Flashback

by Michael Palmer

  "Okay, George, " he said to the tissue technician, "do your thing."

  "Well? " Zack asked, after the technician had left. "What do I think?"

  "Uh-huh."

  "You are, perhaps, familiar with the immutable medical law of eighty-five/fifteen?" Zack shook his head. "I'm surprised, " Yoshimura said, "your being Harvard-trained and all. Well, simply put, the law states that every probability in medicine is either eighty-five percent likely or fifteen percent likely. Proper application of the law means one can never be wrong, as long as one knows whether the event in question seems remotely likely or not so remote."

  Zack smiled. "I take it you scored well on your boards." Kash Yoshimura nodded. "I did okay, " he said. "And the biopsy is eighty-five percent likely to be…"

  "Benign. An adenoma, I would guess."

  "Wonderful." Zack pumped his fist. "At this point, you may be eighty-five percent enthusiastic, " the pathologist cautioned. "No more."

  "I understand."

  Yoshimura reached across and patted Zack understandingly on the shoulder. "We'll have the answer in just a few minutes, " he said.

  "Meanwhile, all I can tell you is that our mutual friend is in remarkably capable hands."

  "Mainwaring? " Zack flashed on his initial, unpleasant encounter with the man. Kash nodded. "I watched him work a number of times when I was a student and resident. He is a superb technician."

  "So I've heard. He's a little short on tact, though. In the first five minutes after we met, he managed to say something snide about virtually every aspect of my life."

  "Perhaps he finds a new neurosurgeon in town threatening to his ego.

  "Perhaps. Where was it you trained?"

  "Hopkins."

  "Mainwaring was at Hopkins?"

  "He was. No small fry, either. A full professor, if I'm not mistaken."

  Zack was surprised. "I wonder what on earth he's doing up here in the boondocks, " he said. "Especially the northern New England boondocks.

  That accent of his puts him well below the Mason-Dixon line."

  The pathologist shrugged. "Beats me. Apparently, he doesn't deem pathologists threatening enough to insult. Aside from my reporting biopsies to him, we haven't had more than a one or two-word conversation since he arrived a year or so ago."

  "Actually, " Zack said, suddenly anxious to learn more about the man Guy Beaulieu claimed was helping to drive him out of practice, "it was closer to two years. Did you ever tell him you watched him operate at Hopkins?"

  "As a matter of fact, I did. Once, shortly after he got here."

  "And what did he say?"

  "Nothing, really. He glared at me for a moment with that steely look that I think surgeons practice in front of a mirror to use on nurses and anesthesiologists and the like." He grimaced. "I mean some surgeons," he qualified. "Then he just said, That's nice, — something like that-and walked away."

  "And no mention of that since?"

  Yoshimura shook his head. "How weird. Mainwaring seems very much the old-boy type. I'd expect him to go out of his way for someone from his college or his hospital-especially a prestigious place like Hopkins."

  "Believe it or not, " Yoshimura said without rancor, "there are still those about, even in our lofty profession, who are… uncomfortable with certain aspects of certain anatomies." He gestured toward his eyes.

  "Whatever the reason, the social circle Jason Mainwaring runs in certainly does not include the Yoshimuras."

  "Well, I'd enjoy it very much if mine did, " Zack said. Kash Yoshimura eyed him for a second, and then he smiled. "I think we would like that, too, " he said. The histology technician announced his return with a soft knock on the doorjamb. "Ah, " Kash said. "This is the moment we turn our eighty-five/fifteen into something quite a bit more certain.

  Good sections?"

  The technician nodded proudly, and set down a cardboard holder containing a dozen or so glass slides. Zack was struck by the remoteness of the unfolding scenario from the woman whose quality of life, and even, perhaps, whose very existence, was at the center of the drama-a marked contrast to the immediacy and intimacy of surgical medicine.

  Still, he knew, in the moments to follow, Kash Yoshimura would hold as much power, as much responsibility, as if he were the man in the operating room with the scalpel. The pathologist slid the first of the sections onto the stage of the dual-view teaching microscope, and motioned Zack to the second pair of oculars. Silently, Zack watched, barely breathing as the multicolored cells slid through the brightly lit field. One by one, Yoshimura worked his way through the slides. With the fifth or sixth one, he had resumed his humming. Finally, he stopped, and looked over at Zack. "You have an opinion? " he asked. Zack nodded.

