Cutter's Trial

by Allen Wyler

  This was a hot button for many of the clinicians. “In other words,” Alex answered, “it’s the job of the surgical departments—and not tax dollars—to support the overhead and salaries of non-revenue-generating departments in a state medical school?”

  She smiled. “Bluntly speaking, yes.”

  Alex felt his muscles tense. At the moment, an argument would be counterproductive. “It all comes down to one thing: if the state wants a medical school, tax dollars should fund it, not the surgeons whose primary job is to train more doctors and to do research.”

  “Yes, but we’re getting off into the weeds with this discussion,” the chair broke in. “I’d prefer you address the initial question: If the primary goal of a medical school is to train physicians and surgeons, isn’t it in our best interests to do just that?”

  The biophysicist held up her hand to indicate she wasn’t finished. “If your department is primarily concerned with research, how can you possibly expose your residents to enough clinical material to produce competent graduates?”

  Alex saw his position rapidly eroding. Clearly, the committee had decided where to focus their search, and it was toward a strong clinician. They were now simply going through the motions of asking for the input of the current faculty. “With the exception of some very tricky surgeries—aneurysms or AVMs for example—neurosurgery is, to be blunt, quite rote. It’s piecework. How many subdural hematomas does a resident need to remove before being competent at that? Ten? Fifty? A hundred? Speaking strictly for me, my fifteenth didn’t teach me anything more than did my tenth. On the other hand, learning to design a research protocol has taught me a lot about critical thinking. I submit that critical thinking benefits a neurosurgeon more than does purely manual skills.” He knew his argument fell on deaf ears, but felt compelled to give it anyway.

  The one to the chair’s right, an older professor Alex recognized as a thoracic surgeon, said, “I don’t agree with you, Alex. Things happen on the wards and in the operating room, sometimes strange things, and they always seem to pop up at the damndest times. Having to deal with them and get the patient through unscathed provides a richness of clinical experience that simply can’t be taught from a textbook or lecture. We learn from doing and observing. Seeing an attending handle tricky, sometimes novel, situations that arise when least expected is an invaluable learning experience. Or do you disagree?” The older man’s bushy eyebrows rose, accentuating the question.

  Another loaded question, one he’d be a fool to disagree with. Alex nodded. “You have a good point.” He wanted to circle back to his original argument but knew it’d be beating a moribund horse. If there was one thing Waters had instilled in him, it was intellectual honesty. That was the most important facet of Waters’s training program. He hated the thought of a hard-driving clinician destroying such an important aspect of the established culture.

  “As much as I find this conversation stimulating,” the chair said, “we’re held hostage to our schedule. Sadly I must move this interview along. Are there any members of the present faculty you believe to be a suitable replacement for Doctor Waters?”

  He thought of Ogden’s desire to take command. “No, sir.”

  “Is there anyone on the present faculty you would not want to see become the new chair?”

  Thank you, Jesus! “Yes, sir. Doctor Ogden.”

  The chairman’s eyebrows arched again. “Oh? Why is this?”

  “A chairman needs to be the strongest team player on the faculty. If he isn’t, he won’t get the best performance from the others. Doctor Ogden is not a team player.” He believed this to be true.

  One of the committee members began tapping a pen on his notepad. “Isn’t Dr. Ogden well respected in national neurosurgery circles?”

  “Yes, but only because his older brother—who’s very well connected—has promoted him.” Alex doubted his words would make much difference, but you never knew,…

  “There any outside candidate you’d recommend?” the chair asked.

  “I haven’t really given it much thought.” True. “Sorry, I guess that doesn’t reflect well on my preparedness for this meeting, but I’m still having a hard time wrapping my head around the idea of Dr. Waters not being chairman.”

  The hematologist asked, “How about you? Are you looking for the job?”

  Alex chuckled. “No way.”

  The chair nodded sagely. “How about Richard Weiner; do you know him?”

