‘Can’t you slow down, Ben?’ Terri complained.
‘Want me to get another assistant?’ he had replied amicably.
‘No way – I’m learning too much. I just wish you’d ease up for your own sake.’
By April, four months after the operation, Bennett was back leading the ‘normal’ life of a chief surgical resident – merely his share of the 36-hour shifts.
He was just tearing off his blues after a grueling stint when Terri popped her head through the door of the men’s dressing room (there wasn’t an equivalent for the women surgeons – they had to dress with the nurses).
‘Ben, Professor Baye just called down from Hematology. He needs a splenectomy on a leukemia patient. He specifically asked if you’d do it. But we’re booked solid from eight-thirty on. What should I tell him?’
‘Tell him we’ll do it at six-thirty – if he can get up that early.’
‘Dr Landsmann,’ she cautioned good-humoredly, ‘keep this up and you’ll die young.’
‘Too late for that, Ter. Anyway, tell Baye to send down the guy’s charts and I’ll study them tonight. And make a copy for yourself – just in case I get senile halfway through the procedure.’
A spleen removal in patients suffering from lymphocytic leukemia is carried out either because the organ has become so enlarged that it is painful, or because it is causing a symptomatic reduction of platelets – small blood cells that help control bleeding.
Bennett arrived at the hospital a little before 6 A.M. and fortified himself with chocolate chip cookies and several cups of coffee. Although he had all but memorized it the night before, he took yet another look at the medical history of his patient, Harry Scanlon, thirty-nine-year-old male Caucasian.
At 6:30 A.M. sharp he was stationed at the head of the operating table.
He acknowledged the two professors with a polite greeting and then, like an orchestra conductor, glanced at his concert-master, in this case the anesthesiologist. The latter nodded and in a matter of seconds murmured, ‘The patient is under, Doctor.’
Bennett received the information with a wordless nod and immediately set to work, deftly making a long midline incision. With an intern and nurse holding retractors to give him more visibility, he began the standard exploration of the viscera his incision had disclosed.
He then checked the liver for cirrhosis and infiltration by neoplastic cells, palpated the gallbladder for possible stones, and explored everything up to the upper border of the pancreas. No anomalies. He could proceed.
He slid his right hand gently across the light pink convex surface of the spleen, placed the organ into his left hand, and pulled it up toward the abdominal incision.
He craned his neck to get a better look at what he was about to excise – and at this moment he felt an inexplicable tingling in the little fingers of both his hands. He ignored it, thinking that perhaps Terri was right – he had been pushing himself too hard. But this was no time for such thoughts.
He quickly dissected the spleen artery and vein from the surrounding tissue, motioning to Terri to affix clamps. He held out his hand and requested, ‘Scissors.’ When they were slapped into his hand, he cleanly cut free the spleen.
The next stage would be messy but routine. He had now to tie off the two little tubes that were artery and vein. Bennett took the silk to ligate them and tied what felt like firm knots.
‘All right,’ he spoke to himself out loud. ‘We can take the clamps off.’ He reached over to remove the metal instrument from the vein.
And suddenly there was blood. Blood everywhere.
There was a barely audible gasp from the onlookers. Bennett was shaken. He had never seen anybody make this kind of gaffe. But there was no time to berate himself. He had to repair the damage as quickly as possible.
He called for suction to retrieve the vein, and this time resutured it successfully. He then casually ordered Terri to close up shop, and walked back to the dressing room, trying to affect a confidence he did not feel.
He sat down and tried to comprehend what had occurred. It could simply be tension, he tried to convince himself. Or human frailty … but what the hell was that tingling he had felt in his fingers?
As he was sitting pensively in the surgeons’ dressing room, there was a gentle knocking at the door, after which Terri Rodriguez called out, ‘You alone in there, Bennett?’
‘Yeah,’ he replied, ‘come on into the sanctum.’
‘Are you all right?’ she asked.