  "Uniform cell type, uniform pattern, no obvious foci of necrosis, " he said. "I can't put a name on it, but I can say that it sure as hell looks benign."

  Yoshimura nodded. "Should you ever tire of neurosurgery, Dr. Iverson, I would say you have quite a future as a pathologist."

  He picked up the phone and dialed the operating room. "This is Dr.

  Yoshimura calling from pathology, " he said. "You may inform Dr.

  Mainwaring that he has excised a totally benign, fibrous adenoma. Thank you."

  Zack pumped the man's hand as if he had been the cause of the tumor being noncancerous, rather than merely its interpreter. Before it had really even begun, Suzanne's nightmare was over. Anxious to be at the bedside when she awoke, Zack hurried to the recovery room. One story above, in operating room 3, Jason Mainwaring received the news of the biopsy impassively, and then looked over at his anesthesiologist. "So, Jack, " he said, "if it's all right with you, we are ready to close."

  Jack Pearl, a ferret-like man in his mid-forties, smiled at the surgeon from beneath his mask. Then he glanced down at the serene face of their patient. "Everything is better than all right, Dr. Mainwaring, " he said. "In fact, it's perfect. As always. Absolutely perfect."

  Subtly, unnoticed by anyone else in the room, Jason Mainwaring returned the smile and nodded his approval. At that moment, both men were focused on precisely the same thought, Four hundred ninet-one down. Only nine to go.

  CHAPTER EIGHT

  Over the more than thirteen years that Zack had spent as a medical student and surgeon, Suzanne represented, without doubt, the most striking recovery from general anesthesia he had ever encountered. He was already in the recovery room, waiting by the nurse's station, when she was wheeled in from the surgical suite. She was awake, smiling, and totally alert. Her jubilant thumbs-up sign to him made clear that she was also well aware of the results of her operation. "That is the most amazing wake-up I've ever seen, " Zack commented to one of the recovery room nurses as Suzanne, with very little help, transferred herself from the litter to her hospital bed. "It's hard to believe she was ever really asleep."

  The nurse, an animated young redhead whom Zack knew only as Kara, beamed with pride. "Oh, she was out, all right, " she said. "Isn't it wonderful?

  Almost all of Dr. Pearl's cases come out of the operating room looking like that."

  "Mine didn't, " Zack said, recalling the prolonged, but quite typical recovery of his cervical disc case. "Pardon?"

  "Nothing. I'm just really impressed, that's all."

  "Every one around here is, " the woman said. "Part of it may be Dr.

  Mainwaring, too. He demands that his patients be anesthetized just so, and Dr. Pearl is the only one he'll allow to work with him. I used to scrub before I got the job in here, and I tell you, they are quite a pair. Things have really taken a turn for the better at this place since they teamed up."

  Across the recovery room, Zack saw Jack Pearl peering through an ophthalmoscope, examining the nerves and vessels on Suzanne's retinae while one of the nurses checked her vital signs. He was a slight, sallow man with a pencil-thin moustache and a broad, high forehead that dominated his nondescript eyes. "What do you mean, a turn for the better'? " Zack asked, knowing he was fishing for some o
pinion on Guy Beaulieu. "I grew up in Sterling and then did an externship here. I always thought we were pretty fortunate with the surgeons we had."

  The nurse eyed him warily, suddenly uncertain as to whether she might have said too much to a virtual stranger. Zack tried his best to appear only marginally interested in her response. After a beat or two, she shrugged and brushed a wisp of hair from her brow. "Ormesby's okay," she said, "at least for routine things. But I think it might be time for Dr.

  Beaulieu to retire, especially with all the trouble he's been having, and with someone as good as Dr. Mainwaring around."

  "Is that the general feeling of the nurses? " Zack ventured. Again, she appraised him. "Dunno, " she said finally, although her eyes told him otherwise. "But they like you. I can tell you that much. And we all like having a neurosurgeon on the staff. It makes Ultramed-Davis seem more-I don't know-special."

  "Thanks, Kara. Thanks for telling me that."

  The young nurse blushed. "Well, I've got to get back to work, " she said. "See you."

  "See you."