  “Dick?” he said, surprised. He considered that a moment. Young, aggressive, a surgeon who also ran a research project. In fact, very similar research to his own. “Yeah, sure, I know him. We share the same research interests.”

  “Your thoughts about Dr. Weiner?”

  Alex’s immediate thought was Dick was too junior to handle the tenured full professors in the department. It would certainly be a struggle, especially to deal with Baxter and Ogden. “He’s only marginally more senior than I.”

  “Yes, but would he be a good replacement?”

  “I don’t have any firsthand experience with his administrative capabilities. I guess I’ll have to pass on that.” A foreboding morphed in Alex’s gut. Clearly, the committee was considering Weiner a hot contender. And if he got the job …

  Couldn’t possibly happen. Dick’s way too junior.

  Right?

  “Thank you for your time, Dr. Cutter.”

  13

  “What things do you think can be improved within the department?” Dick Weiner asked Alex, the two of them sitting across from each other at a noisy downtown restaurant frequented by business people catching a quick but elegant lunch. Weiner, a short, plump, prematurely bald man with a ski-slope nose and thick fingers, had been pumping Alex for inside department information for the last ninety minutes, making Alex feel awkward and a bit like Benedict Arnold.

  “I don’t want to see things changed,” Alex replied.

  “Oh, c’mon.” Weiner waved his palm in a “no, no, no” gesture. “I’ve seen the numbers. Because you cover the trauma center, you’re the single biggest earner in the group. In spite of that, you’re taking home the smallest paycheck, just about a fourth of what Baxter pulls down. How you feel about that?”

  Easy answer. “I’m not doing this for the money. If I were, I’d be in private practice with a friend in Boise.”

  Weiner sipped his ice tea. “Wow, sounds like you’ve got something against private practice.”

  Alex shifted on the seat cushion, partly because he’d been sitting in one place for ninety minutes, partly because Weiner kept trying to pry personal information from him. He didn’t like it. “Private practice is okay,” he said. “It’s just not for me. I love my research.”

  Weiner jiggled the ice in his empty glass. “You ever done any private practice?”

  Where was this going? Besides, Dick undoubtedly knew the answer. “No.”

  Weiner nodded, the lights from the wall sconce reflecting off his oily scalp. “You like the job here? Other than your lab?”

  “Boy, there’s no good way to answer that. I say no, I look like an idiot for staying. I say yes, I look like an idiot for working for peanuts. Like I said, the reason I’m here is because of my research. I had the lab going when I graduated, so there was no start-up time.”

  Weiner copped a glance at his watch. “Looks to me like you’re saddled with all the shit jobs in the department. Covering the VA, covering trauma call, working the charity clinic. How much trauma call you take?”

  A sore point for sure, and Weiner probably knew that answer, too. Why bother asking? “All of it, unless I’m out of town.”

  Weiner laughed and shook his head woefully. “How’s that working for you? I find it hard to believe a lab rat like you wants to take all that trauma call.”

  Good point. “Can’t say I love that, but the department pays my salary until I get funded.” He was curious to know how Weiner got his lab funded but thought asking might come across as sour grapes.

&nb
sp; “How often you make rounds there?”

  “Every day at the trauma center, once a week at the VA.”

  Weiner sat back and laughed again. “Every day? No way. You like that?”

  “It’s a hassle,” Alex admitted. “By the time I finish up at the U, I have to fight traffic to get across town. Only good thing is the traffic’s pretty much played out by the time I head home. Still, it’s a thrash.”

  “And all those tenured full professors won’t help? That type of work beneath them?”

  The words made Alex feel even more like an idiot. As uncomfortable as this conversation was making him, he wasn’t about to badmouth colleagues to Weiner. “Not really.”

  “How’s that? Give me an example.”

  “As you probably know, we discuss the week’s OR schedule at Monday conference. If a case shows up—an aneurysm for example—that’s someone else’s subspecialty, it’s transferred to whichever surgeon does that work at the U.”

  Weiner snorted. “In other words, they cherry-pick the good cases and leave you all the crap. That about sum it up?”

