Cutter's Trial

by Allen Wyler

  Alex glanced from one man to the other, searching for any telltale sign that a huge joke lurked behind the statement. They were dead serious.

  “No kidding,” Baxter said, reading Alex’s thoughts. Baxter nodded for emphasis. “Word has it, they’re going whole hog on the renovation. Wood paneling, designer carpets, designer colors. No one’s sure what kind of package Weiner negotiated from the dean and administration, but it had to be massive. I’ve never heard of this kind of money being spent on that place.”

  The original hospital, like most county hospitals during the pre-Medicare/Medicaid days, was built to serve uninsured patients—a municipal “charity” hospital. In addition to the actual hospital facilities, the building housed other county health-related offices such as the medical examiner and public health officials. In contrast to plush private hospitals with their base of wealthy donors and paying patients, its fiscal health depended solely on tax revenues. With the emergence of regionalized trauma centers serviced by Medic One responders, a spiffy new trauma center had been built contiguous with the original 1930s art deco building. The complex now served as a major teaching hospital for the local university, a standard symbiotic relationship between a state school and a municipal hospital. This parasitic affiliation provided an easy source of round-the-clock physician coverage for mere pennies on the dollar. But when tax revenues remained flat in periods of soaring costs, the county and university ran into budgetary deficits, forcing them to cut costs. Since both institutions received various state monies, it made fiscal sense to contract medical personnel from the university, which, in turn, forced the medical school to assume primary responsibility for patient medical care. This was delegated, in large part, to residents.

  “Okaaay… but if he’s over there, what happens to Dr. Waters’s office?” Alex asked, a bit perplexed. The thought crossed his mind that if Weiner was true to his word and made him second-in-command, it might become his office. Interesting.

  Geoff shrugged. “Remains empty. And that’s another bit of news: Weiner won’t grant Art professor emeritus status. Word has it he wants him physically off campus soon as humanly possible.”

  Baxter crossed his legs, smoothing the crease of the black slacks he wore daily. “He’d get rid of us too—if he could. But he can’t. We’re tenured.” Baxter glanced at Alex. “You, on the other hand, little lamb, are as vulnerable as a newborn in an incubator. I suggest you begin sending out feelers to see what openings are available.”

  Jesus, Baxter looked serious too. “Why would he want to get rid of me? I don’t make the same salary you do.” He remembered Weiner’s rant about how the others were pulling down the top spots in the salary range.

  Baxter shook his head. “Don’t be naive, Alex. I’ve seen this happen elsewhere. This is exactly what we predicted would occur if an outsider assumed control. He’ll want to clean shop and replace all of us with his own people. Part of that, I guarantee you, will be to make our lives so miserable we’ll want to move. But Geoff and I aren’t going anywhere, are we Geoff.” It was a statement, not a question.

  Arms folded defiantly across his chest, an expanse of glistening gums exposed, Geoff nodded. “We’re staying right here. We’re tenured. He can’t do diddly-squat to us.”

  “And,” Baxter said with an imperious wave, “we’ll sit right here and torment him by simply doing our thing.”

  Silence.

  Baxter continued. “He’s making a huge mistake by moving administrative downtown. When the cat’s away, the mice will play.” He flashed a knowing smile across the table to Geoff, who appeared to know exactly what the threat implied. “We can keep on doing our thing here at the university while the money in our TIAA-CREF just keeps on accumulating, ka-chink ka-chink.” There was a mischievous twinkle in his eye. “Nope, no way is Herr Doctor Weiner going to get us out of here.”

  “That’s right,” Ogden seconded. Baxter’s words made sense. New chairman meant a new culture. Hadn’t Weiner said as much? But Weiner had given Alex his word. Then again, now that he thought about it, he had nothing in writing. Weiner could do exactly as he pleased. Suddenly, the coffee burned like acid in his stomach.

  16

  “Patient is a fifty-five-year-old Caucasian female.” the resident flipped the switch to illuminate one panel of the viewing screen on which several CT scans hung. “Story is, she screamed, grabbed her head, and immediately lost consciousness. Her husband called 911. When the paramedics found her, she was a Glasgow nine.” The Glasgow Coma Scale was a standardized measure of global brain function that ranged from three, coma, to fifteen for normal. It’s an easy way for paramedics and other medical personnel to quickly transfer a pithy assessment of neurologic function from one person to another.

