That's what I wrote and now they can take it from there. They can take it from there, but Alex Johnson would be amazed, amazed that my segmental resection may yet be as big a luxury here as it would be in China but my letter would have pleased him. Can you imagine them putting a standard fee on a skill like Alex Johnson's? That letter would have pleased him, but the man to write the letter was Leo Kastner, except that Leo never would have been interested in a nicety like my segmental resection. Refinements never meant anything to Leo because with Leo it was all simplification, not refinement, but when somebody crossed him or even challenged him he could blast them and he would have been the one to write that letter and I would have loved to read it.
He was a genius, Leo was, or close to a genius and it would have been some letter because he would have blasted them like he did that cop that first day when we were going to lunch and there were no parking spaces and he double-parked that Cadillac he was driving and the cop came along in the patrol car. All the cops knew him and he knew all the cops and the cop said: "I'm sorry, Leo, but you'll have to move that." And Leo turned on him and said: "I'm not going to move it and if you get out of that car I'll break your goddam jaw." So the cop just pulled his head back in and drove off and we went into the restaurant and had a drink and he was telling me that three nights a week he played violin with a string trio and I reached over and took his left hand to feel the calluses on his fingers and he turned on me and he said: "You doubted it? Well, from now on remember that whenever I tell you I can do something I can do it and don't you dare doubt it."
I doubted it because he looked like a gorI'lla. He really did and it was a shock when you first met him because I'd been hearing those stories of how he did three majors in two hours and twelve operations in a day and I'd been saying it was impossible and I went there full of antagonism. I was late getting there and it must have been about 9 o'clock and I said to the O.R. supervisor: "Is he operating?" And she said: "Oh, a whole bunch." And I said: "What room is he in?" And she said: "Oh, he hasn't come in yet. He always starts at 10."
So I waited for him in the locker room and when he came in and we started to strip down I couldn't believe it. He had those long arms to mid-thighs and he sloped from his ears to his elbows, with a big neck and those powerful, sloping, but narrow shoulders and while I was looking him over he saw my nose and he said to me: "Do you box?" I said: "I did in college." So he said: "I wrestle. I was wrestling this morning."
He was getting out of his shorts when he said it, and when he turned to hang them in his locker I saw that hematoma on his left thigh. He was black and blue from his belt line to his knee and I said: "Did you get that wrestling or were you hit by a truck?" And he said: "No. My horse kicked me. I've got the greatest animal in the world but he's the meanest sob you ever saw and every day it's a contest between us. He kicks me and I belt him, but he's a great animal."
Then we got into our scrub suits and he reached into his locker and took out this white stocking cap with a wool ball on top that his wife knitted for him. He never operated without it but he never wore a mask and when we went into the O.R. there were seven or eight and sometimes a dozen observing him and he always had them banked up on those rolling metal stands. He kept them at a distance where they could observe but where they couldn't learn his tricks and the only reason he let me come up close was that I was from out of town and I was no competition to him.
So he did those three in the two hours before lunch. He did a cancer of the rectum and a hysterectomy and a gall bladder and then before we went to lunch he made rounds. I remember we walked in to see that one old man and it was five days after he'd removed the gall bladder and the old man was still running a high fever. So Leo said to the nurse: "What's causing this patient's temperature?" She said: "I don't know, Doctor." Then he turned to his assistant and said: "What's causing the temperature?" The assistant said: "I don't know." So he said to the nurse: "Pull down the sheet." When she did Leo made a fist and belted the old man over the liver and the old man jumped and let out a cry and Leo turned to his assistant again and said: "He's got a sub-phrenic abscess. Drain him this afternoon." Then he turned to me and said: "Let's go to lunch."
Then after he abused that cop and we had a drink and some lunch we came back and he did a stomach resection and two hernias and then two pilonidal sinuses. He did everything under spinal anesthesia and he had those big orderlies who put the patient into position and then he'd do the spinal himself. That was what got them. He was the great advocate of the spinal and it got all the anesthetists and anesthesiologists. They thought he was a wild man and they tried to destroy everything he wrote and even my own anesthetists didn't believe it so at that A.M.A. meeting in Atlantic City I got them together. I remember the first one coming up to me and saying: "I understand you know Kastner." And I said: "That's right." And he said: "A few of us want to meet that sob." So I told Leo there were three or four who wanted to meet him and when we got down to that bar in the hotel that night there were eight of them, all holding professorships, and we all sat down at two tables pushed together at the back and I introduced Leo to them and they went at him. For two hours they went at him and at no time did he fail to come up with a case to neutralize whatever they said.
