The surgeon Read online

  Copyright © 1963 by W. C. Heinz

  All Rights Reserved

  Printed in the United States of America

  To the many skilled surgeons

  Author's Note

  This book, which the publisher has decided to call a novel, was not intended to be a fictional portrayal of a surgeon of our time. Rather, it was to be a factual narrative, but early in the research it became obvious that for this effort to obtain its objectives it would have to go beyond the beginnings and experiences of any one man. What those objectives were I shall leave to the reader, but he should know that the professional characters portrayed are composites, and that only those giants of the past, such as Osier, Billroth, Liston, and Evarts Graham are identified by name. Although the surgical cases dealt with are true, the names, occupations, and other identifying characteristics of the patients have been changed to insure privacy.

  Because of the anonymity which the medical profession prefers to impose upon its members I am unable to thank by name those dozen men who gave so freely of their knowledge, patience, and understanding. They know that I am in their debt.

  6:45 AM

  I

  "Good morning, Dr. Carter," the voice of the woman on the phone was saying. "It is now 6:45."

  He had been lying there only half asleep in the heavy gray darkness, half waiting for the phone to ring. When it had rung he had picked it up quickly, before it could ring a second time, he had sat up and swung his legs out from under the covers, and now he was sitting on the side of the bed and, with his feet, finding first one slipper and then the other.

  "At 8 o'clock, Doctor," the woman's voice was saying, "you're at Mercy Hospital for a pneumonectomy. At 1 o'clock you're at University Hospital for a conference. At 2 o'clock you have a mitral stenosis there. At 5 o'clock you're at your office to see patients until 7. At 8:30 you're at the Academy for a meeting of the Medical Society. That's all."

  "Thank you," he said, softly.

  "You're welcome, Doctor," the woman's voice said.

  He sat there for a moment, listening to his wife breathing evenly in the other bed by the heavy-draped windows, and then he bent over and pulled the phone plug out of the wall jack. He stood up and, carrying the phone, he went out and closed the door softly behind him and walked down the dark hall toward the light of the lamp on the table in the foyer.

  Good morning, Doctor, he was saying to himself, hearing the voice again. For twenty years they have been awakening me like this and, unless I have passed them on the street or, perhaps, in a restaurant, I have never even seen them.

  In the foyer he put the phone on the table and plugged it in. Then he went into the guest bathroom.

  For twenty years, he was still thinking, theirs are the first voices I hear each day and I have no idea what they look like and I am seldom even conscious of the difference in one voice from another. The only one I could ever distinguish was that one with the English accent and I suppose I remember her because she sounded so cultured. In fact, I do not even know where that switchboard is they call from, because Carrie pays the Bill, whatever it is, from the office, and every Valentine's Day, instead of Christmas, she sends them that perfume.

  "But what do you want to send them?" she said once. "Mink stoles?"

  "I don't know," he said. "I just wonder how they can use up the perfume everybody else sends them on Christmas by the fourteenth of February."

  "Oh, for John's sake!" she said. "If that's all you have to think about, why don't you at least look at your mail?"

  When he came out of the bathroom he walked to the kitchen and went to the range. He lifted the percolator off one of the back burners and onto a front one, and he could tell from the weight of it that there was enough water in it. He took the top off and saw the fresh coffee grounds and fitted the top back on. Then he turned the gas up under it and, hearing it ignite, he saw the flare of the blue flame and turned it down just enough so that it would not boil over while he shaved.

  What this is going to come down to with this Mr. Scheller this morning, he was thinking, the razor in his right hand and starting to shave the lather from the left side of his face, is about five minutes in the three hours or so it is going to take me to do this thing, if the cancer hasn't spread too far already and if I do it at all. Actually, I can win it in three and a half minutes, or four, but I have those five minutes if I need them, and I lost before because that polyethylene tube slipped. It slipped because it was a first try and I did not flare the flange at the end of it enough, and by the time I had reclamped and recovered I had used up my time. And that, he thought then, is just a professional euphemism, because what I had really used up was my patient's time, not my time but that little Brazilian lawyer's time, the time of that little, dark-haired, dark-eyed Roberto Leon who came into my office so dynamic and decisive and, when I told him what had to be done, said: "I have confidence." I will never forget it, or him, and it was his time.

  As he started to shave the right side of his face he shifted the razor into his left hand, but he did it automatically, without thinking and without remembering. He had begun to develop the dexterity of his left hand in his third year in medical school, so what ambidexterity he possessed was really born of boredom in Parasitical Diseases.

  The course lecture was right after lunch when, as he knew by then, the distribution of his twelve pints of blood would be primarily devoted to supplying his digestive organs rather than his brain, which would be slightly ischemic, or sluggish. Because he went reluctantly, he was always one of the last to file in. He would sit in the back, rather than walk down the tiered, curved rows of the old amphitheater, and down at the bottom, backed against the blackboard, that tall, thin, and tired old Westby —Millard fillmore Westby—would clear his catarrh and begin. He was one of those mumblers who talk to the floor, so what you saw, as you looked down at him from above, was his long and narrow bald head.

