Cutter's Trial

by Allen Wyler

  “Anything else? Long as I’m taking a break, might as well grab a cup of coffee. Want one?”

  “No thanks.” His was stomach now too upset for caffeine, or anything else for that matter. Had to be Geoff. Just fucking had to be. Waters’s secretary had given Alex a carbon copy of his letter. Same with Jack Harris—the chief resident Alex’s first year—now practicing in Portland. Of the four supporting letters, three were verified. Unless, of course, something else had gone wrong. What that could be, he had no idea.

  Blowing another slow breath, he shut the door again and tried to relax sufficiently to make a phone call. A moment later, he dialed AANS headquarters in Chicago.

  “May I help you?”

  Alex stared out the window, the outside coat of grime more noticeable than usual. “I’d like to speak to the secretary in charge of membership, please.”

  “One moment, I’ll transfer.”

  Muzak.

  “Membership, Maureen speaking.”

  “Hello. My name’s Alex Cutter. Six weeks ago I applied for membership. Today I saw the latest bulletin and noticed my name isn’t listed. Is this a mistake or did something happen to my application?”

  She answered without hesitation. “No, Doctor Cutter, there is no mistake. Your application wasn’t forwarded to the membership committee because it wasn’t complete.”

  Not complete? The words reverberated through his mind like a tuning fork. Geoff. Had to be.

  “I’m not sure I understand. I submitted everything along with four letters of support. What was incomplete?”

  “That’s the problem. Not all your letters were received.”

  “Oh?” He knew, but just had to ask. “Which one is missing?”

  “Dr. Ogden’s.”

  “Excuse me, I don’t want to sound difficult, but why wasn’t I notified?”

  “Dr. Cutter, there can be any number of reasons a member might not endorse a candidate. I’m sure you understand. It’s for this reason we prefer to not notify the applicant. We did, however, send Dr. Ogden two reminders, both stressing how vital his letter was for your application. We never received a reply.”

  “What do I do now? Is there any way to keep my application active until I can arrange for another letter of recommendation?”

  “I can certainly do that, but you realize, of course, your application will not be reconsidered until the membership committee reconvenes in six months.”

  Six months.

  Alex slumped in his chair, trying to mask heavy disappointment from his voice. “I understand. That would be wonderful if you would do that. I’ll have another letter in your office within two weeks. Thank you.”

  “Anything else I can help you with?”

  You’ve got to be kidding! “No, thanks. You’ve been very helpful.”

  Alex fought the urge to throw the goddamn phone against the wall, gently dropping it into the cradle instead. Think. What had he done to provoke sabotage from Geoff? Perhaps this was all a mistake, and it wasn’t his fault. Yet, an instinct hovering just below the brink of consciousness knew Geoff had intentionally torpedoed him. Why?

  Alex stood in Geoff’s open office doorway. “You busy?”

  Geoff glanced up from his typically cluttered desk in the center of his typically cluttered office; books, journals, and unfiled papers were stacked to the point of tumbling over, filling every available horizontal surface. Alex wondered yet again how the hell he found anything. Amazingly, Geoff always seemed able to pull the rabbit from the hat. Might take a few minutes, or even days, but he apparently had the key to this random access filing system solidly embedded in his memory. Geoff slowly removed his glasses and pinched the bridge of his nose. He blinked. “Yes?”

  Alex closed the door for privacy. “Remember I asked if you’d write a letter to the AANS supporting me?”

  Out came the coins. Geoff eyed his hand, busily organizing them. “Yes.”

  Aw man, guilty! “You agreed to write it.”

  “Yes.”

  “But you didn’t.”

  Geoff glanced out the window. “I’ve been too busy.”

  The words enraged Alex. Five minutes. Tops. Insert dictation belt, press button, dictate letter, hand belt to secretary. Done. Five fucking minutes was generous.

  “Then why didn’t you tell me that in the first place? Why didn’t you just say, ‘I don’t have time’?”

