Ken McClure: Past Lives

Macandrew thumbed back the catches on his briefcase and took out a clear plastic file of notes on the patient he would be operating on this morning. He took them over to a seat by the window and sipped his coffee as he flicked through them. Jane Francini was thirty-four years old, two years younger than he himself and had been suffering from increasingly severe pain behind her eyes. She had been treated for migraine by her own physician for several weeks before finally being referred to the Med Centre where a battery of tests had revealed the presence of a tumour in her pineal gland. This morning Macandrew was going to remove it.

Normally, the surgical aspects of this procedure would present no special problems but Jane Francini had a history of heart trouble and had undergone cardiac surgery less than three years before. There was a question mark over her level of general fitness to undergo major surgery but only an academic one. The operation was essential. The tumour had to go.

Jane’s husband, Tony Francini, a successful businessman who sold farm machinery all over the mid-west, had been keen for her to have the operation done at one of the big teaching hospitals on the West Coast, but Saul Klinsman, chief of neurosurgery at the Med Centre, had persuaded him that Kansas City could handle the job. Francini had finally agreed but only after an aggressive inquisition of Macandrew on learning that he would be the surgeon doing the operation.

Macandrew’s background of Columbia Medical School and subsequent positions in several prestige-name hospitals and clinics back east seemed to satisfy Francini whose bluntness had culminated in the question, ‘So what the hell are you doing here?’

Although he did not suffer from the paranoia of some of his more senior colleagues, Macandrew was irritated by Francini’s attitude. He was typical of the type of man who thought financial success an acceptable excuse for a total lack of charm and manners. Macandrew was well aware of his nation’s lack of esteem for the mid-west, assuming that, because its people had the reputation of clinging to the values of a bygone age, science and the arts must be stuck in a similar time warp. They were not entirely mistaken but KC Med Centre was good by any standards.

Macandrew’s original, unashamed career plan had been to work for three years on the East Coast and then head for California in search of big bucks and the good life. He had surprised himself when a job came up in Kansas City and he had applied for it, arguing to Kelly, his girlfriend at the time, that it would be invaluable in adding to his all round experience of American medicine.

The real reason however, was somewhat different and had much to do with his family background. His great grandfather, after emigrating from Scotland, had settled in the mid-west in a place called Weston, Missouri. For reasons, which he himself could not properly explain, he felt that he wanted to follow in his footsteps and reinforce a link with this part of the States. Kelly had made it clear that Kansas was not for her or her planned career in obstetrics. They had kept in touch through phone calls and letters for a while but even that had largely stopped. Kelly had moved on to Johns Hopkins University Medical Center in Baltimore and a different world.

Macandrew saw on the duty schedule that Mike Kellerman would be the anaesthesiologist today. Despite having an off-hand manner, Macandrew knew that he was good. He had worked with him in the past and had never had a moment’s worry over patient stability. He didn’t ask for anything more. He finished reading through Jane Francini’s notes without learning anything new; he hadn’t expected to; he had just been making sure that he hadn’t missed anything.

As he put them down, he became conscious of the radio again. The presenters — two of them, working in tandem — were engaged in a local news round up. The way they fed each other lines and laughed at their own jokes irritated him — a sure sign that he was becoming edgy but then, he always was before an operation.

His walk to the Med Centre followed a route parallel to 39th Street, avoiding the main thoroughfare until it became unavoidable. The sidewalks were in bad condition but he was used to that. No one walked anywhere in Kansas City unless they were too poor to do anything else and therefore didn’t matter in the great scheme of things. Home — car — office, office — car — home was the routine for the overwhelming majority. The lack of people however, made the walk more pleasant — although it was necessary to run the gauntlet of an occasional guard dog, straining at its leash as he passed. The dogs were trained to regard anyone on foot with grave suspicion.

He crossed 39th Street near the intersection with Rainbow Boulevard and entered the Med Centre through the swing doors. Just before he did however, he took off his topcoat in preparation for the warmth he knew would hit him like a wall.

‘Good Morning Doctor Macandrew,’ smiled one of the nurses. ‘Miss Givens has been paging you.’

‘Thanks,’ replied Macandrew mechanically, glancing at the clock on the wall. It was a few minutes after nine. He approached Reception and a woman in her early fifties, wearing ornate glasses, perched on the end of her nose, smiled at him and handed him a piece of paper that she tore from the pad in front of her. ‘Mr Francini would like a word Doctor,’ she said in the manner which fifty-year old women wearing ornate glasses regarded as “gracious”.

Macandrew looked at the paper and saw that Francini had been put in G4, one of the rooms on the ground floor used by staff to give out news of progress or lack of it to friends and family of people brought into the Emergency room. As he passed G3, Macandrew looked in through the small glass panel in the door and saw a Hispanic woman sitting there with a white handkerchief pressed to her face; he could hear sobbing. He hoped Francini couldn’t.

‘Good morning Mr Francini. What can I do for you?’

Francini got up from his chair and smoothed back his shiny black hair with both hands. His suit, silk tie and Gucci shoes spoke of money but his swarthy features said Italian peasant stock.

‘I know Janey’s got to have this operation, Doc, but I just thought I would remind you to be careful with her. She’s the only wife I got.’ Francini laughed at his own joke but it was forced and his eyes remained hard.

‘Of course, Mr Francini.’

‘Shit, I don’t know how you guys do it,’ said Francini affecting a broad grin, which showed off expensive dental work. ‘You’re about to take somebody’s life in your hands and you’re Mister Cool. I gotta hand it to you. You guys are somethin’ else.’

‘It’s my job,’ replied Macandrew. ‘It’s what I’ve been trained to do. I don’t think I’d be very good at selling harvesters.’

Francini snorted and laughed. He said, ‘Hell, anyone can sell harvesters in Kansas. Now, selling harvesters in Boston? That might be different...’ He laughed again.

Macandrew smiled and glanced at his watch. It had the desired effect. Francini said, ‘I won’t hold you back any longer. Just remember what I said, huh?’

‘I will. I promise.’

Macandrew escorted Francini to the front door and then went upstairs to his own office. He phoned and checked with the head nurse that Jane Francini had been given her pre-med on time and that there were no hitches.

‘She’ll be ready for you Doctor,’ replied the nurse.

At nine thirty, Macandrew drained the last of his coffee from a paper cup and went along to surgery to begin scrubbing up. He found Mike Kellerman already there.

‘And how’s Mac the Knife on this fine morning,’ asked Kellerman with a smile.

‘Fine, Mike. How are you?’