Cutter's Trial

by Allen Wyler

  Time for a career change?

  Another good question.

  His present life was—for lack of a better term—a sure thing. He’d become a respected member of the Baptist medical staff and a top earner in the clinic. His savings, grown by conservative investing, ensured an eventual comfortable retirement. Finally, Lisa loved the niche she’d made for herself. Leaving a stable, certain life for a risky start-up would mean taking a huge gamble land-mined with massive potential pitfalls. What were the odds the company would succeed? No way to know. Did he believe enough in what they were doing to make the gamble?

  Such a move would be in direct conflict to the old school way he’d lived life thus far: minimizing risk by choosing conservative options. He remembered his awe and dismay a few days after high school graduation when his best friend decided to forgo college to travel the world until his money ran out. In contrast, Alex became a poster child of the quintessential goal-directed career: high school to premed to med school to internship to residency, and finally, to his research and surgical work.

  Was he now being presented with a one-shot opportunity? Would this chance ever come his way again?

  Knowing he might not be able to sleep, he undressed and climbed into bed.

  “Sorry I won’t be able to drive you to the airport after your last meeting,” Levine said. Alex and Levine were breakfasting in the hotel coffee shop. “Any questions for me?”

  Several. But he decided to not ask them until he was sure about taking the job.

  “Not at this point. The underlying concept and your preclinical data are very exciting.”

  “Thank you. Don and I are very excited at the possibility of you joining the team.” Levine wiped the corner of his mouth with his napkin. “Any inkling of which way you’re leaning?”

  Alex wanted to be completely honest. “No. It would represent a big change with major repercussions. It’s not something I can decide easily.”

  Levine smoothed his napkin along the edge of the table to rest his forearms on. “Fair enough. Let’s say you decide not to come work with us. Would that preclude consulting?”

  “I think you can pretty much count on me to be a consultant for the company. But after our discussion yesterday, it’s really appealing to have more involvement than that. Your team’s energy and excitement is intoxicating. Besides, I may never get another opportunity like this. That alone is a huge attraction. One way or another, I’ll have an answer for you Friday.”

  “How was the flight?” Lisa asked as he slid into the passenger seat. Their routine when he returned from business trips was for Lisa to pick him up outside of the baggage claim instead of leaving his Audi in long-term parking.

  “Good. No turbulence.”

  “I’ll drop you at the clinic,” she said. “Leave your bag in the car and I’ll take it home and unpack it later. We can talk tonight after you get home and have a chance to relax.”

  “Thanks.” Before the flight to Seattle, he’d parked in the clinic garage so Lisa could drop him there now. He planned to catch-up on messages, sort mail, and pre-op the two craniotomies for the following day, both of whom Betsy Lou should’ve already admitted. He rubbed his tired eyes and blinked away the fatigue that comes with travel. He looked forward to a relaxing evening and an early turn-in. Thank God I’m not on call.

  61

  The next morning, Alex nosed the Audi into a parking spot and killed the engine. For several seconds he sat staring at the drab, familiar interior of the Baptist Medical Center parking garage. As he walked through the sky bridge, he stopped halfway across, gob-smacked by the too-familiar route and his cast-in-concrete routine: cases every weekday except Wednesday, his clinic day, the same schedule every week, almost fifty weeks a year. He never used up all his allotted vacation and sick leave. Why not? Why work more than I have to? Well, for one thing, he enjoyed the status of being one of the clinic’s top earners, for it validated his worth as a surgeon. If he couldn’t be a nationally respected scientist, he would be a regionally respected neurosurgeon.

  He thought of the discussions with Lisa about changing career paths. She made a valid point about their present life: What’s not to like? Life is good.

  I make more money than I dreamed possible.

  Yeah, but can I continue now that I know I’ve killed people?

  His heavy caseload raised the odds of it happening again. Accidents are accidents; that’s why they’re called accidents. If you could prevent them, you wouldn’t have them.