  Zack watched as the woman returned to her patient. Her opinion of Guy Beaulieu was, he suspected, typical of what he would encounter from most of the other nurses on the staff. Whether justifiably or not, the man's reputation at Ultramed-Davis was shot. And Zack knew that given the nature of medicine, gossip, and the intense microcosm of hospitals, there was probably nothing on God's earth that Beaulieu could do to reverse the situation. Still, despite all the rumors and innuendoes, despite Frank's vehemence and the damning letter from Maureen Banas, Zack could not shake the belief that Guy was the victim of some sort of calculated effort to drive him from practice. The thought was so sad, so pathetic, that it almost defied comprehension. On some level, Zack realized, he was half hoping the charges against Beaulieu would prove true. At least then he could make some sense of it all. Jack Pearl had finished his evaluation of Suzanne and was headed back toward the operating room when he noticed Zack. "Morning, Iverson, " he said.

  "Jack." Zack nodded. "How goes it?"

  "No. I just stopped by to see how Suzanne was making out. She looks great."

  Pearl glanced back at her. "Pretty routine business, " he said. "What did you use?"

  For the fraction of a second, the anesthesiologist's expression seemed to tighten. Then, just as quickly, it relaxed. "The usual, " he said. "A little Pentothal, a little gas. Mainwaring likes his patients really light."

  "I guess. She doesn't look as if she's even been asleep."

  Again, tension flickered across Pearl's face. "Well, she was, " he said simply. He glanced at the clock over the nurse's station. "Got to go, Iverson. You have a good day, now."

  "Yeah, Jack. You, too."

  As the taciturn little man shuffled away, Zack realized that during this and all their previous encounters, Pearl had not once made direct eye contact with him. The trait was not that surprising, he acknowledged, given the nature of the breed. Although the exceptions were far too numerous for any generalization, many of the anesthesiologists he had known were introspective loners, skilled more in biochemistry and physiology than in the more subjective arts of clinical medicine, and committed to one of the specialties where conversation and interaction with patients-awake patients at least-was at a minimum. Still, there was something unusual about Jack Pearl, something furtive and arcane, that Zack found both curious and disconcerting. He wondered if perhaps the man had a past-trouble somewhere along the line-and he made a mental note to ask Frank about him sometime. Then he turned and headed to Suzanne's bedside. Though a bit pale, she was still smiling, radiant and wide awake.

  "Hi, lady, " he said. "What's new?"

  "Oh, nothing." She feigned a yawn. "A little this, a little that. You know. Just another routine, humdrum day."

  "Yeah, my day, too."

  "That's quite obvious from those dark circles around your eyes," she said. "Hey, before I forget to mention it, thanks for your note. It meant a lot."

  "You look fine. Are you in any pain?"

  "Not really. At least not compared to what I would have been in if that biopsy had been positive."

  "It does seem a bit easier to deal with this way, " Zack said. "I thought I'd have the chance to break the good news to you, or at least to remind you of it, but you came out of the O. R. as if you'd never been asleep. It's absolutely incredible how light you are so soon after general anesthesia."

  "I know. Jason said I would be. It's wonderful. I had my appendix out when I was seventeen, and I remember being totally out of it for a day.

  Jack Pearl said that if it was okay with Jason, I could go home this afternoon."

  "That's great."

  "Zack, God bless every woman who has to go through this madness. I know we're supposed to believe that there's some sort of grand, cosmic scheme operating in life, but cancer-especially breast cancer-just doesn't lend itself very easily to any philosophizing. I tell you, I'm so relieved, all I want to do is cry."

  "Well, go ahead and do it. In fact, I'm pretty relieved myself, so if you're free tomorrow night, I could come over with a bottle of wine and a box of Kleenex."

  Her eyes darkened. "Zack, I…"

  "Go ahead, " he said. "I really owe you for staying with me the way you did last night…"

  "There's a but' coming. I can feel it."

  "Zack, Wednesday night was wonderful, " she whispered. "I really mean that. But it's just not like me to start things in the middle that way.

  Do you understand?"

  "I guess so."

  "For weeks I've been so consumed with my damn lump, then suddenly you show up in my life and… Zack, I just need some time and a little space to sort some things out. You said the other night that you had no expectations. I hope you meant it."

