Final Mercy

by Frank J Edwards

  Zellie retrieved her suitcase from the porter and went to the ticket counter. She waited for a girl to look up from a magazine.

  “Could you tell me if the Seneca Hotel is within walking distance?”

  The girl turned away and seemed to be speaking to someone in the office behind her. She turned back to Zellie and said, “Just go out the front and head left at the next intersection. It’s not too far.”

  Zellie felt a tap on the shoulder. It was an elderly man wearing an Irish tweed cap. Thankfully, he didn’t have a mustache or a beard so his lips were easy to read.

  “I beg your pardon, Miss, but I overheard you asking directions. You must be a stranger to town. My wife and I are getting a taxi home, and we’ll be going right by the Seneca Hotel. You don’t want to walk it. It’s half a mile, and you’d have to stroll through a rather rough neighborhood.”

  The taxi driver loaded their suitcases in the trunk, and Zellie sat between the man and his wife. The cab lurched out onto the street and sped away from the station.

  “So, you’re going to stay at the Seneca?” the woman said. “A very good choice. John took me there on our first date to see the Duke Ellington Orchestra. We’re just getting back from a cruise. We had a wonderful time, didn’t we, John?”

  “Yes, indeedy.”

  Zellie had to keep her head a-swivel to follow the conversation.

  “So, what brings you to town, my dear?” asked the woman. “Is this your first visit?”

  “It is, yes.”

  “Work or pleasure?”

  “I’m writing a magazine piece about the medical center.”

  “How interesting! I’m so glad people are writing about our hospital. It’s such a fine place. My sister-in-law used to write children’s books under the pen name Emma Goldenrod.”

  “So, you folks are natives?”

  “I am, but John is a transplant from Schenectady. Now that we’re retired, though, we like to wander, but how good it feels to be back home.”

  “Where was your cruise?”

  “Iceland, and it was fabulous. I’m not a traveler by nature, but give my husband a boat and he’d paddle around the world.”

  “Primarily upstream,” John said.

  Zellie grabbed the front seat for support as the taxi veered around a corner.

  “Speaking of articles,” said the woman. “There was a wonderful piece about this region recently in Yankee magazine. You should look it up. It was called ‘New Canterbury: A Town for All Seasons,’ and how true. We have Lake Stanwick for summer fun and a ski slope not far away, and in the autumn people come from all over to see our leaves. Unfortunately, we’re two weeks past the peak. And then there’s the university and the medical center. And there it is! Driver, please slow down so we can see. That’s the main campus of the university on our left. That big thing with the dome is the library. That’s where I used to work.”

  But Zellie’s attention was drawn to the other side of the highway, where an even larger complex of buildings lay.

  “So, that’s the medical center over there?” she asked.

  “You bet,” John said. “That’s where Brenda Waters is going to let the nation look up her rear end tomorrow.”

  “John, that’s disgusting.”

  “Tell that to all the people who’ll be tuned in. That’s why we came back, Zellie.”

  “No, it was not,” his wife protested.

  The medical center was much larger than she had expected—multiple interconnected buildings on a scale that would have done justice to a much larger community. As they drew closer, she could see a big archway of brick and glass that looked like the main entrance. In front of this was a fountain with a a stainless steel caduceus in the middle, which in warmer weather, she suspected, would be bathed by a ring of water jets.

  Then they were past, and the driver accelerated, pushing Zellie back into her seat.

  VII

  A Team Sport

  All the senior faculty members at New Canterbury—deans, interim deans and department chairs included—rotated through the clinical teaching schedule. This was Bryson Witner’s week to serve as the Blue Team teaching attending.

  Directly after the faculty meeting, he strode to the East Clinical Tower, obsessed with the image of walking into the Flexner Room and seeing Gavin sitting there surrounded by people. He found the team, a group of eight residents and students clustered near a coffee shop on the ground floor, waiting for him to begin morning rounds. He motioned for them to follow and continued marching down the green-carpeted corridor toward the elevators. They quickly fell in behind like a flock of white-coated ducklings.

