by Allen Wyler
“Yes, Doctor Cutter, we received a call from a Mr. Suzuki. He’d like you to call him. May I give you the number?”
“Yes.” Alex slipped an index card from his white coat and readied a pen.
“Doctor Cutter, Agent Suzuki. Thanks for calling back.”
Ah, the FBI agent. Now he recognized the name. “What can I do for you, Agent?”
“We’re having trouble finding people to corroborate your allegations.” Just putting it out there and letting it hang.
“That’s not surprising. Weiner rules through intimidation. You spoke to the residents?”
“Yes, we have. And I always come away with the impression they’re not being completely truthful. Several of them imply what you’ve said is correct, but when it comes to being put on record, they shy away. That fits with your suggestion, but at this point, without hard evidence, we’re hard-pressed to continue the investigation.”
Stalemate. Weiner was going to get away with it.
When he didn’t say anything, Suzuki added, “This means, of course, you will not be eligible for a whistle-blower fee.”
Alex laughed at that. “That wasn’t my motivation for tipping you guys off.”
“Anyway, thanks for contacting us.”
“Before you go, I have one more idea.”
“I agree with you,” Lisa said after listening to Alex’s story of the encounter with Clarence. They were enjoying a glass of wine before dinner. “Did Garrison give you any reason for supporting him like that?”
“No, nothing other than ‘Clarence is following his Christian conscience.’”
She nodded, seemingly considering his words. “Do you think maybe you’re too protective of Steve?”
Good question, but irrelevant. “Sure I’m protective of him. He’s a good resident. Like you’ve always said, we go back to a time before we moved here. But whether or not we’re friends more than a student-teacher relationship is beside the point. The point is whether or not Clarence has the right to pressure a resident to do something totally unrelated to their job.”
“Would you feel the same if one of the other residents complained?” She didn’t sound argumentative, just inquisitive.
“Absolutely. The purpose of the residency is to teach neurosurgery. Period. It’s not a free pass to proselytize religion. Besides, like I said to Garrison, residents are at the mercy of the professors. Clarence as much as threatened to keep Steve from graduating if he didn’t start attending church with them. Is that right?” Okay, perhaps a slight exaggeration of what Steve actually said, but close enough.
“But you have the power to see that it doesn’t happen.”
“Yes, I do. For Steve. This time. But what happens when I’m gone and Clarence is still here? What’s going to happen to a Jewish or Muslim resident then?”
“Then it won’t be your problem. Look, you’re not going to convince Clarence he’s wrong any more than he’s going to convince you he’s right.”
As much as he hated to admit it, she was right.
48
“Doesn’t surprise me at all,” Martin said between breaths, his stride awkward and flat-footed. For the past three months Alex and Martin routinely jogged five miles every Saturday morning. The course started at Alex’s house, continued down Central to the University Club, and looped around a block before heading back again via a zigzag route of side streets.
“What I don’t understand,” Alex continued, “is why Clarence and Garrison are so tight to begin with. How’d that come about?” He wiped his eyes with his sodden white sweatband, the morning already eighty degrees and as humid as a steam bath. Alex inhaled a floral scent he couldn’t identify—sweet and succulent, curiously pleasing.
“What’s to understand? He’s a suck-up. Garrison is an easy mark for suck-ups. And the truth is, most of us find it hard to be objective when someone’s sucking up to us. You know, don’t you, that Garrison is godfather to Clarence’s children?”
“Sure didn’t.” Could Martin be right, could it be just that simple? They jogged in silence past the high laurel hedges enclosing the University Club tennis courts, now starting the return route to Alex’s house.
“Gotta ask you something,” Alex said. “If it’s too personal, just tell me to drop it.”
“Sure.”
“I came here expecting to encounter racial prejudice, so when I did, I wasn’t really surprised. But what I didn’t see coming was the amount of anti-Semitism. That caught me completely off guard.”
Martin blinked sweat from his eyes. “What’s your question?”