  Zack swallowed hard. "I hope so, too, " he said. She smiled thinly and squeezed his hand. "Thanks at least for trying. Listen, I have the next week off. I owe Jen some quality time with her mother and my partner a few days of help in the gallery. I'll call you toward the middle of the week, okay?"

  "Middle meaning like Tuesday?"

  "Zack, please."

  "Okay, sorry, sorry. Middle of the week is fine. Can I at least drive you home later?"

  "I'll be fine. Besides, I don't even know if I'll be going home later.

  Zack, there'll be time. If it's supposed to be, there'll be plenty of time."

  There was a sadness in her eyes that helped keep him from pushing matters any further. "Sure thing, " he said. "Hey, for what it's worth, I just ran into your replacement in Annie's room."

  Suzanne smiled broadly, obviously relieved at the change in subject.

  "Don Norman? Is he overwhelmed yet?"

  "Hardly. Norman doesn't seem like the type to be overwhelmed very easily-at least not as long as there are guidelines and policies for him to follow. And Ultramed seems to have provided all the guidelines and policies he could ever want, so not to worry."

  "I won't, " she said. "And I agree totally. The man is conscientious as hell, but he is a little medical robot. Julia Childs with a stethoscope-strictly cookbook. Annie okay?"

  Zack nodded. "When I stopped by, she was fighting with Norman about her sodium restriction, so I guess that's about as good a sign as any. Oh, get this, right in the middle of their little altercation he puffs himself up like he loves to do-you know, like this-and he says, "Mrs.

  Doucette, pull-eese. Whether you know it or not, I am the Chief of Staff at this hospital. I certainly know what is best for my patients."

  "Good imitation. Excellent. And what did Annie say?"

  "Nothing too inflammatory. She just eyed him with this great Annie look, called him Tubby, and suggested that he should lose weight so that he would be a better example for his patients."

  "Oh, no."

  "It was great. Norman turned ten shades of red, and looked for a moment as if he might haul off and pop her in the nose. Having been brought up by the woman, I can say that it's lucky for him he didn't. Even a
fter cardiac arrest, my money would have been on Annie. Well, listen, I've got to go play doctor. If you change your mind about that ride home, give me a page."

  "Sure."

  "You know, I still can't get over it."

  "What? " she asked. "How light you are. The nurse I was talking to said all of Mainwaring's patients come out of the O. R. like that. I've got to ask him his secret."

  "No secret, Doctor. Just good technique."

  Jason Mainwaring, sans mask and haircover, appraised them from the foot of the bed. "Well, " Zack said casually, trying not to appear as startled by the intrusion as he was, "whatever it is, it's impressive.

  I'd like to scrub with you sometime to learn firsthand how it's done."

  "My goodness, " Mainwaring mused, "a neurosurgeon who doesn't know everything. What will the gods send us next?"

  "Now just a minute, " Zack countered, again feeling his hackles stiffen at the man's superciliousness. "I don't know if you're like this with everyone, or just with me, but I-"

  "Hey, fellas, " Suzanne cut in, "remember me? The patient?"

  Mainwaring smiled down at her as if Zack were no longer there. "Is everything still all right, my friend? " he asked. "Perfect, Jason. I can't tell you how pleased I am."

  "That's fine. Just fine, " he drawled. Zack, arms folded tightly, stood back from the bed a step, wondering if he should say good-bye or simply leave. It was obvious that Jason Mainwaring, for all of his glistening reputation and surgical skills, was too threatened by him to let up even for a moment. Unless he could find some way of reassuring the man that they were playing for the same team-and his experience with similar egos told him that possibility was highly unlikely-the two of them seemed destined to be enemies. Well, so be it, Zack thought. It would only make things that much easier if, in fact, Mainwaring did prove in any way responsible for Guy's difficulties. "Can I go home this afternoon? " Suzanne asked. Mainwaring smiled, walked to the bedside opposite Zack and took her hand. "If there's no major bleeding from that incision, " he said, "and you still feel the way you do right now, I don't see why not. Listen, I've got an emergency exploratory in just a few minutes, and a gall bladder at two. Why don't I stop by after that-say, four-thirty? Then, I'll not only discharge you, but I'll even drive you home. Your place isn't very far out of my way."