Robin Cook - Godplayer

“The surgery is not definite,” snapped Thomas.

Hearing the anger in Thomas’s voice, Larry looked up. “I didn’t mean it was necessarily definite,” he managed. “I’m sorry I brought it up. It must be difficult for you. I just hoped that she was okay.”

“My wife is perfectly fine,” said Thomas angrily. “Furthermore, I don’t think that her health is any of your business.”

“I’m sorry.”

There was an uncomfortable silence as Larry quickly finished with his shoes. Thomas tied his tie and splashed on Yves St. Laurent cologne with rapid, irritated motions.

“Where did you hear this rumor?” asked Thomas.

“From a pathology resident,” said Larry. “Robert Seibert.”

Larry closed his locker and told Thomas he’d be in the recovery room if he was needed.

Thomas ran a comb through his hair, trying to calm down. It just wasn’t his day. Everyone seemed intent on upsetting him. The idea that his wife’s ill health was a topic of idle conversation among the resident staff seemed inexplicably galling. It was also humiliating.

Placing the comb back in his locker, Thomas noticed a small plastic container. Feeling a rising inner tension and the stirrings of a headache, he flipped open the lid of the bottle. Snapping one of the scored yellow tablets in two, he popped the half into his mouth. Hesitant, he then popped in the other half as well. After all, he deserved it.

The tablets tasted bitter, and he needed a drink from the fountain to wash them down. But almost immediately he felt relief from his growing anxiety.

The Friday afternoon cardiac surgery conference was held in the Turner surgical teaching room diagonally across the hall from the surgical intensive care unit. It had been donated by the wife of a Mr. J. P. Turner, who’d died in the late nineteen-thirties, and the decor had an Art Deco flavor. The room provided seating for sixty, half the medical school class size in 1939. In the front there was a raised podium, a dusty blackboard, an overhead rack of ancient anatomy charts, and a standing skeleton.

It had been at Dr. Norman Ballantine’s insistence that the Friday meeting be held in the Turner teaching room because it was close to the ward, and, as Dr. Ballantine put it, “It is the patients that it’s all about.” But the small group of a dozen or so looked lost among the sea of empty seats and distinctly uncomfortable behind the spartanly designed desks.

“I think we should get the meeting under way,” called Dr. Ballantine over the hum of conversation. The people took their seats. Present at the meeting were six of the eight cardiac surgeons on staff, including Ballantine, Sherman, and Kingsley, as well as various other doctors and administrators, and a relatively new addition, Rodney Stoddard, philosopher.

Thomas watched Rodney Stoddard sit down. He looked like he was in his late twenties despite the fact that he was mostly bald and his remaining hair was such a light color that it was difficult to see it. He wore thin wire-rimmed glasses and an expression of constant self-satisfaction. To Thomas it seemed as if the man were saying, “Ask me about your problem because I know the answer.”

Stoddard had been hired at the university’s insistence. Until recently doctors were committed to trying to save all their patients. But now, with the advent of such expensive and complicated procedures as open-heart surgery, transplants, and artificial organs, hospitals had to pick and choose to whom to give these life-saving operations. For the time being, these techniques were limited by extraordinary costs and by the space available in the sophisticated units needed for aftercare. In general the teaching staff tended to favor patients with multisystemic disease, who did not always do well, while private physicians such as Thomas leaned toward otherwise healthy, productive members of society.

Looking at Rodney, Thomas allowed an ironic smile to steal across his face. He wondered just how self-confident Rodney would feel if he held a man’s heart in his hand. That was a time for decision, not discussion. As far as Thomas was concerned, Rodney’s presence at the meeting was one more indication of the bureaucratic soup in which medicine was drowning.

“Before we start,” said Dr. Ballantine, extending his arms with hands spread out as if to quiet a crowd, “I want to be sure that everyone has seen the article in this week’s Time magazine rating the Boston Memorial as the center for cardiac bypass surgery. I think we deserve it, and I want to thank each and every one of you for helping us reach this position.” Ballantine clapped, followed by George and a smattering of others.

Thomas, who’d sat near the door in case he was called to the recovery room, glowered. Ballantine and the other doctors were taking credit for something that was due largely to Thomas and to a lesser extent to two other private surgeons who happened to be absent. When he had gone into surgery, Thomas thought he would avoid the bullshit that surrounded most other professions. It was going to be him and the patient against disease! But as Thomas looked around the room, he realized that almost everyone at the meeting could interfere with his work because of one aggravating problem-the limited number of cardiac surgical beds and associated OR time. The Memorial had become so famous that it seemed as if everyone wanted to have their bypass there. People literally had to wait in line. Especially in Thomas’s practice. He had been limited to nineteen OR slots a week and he had a backlog of more than a month.

“While George passes out the schedule for next week,” said Dr. Ballantine, extending a stack of stapled papers to George, “I’d like to recap this week.”

He droned on as Thomas turned his attention to the schedule. His own patients were scheduled by his nurse, who collated the necessary information and got it over to Ballantine’s secretary, who typed it up. It contained a capsule medical history of each patient, a listing of significant diagnostic data, and an explanation of the need for surgery. The idea was that everyone at the conference would go over each patient and make sure that the operation was needed or advisable. But in reality it rarely happened, except if you missed the meeting. Once when Thomas had been absent, the anesthesiology department had canceled several of his cases, resulting in a row no one was likely to forget. Thomas continued reviewing the sheets until Ballantine mentioned something about deaths. Thomas looked up.

“Unfortunately there were two surgical deaths this week,” said Dr. Ballantine. “The first was a case on the teaching service, Albert Bigelow, an eighty-two-year-old gentleman who could not be weaned from the pump after a double-valve replacement. He’d been scheduled as an emergency. Is there word on the autopsy yet, George?”

“Not yet,” said George. “I must point out that Mr. Bigelow was a very sick cookie. His alcoholism had seriously affected his liver. We knew we were taking a risk going to surgery. You win some and you lose some.”

There was a silence. Thomas commented sarcastically to himself that Mr. Bigelow’s untimely demise had prompted a stimulating discussion. The galling part was that it was this kind of patient that was keeping Thomas’s patients waiting.

Ballantine glanced around, and when no one spoke he continued: “The second death was a patient of mine, Mr. Wilkinson. He died last night. He was autopsied this morning.”

Thomas saw Ballantine look over at George, who shook his head almost imperceptibly.

Ballantine cleared his throat and said that both cases would be discussed at the next death conference.

Thomas wondered at the silent communication. It brought to mind the weird comment George had made up in the lounge. Thomas shook his head.