‘Why shouldn’t I be all right?’
‘I don’t know, I just thought you might be upset by that little accident. It was really nothing.’
‘Come on, Ter, you’re too good a doctor not to know better. That was a horror show. Stop lying to me and I’ll stop lying to you.’
For a moment she was silent and then said, ‘You’ve got a radical mastectomy in half an hour. Do you feel up to it?’
‘Why the hell shouldn’t I feel up to it?’ he barked angrily.
It was the first time in the year she had worked with him that Terri had seen him lose his temper.
‘Okay, Ben, okay. I’m going to grab a roll and coffee. Can I get you anything?’
‘No. Thanks, Ter. I’m sorry I flew off the handle.’
‘No problem,’ she replied and retreated from the domain on which she had been trespassing.
For once in his life, he sought psychiatric help. Or at least the help of a psychiatrist. He asked Barney if he knew of any cases where surgeons get ‘stage fright’ or something similar which might account for his sudden maladroitness.
‘There’re plenty of surgeons who panic,’ Barney replied. ‘My partner sees them all the time. But then it’s usually a total freak-out – they can’t even go near their patients. No, Ben, I don’t think it’s in your head. If I were you I’d see a neurologist as soon as possible.’
‘Can you fix me up with someone in New York, Barn? I’d hate like hell for the word to get around Yale, especially this close to the end of the year.’
‘Hey, Landsmann, be reasonable. If it’s nothing then who cares who knows about it? And if it is something, you sure as hell don’t want to go on operating till it’s fixed. Am I right?’
‘I’m afraid so,’ Bennett replied, trying to suppress his own fears. But dammit, he prided himself on always being honest with his patients. Now he knew he owed it to them to be honest with himself.
Unable to take refuge in the psychosomatic, Bennett screwed up his courage to go back to Professor Kirk. He now had too many symptoms: backaches, intermittent numbness in his arms and fingers. As he himself diagnosed it, ‘Jeff, this poor muscle function in my “intrinsics” has got to stem from the eighth cervical root.’
Both doctors knew a CT scan of Bennett’s cervical spine was called for, and both men knew instinctively what it would show. Bennett’s fracture had slipped marginally, resulting in nerve root impingement.
Moreover, his neurological deficit would progress unless he had an immediate operation to fuse the vertebrae.
‘I don’t want surgery!’ Bennett roared.
‘And I don’t want to go deaf, so quit shouting into the phone,’ Barney replied. ‘For chrissake, Landsmann, do you want to risk becoming a basket case? You know that Kirk’s the best cutter in the business. What the hell are you worried about?’
Bennett put it in a nutshell. ‘I’m a surgeon, too – remember? I know this operation’s only successful … most of the time.’
40
As she sat in the audience, Antonia Esterhazy could feel the tension. This time the size of the crowd at the San Francisco Institute of Psychiatry was not merely because of Maury’s eminence. Many of them had come hoping to see some kind of confrontation between their esteemed colleague, Frederick Eastman, and the man they had learned was his estranged son.
Maury was already seated on the platform when one of the Senior Fellows began to introduce him.
His eyes darted here and there through the au
dience to find his father. He knew that as former president, Fred Eastman had to make a showing.
In fact, Dr Eastman had taken the least obtrusive seat in the back of the room, where only a few spectators could savor the drama of watching his facial reactions when the lecturer took the podium.
Meanwhile, the introduction continued.
‘We are especially gratified, since Dr Esterhazy was born and raised in this very city and has, in fact, some familial ties with our Institute.’
There was a smattering of nervous laughter. Now all eyes were focused on Maury to see how he would react. He gave nothing away.
But a sense of foreboding drew the blood from Antonia’s face and made her squirm uneasily in her seat.
Maury rose, acknowledged the polite applause with a friendly smile, and took the podium.
