Patient (13 page)

“Ka-boom!” Jessie whispered to Emily.

The initial test of wills between Gilbride and the Countess lasted through several exchanges before the Count intervened and brokered a compromise. Jessie and Emily would stay, along with Hermann’s older son, Derrick, a man with watchful eyes, strongly built like his father, but with little resemblance beyond that. Tolliver, who observed the conflict and resolution from the doorway, smiled understandingly and motioned that he would be waiting in the hallway.

“Now, then,” Orlis said, immediately seizing the initiative, “exactly what is the procedure you intend to do on my husband, and when will it be done?”

“I will answer each of your questions in due time, dear lady. But not until I have had the chance to examine my patient.” He turned from her and continued speaking with a deliberateness that bordered on patronizing. “Count Hermann, I am pleased to make your acquaintance. I look forward to the successful treatment of your problem.”

“I wish that will be so,” the Count said.

Orlis, her expression stony, stood aside as Gilbride did a more painstaking and meticulous neurologic examination than Jessie had ever seen him perform.

Spare me
, was all she could think. It was comforting and amusing to know that a few feet away, Emily was thinking the same thing.

“An excellent exam,” Gilbride said finally, putting his reflex hammer and the tuning fork used to test vibratory sense back into his lab coat pocket. “Excellent. Count Hermann, your neurologic exam is surprisingly good. Your tumor is rather slow-growing and nonmalignant, which means it does not spread to distant parts of the brain, or to other organs. However, it is taking up increasing amounts of space, and has begun compressing normal brain tissue. You will need surgery to remove it.”

The Countess inserted herself between the two men, making no attempt to hide her impatience to hear something she did not already know.

“Do you intend to use the same device you used successfully on that young gymnast?”

Almost in spite of himself, Gilbride glanced at Jessie. She looked away.

“Well, yes,” he said. “I suspect we will do this operation in the MRI operating room, and we probably
will
use our robotic assistant.”

“We don’t want probably,” Orlis said sharply. “My husband came here because you said you had something to offer that other neurosurgeons did not. I want everything necessary to be done for him. He is a very special man and helps a great number of people.”

Gilbride rose to meet the challenge.

“I appreciate your anxiety, Madame,” he replied, “but I feel I must remind you that I am the surgeon. If I think robotic assist will help us remove your husband’s tumor, that is what we will use. And if not, well then, we shall not. I hope that is clear?”

Orlis looked to the Count, who nodded his agreement. Then she thrust back.

“When will the operation be done?” she asked.

Gilbride turned to Emily.

“You have the OR schedule?”

Emily, clearly unwilling to be anyplace but on the sidelines of this battle, handed the notebook over to Jessie.

“We’re limiting ourselves to the MRI operating room?” Jessie asked.

“Precisely,” Gilbride replied.

“Okay. The room is maxed out for three weeks. We have two cases a day booked every day, including Saturdays.”

“But I have promised Mr. Tolliver I would be doing an ARTIE case that he could observe. We need to fit Count Hermann into the schedule by the end of the week.”

Jessie sighed.

“Tomorrow Dr. Wilbourne from Infants and Children’s has his case scheduled first thing in the morning. In the afternoon is the re-op on Terence Gilligan. He’s in the unit right now and not doing well. He really needs to have his surgery done as quickly as possible. The day after tomorrow, your patient, Lindsay Pearlman, is first. She’s quite symptomatic, and I think there would be a serious risk in delaying her. After her is that man you’re going to do with the surgical team from China. They’re all flying in tomorrow. Thursday I’m doing Ben Rasheed in the morning. He’s been postponed twice, and he really has to be done soon or something disastrous is going to happen. It might be possible to push the Thursday after noon case into next week. That’s your re-op on the Hopkins boy.”

“What are you trying to say?” Orlis demanded.

“In my opinion,” Jessie went on, “the best we could do—the very best without endangering patients who are much more unstable than Count Hermann—would be three days from now in the afternoon slot.”

“That is ridiculous and unacceptable,” Orlis snapped.

“Orlis,” the Count said, holding up a calming hand.

The Countess took a deep breath and exhaled slowly.

“Dr. Gilbride,” she said, nearly shaking, “my husband has had two seizures already. I want this surgery done tomorrow or Wednesday at the very latest.”

“Jessie,” Gilbride said, “I would rather not keep Eastman here any longer than necessary.”

Jessie shrugged.

“These cases are really in critical shape,” she said. “I would hate to delay any of them any more than they already have been, and I don’t think you want to tell the Chinese they’re being bumped.”

Gilbride studied his fingers, clearly weighing the political and malpractice implications of putting off a case and having some sort of catastrophe befall the patient.

