Cutter's Trial

by Allen Wyler

  Cole nodded, his jaws working over a bite of sandwich.

  “You guys”—meaning anesthesiologists—“see just about every surgeon here, right?”

  Cole swallowed. “Pretty much. Certainly all you clinic guys. But we’re not the only gas-passers here. Some surgeons, Friedman for example, use the other practices. Friedman prefers to use his brother exclusively, surprise, surprise.” He wagged his eyebrows Groucho Marx style.

  “I didn’t realize that. Only other place I’ve worked was a closed shop. No one but faculty practiced at University Hospital.”

  Cole swallowed. “What’s your question?”

  Alex weighed asking. He trusted Cole with his patients, but could he trust him to keep a conversation private? Or should he just keep his mouth shut? “You’ve seen Martin Berger in action. What’s your opinion?” he said, leaving the question open ended.

  Cole brushed off a small chunk of olive from his lower lip with a paper towel. “Nice guy. Does a ton of spine work.”

  A nonanswer answer. Watching Cole made Alex suck a piece of olive free from between his teeth. “Yeah, but would you have him operate on your mother?” That, of course, was the trump-card question.

  Cole grinned. “She’s dead, so I guess I’d have to say no.”

  “You know damn well that’s not what I’m asking.”

  Cole considered his answer a moment. “All I can say is, calling you for help doesn’t really surprise me if that’s what you’re asking.”

  A morbidly obese man in a pinstriped blue suit waddled into the lounge, heading straight for the coffee. Alex watched him pour a cup and stir in sugar and cream while chatting up a nearby surgeon. Alex counted: one, two, three packets of sugar. Same as usual. He’d seen this routine numerous days and it never ceased to amaze him.

  “Who is that guy?” Alex asked, voice low. Alex was reminded of college chemistry, how there’s a saturation point past which a substance will no longer dissolve in a liquid and just accumulates at the bottom of the beaker. Alex was pretty sure the man’s coffee was past that point after the second packet.

  “Gene?”

  “If that’s his name. See him in here least once a day, drinking that supersaturated sugar coffee he loves to concoct. Most mornings he downs one or two maple bars to boot, I kid you not.”

  Cole thumbed away another morsel of olive from the corner of his mouth. “I know. Hard to watch, given his weight. Name’s Gene Roux. If you ever need a hematologist, that’s your man. No better blood guy in the area.”

  “That explains why I never see him in scrubs. What’s he doing up here instead of downstairs in the physician’s lounge?”

  Cole laughed. “Claims the pastry’s better up here.”

  Alex did a double take. “You shitting me?”

  Cole wadded up the sandwich wrapping, wiped his fingers, and tossed the ball into the trash. “Dead serious.”

  “Doctors Cutter and Cole, ready for you in Room Three.”

  As they passed Ellen Bowen’s glassed office, Ellen popped her head out. “Doctor Cutter, got a moment? I know you have another case starting; this won’t take long.”

  “For you, always.” He stopped as Cole continued down the hall to start the case.

  Ellen smiled. For warmth against the A/C chill she wore a surgeon’s gown over her scrubs like an overcoat, the ties dangling down the front, the sleeves rolled halfway up the forearms. “We’re all tickled pink about the way your caseload’s increasing, and I want to do everything I can to help grow it. Starting today Chuck will be assigned to all your cases. You okay with that?”

  Having the same scrub tech for every case improved efficiency. Chuck knew Alex’s instrument preferences, so he could quickly set up the packs to be sterilized for the next day’s schedule. Chuck was so familiar with Alex’s technique, he routinely had the next instrument waiting for him before being asked. Last week Alex had toyed with the idea of asking Garrison to hire a dedicated scrub tech for exactly these reasons. The tech’s salary could easily be offset by the improved OR efficiency. Now it was a done deal and at no clinic expense. Better yet—he had to admit—was the satisfaction this validation brought. Without being egotistical—because he objectively knew his complication rate was admirably low—his growth of referrals indicated a regional reputation for excellence. He’d even started flirting with the idea of promoting himself nationally, like Reynolds, by attending more meetings to present his outcomes—a marketing ploy he’d previously frowned upon.

