The Patient

by Michael Palmer

  She wandered out to the sitting room of her suite and called the neurosurgical ICU at Eastern Mass Medical. As she had anticipated, Sara’s condition was unchanged. Jessie had known better than to expect any improvement, and yet she had held her breath, waiting for the terse report.

  Gilbride’s presentation, as it turned out, was scheduled for one in the afternoon, not eleven in the morning as he had told her. She could have gone down to the lecture hall to listen to some of the other talks. Instead, she decided on a nap. First, though, she took a twelve-dollar mason jar of cashews from the in-room minibar and washed some of them down with a few swallows from a three-dollar can of diet Coke. God only knew, she had earned the indulgence. With any luck, sometime in the future the expenses for her trip would float across Gilbride’s desk, and there they’d be—fifteen bucks’ worth of cashews and Coke. She opened a five-dollar Toblerone bar for good measure, and set it aside after one small bite.

  I’m a vindictive enemy, Gilbride, she thought as she checked off the three items on the minibar tally sheet. Take that! And that!

  The phone rang with the wake-up call she had requested, anticipating that the strain of the past two days and whatever Freudian factors were at work might have her napping through her presentation. She arranged for a delayed checkout and gathered her things for the talk, which Gilbride had modestly titled “Robotics and Intraoperative MRI: A Marriage for the Ages.” Finally, after one last survey in the mirror, she headed down ten flights to the Northeast Salon.

  Gilbride and Copeland, she was thinking. A Marriage for the Ages.

  JESSIE WAS INFINITELY more comfortable teaching a small group of residents or students than she ever would be standing up before a crowd. She was grateful that most of this talk was commentary on slides, with the house lights down. Except for the clearing of throats and an occasional cough from among the 150 or so attendees, she felt alone much of the time, lecturing in a cocoon of darkness. Carl Gilbride, a master at such presentations, had interspersed his charts and photographs with a number of cartoons, some of which were unabashedly sexist. Jessie had weeded out the most offensive ones, and then appalled herself by leaving in two of the borderlines, just to show the almost-all-XY audience that she could be one of the boys.

  She had been allotted forty-five minutes and was pleased and relieved to realize that, with seven minutes left, she was done. She turned on the house lights from the lectern and asked for questions. Three microphones had been placed along the center aisle. Immediately one surgeon was up at each one—a good sign that the entire crowd hadn’t drifted into dreamland. The first two questions were softballs—simple clarifications she could easily handle. Both men—neither of whom looked like potential spice for her personal life—complimented her on an excellent presentation and fascinating research. So far, so good, she thought as the two physicians were quickly replaced at their microphones.

  The third questioner was a tall black neurosurgeon from California named Litton, a researcher in one of the programs developing a competitor for ARTIE. In their brief encounters with each other, Jessie had found him to be impressively intelligent and absolutely humorless. He had arrived fifteen minutes late, during one of the brief lights-on periods of her talk. She sensed trouble even before Litton began speaking.

  “Dr. Copeland, Ron Litton, Stanford University, here. I want to congratulate you on an excellent presentation of fascinating research into the field of intraoperative robotics. But there is one thing troubling me.”

  “Yes?”

  “You said that to this point you’ve done some work with your ARTIE on animals and cadavers.”

  “That’s right.”

  “And that you and your department head, Dr. Gilbride, had begun making preparations to submit a proposal for approval by your hospital’s committee on human experimentation.”

  “That’s exactly what I said, yes.”

  “Then I would suggest that perhaps you and your chief of neurosurgery should get on the same page. I was several minutes late arriving for your presentation because I was glued to the television in my room. CNN, to be precise.”

  “Dr. Litton, I don’t understand what that has to do with our submitting a human experimentation protocol.”

  “Dr. Copeland, I certainly hope you have approval from that committee already. Because according to the news and the interview with Dr. Gilbride that I just watched, earlier today he used your friend ARTIE to excise and successfully remove a tumor from the brain of the Olympic gold medal gymnast Marci Sheprow.”

