Cutter's Trial

by Allen Wyler

  “Don’t shoot the messenger. I’m just telling you the law.”

  Still fuming, Alex pulled the patient chart—an Any Doctor—from the wall holder beside the exam room door. He scanned the information, but not a word registered. He calmed down enough to read it again, forcing his concentration to interpret the words. It didn’t register this time either, because he couldn’t stop rehashing several events in one endless loop: the AVM, the malpractice suit, the preventable fatal air embolism. All reasons to now hate the beloved career he’d worked so hard to obtain. Disasters. He’d killed an innocent man. He’d allowed Stein to kill another patient. How could he continue to do this? Good question.

  As a kid, his grandmother had asked what he wanted to be when he grew up. He’d said, “A doctor.” Everyone laughed, thinking him cute. But at that moment, his life goal cemented into place. He never wavered or entertained second thoughts, almost like a chick imprinting on its mother. In one unconscious moment, he’d mentally pledged blind obedience to a goal that seemingly materialized from nowhere.

  He shook his head and reread the chart. The patient had been initially seen for leg pain two years ago by Martin Berger and had been bouncing back to the clinic for pain meds ever since. Inside the exam room he found a clean-shaven forty-five-year-old male in a white button-down shirt, typical preppy tie, blue blazer, and suntans, the outfit almost a male uniform around here.

  “Morning, Mister Bingham. I’m Doctor Cutter.” Murderer. “What brings you to clinic today?”

  “Morning, Doc. Well, see, got me a bad back. Work injury from years ago. Been disabled ever since. Hurts all the damn time. Hell of a pain. Only relief I get’s from them pain pills. Don’t much cotton to the idea of taking dope all the time, but there’s nothing else I can do.”

  “I see.” Alex thumbed through the chart, looking specifically at past outpatient visits. They were all for pain medication, the most recent being the previous week when Martin saw him. He checked the front sheet to see which doctor originally saw him. An interesting red flag appeared. Mr. Bingham had seen only Any Doctors for an entire year and obviously knew the clinic system well.

  “What kind of work did you do?” Alex asked.

  “Mid-level manager. Retailing.”

  “How’d you injure your back?” He could easily read the initial evaluation but preferred to hear the patient’s own words.

  “Was at work when a shipment comes in. Things we need to put on display ’cause of the holidays and all. Bend over to pick up this here box and hear a loud pop in my back, like bam! Been hurting like the devil ever since.” With a hangdog expression, he sat listing to the right, his left leg extended at the hip, a posture more indicative of hip disease than a low back problem.

  “Pain go down your leg, or is it all in the low back?” he asked, motioning toward the patient’s left leg.

  “Yep, goes down the leg like a red-hot poker.”

  “On a scale of zero to ten, and ten being the worst pain you’ve experienced, where would you rate it at this moment?”

  He answered immediately. “Eleven.”

  “In a twenty-four-hour day, how many hours is it there?”

  “Every damn minute.”

  “What helps it?”

  “Hate to say this, Doc, but them codeines is the only thing does me a lick of good. Oh, and an occasional Valium.” He offered a weak smile. “That seems to help too.”

  Alex made a show of thumbing through the chart notes. “Seems like you come in a lot on days Doctor Berger’s in surgery. Any reason for that?” Alex kept his tone neutral and inquisitive.

  “Have I? Huh! Didn’t realize it.” A smile and a shrug. “Guess that’s just the way things happen.”

  Alex scanned the lab tests, including X-rays. Here, sitting before him, was probably the only back pain patient in the world who Martin Berger hadn’t touched with a scalpel. That alone spoke volumes. Martin’s threshold for surgery was the lowest of any surgeon he’d known. Finished reviewing the chart, Alex asked, “What happened to last week’s prescription?”

  The patient let out a short, forced laugh. “Reckoned you’d ask ’bout that. Well, see, my place got broke into last week. Must’ve been some dope heads ’cause they went straight for my meds. Cleaned me out. Been suffering bad ever since, but I was afraid to ask for more on account of this very reason.”