  “Ah, that’s great. He’s wonderful. But as long as we’re on the subject, I was planning on asking for priority time on Tuesdays. As of this week, I’m off the out-clinic rotation.” Much to his relief. Flying in a private plane hadn’t become easier with time. Quite the opposite. Each time they went up, he figured the odds increased against them, that sooner or later they would have a disaster. “Garrison prefers I spend my time here rather than out there.” Priority time was a designated OR time the office could count on when scheduling cases. A new surgeon usually was assigned the hours no one else wanted or had to tag cases onto whatever time remained after the big dogs used up their time, often being relegated to late afternoon or even early evening.

  “I’ll see what I can do. That time’s already allocated, but I might be able to steal a room from Ortho. Reckon you want to stay in Room Three?” This would give him not only a stable team but a dedicated room as well. Too good to be true.

  “That’s my preference.” Now, if he could have Cole negotiate a similar arrangement with his group, he’d have a winning team.

  The overhead speaker crackled and a voice chirped through. “Doctor Cutter, ready in Room Three.”

  “Mind if I walk out with you?” he asked Garrison, catching up with him at the stairwell to the parking lot. Both men preferred to take the stairs instead of waiting for the slow-as-molasses elevator.

  “I welcome the company,” Garrison said, pushing open the horizontal bar to the steel fire door. They started down, footsteps echoing off bare, musty concrete.

  “Got a question for you,” Alex said after the first flight of stairs.

  “Shoot.”

  Alex debated how best to phrase the sensitive subject. “This is extremely confidential, okay?”

  “Okay.”

  “What’s your opinion of Berger’s surgical abilities?”

  Garrison stopped at the landing to the parking garage. “Why? What’s up?”

  Alex related being called into Martin’s room to help solve what Alex believed to be a simple problem for a neurosurgeon opening a skull. “Given the fact he does mostly spine surgery, I’m wondering if he should still be doing craniotomies.”

  Garrison pushed through swinging doors into warm evening humidity. “Determining surgical privileges isn’t the clinic’s responsibility. The hospital credentials committee does that. Every clinic member is Board Certified, meaning they can do spine, intracranial, and peripheral nerve surgery.” Clearly, he wasn’t pleased with what Alex just said.

  “True, but some of us are better at some things than others. Since we share profits equally, there’s no reason for each surgeon to do everything. It’s exactly the reason some of us subspecialize. You, for example. You’re the clinic’s go-to guy for aneurysms and AVMs.”

  “That’s different. That takes special skills. I’m good at it primarily because I do all those cases for us.”

  Alex reached out and touched his arm, stopping him. “Why is that different?”

  Garrison opened his mouth to reply, seemed to think better of what was about to come out, and said, “No one’s going to stop Martin from doing craniotomies, Alex, so get over it.”

  Alex shot him a disgusted look. Garrison shook his head. “Which would you prefer he do, plow ahead on a problem or call a partner to help him out?” Garrison’s tone and demeanor was one of mild irritation.

  “Of course he should ask for help if he’s in trouble. That’s why I helped him. That’s not the point. The point is
, I’m not sure he should be doing cases that carry a likely risk of getting him into trouble. He was flat-out lost. Maybe there’s a damn good reason he does mostly spine. Maybe he shouldn’t be opening people’s heads. The clinic’s primary concern should be providing the best possible care to our patients, not worrying about hurt feelings.” Alex believed they both had points.

  Garrison studied Alex a moment. “You looking for ways to expand your turf? Is that what this is all about?”

  Aw, Jesus. “No. That’s not the point.”

  “Well, you could’ve fooled me, ’cause that’s the way it sounds.”

  “Look, I’ve been watching the schedule. Martin does a hell of a lot of second, third, and forth disk reoperations. How’s that justified?”

