The Patient

by Michael Palmer

  “I don’t know how you do it.”

  Jessie rubbed at the fatigue stinging her eyes.

  “It’s not all that hard,” she said, “as long as you don’t look in the mirror.”

  “NO, I WILL not have a resident touching my daughter, and that’s final. I want this … this Dr. Copeland down here now.”

  Jessie stood outside the doorway to room 6 in the ER, vainly searching for a way to avoid having to deal with Marci Sheprow’s mother. Del Murphy had warned her about the woman as they were reviewing the MRIs. Aggressive, entitled, smart, protective, and very suspicious.

  “Not frightened?” Jessie had asked.

  “Not that I can tell. At least not that she lets on.”

  Del had correctly read the MRIs as showing a very localized, well-defined tumor—almost certainly a low-grade meningioma—pressing between the inner skull and Marci’s brain on the left side, directly over the areas controlling movement of the right arm and leg. If there was such a thing as good news for someone with a brain tumor, this diagnosis and location was it.

  Jessie made a futile attempt to smooth some of the wrinkles from her lab coat and scrubs, and cursed herself for not thinking to replace them before coming down. Then she noticed that she still had on the pink canvas Keds she had worn in the operating room. Lord. One look at those and Barbara Sheprow would probably be on the phone, calling an ambulance to spirit her daughter across town to White Memorial.

  “Oh, well,” she breathed, and stepped into the room.

  She introduced herself first to Marci, then to her mother. The Olympic gold medalist, an icon well known in virtually every country in the world, looked frail and very young. But the spark in her green eyes belied that impression. Barbara Sheprow glanced over at Del Murphy uncomfortably.

  “I … I expected a … what I mean is, Dr. Murphy didn’t say you were …”

  “A woman?”

  “That, yes, and so young.”

  “I’m afraid I can’t do much about the woman part,” Jessie said, “but, I can be very reassuring about not being too young.”

  “I didn’t even know there were women neurosurgeons,” Marci’s mother said, pushing.

  A dozen flip remarks crossed Jessie’s mind, but stopped short of her tongue.

  “There aren’t too many of us, Mrs. Sheprow, but there are some. And as you might suspect, we’ve all had to be twice as good to make it to where we are. As I hope Dr. Murphy will affirm, I’m a very well trained and experienced neurosurgeon.”

  “I appreciate the reassurance,” Barbara said, sounding not at all reassured. “I had Marci brought here because Bob McGillvary, our doctor down on the Cape, knew Dr. Shea, the orthopedist who fixed her wrist, and Bob referred us to him. I … I never dreamed we’d be needing a neurosurgeon.”

  “Well, at this point, I’m not certain what you need. But I do know that to do my job right, I need to hear in Marci’s own words what happened tonight.”

  Barbara Sheprow looked over at her daughter. Jessie could almost hear the woman weighing her options. This was the mother of an Olympic champion, Jessie reminded herself—a woman used to dictating to others, not to being dictated to herself. Finally, Barbara stepped aside and motioned for Jessie to go ahead.

  Del Murphy mumbled something about seeing a consult and returning in a little while, and left the room, perhaps sensing that as long as he was there, Barbara Sheprow would be directing her clinical concerns to him. Under Barbara’s watchful eye, Jessie’s history-taking and neurologic exam lasted half an hour. During that time, she could sense a pleasant rapport developing between herself and Marci, who was brighter and more philosophical than she had anticipated. The MRIs and current neurologic findings suggested that surgery did not have to be done on an emergency basis. But the nature of Marci’s sudden weakness and loss of consciousness shouted a clear warning. There was no question an operation was in her near future.

  Finally, Jessie had all the information she needed. Marci’s father and younger sister were brought in from the waiting room.

  “This is Dr. Jessie Copeland, Paul,” Barbara said to her husband. “She’s on call for the neurosurgical department. It’s her job to evaluate Marci and give us her opinion as to what’s happened.”

  Not exactly a vote of confidence, Jessie thought.

  She slid the MRI films into the two view boxes and described to Marci’s father what she had found.

  “When would you be doing this procedure?” Paul Sheprow ventured when Jessie had finished her explanation.