  To his side drew young Dr. Randolph Delancy. Blond-haired and little-boy-faced, Delancy carried a large notebook, for it was his job to make sure the team stayed on target.

  “How did the meeting go, sir?” he asked. “Anything interesting?”

  Witner looked at him. There was no trace of guile in the young man’s face. The news of Gavin’s return was still not widespread.

  “Nothing unexpected, Randy, and nothing that won’t be appropriately dealt with in due time.”

  “That’s good, sir.”

  “Yes, that is good, Randy.”

  Witner was pleased with his choice of Delancy as chief resident for the Blue Team. He had separated the man from the ranks of senior residents back in August and elevated him to the newly created position. None of the other three internal medicine teams—Gold, Green and White—had permanently assigned chief residents, but neither did the other teams have the interim dean taking them on as special projects.

  The Gold Team was a non-teaching service devoted mainly to rich locals who wanted VIP treatment, along with a sprinkling of Canadians wealthy enough to opt out of the assembly line up north. There was also a small but steady trickle of Saudis and Kuwaitis who, thanks to Nelson Debussy’s representatives in Riyadh and Kuwait City, arrived in large white cars and paid in cash from briefcases carried by assistants with British accents and Brooks Brothers suits. They received special meals, deluxe nursing care, private rooms with a southern view, and no exposure to medical students. The Gold Team was fine as it stood.

  “Tell me, Randy, how did things go last night with admissions?” Witner asked. “You’re not letting any good cases slip on to White and Green, are you?”

  “No way, sir. A potential pheochromocytoma almost got admitted to White, but I got wind of it in time.”

  “Good lad.”

  “They were not happy about it.”

  “Their happiness isn’t the issue,” Witner said. “You’re only doing your job—and doing it well.”

  Green, White and Blue Teams, unlike Gold, were training-focused, but the Blue Team had a special niche—it took only the most interesting patients. Its history dated back to the 1940s when the dean at that time, George Blankenship, decided to put the brightest house staff in contact with the most rewarding clinical material by creating a special team for that purpose. Let dullards deal with the routine pathology—the strokes, pneumonias, drunks with pickled pancreases, and so forth.

  Blankenship’s successor, James Gavin, had allowed the Blue Team’s special mission to degenerate until it became indistinguishable from Green and White. That had been a shame, and when Witner took the helm in July, he encouraged a more-than-willing Norman Scales to resurrect the Blankenship paradigm.

  They created the post of Blue Team chief resident, empowering him with the right of first refusal for all non-Gold Team admissions; and Witner had selected Delancy, who was bright, ambitious, circumspect—and whose father was chairman of the university’s board of trustees. Among the benefits of giving Randy this appointment was that Witner was now a frequent dinner guest at the Delancy home.

  He smiled as he ushered the team into an elevator, watching them press shoulder-to-shoulder. He entered last, pushed the button and stood by the door, inhaling the familiar odor of medical people in training. Someday, he should mention this in an article—th
e sour pheromonic smell of young humans spending the prime of their lives caged inside hospitals and libraries, poring over books into the wee hours, or who’d been up all night with patients. It was a miasma of stale clothing and body odor, fading deodorant and perfume, and mixed with it the carroty, yeasty smell given off by a vegetarian. For it never failed—there was always a vegetarian or two among the residents and students.

  The door slid open, and he stepped with some relief into the hospital smell of isopropyl alcohol and urine. He resumed marching.

  “Where do we start this morning, Randy?”

  “Room sixty-four-thirteen, sir. The patient’s name is Gladys Vanderwulf, and she was admitted last evening with fever and weight loss.”

