Knife Music

by David Carnoy

  In the off-season, they watch videotapes of the Padres’ and A’s pitching staffs, among the best in the league, then drive over to La Entrada where his son pitches to him. The only problem is that Madden isn’t a good catcher. Anything a few feet too far to the left or right of him he has trouble getting to, which frustrates Henry because it embarrasses him to watch his father scramble awkwardly for the ball. He thinks he looks goofy.

  “I know I look goofy,” Madden admits. “So don’t make me move. That should be your priority.”

  The advice has paid off. Today, his son is pitching strike after strike. The catcher barely has to move his mitt. After each out, Henry glances over at his father, who nods in approval. No words, not even a smile, just a nod. Then, in the middle of the third inning, Madden’s beeper goes off.

  He winces. It’s the number of another detective, Jeff Billings. He waits a moment, then takes out his cell phone, turns it on, and speed-dials the number.

  When Billings answers, he asks, “What’s up?”

  “Where are you?”

  “I’m at my kid’s Little League game. It’s opening day.”

  “Pete’s looking for you,” he says, referring to their boss, Detective Sergeant Pete Pastorini. “Why aren’t you answering your phone?”

  “I didn’t want to be reached.”

  “Funny.”

  “It’s true.”

  “Well, he got a call a little while ago from someone in the DA’s office and had to go out and meet some people.”

  “What people?”

  “The parents of a girl who say she was raped by her doctor.”

  Madden feels his throat tighten and his heart jump a little. It always happens, the moment he hears a doctor is involved. He can’t help it. He hates that he can’t help it, and he hates that Billings knows he can’t, which only makes his heart race faster. Taking a breath, he looks at the mound. Another strike. Henry still hasn’t allowed a hit. Damn, he thinks. Why today? Why now?

  “You’re the one on-call,” he says. “Why don’t you take it?”

  Technically they’re all on-call, but they have an official schedule where each detective is assigned to specific off-hours blocks. That ensures that at least one detective will be able to respond quickly and soberly.

  “He wants you, Hank,” Billings says, hiding his envy well. There’s only a faint hint of resentment in his voice. “Don’t ask me why. But he sounded anxious.”

  If the sergeant had requested him, it must be important. It must be something he didn’t feel Billings, the youngest and least experienced in the group, could handle.

  “OK,” he says. “Where am I going?”

  3/ PARTING THE RED SEA

  November 10, 2006—12:34 a.m.

  COGAN WALKED OUT OF THE OPERATING ROOM.

  “Beautiful, Dr. Kim,” he said as he left. “If you don’t make it as a surgeon, you have a bright future as a tailor.”

  “Believe me,” said Kim, who was closing the girl, “I’ve considered it.”

  By the scrub sink, Cogan pulled down his mask, stripped off his gloves, and removed his gown. Then he washed his hands and face, first with hot, then cold water. After he was finished, he checked his shoes for blood and wiped them clean with a paper towel, which he always did before meeting with a patient’s family.

  “They’re outside, in the waiting room,” the desk nurse, Julie, informed him. “Mother and father.”

  At this late hour, the OR was practically deserted. Just a skeleton staff remained.

  “She insured?” Cogan asked.

  “Through the father’s company.”

  “Hey, you wouldn’t have any of your famous herbal tea packets stashed away there, would you?”

  The nurse smiled. “What’s in it for me?”

  “I’ve got cookies.”

  “What kind?”

  “Homemade chocolate chip. Remember O’Dwyer, the guy who was in the fight the other night? His wife hooked me up.”

  She thought about it. Then, looking inside her desk drawer, she said, “It’s your lucky night, Cogan. I’ve got apricot.”

  “I’ll be back.”

  He pushed a button on the wall that opened the automatic OR doors and walked through them, down the hall to where the couple was seated on a vinyl couch.

  “Mr. and Mrs. Kroiter?”

  They stood up anxiously. “Yes.”

  “Hello, I’m Dr. Ted Cogan. I’m a surgeon. Please. Sit down.”