  That stung. “I wouldn’t really put it that way, Dick.”

  “Oh yeah? Then how would you put it?”

  “We all have subspecialties. Mine’s brain tumors. Baxter’s is vascular—”

  Weiner cut him off. “Yeah, yeah, yeah, I know all that crap. My point in all this is those clowns refuse to roll up their sleeves and cover that service unless there’s a case they want. Then it gets transferred to the almighty U so they don’t have to sully themselves with driving downtown. That’s exactly the kind of shit that drives the administration at County crazy insane. On top of that, everyone—meaning Coastal-County and the U—loses money each time they pull that. Those holier-than-thou full professors are shafting the system, Alex. Don’t you get it?”

  Enough. “What’s your point?”

  “Just so we have things in perspective, everyone but you is a full professor with tenure.”

  “So?”

  “They’re at the top of the university’s salary range.”

  “Again, so what?”

  “So, none of them are going anywhere. Why should they? They have no incentive to leave. They’re getting paid top dollar to sit around their offices and drink coffee every afternoon and do the minimum amount of work. And frankly, who’d want to hire them? Not one of those clowns knows how to work. They’re all deadwood.”

  “Again, I don’t see your point.”

  Weiner smiled. “Believe me, if I take over the department, those fat cats aren’t going to be living as they do now. I know exactly how many cases they’re doing. No other department in the world allows surgeons get away with the shit they’re pulling.” Weiner shook his head with a look of disgust. “Believe me, things are going to change. And I can tell you this, you’ll be the first one to benefit.” His expression turned serious. “Will you back me on this?”

  Alex found the question deeply unsettling. “I’m not sure what you mean by that.”

  “You’ll get a vote on who replaces Waters. Will you support me?”

  Alex didn’t answer.

  “Let me be very clear, Alex. You back me, I’ll guarantee I’ll fund your lab until you get a grant. Not only that, I’ll make sure you have the time to actually set foot in your lab for more than a couple minutes at a time. Since you and I would be the youngest members of the department, we can make a good team. I’ll appoint you vice-chair. How does that sound to you?”

  Alex mentally compared Weiner to the other two viable candidates, both as senior as Baxter and Ogden, both currently at prestigious East Coast universities. If Weiner would guarantee to support his lab, well, why not vote for him? Baxter and Ogden would vote for themselves, and Waters couldn’t vote. Depending on how the search committee felt, Weiner might just get it in spite of his age. Certainly things would drastically change from the Camelot environment of the Waters years. Was that bad? Weiner put out his hand to shake. Alex took it. “Yes, I’ll support you.”

  If Waters had to step down, wouldn’t it be better to have a research-oriented surgeon take over?

  14

  “… and it is unto Jesus Christ our Lord …”

  Alex sat on butt-numbing oak, spacing out and doing his best to ignore the nauseating combination of scents that filled the room: mourning lilies, perfume, body odor, and—from someone—the rank odor of a silent fart. The sermon, Alex believed, contained far too much fire and brimstone and threats of spit-roasting in eternal hell if the congregation didn’t accept Jesus into their hearts as lord and master. He hated this sort of crap. First of all, he believed funerals were to honor the deceased, not to threaten and intimidate the mourners. Although he believed in God, it wasn’t Jesus Christ. Neither did he believe the man named Jesus who walked the earth had necessarily been God’s son. Because of these doubts, he found the self-righteous fundamentalists obnoxious and sanctimonious in their insistence on having “The Answers.” No one knew all “The Answers.” Not by a long shot.

  Lincoln: the capitol and the second-most populous city in Nebraska after Omaha. A series of exits off Interstate 80 fed a flat grid of streets with a population of almost a quarter million. The kind of city, he suspected, that its salt-of-the-earth inhabitants regarded as “a great place to raise a family.” His preference was the West Coast. But now that he thought about it, he’d never lived anywhere else, so what did he know? He’d spent two quarters of medical school on a surgical clerkship at Middlesex Hospital in downtown London, but the remainder of his life had been confined to within fifty miles of the Pacific Ocean.