  With a snarky smile Geoff finally looked up. “I’m very busy, Dr. Cutter. In addition to my departmental commitments, I serve on several AANS committees. And, I might add, I serve on the editorial board of Neurosurgery. This all takes time. You need to realize this.”

  Alex wanted to scream. “But you knew all that when you agreed to write the letter.”

  Geoff returned to sorting the coins. “I suppose so.”

  “You fucking suppose so?” Alex stopped. No sense rehashing what had already been said.

  Face puckered like a prune, Geoff dumped the coins back into his pocket and picked up his pen. “If we’re done with this conversation, I need to get back to work.”

  Livid, Alex fought the urge to sweep a few stacks of papers and journals off the desk. Don’t be juvenile. Geoff continued to ignore him.

  Fuming, Alex sat in his office with the door closed, staring out the window, no longer aware of the grime coating the outside. He was trying to quell his anger but couldn’t get his mind off of Ogden. Why? What have I ever done to him?

  He noticed the unopened letter on his desk from NIH. With trembling fingers, he opened it:

  GRANT: INVESTIGATION OF STEM CELLS IN CNS NEOPLASIA

  PI: ALEX CUTTER, MD

  PRIORITY SCORE: 250

  FUNDING CUT OFF: 200

  Better score than last time, but still not good enough to be funded. The lower the score, the higher the priority. Just fucking perfect! There anything else that can make this day worse?

  A knock on the door.

  “Yes?”

  Rip’s muffled voice came through the door. “Dr. Cutter, clinic just called. You have patients waiting.”

  Slowly, Alex pushed out of the chair, shrugged on his white coat, and trudged from his office. This time the hallway walls appeared dinged and scarred, the scuffed linoleum in need of buffing.

  10

  “I’m in the kitchen,” Lisa called out as he came through the front door. Alex paused for a moment, then hung his coat in the hall closet before heading to the kitchen where he found Lisa reading Vanity Fair.

  She glanced at him, did a double take. “Uh-oh, bad day?”

  “Really bad.” He pulled two glasses from the cupboard and started to open a bottle of cabernet as he told her first about the Geoff Ogden brouhaha, then about his grant’s priority score.

  When he finished, she said, “Oh Alex, I’m sorry. What do you do now?”

  He explained to her that the AANS agreed to keep his application active and that he’d already arranged for another letter of recommendation. And as far as his research went, he would submit a revised grant application taking into account the criticisms of the study section. Starting tomorrow, he planned to devote evenings and weekends to the revision so it could be submitted in time for the next review cycle. The longer his lab went unfunded, the more tenuous his departmental funding would be, especially if there was any chance that Geoff Ogden might become the new chair.

  She didn’t seem pleased with the plan. “Guess that means instead of working nights in your lab, you’ll be working on the grant.”

  He nodded. “Well, at least I can do some of this at home, but this is the treadmill that comes from trying to support yourself on grant money. Half the time you’re doing your research and the other half you’re scrambling for funding. One day, if I keep at it and get funded, I’ll be able to apply for a five-year grant instead of just two.”

  “Always the optimist. But that’s assuming you get funded to begin with.”

  “Well, there’s that too.”

  They sat in sil
ence for a while until Lisa spoke up. “This Ogden thing. Why would he do something like that?”

  Good question. “I have no idea.” Alex shook his head in dismay. “It’s not like he’s so busy he can’t find two minutes to dictate a damn letter.”

  Lisa paused. “Maybe you should’ve gone elsewhere. Maybe you’re not taken seriously here because you were their resident.”

  He rubbed the back of his neck, trying to loosen up the muscles so tightly knotted. “You know how many times I’ve thought about that, but you know what? Everyone except Baxter trained here, and look where they are: full professors, every last one of them.”

  “Yes, but if you think about it, only Baxter has a real research program going.”

