Cutter's Trial

by Allen Wyler

  Alex wondered why Reynolds needed extra money on top of his clinic salary. Not only was he pulling down great money at the hospital, but Alex learned from Betty that Reynolds’s wife sold real estate in the neighboring suburbs. “Thanks for the offer, but don’t think I’m the military type.”

  “Hey, your loss. Offer’s good if you change your mind. Okay, gotta get back to the farm. Owe you one for taking her for me.”

  Chart in hand, Alex knocked on the open door to the patient’s room. “Ms. Alexander?”

  A thin, dark African American woman lay in bed facing the TV, a hefty, lighter-skinned man in the chair to her right. She jerked at the sound, her head snapping around toward him. “Yes?”

  He approached the bed, dragging the other chair with him. “I’m Dr. Cutter. I’ll be your surgeon tomorrow. Dr. Reynolds was called out of town unexpectedly and asked if I’d substitute for him, assuming, of course, that it’s okay with you. If not, I’m sure he’d be more than happy to reschedule for a time when he’s back. May I sit down?”

  “Any questions?” Alex asked, having spent the past twenty minutes explaining the surgery to the couple, who appeared scared shitless. He always hated this part because there was little he could do to assuage a patient’s anxiety. He placed the consent form—which he’d filled out before coming into the room—on the sky-blue plastic chart binder. Next step would be for her sign.

  She glanced from the consent form to Alex’s eyes. “Only one.”

  “Yes?”

  “Will you pray with us?”

  Not used to this request, he had to actually think about his answer. “Yes, of course.” Whatever helps give you peace.

  She extended her left hand to him and her right hand to her husband. Not knowing what to do next, Alex simply held her hand and bowed his head. The husband reached out to hold Alex’s left hand, forcing Alex to lean awkwardly across the bed, straining his back. It was Latisha who spoke first. “Heavenly Father, please watch over us,…”

  As he listened to her words, he wondered, Is her God listening? If so, is he or she—if the deity possessed such a thing as gender—aware of his conflicted beliefs? Of how self-serving and hypocritical his charade of praying was? Instead of genuinely asking God to bless the surgery, he was merely trying to put this couple at ease. A pang of guilt hit. Don’t be ridiculous. You’re doing the right thing. You can never be faulted for that.

  Can you?

  28

  “Cheers!”

  Alex, Lisa, and Andrew and Diana Canter clinked wine glasses.

  “Glad we’re finally able to get together and be properly introduced,” Andrew said. “Having been neighbors now for what, four weeks?” The Canters—who lived directly across the street—had introduced themselves the day the moving van pulled up to the curb in front of Alex and Lisa’s house. The two couples had tried to schedule a dinner out ever since, but Andrew’s job required business travel and Alex had night call, leaving this evening their first opportunity to socialize.

  Lisa laughed. “Something like that.”

  They were at Ridley’s, a basement barbecue joint off a downtown alley. Not much in the way of atmosphere, but the place had a regional reputation for killer ribs featuring a spicy dry rub instead of the more common wet sauce. Years of barbecue smoke, beer, and sweat filled the air with a musky but pleasant odor, attesting to the dive’s long-standing popularity.

  “How do you like the new job?” Andrew inquired. Both Canters spoke with British accents.

  “So far so good, but we’re still in the honeymoon phase. I’m sure that sooner or later something will come up to dampen my enthusiasm.” He considered bringing up Reynolds’s racist comments but decided against it. “Long as you brought up the subject of work, I’m sorry to say this will need to be a short evening. My debut surgery is scheduled for first thing in the morning. I want to be there early so I can make sure things are set up the way I like.” He disliked talking about his work, so he redirected the conversion toward Andrew. “I’m sorry, but I don’t think I know what it is you do.” He vaguely recollected something about Proctor and Gamble.

  “I’m a chemist by training, but now I manage people. The plant I’m presently assigned to is a division of Proctor and Gamble, which explains my need to be constantly running back and forth to Cincinnati. That’s where our corporate headquarters are located.”

