The surgeon

by Wilfred Charles Heinz

  "It will probably continue to grow, and you'll have increasing pain. It's already a fairly sizable growth."

  "Then there's no need for me to go in for a test? I can save time if I just have it taken out?"

  "That's right."

  "I'm opening up a new plant in the South. I want to get this thing out, and be done with it."

  "What business are you in?"

  "Plastics. This will be my third plant, and I've got to be down there next week."

  "How long will you be gone?"

  "Four days or so. How long will I be in the hospital?"

  "Oh, a couple of weeks."

  "Why that long?"

  "This is major surgery. Even after you're out you'll have to take it easy for a while."

  "There's no reason why I can't handle some of my work at home, though, is there?"

  "That depends on you. I just recommend that you have this done as soon as possible."

  'Today's Thursday. How about a week from Monday?"

  "Make it a week from Tuesday. I'll have my secretary book you in and call your office."

  Benjamin Davies finished dressing then and left. He walked out as if he were leaving one business conference for another.

  "How would you like to work for him?" Rob said.

  "He may be all right. He probably does a great job for his stockholders."

  "What do you think now?" Rob said.

  "I think it's a cancer sitting on his right pulmonary artery."

  "That's why he's been coughing up that blue blood," Rob said.

  "The other lesion is so small and dense," he said, "that I'm inclined to think it may be an old TB scar he never knew he had."

  The following Thursday afternoon Benjamin Davies's secretary called Dr. Matthew Carter's office, and spoke with Carrie McKeen. Later that afternoon Carrie McKeen relayed the message to Dr. Carter.

  "Benjamin Davies wants to see you tomorrow morning. He's too busy to come over this afternoon or evening."

  "I can't see him tomorrow morning. I think I'm operating all morning."

  "You are. You have an 8 o'clock at Mercy, and an 11:30 at University, but he'll see you anywhere you say."

  "Tell him to meet me outside the north entrance of Mercy tomorrow morning at 11 o'clock."

  At 11:06 the next morning, when Dr. Matthew Carter came out of the north doors of Mercy Hospital into the flat, humid August heat, he saw a black CadI'llac parked at the curb, a uniformed chauffeur standing beside it. In the back seat Benjamin Davies was sitting, and he tapped on the glass and the chauffeur opened the back door and Dr. Matthew Carter got into the air-conditioned CadI'llac and sat down beside Benjamin Davies.

  "Good morning," Benjamin Davies said.

  "Good morning. How are you feeling?"

  "About the same," Benjamin Davies said, putting some papers into a black leather attaché case on a small writing desk that folded down from the back of the front seat. "I've been giving this trouble of mine some thought, and I have some questions."

  "Go ahead."

  Benjamin Davies had in his hand a large, yellow, blue-lined note pad. He looked at it and then took out a pack of cigarettes.

  "Smoke?" he said.

  "No, thanks."

  "First question," Benjamin Davies said, lighting a cigarette. "What do you think the chances are that I have cancer?"

  "I don't know. It's impossible to put a figure on it, but in a man of your age we've got to consider it seriously. That's why you're going into the hospital."

  "You're not answering my question, Doctor. You've handled enough cases so you can give me a pretty good estimate of the odds."

  I have, he thought, and I can give you your pretty good estimate but I won't.

  "Estimates are valueless in my business," he said, "so we don't think that way. We have to check everything out, and we've checked nothing on you except your X-rays and the general state of your health."

  "All right. Suppose, instead of surgery, I had radiation treatments?"

  "Now you're trying to cross a bridge before you're there. We don't know anything about that tumor in your chest. That's why we're operating."

  "But what about radiation? Suppose you find cancer. How effective would radiation be?"

  "There's no law that governs that, either. I've had patients who have been cured that way. Some cancers are vulnerable to radiation, some aren't. We never know what we're fighting until we take a piece of it and examine it under the microscope."

  "What about chemical treatment of cancer?" he said, looking at the yellow pad.

  "In some cases they've had a very significant effect, but again we have to wait and see what this particular shadow is."

  "What about hormones?"

  "Hormones are used mostly for tumors of the endocrine glands—like the testicles, breast, ovaries and prostate."

  "All right. Why do you think I might have cancer?"

  "If you're talking about cause, we don't know the cause. What you're doing right now doesn't help you."

  "What?"

  "Smoking two or three packs of cigarettes a day."

  "You believe in this cigarette scare? It hasn't been proven."

  "Certain things have been proven. We know that tobacco tar is an irritant. We know that the death rate from lung cancer among heavy smokers is between twenty-five and thirty times as high as it is among non-smokers."

  "But after thirty-five years I can't give up smoking, especially working the way I do."

  "Try cigars."

  "Why? They've got tobacco tar in them, too."

  "You won't inhale them like you do cigarettes."