  The couple probably would have been glad to continue standing, but Cogan was the one who wanted to sit. He’d been standing for the last two and a half hours.

  “Your daughter was in a car accident,” he began. “We’re not exactly sure what happened—we don’t know what caused the accident—but the paramedics said her car jumped the curb and she hit a telephone pole.” He paused briefly to let them absorb what he said, then continued, “She came into the hospital and we realized she was bleeding internally, so we took her to the operating room. It turned out she’d ruptured her spleen, and we had to do a splenectomy. The operation was uneventful, and she’s doing very well. She has a few broken ribs and some minor cuts and scratches, but otherwise there’s nothing wrong with her. She’s on her way to the recovery room as we speak.”

  “Does that mean she’s OK?” the girl’s mother asked.

  Cogan looked at Mrs. Kroiter. More and more, he noticed, his initial impressions of people were rooted less in looks but in temperament. Beauty registered, certainly, but his primary concern—the first question he invariably asked himself—was, “Is this person going to be difficult?”

  The couple didn’t look difficult. She was dressed in a nylon warm-up suit, purple and green, Nike—something she might wear for a quick trip to the mall or Safeway. The husband had on a jacket and tie. Business looking. Nothing flashy. Funny, Cogan thought, he prefers to face the public in his standard uniform, even at two o’clock in the morning. Mrs. Kroiter was slender, in her early forties, as was the husband. She had short hair, dark eyebrows, and blue eyes that were puffy and red, presumably from crying. The husband was bald but it didn’t hurt his looks, for he had a military air to him, good strong bone structure in his face, and blue eyes like his wife, but brighter, more alert, and seemingly more patient. One of those guys who played football in high school even though he probably shouldn’t have, he thought.

  “Mrs. Kroiter,” he said, “your daughter has sustained a very serious injury, but if all goes well she should recover from it.”

  “So she’s going to be OK?”

  “Again, you have to understand, your daughter’s just come out of surgery. We had to remove her spleen. Everything went very well. She’s doing very well.”

  The husband put his arm around the wife, who was seated next to Cogan, and extended his right hand across her. “Bill Kroiter,” he said in a deep, confident voice.

  Cogan shook the hand.

  “Cogan, you said your name was?”

  “Yes.”

  “You performed the operation?”

  “That’s right.”

  “The spleen, that’s an organ?”

  “Yes. The spleen filters your blood and protects against bacterial infection. The body—especially the adult body—can function fine without it, but a major infection will always be a possibility. We gave your daughter an injection in the operating room to protect her from the bacteria to which she will be most susceptible, streptococcal pneumonia. She’ll have to take antibiotics until she’s twenty-one, and she’ll have to be very careful when she has a cold or feels at all fluish.”

  It went like that for a while. The couple asking questions and Cogan trying to answer them as clearly and succinctly as he could. But he kept having to repeat himself. It was the same with most families. They didn’t trust you at the start (they didn’t trust doctors), but if you could manage to give the same answers and tell the same story over and over, they started to believe you. And then, of course, there was always one final questi
on: Could they see her?

  “Sure,” Cogan said. “But just for a minute, OK?”

  He explained that they preferred not to have people visiting with patients in the recovery room. In the morning, she’d go to the floor—she’d be put in a room where they could visit with her as much as they wanted.

  “If you could hold on a moment, I’d just like to make sure she’s settled in,” he said. “And if you have any more questions, I’ll be available during the day. The nurses will know how to track me down.”

  Cogan walked back to the OR. Posted at the entrance, just above the button for the automatic doors was a large sign that read: “AUTHORIZED PERSONNEL ONLY. PROPER OPERATING ROOM ATTIRE REQUIRED.”

  “She out yet?” he asked Julie, the desk nurse, a woman in her late thirties who was strikingly good-looking above the waist but had inherited her father’s short, stocky or—as she sometimes called them—“fugly” legs.

  “Not yet,” she said. “Here.” She handed him a mug of steaming tea. “Don’t burn yourself.”

  “Thanks.”