“How do you put up with it?”
Martin slowed in order to be able to talk in complete sentences instead of gasps. “Same reason the blacks around here tolerate racism: we don’t have a hell of a lot of choice. Besides, we have our own community and our own country club. Doesn’t mean it doesn’t hurt or that I like it when I encounter it, but I learned a long time ago to live with it. When it comes down to it, I suppose I put up with it because I was born and raised here. Went to medical school and residency here; this is my home. If you think about it, that’s pretty much Hill’s story too. Born, raised, and trained here, so it’s his home too. That answer your question?”
Alex wiped his brow again. “Not really. Guess that means I didn’t quite ask the right question. It’s just so different than what I’m used to. Don’t think I’ll ever get used to it.”
“Well, if y’all plan to live here permanent, y’all better get used to it. Don’t reckon things are likely to change anytime soon. Not as long as bigots like Hill live here. Which reminds me, hear what he did right after moving back to town?”
Alex slipped off a sweatband and squeezed sweat from it before slipping it back on. “No. What?”
“Story is he came back to the same church he’d been attending before going into the service. But this time ’round he decided it was too liberal, especially the way the elders interpreted the Bible. Too liberal! Can you imagine that? He quit to join a really fundamentalist group. I was shocked to find out there’re folks more fundamentalist than the damned Baptists. Boggles the mind.”
Alex raised his hand. “Hold up a second.”
They stopped, both men leaning over, hands on thighs, gulping deep breaths of steam-bath air. “It may look like I’m about to pass out here, but I am listening,” Martin said with a smile.
“You asked why Clarence’s proselytizing bugs me so damn much. Well, maybe this will help you understand. I told you, didn’t I, that after my birth father died my mom remarried?”
Knees straight, Martin bent at the hips to touch his toes, stretching his hamstrings, and held the pose for several seconds. “Yep.”
“My stepdad adopted us. That’s how come my name turned out to be Cutter. My birth name was Lippmann.”
Martin straightened slowly, a quizzical expression on his face. “Nice Jewish name. What was your mother’s maiden name?”
“She was a goy if that’s what you’re asking.”
Martin scratched his crown of salt and pepper hair. “Why’d she have you adopted?”
“She had encountered too much anti-Semitism. She didn’t want us to have to deal with it.” He paused. “But enough of the true confessions. At Monday conference I’m going to make a point of telling the residents to report any proselytizing.”
Martin motioned for them to start running again. “Might want to think on that before you do.”
“Why?”
“’Cause it’ll just cause more problems than it’s worth. You made your point with Clarence, so I think you’re good. That is, until Reynolds gets back. After that, well, who knows what the hell’s gonna happen.”
49
“I’d prefer it if Estella can stay in the room with us,” Meredith Costello said preemptively when Alex entered the exam room.
Alex closed the door and plunked down on the rolling stool. “No problem. Hope you don’t mind me asking, what’s your relationship?”
“She’s my life partner,” Meredith said with a hint of defiance.
Ah. “No problem.” Alex stood up from the stool and motioned for her to sit on the exam table. “Let me take a look at your incision.”
As she stared straight ahead, Alex studied the question-mark-shaped wound on the left side of her head and was pleased. Healing well, no more inflammation than normal. “I’m going to remove the staples now.”
Staples removed, Alex returned to the stool, hands clasped together. He dreaded this next part and wished there was some way to telepathically transfer the information rather than having to actually say the words. There wasn’t any, of course, and he certainly didn’t believe in building false hope. After a deep breath, he said, “The pathology report came back and it’s not good, Meredith. You have brain cancer. The formal name of it is a glioblastoma multiforme.” He didn’t add that they’re one hundred percent fatal. “The only thing we need to decide now is what treatment you wish to receive to maximize your quality of life.” He typically paused at this point to allow the awful news to sink in. Usually, the words didn’t fully register until later. Most patients came to this appointment expecting the worst, yet when those fears were realized, they needed time to fully process the implications.
