Cutter's Trial

by Allen Wyler

  “I agree,” Reynolds said with a vigorous nod. “But before you sit down, tell us your approach.”

  Alex studied the scans more, absentmindedly pinching the back of his neck, visualizing how best to get at the entire tumor.

  “I’d position her in the lateral decubitus position,” he said, indicating her side. “I want the right hemisphere down. I’d incline the table slightly with the head above the feet and have a lumbar drain in place. I wouldn’t open the drain until I was ready to open the dura. My bone flap would cross the sagittal sinus.” This was a large vein running front to back in the dura between the hemispheres. “Cutting the bone flap across that sinus is the riskiest part of the operation, because if you accidentally open that puppy, you could be in a world of hurt. Stay out of it. Once I started to open the dura, I’d begin to drain off spinal fluid to allow me to retract the frontal lobe with as little pressure as possible. In fact, the whole point of having her on her side is to let gravity retract it for you. I’d preserve the sagittal sinus if possible, but since you’re in the anterior third of the sinus, if absolutely forced to, you can sacrifice it. But only if absolutely necessary.”

  Reynolds smiled, his hand on his chin. “Lateral decubitus position. Never would’ve considered that. We’d usually put the patient brow up with the head rotated away from the side of the tumor. Lateral decubitus position … hmm!” He turned to the residents. “Good suggestion. Y’all need to think about what Dr. Cutter just said. Might be better than what we’re doing.”

  Alex sat down, glowing from Reynolds’s words of endorsement. This wouldn’t happen where he came from, especially with Weiner now in command. There, he was a non-entity, the junior faculty member. Here, he now felt the stature of being a professor and surgeon, capable of expressing new thoughts and bringing fresh skills to a deeply inbred training program. This move might become one of the best things to happen to his career. He glowed.

  After conference, he walked out of the auditorium with Reynolds. At a T in the hall, Reynolds stopped at the bank of elevators. “Going upstairs to check on a couple post-ops. Great to have you here, Alex.”

  “I have a question for you. Know of any squash courts in town?”

  “Squash?” Reynolds rubbed his chin. “There’re a couple over at the University Club. I have a membership, so y’all let me know if you want me to sponsor you. Garrison has one, too, so I’m sure he’ll be happy to support you.”

  Wonderful. He wanted to begin a routine of regular exercise again, assuming he’d be able to wedge it into his busy schedule, whatever that turned out to be. “Take you up on the offer soon as we get more settled and I have time. Appreciate it.”

  Reynolds seemed to remember something. “I appreciate the fact you’re not officially working yet, but I have several matters in need of settling. You mind dropping by the office tomorrow?”

  The only things he had on his plate for the next day were several honey-dos around the house, getting some final touches done while he still had his days to himself. An excuse to break away would be welcome. “No problem. What time?”

  “Late morning works best for me, say between ten and eleven? Tomorrow’s my day at the university office, and I’ll make sure to be available round about then.”

  “I volunteered for the decorations committee for their annual black-tie affair,” Lisa said with as much enthusiasm as Alex had heard in years. “I did it more as an act of self-preservation than desire. What they really want are volunteers for the procurement committee. I did that once before and hated it. I just don’t feel comfortable walking into businesses and asking for donations, especially being new in town and not knowing a soul.”

  They were in the TV room with the news on but the volume turned low, enjoying a glass of chardonnay before another take-out dinner of fried chicken and slaw. Tomorrow one of his many tasks was to rehabilitate the gas barbeque in the back yard. It sat under a large oak tree and was covered with pollen, sap, and debris. By the looks of it, it hadn’t been used in a year or more. On the drive back from the conference, he noticed a barbeque dealer on Central Avenue so planned to stop in on his return trip after meeting with Reynolds tomorrow.

  “Think you’ll enjoy working on that?” he asked Lisa.

  “Yes, but I was so embarrassed. I showed up in my denim skirt, which would’ve been okay back home. All the other woman were in dresses. I felt totally out of place. I need new clothes if I’m going to be going out. Nothing I have fits in here.” She paused to sip wine. “Oh, how’d your meeting with Reynolds go?”