  “Good point, but that doesn’t change my funding predicament. I just have to buckle down and work harder. I’ve even thought about going back for a PhD. That way I could do research full time. Trouble is, we haven’t even paid off my students loans yet. We’d be back to where we’re accumulating debt again, and I’m getting too old to not be solvent.”

  “You really serious about being a full-time lab rat? Somehow I can’t see you giving up medicine for research no matter how much you think you might want it.”

  “I know. Besides, going the research route is just too daunting. I’d have to secure a postdoc position somewhere, meaning I wouldn’t be able to do my own work for years. I can’t see losing all the time it would require, especially now that I believe I’m really onto something with the stem cells. I can’t give that up now. It all boils down to not really having a choice.”

  He could see something else was bothering her, something she hadn’t yet mentioned, and it triggered a pang of guilt for being so self-absorbed that he missed it until just now. “Something wrong?”

  She poured them both more wine. “More bad news. Mom.”

  “Why? What’s going on?”

  She paused to sip. “I have to fly back to Lincoln.”

  Uh-oh. “Why, what happened?”

  Lisa folded her hands in her lap, an unconscious habit when giving bad news. “She’s really going down hill rapidly. Laura says she might not last two weeks.”

  Aw shit. He reached across the table, offering his hand to her. “Well then, fly back. I’ll call the airlines now and make a reservation. You can fly out tomorrow. Take as long as you need.”

  She didn’t take the offered hand. “I don’t think I can get the time off work again.”

  “Sure you can. What can they say? It’s your mom we’re talking about. They’ll understand. This is important.”

  Alex could see the tension pulling at the corners of her eyes. “I took ten days off last month to fly back. I’m worried they’ll fire me if I take any more time off.”

  “Hey, let them. You could get another job in a blink, especially with your background. The point is, family is more important than work. Laura needs support and you need to see Mom. There’s no other option. Ted will understand; he’ll give you the time off. There, it’s settled: I’ll call United and book a ticket for day after tomorrow.”

  11

  Every Monday afternoon three hours were devoted to teaching conferences. It started with the 2 p.m. Radiology session and was followed by Morbidity and Mortality, in which complications and deaths throughout the preceding week were discussed in detail. In addition, all scheduled elective surgeries for the week were reviewed, emphasizing the indications for each. This last conference usually dragged on for as long as the professors wished to pontificate, confining their serfs to soporific CO2 levels as the evening’s scut work continued to pile up, making it impossible for an off-call resident to head home at a reasonable hour. For the on-call residents who had to drive back across town to the trauma center, their workday would not end until late evening, if at all.

  At the Radiology conference, residents and professors sat in rows of five metal folding chairs, the faculty in the front with the residents behind, allowing them to step out of the room to answer frequent pages. The room’s only light emanated from the X-ray panels, casting eerie shadows that sometimes gave the presenting resident a Bela Lugosi flair.

  Neuroradiology professor Larry Harris slid a CT scan onto the multi-panel screen and asked the group, “Can anyone tell me what this is?”

  Without really thinking—for the picture, strange as it appeared, could logically only be one thing—Alex blurted, “A vein of Galen aneurysm in an infant.”

  Dead silence. Harris seemed shocked at the answer. After a few beats, he asked, “What made you pull that one out of your hat?”

  Alex had to stop, back up, and think about his shoot-from-the-hip conclusion. “Well, the shape and thickness of the skull along with the open sutures make the patient an infant, probably a newborn.” He went into detail, as the point of the conferences was to provide in-depth explanations to teach residents logical clinical associations. “The abnormality is located in the midline, exactly where the venous sinus are. This lesion is large and contrast enhances, which indicates it’s filled with blood. The smooth, linear, discrete borders and the enlargement at confluence support it being a vascular structure. Lastly, the mesial edge is perfectly straight, suggesting it abuts the Falx”—the membrane that separated the two hemispheres. “Keeping those things in mind, the only reasonable diagnosis would be a vein of Galen aneurysm.” Then again, he realized, it could be something really off-the-wall weird, like a bizarre vascular tumor. But he seriously doubted that.

