The surgeon

by Wilfred Charles Heinz

  "Like everyone else in medical school," Frank Stanczyk said, "I haven't had too much time for hobbies, but I play a little tennis and I enjoy classical music and I collect hi-fi records, when I can afford to buy one."

  "You know, I suppose, that Billroth had an interest in music," Ross Young said. He was referring to the great nineteenth-century German pathologist and surgeon after whom a whole series of abdominal operations of his own invention are named, and Matthew Carter knew that Ross Young was testing Frank Stancyzk's professed interest in classical music now. He was testing it to see if it were genuine or merely borrowed to give the appearance of the well-rounded young man.

  "Yes, sir," Frank Stancyzk said. "In fact, he and Brahms were good friends."

  "That's right," Ross Young said. "Didn't Brahms play much of his chamber music at Billroth's home before introducing it publicly?"

  "Yes, and Billroth played the piano quite well himself," Frank Stanczyk said. "He must have been quite a man."

  "I guess he was," Ross Young said.

  He asked Frank Stanczyk if he had any other interests. Frank Stanczyk said that, while in high school, he had been fascinated by the mechanics of the internal-combustion engine, but that he had outgrown his interest in cars except as a means of transportation. He said that he hoped to take up woodworking, when he had the time and the money for the equipment.

  "As a medical school senior," Ross Young said, "you know that it will be a long time before you're able to earn the money, and when you do, you probably won't have the time."

  "I realize that," Frank Stanczyk said, smiling.

  "Then may I ask you," Ross Young said, "why you want to be a doctor?"

  Frank Stanczyk was saying now what he had said two years before, sitting that afternoon in the clapboard building by the gas pumps, but he was saying it better. As Matthew Carter listened, he heard Frank Stanczyk explaining that he didn't believe in confusing self-service with public service. He was saying that, because of the nature of his own personality, for which he could take no credit, and because, perhaps, of his own emotional needs, he could conceive of being happy in life only if he could be doing something for a common good. Like everyone else, he was saying, he was merely seeking his own fulfillment, and in his case it happened to be in medicine.

  "I simply feel," he was saying, looking right at Ross Young, "that if I could just extend one human life just one day I would be doing more than I could be doing in any other field. I realize that any doctor does much more than that—that, as a doctor, I'd better do more than that— but I'm not quite a doctor yet and when I am III probably forget all about such a limited concept as that."

  "I hope you never do," Ross Young said, and Matthew Carter heard his own words coming back to him from the garage on the other side of the Memorial Bridge.

  Ross Young thanked Frank Stanczyk then for coming in to see them, and Frank Stanczyk got up and thanked them and left. As they watched him turn and walk out Matthew Carter realized he had never told any of them that he had ever heard of Frank Stanczyk before, and while he had been in the room their eyes had never met.

  "I'd like to make a prediction, gentlemen," Ross Young said. "We've still got one hundred and three to go, but I predict we'll find that this young man is the best of the crop, and if it so happens that you gentlemen agree with me, I'll predict he'll make the best house officer we've got."

  Then he pushed the button on the desk in front of him to signal his secretary. In a moment the door opened and the next applicant came in.

  It evolved as Ross Young had predicted that it would, and as Matthew Carter had known that it would. Frank Stanczyk was the best of the interns and he became the best of the surgical residents. He had the mental capacity and the emotional stability, the physical resiliency and the manual dexterity. He had the curiosity and the appetite for it, and he was as demanding, in the easy, natural but persistent way of his questioning, of the members of the surgical staff as they were demanding of him.

  It was obvious, although no one else knew the beginnings of it, that he idolized Matthew Carter and that Matthew Carter saw in Frank Stanczyk an extension of himself. Two years after Frank Stanczyk had completed his chief residency and had started out in general surgery he was still known as "Matt Carter's boy."

  XIV

  When he walked into the locker room he saw that Frank Stanczyk was alone, sitting back in the lounge chair, his head back and his eyes closed. His hair was still damp and matted from his sweating under the cap and he needed a shave. He was still in his scrub suit, and had sweated under the anus and there was also an island of it, gray on the light green, on the front of the short-sleeved shirt.

  "Oh, hello, Matt," he said. "How are you?"

  "I'm all right. How are you?"

  "Lousy."

  "Why don't you get out of that suit and take a shower?"

  "I'm too bushed right now. It's warm in here anyway."

  "At least get out of that shirt," he said and he turned and walked into the lavatory and shower room. He took a clean bath towel off the shelf and walked back.

  'Take the shirt off," he said. "C'mon."

  Frank Stanczyk got up and pulled the shirt over his head and turned and threw it at the hamper. It hit the edge and hung there and he took the towel and toweled himself off, his chest and back and under the arms. Then he draped the towel around his neck and sat down again.

  "Pull that foot rest out and put your feet up. You'll have varicose veins before you're forty."

