Robin Cook - Godplayer

Cassi’s eyes blinked open. It was a little after five in the morning and was not yet light outside. The alarm wasn’t scheduled to go off for another two hours.

For a while she lay still, listening. She thought perhaps some sound had awakened her but as the minutes passed, she realized that the disturbance had come from within her head. It was the classical symptom of depression.

At first Cassi tried turning over and drawing the covers up over her head, but she soon recognized it was useless. She couldn’t go back to sleep. She got out of bed, knowing full well that she would be exhausted that day, especially since Thomas had made her accept an invitation to go to the Ballantines that evening.

The house was frigid, and she was shivering before she got on her bathrobe. In the bathroom she turned on the quartz heater and started the shower.

Stepping under the water, Cassi reluctantly allowed herself to remember the reason for her depression-the discovery of the Percodan and the Talwin in Thomas’s desk. And Patricia was undoubtedly going to inform her son that Cassi had again been snooping in his study. Thomas would guess that she’d been looking for drugs.

Getting out of the shower, Cassi tried to decide what to do. Should she admit she’d found the drugs and confront him? Was the presence of the drugs sufficiently incriminating? Could there be another explanation for their presence in Thomas’s desk? Cassi doubted it, considering the additional fact of Thomas’s frequently pinpointed pupils. As much as Cassi did not want to believe it, Thomas was most likely taking the Percodan and Talwin. How much, Cassi had no idea. Nor did she have any idea how much she was to blame.

The thought occurred to Cassi that maybe she should seek help. But who to turn to? She had no idea. Patricia obviously wasn’t the answer, and if she went to any of the authorities, then Thomas’s career could be ruined. Cassi felt almost too depressed to cry. It was a no-win situation. No matter what she did or didn’t do, it was going to cause trouble. Lots of trouble. Cassi was aware that her relationship with Thomas could very well be at stake.

It took all her strength to finish getting ready for work and make the long drive to the hospital.

Cassi had no more than dumped her canvas bag on her desk when Joan’s head came through the door.

“Feeling any better?” asked Joan brightly.

“No,” said Cassi in a tired, flat voice.

Joan could sense her friend’s depression. From a professional point of view she knew Cassi was worse than she’d been the previous afternoon. Unbidden, Joan came into Cassi’s office and closed the door. Cassi didn’t have the energy to object.

“You know the old aphorism about the sick doctor,” said Joan: “ ‘He who insists on taking care of himself learns he has a fool for a patient.’ Well, that applies in the emotional realm as well. You don’t sound so good to me. I came in here to apologize for foisting my opinions on you yesterday, but looking at you now, I think it was the right thing to do. Cassi, what’s happening to you?”

Cassi was immobilized.

There was a knock on the door.

Joan opened it and confronted a tearful Maureen Kavenaugh.

“Sorry, Dr. Cassidy is occupied,” said Joan. She closed the door in Maureen’s face before the woman could respond.

“Sit down, Cassi,” said Joan firmly.

Cassi sat down. The idea of forceful direction was appealing.

“Okay,” said Joan. “Let’s hear what’s going on. I know you have your hands full with your eye problem. But it’s more than that.”

Once again Cassi recognized the seductive pressure of the psychiatric interview on the patient to talk. Joan inspired confidence. There was no doubt about that. And Cassi could be assured of confidentiality. And in the last analysis Cassi desperately wanted to share her burden with someone. She needed some insight if not merely support.

“I think Thomas is taking drugs,” said Cassi in a voice so low Joan could barely hear. She watched Joan’s face for the expected signs of shock, but there weren’t any. Joan’s expression didn’t change.

“What kind of drugs?” asked Joan.

“Dexedrine, Percodan, and Talwin are the ones I know of.”

“Talwin is very common among physicians,” said Joan. “How much is he taking?”

“I don’t know. As far as I am aware, his surgery hasn’t suffered in the slightest. He’s working as hard as ever.”

“Uh huh,” nodded Joan. “Does Thomas know you know?”

“He knows I suspect the Dexedrine. Not the others. At least not yet.” Cassi wondered how soon Patricia would tell Thomas she’d been in his study.

“There’s a euphemistic term for this,” said Joan. “It’s called the ‘impaired physician.’ Unfortunately it is not all that uncommon. Maybe you should read up on it; there’s a lot of material in the medical literature although doctors themselves usually hate to confront the problem. I’ll give you some reprints. But tell me, has Thomas exhibited any of the associated behavioral changes-like embarrassing social behavior or disruption of his appointment schedule?”

“No,” said Cassi. “As I said before, Thomas is working harder than ever. But he did admit that he is getting less enjoyment from his work. And he seems to have less tolerance lately.”

“Tolerance for what?”

“For anything. For people, for me. Even his mother, who essentially lives with us.”

Joan rolled her eyes. She couldn’t help it.

“It’s not that bad,” said Cassi.

“I’ll bet,” said Joan cynically.

The two women studied each other in silence for a few minutes.

Then Joan asked tentatively, “What about your married life?”

“What do you mean?” asked Cassi evasively.

Joan cleared her throat. “Often physicians abusing drugs will suffer episodes of impotence and actively seek extramarital affairs.”

“Thomas has no time for extramarital affairs,” said Cassi without hesitation.

Joan nodded, beginning to think that Thomas did not sound very “impaired.”

“You know,” said Joan, “your comment about Thomas’s low frustration level and the fact that he’s getting less enjoyment from his work these days is suggestive. Many surgeons are slightly narcissistic and share some of the side effects of the disorder.”

Cassi didn’t respond, but the concept made sense.

“Well, it’s food for thought,” said Joan. “It’s an interesting idea that Thomas’s success could be a problem. Narcissistic men need the kind of structure and constant feedback you get in a competitive surgical residency.”

“Thomas did remark that there was no longer anyone for him to compete with,” said Cassi, catching Joan’s train of thought.

Just then Cassi’s phone rang. As Joan watched her friend pick up the receiver, she was pleased. Cassi was already acting less depressed. In fact, she managed a smile when she realized it was Robert Seibert.

Cassi kept the conversation brief. After she hung up, she told Joan that Robert was in seventh heaven because he got another SSD case.

“That’s wonderful,” said Joan sarcastically. “If you’re about to invite me to the autopsy, thanks but no thanks.”

Cassi laughed. “No, in fact I declined myself. I’ve scheduled patients all morning, but I told Robert I’d come up at lunch to go over the results.” Talking about time made Cassi glance at her watch. “Uh oh! I’m late for team meeting.”

The meeting went well. There’d been no catastrophes overnight nor any new admissions. In fact, the resident on call was pleased to report that he’d gotten nine hours of undisturbed sleep, which made everybody extremely jealous. Cassi got a chance to discuss Maureen’s sister, and the consensus was that Cassi should encourage Maureen to contact her herself. There was general agreement that it was worth the risks to bring the sister into the treatment process if possible.