Robin Cook - Godplayer

The lights came back on.

“All this shows…” said Robert, pausing as if for effect, “that there was no cause of death in this case.”

The audience responded with surprise. Such a statement was completely unexpected. There were even a few laughs as well as a comment from one of the orthopedic men who asked if this had been one of those cases that had awakened in the morgue. That inspired more laughter. Robert smiled.

“Must have been a stroke,” said someone behind Thomas.

“That is a good suggestion,” said Robert. “A stroke that shut down the breathing while the heart pumped the unoxygenated blood. That would cause deep cyanosis. But that would mean a brain-stem lesion. We went over the brain millimeter by millimeter and found nothing.”

The audience was now silent.

Robert waited for more comments, but there were none. Then he leaned forward and spoke into the microphone: “With permission I’d like to present another slide.”

Cleverly he’d caught the imagination of the gathering.

Thomas had an idea of what was coming.

Robert switched off the lights, then switched on the projector. The slide showed a compilation of seventeen cases, containing comparable data on age, sex, and points of medical history.

“I’ve been interested in cases such as Mr. Wilkinson for some time,” said Robert. “This slide is to show that his is not an isolated case. I have found four similar cases myself over the last year and a half. When I went back in the files, I found thirteen others. If you’ll notice, they have all had cardiac surgery. In each circumstance, no specific cause of death was found. I’ve labeled this syndrome sudden surgical death, or SSD.”

The lights came back on.

Ballantine’s face had turned bright red. “What do you think you are doing?” he spat at Robert.

Under different circumstances Thomas might have felt sorry for Robert. His unexpected presentation did not fit within the rather narrow protocol for a death conference.

Glancing around the room, Thomas saw many angry faces. It was an old story. Doctors did not like to have their expertise questioned. And they were reluctant to police their own.

“This is a death conference, not a Grand Rounds,” Ballantine was saying. “We’re not here for a lecture.”

“In discussing the case of Mr. Wilkinson, I thought it would be enlightening…”

“You thought,” repeated Dr. Ballantine sarcastically. “Well, for your information you’re here as a consult. Did you have something specific to say when you presented this list of supposed sudden surgical deaths?”

“No,” admitted Robert.

Although Thomas preferred to stay silent at such meetings, he had to ask a question: “Excuse me, Robert,” he called. “Did all the seventeen cases have deep cyanosis?”

Robert could not have been more eager to field a question from the audience. “No,” he said into the microphone. “Only five of the cases.”

“That means that the physiologic cause of death was not the same in all these cases.”

“That’s true,” said Robert. “Six had convulsions prior to death.”

“That was probably air embolism,” said another surgeon.

“I don’t think so,” said Robert. “First of all, the convulsions occurred three or more days after surgery. It would be hard to explain that kind of delay. Also when the brains were autopsied, no air was found.”

“Could have been absorbed,” said someone else.

“If there had been enough air to cause sudden convulsions and death,” said Robert, “then there should have been enough to see.”

“What about the surgeons?” called the man behind Thomas. “Were any more heavily represented than others?”

“Eight of the cases,” said Robert, “belonged to Dr. George Sherman.”

A buzz of conversation broke out in the back of the room. George rose furiously to his feet as Ballantine nudged Robert from the podium.

“If there are no further comments…” said Ballantine.

George spoke out: “I think Dr. Kingsley’s comment was particularly cogent. By pointing out that there were different mechanisms of death in these cases, he indicated that there was no reason to try and relate the cases.” George looked over at Thomas.

“Exactly,” said Thomas. He would have preferred to let George sink or swim on his own, but he felt obligated to respond. “It occurred to me that Robert had correlated the cases because of some similarity he saw in their deaths, but that didn’t seem to be the case.”

“The basis of the correlation,” said Robert, “was that the deaths, particularly over the last several years, occurred when the patients were apparently doing well, and there was no anatomic or physiologic cause.”

“Correction,” said George. “No cause was found by the department of pathology.”

“It’s the same thing,” said Robert.

“Not quite,” said George. “Maybe another pathology department would have found the causes. I think it’s more of a reflection on you and your colleagues than anything else. And intimating that there is something irregular about a series of operative tragedies on such a basis is irresponsible.”

“Hear, hear,” shouted an orthopedic surgeon who began to clap. Robert quickly stepped down from the podium. There was an air of tension in the room.

“The next death conference will be one month from today, January seventh,” said Ballantine, switching off the microphone and gathering his papers. He walked off the stage and over to Thomas.

“You seemed to know that kid,” he said. “Who the hell is he?”

“His name is Robert Seibert,” said Thomas. “He’s a second-year pathology resident.”

“I’m going to have the kid’s balls in Formalin. Who does the little turd think he is, coming up here and putting himself up as our Socratic gadfly?”

Over Ballantine’s shoulder, Thomas could see George making his way over to them. He was just as provoked as Ballantine.

“I got his name,” said George menacingly, as if he were revealing a secret.

“We already know it,” said Ballantine. “He’s only in his second year.”

“Wonderful,” said George. “Not only do we have to put up with philosophers, but also smart-ass pathology residents.”

“I heard there was a death this month in one of the cath rooms in radiology,” said Thomas. “How come it wasn’t presented?”

“Oh, you mean Sam Stevens,” said George nervously, watching Robert leave the room. “Since the death occurred during the catheterization, the medical boys wanted to present it at their death conference.”

While Thomas watched Dr. Ballantine and George fume, he wondered what they’d say if he told them that Cassi had been involved with the so-called SSD study. For everyone’s sake he hoped they wouldn’t find out. He also hoped that Cassi had had sense enough not to continue her association with Robert. All it could do was cause trouble.

In a totally dark examination room, Cassi was lying flat on her back and could not have been more uncomfortable. She wasn’t in pain but close to it as she was forced to keep her eye still while Dr. Martin Obermeyer, chief of ophthalmology, shined an intensely bright light into her left eye. Worse than the discomfort was her fear of what the doctor would say. Cassi knew she’d been less than responsible about her eye problem. Desperately she hoped that Dr. Obermeyer would make some reassuring comment as he examined her. But he remained ominously quiet.

Without so much as a word, he shifted the light into her good eye. The beam came from an apparatus that the doctor wore around his head, similar to a miner’s light, but more intricate. Although the light seemed bright in her left eye, when it shifted to the good eye the intensity was so great it was difficult for Cassi to believe it did not cause damage in and of itself.