The Patient

by Michael Palmer

  “I guess.”

  “It was awful for all of us to go through. It must be ten times as hard for you.”

  “Thanks for understanding that. I’ll never get used to this sort of thing.”

  “I hope you don’t.”

  She put her hands on his, then stood and let him hold her for a time.

  “I’m glad you came up here,” she said.

  CHAPTER 15

  JESSIE SPENT A RESTLESS NIGHT IN ONE OF THE tiny on-call rooms, rebreathing lungfuls of stale air and answering just enough phone calls to keep from reaching any deep, renewing sleep. She awoke for the last time at six, vaguely aware that she had been dreaming of Jackie Terrell racing through a brilliant, sunlit day over a carpet of emerald grass, chasing an endless succession of fly balls.

  Throughout the evening, reporters had paged her to ask about the boy. They all were referred to the hospital’s public relations people, who read or faxed them a statement she had helped to prepare. Undoubtedly, Eastern Mass Medical Center would be on the front pages for the second time in a week. This time, it was doubtful the item would stimulate any three-million-dollar grants.

  Jessie showered, pulled on a fresh set of scrubs, and tried a brief meditation. Still, as she headed over to the cafeteria for her usual in-house fare—sesame bagel with sliced tomato and cream cheese, coffee, and a banana—she felt unprepared for another frenetic round of post-Sheprow neurosurgical clinic. The four physicians she joined in the doctors’ dining room were engaged in what had become the standard, almost exclusive, mealtime conversation at the hospital—a can-you-top-this of managed care horror stories and jokes.

  Generally, Jessie’s zeal to make rounds on her patients and get her day going kept her from spending more than fifteen or twenty minutes with the breakfast crew. Today, although the stories and humor were as stale as the air in the on-call room, she couldn’t pull herself away. She even tried out a joke she had recently heard about the managed care executive who died and went to heaven, only to find out God had limited him to a three-day stay. The polite reaction from the others told her they had already heard it.

  Finally, at seven-fifteen, she paged Emily and met her on Surgical Seven for rounds. Their patients were reasonably stable. As Jessie anticipated, Gary Garrison’s headaches had begun to abate. He was still frightened of a rebleed from his aneurysm, though, and jumped at her offer of one last day in the ICU. Dave Scolari’s hands and arms were making remarkable progress, and his legs were showing encouraging strength as well. A miracle. They were heading out of Dave’s room when Emily mentioned Jackie Terrell for the first time.

  “Did you see the Globe this morning?” she asked.

  “Nope.”

  “They wrote about the heroic efforts of the doctors at Eastern Mass Medical.”

  Jessie knew her friend well enough to leap ahead some steps.

  “I’m okay about it, Em,” she said. “Honest, I am. I’m not blaming myself for something even the radiologist couldn’t see. It’s just so damn sad, that’s all.”

  Emily put her arm around Jessie’s shoulder.

  “I know, pal. I know it is. I went home last night and demanded that my kids turn off the tube and snuggle up with me on the couch for half an hour.”

  “Good move. They’re great guys.”

  “Speaking of guys …”

  Jessie smiled coyly and shrugged.

  “Dunno,” she said.

  “You do, too. I can see it all over your face. Did he come to see you after the case?”

  “Maybe.”

  “Ohmagosh, you really are bit, and it sounds like he might be, too. I think that’s great.”

  “We’ll see. Look, I’m sorry for being in such a testy mood this morning. Gilbride’s off being famous again, so I’m facing another crazy day in outpatient. It’s like he opened this dam of referrals and then just swam away.”

  They turned in to the next patient’s room, a tumor case of Gilbride’s. Jessie was surprised to see Lisa Brandon, the candy striper who had been with Sara, seated at the bedside.

  “Evening shift one day, day shift another,” Jessie said. “Are you going for some sort of volunteer-of-the-year award?”

  Lisa shifted uncomfortably.

  “I hope it’s all right that I’m here again. Actually, there isn’t much for me to do at home, and I really like helping the patients.”

  “In that case we’re lucky to have you. Work all three shifts if you want. Why not? I do.”