  He sat down in a chair next to her. As he took tiny sips of tea, he stared down at the floor. He was thinking about how much sleep he could get. If he went to sleep in fifteen minutes, after he was through with the girl’s parents, he could probably get three, maybe three and a half hours…

  “You ever been to a spa, Ted?”

  He looked up. “What?”

  “You ever been to a spa?”

  “Yeah. With my ex. She was a firm believer in paying to be pampered.”

  “You never went alone, though?”

  “No.”

  “But what if you wanted to meet someone?”

  “Would I go to a spa?”

  “Yeah.”

  He shrugged. “I think you’d be better off at Club Med.”

  “But everybody’s looking there. It’s a meat market.”

  “I’d tend to think that would increase your odds.”

  “But I don’t want to go to a place where everybody’s looking. It’s, you know—”

  “Unromantic,” he said.

  “Exactly.”

  He told her she was going to have to get over that part. The fact was that after you get married, it doesn’t matter where you met your husband. Wherever you met him was going to seem romantic. Or not, depending on how they were getting on.

  “I met my ex-wife on a chairlift, skiing at Heavenly Valley,” he said. “Not bad, right? But what does it count for now?”

  She looked at him sympathetically and nodded. “So you really don’t think a spa is the way to go?”

  He laughed. She’d already decided.

  “Sure,” he said. “Why the hell not?” Then, standing: “Hey, what’s going on in five?”

  They both looked over at the door to operating room number five. Through a small window in the door, they could see glimpses of a commotion.

  “Who’s in there?” he asked.

  “Dr. Beckler. Emergency gall bladder.”

  “Really. How’s the bug up her ass doing?”

  “Thriving, last I checked.”

  “I’m going take a closer look.”

  “Be careful.”

  Cogan took another sip of tea, set the mug down, then put his mask on and went into the operating room. There were five people in the room: surgeon Dr. Anne Beckler, a resident, an anesthesiologist, a nurse, and the patient, an extremely fat woman who was sprawled out on the table, the right side of her belly split open where Beckler had made a six-inch incision.

  “Can you hold her open or can’t you?” Beckler was shouting at the resident, who was trying to keep the hole open so Beckler could get her hand inside the patient and see what she was feeling at the same time. The resident was trying to reattach a small retractor that had slipped off a contraption called a Book-walter retractor, a steel halo that was affixed to the gurney and positioned over the patient. Several small bear-claw retractors were clipped onto the halo, their claws hooked into the tissue around the sides of the wound, pulling it back and creating a generous entrance into the body.

  In the old days, when Cogan was in medical school, the Book-walter didn’t exist. You had to hold wounds open “manually,” pulling the retractors apart yourself, which, in this instance, would have posed a particularly difficult challenge, because the patient was so fat that it would have taken the Incredible Hulk to hold her open for more than a few minutes without a rest. And the resident, Evan “DocToBe” Rosenbaum, was no Incredible Hulk. He was a skinny, five-foot-eight, twenty-nine-year-old from Long Island whose parents, the story went, had bought him a personalized license plate for his first car that read “DOCTOBE.” Rosenbaum spent all his free time playing golf, desperately trying to make up for his inadequacies as a surgeon. He was a 20-handicap surgeon but a superb golfer, a skill that impressed some of his fellow surgeons far more than anything he could have accomplished in the operating room.

  “I got it,” DocToBe Rosenbaum answered, finally getting the retractor properly attached. Cogan estimated the woman weighed close to four hundred pounds. Each flap of fat had to be a foot thick. Rosenbaum might as well have been trying to part the Red Sea, which, in this case, happened to be more white than red.

  “What do you want, Cogan?” Beckler said without looking at him.

  “Oh, I’m fine, Anne, and how are you this evening?”

  “Take the peanut gallery somewhere else. I’ve got my hands full.”

  Beckler always seemed to have her hands full. Cogan thought it was the only way she was able to function. The only problem was that in order to maintain her superiority she had to intimidate everybody into a more frazzled state than hers. The method worked well with her underlings—nurses and suck-ass residents like Rosenbaum. But it had less satisfactory results with her fellow surgeons, with whom she was forced to use more vicious tactics, the last of which was charm.