  "That's the least of my worries," Frank Stanczyk said.

  "I know."

  "You heard?"

  "Yes."

  "Who told you?" Frank Stanczyk said, looking right at him.

  "Sally Wheeler. Stop worrying about your reputation."

  "I'm not worried about that."

  "I know you're not. Sally told me because I follow you into that room."

  "I'm sorry to hold you up."

  "Don't be ridiculous."

  "For over six hours I fought that thing, Matt," Frank Stanczyk said. "I actually thought of calling you but I knew you had that 8 o'clock case. I tried everything I know. Three times I thought I had it won. You know?"

  "Of course I know. Don't you think I get those, too? You do everything you can, and when that's not enough you take your shower and try your best to put it out of your mind."

  You try your best to put it out of your mind, he was thinking, but you never quite do.

  "I did everything. I did everything including making the mistake that got me into the mess in the first place."

  "Look," he said. "You know there isn't a man alive who hasn't made his mistakes. That's trite but it's still true, and I could tell you a few of my own."

  "But it looked so easy, Matt," Frank Stanczyk said. "It looked so damn easy."

  That's the kind that trap you, he was thinking, listening. The enemy leads you into that false sense of security and you walk in there and he hits you from the side and if you haven't prepared your escapes, the first thing you know he's all around you and behind you and then there's no way out.

  It had occurred to him once, years before, that it is like the time that new infantry outfit came up into the Huertgen during the war. The first day they were in there they sent two companies out to take those two small towns that were sitting right out there in the open and that looked so easy. He could never remember the names of those towns, but the Germans had the woods on both sides and the high ground beyond. They were just sitting there, waiting, as they had been waiting for weeks, and when the two companies moved in they closed on them and cut them off and it was plain slaughter.

  He didn't see the first of the wounded they managed to get out and move back through battalion and regiment and division until late that afternoon. He was operating then in the kitchen of a church social hall and he worked all night and all the next morning and until about 1:00 the next afternoon. Some years later he met a colonel from the outfit that had been relieved, and when
he mentioned the towns the colonel, although it must have been six or even eight years later, was still irate.

  "Damn foolishness" the colonel said. "They were absolute damn fools. When they relieved us we filled them in on everything. We gave them all our intelligence and we said: 'Don't take those towns. We've been looking at them for three weeks, but we know what they are. They look sweet, but they're sour. The easy way to those towns is not the short way, but through the woods.'

  "I guess the damn fools were just starting to feel their oats and they wanted to make a show," the colonel said. "I guess they wanted to make a show on the map at Corps and Army, and they damn well did."

  It is like that with surgery, he had thought after talking with the colonel. It is never a matter of making a show, but it takes time, this going, you might say, from tree to tree, even though with modem anesthesia you've got the time and nobody has to take a leg off in twenty-eight seconds as Liston could do more than a hundred years ago. Of course, any man who doesn't take the short way whenever he can is either incompetent or a coward, but if he's brave enough he'd better also be knowledgeable enough to know what's on both sides of him and cautious enough to keep his escape routes open until he finds out what's ahead.

  "It just looked so damn easy," Frank Stanczyk was saying, "that when I first got in there I thought it was going to be a snap."

  "You're not the first one to make that mistake, either," he said. "What was the problem?"

  "He came in about 5 o'clock yesterday afternoon," Frank Stanczyk said, "vomiting blood and passing bright red, and pretty shocky. He was fifty-four and he had a history of a duodenal ulcer about ten years ago but it hadn't bothered him in years and there was hardly a trace of tarry stool.

  "Anyway, he couldn't keep the barium down so we couldn't X-ray him. We gave him the first two pints of blood and his pressure responded and it looked pretty good for the time being. About 3 a.m. he started vomiting again, unchanged bright red, and his pressure dropped and they called me. I opened him and found this duodenal scar, but there was no swelling around it. There was blood in his entire G.I. tract, though, and you know what it was?"

  "Aneurism of the abdominal aorta?" he said, meaning a blood-filled tumor of the main artery that carries the blood from the left ventricle of the heart.

  "That's right. It took me some time to realize what it was because I'd never seen one quite like this. The aneurism, in expanding, had become fused with the duodenum and, finally, had perforated into it. There was no blood in the abdomen, but it was leaking into the duodenum itself, as if it were an ulcer."

  "So what did you do?"

  "Well, I felt around it, and I got cocky, I guess. The aneurism wasn't much bigger than a large grape, and I've done big ones with so little blood loss that I figured the simplest thing to do was to put a tangential clamp at the base of the aneurism, take the duodenum off, close the duodenum, and close the aorta."

  "It would have been a nice trick if you could have brought it off," he said, but he was thinking: He should have gone upstream. He should have dissected around the aorta above in order to cross clamp it and leave himself an escape. He should have gone through the woods, as he knows well enough now.