  The steam radiators were under the low, curved windows, high in the hack, and near the top of the high room the temperature must have been in the 80s. On clear days in winter the sun's rays would cut across the room on sharp, slanting planes, and in them the dust would settle slowly and somewhere along the back a steam valve would open and a radiator would hiss.

  One day, because the subject was schistosomiasis, which is a disease prevalent in Egypt and the Orient and contracted by wading in infested water, and because he had already decided that he wanted to be a surgeon and would probably never go to Egypt or the Orient anyway, he began to equate the dexterity of his left hand with that of his right. To remain awake he began to write his notes with his left hand, his notebook on the desk arm of the seat to his left, and by the end of the course he could write as legibly, if not as neatly, with his left hand as with his right.

  Sometime during that period he began to shave with his left hand and to brush his teeth with it too. Ambidexterity is not an absolute essential in surgery but it is an asset. It increases your speed and smooths out your moves and, if you can do it, you use your left hand almost as much as your right when you work in a right chest, as he would do this day.

  So the first thing for me to check on, he was thinking, still shaving, is that they have that polyethylene tubing in three sizes soaking in that germicide. The diameter of the superior vena cava, which is the main vein that drains the blood from the upper half of the body to the right atrium of the heart, varies with the individual, but you can eye-match it for size when you get in there. You can eye-match it, or sight-measure it, or whatever you want to call it, if you have to, meaning if the cancer has spread from the right lung to the pericardium, the covering over the heart, and to the superior vena cava.

  He realized then, as he had realized many times over the past eighte
en months, that what he was hoping to find, when he opened that chest this day, was something that no sane and decent human being could wish upon another. During those past eighteen months, though, when he could find time, he had perfected his procedure in the dog lab, and now he had four live animals to prove that he could do this, if he had to, upon a human.

  Besides, he said to himself now as he had before, my waiting for this and my desire to find it and to defeat it, will have nothing to do with whether this man, this Mr. Scheller, has it or not. Besides, for twenty years I have been seeing this about once every two years and, like all the rest of us, I have been closing them and leaving them to die within days or, at the most, weeks. That is ten cases for me alone in twenty years, and if I find this today I know I can do it and I can cure this man, and that will be the end of all this for all time. Certainly, he thought, it is not wrong for me to wish this for this day.

  When he finished shaving he went to the window in the guest room and looked across the seventy-five feet of the court toward the opposite wing of apartments and then down at the grass plot with the rhododendrons and laurels. The air had that gray-gauze quality of early morning city air before the day has a chance to assert its character through the smoke and the dust and the fog.

  If it has any character, he thought, starting to dress. A man shouldn't live in a city like this. He should live in the suburbs of a city of about 150,000 where a good clear day has a chance. It takes about 150,000 in population to support a thoracic surgeon, but the trouble with me is that, when I started, the thoracic giants were either in the universities or the big cities and I had to be with the best. I had to leam from the best and then you leam and the first thing you know you are one of the best and you're fifty-two and the big city has you. What it all comes down to, when you think of it, is that a man goes where his kind of work is, whether he's a fruit picker or a bridge builder or a chest surgeon or whatever he is.

  He was dressing from the mahogany valet stand that they sent him air freight, special handling, from Costa Rica after he went down there to deliver that paper on "The Management of Chest Injuries" and to do that lobectomy for tuberculosis. He had admired one just like it in that little Juan's house on the hillside outside San José, deriving an actual pleasure sensation from the look and the feel of the hand-turned and hand-polished mahogany across the top where it represents the cervical region and the shoulder girdle in the human anatomy.

  Then that little Juan says nothing and never lets on and just sends it, he thought, and he's a good little surgeon, too. If I had to describe him I would call him quick, rather than fast. He does everything quickly, and his only fault is that he doesn't know change of pace and his operations have an almost frenetic quality about them. That could be putting it a little strongly, because it doesn't make one bit of difference in the final result, but the operations that are pleasing to watch and to do are the ones that have the smoothness and the easy natural rhythms of a fine piece of music.

  Maybe that's just a North American temperament talking, and you don't get that every day, anyway. A man operates according to his personality, and the Central and Latin Americans are different, and so is their music. That could be the answer right there.

  He left his tie and his coat on the stand and he walked to the kitchen. He could smell the heavy-bodied, soft, head-filling aroma of the coffee, and he turned the gas off under the percolator and went to the counter and came back, carrying the cup on the saucer. He started to pour the coffee, the steam following it but coming up off it, into the cup, and he saw from the color in the bottom of the white cup that it would be strong enough. He filled the cup almost to the top and then he carried it to the table and put it down and walked out to the foyer and to the front door.