  Jessie introduced Lisa to Emily as a leader in the don’t-know-what-to-do-when-I-grow-up club, and Emily proclaimed herself a founding mother of the organization.

  “Cute kid,” Emily said after they had left the room.

  “She’s no kid. She’s in her early twenties.”

  “Have you looked at the birth date on your driver’s license lately, honey? She’s a kid.”

  IT WAS MIDAFTERNOON. Jessie was in Carl Gilbride’s office waiting for Eastman Tolliver to join the two of them for what would essentially be catch-up rounds for Gilbride on his patients. He had returned from New York City a short while ago in triumph—a full ten minutes on the Today show, followed by an interview with the Times, a hastily called grand rounds presentation at Columbia Presbyterian, and a lunch meeting with a robotics manufacturer interested in cutting some sort of deal for ARTIE. Now, after finally telling his secretary to hold all calls, he was shamelessly pumping Jessie for any information that would give him an edge in his quest for a three-million-dollar grant.

  “So what do you make of this guy?” he asked.

  “Carl, I only spent an hour or so with him yesterday. He’s pleasant, and very interested in our program. That’s all I can say. I expected he might come in for rounds this morning—I invited him—but he called and said he’d wait until you got back.”

  “Did he seem angry I wasn’t here?”

  “Not really—at least not as far as I could tell. He seems very, I don’t know, Californian. Sort of laid-back.”

  “Surely he must understand that I would never have left him hanging except that this was all very important stuff.”

  “Critical. How many times does a body ever get invited to be on the Today show?”

  “Exactly. So, what’s his background? What are his interests?”

  “He hasn’t been at the MacIntosh Foundation all that long—six years, I think he said. Before that he was a college professor of some sort.”

  “He’s bright, then?”

  Bright enough to see through you, I fear.

  “Yes, that was my impression.”

  “Mine, too,” Gilbride said. “I think we should—”

  Gilbride was interrupted by his secretary buzzing in with the announcement that Tolliver had arrived. The foundation director strode into the office and greeted them both with vigor.

  “Dr. Copeland, I’m terribly sorry to hear of that child’s death,” he said.

  “Thank you,” Jessie replied, noting that her department chief hadn’t mentioned a word about the case.

  “I was in your cafeteria and heard some people talking about what a heroic job you did by even getting the boy to the operating room.”

  Jessie sighed.

  “The whole thing is very tragic.”

  Tragic. The word seemed to galvanize Gilbride into action. It was as if he couldn’t stand to let any negative connotation hang in the air.

  “So, Eastman,” he said, clearing his throat for a transition, “what do you think of what you’ve seen so far?”

  Tolliver’s expression flickered annoyance at Gilbride’s inappropriate lack of subtlety. Jessie was as certain she saw the reaction as she was that her chief hadn’t.

  “So far, so good,” he said. “But I’m still anxious to learn more about ARTIE, and to watch him in action.”

  “Well, I can’t say that I blame you,” Gilbride said. “I believe we are seeing the future of neurosurgery—perhaps even of all surgery—in our little robot.”

  “Ha
ve you experienced any problems with the device?”

  “Some mechanical glitches, but nothing major.”—Unseen by either man, Jessie rolled her eyes.—“Even though we’re doing cases now with ARTIE,” Gilbride went on, “we’re still working with him in the lab. The search for perfection isn’t just the motto of our research unit, it’s the rule. We see the next generation of the device being even smaller, more maneuverable, and more powerful than the one we’re using. I believe it’s no exaggeration to say that at some point, not that far down the road, the surgeon interface between the robot and the MRI may be eliminated altogether. The device could simply be inserted beneath the patient’s skull and turned loose, as it were.”

  “Sounds like something straight out of science fiction,” Tolliver said.

  “So were Jules Verne’s submarine and rocket to the moon,” Gilbride responded, now clearly on a roll. “MRI-assisted surgery is merely in its infancy. The future is limitless.”