  “Not sure I see your point. He’s referred a lot of patients.” Garrison’s voice had turned steady and cool, transmitting an unstated message: fuck off.

  He was past the point of no return. “Have you read the L and I statistics”—L and I meaning Labor and Industry—“for second, third, and forth reops?”

  “Can’t say I’ve stayed up nights riveted to that.”

  “Each redo has less chance of producing a good result. Certainly, no one goes back to work after the second operation.” Garrison used his thumb to wipe the corner of his mouth. “Getting patients back to work is not our concern. Making them comfortable is.”

  “That’s exactly the point. It doesn’t work. But more importantly, why are you defending him so strongly?”

  Garrison took a deep breath and began to play with the tie from the surgical mask dangling around his neck. “I’m not defending him. Martin Berger is the clinic’s highest producer. Why should I look for ways to kill the golden goose?”

  There it was. “In other words, billings trump quality.”

  Garrison shook his head in disgust. “Right now you remind me of Douglas,” he said, referring to his adolescent son. “Everything’s black or white, and there’s no such thing as gray or middle ground.”

  Alex’s temples tightened. “Tell me the middle ground in this?”

  “Berger’s Jewish.”

  Alex recoiled. “What the hell does that have to do with the price of yak dung in Timbuktu?”

  “If you haven’t noticed, he’s the only Jew we got.”

  Alex still didn’t get it. “And your point is?”

  “He’s our only conduit into that referral pool.”

  Alex took a step back. “Please tell me you didn’t just say that.”

  Garrison sliced a hand through the air—discussion over. “New topic, now that we’re done with that one. Two new topics, actually. We hired your nurse and she just finished her clinic orientation today. She’s replacing Linda tomorrow morning.”

  Alex wasn’t listening. Honeymoons typically end with the first argument. Partnership can’t exist without occasional discordant views. He and Garrison just crossed that line, leaving him feeling hollow, unsettled, and wishing he could rewind the last ten minutes and start over. He’d always known there was no such thing as a perfect job. Still, he’d worked to stave off this inevitable disillusion, believing that each day without confrontation buttressed his solidity within the clinic. Yet he knew somewhere along the line, a controversial issue was bound to arise. Could he live knowing he hadn’t taken a stand once one arose? No. To say nothing would be worse than going on record. His words might not change a damn thing, but he’d feel worse if he hadn’t said a word. He vowed that from that day on, the clinic could practice their way, but he would practice his way. As long as he held true to his own professional and moral compass, he’d be okay. Still,…

  There was more he wanted to say but decided against it. “Look forward to meeting her, but I’m sure going to miss having Linda around. She’s terrific.”

  “She enjoys working with you. She says you’re a good doc.”

  He sensed their tension dissipate. “What’s the other thing?”

  “Clinic’s adding a new partner.”

  “Partner?”

  “Sorry, I’m getting ahead of myself. He’ll start on the same path as anyone new: a probationary year first, then partnership. Good man, you’ll like him. Trained here before spending four years in the Air Force. When that obligation was done, he took a job with Randy Clever down in the Gulf for a year, but that turned out to not be a good fit for him, so he called a month ago and I promised to find a place for him here. He’s a good person as well as an excellent surgeon. You’ll see.”

  Considering the way this conversation had just gone, Garrison’s recommendation didn’t hold the same weight as it might have a day ago. Sad. They turned away from each other to walk to their respective cars.

  36

  “I’d like you to meet Betsy Lou Osborne,” Linda Brown said, introducing Alex to an overly buxom woman with a long, plain face that hadn’t benefited from either her excessive make-up or her frosted blonde hair. Her white blouse was tucked into tight white jeans. White socks and white running shoes completed the ensemble.

  Linda had nabbed him beelining to the stairwell for a quick trip to the hospital to discharge two post-ops. He held his hand out to the new hire. “Welcome aboard.”

  Smiling, she shook his hand warmly, holding it a few seconds longer than necessary. “Nice to meet you, Doctor Cutter. Linda says you’re one of the top docs here. I look forward to working with you.” Smiling, she primped her hair.