Meredith listened carefully, showing no shock, surprise, or disappointment. She nodded to her partner as if to say, “See, told you so.” Then her eyes misted up as she blinked away tears. “How long do I have?”
Ah, so she did understand. “Can’t say for sure. All I can give you are the broad statistics. With no additional treatment you have perhaps six months to a year. Radiation might extend that by six months. Chemotherapy alone isn’t as effective as radiation, but by combining chemo with radiation, you can perhaps eke out a few extra weeks.”
“A few weeks?” She snorted a sarcastic laugh. “At what price? I mean, what’re the side effects of that combination? I’ve heard some awful things about chemo. Terrible things.” Having anticipated the bad news, she’d prepared the right questions.
Personally, with the present state of the art, Alex wouldn’t choose chemo. The only effective drug—if you could call it that—was BCNU, a drug neurosurgeons darkly referred to as “Be Seeing You.”
“Well, you can always hold off on the chemo and add it later if you change your mind. But I strongly advise you to start the radiation as soon as possible. The wound’s healed enough to be able to tolerate it.” Because the objective of radiation was to kill replicating cells, it was not a good idea to radiate fresh wounds that were still laying down fresh scar tissue.
Now came the part of his canned dialog he hated, because it was intended to instill false hope. “A lot of research is being focused on this problem, and several new drugs are in the pipeline. Who knows, maybe tomorrow we’ll have one with superior effectiveness to what’s now available. What I’m saying is, don’t give up hope.” He hated himself for saying this, because he knew nothing worth a damn was presently in a clinical trial. And if a new drug did come along, Meredith would most likely be dead by the time it could be used on her.
She looked him straight in the eye. “You really don’t believe that, do you Doctor Cutter?”
He hesitated a beat. “Yes, I do believe it.”
She nodded as if to say, “I forgive you for lying.”
“Don’t forget one thing,” he added. “A few patients with this tumor have survived.” But in all likelihood their pathology had been misread. Alex personally reviewed slides of every patient with the pathologist, so he harbored no doubt hers was the real thing. She was terminal and it broke his heart to be the one to tell her.
Betsy Lou poked her head into the room. “Doctor Cutter, see you a moment?”
In the hall, exam room door closed, he asked, “What is it?”
“They want you in surgery STAT. Someone’s in trouble.”
“Who?”
“Don’t know, but it sounds urgent.”
“Okay, tell you what. Explain the situation to Meredith. Then schedule her to see Tom Thatcher.” Tom was the radiation oncologist to whom Alex referred patients. “Set her up to start radiation ASAP. Schedule another wound check in two weeks.” He monitored wounds closely during the radiation treatments.
Alex inspected his left palm. Two months ago the skin in the center had broken down to the point of being continually red, painful, and weeping—on the verge of bleeding. The right palm wasn’t as bad but was heading in the same direction. He’d begun to not scrub the area with the disposable plastic sponges, yet during long cases the area would weep, forcing him to double glove.
“What’s up?” Alex asked no one in particular as he shouldered through the OR doors, taping his loupes to the bridge of his nose to hold them in place. The operating room chill immediately sprouted goose bumps on his exposed flesh. The surgeon, Dana Cramer, was one he barely knew. She was second banana in a two-person group that kept to themselves and had never been included in resident coverage. If they got in trouble, they relied on the university surgeons to help.
Cramer’s body language radiated anger and tension. “What took you so long?”
“Hey, I’m here, aren’t I? Had to change into scrubs. What’s the problem?”
“Got a real motherfucker of a bleeder. Can’t control it.” She had stuffed a lap pad into the wound and was holding pressure on it.
Alex stepped in for a closer look, keeping well away from the operative field to prevent contaminating it. “What kind of case is this?” He saw the right side of the patient’s neck exposed in the field.
“Carotid endarterectomy.” She nodded at the X-rays on the view box. The series of shots had been taken as contrast material was passing through the neck vessels. It showed a severely clogged carotid artery, a bad case of carotid stenosis. “Where’s your partner?” he asked out of curiosity.