  Jessie felt her gut knot. Just a short while ago, a mechanical malfunction had caused ARTIE to rip into the normal brain tissue of her cadaver-subject. Still, she knew better than to so much as mist on Gilbride’s three-million-dollar parade—at least not until she was ready to start searching for a new position. If Gilbride wanted to compare himself as visionary with Jules Verne, so be it.

  “Well,” Tolliver said, “you certainly make a good case for your invention. However, before I return to California, I would hope to see this ARTIE perform an actual operation. Is that possible?”

  Gilbride’s bluff had been called. Not surprisingly to Jessie, Eastman Tolliver had no intention of buying a pig in a poke. If the MacIntosh Foundation was going to lay heavy money on a device, he wanted to see it in action. Jessie knew what was coming next.

  “So, Jessie,” Gilbride said, turning to her, “you have my OR schedule. Are there any cases appropriate for ARTIE?”

  No, Carl. As a matter of fact, at this stage of the game, there are no cases anywhere that are appropriate for ARTIE.

  “Actually, Emily has the OR schedule. We’ll be meeting her in the ICU. You can decide for yourself once you’ve gone over it and met your new patients.”

  “And I shall.” Once again Carl cleared his throat, signaling he was about to transition. “So, then, shall we make our way to the ICU?”

  ROUNDS BEGAN SMOOTHLY enough, with Gilbride at his bombastic best, leading an entourage that included Jessie, Emily, two other nurses, two medical students, two residents, and the foundation director on a leisurely patient-by-patient tour—first of the unit, then of the rest of the floor.

  By and large, Gilbride’s patients were docile and seemed happy to have their surgeon back and grateful he had stopped in to see them. There were, however, three of the sharper ones who made snide or angry remarks about his lack of involvement in their cases. Jessie wasn’t certain whether the cynicism was ignored by Gilbride or simply went over his head. But the jab of one elderly patient, Clara Gittleson, clearly hit home.

  “Dr. Gilbride,” she said crisply, “I have to tell you that I never knew how little attention you were paying to me until Dr. Copeland and Emily started coming around.”

  Gilbride mumbled something that might have been an apology. A nerve twitched at the corner of his mouth. He asked Jessie a number of questions about the woman’s post-op mental status. Finally, he suggested that a psych consult might be in order to deal with what was obviously a combination of depression and reaction to post-op medications. Jessie glanced over at Tolliver, who seemed unaffected by the exchange but remained steadily focused on Gilbride.

  As they headed for the next room—Rolf Hermann’s—Jessie lagged back and subtly motioned for Emily to join her.

  “Have you been in to see Orlis yet?” she whispered.

  “Dragon Lady? Oh, yes. I stopped by a few hours ago while I was checking to make sure everything was in place for the emperor’s return. She wanted to see me about as much as she wants to see a zit on that perfect face of hers.” Emily adopted a passable German accent and added, “I vish only to speak viz Ducktor Geelbride.”

  “Well, Orlis, be careful what you wish for. You just might get it.”

  “I can hardly wait.”

  “Dr. Copeland,” Gilbride called out from outside the door, “would you mind terribly continuing on rounds with us?”

  Jessie hurried up to the group, presenting the next patient as she arrived.

  “Count Rolf Hermann is a fifty-three-year-old married German man, the father of three, who was perfectly healthy until he experienced the first of two seizures about six weeks ago. Evaluation in Europe led to these MRIs.”

  Jessie knew better than to upstage Gilbride by identifying the tumor or giving any clinical opinions. Instead, she merely nodded to Emily, who took Hermann’s MRIs off a stainless steel rolling cart and slid them onto two of the view boxes inset in the wall across from his room. Gilbride’s thoughtful pacing back and forth in front of the films was clearly for the benefit of Tolliver and perhaps the medical students, because all of the others could have made the correct diagnosis from a passing train.

  “Well,” he said finally, “it appears what we have here is a large subfrontal meningioma, wouldn’t you say, Dr. Copeland?”

  “I would, yes, sir.”

  “Well, what do you think of this tumor as appropriate for our intraoperative MRI with robotic assist?”

  Jessie knew that if any case was ideal for ARTIE, this one was. But she still had serious reservations.