  CHAPTER 9

  “DR. GILBRIDE, WOULD YOU SAY THAT FROM WHAT YOU’VE seen of Marci Sheprow so far, your surgical robot has scored a perfect ten?”

  Gilbride, looking earnest and professorial, met the cameras covering his press conference warmly.

  “Nothing in neurosurgery can be taken for granted, Charlie,” he said, tenting his fingers, “but at the moment, Miss Sheprow is looking very good, and we’re expecting a rapid recovery. The trauma associated with traditional surgery was certainly diminished through the use of our intraoperative robotics.”

  Come on, Carl, have you no shame?

  Jessie sat slumped in stunned silence on the couch in her suite, watching her boss perform for the cameras and at least two dozen microphones bunched on the table before him. To his left, propped on an easel, was an artist’s graphic rendering of Marci Sheprow’s head, the location of her meningioma, and the path followed by ARTIE. It was as if Gilbride were General Schwarzkopf and Marci’s brain Iraq. It appalled Jessie, but did not at all surprise her, that he had commissioned the artwork before he did the surgery.

  “Dr. Gilbride, Pat Jackson, Associated Press. Could you give us some idea of the future of robotics in neurosurgery?”

  “In all of surgery, Pat. Advances in medicine are coming so fast. People forget that CT scans weren’t in general use until twenty years ago, and MRIs just over half that. Ultrasound’s been around since World War Two, but with nothing like the sophistication we have today. Now there’s fiber optics, which has made all of the various scopes possible, and looming on the horizon is robotics. The potential is limitless, and I’ve told the researchers in my department that it’s full speed ahead in this area.”

  Jerk.

  Jessie wondered about her future at EMMC. Had Gilbride left her any option but resignation? He had lied to her about getting ready to apply for authorization from the human experimentation panel. The five-member panel was largely made up of his cronies. Clearly he had already gotten approval from them for a clinical trial with ARTIE, and was just waiting for the perfect case.

  And then there was the matter of Marci Sheprow’s tumor. It wasn’t much of an exaggeration to suggest that a reasonably competent neurosurgeon could have successfully removed her meningioma with a Black & Decker drill, a teaspoon, and a Swiss Army knife. This was hardly the sort of case for which ARTIE was being developed. But only the few who were present when Jessie was working on Pete Roslanski’s tumor knew how much damage ARTIE-2 could have done to Marci’s brain had it malfunctioned the way ARTIE-1 had. No wonder Gilbride had gone haywire about her cadaver trial. He was already primed and waiting for the right moment to make history. The technical problem she had encountered, however remediable, would create a major glitch in his plans should word filter back to the human experimentation panel. Enter Marci Sheprow—a morsel just too tasty to pass up.

  The news conference was continuing, but Jessie had seen and heard all she cared to. She left her suit and underwear where they fell on the bedroom floor and stood in a steaming shower for twenty minutes, washing herself over and over, as if she could somehow scrub away the contamination from her association with the man.

  She dried her hair, then pulled on jeans and a crewneck sweater and packed up her things for the flight home. It would be fairly late by the time she returned to the hospital and it was doubtful she’d have to be dressed up to face the press. Even if someone did manage to connect her to ARTIE, so what. She w
as just the robot’s nursemaid. Gilbride was its press agent.

  She started out of the room, then returned to the minibar and added a three-dollar bag of M&M’s to her purse.

  Take that!

  THE PHALANX OF satellite broadcasting vans parked in front of the hospital was the first giveaway that Jessie had seriously underestimated the media’s devotion to Marci Sheprow, and their fascination with the technology that had saved her life. There were security guards everyplace she looked, and clusters of news and camera people in the main lobby and hallway. As she showed her ID to a guard, several reporters began calling out questions to her on the off chance that she had something—anything—to do with Marci. Others began shuffling toward her like extras in a zombie picture.