  Alex closed the chart. “What very reason?”

  That stopped him momentarily. “Well, see, I can hear it in your tone of voice you don’t exactly believe me. This is what I feared might happen. Swear on my mamma’s grave I’m telling y’all the truth.” His hangdog expression morphed into overdone innocence.

  Alex had heard enough, his tolerance suddenly worn thin. Aside from the fact that narcotics shouldn’t be used for treating chronic pain—if in fact this patient actually suffered from it, something he seriously doubted—he wasn’t sure who was more to blame: the doctors who enabled these patients or the patients who connived the doctors. Regardless, he was tired of dealing with them.

  “Know what, you’re right. I don’t believe you. If you hurt as much as you claim, go to Kroger or CVS and buy a bottle of ibuprofen. We’re done here.” Alex stood.

  A shocked expression swept over a reddening face. “Hey, Doc, you shittin’ me? ’Cause I don’t think you’re funny at all. In fact, I think you’re gol-darn insulting.”

  Alex put a hand on the doorknob. “No, I’m not kidding. You can leave now.”

  The patient stood, left leg functioning perfectly well. “I’ll sue your ass, dang nabbit!”

  “Yeah? Go ahead, knock yourself out. But deal with the fact you’re not coming back to this clinic for narcotics. Have a good day.”

  Back in his office, Alex was dictating a note when the phone rang.

  “Doctor Cutter,” the clinic operator said, “a Don Slater from Seattle on line one.”

  Don Slater? Who the hell?

  “… I’m VP of product development with a medical device start-up called Northgate. We just finished a proof-of-principle study and are in the process of planning a feasibility study. I came across several of your papers during my literature search and was interested to see that your research aligns with what we’re doing. The reason I’m calling is to find out if you might have any interest in consulting for us.”

  Kicking the office door shut, Alex dropped into his desk chair. A start-up? Huh. He knew nothing about what that actually meant, although he had a vague idea.

  “When you say consult, what are you looking for?”

  “We need a physician—ideally a neurosurgeon or neurologist like yourself—to help design the protocol for a clinical trial. Because of your work, you’d be a perfect fit. But, before I get ahead of myself, I need to ask if you have consulting agreements or any formal involvement with any other companies. We have to be sensitive to any possible conflict of interest.”

  Easy enough to answer. “No, I don’t.”

  “Excellent. Now comes the tricky part. We prefer to discuss this face to face. I could fly there, but it would be preferable if you could come to Seattle for a meeting. I understand you’re busy, so we will, of course, reimburse your expenses in addition to a per diem.”

  Mind racing, Alex leaned back to stare at the ceiling. Here was a possible opportunity to become involved in research again. The glimmer of hope suddenly made him realize how much he missed that aspect of his life. How long had it been since he took the time to ponder theories and to pore over related publications? That facet of professional life had been smothered by practice. Or was this longing nothing more than a by-product of his present funk? Good question.

  “I’m intrigued. Intrigued enough to come to Seattle.” He glanced at his schedule: surgery booked solid for the next two weeks.

  Slater didn’t waste a moment. “When? We’ll do anything to accommodate your schedule.”

  “How much consulting time are we talking about?”

  “Depends on how much you’re
willing to be involved. Realistically, we could use as much time as you can spare.”

  Alex realized he was getting ahead of himself. “I need to think about this. When do you want an answer?”

  “The sooner the better. Ever worked for a start-up?”

  “No.”

  “They’re tricky, because they’re typically forced to move quickly due to limited money. Our entire future depends on getting the clinical trial up and running, then completed.”

  “I’ll have an answer for you by Friday at the latest.” Something about Slater’s tone—maybe his lack of a southern accent, maybe his directness—resonated.

  “Hope it’s positive.”

  “Mind running out to pick up fried chicken and slaw for dinner?” Lisa asked as Alex came through the back door from the carport. She was at the kitchen sink washing dishes. “Got tied up with the fundraiser planning committee and didn’t get home until a few minutes ago.”