  “Great. I finally feel like a real professor instead of a senior resident. It’s forcing me to think the move might actually be good for me. For you too, from the sounds of it.” He checked their glasses. “One more small glass before we eat?”

  “Sure. Why not. Oh, I tell you, I was sooo embarrassed today.”

  24

  The candy-cane-striped arm swung up, allowing Alex to drive into the large, six-floor concrete parking behemoth serving Baptist Central. As he worked his way up looking for a parking space, Alex learned the first three floors were reserved for physicians. He made a mental note to ask Reynolds about obtaining a parking card to open the gate. After scouring every floor without luck, he eventually found one narrow space on the roof between two Ford pickups. Both trucks were decorated with confederate flag decals on the rear cab window. One had the silhouette of a kid pissing on a Chevy emblem. Nice. Almost immediately upon driving back into the blazing sun, he could feel heat radiating through the car roof. The car would be a pizza oven by the time he returned. In self-defense, he cracked the front windows and sunroof but knew that would help only minimally. He squeezed out of the door hoping one of the pickups would be gone by the time he returned.

  He discovered a stairwell to the left of the two elevators and decided to walk to ground level in an attempt to learn as much as possible about navigating the massive medical complex before officially starting. Too lazy to walk the half block to the intersection, he waited at the curb for a break in traffic, sprinted across the street to the campus, and wandered the pleasant, tree-lined paths until finally recognizing the building that housed Reynolds’s academic office. Claude, Reynolds’s secretary, sat behind her desk typing on an IBM Selectric, the door to her boss’s office closed. A cigarette burned in an ashtray next to the typewriter. She glanced up with a guilty smile when he entered. “I’ll see if he’s available,” she said and picked up the phone.

  “Settlin’ in?” Reynolds set his pen down and leaned on the armrest of his desk chair, tie loosened, shirtsleeves rolled up, glasses smudged as usual.

  “Pretty much. I’m ready to start on Monday, that’s for sure. I miss work, to tell you the truth.” The room carried the faint odor of stale cigarette smoke, but he spied no ashtray.

  “Can’t”—pronouncing it cain’t—“tell you how happy I am to have y’all here. Going to be wonderful for the residents to get more academic input. You’re exactly the person to do that. Believe I mentioned to you previously, the residency review committee dinged us for not having a strong enough teaching program. I’m counting on y’all to remedy that.

  “Having said all that,” Reynolds continued, “the most important item to be discussed today is which level of resident you want. Given that we graduate two a year, you’ll be assigned residents for six months at a stretch. This means that one or two of the private guys won’t receive coverage any longer, but reckon that’s just tough titty. You better believe we can expect some howling from whoever we decide to cut. Long as I can remember, some of them been just using our boys for their convenience, having them assist on cases and cover the ER. Most of ’em haven’t paid a lick of attention to our boys’ education.

  “I have the fifth-year guys assigned to me. Advantage to that is it gives me more flexibility in having them open and close my cases. Might wanna consider doing the same.”

  Reynolds finally stopped talking and Alex took the cue. Luckily, he’d anticipated
this question and given it some serious consideration. “I prefer to have the first-year residents with me.”

  Brow furrowed, Reynolds leaned forward, forearms on the desk. “Y’all serious?”

  When Alex didn’t answer, he said, “Means you’ll have to watch ’em like a hawk. Know that, don’t you? Sure y’all don’t want a more experienced set of hands with you?”

  He felt obliged to defend his decision. “Way I see it, their first year is the most formative. Get them when they’re fresh and you can mold them. Get them when they think they know it all and just want to get out on their own, you’re not as effective. If our goal is to change the program orientation, we’ll have a better shot at success if I get them fresh.”

  Reynolds sat back again, steepled fingers tapping his bottom lip. He stayed this way a moment before a smile played at the corners of his mouth. “See your point. Huh! Smart. Damn smart. Must admit, you’ve got a point. I’ll give you that. Okay then, that’s settled.” Reynolds flipped a page on the notepad to his right. “Next order of business. How about your research?”