  Jessie hurried up to the OR dressing room on Surgical Eight and changed into scrubs and a lab coat. Then, full of nervous tension, she raced down to Surgical Seven.

  Marci was still in the NICU. Jessie had planned to stop in and see her after she had checked on Sara, but Barbara Sheprow caught her eye as she passed and motioned her in.

  “How was your talk?” Barbara whispered, conscious of her sleeping daughter.

  “It went fine. I’m so pleased with what I’ve heard about Marci’s operation.”

  The gymnast was off all life support, and looked to be breathing comfortably.

  “She’s opened her eyes several times, and has even spoken. But mostly she’s been sleeping.”

  “That’s certainly normal.”

  “Dr. Copeland, I hope there’re no hard feelings about my decision to go with Dr. Gilbride on this.”

  “This isn’t a contest, Mrs. Sheprow. It’s your child’s life. You’ve got to be as comfortable as possible with her surgeon. I wouldn’t want to be that surgeon if you weren’t.”

  Without waiting for further conversation, she brushed some hair from Marci’s forehead, studied her perfect, un-lined face, and said a silent prayer of thanks that nothing had gone wrong during Gilbride’s grandstand play. Then she left. Barbara was obviously ecstatic with the decision she had made in choosing Gilbride. Jessie hoped she would never know how shamelessly her daughter had been used.

  Sara remained on assisted ventilation, but the covering neurosurgeon’s notes stated that she had begun gagging a bit on the breathing tube—a slightly hopeful sign. He had also reported a flicker of movement on Sara’s left side. Flicker of movement. A brilliant, vibrant teacher and mother of three, and that was what her world had been reduced to. At the moment, Jessie reminded herself. At the moment. But she also knew that every passing hour with minimal or no progress, each passing day, made a recovery without major deficits less likely.

  Jessie did a brief neurologic exam, which revealed no reflexes, poor muscle tone, and nothing approaching even the flicker her covering doctor had described. This was not just a battle, this was Sara’s Armageddon.

  Looking down at her friend, she wondered how Barry and the kids would react to the news that she had decided to resign from the staff. What about Tamika Bing and Dave Scolari and Mrs. Kinchley and her other patients? What about Skip Porter, and Hans, and all those who had helped breathe life into ARTIE? If only Gilbride had stayed on his side of the line. Minimal, unavoidable contact she could have handled. Now, she was being forced to make a choice that would only hurt people—most prominently, she reflected sadly, herself. She wrote a few perfunctory orders on Sara and headed, downcast, toward the ward, intending to make quick rounds on her patients before heading home. The unit charge nurse called to her before she reached the doors.

  “Jessie, hi,” the nurse said, handing over an envelope with Jessie’s name printed on it. “Dr. Gilbride said you would probably be in here tonight. He left this for you.”

  More than curious, Jessie thanked the nurse and hurried to her office with the envelope before opening it.

  MEMO

  From: Carl W. Gilbride, M.D.; Chief, Department of Neurosurgery

  To: Roland Tuten, M.D.; Chairman, Professional Standing, Credentials, and Promotions Committee

  Re: Jessie D. Copeland, M.D.; Instructor in Neurosurgery

  Dear Dr. Tuten:

  I am writing to inform you of my intention to recommend Dr. Jessie D. Copeland for a promotion from clinical instructor to Assistant Professor of Neurosurgery, effective as soon as I receive approval from your committee. Dr. Copeland has served this department and Eastern Massachusetts Medical Center with distinction, and has been especially instrumental in the development of our program in intraoperative robotics. It is my intention to reward her for these efforts with this upgrade in her academic rank.

  Assistant professor—a serious step toward tenure; a significant raise in pay. Jessie stared down at the memo. She had believed herself to be two years away from a promotion, maybe three—if she got one at all. She also knew that she would be leapfrogging several members—XY members—of the department. She wasn’t a militant feminist, but she couldn’t deny her satisfaction at the idea.

  “I wanted to wait to speak with you until you had read that.”

