by LaGreca, Gen
“I won’t back down, Nicole. I won’t let anything or anyone stop me. You have my solemn promise.”
* * * * *
The corridor and nurse’s station outside of Nicole’s room were abandoned that evening. David walked along the lonely halls in the eerie silence, wondering where the staff had gone. He encountered them in a small room, hovering around a copy machine, whispering nervously as they grabbed sheets of a document being printed.
“What’s going on?” he asked.
“Have you seen the new statement of policy?” a nurse replied.
“The what?”
“The new crack-down by CareFree. Copies are being sent to everybody. Here, take this one.”
The document that David read was titled “A Statement of Policy for All Clinical Personnel from the Director of Medicine of Riverview Hospital.”
You are hereby notified that CareFree aims to eliminate all violations of its policies and to achieve full compliance. As you know, Riverview Hospital is committed to following the regulations to the letter of the law. If circumstances have allowed exceptions in the past, you are hereby forewarned that there must be strict adherence starting immediately. This statement of policy summarizes the steps that you need to take in order to ensure your total compliance with the CareFree program. We expect your utmost cooperation.
David skipped past other information to a paragraph titled “Surgeons.”
Surgeons must obtain prior written authorization from CareFree before performing any operation. The doctor must submit diagnostic test results and patient records to the hospital’s Surgical Authorization Committee (SAC), which will relay the case to CareFree’s Surgical Advisory Department (SAD) to determine if the procedure is necessary. Then SAD will advise SAC of its decision. If SAD is closed, then SAC, staffed twenty-four hours a day, will determine for the physician whether the surgery should be performed.
The last sentence of the order was capitalized:
Under no circumstances will an operating room be assigned to a surgeon who has not obtained prior written permission to perform the procedure from SAD or SAC.
No one noticed that the serene look of radiant purpose, an afterglow from his moments with Nicole, had vanished from David Lang’s face.
Chapter 12
The Treatment
A pair of white swinging doors sliced the third floor of Riverview Hospital. No Admittance was stenciled across them in bold black letters. Beyond the doors was the Department of Surgery. Before them stood a small, circular stand resembling a guard’s post. David approached the high-countered station, which was manned by a petite nurse in blue scrubs, her hair tucked in a surgical cap, her eyes large in her hairless face. Among the duties of those staffing “the desk,” as the post was known, was assigning operating rooms to surgeons.
“MaryAnn, I need a neurosurgical suite for an emergency case I’m bringing up.”
“Do you have a procedure code?”
“I have an injured patient.”
“Does the patient have an employee certificate, a student voucher, a senior citizen card, or a handicapped number?”
“She has a head trauma.”
“But how did she get here, Dr. Lang? Did she join a worker’s cooperative? Is she an unwed mother? Did she register at a CareFree district office?”
“She fell from a stage.”
“Does the patient need a regular case number or a supplemental rider?”
“She needs surgery.”
“You need to show me written authorization.”
“I need to operate.”
“Someone has to allow you to operate. Did you get permission from CareFree’s Surgical Advisory Department or from the hospital’s Surgical Authorization Committee?”
“I got permission from the patient.”
“Dr. Lang, I need notice that the procedure is necessary.”
“I give you notice; it’s necessary.”
“I need authorization from SAD or SAC.”
“MaryAnn, how many times have we gone through this? You advise me of what I have to do, and I advise you that I have been so advised. You did your job. Now, I must have a room!”
“How can you ask on today of all days?”
“How can you refuse on this case of all cases?”
“Have you carefully examined the new statement of policy?”
“I carefully examined the patient.”
“I’m sorry, Doctor.”
He leaned wearily on the counter and placed his hands over her forearm, his voice pleading, his eyes desperate.
“MaryAnn, I’ll take full responsibility. You won’t get in trouble. Haven’t I always protected you? And I’ll never ask again. Just this one last time. It would be so helpful if I didn’t have to go to . . . anyone else.”
“Doctor, I can’t, so please don’t ask!”
“MaryAnn, it’s a little silly, isn’t it, that I should have to plead with you, the clerks, the secretaries, and the man in the moon every time I have to work? This case is such a small thing for the hospital. We do thousands of operations. How many bullets have I pulled out of the skulls of thugs, robbers, and murderers? And how many of them have cursed me for saving their rotten lives? MaryAnn, if you only knew how happy someone would be if I did this one surgery, someone who wants so much to live. Isn’t it right that she should have a chance, too?”
MaryAnn fidgeted. “I don’t know what’s right or wrong anymore. I just follow the rules.”
“If you could save someone from a life of misery by doing one small thing, isn’t that what we’re here for? Wouldn’t that make you happy?”
“Nothing makes me happy! I’m getting to hate this job! I’m sorry, Dr. Lang, but I can’t give you a room without authorization. Not anymore.”
He released his hands from her forearm, surprised to see the red marks that they left. He rubbed the arm as if to erase the hurt that he had caused, then he grabbed the phone on the counter. His hand hesitated on the headpiece for a long moment before he lifted it and dialed.
“Randall Lang,” said a voice through the wires.
“Randy, I . . . have to speak to you.”
“What’s wrong, pal?”