  He liked the enthusiasm in Delancy’s voice; it was proof the young man remained grateful for his position. And well he should be. Every resident on the Blue Team had cause for gratitude. Not only did they get the most exciting patients—the carcinoid tumors, the histiocytosis X cases and the hairy cell leukemias, the pituitary dwarfisms and the Marfan syndromes, and all the exotic parasites that came to these shores so rarely—but their call schedule was only one night a week, even for interns, allowing them maximum time for reading and knowledge absorption.

  The other medical teams were on call every third night.

  To sweeten a Blue Team rotation even more, the residents were handed free meal passes to the faculty club, where filet and prime rib were served at lunch, along with unlimited gym access and a dedicated Blue Team conference room with couches, a well-stocked fridge and a TV.

  “Dr. Witner,” Delancy said, lowering his voice, “I just wanted to mention what a pleasure it’s been having you as the teaching attending this week. We all wish you’d do it more often.”

  “I would enjoy that, Randy.” Witner lowered his voice as well. “But I must spread the wealth around.”

  Which was true enough. Internal medicine faculty members were clamoring to teach the Blue Team. That was one of the reasons Norman Scales had been delighted when Witner revived the team—it was a perfect political lever for rewarding those who deserved it, and he and Witner doled out those favors behind closed doors.

  Delancy looked at his notebook. “Here we are. Room sixty-four-thirteen.”

  Witner stopped, and the team gathered.

  “Who’s the first-year resident, the intern who worked up this case?” he said.

  “Me,” replied an anorexically slender young woman.

  “And you would be?”

  “That’s Dr. Chen, sir,” said Delancy. “Mary Chen.”

  “Present the case, please, Dr. Chen.”

  Mary Chen had black hair pulled into a tight bun and a face marred by dark circles under her eyes and a general look of fatigue. Her lab coat had a large coffee stain on the lapel. She’d obviously been up most of night researching in preparation for this presentation, her moment of glory. She stole a look at her notes and began to describe the case.

  The patient was a forty-nine-year-old woman who’d developed a recurrent fever five weeks ago. Blood smears for malaria were negative, and all the other serologic testing had so far been inconclusive. As she grew weaker, her family doctor finally referred her to New Canterbury. Chen had reviewed the symptoms, discussed her past medical history, and then noted the woman and her husband, a Baptist minister, had returned four months previously from a mission to Central America.

  The husband had not gotten sick.

  Chen droned on, and Witner began tapping a fingertip with increasing rapidity against his chin. It was an excellent presentation for an intern, better than most second-year residents. Chen had obviously spent a great deal of time reading the case presentations in the New England Journal of Medicine and was attempting to equal that level of precision and detail. Her presentation was so good, for an intern, it reeked of arrogance.

  He abruptly raised his hand.

  “I believe you‘ve gone into these details far enough, Dr. Chen, if you don’t mind,” he said. “We are awaiting your differential diagnosis, please.”

  “I was just about to go there,” she said, shooting him a glance.

  Petulance? Was that petulance he heard?

  “I see,” he said, thoughtfully. “Then perhaps, Dr. Chen, you could answer a little question for me before you proceed. Tell the group exactly why you believed it was important to mention that your patient’s spouse was a Baptist minister? Does this expose her to certain diseases that a Catholic might escape? Or a Mormon?”

  The laughter that erupted was hearty enough to draw attention from the nursing station at the end of the hallway. Mary Chen frowned. She tried to hide her embarrassment with a smile, but it wasn’t convincing.

  “Or a follower of the Buddha, Dr. Chen?” Witner continued.

  He had timed it well, and the laughter redoubled. Mary Chen’s eyes now betrayed a flash of anger and pain.

  Witner raised his hand. “Continue, Dr. Chen, and please, try to be relevant,” he said. “We have three more patients to see. Unless, of course, there really is something about being married to a Baptist that anticipates an illness.”

  Another wave of mirth ended with a clearing of throats and a final retrospective chuckle. Clearly, the others had found her a little too competent and were enjoying her comeuppance.