‘I’m sure you are all familiar with the song “I Left My Heart in San Franciso.” At the very least, I can say with certainty that I left my childhood tricycle. My psychiatric colleagues can think what they like, but I’ve come to retrieve it for my kids.’
His reassuring smile encouraged the audience to be at ease. He was not about to denigrate his father. Or praise him. Or even mention him.
Dr Frederick Eastman sat ramrod straight and expressionless.
Maury’s lecture elicited the same warm response that it had in New York, Philadelphia, and Boston. If anything, the dialogue during the question period was more deferential to him than it had been on the East coast.
At last the audience began to disperse, with murmurs of praise coming from every corner.
But now came the dilemma. The Senior Fellows had arranged a dinner in honor of their guest speaker. Dr Eastman had naturally been invited to attend and was reassured – to his own surprise – that Maury had no objection. His son’s reply, conveyed to him verbatim, had been a monosyllabic ‘Fine.’
The party was in a huge house so high on Nob Hill that, as the host was wont to remark, ‘On a clear day you can see Alcatraz.’
Frederick Eastman entered the room and glanced uneasily at the crowd of admirers surrounding his son.
‘Dr Eastman?’ inquired an English-accented voice. He turned to his left and saw an attractive young woman.
‘I’m Antonia Esterhazy,’ she said, offering her hand. ‘I’m sure you’re anxious to see Maurice so why don’t I extricate him?’
‘I – uh – that would be very kind.’
Earlier she had asked the host’s permission to use a quiet corner of the house – and the doctor had suggested they use his own office.
It was thus that, beneath a photograph of Sigmund Freud, Maury and his father came face to face after more than a decade.
Maury could sense his father’s uneasiness. But he felt incapable of compassion. Years of analysis had purged him of rage, but still could not replace it with forgiveness. That was for saints.
He was determined to make his father speak first. For the important thing was no longer what he had to say to his father – but rather what his father had to say to him.
And Fred Eastman quickly realized that was the way the scenario had been preordained. The only decision left to him was the choice of opening dialogue. At last he said, ‘I knew Melanie Klein. She was a very clever woman.’
‘A magnificent analyst,’ Maury added. ‘It’s a pity she isn’t appreciated more.’
And then a pause. Eastman himself was determined not to say too much. For when he had tried to probe his own psyche to find some buried or repressed affection for his brilliant son, he had been unable to discover anything but feelings of rivalry and resentment.
He had rationalized that this was the result of his inevitable anger that Maury’s very existence was a living reminder of the pain he had felt when the boy’s mother had died.
And of course Maury had always known it. He had been made to feel he owed his father an eternal apology simply for being alive.
‘Your wife is charming,’ Fred Eastman allowed.
‘Thank you.’
Another silence.
‘In your lecture … you mentioned children. The joke about the tricycle …’
‘Yes. We have two boys.’
‘Oh.’
Yet another silence, until Maury finally said, ‘Look, I don’t think we have much to say to one other.’ He was careful not to use the word ‘father.’
‘Is that the way you want to leave it, Maury? Is that all you came here to say to me?’
‘I came here because I was invited to give a lecture. You were just a member of the audience.’
At that instant, Antonia poked her head in. ‘Don’t forget, Maurice, we’ve got to catch the eleven-thirty to Los Angeles.’
He turned back to his father, who then asked, ‘Well, Maury, have you gotten your revenge?’
‘Yes.’
‘Do you feel better now?’
Maury paused. And then quietly answered, ‘No.’
Laura liked Toronto best when it was swathed in snow. It was then that the normal pace of the city slowed to a peaceful immobility. Moreover, unlike the flakes in Brooklyn which turned gray almost the instant they hit the ground, here the heavens’ sprinkling of white feathers stayed pure, creating a sense of pristine tranquillity.
Not that she ever did much more than tramp in the snow behind the hospital. Since she had no desire for a social life and was working night and day in Queen’s Hospital, it had seemed logical to live there as well.