“Thursday afternoon it is,” he pronounced finally. Orlis’s porcelain face reddened.

“This is unacceptable,” she said again.

Gilbride seemed to enjoy having the upper hand. Clearly this was one HC who had pushed him too hard.

“Furthermore,” he said, “I would suggest that you and your family check into a hotel until Thursday morning.”

“We are paying in cash, Dr. Gilbride. We have Dr. Marcus’s permission to occupy our rooms, and we will not be leaving.”

“Suit yourself, Countess.”

“Dr. Gilbride, I want you to know that we are not accustomed to this sort of treatment.”

“Mrs. Hermann, I assure you there are a number of other neurosurgeons in the city.”

Without waiting for a response, Gilbride swung around and led Emily and Jessie from the room. Eastman Tolliver was waiting just outside the door, where he couldn’t have helped but hear everything that had transpired. Jessie tried unsuccessfully to read anything into his expression. Removing Rolf Hermann’s tumor by any method was hardly going to be a stroll in the park. And although confidence was as essential a quality in a surgeon as a steady hand, the line between self-assuredness and hubris was a fine one. Jessie wondered now if Gilbride’s determination to impress Eastman Tolliver had just pushed him across it.

Chapter 16

JESSIE HAD JUST FINISHED DINNER WITH ALEX IN the cafeteria when she was paged to an in-house number.

“This is Dr. Copeland, returning a page.”

“Ah, yes, Jessie. Eastman Tolliver here. I hope I’m not interrupting you.”

Jessie looked over at Alex, who had cleaned their table and was now pointing at his watch and motioning that he was leaving. “See you later,” he mouthed.

“No,” she said to Tolliver. “You’re not interrupting anything.”

“I wonder if at some point this evening we might talk for a bit,” Tolliver said.

“Is there a problem?”

“No, nothing like that. I just had some questions that I felt you might better be able to answer than Dr. Gilbride.”

I’d really rather not get involved in this grant business any more than I already have been. ... Nothing personal, but I think you should direct any questions you have to Carl. ... I am absolutely beat, and I had hoped to make it an early night tonight. ...

In the few seconds it took her to answer, Jessie rejected half a dozen responses that were each more accurate than the one she ended up giving.

“Of course. Where are you now?”

“In the library going over your—I mean Dr. Gilbride’s—grant application, and boning up on my neurosurgery.

“I can be done by nine. Will that be too late?”

“Nine will be fine.”

“Tell you what. Meet me in the lobby. You can escort me to my car, and I’ll drive you to your place. We can talk on the way.”

Over the next hour Jessie returned eleven phone calls—seven of them for Gilbride. There appeared to be no letup in the frenzy he had created with his gold medal operation. It was actually five after nine by the time she had changed out of her scrubs and made it to the lobby. Eastman Tolliver was there, dressed conservatively in a lightweight tan suit, button-down white shirt, and muted tie. Perhaps sensing that she had had a long day, he wasted no time on small talk.

“So,” he said as they descended the stairs from the main entrance, “Dr. Gilbride has told me that he has a case scheduled Thursday afternoon in which he will probably be using your robotic assistant. I am planning on returning to California shortly after I observe that operation. I was hoping that before I leave, we two might talk a little business.”

“Business?”

“Yes. I would appreciate it very much if you could tell me about your recent misadventure with ARTIE.”

Jessie looked over at him, stunned. “Misadventure?”

Tolliver’s dark, intelligent eyes sparked.

“I didn’t come all the way to Boston just to be charmed by your department chief,” he said, “although I have been positively disposed toward him thus far. I came to learn about your work and to gather the information necessary to make what will amount to a four-million-dollar decision.”

“Not three?”

“Probably not. And please, don’t feel you are breaking any confidences. Dr. Gilbride has encouraged me to speak with whomever I wish.”

Jessie couldn’t help but be impressed with the man’s thoroughness. Pleading ignorance at this point hardly seemed appropriate.

“Well, I don’t know for certain what you mean by misadventure,” she said, “but I assume you’re talking about the procedure I did on a cadaver not too long ago.”

“Precisely.”

“ARTIE was functioning perfectly, but a microcable snapped, and I lost control of him. It was that simple.”

“Could that happen again?”

“I would hope not, but speaking as a former engineer, I can tell you that with something mechanical anything can happen.”

“But the design of these cables is as good as it can be?”

“If a thing is man-made it can be improved upon,” Jessie replied, “but for the moment, I would say yes, the guidance system on ARTIE is as good as we can make it.”

“Did you participate in the decision to use the device on Marci Sheprow?”

Again, Jessie stared over at him.