“You going to help or play twenty questions?”
He did a double take while seriously considering telling her to “fuck off.” Instead, he turned to the scrub tech who, being an employee of Cramer’s group, wasn’t familiar with his routine. “I wear seven and a half browns.”
Outside the room, at the scrub sink, he kneed on the water valve and began to wash his hands with Betadine. Because of the palm sores, he didn’t bother with the more abrasive scrub brush. It was time to make an appointment with Seth Kaufman, the dermatologist three floors above his office. Garrison had recommended him a week ago, but Alex hadn’t gotten around to scheduling a visit because of his busy schedule. Now the sores were becoming a problem he couldn’t ignore, and the risk of them contaminating a wound was forcing the issue.
“Let me take a look,” he said as he shouldered Cramer out of the way and took control of the lap pad. He asked the anesthesiologist, “What’s his pressure?”
“140 over 60.”
“How many units we have on tap?” He felt uneasy without Cole on the other side of the drapes to help.
“Four units of red cells. Want his BP lowered?”
“Yeah, take it down to whatever you think you can safely get away with.” Lower blood pressure meant less blood pouring out of the bleeding site. “Let me know when you have it bottomed out.”
“Harry’s out of town,” Cramer said, referring to her partner. “That’s why I called.”
“No problem,” he lied. In fact, he resented this group for cherry-picking insured patients and referring all their uninsured to Baptist’s “charity” practice, which was covered by residents, which in turn became his responsibility. That wasn’t the only issue he had with them.
With the blood pressure lowered and Cramer poised with a large-bore sucker, Alex said, “I’m going to take a peek now,” and rolled back the lap pad.
The surgery—to remove cholesterol plaque clogging the artery—requires an incision along a short length of the vessel, directly over the plaque. Once the plaque was scraped off the inner wall, the artery was sewn back together. Although she’d removed the plaque—or at least she
claimed to have—she botched the repair. Now the poorly stitched incision was hemorrhaging along the incision line. With a clear idea of the problem, he replaced the lap pad until they had everything set up and ready to go. The problem now was that each puncture wound from each stitch slightly chewed up the two edges of the incision, and replacing the sutures added more punctures. This forced him to plant new stitches slightly further from the edge, narrowing the artery. He withdrew the lap pad again for a closer inspection. It appeared to be repairable, but only if the original sutures were totally replaced.
Satisfied that he now had a plan, he told the scrub tech, “I want two vascular clamps, small pointed scissors, and pick-up. Then load me up a 4-0 Vicryl on a vascular needle.” He planned on using one long suture for a running closure instead of individual sutures.
“Change that to nylon,” Cramer corrected.
Alex’s patience just reached the edge of a cliff. “You want me to do this, or do you want to do it? Be my guest, because I have a full clinic waiting on me.”
“I use nylon,” she said defensively.
“Fine, but I don’t. What’s it going to be? Your call.”
“Oh, for Christ’s sake, go ahead.”
Alex removed the failed sutures as carefully as possible to preserve damaging the edges more. With the old suture gone, he quickly sewed shut the incision and removed the arterial clamps, reestablishing blood flow in the vessel. “Okay, bring the pressure back up to normal and let’s see how it holds.” He glanced at the wall-mounted stopwatch. The amount of time the vessel had been clamped was well within safe limits. Keep the vessel clamped too long and you risk a stroke. The suture held securely.
“Okay, we’re golden. Lay down some thrombin-soaked Gelfoam over that and close it up.” He stripped off his gloves. “I’m out of here.”
“Thanks,” Cramer mumbled begrudgingly.
Alex was able to score the one remaining donut from the lounge’s morning supply—a plain cake one, always the last to go—along with a cup of coffee. He munched the donut while changing back into slacks and a sports coat. As he was leaving the lounge, “Doctor Cutter to OR Five, STAT,” came from the overhead speakers.