Robin Cook - Godplayer

After testing her urine again, Cassi went to the refrigerator and removed a package of regular insulin and one of Lente insulin. Using the same syringe, she drew up a half cc of the U100 regular and then one-tenth cc of the U100 Lente. Knowing she had injected herself in her left thigh that morning, she chose a site on her right thigh. The whole procedure took less than five minutes.

After a quick shower, Cassi knocked on the door to Thomas’s study. When she entered she sensed that Thomas was more relaxed. He’d just finished buttoning a fresh shirt and ended up with more buttons than buttonholes when he got to the top.

“Some surgeon you must be,” teased Cassi, rapidly fixing the problem. “I met a medical resident whom you impressed last night. I’m glad he didn’t see you buttoning your shirt.” Cassi was eager for light conversation.

“Who was that?” asked Thomas.

“You helped him on a resuscitation attempt.”

“It wasn’t a very impressive effort. The man died.”

“I know,” said Cassi. “I watched the autopsy this morning.”

Thomas sat down on the sectional sofa, pulling on his loafers.

“Why on earth were you watching an autopsy?” he asked.

“Because it was a post-cardiac-surgical case where the cause of death was unclear.”

Thomas stood up and began to brush his wet hair. “Did the entire department of psychiatry go up to watch this event?” asked Thomas.

“Of course not,” said Cassi. “Robert called me and…”

Cassi paused. It wasn’t until she’d mentioned Robert’s name that she remembered the talk they had had in the car. Fortunately Thomas kept brushing his hair.

“He said that he thought there was another case for the SSD series. You remember. I’ve spoken to you about that before.”

“Sudden surgical death,” said Thomas as if he were reciting a lesson in school.

“And he was right,” said Cassi. “There was no obvious cause of death. The man had had a bypass operation by Dr. Ballantine…”

“I’d say that was a sufficient cause,” interrupted Thomas. “The old man probably put a suture right through the Bundle of His. It knocks out the heart’s conduction system, and it’s happened before.”

“Was that your impression when you tried to resuscitate him?” asked Cassi.

“It occurred to me,” said Thomas. “I assumed it was some sort of acute arrhythmia.”

“The nurses reported the patient was very cyanotic when they found him,” she said.

Thomas finished his hair and indicated he was ready for dinner. He gestured toward the hall while he spoke: “That doesn’t surprise me. The patient probably aspirated.”

Cassi preceded Thomas out into the hall. From the autopsy she already knew the patient’s lungs and bronchial tubes had been clear, meaning he had not aspirated anything. But she didn’t tell that to Thomas. His tone suggested he’d had enough of the subject.

“I would have thought that beginning a new residency would keep you busy,” said Thomas, starting down the stairs. “Even a residency in psychiatry. Aren’t they giving you enough work to do?”

“More than enough,” said Cassi. “I’ve never felt quite so incompetent. But Robert and I have been following this SSD series for a year. We were eventually going to publish our findings. Then, of course, I left pathology, but I truly think Robert is onto something. Anyway, when he called me this morning I took the time to go up and watch.”

“Surgery is serious business,” said Thomas. “Particularly cardiac surgery.”

“I know,” said Cassi, “but Robert has seventeen of these cases now, maybe eighteen if this new one checks out. Ten years ago SSD only seemed to occur in patients who were in coma. But lately there’s been a change. Patients who have come through surgery with flying colors are seemingly dying postop without cause.”

“When you consider the number of cardiac cases done at the Memorial,” said Thomas, “you must realize how insignificant a percentage you’re talking about. The Memorial’s death rate is not only well below the average, it’s equal to the best.”

“I also know that,” said Cassi. “But still it’s fascinating when you consider the trend.”

Thomas suddenly took Cassi’s arm. “Listen, it’s bad enough that you chose psychiatry as a specialty, but don’t try embarrassing the surgical department about our failures. We are aware of our mistakes. That’s why we have a death conference.”

“I never intended to cause you embarrassment,” said Cassi. “Besides, the SSD study is Robert’s. I told him today that he was going to have to carry on without me. I just think it’s fascinating.”

“The competitive climate of medicine always makes other people’s mistakes fascinating,” said Thomas, gently propelling Cassi through the archway into the dining room, “whether they are legitimate mistakes or acts of God.”

Cassi felt a pang of guilt as she thought about the truth of Thomas’s last statement. She never considered it that way, but it was true.

As they entered the dining room, Harriet gave them a petulant glance and said that they were late.

Thomas’s mother was already seated at the table. “It’s about time you two showed up,” she said in her strong, raspy voice. “I’m an old woman. I can’t go this long before dinner.”

“Why didn’t you eat earlier?” said Thomas, taking his chair.

“I’ve been by myself for two days,” complained Patricia. “I need some human contact.”

“So I’m not human, am I?” said Harriet with annoyance. “The truth has finally come out.”

“You know what I mean, Harriet,” said Patricia with a wave of her hand.

Harriet rolled her eyes and began serving the casserole.

“Thomas, when are you going to get that hair of yours cut?” said Patricia.

“As soon as I have a little extra time,” said Thomas.

“And how many times do I have to tell you to put your napkin on your lap,” said Patricia.

Thomas pulled the napkin from the silver holder and threw it onto his lap.

Mrs. Kingsley placed a minute amount of food in her mouth and began chewing. Her bright blue eyes, similar to Thomas’s, ranged around the table, following Harriet’s progress, waiting for the slightest slip-up. Patricia was a pleasant-looking, white-haired lady with a will of iron. She had smoked Lucky Strikes for years and had deep creases running from her mouth like spokes on a wheel. She was obviously lonely, and Cassi continually wondered why the woman didn’t move to some place where she’d have friends her own age. Cassi knew the thought was motivated by her own interests. After more than three years of eating almost every evening meal with Patricia, Cassi longed for a more romantic end to the day. Despite Cassi’s strong feelings in this regard, she never said anything. The truth of the matter was that Cassi had always been intimidated by this woman, and she’d been reluctant to offend her and thereby incur Thomas’s wrath.

Still and all, Cassi got along passingly well with Mrs. Kingsley, at least from Cassi’s perspective, and she did feel sorry for the woman, living in the middle of nowhere over her son’s garage.

After Harriet served, the dinner proceeded in silence, punctuated by silver clanking against china and whispered negatives to Harriet who tried to force seconds on everyone. It wasn’t until they were almost finished that Thomas broke the silence: “My surgeries went well today.”

“I don’t want to hear about death and disease,” said Mrs. Kingsley. Then she turned to Cassandra and said, “Thomas is just like his father, always wanting to discuss his business. Never could talk about anything important or cultural. Sometimes I think I would have been better off if I’d never married.”