  “Ah, that does explain it. Where are you from originally?”

  Diana chuckled. “Our accents give away that we’re not natives?”

  Alex nodded with a laugh.

  Andrew was playing with the square packets of hand wipes from the table supply, perfectly aligning them in a stack, then spreading them out again. “A small town in England, actually.” Pronouncing it act-sley. “I’d be shocked if you’ve ever heard of it, so I won’t bother supplying a name. Suffice it to say, it’s about a hundred kilometers northwest of London, if that’s of any help.”

  “And the reason you’re here in the States?” Alex remembered that P&G was an international company.

  “Been with the company my entire career. Started straight out of Cambridge and have been a good soldier ever since, moving whenever and wherever they wished to post me. Probably still have one or two relocations before I retire. Just happen to be here in the U.S. at present.”

  Alex loved hearing what other people did in their jobs. “And what does a chemist-turned-manager do?”

  Andrew smiled politely. “When a plant is having issues of various types, I am sent to sort them out. I reckon that qualifies me as a fixer of sorts, although there is no real job description. Not very glamorous, but it keeps a paycheck coming.”

  Alex and Lisa exchanged glances, making Alex wonder if she had the same question on her mind as he did. “How long have you lived here?”

  Andrew thought about that a moment. “Over a year now.”

  “How do you like it?” Lisa asked, picking up on Alex’s direction.

  Andrew hesitated a beat. “Just fine.”

  “No culture shock?” Lisa probed. “It has been for us. We’re West Coast people.”

  “Yes, well,” Andrew said with a glance at his wife, “every place has its own unique culture, this being no exception. However, I must admit we have met a lot of nice people here. I’m sure you will too as you settle in, the neighbor boy included.”

  “Richie? The kid who sneaks around the neighborhood in camouflage and climbs over our fence with his pellet gun?”

  “Mmhmm, that’s him.”

  Andrew’s words were guarded, leaving Alex to suspect he hadn’t reached his level of upper management without honing some very strong diplomatic skills. Most likely, the Canters didn’t feel comfortable divulging personal opinions to complete strangers. Perhaps they never would. One never knew what might filter back through the grapevine and cause embarrassment. Alex had hoped for an opportunity to discuss race relations in this city. So far, no African American he’d encountered had said a word about it. He sensed smoldering unrest among them and wondered how prevalent it was.

  How could it not be present?

  Guilt still nagged him for not voicing an objection to Reynolds’s use of nigger. But he rationalized his silence by thinking he needed to establish himself before taking a stand on such politically loaded issues. He found his heightened sensitivity to such diplomacy both necessary and disgusting.

  Diana rescued the pause in conversation. “And Lisa, what sorts of things are you interested in doing? Are you involved with any volunteering?”

  “I worked at the university bookstore before we came here but don’t work presently. Not sure if I’ll look for a job. I’ve been asked to do some volunteer work, and that, hopefully, will keep me busy enough. I’ve grown very fond of being able to have options and control my time. It’s a luxury.”

  Diana smiled, as if pleased with the answer. “We have a lovely book club that I’d be pleased to have you join—that is, if you’re into that sort of thing. I find severa
l of the ladies quite interesting.”

  “Yes, I’d like to try it.”

  Interesting. Lisa had never been one for luncheons or book clubs or other girly-girl activities.

  “You folks ready to order?” asked their waiter, who’d been eyeing them since serving their wine.

  29

  For the 7:30 a.m. start, Alex arrived in the surgeons’ lounge by 7:00 and went straight into the men’s locker room without bothering with a cup of coffee from the three fresh pots on the counter hotplates. There he changed into scrubs, selected his style of mask, and pulled a bouffant-style cap over his head instead of the traditional surgeon’s cap which became too hot during cases. Now dressed, he went to his locker and grabbed the mitered wooden box containing his loupes. He closed the narrow door, spun the combination once, and verified the lock was secure. Every now and then surgeons who didn’t secure their lockers discovered valuables stolen.

