The surgeon Read online

  He walked back to the table and sat down. Then he took the phone off the hook and dialed the hospital and, while he waited for the answer, he took another drink of coffee.

  "Mercy Hospital."

  "Good morning," he said. "This is Dr. Carter. Do you think you can find our eminent thoracic surgical resident, Dr. James Bronson?"

  "Yes sir, Doctor. I'll try. . . . I'm ringing. . . . Just a moment. . . . Here he is."

  "Hello?"

  "James? Matt Carter."

  "Good morning, Doctor."

  "You know my 8 o'clock has been delayed?"

  "Yes, sir."

  "How's everything else?"

  "Yes and no."

  "What's the trouble?"

  "I have a question about Benjamin Davies."

  And I know what your question is, he thought. You want to know why I'm taking him off the morphine.

  "Shoot," he said.

  "His night nurse called me, and said the sedation is wearing off and the patient is starting to complain. I checked the orders you left last night, and I see you don't want him to have any more morphine. It seems to me that the pain will increase and I'm wondering if you want to revise the orders."

  "No," he said, "and I'll tell you why. You and I know this man is terminal, and he hasn't got more than about thirty-six hours, at the most, to go. When Bob Robinson and I operated on him originally a couple of years ago he forbade me to tell his wife it was a cancer. I went along with this, and now I have to pay the price."

  "That's not right," Bronson said.

  "I've never met his wife. When we operated on him he told her it was for an old football injury and, as far as I know, she never came to the hospital. When he checked in a couple of days ago she was with him but I was operating and Bob Robinson saw her. Since then the grown daughter has arrived in town but I've had him heavily doped up all the time and they're complaining. When they come in to see him, if he's awake at all, he doesn't recognize them, and they want to talk to him."

  "I see."

  "Now they called last evening to say they'd be in at 9 o'clock this morning, and that's the reason for the orders to take him off the morphine. We know his physical and mental state is such that there won't be much of a conversation, but this is a husband and a father and this is going to be the last chance these people will have to see any resemblance to the man they knew. After all, they're going on living, so I'm allowing them this."

  "I understand."

  "As a matter of fact, when they see him and find out he's having pain they're going to come running to me to ask me to put him back on the drug. He won't be off for long."

  "I see."

  "You'll soon find out that for every patient you treat you've got to treat two or three or four relatives."

  "I've found that out already."

  "Just remember that, about four thousand years ago, when the patient died they cut off the surgeon's hands. They later amended that custom so that, when the surgeon failed, he was given to the patient's relatives to do whatever they wanted with him."

  "Then things are improving?"

  "We sometimes wonder. How's Mrs. Kirk?"

  "She's doing all right. She had some nausea."

  "That's expected. Did they change her position from her back to her right side?"

  "Yes, sir."

  "Do you know why?"

  "I have an idea."

  "That's to reduce any chance of pneumonia."

  "She's a very fine woman."

  "And she's got two nice girls and, I understand, a fine husband. We're not going to tell her that I just opened and closed her chest without being able to do anything for her, but I've got to tell her husband. Hell be in this morning, and I've got a little time now with this delay. Tell the nurse to call me if I'm not on the floor while he's there, and if I'm not in the O.R."

  "Yes, sir."

  "How's Bernie Waterman?"

  "Fine. He had a good night, and he says he's hungry."

  "You may not believe it, but in about three weeks or a month I'll buy that kid a steak, and he'll be able to eat it."

  "I believe it, Doctor."

  "All right. If you have no problems, I'll be over in an hour."

  That Bronson is all right, he thought, finishing his coffee. He's conscientious and he's a learner and I'll open his eyes today if we get to that vena cava problem. I'd really like Stan to see it but Sally says he's having trouble and he'll work his way out of it but this won't be the day for him to watch me. This will be one of those days when he'll be doubting how good he is and right now he's at that stage where he suffers a little by comparing himself to me.

  That's what happens when you like some kid and you take him under your wing. While he's interning or in his residency he thinks you're a god. He may dream it, but he never quite dares say to himself that he will be as good as, or better than, you. Then he's out two years and starting to move, and one day it comes to him that maybe he can be you. Now he's lost a god, and when he looks at the man he's found he forgets that you've got twenty years to his two. This man, toward whom he feels a challenge for the first time, is too much for him, and this is when he needs you as much as he ever has. This is no time to dazzle him, because as much as you have enjoyed it you can never be a god again anyway, and he doesn't need that any more.

  It is like Pete Church and me, he thought. When I came back after five years and watched him again that first day doing that lobectomy I thought: "He's slipping. He's not what he used to be." The truth was he was better than he had ever been, but while I had been moving forward whole yards at a time his progress was in inches, as it must be after so many years and when about all that there is left for you to do is to refine your techniques. It was only the gap between us that had narrowed.