When she had first arrived she had caused the usual flutter of masculine hearts. But the romantic tachycardia was quickly cured by her indifference. As she told Barney on the phone, the last thing in the world she wanted was ‘a date.’
‘I have this kind of Pavlovian response to the guys who ask me out – the more attractive they are, the more I think I’ll end up hurting. So I’m now the fulfillment of both my parents’ dreams – a doctor and a nun.’
All she could think of was the babies. It was as if she regarded every new hospital admission as a member of her family. No matter what the problem – trauma, febrility, orthopedic, or respiratory, she seemed always to be there trying to help.
And all this in addition to her official training in a neonatal program that involved a lot of hands-on treatment of those unfortunate infants whose fate it was to enter life already sick or dying.
As never before in the history of medicine, the progress of technology was influencing doctors. And nowhere was this more evident than in the treatment of the newborn. The definition of prematurity and viability seemed to be changing at a dizzying pace. Until recently a baby born even a few weeks before the expected forty-weeks gestation was regarded as a ‘preemie’ whose life was in peril. Now doctors realized that not only these, but younger babies were savable. Their increasing ability to detect anomalies in children yet unborn gave the experts in neonatology a chance to rectify problems as soon as the baby saw the light of day.
The new presence of the neonatologists in the delivery room inevitably created a kind of custody battle for the unborn infant. Traditionally both mother and child had been the obstetrician’s responsibility. But now the pediatricians were proving that in critical circumstances the baby needed its own individual specialist.
In every case it had become standard procedure to assess the baby by giving it an Apgar score, a technique named after its originator, Dr Virginia Apgar. It involved an evaluation of the five crucial elements of the baby’s condition – one minute after birth and five minutes thereafter. The baby would receive either zero, one, or two points for heart rate, color, respiration, tone, and responses to suction.
An infant who scored over seven on the first exam could already begin training for the Olympic event of its choice – whereas one whose Apgar was less than four would be fighting for life and need all the help that medical science could offer.
Laura was learning more each day she spent at Queens, but she had not made many friends. She had a few acquaintances with whom she might have conver
sations over coffee at the nurses’ station, but she was generally viewed as severe and distant.
She constantly complained of hospital bureaucracy, the amount of paperwork involved in, for example, getting a sick baby from the front door to the Pediatric Ward. She was openly critical of mistakes on the part of her colleagues, senior and junior.
‘We’re human beings,’ an IUC nurse once dared to remind her. ‘To err is human—’
‘No,’ Laura had retorted. ‘To err is fatal.’
She had somehow lost the ability to catch brief snatches of slumber during night duty, but made the best use of her insomnia by reading professional literature and outlining articles of her own. She had become interested in the problem of hemorrhaging in the newborn, which was almost always detected too late. If only some kind of early-warning technique could be developed, so many more could be saved.
At three one morning when she was in the on-call room studying, the phone rang. It was Christian Lemaistre, the department’s leading obstetrician.
‘May I speak to the on-call pediatrician, please.’
‘This is Dr Castellano,’ she replied.
‘Oh.’ He had obviously been expecting a baritone and not a soprano.
‘Can I help you, Dr Lemaistre?’
‘I’ve got a woman having problems with her labor and I may have to do a caesar. Can you be scrubbed and ready in fifteen minutes?’
‘No problem, Doctor.’ She hung up the phone, put on her shoes, gulped down the now-cold coffee that had been on her desk, and raced for the elevator. The obstetrician had already dressed and scrubbed. As she quickly did likewise and hurried into the O.R., she could not help noticing that – even with his mask on – what she could see of Lemaistre’s face substantiated his reputation as disconcertingly handsome.
Twenty-five minutes later, the obstetrician had pulled out a tiny baby boy. Laura pressed the O.R. stopclock, rushed the baby under a radiant heater, and as a nurse dried him with a warm towel, began her assessment. His breathing was poor – in fact, in the next instant she announced, ‘Respiration nil.’