  He poked his head into Ellen’s office. She was sitting at her desk, white Styrofoam cup in hand, talking to another scrub-clad woman. “Did Dr. Reynolds mention I’ll be doing his case this morning?”

  She glanced up and smiled. “Yep. His office called yesterday. Room East Three—straight down the hall, last room on the left. We pulled the patient’s X-rays. They should be in your room already.”

  Your room. He liked the sound of that, made him feel respected as a surgeon again. Much better than at the university where OR personnel fostered the attitude of doing surgeons a favor by even bothering to acknowledge them. “Thanks.”

  Alex shouldered through the heavy swinging doors into the OR. His arms immediately sprouted goose bumps from the chilly, metallic-tasting conditioned air. One scrub nurse and one circulating nurse were busily counting instruments while a third nurse was filling out forms. An anesthesiologist was putting together an induction tray on his anesthesia cart as a black Sony boom box to the left of the tray softly played Bob Seger’s “Hollywood Nights.” A stack of CD cases was on the floor next to the cart. The scrub nurse glanced up. “Can I help you?”

  “Yeah, I’m Doctor Cutter. I’ll be doing the case today.”

  The scrub nurse nodded. “Hi again, Doc. I’m Chuck and this here’s Susan,” he said with a thick drawl. He pointed to the third nurse now spinning the large locking wheel of the autoclave door. “Roberta is just helping us set up. She’s leaving as soon as we get started.”

  He remembered Chuck from his first meeting with Ellen but had already forgotten the other names, his mind too distracted by making sure the room was as he wanted it. He intended on making this case go perfectly. He believed that first impressions heavily colored subsequent interactions and wanted make known his attention to detail. He also believed that not paying attention to detail greased the skids for complications, and the longer you postponed the inevitable complication, the better your reputation. God help the surgeon who had a disaster in his first case at a new hospital.

  The anesthesiologist waved hello. “Hi, I’m Bob Cole, your gas passer today.” He wore an untied patient gown over his scrubs for extra warmth. A powder-blue surgical mask partially obscured a beard of closely cropped white hair. Twinkly eyes suggested a smile under the mask. Perhaps it was his choice of music or the way in which he introduced himself or the combination, but at once Alex felt a familiar resonance toward him.

  “Bob Seger and the Silver Bullet Band. Love that CD. In fact, love most everything he’s recorded,” Alex said, walking over to the X-ray folder.

  “Then we’re going to get along just fine. That is, unless you want to hear whiny girl songs. Don’t have any of those.”

  Alex picked up the folder to double-check the patient name and hospital number. “Good. Don’t like them either. Give me Motown and Blues and that ‘Old Time Rock and Roll.’”

  “I’m also happy to turn it off if you want silence.”

  “You kidding? Can’t drive if I can’t jive.”

  Cole laughed and resumed organizing various syringes on the tray, filling them with the drugs used to put the patient to sleep. “Don’t usually see surgeons until start time. Even then, some show up late. Anything special you want on this case?” “Night Moves” began, another of Alex’s favorites.

  “No. Just here to watch you guys set up, this being my first case here. But it’s also something I’ve always done. Superstitious behavior, I guess.” He felt a twinge of embarrassment from the admission and worried the OR staff might interpret his behavior as a vote of no confidence in their ability or as an attempt to micromanage their jobs. But he didn’t apologize. If all went well, he wouldn’t feel compelled to be here as early for the next case. He began sorting out which films to display on the X-ray panels.

  “Anything special I need to know about for the case?” Cole asked.

  “Yeah. You’ll want a central line in her. We’re going into the posterior fossa tumor with the patient in the sitting position.” Then to the circulator, “I want a lumbar drain for the case.” Alex nodded at the boom box. “‘Working on mysteries without any clues.’ That’s got to be one of his best lines.”

  Cole dropped a drug vial into a drawer on the red anesthesia cart and locked the door. “He really captures the mood and mind of being a teenage male. At least that’s the way his songs seem to me.”