  “I think ARTIE would be one way of getting at it,” she said, choosing her words carefully.

  “Excellent. We’re in agreement, then. Mr. Tolliver, here’s your case. Dr. Copeland, is there anything else you think I should know about this fellow?”

  “Not really.”

  “Well, then, let’s go meet the man.”

  “He speaks some English,” Jessie said, “and understands it completely, but his wife does most of the talking.”

  The room, which was large for a single, was packed even before the arrival of the medical entourage, with Orlis, her husband, and his three grown children sharing space with a considerably overweight private-duty nurse. Jessie introduced Gilbride, feeling as if she were passing off the baton in a barefoot relay race across hot coals.

  “Well, it’s a pleasure indeed to meet you,” Gilbride said. “However, before we conduct our business, I must ask your children and nurse to wait in the hall. We are a teaching hospital, and after I bring everyone in who is making rounds with me today, I’m afraid this room will get a bit crowded.”

  “You will not be bringing everyone in,” Orlis responded. “Count Hermann will not take part in any medical circus.”

  “Ka-boom!” Jessie whispered to Emily.

  The initial test of wills between Gilbride and the Countess lasted through several exchanges before the Count intervened and brokered a compromise. Jessie and Emily would stay, along with Hermann’s older son, Derrick, a man with watchful eyes, strongly built like his father, but with little resemblance beyond that. Tolliver, who observed the conflict and resolution from the doorway, smiled understandingly and motioned that he would be waiting in the hallway.

  “Now, then,” Orlis said, immediately seizing the initiative, “exactly what is the procedure you intend to do on my husband, and when will it be done?”

  “I will answer each of your questions in due time, dear lady. But not until I have had the chance to examine my patient.” He turned from her and continued speaking with a deliberateness that bordered on patronizing. “Count Hermann, I am pleased to make your acquaintance. I look forward to the successful treatment of your problem.”

  “I wish that will be so,” the Count said.

  Orlis, her expression stony, stood aside as Gilbride did a more painstaking and meticulous neurologic examination than Jessie had ever seen him perform.

  Spare me, was all she could think. It was comforting and amusing to know that a few feet away, Emily was thinking th
e same thing.

  “An excellent exam,” Gilbride said finally, putting his reflex hammer and the tuning fork used to test vibratory sense back into his lab coat pocket. “Excellent. Count Hermann, your neurologic exam is surprisingly good. Your tumor is rather slow-growing and non-malignant, which means it does not spread to distant parts of the brain, or to other organs. However, it is taking up increasing amounts of space, and has begun compressing normal brain tissue. You will need surgery to remove it.”

  The Countess inserted herself between the two men, making no attempt to hide her impatience to hear something she did not already know.

  “Do you intend to use the same device you used successfully on that young gymnast?”

  Almost in spite of himself, Gilbride glanced at Jessie. She looked away.

  “Well, yes,” he said. “I suspect we will do this operation in the MRI operating room, and we probably will use our robotic assistant.”

  “We don’t want probably,” Orlis said sharply. “My husband came here because you said you had something to offer that other neurosurgeons did not. I want everything necessary to be done for him. He is a very special man and helps a great number of people.”

  Gilbride rose to meet the challenge.

  “I appreciate your anxiety, Madame,” he replied, “but I feel I must remind you that I am the surgeon. If I think robotic assist will help us remove your husband’s tumor, that is what we will use. And if not, well then, we shall not. I hope that is clear?”

  Orlis looked to the Count, who nodded his agreement. Then she thrust back.

  “When will the operation be done?” she asked.

  Gilbride turned to Emily.

  “You have the OR schedule?”

  Emily, clearly unwilling to be anyplace but on the sidelines of this battle, handed the notebook over to Jessie.

  “We’re limiting ourselves to the MRI operating room?” Jessie asked.

  “Precisely,” Gilbride replied.

  “Okay. The room is maxed out for three weeks. We have two cases a day booked every day, including Saturdays.”

  “But I have promised Mr. Tolliver I would be doing an ARTIE case that he could observe. We need to fit Count Hermann into the schedule by the end of the week.”