  Cogan always wondered whether he would have forgiven her behavior if she’d been better looking. Not that she was bad looking—she was tall, thin, and had nice green eyes and alabaster skin. But out of uniform she dressed badly and was decidedly unsexy, almost androgynous. Cogan thought the longer she’d been one of the boys—been part of the club of surgeons—the more her exterior, from her mannerisms to her language, had become male. But on the inside she was still fiercely female or, at least, a fierce defender of feminist principles. And in that sense, Cogan, the Harvard man and an old boy if ever there was an old boy, represented to her all that was evil.

  He, of course, disagreed with her assessment.

  “What’s going on?” he asked.

  “Dammit,” Beckler said, ignoring him, “get the light in here. Are you sure she hasn’t had it out already?”

  “I checked, Doctor,” the anesthesiologist said. “It’s not on her chart.”

  “Check it again. She’s got scars all over the fucking place.”

  Cogan took the patient’s chart from the anesthesiologist and looked at it. He could see why Beckler was concerned. The woman already had four scars on her belly from previous operations. Two were from C-sections, one was an appendix, and the other could have been from any number of other procedures.

  “What’s the problem, Anne?” he asked.

  “Let me see her chart,” said Beckler.

  He held up the chart. “There’s nothing here about a gall bladder being removed.”

  “Shit.”

  “She can’t find it, can she?” Cogan whispered to the nurse.

  “No,” the nurse whispered back, “she can’t.”

  “Anne, why don’t you get a laproscope in there,” he said.

  “I wouldn’t need a camera if Rosenbaum wasn’t such a lightweight.”

  “Well, Rosenbaum is a lightweight. And I’m not scrubbing in. So you better get a scope in there.”

  She shot him a piercing glance. Then she looked at the others, who were all waiting for her to respond. She was cornered and she knew it.

  “O
K,” she said after a moment, “let’s do it. Get her on TV.”

  Usually, the camera, which looked liked a stainless steel wand, was used for laproscopic surgery, which was much less invasive than open surgery. Four small holes were cut into the belly. In one went the camera wand, and in the others, the surgical instruments. The surgeon could do the whole operation looking at a television screen and the patient would, in theory, be out of the hospital in two days instead of five.

  “To the left,” Beckler said.

  They all looked at the television screen. Rosenbaum was maneuvering the wand into position under the liver, where the gall bladder was supposed to be. He moved the camera around the area, once, twice, then a third time. Cogan didn’t see the gall bladder. But if the chart said it was there, it had to be there. And then he saw it.

  “There,” he said pointing.

  “Where?” Beckler asked.

  “On the liver.”

  Rosenbaum moved the camera to where he was pointing and pushed the liver to one side, flipping it up a little. And there, indeed, it was. A brown, pathetic-looking mass attached to the liver.

  “Wow, look at that,” Rosenbaum said. “It’s literally fused to the liver.”

  “Disgusting,” said Beckler.

  Cogan smiled—a smile no one could see through his mask. But the pleasure showed in his eyes.

  “Well, this surgeon’s got an appointment with his bed. It’s been fascinating as always. Goodnight, all.”

  “’Night, Ted,” the nurse said.

  “Goodnight, Anne.”

  Beckler didn’t answer him. “Kelly, clamp, please,” she said to the nurse.

  He thought of saying goodnight to her again, but then thought better of it. He’d had enough fun with her for one evening. And she was definitely not amused.

  4/ DOMESTIC DISPUTE

  March 31, 2007—4:38 p.m.

  THE HOME IS JUST OFF MIDDLEFIELD ROAD, IN A DEVELOPMENT called Vintage Oaks, a gated community in Menlo Park a few blocks from Menlo-Atherton High School. Madden knows the place well. The land it’s on isn’t exactly sacred, but in the early 1990s some residents predictably accused nearby St. Patrick’s Seminary, which once owned the property, of making a “deal with the devil” when it sold forty-two acres of vacant land to Vintage Oaks’ developers for $22 million to escape financial crisis.