  Of course this Mr. Scheller's vena cava may be free of the cancer, anyway, he thought. He had rinsed the cup and saucer at the sink and left them on the drainboard and he was walking back to the guest room. You can't really be certain about a thing like this from the X-rays, but after you have looked at enough of them you can almost sense it. If I get shut out again I hope it's because this vena cava is clean and not because the cancer has spread to the diaphragm and it's hopeless and I've got another Mrs. Kirk.

  So how will I tell Mrs. Kirk's husband? How will I tell him that in five months or six he will be left alone with two little kids? He will look at me and force a smile and say: "Well, Doctor, what did you find?" I'll look back at him and somehow I'll tell him, although I don't know exactly how I will do it because I have never learned it in twenty years and I never will.

  When he finished dressing he went out and closed the door behind him. He rang for the elevator and looked at his watch and saw it was 7:40.

  II

  "Good morning, John," he said to the doorman. "Good mornin', Doctor," big John said, handing him the car keys. "It's still across the street where you're leavin' it last night."

  "That's all right. How's your health?"

  They were standing on the sidewalk, under the awning. Big John, in his uniform overcoat, seemed bigger than ever.

  "I'm not for complainin'."

  Any day now big John would tie one on. About twice a year he tries to challenge single-handed the combined inventories of Schenley and National Distillers and then his son, the cop, comes into the office on his way home from the precinct and he says: "Dad's got that bronchitis again, Doctor. will you write out that prescription and send a note to the superintendent saying you're treating him and hell be back to work in a couple of days?"

  "So what kind of a day are we going to have?" he said now, feeling the chill.

  Across the street, in the park, the two black oaks near the fence still held some of their jagged, dried, rust-brown leaves. Beyond them the single-pointed, almost ovate, light brown leaves of the big gray beech would cling, most of them, into the winter and beyond it, but the maples and the plane trees were already bare.

  "I'll not be predictin' the weather, Docto
r. There's too much smoke and fog every day now."

  "That's right."

  "Now you're a doctor, and you'll be knowin' this better than I, but I think it's them Bolsheviks explodin' their bombs that's makin' this."

  "You may know as much about it as I do," he said.

  "I'll be goin' home now and to bed, anyway," big John said.

  "Good."

  He drove the Mercedes down the half-block to the dead end and swung it around the concrete stanchion and came back past the apartment house. At the comer, as he passed under the traffic light, it changed from green to yellow, so he turned left, knowing that he could pick up three green lights going south before he turned west again and, if he timed it right, pick up three more green lights before he would have to stop.

  Near the first corner, in the gray dampness, a middle-aged woman in a green coat with the fur collar held tight around her throat and her hair in curlers was curbing a black cocker spaniel. At the bus stop on the next comer two teen-age girls, their stacked books cradled in their crossed arms, were talking and laughing, and on the one-way street the traffic, mostly trucks and taxis, the taxis cruising empty or heading back to the garage, moved easily and with a shushing sound.

  It is all right, he thought, knowing again the sensation that is not nervousness, but the starting small, spreading feeling of excitement. When he was younger and just beginning and still insecure, every operation would be prefaced by anticipation and tension. He would he in bed the night before and play it over and over, trying to imagine every complication that he could possibly run into and trying always to think one step ahead. What, he would ask himself, if I run into this? Now he was fifty-two and had opened more than three thousand chests, and he had it all so beautifully systemized that each move was almost a reflex. It is never boring, because no two are exactly alike, but now, in most of them, the tension is gone and so is almost all of the exhilaration, and now you just refine and refine and refine.

  "My God, Matt!" Bob Robinson said to him one day, assisting and watching him dissect around the aorta, which is the great artery. "How simple can you make it?"

  Rob will be a little anxious today, he thought. We've got those four dogs, living, but he won't really be convinced until we succeed in a human. Thinking this, he could see the superior vena cava, thin-walled and showing the dark blue of the de-oxygenated blood it is returning to the heart and, where it crosses it, he could see the right pulmonary artery, thicker-walled than the vena cava and pink, and both of them about the size of a man's thumb.

  Sally won't have that jam cleared away before 10:30, he thought now. He turned right then and, finding no parking space in front of his office, he drove halfway down the block before he found one. After he had backed in he walked back and through the arcade and around the fish pool, dry now and its bottom covered with damp leaves, and he unlocked the door and went in.

