Noble Vision: A Novel

by Gen LaGreca

  If he wanted a life’s work that demanded the skill of splitting the atom, the precision of a bombardier, and the daring of a tightrope walker, David knew the only work that could qualify. At age eleven, he knew. As he gazed up at his father with a smile that was a salute, the father knew, too. He winked at the child in answer.

  Walking to the Manhattan offices of the New York Bureau of Medicine, David was gripped by a sudden longing for the man in the OR who had winked at him on that final day of his childhood. He reproached himself, feeling it was silly for a grown man in a time of crisis to wish for his father. However, that presence in his life was inextricably linked to his career and to the meaning of Nicole’s surgery.

  He approached an old brick building with a plaque above its entrance that read To serve the public interest above all other concerns—this is the noble work of medicine.

  The quotation was attributed to the secretary of medicine. David stared at the inscription long after reading the words. The man who had made that statement was the man he loathed more than any other, the man who wanted to destroy him and Nicole.

  He took the elevator to the top floor of the building. Horizontal strips of wood-paneled walls converged on a varnished oak door at the end of the hall. He walked down the narrow corridor that seemed like the dead end of a one-way street. The man he was about to see was armed and dangerous, he warned himself. He must not be caught off guard.

  The woman sitting at the desk of the outer office had been a nurse for the secretary during the years in which he had practiced medicine before accepting his current post. Involuntarily, she began to smile at the man entering the office, as if greeting an old acquaintance. She suppressed the impulse on seeing the solemnity of the visitor’s face.

  “He’s waiting for you, David.” She gestured to the door of the inner office.

  The visitor reached the door. For a long moment, the knob seemed too heavy to turn, and then he disappeared inside.

  The room’s proprietor was standing by a window and vacantly staring out, absorbed in thought. David looked at the man whom he had not seen in two years, since the day he had denounced him for accepting the post of secretary of medicine and vowed never to speak to him again. The eyes of the two men filled with venom, but their voices sounded oddly, jarringly too soft.

  “Hello, Father.”

  “Sit down, David.”

  Chapter 15

  The Law

  Mrs. Lang seemed to have played no part in the birth of her firstborn, David. The tall, slim lines, high cheekbones, and stunning green eyes made the resemblance between Dr. Warren Lang and his son astonishing. Even the silky hair was identical in both men, except that the father’s was bleached white by an added generation. When Warren’s hair was black, David was sometimes mistaken for him. “Mind you, we have our differences,” Warren would proudly say to those remarking on their likeness. “I’m the good surgeon of the family, but David’s the great one.”

  After studying each other for an awkward moment, both men averted their eyes as if to ignore the stubborn resemblance forcing itself on their consciousness. David surveyed the office, surprised at its power to disturb him. The room was a marked departure from the medical office of the man who used to be his father. At thirteen, David had lovingly sketched that sacred place and then hung the drawing in his room to dream about the future. Gone from the new office were the copious medical diplomas and certificates that David remembered; in their place were pictures of Warren waving a campaign banner at a political rally, making a speech from a podium thick with microphones, and shaking hands with a powerful politician. Gone were the massive bookcases of medical volumes, replaced by the present room’s only reading material, a stack of news magazines spread over a coffee table.

  The desk of Dr. Warren Lang the surgeon had held only items essential to medicine—a replica of the brain, a clinical journal, a patient’s chart. The desk of Secretary Lang was cluttered with newspaper clippings about CareFree, portraits from a photography session, a party invitation, a silver plate from an awards dinner. A tall vase on the desk contained a floral arrangement from a medical society that wooed him, its card reading: “With heartfelt appreciation for the rousing speech you gave at our banquet.” The display featured two-foot-high gladiolas balanced precariously in the narrow vase. Like the tottering profession that gifted them, thought David. Only one personal object had been permitted on the desk of Warren Lang the surgeon. David’s eyes involuntarily searched for—and found—it: a photograph of him at eleven, wrapped in a sterile gown on the day when he saw his first surgery. It was the only object surviving the radical transformation from the surgeon’s to the secretary’s office.

  “You’ve gone too far!” Warren broke the uncomfortable silence. “You’re disgracing me! I don’t care what happens to you now, David. I must treat you like any other official matter I handle—all in a day’s work.”

  David did not remember when he had last drunk anything, and he was perspiring too much from his walk—two facts that suddenly struck him when the room swirled, then turned black. The next thing he remembered was sitting in a chair with the concerned eyes of Warren and his secretary peering at him. His father was loosening his tie, unbuttoning his shirt, wiping his forehead with a cool, wet handkerchief.

  “Doris, he’s been in surgery all night, and you know how David works. He probably hasn’t eaten or slept in who knows how long! And his shirt is soaked.” He poured a glass of water from a pitcher on his desk.

  “Here, drink this, you crazy kid!”

  David drank eagerly.

  “Do you realize it’s ninety-five degrees outside? What’d you do, walk here? You look like hell!”

  “That will do.”

  “Doris, would you get David a quart of orange juice? He’s not moving from that chair until he drinks it!”

