through them.

  "How are you feeling?"

  "Not badly."

  "That's not why you came in to see me."

  "I came in because of those damned X-rays. What's that in my lung?"

  "We're not sure. Do you play golf?"

  "Yes. Why?"

  "Dr. Robinson and I think you may have inhaled a golf ball."

  "Whatever it is, are you going to take it out?"

  "Someone has got to take it out. Do you have any pain now?"

  "Not right now. Once in a while in my chest, here, for the last month or so."

  "Any pain up here in the right shoulder?"

  "Once in a while, in the back."

  "Have you been coughing up anything?"

  "About six weeks ago I spit up quite a lot of phlegm."

  "What color was it?"

  "Rather odd. Sort of dark blue, not the color of blood. Then it disappeared."

  "But then it recurred?"

  "Yes, but the second time it cleared up quicker."

  "And now it recurs more often?"

  "That's right. The other day it happened at a conference, and I had to get rid of it in my handkerchief. It's damned embarrassing and a nuisance."

  "Does the phlegm have a metallic taste?"

  "That's right. It does."

  "Now I don't think I know your doctor. What has he told you?"

  "He recommended you. He's the doctor who handles my employees at the plant. Except for a banged-up knee I've never needed a doctor in my life."

  "Where did you play football?"

  "Princeton. How did you know?"

  "You've got what we call a running-guard knee. You pulled out of the line once and turned and the knee went."

  "That's exactly the way it happened. My last year. That's amazing."

  "That's the way they usually happen with linemen, unless they get clipped."

  "Do you think it's cancer, Doctor?"

  "I don't know," he said, stalling him. "We can't tell from X-rays, or just a general physical examination."

  "How can you find out?"

  "Well, we can put a bronchoscope down into your windpipe and take a small sample of that golf ball and the laboratory wil
l be able to tell."

  "How long does that take?"

  "Oh, you'd be in the hospital for a half a day, and it would be a couple of days before we got the lab report. On the other hand, it's got to come out, no matter what it is."

  "Why?"