  Sensing motion to his right, Alex glanced in that direction. Dick Weiner had just entered the conference and was motioning a resident in the front row to vacate his seat. The resident stood, Dick sat, and the resident presenting the case continued reciting the patient history. When the resident finished, Weiner turned to a first-year resident. “What’s the diagnosis?”

  “Subarachnoid hemorrhage. From the distribution of blood on the scan, it’s probably an aneurysm of the left middle cerebral artery.”

  Weiner cocked a finger-gun and shot the resident. “Correct.” He pointed to a junior resident. “How do we treat it?”

  The resident glanced beseechingly at a senior resident in hopes of a bail-out, but since Weiner’s arrival, residents quickly learned to not aid colleagues when being grilled.

  Weiner leaned toward the resident, getting right into his face. “Well? We don’t have all day, Olson.” He held the position, inches from the kid’s face, glowering intently into his eyes.

  Olson swallowed. “It’s fair to say the treatment is debatable and—”

  “Debatable? Wrong!” Dick swiveled ninety degrees, arm across the back of the chair to scan the others in the room. “There is only one—I repeat, one—way to treat these patients.” His voice grew louder. “From this point on, any SAH who arrives in the ER will be immediately squirted”—administrating an X-ray angiogram to show blood vessels—“and if it demonstrates an aneurysm, that patient will go straight to the OR and the aneurysm clipped. This is departmental policy.” He spun around to the resident again. “Stand the fuck up, Olson, you’re not done yet.”

  The room became stone-cold still, pulsing with tension. Weiner slowly rose from his chair to stand beside the view box. “Why operate immediately, Olson?”

  The resident paused, either wanting to think or as a way to deal with the intimidation. “To prevent rebleeding?”

  Weiner shook his head. “I’m asking the questions. Answer me.”

  Olson swallowed. “To prevent a second bleed.”

  “Bullshit, Olson. That’s the reason any aneurysm is clipped, regardless of whether it’s done early or late. Try again. You’re not sitting down till we finish this case; I don’t care if it takes the rest of the goddamn night.”

  By now Olson appeared mute, so Baxter piped in. “Acute surgery removes the aneurysm so that any vasospasm can be treated, which results from the irritant effects of blood against the outside of the vessels. You can’t do this if the aneurysm hasn’t been treated.”

  Weiner’s face grew red. “Goddamnit! I asked Olson, not you.”

  Baxter ignored him. “Vasospasm”—a narrowing of the blood vessels—“evolves within the first seventy-two hours of a bleed and carries a mortality rate of well over 50 percent. However, the residents should know that there are very valid arguments against such an aggressive approach. There are no objective data to support the concept that early surgery is superior to delayed surgery.”

  Weiner’s eyes burned at Baxter like lasers. “Sit down, Olson.” The room remained ominously silent. Alex saw a satisfied smile flicker across Baxter’s lips. Weiner was pacing in front of the X-ray viewing panel, the knuckles of his fists white at his sides. After composing himself, he cleared his throat. �
��An agreement has been reached with Coastal County and the county-wide emergency services that all 911 responses suspected to be subarachnoid hemorrhages will be taken directly to the trauma center regardless of the family’s wishes. This is in the patients’ best interests. Should, for some unanticipated reason, such a patient arrive at the university ER, I want that patient transferred immediately to the trauma center where they will be handled appropriately.”

  “I want the residents to know there are no AANS guidelines for the treatment of aneurysm patients,” Baxter added.

  Weiner jabbed a finger at Baxter. “Fuck guidelines. This protocol has the patients’ best interests in mind.” He swept his palm toward the university faculty. “You can continue treating patients incorrectly, but I guaran-fucking-tee you if I find that any faculty operated any kind of vascular abnormality at University Hospital, they will have their operating room privileges revoked.” Baxter was the only surgeon in the group who specialized in vascular work, so the threat was obviously directed at him.