“I have a problem.”
“What is it?”
“Can you come to Surgery? I’m at the desk.”
“I’m on my way.”
Randy soon sprang from the elevator, his shirtsleeves rolled, his jacket left behind in his haste. “What’s up, David?”
“I have a trauma case from the explosion this afternoon. The optic nerves are completely severed, resulting in permanent, total blindness. The patient is a perfect candidate for nerve regeneration—”
“I hope you’re not thinking the unthinkable—”
“I called CareFree to explain the situation, and . . . and . . .”
“And?”
David was rendered speechless by eyes looking into his with unconditional trust. But he could still hear Nicole screaming that she wanted to die.
“I got permission to try the surgery.”
“From whom?”
“From the secretary of medicine.”
“You called him?” Randy asked incredulously.
“Yes.”
“And how did he react to hearing from you?”
“We had a nice chat.”
“And you asked him if you could try your new surgery?”
“That’s right.”
“And he said yes?”
“He did.”
“You mean he didn’t tell you to wait until all the infected hangnails were cured? He didn’t lecture you on how his hands are too clean to pull any strings? He didn’t give you a song and dance about the public interest?”
“He said my surgery was in the public interest.”
Randy laughed with an exuberance that blew David back to a time when that hearty sound was as much a part of his day as the sunrise. He realized how much he had missed the joy that had vanished from his brothe
r’s voice in recent years.
“You mean it was that simple, David? You asked our Great Civic Leader, and he said yes?”
“That’s right.”
“Well, I’ll be damned! Congratulations, pal!” Randy raised his arms to embrace his brother, but David stepped back.
“I . . . uh . . . called him after his staff had left for the day. He gave me his consent verbally and said he’d send written approval in the morning.” He gestured to MaryAnn at the counter. “If you could—”
“Of course. No problem. You’ll have the operating room and the surgical staff you need.”
“And I want no interruptions. No press, no cameras, no audience. Don’t tell anyone what I’m doing until tomorrow morning. No one must know!”
“Of course.”
“And don’t tell Marie!”
“Whatever you say.”
Randy’s beaming face seemed ready to agree to anything.
“David, I never dreamed that tomorrow I would not only be announcing your appointment as chief of neurosurgery”—Randy was too excited to notice David’s head turn away—“but also this historic experiment for medicine and for you!”
“Yeah, well, I really need to get ready—”
“Tomorrow you’ll be a hero, brother! And I’ll be one, too, because I backed you. After you left the board meeting today, I told those zombies that I would stake my reputation on you, that you would bring honor to Riverview Hospital, that you would become a medical legend—”
“Stop it! Please!”
Randy threw his sandy blond head back and laughed. “Don’t look so grim. You’ll need to get used to compliments. And me, too! My salary is up for review this month. I suppose I’ll have to accept a fat raise. It’ll come in handy with Michelle’s tuition, Victoria’s ice skating competition, and Stephen’s piano training. Just wait till I tell my kids that their uncle’s talent has made their father look good and given their futures a boost.” He was talking to a bent head and closed eyes. He threw his arm around David’s shoulders. “What’s the matter, brother? You look so pale and . . . upset.”
“I’ve got to go,” David whispered, his eyes fixed to the ground.
“Of course! Leave the desk to me. Go and do what only you can do.”
David’s eyes seemed like two lead weights that he could barely raise to meet Randy’s trusting gaze. “I can’t refuse! Not for anything or anyone. Not even for you!”
The exit door creaked as David disappeared down the stairwell, escaping Randy’s curious gaze.
* * * * *
When he entered OR 6 at 7:30 that evening, the only visible features on David Lang’s face were his eyes, two green lasers between a cap and mask. His blue scrubs outlined the broad shoulders, long legs, and trim waist of a body poised for action. When the three members of his OR team had assembled, he announced loudly that he had obtained permission from the BOM to perform a new procedure. By the formality of his statement, he intended to leave no doubt that he had lied to the others; therefore, they could not be held responsible for his action. The only other person whom David had involved, a surgeon to set Nicole’s broken nose, would not arrive until the next morning, after the neurosurgery was completed.
Attempting to second-guess the people wielding power over him and his patient had wracked his body with anxiety. Now that the arrangements were made and he felt certain that he could protect the others in the room from punishment for his deed, he wanted only to focus on the task ahead. The tension inside him was like an alien creature needing to be curbed before he could enter the shrine that was Nicole’s brain.
He clipped the patient’s brain scans to the view box on the wall. As he examined the films, the stress began draining from his body, as if the OR possessed the power to heal him, too. From a distance, his casual pose, with arms crossed and weight shifted to one leg, suggested someone waiting for a bus to the country. However, a closer look revealed that his eyes were riveted to the images with an unusual intensity. He soon forgot the people around him, the room, and the world, his thoughts buried in the scans. He calculated precisely where he would cut the skull and how he would reach the nerves. He mentally rehearsed how he would reattach the severed nerve ends and implant the capsules of the new drug that he had brought with him to the OR, the embryonic growth protein. He postulated the things that could go wrong in the minefield of tissue and how he would respond to each unexpected situation.