  He felt something off-putting about the way she looked him in the eyes. Wanting to stay on schedule, he shrugged it off. “I’m heading over to the hospital to discharge two patients. Tag along if Linda’s done with you.”

  “I am. As of now, she’s assigned to you full-time.” Linda glanced from Alex to Betsy and back again before walking away.

  Alex headed toward the stairwell. “I prefer to take the stairs. Saves time.”

  “Typical surgeon.”

  They started down the stairs to the second-floor sky bridge. “You from around here?” he asked in an attempt at small talk.

  “Born and raised in Little Rock, where I attended nursing school. As soon as I graduated, hubby and I moved here. Been here ever since.”

  He pushed open the fire door onto the sky bridge, Betsy keeping pace. “Where have you worked before here, Betty?”

  “It’s Betsy. Worked here and there. My first love is pediatrics, so for five years I was with Brett Hoagland. Know him?”

  He waved at a referring physician heading in the opposite direction. “No. Don’t do any peds, so probably haven’t run across him.”

  “Oh, well, he’s been dead a couple years now.” She was on his left, matching him stride for stride. “Tragic.”

  They reached the bank of elevators and Alex punched the “up” button. “Sorry. What happened?”

  Another hair primp. “T-boned his Corvette into an eighteen-wheeler while crossing an intersection outside of town. The car’s body went right under the rig, completely demolishing the top of the car and decapitating him.”

  Alex shivered at the thought. “That’s awful.”

  She touched his arm. “But his nurse survived without a scratch,” she said with a conspiratorial smile. “How do you suppose that happened?”

  Aw, Jesus. He stepped away from her. “She was extremely lucky, I guess.”

  The elevator arrived, they entered, and he punched “7” while making sure to stand well away from her.

  Am I being paranoid?

  “Neuro’s on seven,” he explained. “Except for my ICU post-ops, this is where all my patients are.”

  As they exited the elevator, Steve Stein stood next to the nursing station writing in a chart. He saw Alex and closed the chart. “Morning, Doctor Cutter.”

  Alex introduced him to Betsy.

  “Got that information you asked about,” Steve said.

  “Oh?” He knew Steve was smart enough to defer any further conversation on the topic until they could arrange a more private situation.

  “The a
nswer is yes,” Steve said with a knowing glance.

  “Okay, good. We can discuss it more detail later. When you have a minute, drop by the clinic. I’ll be there all afternoon seeing patients.”

  “Let me see your orders,” Betsy Lou said, moving next to Alex at the 7 Madison nursing station. He was writing orders in the chart after she had listened to him verbally instruct the patients. The sooner she learned his routines, the more scut work he could begin to delegate while he was in the operating room. Linda was great when she had time, but she was overloaded with covering Garrison and managing the other clinic nurses.

  “I close every scalp in two layers. Deep layer with tight inverted sub-cutaneous Vicryl followed by skin staples.”

  “I notice the dressing’s off and the wound exposed. That seems unusual.”

  What a relief. She knows a few things.

  “A properly closed wound forms a protein-rich seal within 24 hours. Long as the patient doesn’t pick at it and break it open, it’s better left exposed to air than all covered up with goop that makes a perfect culture for bacteria. Unless there are specific reasons for the staples to stay in longer, I remove them at five days. Produces less scar that way.” She seemed to listen closely, which he appreciated.

  “Why staples? Most surgeons I know use nylon.”

  “Less tissue reaction, less inflammation, less scar.” He resumed writing discharge orders.

  Her right breast pressed against his left arm. “Oh, I see.”

  Shit. He stepped back and locked eyes with her. She glanced away, flustered and blushing.

  Let it go at that. If she’s smart, she got the message.

  37

  “Deep tendon reflexes normal at two-plus and symmetrical, Babinskis negative.” A knock on the open door interrupted dictation. Alex turned from the window to see Garrison’s large frame in the doorway.