  He gazed out along familiar Madison Street toward the business district, then in the opposite direction where commercial zoning segued into residential property. This city, flat, drab, and dusty, was made up of two economic poles, the haves and the have-nots. Unlike Seattle, Portland, San Francisco, or Los Angeles, the minority here was the middle class, producing a dichotomy of country club members and unskilled laborers.

  The moment he entered the surgeon’s lounge, he paused, acutely attuned to the chatter and the smells of coffee and yeasty sugar from the morning pastry. As he moved to his narrow locker, another thought hit: I’ve lived here five years now. Five years! Hard to believe. Another five could just as easily flash by unnoticed. Then another. On and on until one day he would attend his retirement party at the University Club. What then?

  It’d be too late to do anything other than perhaps learn to play golf.

  “Doctor Cutter, ready for you in Room Three.”

  His first case in the recovery room, Alex sat back in the lounge, his muffuletta on a grease-stained brown paper sack, a diet Dr. Pepper on the table to his right. Alex took a paper out of his pocket and picked up the phone, double-checking the digits as he dialed. The connection clicked through, then rang three times. “Harold Levine.”

  “Harold, Alex Cutter.”

  “Didn’t think I’d hear from you until tomorrow. This mean bad news, does it?”

  “Guess that depends on your perspective. FedEx the employment contract to me, and I’ll sign and send it back. That means you probably won’t get it until Monday or Tuesday, but it’s a done deal.”

  “Wonderful news. The team will be excited to hear this.”

  “Yeah, I can’t wait to join them.” At that moment Alex felt more alive than he had for years.

  “May I ask how soon before you can start?”

  “I’ll find out later today when I give notice. The university requires a month, but I’m not sure about the clinic, so I’ll be held hostage to my contract. But I never used all my personal time, so there’s a ton of days accumulated. Figure perhaps a month before I can leave town, but that doesn’t preclude me from working on the trial design and protocol. I’ll start winding down my schedule, which will free up more time.”

  “Don will be happy. You just made our day.”

  “Likewise.”

  “Bother you a second?”

  Garrison glanced up from the note he was writing in a patient chart. “Sure, Alex. What’s up?”

  “I’m leaving.”

  “Okay.” Garrison nodded, clearly not understanding. “When will you be back?”

  “No, see, that’s the thing. I’m quitting. This is my notice.” Alex handed him the paper he typed himself, formally resigning from the clinic.

  Garrison stared at the paper for several seconds as a collage of expressions flashed across his usually expressionless face. Disbelief, questioning, acceptance. “May I ask why?”

  “You may, but I doubt you’ll understand. In spite of this being a wonderful practice for me, moving on is something I need to do. Can’t tell you how much I appreciate what you did to make a place for me here. For the most part, I’ve enjoyed being a member of the clinic. But I can’t see my future here.”

  Garrison’s brow furrowed. “That’s simply not true. You’re one of our stars. You’ve built a phenomenal practice. Why leave?” He held up a hand. “Hold on, let me rephrase that. Guess that means you have another job. You get a chairmanship somewhere? Is that it?
”

  Alex laughed. Chairmanship. That dream seemed so long ago and foreign now. “No. I’m joining a start-up company. In Seattle.”

  “A start-up?” Garrison looked totally bewildered.

  “I’d appreciate you not saying a word to anybody until I’ve had a chance to tell Doctor Reynolds. I’m heading over there now before he cuts out for the weekend.”

  Garrison nodded, resigned to this not being a joke. “Okay. But you never really answered my question. Why are you leaving?”

  Alex was torn between dropping the subject or not. Part of him knew he had to say something or he’d always regret it. “That AVM I did? The patient who died?”

  Leaning back in his chair, Garrison nodded. “I remember.”

  “You were in the office that day when I called for help. You sent back word you were too busy. Long as I’ve known you, you’ve never been too busy to help a colleague, especially if it’s a clinic member. The patient died. I can’t help but wonder if he might’ve lived if you’d helped me. I can’t let that go, Garrison. I just can’t.”