  Carl Gilbride, looking no less fresh than he had during his press conference hours ago, stood in her doorway. Jessie held up the memo.

  “In the outside world they throw people in jail for accepting a payoff like this,” she said.

  Gilbride slipped inside the office and closed the door behind him.

  “Call it what you wish,” he said. “Either way, you’ve earned it. I knew you’d be upset by what happened today.”

  “I’m worse than upset, Carl. I’m horrified and furious, and … and mortified. ARTIE wasn’t ready for something like this, and you know it.”

  “That’s not what Skip Porter told me. He said that … that little problem you had the other day was purely mechanical—a broken wire, not any design or computer flaw. Besides, when is a new technique or drug ever really ready? At some point, clinical scientists have just got to take the bull by the horns and do it.”

  Jessie shook her head slowly.

  “Spare me, please,” she said.

  “Jessie, I appreciate all you’ve done with ARTIE. But I also don’t think you appreciate some of the realities of financing a research-oriented neurosurgical department.”

  “Carl, you placed that girl in danger for no reason.”

  “If there was any trouble with ARTIE, I was set to open her up and go after her tumor that way. And don’t say the device was used for no reason. Look at these.”

  Gilbride withdrew a large, stuffed manila envelope from his briefcase and passed it over. It contained dozens of congratulatory e-mails, phone messages, faxes, and even several telegrams. Patients from countries around the world were already contacting Gilbride, asking him to take a crack with ARTIE at their “inoperable” tumors.

  “Please, I was hopeless until now,” one fax read. “I have nothing to lose. Please help me.”

  “Congratulations,” Jessie said, hoping her tone reflected her lack of sincerity.

  “Two of those faxes and one of those telegrams are from agencies that could or do help fund our research,” Gilbride said, reaching across the desk to separate them from the others. “Here.”

  The telegram was from the medical director of Durbin Surgicals. Jessie knew that a good portion of the work on ARTIE had been done with their help through a grant that was in Gilbride’s name, but for which she had written the application.

  Dear Carl. We at Durbin are proud that research done in part under one of our career development awards has made such an impressive impact. Congratulations to you, Dr. Copeland, and the rest of your staff. I suspect when you apply for a renewal you will find smooth sailing.

  “And look. Look at this one. It’s from the executive director of the MacIntosh Foundation in Los Angeles. You’ve heard of them?”

  “Of course.”

  Dear Dr. Gilbride,

  Congratulations on your successful use of intraoperative robotics in the case of Marci Sheprow. As you know, the MacIntosh Foundatio
n is committed in part to the furtherance of medical science as it directly impacts the public. I know you have been anxiously awaiting our response to your recent grant application to our agency. We are impressed with what you have accomplished, and will be evaluating your research for one of our Class 1 awards, which, as you may know, has a minimum value of three million dollars. I will be contacting you directly should we require any further information, or should our grant awards committee reach a decision on your application.

  Sincerely,

  Eastman Tolliver

  Executive Director

  “Three million,” Jessie said, genuinely impressed.

  “Just the beginning. Because of this case, we’re going to be right up there with the elite programs in the country. My guess is that by the time this week is over, we’ll be getting more referrals and doing more tumor cases than any other program around. We’re also going to have tremendous clout when it comes to competing with places like Stanford and Baylor for money—especially with Iowa no longer in the picture.”

  “Carl, I appreciate all you’re saying. But I just can’t forgive you for lying to me about not having the human experimentation approval.”

  “I didn’t. The day after Marci presented to you in the ER I pushed through the approval. Not before.”

  Jessie eyed him suspiciously.

  “You can provide me proof of that?”

  “If you want it. Jessie, I understand you’re angry. People get angry with me all the time. It’s part of running a department and pushing it toward the top of the heap. But I don’t want the department to lose you. That’s what this promotion is all about. Now, what do you say?”

  By claiming that he had not lied regarding the HE panel’s approval, Gilbride had opened the door just a sliver for Jessie to remain at the hospital. It was really all she wanted.