Robin Cook - Godplayer

Disposing of the towel, Thomas slipped on the sterile gown held by Teresa. Then he thrust his hands into special brown rubber gloves. As if on cue, Dr. Larry Owen, the senior cardiac surgery fellow, looked up from the operative field.

“Mr. Campbell is all ready for you,” said Larry, making room for Thomas to approach the OR table. The patient lay with his chest fully opened in preparation for the famous Dr. Kingsley to do a bypass procedure. At Boston Memorial it was customary for the senior resident or fellow to open as well as close such operations.

Thomas stepped up to his position on the patient’s right. As he always did at this point, he slowly reached into the wound and touched the beating heart. The wet surface of his rubber gloves offered no resistance, and he could feel all the mysterious movement in the pulsating organ.

The touch of the beating heart took Thomas’s mind back to his first major case as a resident in thoracic surgery. He had been involved in many operations prior to that, but always as the first assistant, or second assistant, or somewhere down the line of authority. Then a patient named Walter Nazzaro had been admitted to the hospital. Nazzaro had had a massive heart attack and was not expected to live. But he did. Not only did he survive his heart attack, but he survived the rigorous evaluation that the house staff doctors put him through. The results of the work-up were impressive. Everyone wondered how Walter Nazzaro had lived as long as he had. He had occlusive disease in his main left coronary artery, which had been responsible for his heart attack. He also had occlusive disease in his right coronary artery with evidence of an old heart attack. In addition he had mitral and aortic valve disease. Then, as if that weren’t enough, Walter had developed an aneurysm, or a ballooning of the wall, of his left ventricle of his heart as a result of the most recent heart attack. He also had an irregular heart rhythm, high blood pressure, and kidney disease.

Since Walter was such a fund of anatomic and physiologic pathology, he was presented at all the conferences with everyone offering various opinions. The only aspect of his case that everyone agreed upon was the fact that Walter was a walking time bomb. No one wanted to operate except a resident named Thomas Kingsley, who argued that surgery was Walter’s only chance to escape the death sentence. Thomas continued to argue until everyone was sick of hearing him. Finally the chief resident agreed to allow Thomas to do the case.

On the day of surgery, Thomas, who had been working with an experimental method of aiding cardiac function, inserted a helium-driven counterpulsation balloon into Walter’s aorta. Anticipating trouble with Walter’s left ventricle, Thomas wanted to be prepared. Only after the operation had begun did the reality of the situation dawn on him. Excitement had changed to anxiety as Thomas began to follow the plan he had outlined in his mind. He would never forget the sensation he experienced when he stopped Walter’s heart and held the quivering mass of sick muscle in his mind. At that moment he knew it was in his power to restore life. Refusing to consider the possibility of failure, Thomas first performed a bypass, an experimental procedure in those days. Then he excised the ballooned area of Walter’s heart, oversewing the defect with rows of heavy silk. Finally, he replaced both the mitral and aortic valves.

The instant the repair was complete, Thomas tried to take Walter from the heart-lung machine. By this time, unknown to Thomas, a significant audience had gathered. There was a murmur of sadness when it was obvious that Walter’s heart did not have the strength to pump the blood. Undaunted, Thomas started the counterpulsation device he had positioned before the operation.

He would always remember his elation when Walter’s heart responded. Not only was Walter taken off the heart-lung machine, but three hours later in the recovery room even the counterpulsation assist was no longer needed. Thomas felt as if he had created life. The excitement was like a fix. For months afterward he was carried away by open-heart surgery. Reaching in, touching the heart, defying death with his own two hands-it was like playing God. Soon he found he became deeply depressed without the excitement of several such operations a week. When he went into practice he scheduled one, two, three such procedures a day. His reputation was so great that there was an endless stream of patients. As long as the hospital allowed him sufficient time in the OR, Thomas was supremely happy. But if another department or the boys in full-time academic medicine attempted to cut back his operating hours, Thomas became as tense and angry as an addict deprived of his daily drug. He needed to operate in order to survive. He needed to feel Godlike in order not to consider himself a failure. He needed the awed approval of other people, the unquestioning approval that was in Larry Owen’s eyes this moment as he asked, “Have you decided if you’re going to do a double or triple bypass?”

The question brought Thomas back to the present.

“It’s a good exposure,” said Thomas, appreciating Larry’s work. “We might as well do three provided you got enough saphenous vein.”

“More than enough,” said Larry with enthusiasm. Prior to opening the chest, Larry had carefully removed a length of vein from Mr. Campbell’s leg.

“All right,” said Thomas with authority. “Let’s get this show on the road. Is the pump ready?”

“All ready,” said Phil Baxter, checking his dials and gauges.

“Forceps and scalpel,” said Thomas.

Swiftly but without haste, Thomas began to work. Within minutes the patient was on the heart-lung machine. Thomas’s operative technique was deliberate and without wasted motion. His knowledge of the anatomy was encyclopedic, as was his sense of feel for the tissue. He handled sutures with an economy of precise motion that was a joy for the aspiring surgeons to watch. Every stitch was perfectly placed. He’d done so many bypass procedures, he could almost function by rote, but the excitement of working on the heart never failed to stir him.

When he was through and convinced the bypasses were all sound and there was no excessive bleeding, Thomas stepped back from the table and snapped off his gloves.

“I trust you’ll be able to put back the chest wall the way you found it, Larry,” said Kingsley, turning to leave. “I’ll be available if there is any trouble.” As he left, he heard an audible sigh of appreciation from the residents.

Outside the operating room, the corridor was jammed with people. At that time of day, midafternoon, most of the thirty-six operating rooms were still occupied. Patients, either going to or coming from their surgery, were wheeled through on gurneys, sometimes with teams of people in attendance. Thomas moved among the crowd, occasionally hearing his name whispered.

As he passed the clock outside of central supply, he realized that he’d done Mr. Campbell in less than one hour. In fact, he’d done three bypass cases that day in the time it took most surgeons to do one or two at best.

Thomas told himself that he could have scheduled another operation although he recognized this was not true. The reason he had scheduled only three cases was the bothersome new rule that all surgeons attend Friday afternoon cardiac surgical conference, a relatively recent creation of the chief of the department, Dr. Norman Ballantine. Thomas went, not because he was ordered to do so, but because it had become the ad hoc admitting committee for the department of cardiac surgery. Thomas tried not to think about the situation, because whenever he did so, it made him furious.

“Dr. Kingsley,” called a harsh voice, interrupting Thomas’s thoughts.