  “Sure, just let me change first,” he said, continuing through the kitchen toward the bedroom. “Got an interesting phone call this afternoon.”

  “See if they’ll give you thighs and drumsticks instead of breasts,” she called after him. “I asked for it last time, but they didn’t actually do it. Depends on who waits on you.”

  He changed from his white shirt and tie into cargo shorts and a T-shirt. “It was a start-up in Seattle. They want me to consult for them.”

  She wandered into the bedroom, drying her hands on a dishtowel. “What do they do?”

  He cinched up his belt. “They’re working on a drug delivery system for brain tumors.”

  She sat on the edge of the bed. “Seriously?”

  “Seriously,” he said, slipping on a pair of topsiders.

  “Now I know you’re joking.”

  Since hanging up the phone, he’d been fantasizing on how it might feel to return to research. The intellectual stimulation between colleagues was something he missed in clinical practice. Although he loved his work colleagues—Chuck, Ellen, Cole—the surgeries were mostly mind-numbingly rote, glorified piecework. Slater’s words, “Ideally, we can use as much time as you can spare,” continued to echo through his mind.

  Don’t get ahead of yourself. Take this one step at a time.

  “No, I’m not.”

  “Go get the chicken and then tell me more about it.”

  He sipped wine, thinking of how best to explain the complex emotions that had haunted him these past months. “I grew up believing all I ever wanted to do in life was be a really good doctor. But having two patients die in surgery because of judgment errors has changed me in ways you can’t possibly understand. I’m not sure I can do surgery anymore. Understand what I’m saying?” The disastrous AVM had drained his self-confidence, leaving him edgy and afraid during even the most routine cases at times. As if he finally realized the gravity of his work.

  “I think so. Go on.”

  “Funny how so many things we believe in as children end up being wrong.”

  “Like?”

  “When I was a kid, I somehow thought all policemen were good guys who upheld the law. And maybe most of them are. But then you see videos of cops beating people senseless and you go, ‘Wow, that’s crazy, that’s not right.’” He paused to lick his lips. “For some reason I thought law and justice were equivalent. Ha! How nuts is that?”

  He glanced around the kitchen at the hideous wallpaper Lisa’s designer had talked them into putting up. The house no longer possessed the same magic for him that it once did.

  “Here’s another one: I believed doctors were uniformly good people. Poof, that one went out the window when Dick Weiner entered my life. He’s been cheating the system for years, charging for surgeries he didn’t do, bullying residents into covering for him.” He wondered if Suzuki had made any progress since their last conversation. How long had it been since they last spoke?

  He paused, corralling his thoughts. He wasn’t sure where this ramble was headed or if it made sense, but it felt good to talk.

  “Waters taught me that teaching residents was a high calling. I enjoyed teaching the kids how to make their first incision or turn a bone flap or remove a tumor. I pushed to allow them to be primary surgeon with the argument that there’s no way to acquire manual skills other than doing the actual surgery, that the residents don’t have the equivalent of a flight simulator. Then Steve caused that damn air embolism.” He shook his head regretfully. “I’m the one responsible for that death, not Steve.”

  He now realized where this ramble was headed. “But the one thing I know will haunt me the rest of my life is the AVM. I can’t believe I allowed hubris to cloud my judgment. There’s nothing I can ever do to make amends for that case. It eats at me incessantly. If there’s any possibility of creating a job in Seattle, I think I’m going to try to do that.”

  The next morning Alex walked into the lounge after completing his first case—a routine craniotomy—dropped onto an empty couch, and was immediately struck by the well-worn familiarity of it all: CNN talking heads, scrub-clad surgeons and anesthesiologists milling about, the scent of coffee, pastry, and A/C-tinged air. A homey microcosm of life—warm, inviting, womb-like. He checked the wall clock and calculated West Coast time. From his scrub shirt breast pocket he pulled a folded paper. Using the phone on the end table, he dialed the access number for an outside long-distance line.