  Jessie could see the man’s wife stiffen.

  “Now, Paul,” Barbara admonished, “no one has said anything about who would be doing Marci’s surgery, let alone when, or even whether.”

  “But I thought—”

  “Please, dear. Dr. Copeland, is this the best hospital for Marci to be having this surgery?”

  “It is certainly one of the best. We have a great deal of significant research going on, and we do a lot of brain tumor surgery.”

  “We?”

  “The department, I mean.”

  “And where do you rate in that department?”

  “Mother!” Marci exclaimed. “Give her a break.”

  “I will not. This isn’t exactly deciding who is going to do your nails.”

  “If I’ve got to have an operation, I think she’ll do fine.”

  “I’ll tell you what, Marci. When it’s your child’s head someone wants to operate on, I’ll let you decide whether they should or not, and who should do it.”

  “Look,” Jessie said, “there are forty or fifty neurosurgeons in Boston. Any one of them would be happy to give you a second opinion, and also a second choice. I want you to be totally confident in me or whoever does this surgery. Having this kind of operation is frightening enough without your having doubts about the surgeon.”

  “If you did the procedure, when would you do it?” Barbara asked, not acknowledging Jessie’s words of reassurance.

  “This is a benign tumor in that it doesn’t spread to other sites in the body,” Jessie replied. “And as I pointed out, it appears to be the kind of meningioma that is the easiest for us to remove. But the skull is a closed container, and there is pressure building up. The episode tonight was a pretty strident warning.”

  “So you’re saying soon.”

  “Two days, three. I wouldn’t wait much longer than a week.”

  “And are there other treatment possibilities? Radiation? Chemo?”

  Jessie shook her head.

  “Barb, Dr. Copeland sounds pretty confident in herself,” Paul ventured.

  Barbara Sheprow never had the opportunity to tell her husband to keep his thoughts to himself. For at that moment, lacking only a flourish of trumpets, Carl Gilbride swept into the room followed by two residents. He was as impeccably dressed as Jessie was rumpled, and he exuded stature and confidence.

  “Mrs. Sheprow, Mr. Sheprow, Marci, I’m Dr. Gilbride, the chief of neurosurgery here at EMMC,” he said, shaking hands with the parents, while cutting Barbara off from Jessie like a champion wrangler. “I had just stopped by the hospital to check on a post-op patient, and heard you were here.”

  What post-op patient? Jessie wanted to scream. A news flash on TV, a call from the orthopedist or from someone else—those were possibilities. But not a nine o’clock drop-in to check on a post-op. Give me a break!

  The passing of the surgical baton took just five minutes. If only Gilbride were as masterful in the OR as he was in situations such as this one, Jessie thought, Sara Devereau might never have needed two re-operations.

  “Dr. Copeland is one of our finest young surgeons,” Gilbride said after his cursory exam and glance at the MRI. “I assume it was her opinion that an operation is necessary on this meningioma, and fairly soon.”

  Finest young surgeons. Jessie swallowed back a jet of bile. Gilbride was only six or seven years older than she was, if that.

  “We’d be pleased to have the chief of neuro
surgery handle this,” Barbara said, carefully avoiding eye contact with her.

  Jessie could see Gilbride’s chest puff like a pigeon’s.

  “Well,” he said, “I’m certain that for someone who has brought such glory to us all, we can free up an OR whenever we need one. There is some danger in waiting, and it’s been my experience that people are much happier just getting this sort of thing over with.”

  “I agree with you there,” Barbara said.

  “Good. My recommendation is the day after tomorrow. I’m scheduled to present a lecture at the Midwest neurosurgical meeting in Chicago that day, but the topic is research that Dr. Copeland has been assisting me on. I’m sure you won’t mind standing in for me there, Jessie, yes?”

  “Well, actually, I have Sara Devereau in the ICU right now and—”

  “You can fly out tomorrow, give the talk at eleven the next morning, and be back by evening. The department will fly you there and you can take my room at the Hilton. The staff here’ll be happy to cover your patients for the short time you’ll be gone. After all, we are a team.”

