Michael Palmer - The Society

Patty had told him the significance of the two letters in the envelope and had disclosed the other six after extracting the promise that he would share the information with no one. At various breaks in the evening, he tried playing around with the eight letters, but nothing leapt out at him that made any sense.

At two o’clock, suddenly drained, he made his way up to the surgical on-call room and dropped face-first onto the bed. When the jangling phone shattered a bizarre, X-rated dream featuring a scantily clad, green-eyed brunette with a shoulder holster, he had been deeply asleep for three uninterrupted hours. Remarkable. The switchboard operator apologetically reminded him that he had asked for a five-fifteen wake-up call. Just before he tarnished his reputation by calling her insane, he remembered his eight-o’clock case.

If it was possible to call anyone with cancer of the pancreas lucky, Kurt Goshtigian qualified. In general, by the time pancreatic cancer caused any symptoms, it was too late for anything except condolences and maybe some palliative chemotherapy. But Goshtigian’s tumor had been diagnosed by accident on a CT scan done after a beam swung loose on the construction site where he was working and struck him in the lower chest. There was nothing more than a deep bruise from the impact of the beam, but an incidental finding, still well-contained in the portion of the pancreas referred to as the head, was a cancer. Now, a week later, Will was about to cure that cancer through the surgical approach known as a Whipple procedure.

He showered, dressed in a fresh set of scrubs, and paid his customary early-morning visit to the ER lounge for coffee, OJ, and a doughnut with the soon-departing night-shift crew. He was surprised to find Gordo there, powdered sugar still flecked in his beard like Christmas snow. He was regaling the nurses with one of his trademark jokes-the one dealing with lan MacGregor, seated at his usual spot at the bar, deeply and morosely in his cups and, of course, speaking in the heaviest of brogues.

“‘. . See that pier out there,’ MacGregor says, ‘I built that pier. So, do they call me MacGregor-the-Pier-Builder? Noooo! And that shed over there. I built that, too. Do they call me MacGregor-the-Shed-Builder? Noooo! And. . and that stone wall out there? I set every single one of them stones in place myself. So am I known as MacGregor-the-Stone-Setter? Noooo! But fuck one lousy goat. .’ ”

Will joined in the laughter. Even though he had heard the joke enough to qualify as an expert on it, Cameron’s delivery was hilarious enough to make it fresh every time.

“Gordo, what are you doing here at this ungodly hour?”

“Kristin’s snoring woke me up. She swears it was me waking us both up, in addition to the neighbors and a bunch of them in the cemetery down the street, but I know better. Since the powers that be are about to put me on probation for not getting my discharge summaries dictated, and since I’m going to be spending twenty or thirty hours assisting you with that Whipple, I thought I would come on in and get caught up.”

“Kristin’s like a hundred and fifteen pounds,” Will told the crew. “Somehow, I can’t imagine her snoring any louder than a sparrow if she ever even snores at all. My money’s on the Scotsman here. Did you guys save me my jelly stick?”

“We practically had to pry it out of Dr. Cameron’s hands with a crowbar,” a nurse said, “but there it is.”

“Hey, Gordo, you know jelly stick’s my lucky doughnut. I can’t start a big case like this Whipple without having had one.”

“Mea culpa,” Cameron said, “but excuse me for pointing out that it’s the poor slob you’re operating on that needs the luck.”

“Good point.”

Will knew he wasn’t kidding himself about the jelly stick. For as long as he could remember, he had been a creature of lucky maneuvers and talismans, of lucky shirts and rituals. Although his superstitions didn’t run so deep as to paralyze him or even alter his life very much, he did cling to certain routines and clothing when playing poker with his friends in their monthly game or when preparing to do a case in the OR.

After fifteen minutes of small talk, and another Scottish joke, Cameron headed off to the dictation carrels in the record room and Will made his way to the medical library. The Whipple he was about to perform on Kurt Goshtigian was among the most complicated of surgical procedures. Developed in the thirties, the technique was necessitated because the pancreas is anatomically not clearly separated from the GI structures surrounding it-the gallbladder, the duodenum segment of the small intestine, the bile duct, and often the stomach, as well. After the cancerous head of the pancreas and parts of the other organs were removed, the remaining portions would be sutured back to the small intestine to restore continuity and function. Gordo’s sarcastic reference to Will’s painstaking, time-consuming technique in the OR notwithstanding, if things went well, the operation would take four to six hours, and the result would be a cure.

Will had performed or first assisted on fifteen or so Whipples over the years-certainly enough to feel confident about the procedure. Still, the technique and anatomy were complex and variable enough to warrant reviewing them before stepping into the arena. It was crucial before beginning the Whipple to examine the area thoroughly using a laparoscope in order to be as convinced as possible that there was no cancer outside the head of the pancreas. Evidence that the disease had spread to local organs or the inner wall of the abdomen would mean that it was essentially incurable and would strongly if not absolutely mitigate against a procedure as extensive as this one.

After forty minutes of review and actually performing the operation in his mind, Will felt energized and ready. He called the twins to wish them a good day and to review the plans for the rest of their weekend together. Then he made rounds on his three hospitalized patients and finally headed up to the OR suite in the east wing of the second floor.

Thanks to a huge gift from a grateful family’s trust, the surgeons’ dressing room, like the ORs, was state-of-the-art-plushly carpeted with three private showers and a steam room. Following a routine from which he seldom if ever varied, Will left his wallet and watch on the shelf of his locker, laced up his red Converse Chuck Taylors left foot first, pulled disposable shoe covers over them right foot first, tied on a hair cover, then a mask, and finally slipped on the glasses and magnifying loupes he only used in the OR. Next, for five minutes he sat, eyes closed, breathing deeply and slowly, making no real attempt at clearing extraneous thoughts from his mind, but willing himself to relax and thanking God for the opportunity and skill to be a surgeon. By the time he was ready to enter the scrub room, he was experiencing a most pleasant calmness and euphoria. They were sensations he had come to expect, although this one was even more intense than what he was accustomed to.

Kurt Goshtigian was just being wheeled up to the OR when Will entered the scrub room. Gordo, already scrubbed and gowned, was on the other side of the glass OR door, along with a surgical resident who would do the prep and drape on Goshtigian’s abdomen. Will hurried past the scrub sinks and out of the narrow room and caught up with his patient’s stretcher, actually bumping into it, just as it reached the OR. Goshtigian was a solid, weathered fifty-four-year-old with tattoos on his muscular forearms and over his deltoids. His coarse black hair was graying, and his silver stubble suggested he hadn’t shaved for a couple of days. Will pulled his mask down and apologized to the man for bashing into him.

“I’m pretty sure I’ve never done that before,” he said, wondering if maybe he shouldn’t have broken his routine by rushing out of the scrub room.