  "What's the rate of survival from lung cancer?"

  "After surgery?"

  "Yes."

  "Again we're dealing with variables," he said, sparring. "It depends on the individual case. Age of the patient makes a difference. So does the element of time—whether the disease is discovered early or late."

  "What about my case?"

  "We don't know that you've got cancer, but even if you have you've got a fine chance. Your age is in your favor, and so is your general health. You haven't had any complaints, up until the past six weeks, so although that tumor may be growing fairly rapidly we're catching it fairly early."

  "All right," Benjamin Davies said, opening the attaché case and putting the pad into it. "If you're going to operate on Tuesday, I suppose you'll want me in here sometime Monday afternoon."

  "We'll want you in here before 6 o'clock Sunday night."

  "Why? This thing is complicating my schedule as is. I planned to work all this weekend."

  "That's why I scheduled you for Tuesday, instead of Monday. If I were doing you on Monday you'd have to be checking in here today."

  "What's the reason for that? Don't you people function on weekends?"

  "Some of us do, but some of us don't. Hospital laboratory and clerical personnel for example, like to go to the beach or play golf on weekends, too."

  "That's not right."

  "I agree with you."

  "You people need a reorganization. You ought to have swing shifts in your laboratory and clerical departments."

  "We do to a degree, but the problem is not organizational. It's economic. When a hospital gets some money, there are always ten other things to do with it."

  "Suppose I come in Monday morning?"

  "No. They have to get you started very early that morning."

  "For what?"

  "Well, they've got to cross-match your blood, do a urinalysis, take a cardiogram, make a number of other tests. Also, your X-rays are now about a month old, and we want a new set."

  "All right, Doctor," Benjamin Davies said, shaking hands. "I've had good reports on you from everybody. Thank you."

  "You're quite welcome."

  Benjamin Davies reached across and opened the door. The chauffeur standing on the sidewalk, opened it the rest of the way and Dr. Matthew Carter got out.

  It could have been worse, he thought, wa
lking to his own car and feeling the heavy heat pressing in upon him. He's done a little research, or had someone do it for him, and I thought he'd push me harder than he did. He's a realist and may be entitled to more than I told him. Anyone is entitled to all they can accept, but you're never quite sure how much that is and I'm glad he didn't try to nail me on that rate of survival. The trouble with rate of survival statistics is that they're based only on apparent cure after five years and disregard palliation. They disregard the relief of symptoms and the prolongation of life you can give a man you can't cure. They forget that if you give a sixty-year-old man just another four years you're giving him a third or maybe a half of what additional living he has a right to expect, but who wants to accept that? Everybody wants all of it, and I have cured them, completely cured them, and then had them go out in a plane crash or with coronaries or with cirrhosis or killed by a cab.

  On Sunday evening, Benjamin Davies arrived in the hospital at 6:15. He had been preceded by three dozen long-stemmed red roses and a potted white azalea, and he was accompanied by his secretary and his chauffeur. The chauffeur was carrying nine individually wrapped one-pound boxes of candy, and the secretary gave one to the nursing supervisor and left another at the nurses' station. The rest she put in the closet in Benjamin Davies's room for the other shifts and the private duty nurses.

  Although Dr. Robert Robinson had seen Benjamin Davies twice on Monday, Dr. Matthew Carter did not see him again until 7:55 on Tuesday morning when Benjamin Davies had been wheeled in his bed on and off the elevator and down the hall of the fifth floor to the door of the operating room. The wheeling had been done by a bald, middle-aged orderly who happened to be an ex-convict and who, in a few minutes, but unknown to Benjamin Davies, would shave Mr. Davies's chest and back.

  "Good morning," Dr. Carter said to Benjamin Davies. "How are you feeling this morning?"

  "As well as can be expected, I suppose. In the past twenty-four hours I've been poked by every doctor, intern, technician, and nurse in this place. How are you?"

  "I'm fine. I've been looking at the results of your tests. You're going to do all right."

  "How long will it take you in there?"

  "Oh, a couple of hours."

  "All right," Benjamin Davies said. "It's obvious I'm ready when you are."

  "Good."

  It took two hours and twenty minutes. The new set of X-rays showed that the tumor in the right lung was now slightly larger than a golf ball and the shadow in the left lung, although still small, was more distinct. Because the large tumor in the right lung had penetrated the right pulmonary artery Dr. Carter had no choice but to perform a pneumonectomy, meaning he removed the entire right lung. He did this because he knew that as long as the small shadow in the other lung, now presumed also to be malignant, could be reduced, or at least controlled by radiation therapy, the breathing capacity of the left lung would be sufficient for the needs of Benjamin Davies.

  After all, he reasoned, this man is not in the habit of running for trains and he doesn't take stairways two steps at a time. Although the right lung normally performs about sixty per cent of the pulmonary function, he will not even know that it is gone until I tell him, and telling this man at the right time and in the right way should be no problem.