  Harris nodded approval. “Very good, Dr. Cutter. Impressive. Especially since this is the first one I’ve seen on CT.” The professor pointed to a first-year radiology resident. “Hansen, what’s the prognosis?”

  Hansen’s horrified face blanked. “Uh, don’t know, sir.”

  Harris turned to the pediatric neurosurgeon. “John?”

  John Luciano, a boisterous surgeon from the Bronx, boomed out in his New York accent, “Typically these kiddos die of heart failure before anything can be done. But commonly nothing can be done because there’s no known way to effectively treat them.”

  Harris replaced that image with two views of a different skull. “McGinnis, what’s this X-ray show?”

  And so it went.

  12

  “Have a seat, Dr. Cutter,” offered the assistant dean.

  Alex chose the chair at the end of the small, glossy mahogany conference table, the room insufferably stuffy, the warm air spiced with the bitter smell of coffee that surely had been on the hot plate way too long. Four professors, two with their white shirtsleeves rolled up and ties loosened, lab coats draped haphazardly over the backs of their chairs, stared at Alex as if he was the star witness in a murder trial. The one female, a biophysicist with gray hair and big glasses, was the one Alex was least familiar with.

  “Thank you for taking time from your schedule to discuss this important matter of Dr. Waters’s replacement. Would you like some coffee, a glass of water?”

  He would’ve loved some coffee, but this stuff smelled like toxic waste, the sheen on the surface making it even scarier. He envisioned the fluid eating through the Pyrex pot and then continuing on through the floor. “No thanks, I’m good.”

  “Well then,” said the spokesperson, “let’s get on with it. Please tell us the strengths and weaknesses of the department.” Three of the interviewers sat back almost in unison, pens readied over notepads.

  Alex cleared his throat. “The department’s overwhelming strength is a strong culture of academics. By this I mean Dr. Waters provided us with a clear departmental mission. That has been to teach and conduct impeccably honest research. It’s very much the same as the NIH’s program to produce teacher investigators.” He paused, marveling at his off-the-cuff pithy summation of a complex dynamic. “The only weakness—if it can be considered one—is, unlike other departments, our emphasis is on quality research instead of high patient throughput.”

  The chair of the committee nodded sagely. “I’d like to explore that particular issue
a bit, if I may. If the goal of a department is to train neurosurgeons, isn’t a high clinical volume desirable?”

  Certainly a loaded question, Alex thought as he paused to consider his answer. “True, but only if the mission of the residency is to produce cutting neurosurgeons. Although the country does need neurosurgeons, it also needs teacher-scientists if we are to have any hope of advancing the art. This rare species can only come from a department devoted to producing academic clinicians.” He felt passion moving his words in much the same way as a senator delivering a campaign speech. “We produce tomorrow’s leaders. Competent clinicians who, in addition to practicing medicine, have the investigatory skills necessary to raise our art to the next level. Enough residencies already exist to turn out a steady supply of surgeons, but only a handful produce true academicians.” He felt as if Waters was patting him on the shoulder saying, “Atta boy!”

  “Very admirable, Dr. Cutter,” interjected the biophysicist. Alex thought her name was Linda Lehman—or something close to that—but wasn’t sure, and he couldn’t read her name tag. “But the hard reality of this day and age is that particular idealistic philosophy had merit years ago when the feds had enough money to pour funding into biomedical research. Recently, and in the foreseeable future, Congress’s health funding has stayed constant, which means that after factoring in inflation, the money allocated for research is actually shrinking. Bottom line is that medical schools—especially state schools like ours—find themselves in a deficit. Which means that clinical departments, like yours, must generate the dollars needed to keep the school afloat. We can’t, and shouldn’t, rely so heavily on grants and contracts that can dry up faster than the Mohave Desert. Or do you have another opinion on how to solve such fiscal problems?”