  Another topic Alex had been considering since accepting the job. “I’m presently working on a grant submission. Soon as I get settled in the clinic, I’ll arrange a sit-down with Steve,” he said, referring to the chairman of Cell Biology, “and get a better feel for the lab situation. Figure I’ll do things similarly to the past and work with tissue from patients. I’ll see what their tissue culture capabilities are.”

  Reynolds spent a few moments making notes. “Agree. That makes the most sense.”

  Alex knew it wasn’t quite what Reynolds wanted to hear, but it was the best he could do at the present time. Now for the good news. “Do the residents have a journal club?” He suspected they didn’t.

  Reynolds started swiveling his chair side to side. “Nope.”

  “Well then, that’s the first thing I’ll do. We’ll meet monthly at my place, say 7:00 p.m. I’ll have Lisa supply munchies for the guys. I’m thinking first Wednesday of the month in order to avoid conflicts with year-end holidays.”

  Reynolds slapped the desk. “Good! At least we got us something tangible to show the RRC next time they come snooping around.”

  Alex was pleased to make his first contribution to the residency. “Glad it meets with your approval. I’ll set it up next week.” A brief pause. “I have a delicate question for you.”

  Reynolds’s face became serious again.

  Alex’s concern was how to broach the subject without ruffling Reynolds’s ego. He decided a direct approach was his best bet. “I’m vice-chair of the department, am I not?”

  “You are.”

  “What does that mean as far as my authority?” He worried that some personalities might have difficulty sharing or delegating control if they’ve been the only one in charge, especially as long as Reynolds had.

  Reynolds laughed. “Y’all got nothing to worry about on that issue; I’m not your friend Weiner. I’m just tickled you’re here to take some responsibility off my shoulders. Thing you need to realize about this place is there’s good and bad points of being inextricably linked to private practice like we are. The big negative is most of the surgeons who benefit from resident coverage don’t give a hoot about teaching. Like I said earlier, all’s they want’s a warm body to help”—pronouncing it hep—“in the OR and see patients in the ER. The quid pro quo is we benefit from an increased caseload. By the time our boys graduate, there’s not much they haven’t seen or done. But getting back to your question, I want y’all to take as much responsibility as possible without running into conflicts. I need you in control of things when I’m out of town. Which happens to be too damn much of the time. That answer your question?”

  Alex was relieved to have aired the topic. The more he got to know Reynolds, the more he liked his straightforward, no-nonsense approach. Reynolds might not have Waters’s Ivy League smoothness, but the man was certainly far less conniving than Weiner. “Thanks. Was hoping to hear that.”

  Alex was about to broach the parking issue when Reynolds said, “Garrison wants a word when we’re done. Know how to find the clinic from here? Want me to have Claude walk you over?” The meeting was clearly finished.

  “No thanks, I think I can find it. If not, I’ll learn. Have to do that sooner or later. Might as well be sooner.” He stood and extended his hand.

  Reynolds did likewise. “Again, good to have you on board.”

  Alex waited for a break in traffic before sprinting across the wide, busy street, then walked back to the Baptist Central parking garage where he took the second-floor sky bridge to the professional office building. More familiar with the sights and landmarks now, he made fewer wrong turns and quickly found the elevator to the fifth-floor clinic.

  The elevator opened into a hall that connected the waiting room on the left with the doctors’ offices and exam rooms on the right in an H configuration. The clinic took up the entire floor. He approached two receptionists at the front desk of the packed waiting room, introduced himself, and said Dr. Majors wanted to see him.

  “Oh, yes Doctor Cutter. He’s expecting you. Please follow me.” She led him through the elevator area into the clinic, then down that hall to Garrison’s office, the maze of halls also more familiar this time. “Have a seat. I’ll let Doctor know you’re here.”