  “This is my department, not Waters’s. Waters was a pussy when it came to surgery. He trained decades ago and never kept up. Waters wasn’t a neurosurgeon. He was nothing but an administrator. I checked his cases for the last five years, and you can count them on one finger. It’s a damn travesty he was allowed to maintain OR privileges here. This is my department now, and I’ll damn well see to it every resident is trained my way. Conference adjourned. I want the faculty upstairs in the conference room in five minutes.” Still seething, Weiner stormed from the room before anyone else moved.

  With the accordion wall closed to separate the conference side from the coffee klatch half of the room, Baxter, Geoff, Alex, and others waited for Weiner’s arrival in silence, glum from having to deal with another of Weiner’s tirades. Alex wasn’t sure about the others, but anxiety churned his gut. Since arriving, Weiner’s behavior toward the university-based faculty—Alex included—had been capricious, unpredictable, and vengeful. Everyone at the table seemed wrapped up in their own thoughts rather than entering into the usual chitchat. Alex wondered if they knew something he didn’t or if they perhaps worried the conference room might be bugged. He shrugged off that idea as pure paranoia. Weiner wouldn’t do that … would he?

  Appearing relaxed—in a passive-aggressive way—Baxter and Geoff sat quietly at the table, Geoff engrossed in his coin thing, Baxter doodling on a yellow legal pad.

  The hall door flew open; Weiner strutted in like a Gestapo captain. Like many men pushing five foot nine, he fought for additional millimeters of height with a militaristic posture. All he needs is a swagger stick , Alex thought. He halted at the end of the table, door still ajar, the harsh fluorescent ceiling light glistening off his oily scalp. Weiner slowly scanned each faculty member, sending a look of frank contempt. Once he had assured himself of everyone’s attention, he announced, “Roger Delaney is now vice-chair of this department. His office will be adjacent to mine at the trauma center. When duties require him to be here, he’ll use Waters’s old office.”

  Without thinking, Alex asked, “Who’s Delaney?”

  Weiner shot him a withering glare. “My previous chief resident. He graduated a month ago.”

  Geoff was smiling, eyes never wavering from his coins. “That’s not the way we do things, Dick.”

  Weiner glared at Geoff. “Yeah? Well, fuck that. We do things my way now. Meeting adjourned.” He spun around and was out the door.

  Alex jumped from his seat and squeezed past Baxter, hurrying to catch Weiner before he made it to the elevator. “Hey Dick, wait. Need to talk with you.”

  Weiner motioned him into the deserted administrative offices. “In there.” He marched through the reception area into Waters’s vacant office. Once Alex entered, Weiner slammed the door and glared. Alex found the emptiness of the office disorienting. The only sign of Waters was the old black phone on his desk.

  “What do you want?” Weiner’s hands cupped both hips, pushing back his white coat in a pose reminiscent of Hitler.

  Why am I being attacked? “What’s going on?”

  “What do you mean, ‘What’s going on?’ You need hearing aids?”

  When Weiner didn’t continue, Alex said, “Yes, I heard, but I’m not sure what happens to me now.”

  “You’re out of the trauma center now. That’s what you wanted, wasn’t it, to stop taking every night call? Well, don’t piss and moan. You got what you wished for.”

  “The trauma center generates ninety percent of my billings.”

  “So fucking what?” Weiner shrugged. “Not my problem. Find another job.”

  “What about my lab? Our agreement? Me being second-in-command?”

  Weiner shifted weight impatiently. “Why didn’t you take the job in Cleveland?”

  Surprise. “You know about that?” Two days after the dean officially appointed Weiner, Alex received a call from the chair at a Midwest university, asking him to come back to look at a job. Both Baxter and Geoff encouraged him to at least visit, but he declined because, with Weiner coming on board, he anticipated being able to return to the lab.

  “Do I know about it?” Weiner snorted. “Hell, I gave Ajay your name, said you were looking.”

  Looking? Alex suddenly felt nauseous. He swallowed.

  “Well? Why didn’t you accept the offer? It was a good one.”

  A laundry list of reasons flashed past, all of them beside the point. “It wasn’t the right job.”