  David recovered enough strength to abort Warren’s attempt to check his pulse. Doris soon produced a container of juice, then left the men alone, as David sipped the liquid. The fluids brought a warm glow back to David’s pallid face, but his eyes remained cold and unyielding.

  “No one else must be punished for what I did. Everyone else is innocent. Randy knew nothing about this, so call off your mad dogs, Father.”

  “How dare you? I don’t know what you’re talking about.”

  “How could you not know?”

  “Know what?”

  “That your staff’s out for blood, Randy’s blood, goddamn them! They’re denying approvals and levying charges on the hospital just to flex their muscles. Do you consider your public served by vengeance against the innocent?”

  “You’re accusing my agency of misuse of power. Where’s your proof?”

  “The very existence of this institution is proof enough.”

  “We’ll not go into that again. That’s beside the point.”

  “That is the point.”

  “The point is that you will discontinue your nerve-repair treatment at once!”

  “I will not.”

  “And because you unintentionally broke the law—”

  “I intentionally broke the law.”

  “—you will apologize to the governor.”

  “It’s none of the governor’s business what I do in the OR.”

  “Overcome by grief for the patient’s unfortunate condition, you had an overzealous moment in which you didn’t think clearly.”

  “I thought very clearly.”

  “Is your new procedure the same one that you were working on when I saw you last?”

  “It is.”

  “Then it requires a second surgery, doesn’t it?”

  “It does.”

  “You will not perform it.” Warren stood towering above David in the chair, pointing a threatening finger at him.

  “At minimum, I’d have to be dead not to perform the second surgery.”

  “The patient’s health won’t be jeopardized by discontinuing the treatment. The nerves will remain damaged, and that
’s that.”

  “And her life will remain in shambles.”

  “You’ve got to admit you made a mistake and retreat. That’s the only way I can save you.”

  “Then don’t save me.”

  “What?”

  “Use some pretense or other to lift my suspension. Then look the other way until I finish the second surgery. Tie this matter up in a committee, assign a task force to study me, or do whatever it is you do here. Only stall the matter until after the second operation. Then do what you please to me.”

  “Cutting that patient again would be like cutting your own throat.”

  “Why should saving my patient lead to my own destruction?”

  “You have no idea of the hot water you’re in, David, so don’t argue. You must discontinue the treatment.”

  “Why?”

  “Because we made budget cuts. We had to! I issued an edict. I had to! With the rumors about my running for lieutenant governor, every reporter from here to Niagara Falls is watching me. I can’t break the rules for my own son. That would be completely arbitrary.”

  “Any more arbitrary than the other decisions made by this institution?”

  “You don’t understand. Right now there are other priorities that are more pressing than nerve repair.”

  “Not for my patient, there aren’t.”

  “There are the more pressing needs of the public, David.”

  “Like what? Does somebody in Brooklyn need a gallbladder removed? Does somebody in Buffalo need a tonsillectomy? Or maybe some poor guy in Ithaca is waiting for your blessing to have a heart bypass. What must my patient do to win a door prize, too?”

  Warren noticed the absence of something in David’s face that disturbed him—the admiration that face had once held for him was gone.

  “I understand that the patient is a dancer, Nicole Hudson.”

  “Yes.”

  “Fortunately, she’s not very famous, and not a senator’s daughter or congressman’s wife. You’re lucky, David. You could’ve been damned if you did and damned if you didn’t continue the treatment.”

  David smiled bitterly. “Why? Are some people more in the public interest than others?”

  Warren walked behind the desk and paced nervously. “Never mind. You don’t understand the practical expediencies necessary to advance the cause of social justice.”

  “Like selling my patient down the river? Is that what you call a practical expediency? And what type of justice would it advance?”

  “It would save your hide, for one thing.”

  “Why should my survival require the demise of my patient?”

  “Let’s not say ‘demise,’ David, really. Your patient could end up very well off indeed. She’ll sue the daylights out of you. That’s for sure. But your insurance company will pay, and Nicole Hudson will receive a staggering settlement for being subjected to an unauthorized surgery. She’ll be able to buy a condo in the city, a house in the country, a yacht to dock by the house, a plane to land on the yacht, a husband to fly the plane. She’ll be rich. She’ll be powerful—”

  “She’ll be blind.”

  Warren shrugged helplessly as he sank into his chair.

  “Years ago, that would have bothered you,” said David, facing him across the desk.

  “If there were no other concerns, you know how I’d feel about this, son. Why, nerve regeneration is the most exciting thing to happen in medicine in decades! The implications are tremendous.” For a moment Warren’s face looked younger, his eyes livelier. “It could virtually wipe out paralysis as an aftermath of trauma!”

  David saw an animated figure with black hair sitting in an office that was a shrine. That figure had patiently and lovingly shared with him the exciting secrets of the human brain.

  “However, if CareFree hasn’t tested and approved the new procedure, it can’t be justified. But tell me about it anyway, David. And don’t leave out anything!”

  Warren relaxed in his chair, as if ready to hear a bedtime story. Dark lines of puzzlement cut David’s forehead. For an unguarded moment, his face lost its anger, showing only the naked innocence of his childhood.