  Jessie was already inching back toward the door. For sheer gall, stealing a patient this way fell short of some of Gilbride’s past showstoppers, but it was right up there. She wondered if the uncomfortable heat in her cheeks was translating into anything people could see.

  “That will be fine,” she said. “Marci, good luck with all this. Dr. Gilbride is a very good surgeon. You’ll be back on the balance beam before you know it.”

  The girl clearly looked embarrassed, but said nothing. It was as if she had seen her mother in action too many times to bother.

  “Thank you, Jessie,” Gilbride said, oblivious to the silent exchange. “Alice, in my office, will have the carousel of slides and your tickets ready for you first thing in the morning.”

  The best Jessie could manage was a tight-lipped nod.

  “Thanks,” she said. “Good luck.”

  Feeling perilously close to tears, she hurried out of the ER and back up to Surgical Seven. She rarely tried to contain herself if she felt like crying, even in public. But dammit, she vowed, there was no way Carl Gilbride was going to be the cause.

  AT TEN THERE was, as always, still more to do, but Jessie decided that a fifteen-hour nonstop workday was enough. Gilbride’s obnoxious performance in the ER hadn’t broken her spirit, but it had surely left a dent. She felt totally stressed. Her back and neck ached, and she was frantic for a protracted soak in the tub.

  The hospital was located not far from some of the toughest neighborhoods in the city. There was a shuttle that ferried employees to the various parking lots, but at night it only ran at the time of shift change, between ten forty-five and midnight. Jessie was in no mood to wait forty-five minutes. She had made the walk by herself any number of nights without incident, trusting her instincts, her New Balance cross-trainers, and the cylinder of Mace in her purse.

  She made a quick, final sweep through Surgical Seven, wrote some orders, and changed back into her civvies by the OR. Then she headed to the main lobby.

  Carefully avoiding eye contact with any of the gaggle of reporters waiting for news of Marci Sheprow, she signed out with the operator and left the hospital. The night was moonless—dark and cool, with fine, wind-whipped mist. On evenings like this one, Swede was not at its most reliable. For Christmas, Jessie planned to get it a complete physical with a new battery and whatever else was recommended by the specialist. If it let her down tonight and didn’t start, she decided, that checkup was going to come much sooner, and would include a colonoscopy.

  For whatever reason—maybe the heavy darkness, she thought—Jessie kept checking over her shoulder as she walked briskly to parking lot E. At one point, she actually thought she heard footsteps. The mist was building toward a steady rain. By the time she crossed the gravel to her car, she was running. She fumbled with her keys, then unlocked the door and slid behind the wheel. Relieved, she quickly locked the doors, then sat there, panting. Finally, she slipped the key into the ignition and turned it. Nothing. Just an impotent click.

  “Oh, Swede,” she groaned, staring out at the dimly lit parking lot.

  The rain was increasing. Around her, the windows began to fog. She opened hers a crack, then tried the wipers, which worked, and the headlights, which did also. Not a dead battery. She turned off both and tried the ignition again. Nothing. Suddenly, a sharp rapping on the passenger window startled her and seemed to stop her heart for several beats.

  “Y—Yes?” she managed.

  “Open the window, please,” a man’s voice said. “Security.”

  Jessie leaned over and smeared a circle in the condensation with the side of her hand. All she could make out was a blurred face. She opened the window an inch.

  “Identification,” she said.

  The man, rainwater dripping off the hood of his poncho, quickly held up a hospital ID. Grateful, Jessie didn’t bother reading the name. She opened the window another few inches.

  “My car’s dead,” she said. “The battery seems okay, but nothing happens when I turn the key.”

  “Can you pop the hood, please?”

  Jessie did as he asked and felt the car dip from his weight as he bent over the engine. The beam from his flashlight intermittently swung up from under the hood and dispersed across the fogged windshield. Jessie opened her window as far as she could without getting soaked.

  “Do you need any help?” she called out.

  “I don’t think so. A wire’s come off the ignition. I’ve just about got it back on. There. Try it now.”

  Jessie turned the key and Swede rumbled to life.

  “Bless you,” she murmured.