  Garrison’s shoulders slumped. “That case was inoperable, Alex. He should never have been taken to the OR.”

  “Maybe. Maybe not. Maybe he died because of being in the hands of the wrong surgeon. But that doesn’t change the fact you didn’t come to help.” Once again Alex felt the sting of that day full-force, his temples throbbing.

  Garrison cocked his head, looking at Alex sideways. “You telling me you’re fixing to give up a great practice on account of that one case?”

  “No. Nothing’s that simple. But refusing to help me when I really needed it soured my taste for practice here. And losing that patient is something I’ll never forgive myself for. I started medical school with an unrealistic dream of what the practice of medicine was all about. I thought doctors worked for a greater good. Well, I’ve learned that isn’t always the case, that there’s as much special interest as we see from politicians in Washington. In fact, I can’t think of anything more political than this clinic. The way we court referring physicians, the way you sided with Clarence on an issue I still believe is indefensible. I don’t have a clue why you refused to help me that day, but I suspect it was out of some misguided self-interest, revenge for losing a patient to me. That’s nothing but pure, unadulterated politics. Want me to keep going, or have you heard enough?” Being rhetorical, Alex continued. “Let me put it this way: Why shouldn’t I want to leave?”

  62

  “Sorry you’re going, Doctor Cutter. I was looking forward to being on your service,” a first-year resident said as they prepped for surgery in the OR.

  Alex tossed the surgical towel he just dried his hands with into the linen bucket. “I’m going to miss teaching you guys almost as much as I’ll miss the muffulettas.”

  “Seeing’s how this is your last case, you get the honor of picking the music,” Cole called from the other side of the surgical drape.

  He thought back to his first case here at Baptist, the patient with the cerebellar tumor, and remembered the music Cole played. “How about the Bob Seger disc with ‘Hollywood Nights’ and ‘Against The Wind.’ That is, if you brought it today.” Cole always carried a black nylon CD wallet into the OR with twenty or so discs and his boom box.

  “Figured you might want that one.” Cole laughed. “You always did like it. Especially the line ‘working on mysteries without any clues.’”

  Alex finished gowning by knotting the stays around his waist. “Yeah, it’s one of my favorites.” Then he said to the resident, “Pay attention. Here’s how I drape and prepare my field.”

  Chuck Stevens, gowned and gloved, stood on the step of the overhead table, ready to hand off the sky-blue surgical drape. “All set?”

  “I am.”

  In one fluid movement, Chuck passed the head-end of the drape while peeling off the protective cover of the transparent adhesive barrier. Alex accepted the drape, smoothed the sticky, transparent surface over the incision line he’d marked on the scalp with a Sharpie, and pulled out the wrinkles, funneling the drainage system into the sterile suction bag at the bottom of the drape.

  Minutes later they were quickly progressing through the opening, Alex doing it instead of having the new resident muddle through. Besides, this was the resident’s first—and only—day on his service, and the standing rule was to observe the first case before being allowed the privilege of taking the scalpel. Chuck and Alex worked flawlessly as a team, having done so many openings together that Chuck had the next instrument ready before Alex asked for it, now wordlessly passing instruments back and forth, Alex’s hands moving with deft precision, the only sounds in the room the respirator, the heart monitor, the gurgling suction, and Bob Seger’s Silver Bullet Band.

  “Where you from, Trevor?” Alex asked the resident.

  “Chicago.”

  Alex bent slightly for a better view before slipping the dural elevator through the burr holes to strip dura from the undersurface of the skull. “Chicago. Huh!” It was a city home to several residencies. “Why come all the way down here?”

  “Wanted a change. Grew up there and went to Northwestern.”

  “Well, you certainly got what you wanted, didn’t you?”

  “Uh-huh.”

  “Craniotome.”