I remember, too, how at the end there was a string combo playing in the room, walking from table to table, and they were over in the corner by some potted palm trees playing to a young couple. The young guy was handing out dollar bills and finally when I guess he ran out of dollar bills the combo came by our table and Leo had just finished making a point and pulled out a five-dollar bill and handed it to the one with the violin. "Here," he said. "Let me borrow that for a minute." So the violinist took one look at Leo sitting there and looking like a gorilla and he said: "You won't break it, will you?" "No," Leo said and he took the violin and stuck it under his chin and began to play.
When he did, everything in that room stopped. I remember how that room had been full of noise, how we had to raise our voices to be heard, but when Leo started to play that gypsy music that room went completely silent. Even the bartenders stopped mixing drinks and everybody in that dark, smoky, crowded room was looking at and listening to Leo and when he finished and handed the violin back I remember how that whole room broke into applause and in five minutes I'll bet we had twenty drinks on that table.
That was Leo all right and it wasn't too many years after that when that horse killed him. It was a strange thing, but not ironic really when you come to think of it, that it was that horse, that horse that he always called the greatest animal in the world because it challenged him every time he rode it. It was astounding that it was that horse that finally won in what he called that contest they had between them, astounding that that big dumb animal finally threw and killed a man who was a genius or close to it because that's what he was. That was the only way you could explain him because when you first looked at his surgery it appeared so coarse it was appalling until you realized that somehow, by eliminating all the froth and lace and by reducing all the most complicated procedures to their simplest forms he had finally simplified and simplified until he was a kind of Cézanne of his time of surgery.
That's what he was, too, really, a kind of Cézanne of surgery without one wasted motion or hurried movement and the creator of a type of painting that you can't yourself produce or really even imitate. You can't do it or even imitate it and all you can do is borrow a move from it here and there when that move fits you and you can make it your own.
But the risks. When you think of the calculated risks he had to take and the hundreds of mistakes he must have made until he got it that way, got it down to its simplest forms, and that's what it was today, really, the calculated risk. It was the calculated risk and it should have worked but it's strange and this time it's ironic, too, that that was the term that that little Roberto Leon used in the office that night when I asked him about the smoking and he said: "That's what you call the calculated risk." That's what he
said, exactly what he said, so on Roberto Leon I took the calculated risk. I took it because as Rob keeps saying he had no other chance and if I had it, that carcinoma like he had it, I'd want Rob to take it on me because there's no other out and because it's got to work, got to work because it worked on those three dogs and well do another one on Saturday and another and another and it'll be months or even a couple of years before we see it again, probably, but we'll see it again one of these days and when we do I know it'll work because it has to work because there's no reason why it shouldn't work and that's why when we see it again it'll work because it has to work and why I know it'll work.
10:43 A.M.
XVIII
So now if they'll let me, he was thinking, hanging his smock back in his locker and closing the door, I'll do Mr. Scheller. It's true that the O.R. is the only sanctuary we have and if they had let me in there at 8 I'd be closing him by now. I'd know by now if he's a vena cava case and by now we'd have tried that graft or we wouldn't and I'd know that by now, too. If it turns out that we do try that graft, he was thinking, walking to the phone, it'll take me better than three hours and Carrie will have to tell them to delay that mitral at University.
"This is Dr. Carter," he said into the phone. "will you get Carrie McKeen at my office?"
"Yes, Doctor," the operator said. "She's on the line talking with Admissions. Shall I ring her on your public phone?"
"No," he said. "Thanks, but I'll try her again in a couple of minutes."
He went into the lavatory and heard the shower running and knew it was Frank Stanczyk. When he came out he took another cap, glazed-paper stiff with starch, out of the box on the window sI'll and opened it and fitted it on and tied it in back. He picked up another gauze mask, tightly rolled, and went back to the phone.
"Here she is now, Doctor," the operator said. "Thank you for waiting. Here's Dr. Carter."
"Matt?" Carrie McKeen said.
"Yes."
"For John's sake, why aren't you doing Mr. Scheller?"
"I'm going in right now."
"It's about time. What are you people doing over there this morning, anyway?"
"Loafing. Do me a favor and—"
"I've already done you a half-dozen favors this morning. Have you seen Mr. Benjamin Davies' daughter?"
"Yes. About a half-hour ago."
"Well, thank God! She was calling in here. What's the matter with her, anyway?"
"She's losing her father."
"That doesn't give her the right to abuse people."
"Listen," he said. "Call University and get that O.R. supervisor. Tell her I'm going to be delayed getting away from here and tell her to put that mitral stenosis back from 2 o'clock to 3.1 want them to hold up thepre-op medication for an hour and—"
"That's that Mrs. Pappas."