  “Bullshit. You’ll never find the right job because, let’s be frank about it, you like it too much here. You’re just like the rest of that deadwood; you don’t want to move. Well, guess what, Cutter? You damned well better get your head around it, because in six weeks you’re out of here. As of now I’m cleaning house, and you’re the first to go. Roger has your spot now, and he plans to be settled here by the end of next month. And let me tell you, when I finish, every damn one of Waters’s minions will be out on their ass. Six weeks, Cutter. Fair warning.”

  Shock morphed to anger. “We had a deal. You promised me a place.”

  Wide-eyed, Weiner glanced around. “A deal? A deal? What fucking deal?” he yelled, his face now livid.

  Alex swallowed.

  Weiner put his face inches from Alex’s. “Guess what? Gets better.”

  When Alex didn’t answer, he continued. “Starting tomorrow, I’m the principle investigator on your grant. So don’t bother coming to the lab anymore. Use the time to hunt for a job.”

  “You can’t do that. That’s my grant. After I find a new job, I’ll transfer it.” The grant award had just been announced the previous week, ending months of hard work and rejection. It was inconceivable to lose it.

  Dick shook his head as if Alex’s words were totally inappropriate. “No you won’t. It’s a done deal. I talked with NIH today and explained the situation—that you’re leaving and I’m prepared to assume the PI role. This conversation’s finished, Cutter. I’m behind in my schedule as it is, so leave already.”

  Is it even possible? Too late in the day to check with Grants and Contracts. Bastard can’t do this. Can he?

  “We are not done,” Alex sputtered. “That grant was awarded to me.”

  Eyes narrow and hard, Weiner again pushed his nose inches from Alex. “News flash, Cutter. NIH awards grants to institutions, not people. For cases in which the institution believes the PI has diminished capabilities to conduct the granted research, the institutional administration may assign PI responsibilities to whomever it deems fit.” Weiner spoke the lines as if memorized from a procedural paragraph. “End of discussion.” He pointed to the door. “Out!”

  Still reeling, Alex entered the empty hall across from the door to the deserted conference room, the accordion room divider once again opened, the usually glowing red switch of the coffee maker black and cold. For a confused moment, he stood, not knowing where to go or what to do. Without a word, Weiner shouldered past, heading straight for the fire door to the stairwell, th
en was gone.

  I was used. Manipulated. A fool.

  Feeling sorry for himself, he remained in place, paralyzed, unable to decide what to do or where to go. Home. Go home. Talk to Lisa about it; see if she has ideas.

  He sensed someone watching him and glanced up to see Raj, a fourth-year resident, at the end of the hall near the elevator alcove. He wasn’t in the mood for conversation but couldn’t just ignore him.

  “May I have a word with you, Doctor Cutter?”

  Alex nodded and started numbly toward the resident. Raj opened his mouth to say more, but Alex raised his hand, stopping him. Could his earlier flippant thought actually be correct? Did Weiner have rooms bugged? Was that why he denied any agreement in Waters’s deserted office? What seemed ludicrous an hour ago suddenly seemed very possible. “If you don’t mind, let’s talk in the basement.”

  “Good idea.” Raj appeared relieved at the suggestion, which only reinforced Alex’s paranoia.

  A thought hit. “Before we go, I need to pick up a few papers from the lab.”

  Alex trotted to the lab, unlocked the door, and went straight to the cabinet holding his lab books and data. Without checking to verify the bundle contained all of the files, he scooped them into the briefcase he used for shuttling work back and forth from home. Finished, he locked the door and led Raj to the elevators.

  They rode in silence, Alex unsure if the resident was really nervous of being overheard or just wary because of his boiling anger. The door rattled open at level B1 to an echoing, musty-smelling underground hall to the five-level parking garage. Alex stopped. “Okay, what do you want to discuss?”

  Raj shifted from foot to foot, scanning the immediate area. They appeared to be alone. “Have a problem downtown,” he said, referring to the county and VA hospital combination.

  Alex nodded for him to continue. Raj glanced toward the steel fire door again. “Doctor Weiner’s been running two rooms most of the time,” he said, voice barely above a whisper now.