  Just before the funeral service began, he’d glanced around and was shocked at the congregants’ homogeneity: one hundred percent white—probably law-abiding—people who he bet referred to themselves as “folk.” Good, God-fearing, hard-working “folk.” Not that there was anything wrong with that, but he found it a little too Leave It to Beaver-ish for his tastes, preferring an ethnic mix, especially when it came to food. Although they’d only been in town twenty-four hours, the only ethnic restaurants he’d seen were a few Chinese joints featuring all-you-can-eat lunch buffets. Then again, perhaps he was completely wrong, and this really was the perfect place to live and raise a family. He sort of doubted it.

  Lisa dabbed a tissue to her eyes, staining the Kleenex with mascara. With a muffled sniff, she discreetly pushed the sodden tissue under the cuff of her left sleeve. He wished there was some way to comfort her but knew from personal experience that the loss of a parent is inconsolable. He would simply support her as best he could, but that job was made harder by the fact he’d not been close to her mother.

  The funeral made him think of his own mother, of how terrible her disease, glioblastoma, had been and how it compelled him—as melodramatic as it sounded—to search for a cure. It had been heartbreaking to stand helplessly as she lost more and more brain function. Through it all, she remained cognitively intact, aware of exactly what was happening, imprisoned in a body she couldn’t control. And that was the worst part. Countless times he’d wished for a way to lessen her suffering. Toward the end he talked to her doctor about giving her more morphine in the hope of dulling her senses, but the doctor refused, saying she showed no signs of pain. “But what about her mental pain?” he’d asked. The doctor gave him some theological mumbo jumbo that made no sense. Some Hippocratic babble about do no harm. But what harm had the doctor done by steadfastly keeping her heart beating when her brain had long ceased to function? Now, as a doctor specializing in such tumors, he practiced from the heart, ignoring any religious hindrances.

  The black-clad congregation rose en masse at the organ’s introductory chords. Alex dutifully opened the hymnal and found the correct page but made no attempt to even lip synch the plodding, senseless lyrics. He never had been able to carry a tune, so why try now? Occasionally he sang along to familiar songs in the privacy of his car, but even that was only on the best of days. Hymns were another mystery of life. Wh
at was their raison d’être?

  Hymn over, the mourners returned to their seats, and the preacher once again began to drone on.

  Burial was another difference between Lisa’s family and his. His family chose cremation, their ashes—sometimes illegally—scattered over the beloved coast. His mother and father had been released into the waters of San Francisco Bay, his mother off the north shore. The concept of decaying in a box underground seemed, well…

  Alex discreetly nudged up the cuff to his white shirt for a glance at his Seiko. Forty-five minutes now, and they still hadn’t reached the halfway point of the service. He shifted weight again on the hard oak, letting his mind wander to happier thoughts.

  15

  Baxter and Geoff were talking intensely in hushed tones at the small conference-room table when Alex entered, heading to the coffee maker. Baxter turned to him. “Heard the news?”

  “What news?” Alex started pouring a cup.

  Baxter’s face became pained. “The dean just announced our new chair.”

  Alex quickly checked Geoff’s face. Neither one of them appeared happy, so undoubtedly neither had been The Chosen One. He replaced the pot on the hot plate. “Who?”

  “Come sit down first,” Baxter demanded.

  Alex took the chair directly across from Baxter, putting Geoff on his right.

  “Richard Weiner,” Geoff said with just enough venom to be perceptible.

  Alex suppressed a smile. It came as a welcome relief to know Ogden didn’t get the position. Baxter would’ve been a better choice. Marginally.

  “Guess where he intends to set up shop.” Baxter said.

  “He’s not planning to move into Dr. Waters’s office, is he?” Alex asked, surprised.

  “Get this; he talked Coastal County administration into gutting the entire top floor of the old building to convert it into an office suite. A suite, for God’s sake.”