The surgeon

by Wilfred Charles Heinz

  "Well, I felt a little bit better. I feel all right now."

  "Why did you call Dr. Fineman?"

  "Oh, you know. I didn't sleep much, and I was coughing. This morning I thought I could still feel something stuck down there. My husband insisted that I call him."

  "I want you to tell me this, and I want you to tell me the truth. Do you feel any pain, and discomfort, down in the middle of your chest?"

  "Not now. It's just like I told the nurse here. I don't feel anything now, and I'm sorry I even called Dr. Fineman."

  If it were a sliver of bone and not a piece of meat and in the esophagus, he was thinking, it would be stuck where the aorta crosses and it would rub and penetrate as the aorta pulsates with each beat of the heart. If there's anything still down there it's in a lung where she wouldn't feel it.

  "I want to explain something to you, Mrs. Brower," he said. "I want to tell you what we want to do, and why we want to do it."

  "I don't want you to do anything. I'm quite sure there's nothing there any more."

  "Now you're only guessing," he said, "because we really don't know. We're almost certain that there's nothing in your esophagus because you're feeling no irritation there now. If you did inhale a piece of meat, though, it's in your lung."

  "But I don't feel a thing."

  "There's nothing to feel with in the lung, so you can't tell. If it's in your lung, however, it's got to be removed. If we didn't take it out, it could lead to repeated bouts of pneumonia and lung abscess and eventually to destruction of that part of the lung. That's why we can't take the chance."

  "Now you've got me scared, Doctor," she said, looking at him but then looking away and shaking her head. "It's just that I'm sorry that I mentioned it at all."

  "There's nothing to be nervous about. It's a very simple, routine procedure, and it will only take me a few minutes. We Just put you to sleep and I look down into your windpipe and lung with a scope—a tube. If there's anything down there I just reach down with some long forceps and bring it out. You don't know or feel a thing, and you can go home late this afternoon or early this evening."

  "It sounds terrible to me, Doctor," she said. "I've never had an operation, and it just frightens me."

  "I know it frightens you, but it shouldn't. If it will make you feel any better, I can tell you that I've done this—looked down into patients' lungs—thousands of times."

  "You have?"

  "Yes, and there's a boy—fifteen years old—just down the hall here, and I've put a scope down into him at least thirty times in the last six years. I've just operated on him to cure his problem, but he used to come in here once a month to be scoped."

  "Really?"

  "Yes, and it never hurt him. He wasn't frightened."

  She's convinced, he knew, studying her. Bernard Waterman did it.

  "But I just feel so foolish," she was saying. "If you don't find anything, I'll just feel so foolish."

  "You'd be foolish if you didn't let us take a look," he said. "Miss Jasperson here is an anesthetist. She just wants to take your blood pressure and give you something to dry up your mucous membranes. That's all."

  "All right, Doctor. I suppose you're right, but I'm just sorry to be such a bother."

  "You're not a bother at all," he said, "and I'll see you downstairs in a few minutes."

  "I still wish I had never told Dr. Fineman," she said.

  When he got off the elevator at the O.R. floor Sarah Wheeler was walking down the hall toward him. She had her hands up behind her head, untying her mask.

  "I thought you were taking your yacht to the Bahamas," he said. "What happened?"

  "I realized it wouldn't be any fun without you," she said, "so I postponed the sailing until you could make it."

  "Good," he said. "I'll be ready in about five hours."

  "Not today you won't."

  "Why?" he said. "How's Stan doing?"

  "He's not. He's on his tenth pint of blood, and it's O-Negative. He cleaned us out, and we're getting two pints from University and the Red Cross is trying to round up a few of its emergency donors. It's a mess."

  "What's he doing, anyway?"

  "A duodenal ulcer that came in at 5 o'clock yesterday, and started to bleed again at about 4 this morning."

  "He can handle that."

  "It's not the duodenum that's giving him the trouble. It's the aorta, and he's really in a jam."

  "He'll still handle it."

  "Well, he's your boy," she said, "and I hope you're right."

  "I'll do that bronchoscopy now down in Emergency," he said. "Then I'll check back with you."

  "If you ask me," she said, 'lie's going to do it in the next half-hour, or he isn't, so I'll be able to get you in there in an hour or so."

  "Thanks, Sal," he said.

  And I'll bet I know exactly what Stan ran into, he was thinking, walking to the locker room. I'll bet he got one of those that come in vomiting blood and maybe even passing it, too, and you can't take an X-ray because they can't keep the barium down or, if they can, the tract is full of blood clots and you can't see the trouble. Sal says the problem isn't the duodenum but the aorta, so I'll bet it's where the third portion of the duodenum crosses the aorta and he's got an aneurism of the aorta that eroded into the duodenum. If you're doing general surgery you may see that about once every five years but I'll bet Stan didn't spot it early and the first thing he knew his field was full of blood and he's been scrambling ever since.