He noted the largest blood vessel of the brain, the carotid artery, alongside the optic nerves at the site of the lesions. The spot where he had to work touched the route of this major artery that brought blood to the brain. It was a vessel that he would have to avoid at every moment in the hours ahead. To slip just once and nick that artery could swallow his work field in a sea of red for an unspeakable few minutes, ending in total, final stillness. He studied the path of the giant snakelike artery curling through Nicole’s brain, dwarfing all other vessels to the size of worms. He ordered himself not to permit a moment’s lapse in which he would lose sight of that artery, regardless of how tired he became. Then he mentally rehearsed what he would do if the unthinkable occurred.
Behind him, a nurse arranged sterile trays of shiny tools, including scalpels, scissors, tweezers, hooks, and clamps. Some devices seemed gross enough to cut concrete, whereas others seemed delicate enough to split hairs. A large microscope covered with sterile plastic waited in the corner for its cue to go onstage. The anesthesiologist placed potions on her cart, checked the equipment for monitoring the patient’s vital signs, and readied the respirator. Instrument panels, foot pedals, gas lines, and suction devices were placed under huge overhead lights. The room was a setting of metal and plastic, with all props positioned around one central item—the narrow operating table. David rubbed his hands to ease the remaining tension in preparation for the tall task and sleepless night ahead.
* * * * *
Nicole Hudson could tell when her gurney reached an intersection in the hallway by the sudden breeze across her face. An attendant explained that he was wheeling her to the operating room. She thought it odd to be driven by someone else’s power during the worst crisis of her life. Her reaction to adversity had always been to find a solution and to act, as if life were synonymous with an abiding effort to sustain it.
As the wheels of Nicole’s gurney clattered in the dark hall of her awareness, she heard the sound of clapping in a dimmed theater long ago. She was six years old and attending her first ballet. She sat in the balcony with a group of children from St. Jude’s Parish, their tickets the gift of a church benefactor.
The curtain rose on a gathering outside a palace. Fairies in bright costumes of transparent lace danced gaily through a garden. Smiling children swung baskets of just-picked flowers. The stage was a watercolor meadow, lovingly brushed with pastel pinks and powder blues. The child in the balcony stared in amazement at the enchanted garden. Unlike the parks she knew, this one contained no garbage, no beer cans, and no bums, only beautiful people dancing happily to music as sweet as the flowers.
A lively puff of white crinoline fluttered onto the stage. It was the dainty creature who was the guest of honor at the gathering—the princess of the palace. The people had come to celebrate her sixteenth birthday! The princess knew her real birth date, and it was such a special day that the villagers threw a party. The slender princess wore an ivory gown sprinkled with pearls that shimmered as she pirouetted. Nicole looked down at her own threadbare dungarees, wondering what it would feel like to wear a garment new to her—a dress, and one that sparkled.
The lighthearted strings in the orchestra gave way to percussion, sounding a new and frightening theme. A wicked witch entering the scene cast an evil spell on the princess. The king and queen rushed to aid their ailing daughter. Remarkably, the princess saw both of her parents at the same time! As the curse took effect, the princess fainted. She was caught by the caring arms of her mother. The little girl in the balcony was confused; she thought tha
t it was the mother who fainted and the child who did the catching.
The princess fell into a deep sleep from the witch’s curse. Concerned for her safety, the townspeople carried the maiden to the most remarkable bed—one that had a roof! A curtain of rich tapestry hung from the roof, so that the princess could play in her bed without anyone else watching. The thin form of her sleeping body made a small imprint on the sheet. Nicole had not minded her serape and meager accommodation in the hallway—until she saw the cozy bed that was a little house.
A forest grew around the palace as a hundred years passed. The princess still slept under the evil spell. Just when Nicole had lost hope of her being rescued, the orchestra played its most powerful music. A handsome prince dressed in white leaped onto the stage. He towered over the evil witch, turning faster and jumping higher, until he banished the wicked presence from the stage with his lively dancing.
The prince broke the evil spell and awakened the princess with . . . a kiss! He had no knives or fists to fling, just his courage and his kiss. The ballet ended with the prince and princess dancing. But dancing seemed too mild a word to explain the serene tangle of graceful leaps and tender caresses reflected in Nicole’s unblinking eyes.
The child had no words to describe the prince; she only knew what he was not. The prince was not dirty, not stinking, not stumbling, not breaking things, not cursing, not hitting the princess. He performed none of the frightening acts of her mother’s companions. The prince belonged to a world that she could not yet name, a world that she knew only by its immense grip on her.
After the music stopped, the child felt as if she, too, were waking from a magic spell. She was surprised to see the seats around her empty and the children from the parish lined up in the aisle. “Come on, little one, come on!” Sister Luke, their chaperone, was calling to her. The child finally rose to leave the theater, but she knew that she would return. That was the day that Nicole decided to become a dancer.
When she was a teenager, she played the role of the sleeping princess. She recalled the audience clapping enthusiastically as she took her bows. It was then that she discovered the words eluding her as a child, the words to describe the meaning of the ballet. As the audience clapped, Nicole realized that the dance of the prince and princess was a supreme celebration of themselves and of a world of beauty, joy, and goodness.