  Opening the door, he bent over and picked up the folded copy of the newspaper. As he walked back he opened the paper and read the headline:

  RUSSIA EXPLODES 2 MORE;

  K LAUGHS OFF THE BIG ONE

  Damn, he thought, feeling the depression come, as he had felt it come many times in the past year or so. I am feeling good today because I know I can do this thing, and I can cure a man. It makes me feel that I am important, which every man must feel, but after I have worked at my best for three tough hours and saved a life these idiots talk about dropping bombs that will take millions of lives, and what satisfaction does that leave me or any man who is doing his job in our time?

  He was seated now at the table and he put the paper down. He tried the coffee, black, felt the cup too hot against his lips, and took just one small sip. Then, without looking at the headline again, he opened the paper to the sports page and found Red Smith's column on the left and folded the paper and started to read.

  "Men who have heretofore," he read, "looked upon wealth with admiration, if not downright tenderness, choked on their rock Cornish hen in Twenty-One yesterday, when one of their number got up on his hind legs and put the knock on $302,365. Even the Chambertin turned pale.

  "Assembled at lunch were some of the owners and trainers of horses that will endeavor to extract this sum from . . ."

  When he heard the white wall phone ring he reached over with his left hand and took it down. He took another sip of the coffee and put the phone to his ear.

  "Yes?" he said.

  "Dr. Carter?" the feminine voice said, and he recognized it. "Sally Wheeler."

  "Well," he said. "Sarah. How's my gal Sal?"

  "Terrible," she said.

  "Oh, come on," he said. "It's too early in the day for that."

  "It's not too early for me," she said. "We're in a real jam here, and I called to say that your 8 o'clock case, your Mr. Scheller, has to be moved back."

  "To when?"

  "I'm hoping for 9:30 or 10."

  "How about another room?"

  "Not this morning."

  "What's going on?" he said. "What kind of a schedule have you got?"

  "The schedule's not the problem," she said, "but we had a real free-for-all last night Don't even ask me about it."

  "I won't."

  "We got two out of an auto crack-up. We had a stabbing, two Caesareans—and I'm just giving you the hit shows. The girls I have on call I had in here all night, and one of them is having her period. You know that one who has dysmenorrhea?"

  "Yes," he said, although he had no idea about whom she was talking.

  "You know, the one who fainted the other day. Well, even she came in, but she spent most of her time flat on her back in the nurses' lounge. Anyway, three of our major instrument kits are just now being cleaned and they have to be autoclaved and set up. Dr. Berkman and the great Jaffrey are also delayed, but I thought I'd call you first."

  "You're my gal," he said.

  "Listen," she said. "That reminds me. Your young friend Stanczyk has been on an emergency in Room Three since 6 o'clock. The way he's calling for blood he's not enjoying himself."

  "What's he doing?"

  "A sub-total gastrectomy, but what I started to say is that he's got your room, so if he ever gets out of there you'll follow him."

  "All right, Sal," he said. "I'll see you."

  "Listen," she said. "Another morning like this and you'll see me, but as a cardiac patient."

  "You'll handle it," he said.

  "Stop flattering me," she said. "Good-bye."

  She certainly will handle it, he thought, when he had hung up. He had been waiting for this morning and this operation for eighteen months. He could drink his coffee now, however, and feel neither annoyance nor frustration, because years ago he had come to accept that few days, even as few operations, go exactly as you foresee them, and because, for as long as he had known her, Sarah Wheeler had had that quieting influence upon him that only the really competent can impart to others.

  "We've got this operating-room supervisor," he was telling someone, not another doctor, not long ago, "who used to be a great scrub nurse. You ask me if a surgeon ever gets nervous. Well, in my first year of residency, about 3
a.m., this emergency case came in, a woman out of an auto accident, and I had to relieve the pressure on the brain. I'd assisted on this kind of thing and I knew what I had to do, but when you do it your first time you're nervous as hell. After all, it's just you with the assistant resident and the intern and the scrub nurse and the anesthetist, and you're the boss.

  "Anyway, I was sweating right through my scrub suit, but you have a tendency to hold your hand out and this gal I'm telling you about, this Sally Wheeler, was slapping the right instrument in there every time. When I wasn't so sure what I wanted next, she had it in there. She wasn't much older than I was but she'd been around those operating rooms while I was just going through med school.

  "A good scrub nurse," he had told whoever it was, "is like a good caddy. A good caddy may not be able to make the shots himself but he knows his course. You finish a shot and walk up to your ball and stick out your hand and the club he gives you is the one you'd better use."

  Sally's no great intellect and she's a little too flip for some people sometimes, he was thinking now, walking to the range and pouring another cup of coffee, but somebody should have married her. She's about fifty-three now and carries too much weight and those varicose veins forced her out of the operating room, but about twenty-five years ago somebody finishing up his residency would have been a lot better off with Sally than marrying social standing or intellectual stimulation or whatever those losers married. The trouble is, women like Sally don't want that kind anyway.