  "Good morning, Dr. Carter," the intern said. He was sitting in the lounge chair, finishing a cigarette.

  "Good morning," he said.

  I can't think of his name, he was thinking. He's one of the new ones and he's never scrubbed with me but he's observed me a couple of times and I should remember his name.

  "Excuse me, Doctor," the intern said, "but are you doing a pneumonectomy this morning?"

  "Yes," he said, "when I can get in there. They've been rather busy."

  "I'll say," the intern said. "We've had a real rough night."

  "So I heard."

  His name begins with D, he was thinking, hanging his jacket up in his locker. Not Darwin. That's not it. It's Darrow.

  "You're Dr. Darrow, aren't you?"

  "That's right, sir."

  Darrow, he was saying to himself. Darrow. Remember Clarence Darrow. This boy is rather short and Clarence Darrow was taller and big-boned and he had long, straight hair that hung over one side of his forehead, if I remember his picture. Remember Darrow, but don't call this boy Clarence.

  "I thought that, because I've got some time this morning, sir," Darrow was saying, "I'd observe you and Dr. Robinson and Jim Bronson."

  "Good," he said. "This is undoubtedly a carcinoma of the right lung and it appears, on the X-rays, to have invaded the mediastinum. You may see something interesting."

  Especially, he was thinking, if it involves that vena cava of my Mr. Scheller. Then it's going to be more interesting than you think.

  "It's all interesting to me," Darrow said.

  "That's the way it should be," he said. "When I was your age everything interested and excited me, too."

  When Pete Church was doing a chest, the word would spread and he'd be there somewhere. If he wasn't assisting he'd be there on the floor observing, or if he just had five minutes he'd be up in the gallery where you can't hear anything or see much but where he could at least try to feel a part of it.

  He had stripped now to his shorts and his socks. He took off his wrist watch and slid it down inside his left sock. Then he reached into the locker and took the wallet out of the pocket of his jacket. He took out the Bills and put the wallet back and slipped the Bills down inside his right sock and flattened them around the ankle.

  He did this now without thinking, but twice, years before, while he had been in there operating, his locker had been rifled. He lost a watch and between $150 and $200 in Bills, and every now and then somebody would lose something. They figured it must be an orderly or
one of the janitors because you can't pay them enough to get good help. As if you can buy honesty, he had thought, angry when it had happened, but it is an ironic ending to a beautiful operation to realize that while you were in there saving a life somebody was robbing you in the locker room.

  "I think it was Osler," he said now to the intern named Darrow, "who once said that, if you practice medicine early and late, you can't hope to escape the malign influences of a routine life."

  "I suppose that's right, sir," Darrow said, "but it's hard for me to imagine."

  "It will happen to you," he said. "It happens to everybody, but the good ones fight it."

  "It's not one of my problems right now," Darrow said.

  "I'm sure it isn't."

  He took out of his locker one of the wash-faded, starched, ironed-flat, short-sleeved, green scrub shirts and put it on over his head. He climbed into the scrub pants, pulled the draw string tight at the waist, and tied it at the right hip.

  "There he is," he heard Maury Rand say, coming through the door. "I've been here since 8 o'clock, but he just starts to work at 10."

  "Hello, Maury," he said.

  "He keeps bankers' hours," Gene Parente said, coming in after Maury, "and he's got a banker's income."

  "I'll say," Maury said, "but he won't be able to do that under socialized medicine. Hell have to be up before 7 every morning, and be on the job by 8."

  "That's right," he said, sliding first one foot and then the other into the open-backed O.R. shoes, "and every afternoon we'll go home at 4. That's what they do, you know."

  "That's what you do now, isn't it?" Maury said.

  "Absolutely," he said. "As a matter of fact, quite often I get home for dinner by 8:30 or 9 o'clock."

  "Oh, come on," Maury said. "You might impress Darrow here, but you can't impress us."

  Darrow's eyes were following the back-and-forth of the badinage as if it were a badminton bird and he could actually see it.

  "As a matter of fact," Gene Parente said, "under socialized medicine he'll be lucky if he gets any patients. They tell me that the G.P. holds onto the patient so long that, by the time he turns him over to a hot specialist like Matt, it's a terminal case."

  "I'm not worried," he said, putting his white smock on over the scrub suit. "I could use a little leisure."

  "The truth about socialized medicine," Maury said, "is that it's being forced by young doctors like Darrow here."

  "Not me," Darrow said, shaking his head.

  "Not at the moment," Maury said, "but in a few years. You'll want days off, vacations with pay, and an insured income from the start. All you young guys do, and that's where the pressure within the profession comes from."

  "That isn't what I read," Gene Parente said. "From what I read it's us physicians and surgeons who are pricing ourselves out of the market. Isn't that right, Matt?"