  He walked through the heavy, close air of the darkened waiting room and through Carrie's office and into his own. He turned on the lamp on the end table beside the sofa and the hanging light over his desk and saw the stack of opened mail, where he had left it the night before, with Carrie's note, scrawled on a piece of memo paper, lying on top: "will you please look at these!"

  Paper work, he thought. If there is anything you don't want to put your mind to when you would rather be operating it is paper work. You don't want to put your mind to it after you have been operating, either. In fact, you don't ever want to put your mind to it, if you can help it.

  He sat down and picked up the first letter. It was written on notebook paper, white with light blue lines, the rectangular folds still showing, the writing in blue ink level with the lines, but labored and awkward.

  Dear D.R. I don't know who else to turn to for help. D.R. as you no Wm. Siler was cut off the Welfare last June. Just as soon as you said he was able to work they cut him off. D.R. he have look high and low for a job and he just can't find one and you have been so good for him I am wondering if you know a job. . . .

  What she sees in that sob I don't know, he thought. Maybe he's the first and only man she ever had, but he's got the intelligence of a ten-year-old and it is all you can do to get an answer out of him or to get him to look at you. In a stolen car, too, he remembered, and he plants it on top of a fire hydrant and the intern who rode the ambulance said there was water and oil everywhere. Multiple broken bones, and then four years later he comes in with that traumatic aneurism, that dilation, of the aorta.

  Today we'd bypass an aneurism like that with the artificial heart pump, but on that Siler we made a temporary shunt with that cow's carotid artery from that kosher slaughter house. That rabbi was a nice little man and they always cut the carotids at the angle at the jaw so he preserved the length we needed for the shunt instead of cutting it at the origin in the chest the way they do in the commercial stock yards. You might almost say that was another example of the wisdom of the rabbinical laws, and then we took that aorta from that marine killed in that three-car wreck and preserved it by freeze-drying and gas-sterilized it and grafted it onto that aorta of our Mr. Siler.

  What this skinny, sandy-haired, squint-eyed Siler doesn't know is that he's walking around today with about two inches of the aorta of a U.S. marine in him. Then he uses a mail drop to get $65 a month from welfare but he moves in with her and she gets another $65. That's $130 and then she does daily cleaning at different places but not enough in any one place to get on social security and lose that welfare, and Carrie can handle this.

  "You answer," he wrote in pencil at the top of the letter. Then he underlined the "you," and put the letter aside. He picked up the next one, and saw the letterhead of The American Association for Thoracic Surgery.

  This is to confirm acceptance of your paper entitled 'Radical Pneumonectomy for Carcinoma of the Lung' for presentation on the scientific program of The American Association for Thoracic Surgery. Your paper will be presented on April 17. The exact order of presentation has not been decided as yet, but. . .

  He put that on top of the first letter. He picked up a letter typed on single-sheet male personal stationery, and when he did not recognize the engraved name and the suburban address, he looked down at the bottom and saw the signature "Vi Landers." The i was dotted with a small circle.

  This is the second one in about ten days, he thought, and I will bet you dear Vi has lost again. I remember him now, the name on the letterhead, a benign tumor in the upper lobe of the right lung about a month ago, a retired real estate broker in his late fifties and free game for dear Vi.

  "Dear Dr. Carter:" he started to read. "I am writing this while my patient is taking a nap, because it is getting so that he watches everything I do, and there are some things I think you should know. . . ."

  I'd bet, he thought. I'D bet he's got a wife somewhere, or you've overestimated his economic resources or his married daughter doesn't like you or he eats onion sandwiches before he goes to bed.

  In the first place, the patient is fine. He has no more pain, his blood pressure is normal and his appetite has improved. Except for his nap he is up all day (and into the night) and he really has no more need for me. That is, I should say he has no more need for my nursing services. He needs me to cook for him and clean house and do the shopping and run errands.

  As you may recall, when I came out here with him, my understanding was that he had a maid who came in for four hours daily. Since I have been here, however, she has come only on Thursdays, so you can imagine what I have been spending most of my time doing.

  I think you should also know that everything else is not as it appeared, either, and that is why I am writing this. Last evening, to my great surprise, he suggested that we go out to dinner. We did, and he had two bourbons before we left and another at dinner. When we came home he talked more freely than he has before, and after I gave him his sleeping pI'll he told me that the bank owns this place and just about everything else.

  I immediately thought of you, because you know
how I respect you, and after what you have done for him I wouldn't want you to be stuck for your Bill. Please, however, do not write me or call me about this, as he sorts all the mail and overhears any conversations I have on the phone.

  As you know, we will be in for his check-up next Thursday at 4 p.m., anyway. At that time, will you please make it plain to him that he has no more need for me? I'm sure you will, and I hope all else goes well with you.