  “Father, I don’t understand you anymore,” he whispered painfully.

  “I wouldn’t hurt you for anything, son.”

  “How can you sit in this office and say you won’t hurt me?”

  “How can I not sit here? How can I pass up the chance to do something of such social and historic significance?”

  Contempt replaced the innocence on David’s face. He leaned back in his chair, sipped the juice, and began his tale.

  “The patient, a twenty-three-year-old woman, fell from a height of about twelve feet, receiving a laceration of the lower forehead and multiple other bruises. She was unconscious and bleeding from the nose when admitted to the hospital. Despite no direct trauma to the eyes, both pupils were nonreactive to light. She regained consciousness for a moment and reported a total loss of vision.”

  As the secretary listened to the dispassionate speech of a doctor, the father heard the exuberant voice of a boy of nine. Warren remembered the day when he had traced a terrible odor in the house to David’s room. There he found a homeless man named Ben who, David explained, had not brushed his teeth in years and so had growing over them an amazing black substance that intrigued the boy. David had brought Ben home to examine material from the man’s malodorous mouth under his microscope. Warren recalled David’s excitement at discovering a lively colony of creatures in the man’s oral cavity. The father remembered wishing that his son would never lose his capacity to find such an immense thrill in the things he did.

  “A brain scan revealed a fracture in the sphenoid bone. Images through the sinus and sella turcica showed a disruption of the optic nerves in the canal, where fragments from the sphenoid bone had sprung up from the base of the skull to pierce the meningeal sheaths and transect both optic nerves. Because of the laceration of the sheaths, the lesions of the underlying nerves were exposed clearly on magnification; thus, their transections could be diagnosed prior to surgery.”

  Warren Lang looked at the calm face of a doctor, but what he saw was the enthusiasm of a young boy. David at thirteen was displaying an instrument that he had made. Warren had been offered a post in San Francisco and considered moving his family there. With the aid of a science book, David had built a seismograph to measure earthquakes, in preparation for living in San Francisco. He had taken matters into his own hands, the father recalled proudly.

  “When the patient later regained consciousness, she, of course, exhibited total bilateral loss of vision. You know as well as I do, Father, that without my intervention, the trauma to those nerves would have rapidly resulted in total atrophy and permanent, irreversible blindness.”

  “So you took matters into your own hands.”

  “I explained the surgical procedure, its experimental nature, and risks. The patient gave me her informed consent. Then I called Randy.” David leaned forward in his seat, his eyes intense. “I told Randy I had your permission to operate. He believed me. Neither he nor the OR staff nor anyone else knew the surgery was illegal. I lied to everyone. Is that clear?”

  “What happened in the OR?”

  “I performed a pterional craniotomy. I reanastomized the nerve ends. Then I implanted at the lesion site of each nerve an embryonic growth protein, a substance I had discovered in lower mammals that’s active prenatally but absent from the body after birth. I found that the embryonic growth protein plays a critical role in the formation of the central nervous system.” David paused to sip the orange juice. “When I treated injured nerve with this new protein, it imparted to that tissue the most remarkable powers of regeneration.”

  If only I hadn’t been so weak, the father said silently to the figure that still possessed the slim lines and wavy tangle of hair from his boyhood. But, no, I let you have your way in matters where you were wrong. I taught you science, all right, but I was too lenient in another area.r />
  “I encased the nerve ends in a silicon sheath to fix the alignment and focus the medication. Then I placed my embryonic growth protein in a timed-release capsule that will dispense the medication directly to the lesion site of each nerve for three months.”

  You had no right to do what you did to my patient, Bob Martin, Warren scolded the slender boy of ten in his thoughts. Even though Bob bought an extravagant new sports car a month after his surgery and didn’t pay me my fee, and even though he blasted me to the local newspaper for sending a collection agency to get my money, the majority of people in Oak Hills took Bob’s side, David.

  “The operation went smoothly, and the patient exhibited no neurological deficit after surgery.”

  I felt the disapproving stares of the entire community whenever I walked down the streets, Warren silently said to a face resembling his own. I couldn’t stand it, David. So I gave up trying to collect my fee from Bob. I learned my lesson from incidents like that, but I failed to teach you yours.

  “Now the second procedure involves the scar. I discovered a substance that inhibits scar tissue from forming at the lesion site. Unfortunately, the substance inhibits nerve growth as well, so it can’t be introduced until the nerve has been completely regenerated.” David looked calmer, the fascination with his subject overpowering his anger.

  When you slashed the four tires on Bob’s new car, I was shocked at the anger inside you, David. When you refused to pay for the tires with money you had saved from your odd jobs, when you hid that money so I wouldn’t be able to find it, when you defied my order to pay Bob and told me I could beat you instead—what did I do? How could I beat you when you were the only one who had defended me? So I paid for the slashed tires myself, and you didn’t learn your lesson about social responsibility.

  “In the second operation, after I surgically remove the scar tissue that has formed, I aim to prevent any more scar from growing by injection of the scar inhibitor.”