  "And then all hell broke loose," Frank Stanczyk was saying. "I isolated the aneurism and put the clamp on, but there wasn't any room to sew. So I repositioned the clamp, and it tore."

  "And you were looking down the open end of a rifle barrel."

  "That's right. I had to scramble like hell to dissect and get a finger around the aorta. You can imagine what was happening to his pressure. The blood bank here was low on O-Negative and they had to borrow a couple of pints. They got the blood to me all right, but—hell, Matt, do you know how I feel?"

  "Of course I know," he said. "I want to. . ."

  He heard the door from the hall open and hit the rubber stop. He turned and saw Arnold Jaffrey walk in with Maury Rand, still in his scrub suit, behind him.

  "And don't think I don't mean it," Jaffrey was saying to Maury Rand. "I've got every ruddy right to be incensed, and I'm going down and see Baumgartner right now and point out to him that if he thinks he's running an efficient institution here he'd do well to look around."

  He picked a great time to bust in here, he was thinking, and he's sore because they had to postpone his gall-bladder, or whatever he's doing. Instead of threatening Baumgartner I wish he'd threaten to take down his shingle and do it.

  He had known Arnold Jaffrey for twelve years and of late had watched the decline of what was once considered his highly successful and enviable society practice. Arnold Jaffrey was only fifty years old but a remnant of the depression, of the days when the primary requirement for admission to too many medical schools was your ability to pay for it. Too many smart kids couldn't afford it and too many rich kids could, although Arnold Jaffrey may have been rather bright. He probably couldn't drive a nail into a board, because he had never had to, and he had had a year at Oxford, which had been a help. When he contracted osteomyelitis and affected a cane, for which he had no real need, it gave him the license to affect the accent and complement his British tailoring and his prematurely gray hair, for all of which he had great need.

  "Arnold Jaffrey shouldn't be a surgeon," Marion had said one evening, driving home from a dinner party that had included Arnold Jaffrey and his quiet, pleasant, but not very bright wife. "He should be a cruise director."

  "Why do you say that?" he had said, amused and knowing very well why.

  "He'd make a great cruise director," she said. "He could lead everything from the conga fine to the sunrise service."

  "It's strange you should feel that way," he said. "He always seems to like you."

  "How thrilling," she said. "He's one of those phonies who makes a play for every woman he thinks attractive, and if one of them ever took him up on it he'd probably die of fright."

  "Considering that possibility, why don't you take him up on it?"

  "Oh, please," she said. "Who could stand all that fawning around and that accent?"

  "He seems to get along very well with his wife."

  "He'd better," she said. "I understand she has all the money now."

  "His patients adore him."

  "The way they're declining in numbers I doubt that."

  "Actually they do," he said. "He's especially good with the dying, and he's the soul of comfort to the family."

  "Even though he was a contributing factor in the demise of the deceased?"

  "No. I don't mean that at all. Nobody is referring the tough ones to him any more, and if they did he wouldn't attempt them. He's a coward and that's fine. He can do his appendectomies and handle his gall-bladders and spleens and hernias and the results are all right."

  "I'm glad to hear that," Marion had said.

  "Oh, hello, Matt," Arnold Jaffrey was saying now, noticing them for the first time. "Stancayk. Didn't see you there."

  "Good morning," he said.

  "Hello," Frank Stanczyk said.

  "Isn't this preposterous, Matt?" Jaffrey said.

  "I'm sorry, but I've been talking to Stan here. What's your difficulty?"

  "Difficulty? You've been delayed, too, haven't you?"

  "That's right."

  "And that's what I mean. How long are we going to put up with the utter confusion one has to face here merely trying to practice his profession in this so-called house of mercy? I don't mind telling you, as I've been telling a few other people this morning and as I'm going right down and tell Baumgartner, that I'm incensed."

  "I can see that."

  "And with one good reason. Do you know what they've done to me?"

  "No."

  "I've had my patient scheduled for 8 o'clock this morning for three days. That incredible Miss Wheeler, Miss Sarah Wheeler, knows full well, or she should know after all these years, that I always do my cases at 8 o'clock. ..."

  Your two cases a week, he was thinking, so you'll be in plenty of time for a nice leisurely lunch
at the club.

  ". . . and this morning she phones me at 7 o'clock to inform me that

  due to some confusion, the details of which don't interest me in the slightest at that hour, my room won't be available until 11."

  "They did have a rough night around here."

  "And isn't that what any hospital should be prepared to accept? One would think this was Gettysburg after the third day."

  "What's your case?" he said, seeing Maury Rand, standing behind Jaffrey, raise his eyebrows and shrug his shoulders.

  "An inguinal hernia," Jaffrey said, "and that reminds me of something else. Do you realize that this patient has been on the waiting list for three weeks just to get into this place?"