  Just then the main OR door swung open as another scrub-clad male entered. “Doctor Cutter, Lawrence Drew. I’m assigned to be your official scut jockey from now until January.” Alex recognized him as one of the first-year residents in the previous day’s conference.

  A circulator answered the OR phone and spoke a moment before putting a hand over the mouthpiece. “We’re ready when you are,” he said to Alex.

  Alex glanced at Cole and raised his eyebrows. Cole nodded.

  “Where you from, Larry?”

  Lawrence and Alex stood at the stainless steel scrub sink, hands and forearms thickly lathered in rust-colored Betadine soap, Alex working the disposable plastic sponge over the surface of each finger in his habitually methodical manner. He wore his 3.0x magnifying loupes with the upper edge of his surgical mask taped securely over the bridge of his nose and cheeks to keep from fogging the loupe lenses.

  “It’s Lawrence, sir, and Birmingham’s my hometown.”

  Finished with his left hand, Alex started in on his right. “I assume you mean Alabama and not Michigan.”

  “Yes, sir.”

  Alex wasn’t used to people being addressed as “sir” and “ma’am” but had to admit it had a nice ring to it. “What are your plans once you finish up the program?”

  “Man, that’s a long time from now.” Lawrence laughed as he worked the lather over his left pinkie. “Dad’s a neurosurgeon back home. Wants me to join him, so reckon I might just do that. Why d’you ask?”

  “Curious, is all.” So far, no resident he questioned voiced the slightest inclination to pursue research or teaching. Alex kneed on the water valve to begin his arm rinse and bent over the sink. He kept his elbows below hand-level so water—which isn’t sterile—drained from his hands down to his elbows instead of the reverse. Instead of sterilizing skin—which is impossible—these presurgery scrubs were intended only to minimize bacteria that live there.

  Alex accepted a sterile towel from the scrub nurse and began to dry his hands, fingers first, then worked back toward his elbows, not bothering to dry past his mid forearms for fear of contaminating the towel and then his hands. His damp arms would dry in the surgical gown. “What’s the biggest risk when using the sitting position?”

  The resident was also drying his hands. “Subdural hematoma?”

  “Nope. Air embolism,” Alex said. “Next question: How does that happen?” He tossed the damp towel into the linen bin.

  “Not sure, sir. Tell me.”

  Alex shook his head. “No, you tell me. Think about it a moment. If the patient is sitting, where is the heart in relation to the head?” Alex slipped his arms into the surgical gown the scrub nurse held open for him
, gloved, then waited for the circulator to tie the back of the gown closed. Finished gowning, he stepped away from the scrub nurse so Lawrence could repeat the process.

  “Guess it’s below the head.”

  Alex smoothed his gloves over his fingers before holding out his hand for a saline-soaked lap pad. He would use it to clean any residual powder from them. “And that makes the venous pressure in the head what?”

  Lawrence gave an understanding nod. “Guess it’s negative. Hadn’t thought of it till now.”

  “And what big venous structure will we work right next to?”

  “Okay, I get it. Air embolism.” Lawrence tied his gown also.

  “And how will we know if that happens?” Before Lawrence could answer, Alex said to Chuck, “We can move in the overhead now,” referring to a large instrument table with a platform for Chuck to stand on so he could hand tools down to Alex instead of working at his side where there was no room.

  “Not sure, sir.” Lawrence watched as Alex and Chuck jockeyed the table into position.

  “Bob?” Alex asked the anesthesiologist. “Want to answer that one for him?”

  “I have a Doppler stethoscope taped to his chest, right over the heart. It lets us hear any air sucked into his heart, because it causes what’s called a ‘windmill murmur.’ That’s pretty hard to miss. Once you hear it—and I hope you never get the chance—you’ll never forget it.” Bob turned up the volume of the Doppler for a moment so they could listen to the rhythmic whoosh of blood pulsing through the heart chambers.

  “What do we do if we hear it?” Alex asked the resident.

  Lawrence shrugged. “I don’t know.”

  Alex stopped work. “How many months you been a resident?”

  “Five.”