  Alex remained standing to inspect the room. Unlike Reynolds’s utilitarian university office, Garrison’s office contained darkly stained mahogany bookshelves, a heavy matching desk, and two maroon leather wingback chairs with a matching desk chair. This style of interior decorating, he was learning, seemed typical for the region. He preferred contemporary furniture, but it was nowhere to be seen, either in the medical complex or in the houses he had toured with Betty. He took a closer look at Garrison’s vanity wall, inspecting the assortment of diplomas and pictures. Clearly, he flew airplanes. One picture showed him in front of the engine of a red-and-white biplane. Closer inspection revealed the plane matched the model proudly displayed on a corner of the desk.

  “Morning, Alex.” Dressed in green scrubs and a white lab coat, Garrison lumbered into the room. A few inches over six feet, with thinning gray hair and a paunch accentuated by his hunched shoulders, he displayed a disarming folksy demeanor that Alex suspected served him well in managing both clinic and patients.

  “Didn’t know you fly planes,” Alex said, offering his hand.

  “That’s my Pitts you’re looking at. Real beauty, my pride and joy. I’ll be happy to take you up sometime. I fly competitive aerobatics with her. Another pilot and I own her, which is the only way to make one of those things affordable. I share another half interest in a four-seat Cessna which we lease to the clinic for flying to out-clinics each week, but more about that later.” Garrison habitually hooked his right index finger over the white surgical mask dangling from his neck, pulling it this way and that and playing with the ties, wrapping and unwrapping it around his finger.

  The thought of recreational flying, with or without Garrison, left Alex cold. He had no problem flying commercial airlines but had long ago decided hobby flying was dangerous. Especially for physicians who typically overestimated their ability to do just about anything, including navigate through insane weather. “Reynolds said you wanted to see me?”

  Just then a short, crew-cut man approximately Alex’s age came hustling through the doorway. Garrison nodded at him. “Hey Dave.” Then to Alex: “Wanted Dave Ray to stop by to meet you. He’s our business manger. Once you and I finish up, he can walk you through several matters.”

  Dave Ray extended his hand. “Nice to meet you, Doc. Heard a lot a good things about you.”

  Alex hated that particular social platitude, believing it unnecessary. Odds were he hadn’t heard a thing, because there wasn’t anything to hear. “Nice meeting you too, Dave.”

  “C’mon, let me show you around.” Garrison started for the door.

  The tour ended in an office with a desk, chairs, a
nd a bookcase in the exact style as Garrison’s but with empty walls and shelves. A small secretarial alcove separated this from a mirror-image office. “This here’s your office,” Dave said. “You and Marty Berger share Kasey Williams for a secretary. We staff one typist for every two docs. She must be on break at the moment.”

  Garrison spoke up. “I’ve assigned my nurse, Linda Brown, to cover you till we hire a suitable one for you. It’ll take you time to build up to full speed, but in the meantime we’ll keep you busy seeing Any Doctors.

  Alex turned from looking out the window. “Any Doctors? What’s that?”

  Garrison chuckled. “Every day we get a bunch of patients who walk in or call without an appointment. Girls at the front desk ask ’em, ‘You okay seeing any doctor?’ That explain it?”

  Ah, the unscheduled walk-ins, the bane of maintaining a timely schedule, especially if, like so many physicians, you don’t leave time for add-ons.

  “Yes.”

  “Each day the Any Docs are divvied up between whoever’s got clinic that day,” Garrison explained.

  “Since most our docs run a full schedule,” Dave added, “or even overbook, these walk-ins can become a real pain to work in. So you might oughta be prepared to have busy days right from the get-go. We see anyone who walks in regardless of whether or not they’ve been seen at the clinic before. Until you get your own caseload, we’ll assign you all the walk-ins. I can guarantee the other guys are going to love you for that. Sometimes these patients can be pretty gol-darn difficult to deal with.”

  “You can start bringing in your personal items any time you want,” Dave added, handing him a key and a swipe card. “This here’s the key to the office, and this card gets you in and out the parking lot. Be careful to not lose it.”

  Dave looked to Garrison. “That’s it for me. You?”

  Garrison nodded. “Good, ’cause Ellen Bowen wants to talk with him when we’re done. I’ll take him on over.” Then to Alex, “Ellen’s the OR nurse manager.”