"That's right. I'll be finished here at 3 and they can open at 3 and I'll be over there in fifteen minutes."
"All right, but what about patients? You've got patients at 5 o'clock."
"How many?"
"You've got three and Rob has three. You won't be back here before 6."
"I'll be there at 5:30. Is there anybody I don't have to see today?"
"There's Mr. Worthy."
"Who's he?"
"You remember old Mr. Worthy. John Worthy. You did a right upper lobe on him two years ago, that nice old man, and he's due at 5 foranother six months' check-up, and there's—"
"I remember him. If you can get him on the phone tell him I'll be a half-hour late. I haven't got time to talk now, but if I get jammed up Rob can take one of mine."
"All right. I called Marion and told her you'd pick her up at 8.1 ordered that dress shirt and they'll deliver it this afternoon, and—"
"Good," he said. "When it gets there, try it on and see how it looks."
"Oh, for John's sake, Matt," she said. "Go to work."
"I am," he said.
Walking down the hall, tying the bottom strings of the mask around his neck, he saw the foot of the bed coming off the elevator and then the whole of the bed, the white sheet up to the patient's neck. At the head of the bed, pushing it and steering it to make the turn, was Jimmy Wilson, short, stocky, his shoulders full in the white short-sleeved jacket and his skin almost black against the white.
"Here we go now," Jimmy Wilson was saying. "Here we just make this turn, and here come Dr. Carter, too."
"Good morning, James," he said. "Is this my patient?"
"That's right," Jimmy Wilson said. "This here's Mr. Scheller and I just tell him he a lucky man to have Dr. Carter."
"How are you this morning?" he said to Mr. Scheller and walking beside the bed.
"I don't know," Mr. Scheller said, looking up but not moving his head on the pillow.
"You're going to be all right," he said. "This is going to be a lot easier than you've been imagining."
"I don't know," Mr. Scheller said.
"That's what I tell Mr. Scheller," Jimmy Wilson said, positioning the bed against the wall opposite the door. "I tell him Dr. Carter can fix anybody. I tell him that when I get sick I'm gonna have Dr. Carter fix me, too, and then I won't worry."
"Thank you, James," he said. "You're still the best orderly we've ever had."
"I admire that," Jimmy said, smiling and nodding his head.
"Excuse me," he said to Mr. Scheller. "I'll be back in a second."
He opened the door to the O.R. and saw Darrow helping the anesthetist named Anne Morris wheel her machine to the head of the table. At the foot of the table the scrub nurse, her back to him, was sorting the instruments on the tray.
"You people about ready?" he said.
"In about two minutes, Doctor," the anesthetist named Anne Morris said.
"Who's that great scrub nurse?" he said.
"Mary Cleary, Doctor," she said, turning.
"I know," he said. "You doing all right?"
"I'll be ready when they are."
"Good," he said. "Where's Dr. Robinson?"
"He just started to scrub, sir," Darrow said.
"Good," he said.
He closed the door and turned back to the bed. Mr. Scheller, not moving and the sheet still up to his chin, was looking at the ceiling.
"How did you sleep last night?" he said to Mr. Scheller. He had turned down the sheet and taken Mr. Scheller's left hand and he had found the pulse.
"Not much," Mr. Scheller said. "I guess that pI'll they gave me didn't work."
"You slept more than you thought," he said.
He was counting the pulse. Even without a watch he wouldn't be off more than five beats but, more important than that, he could get the regularity and the strength of the pulsation.
"I don't know," Mr. Scheller said.
"You'd be surprised if you knew how much you slept," he said, thinking: His pulse is about 90 and not irregular and it's strong enough. That ten milligrams of morphine they gave him this morning is easing his tension a little but it's not exactly making him as bold as a bandit the way it does with some of them.
"That's fine," he said, releasing Mr. Scheller's wrist and pulling the sheet back up. "You're going to do just fine."
"That's what I tell Mr. Scheller," Jimmy Wilson said.
"Did you tell him you helped build this hospital?" he said, walking to the foot of the bed and picking up Mr. Scheller's charts.
"No, sir," Jimmy Wilson said.
"About five years ago," he said, trying to relax Mr. Scheller but starting to scan the charts, "we had a new wing built here and Jimmy Wilson was one of the builders."
"A mason's helper," Jimmy Wilson said. "I carry the bricks and the mortar."
"Then he decided he didn't want to leave us," he said. He was quickly following the line between the dots on the temperature chart and he saw that the temperature was 99 at 8 p.m. and 98.2 twelve hours later. "He likes it here."
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