  Chuck handed him the air-powered side-cutting drill. Alex pressed the footplate against the tip of his finger and squeezed the trigger. The drill responded with the high-speed whine of an air-driven motor similar to a dentist drill. Alex let it run a few seconds to make sure the footplate didn’t heat up, which would happen if the drill wasn’t perfectly seated. Just one more precaution to make sure to stay out of trouble. As much as he trusted Chuck, he always double-checked. Just like Chuck double-checked him.

  “Irrigate the blade while I cut,” he instructed the resident.

  Chuck passed the resident the bulb irrigator filled with saline to squirt over the skull where Alex worked.

  As Alex began to cut between the burr holes to lift the square piece of skull away, several emotions surged inside. This, he realized, could very well be his last craniotomy. Ever. After today his surgical career would likely end. He would miss some aspects of practice, the intense camaraderie being one. He felt strong bonds to the OR team, the floor nurses, his colleagues. He suspected this bond was similar to what policemen or soldiers felt toward each other. They shared common stresses and joys and the inherent difficulties and triumphs of their emotionally taxing professions. He could explain a difficult case to Lisa, but she never really understood the daily stress or the complex issues he was forced to deal with. Perhaps this is the reason she had some difficulty understanding his decision to abandon a profession he’d worked so hard to obtain. Fourteen years of training would essentially vanish the moment he walked out the OR door in a few hours.

  Also, he was off call now. No sense catching a case if you wouldn’t be around to handle the post-op care. At seven o’clock this morning, at the official termination of his last night on call, an incredible weightlessness came over him, as if the soles of his Nikes barely grazed the floor. A chronic burden pressing on him for years simply vanished, leaving him almost giddy with relief. Gone were the anxiety-provoking, sleep-stealing, middle-of-the-night calls about post-op fevers. No more early morning summonses to the trauma center. Yes, he’d miss the camaraderie, but the emotional price he paid for it no longer seemed worth it. He would find similar relationships in his new job, perhaps starting with Levine and Slater.

  Suddenly, he realized the music had stopped. Glancing up, he saw Cole smile at him.

  “What?” Alex asked. Something wrong? Panic seized his gut.

  “Hail to The Chief” filled the room from the boom box, the volume now up.

  “What the hell?” he asked, glancing around.

  Chuck stood at attention. So did the resident at his side. Then through the swinging doors marched the two chief residents. “Ten hut!” called Chuck.

  T
he two chief residents, Steve Stein and Rene Coumaux, marched to within a foot of Alex and stopped, as if soldiers. “Doctor Cutter,” Stein said, “by the powers vested in me by the residents of this university, I award you the medal of the Silver Scalpel for Excellence in Teaching.” He paused. “I’d pin it on you, but then you’d have to regown and reglove, so I’ll just set it over here next to your loupes.”

  Misty-eyed, Alex scanned the crowd pouring into the operating room—scrub techs, circulating nurses, Ellen, Betsy Lou, other residents who’d scrubbed out of their cases. A lump formed in his throat, causing him to croak a response. “Thanks … guess I … better get back to work before you guys contaminate the field and this patient gets an infection, ’cause then I’d have to stick around to take care of it.”

  Two hours later as Alex knotted a suture—a quick instrument tie rather than using his fingers, a final bit of flash to finish the case—he glanced at the new resident. “One last question.”

  The resident reached in with the scissors to snip the suture tails. “Yeah, what’s that?”

  “What would you say if I told you Humpty Dumpty was pushed?”

  The resident laughed and replied without missing a beat. “Everyone loves a scandal.”

  Alex glanced toward Cole. Cole’s eyes came up over the top of the drape, twinkling. “Goddamn!”

  “Knew someone would eventually get it,” Chuck added.

  Alex shook his head. “Yeah, but it took a goddamn Yankee to figure it out.”

  63

  The ring of the car phone jangled Alex out of autopilot consciousness produced by monotonous miles of interstate. Who the hell would call now?

  “Hello?”

  “Alex?”

  In spite of the hollow cell phone echo, Alex recognized Baxter’s voice. How long since they last spoke? They bumped into each other now and then at AANS meetings, but that was about it. “Baxter?”