  "I don't know," he said, walking to the wooden box on the window sill and taking out a rolled surgical mask and a white cap. "Is that what they say?"

  "He knows all right," Maury said. "One of his patients buys a Cadillac for six thousand dollars. Matt does that great pneumonectomy of his on him and the patient complains when Matt charges him fifteen hundred dollars for saving his life. Right?"

  "I really don't know," he said, winking at Darrow who was watching him. "My secretary does all the Billing, and I haven't the vaguest idea what she charges."

  "I'll bet," Maury said.

  "So we get accused," Gene was saying, "of pricing ourselves out of the market."

  "Listen to this," Maury said. "I'm having one of the rooms at my office painted. I walked in yesterday morning and I hear one of the painters say to the other: Tou know, one of these guys killed my sister.'"

  "I'm sorry, gentlemen," he said, tired of it, "but you wealthy doctors can sit around here all day and, when you get through talking about socialized medicine you can talk about golf and girls. I'm poor, and I have to go to work."

  "I'd like to be so poor," Maury said.

  "What are you doing?" Gene Parente said.

  "A bronchoscopy."

  "A bronchoscopy?" Maury said. "That's not work. I'll bet by now you can do one of those with your eyes closed."

  "I can."

  "That's a nice little thing to have going for you," Maury said. "How many of these do you do a month or a year, anyway?"

  "You gynecologists should ask," he said to Maury. "How many of those D. and C.s do you do?"

  "Why don't you go to work?" Maury said.

  XI

  "How many lives," he said once, "have been saved since Chevalier Jackson developed the bronchoscope no one can possibly calculate. All I know is that it may have saved my professional life."

  In his senior year in medical school they were sitting at lunch in the cafeteria one day, and they were talking about sending out their applications for internships. Because it was a medical school with an inferiority complex, it had, throughout the half-century of its existence, inadvertently transmitted a sense of inadequacy to most of its students, and so most of its seniors applied for their internships to the smaller, less celebrated hospitals.

  "How about you, Matt?" one of them said to him.

  "Me?" he said. "I'm just applying to General."

  "What?" the same one said. "And no place else?"

  "Are you kidding?" another said. "You think they'll take you?"

  "Sure," he said. "Why not?"

  "I wish I had your guts."

  "I'll take his marks," a third one said.

  "You know," the first one said. 'You might make it."

  "I'll make it," he said.

  Here I am, he thought later, playing the hero again. It's a chronic disease with me. I'm not even accepted yet, but it's like that time at the fraternity house when I said I thought I'd go to medical school and they all looked at me as if I'd already performed a completely successful frontal lobotomy.

  Three weeks after he sent his letter of application and his transcript the answer came back. It was a form letter, its impersonality obvious in spite of the fact that it was addressed to, and was personally typed for, him. It thanked him for his application, regretted that its internships were already filled and it wished him success in his career. He read it through three times, looking for some encouragement and finding none.

  "How are you making out with General?" one of them asked him a couple of days later.

  "I don't know," he said, unable to shuck the hero image and admit it. "I haven't heard."

  "They better let you know soon," the other said. "If they wait too long and then turn you down every other place will be filled."

  "I know," he said, "but I'm not worrying about that yet."

  Several nights later he recalled, by what process of mental association he never knew, that somewhere he had heard that Carleton Cheney Grant, the associate professor of surgery, had roomed in medical school with Franklin Pierce Church. Franklin Pierce Church was chief of surgery at General Hospital.

  "I'll be glad to write Pete Church," Grant said the next day. "I don't know how much good it will do, but I can try."

  About a week later Grant sent word he wanted to see him in his office. He had a letter from Church.

  "I am impressed," Church wrote, "by your recommendation of Matthew Carter. Unfortunately, and as he already knows, our internships are filled and, like everyone else, we are short of funds and limited in living facilities. If he is as genuinely desirous of coming here as you say, however, we would be happy to have him as an extern, under one of our research fellowships. That means, of course, that he would be unable to live in, but if he can afford to live out he can take his meals here. If this is acceptable to him, have him write me and. . ."

  "I'll take it," he said to Grant, "and thanks a lot."

  "Can you handle it financially?" Grant said.

  "Sure," he said. "I can get the money."

  He borrowed it from his sister Ruth. She was married to a big Norwegian who operated his own p
lumbing business and they had a couple of thousand dollars in the bank. She agreed to lend him $25 a month, the money to be paid back when her son, then eleven, was ready for college.

  He found a room a mile and a half from General Hospital. It was at the rear of the second floor of a brownstone house owned by a fat German widow named Koeppler, and it had formerly been a closet. He knew it had been a closet because there was just enough room in it for the iron cot, the straight-backed chair, and the washbasin in the corner, and the one window was small and high on the wall.