  60

  “How was your flight out?” Harold Levine, Northgate CEO, asked Alex.

  Slater had met Alex at the airport, driven him to the hotel, and checked him in. They had just caught up with Levine at a seafood restaurant on the shore of Lake Union.

  “Pretty routine. No drama. Exactly the way I prefer to fly.”

  They sat at a table for four next to floor-to-ceiling windows that featured a stunning view of blue water through a forest of white hulls, masts, and antennas, the clear azure sky darkening to dusk. Alex loved the feel of cool midsummer air in comparison to the constant tangible humidity of where he lived. He also found it soothing to dine next to bobbing white boats, docks, and seagulls.

  “Before we start I would like you to sign a non-disclosure agreement.” Levine handed him a manila envelope. “Don sent you a copy to read. This is exactly the same.”

  Alex removed the paper and signed without more than a cursory glance after verifying it was the same as the one attached to Slater’s e-mail. He returned the signed paper to Levine.

  “Don mentioned you’re open to discussing potential employment. Is that correct?”

  Alex nodded. “Depending upon various factors.”

  “Having a doctor and researcher with your stature on our executive team would be tremendously helpful to the company in numerous ways. The position of chief medical officer would be the equivalent of vice president on the reporting structure. This would seem appropriate. You’d be a voting member of the executive team, which makes you eligible to receive stock options as part of your compensation package.” Levine glanced at Alex’s ring finger. “Where’s your wife from?”

  “We’re both originally from the West Coast.”

  “Is she agreeable to relocating?”

  “We haven’t discussed it since I wasn’t sure if it was a consideration.”

  Levine kept his hands folded on the table. “Don said you’ve not previously been involved with a start-up.”

  The waiter brought their wine. Because all three of them ordered cabernet, the waiter talked them into a bottle of Sterling Reserve. With glasses poured and the waiter gone, Alex answered. “That’s correct. I’ve been involved only with two universities and the clinic.”

  “As I believe he mentioned, being with a start-up requires a different mind-set than most environments. It’s not for everyone. Our investors give us a fixed amount of money and that’s it. We either succeed or we’re out of business. In other words, we watch every penny. This doesn’t mean we cut corners, but it does mean we don’t enjoy various perks as other executives might
. We fly coach instead of business class, for instance. Also, executives aren’t compensated as well as a Fortune 500 company.”

  Alex liked Levine immediately. Straightforward, logical, affable—a style that radiated leadership and competence without coming across as overbearing. Qualities anyone would want in the person they reported to.

  Alex sat in an overstuffed chair in front of the hotel room window, looking at a mosaic of city lights. He should be sleeping, he knew, especially since his biological clock thought it was past his usual bedtime. But too many thoughts were rampaging through his mind for sleep. Once the rush of being in a real city again began to abate, he could relax. But not just yet. The difference in this environment amazed and invigorated him. The crisper air, the more casual style, the edgy alertness in people. Grating accents replaced by saltwater air and seagull cries. Taken together, this felt strangely like home. Sitting here, he couldn’t remember having left the coast.

  The engulfing intensity of work that was layered upon his familiar surroundings—the lounge, OR Three, days spent with Chuck Stevens and Bob Cole—had lulled him into a rhythm that burned away days at a mind-numbing rate. Six o’clock in the morning: a quick breakfast, rounds, surgery, more rounds. Seven o’clock at night: pull into the carport. Friday nights at the University Club with the Canters or one of several other couples. Saturday evenings with Lisa. Sunday evenings catching up on journals and preparing for another week. On and on. Was this how he envisioned spending the remainder of his career? On top of the increasing banality of his routine, each day spent in the OR exposed him to the risk of another disaster, the odds unavoidable. Could he live with that threat hovering overhead?

  He thought of Meredith. He’d written the prescription with her best interests in mind. Would he do it again? Good question. Probably not. The problem was, he’d refuse not for moral reasons but rather because of the fear of getting caught and sued again. This saddened him.