  Dr. Carter did not choose to tell Benjamin Davies until the fifth post-operative day. On the third post-operative day Benjamin Davies had asked him if the laboratory had made its report as yet, but Dr. Carter had answered in the negative and diverted him by inquiring about the presence of pain, his sleep problems, his elimination difficulties and his appetite. On the fourth day Dr. Robert Robinson, and not Dr. Carter, had visited Benjamin Davies and he, too, had professed ignorance, detecting not only some annoyance on the part of Mr. Davies but, it occurred to him later, some suspicion as well.

  At 3:15 in the afternoon of the fifth day, which was a Sunday, Dr. Carter had found Benjamin Davies's private nurse visiting at the nurses' station. She informed him that Mr. Davies was dictating to his secretary, and when Dr. Carter entered the room he found Mr. Davies, in a mono-grammed maroon silk dressing gown over gray pajamas, sitting in one arm chair, and his secretary, a thin, bespectacled, stylishly dressed woman in her forties with a sheaf of papers in her lap and a notebook on her knee, sitting in the other.

  "Good afternoon," Dr. Carter said.

  "Oh," Benjamin Davies said. "Hello."

  He introduced Dr. Carter to his secretary. He then told his secretary that he wouldn't be needing her any more that day, reminded her of a couple of details he wanted checked and told her to come back the next morning.

  "I don't know whether you're starting a florist's shop or a lending library," Dr. Carter said after the secretary had left.

  There were flowers on the bureau, on the bed table, and on the floor in one corner of the room. There were a half-dozen books, new in their dust jackets, on the bureau and several more on the window sill.

  "Neither," Benjamin Davies said.

  "How are you feeling today?"

  "I'd feel a lot better," Benjamin Davies said, "if I knew when I could get out of here. I can't find out anything around this place."

  "Well, maybe I can help you," Dr. Carter said. "What would you like to know?"

  I know exactly what he wants to know, he thought. I could have told him the first day he came into the office, and he knows it, too.

  "Did you get that report back from the lab yet?"

  "Yes. We've got it."

  "What did they find?"

  "Well, they found you had a tumor. The X-rays weren't lying."

  "What was it?"

  "It wasn't a golf ball."

  "It was cancer, wasn't it?" Benjamin Davies said, looking right at him. "I know it was cancer."

  "Yes. It was a carcinoma, but. . ."

  "It was a cancer," Benjamin Davies said. "Cancer. Cancer. Don't evade it. Don't. . ."

  "I'm not evading anything. I'm trying to tell you, and please listen to what I'm saying, that it was a cancer but we got it all out."

  'You got it all out?" Benjamin Davies was saying, staring at him now, his face pale. "You got it all out? How do you know you got it all out? How does anybody know you got it all out? How do I know you got it all out? How ..."

  "Now listen to me," he said, and he was standing over Benjamin Davies, his hand on Benjamin Davies's shoulder. "We know we got it all out. Get hold of yourself now, and stop thisl"

  "How do you know you got it all out? How do you know? How do you know?"

  "I know," he said. "Listen to me. It was completely contained in your lung, and I removed the lung. There's no more cancer. . ."

  "My lungl" Benjamin Davies said, looking at him, and then looking down at his own chest. "My God, my lungl"

  He put his right hand, open, over his right chest. Then he dropped his head in his hands and he started to sob, half crying, half talking, gasping, and starting to swallow air.

  "Doctor?" the nurse said, coming into the room, hurrying.

  "I need you. He's going into shock. Get me five grains of sodium amytal quick, and then well get him into bed."

  "My God, my lung!" Benjamin Davies was saying, crying it, swallowing more air, then starting to belch, his skin cold and wet with sweat. "God . . . God . . ."

  "will you listen to me? Stop acting like a child! Listen to me for a minute!"

  When the nurse came back they moved Benjamin Davies, holding him under the shoulders, into the bed. Benjamin Davies was still trying to talk, but now just sobs and air were coming.

  "Let me have that syringe and crank the bed up. He may vomit."

  "Yes, Doctor."

  He took the syringe and, with Benjamin Davies still irrational and unaware of what was happening, and the nurse baring Benjamin Davies's left arm, he found the median cubital vein between the two condyles, the bony prominences of the elbow, and he inserted the needle and slowly injected the sedative.

  "He'll be all right now for about four hours," he sai
d, watching Benjamin Davies subside. "Let's keep him warm."

  "Excuse me, Doctor," the nurse said, "but what happened?"

  "He's been hounding Dr. Robinson and me for the last two or three days about his lab report."

  "I know. He's been hounding all of us."

  "I finally had to tell him he had carcinoma, and that I took his lung."