  Like a fatigued horse thrown off its stride by a bolting fox, Chen began again but immediately tripped over the word interstitial. Three times her tongue twisted it unsuccessfully. She finally took a deep breath. Moisture welled in her eyes, and her chin trembled. On the fourth try, she got it right, however, and began to trot again.

  Oh, yes, she was strong and smart, no doubt about it. In a moment, she would start discussing the differential diagnosis, the part of her presentation she’d probably done the most research on. She might even find a clever way to get back at him. That would never do. He must decapitate her without delay.

  “That will be enough for now, thank you, Dr. Chen,” he said crisply. “Who’s the second-year resident on this case?”

  Mary Chen’s mouth made a gasping motion, and she turned her head to the left and right. Delancy consulted his list.

  “Sullivan, sir.”

  “Dr. Sullivan,” Witner ordered, “kindly take over and discuss the differential for this patient, and please demonstrate to Dr. Chen the value of brevity.”

  Edwin Sullivan stepped forward, his expression displaying no guilt that he was about to capitalize on the work done by his intern while he’d slept. Why should it? Similar things had happened to him during his internship. It was the nature of roundsmanship, and Mary Chen would have plenty of time to repay someone else in kind over the next couple of years as she rose up the pecking order.

  With six hours of solid sleep under his belt, Sullivan summed up the case then discussed the various possible diagnoses and focused ultimately on protozoan parasites vs. liver flukes vs. possible tick-borne rickettsial syndromes. Pending confirmation by laboratory testing, his first choice was dengue fever.

  “Thank you, Dr. Sullivan,” said Witner. “Very fine. By the way, does this disease have a predilection for those of a Baptist persuasion?”

  The team then entered the room and gathered around Mrs. Vanderwulf’s bedside. She was a wiry woman, sallow and emaciated. Witner introduced himself and asked how she’d rested.

  “Gracious,” she said, smiling weakly. “I’ve never been so poked and prodded. I feel like a pincushion.”

  Witner called the medical students forward and made each of them demonstrate an aspect of the exam. That done, the team departed, Mary Chen now fallen to the rear of the crowd, a look of dejection on her face.

  After visiting eight other patients, the team came to the last patient, a twenty-five-year-old man comatose after being resuscitated from a cardiac arrest precipitated by a viral inflammation of the heart. Witner performed the initial chest auscultation himself, wanting a chance to use the new Krackendorf Professor model stethoscope with its solid silver head
he’d just taken delivery on from the factory in Vienna. As he skipped it across the bony arch of the young man’s wasted ribcage, listening, the sounds were clear and loud—it was like taking a Ferrari for a spin.

  He straightened and removed from his ears the earpieces (custom shaped from a mold of his ear canal).

  “Medical students, come forward and observe.” He lifted both of the young man’s eyelids with his thumbs, placed his fingers on either side of the man’s head and slowly moved it side-to-side. “Miss Singh, tell me what am I doing.”

  She was a shy-looking third-year student with dark skin and deep red lipstick.

  “You are checking for the occulo-cephalic reflex, Dr. Witner,” she said in a lilting Indian accent.

  “Good, yes.”

  Witner located Samuels, a senior medical student with acne-cratered cheeks and oversized ears. Samuels wanted to be nothing more than a family doctor. He stood in the far back, trying to be invisible.

  “Mr. Samuels, come here.”

  “Sir?” Samuels’s face turned crimson.

  “Come, step forward and tell us about the occulo-cephalic reflex.”

  “The occulo-cephalic reflex.” Samuels repeated, hesitating. He blinked. “If I recall, it checks for cerebellar dysfunction.”

  Chuckles spread through the group, and Delancy rolled his eyes.

  “Really?” said Witner. “Tell us more about this theory of yours.”

  “Well, maybe it’s the pons nucleus and not the cerebellum.”

  “The pons nucleus? Mr. Samuels, while you’re trying to remember some basic neuroanatomy, why don’t you step closer—come, come—and demonstrate your auscultation technique.”