  The guard appeared at the driver’s-side window. His face was largely hidden by his poncho, but what Jessie could see looked pleasant enough.

  “You’re all set, ma’am,” he said. “I was just heading back to the hospital when you came running by. I’m glad I decided to wait.”

  “Well, I sure am, too, I can tell you that. Do you have a car here?”

  “No, I was walking.”

  “Well, get in. I’ll drive you back.”

  “I’m soaked. I don’t want to get your—”

  “Come on, get in. This car doesn’t care, and neither do I.”

  Jessie leaned over and opened the passenger-side door.

  “Thanks,” the guard said, sliding in.

  “That’s my line,” Jessie said.

  The man, about her age, was tall and broad shouldered. He had deep-set, dark eyes and the sort of rugged looks that women into Hollywood hunks might not have found attractive, but that she had always liked.

  “It got nasty in a hurry out there,” he said, pushing his hood back from his closely cut, light brown hair.

  “I’m very grateful to you for sticking around. Did I look that helpless?”

  “Hardly. I’m new on the job, and to tell you the truth, after a career in the Marines, it’s a bit boring. A woman running through the rain at this hour definitely caught my attention. I appreciate the ride back.”

  “It’s my pleasure. I’m Jessie Copeland, one of the doctors at the old place.”

  She extended her hand. The guard’s thick fingers enfolded it.

  “Well, I’m pleased to meet you, Dr. Copeland,” he said, noting that Jessie was better looking than her photo in the hospital directory. “My name’s Bishop. Alex Bishop.”

  CHAPTER 8

  NOT SURPRISINGLY, CARL GILBRIDE’S “ROOM” AT THE Chicago Hilton was a suite. It had been hard for Jessie to leave Sara in the care of one of the other neurosurgeons, but there had been absolutely no improvement in her level of consciousness or neurologic function. And Jessie strongly believed there wouldn’t be any over the day she would be away. The symptoms and clinical course of cerebral edema—brain swelling—were impossible to predict with any confidence. Some post-op patients were alert within a few hours despite significantly increased intracranial pressure and documente
d swelling on their MRIs, while others, with much less edema, awoke only after being out for days, weeks, or even months.

  It was midafternoon when Jessie had called Barry Devereau with the lack-of-progress report. Then she had changed for the trip in the on-call room. Marci Sheprow’s impending surgery, scheduled for first thing in the morning, was, of course, the talk of the hospital. Coming down the Track earlier in the day, Jessie had seen Barbara Sheprow approaching and had actually ducked into a patient’s room rather than open the curtain on what was certain to be a strained, even embarrassing, interaction with the woman. She also felt some relief each time she walked past the gymnast’s room and the door was closed. She knew she was allowing herself to become a player in Gilbride’s theater of the absurd, but she was also able to acknowledge that she was only human. By the time she had picked up Gilbride’s slides from his secretary and taken a cab to the airport, she was ready to get away from Eastern Mass Medical Center—even if it was only for a day.

  On the flight to Chicago, she had resolved to try harder to accept the fact that nothing she could ever do would change her department chief one iota. That grand decision did little to boost her spirits.

  One thing that did give her a lift was her brief contact with Alex Bishop, the hospital guard who had reconnected the wire in Swede’s ignition and kept a miserable evening from becoming even worse. Bishop was a former medic in the Marines, and was in the process of applying to Northeastern’s physician’s assistant program. He seemed incredibly intense, but he also had a droll, self-deprecating humor that appealed to her as much as his looks.

  After stepping out of her car, he had said, “Well, see you around.”

  She had nearly replied, “When?”

  Jessie set aside the notes she had made for her presentation, opened the closet, and took out the two suits she had brought to Chicago—one a conservative charcoal gray befitting the stand-in for Carl Gilbride, and the other a butter yellow number with a short straight skirt and cropped jacket. It was no contest. The yellow outfit made her feel feminine and yes, maybe even powerful. And who knew, perhaps some guy who was neither married nor lethally self-absorbed would be in the audience. Emily was right. It had been too long. It was time to get her nose out of people’s cranial cavities and look around.