“Eastman, I seldom get too nervous performing brain surgery,” she said, “but the possibility that I might say something that will cost my department a four-million-dollar research grant is another matter altogether. Perhaps we should discuss all this with Carl.”

“I’m sorry. Jessie, yours is not the only program in intraoperative robotics that has applied to us for financial assistance. To make the fairest decision, these are the sorts of things I need to know—the reason I came all the way across the country to evaluate your program firsthand.”

Jessie thought for a time, then shrugged.

“No,” she said simply. “Carl made the decision to use ARTIE on Marci Sheprow without consulting with me. Nor did he have to. It’s his department, his lab, and his invention.”

“But you’re the principal researcher, yes?”

“I think you know the answer to that.”

“I believe I do. And I want you to trust that your response will be kept strictly confidential.”

“I have a degree in mechanical engineering.”

“I am aware of that.”

“Well, I was hired as a resident with the understanding that I would spend some time in the lab working on ARTIE. So I guess you could say I was the principal researcher on the project. But believe me, Dr. Gilbride has been on top of things every step of the way.”

“I have no doubt that he has. The operation Dr. Gilbride was referring to, it will be Count Hermann, yes?”

“Yes, it will. I suppose you heard that when you were in the hall.”

“It was difficult not to. In fact, after I overheard the exchange between Dr. Gilbride and the Countess, I made a point of stopping by later to speak with the Hermanns.”

“The Countess actually talked to you?”

“I found both of them quite easy to converse with.”

“She’s pretty angry at us.”

“Perhaps. But I believe she is simply frightened for her husband. It seems to me that she loves him very much. Tell me, Jessie, in your opinion, is the decision to use ARTIE on Count Hermann the correct one, or is this just being done on my account?”

Jessie looked over at him, but said nothing.

“Please,” he implored. “It’s very important that I know how you feel about this.”

Jessie felt her mouth go dry. Tolliver was extremely intuitive, and clearly had been asking questions around the hospital. She wondered if he sensed that she didn’t believe ARTIE was ready to be used on anyone—or, more to the point, that anyone, including her, was competent enough with the device at this juncture to use it on a difficult patient. Even assuming that ARTIE had no further mechanical problems, the ability to see a tumor in three dimensions and to guide the robotic unerringly through normal brain tissue would come only with time. For sure, she felt her skills improving with practice, but she still wasn’t confident enough to lay one of her patient’s lives on the line.

She knew she was going to have to lie to Tolliver, risk costing her department a four-million-dollar grant, or pick her words with the care of a soldier on land-mine detail.

“I believe the technical problems I encountered have been dealt with,” she said. “I also believe that ARTIE has a great deal to offer to patients whose tumors are difficult to reach.”

“In the right hands.”

Jessie unlocked Swede’s door for Tolliver and waited to reply until she had pulled out of the lot.

“Dr. Gilbride is a skilled surgeon with a great deal of confidence in himself,” she said finally. “That confidence is job one in our specialty. Without it, a neurosurgeon might just as well pack it in.”

Jessie could feel Tolliver studying her, deciding whether to push the matter any further.

“Thank you, Jessie,” he said at last. “I am most grateful for your candor. You have my word that any other questions I have I’ll ask Dr. Gilbride.”

IN HIS MIND, forty-eight-year-old Terence Gilligan had never lost a fight. He had been beaten in the ring a number of times and, on occasion, pummeled. But he had never really lost because he had never broken. Even when his knees refused to straighten, he had never given up. The British had beaten on him, too. He was one of the Rowdies—an arm of the IRA in east Belfast that was noted for its toughness. They had rousted him, hauled him in to the station house, and slapped him around for hours. But they always came away empty. And gradually, they came to know not to bother with Gilligan.

This brain tumor thing was no different, he thought now. Those rotten cells would come to know the same as the Brits—don’t bother with Gilligan.

He had been through so much in his life, it was hard to believe he was lying in a bed in the intensive care unit of a hospital in Massachusetts, with tubes stuck in almost every bloody opening in his body. But that was the way things were. First the girl from South Boston, visiting her ancestral home, then the flight from Ireland to be with her, and finally the merging of his life with hers, her family, and the rest of the Americans.

Gilligan coughed against the huge tube that passed down his throat, connecting his lungs to a breathing machine. Forty years of fags had done his breathing in. Now it seemed like forty years since he had last smoked one. With the friggin’ tube down, he hadn’t been able to speak to anyone for days, neither. Did they even know he could hear them? Understand them—at least some of the time? Did they even know how uncomfortable he was? Or that he was aware of tomorrow’s trip back into the operating room to try and clean out the brain tumor that had regrown, it seemed, in just a few months?

Shit, what lousy luck. If the bullets don’t get you, the cancer will.

Gilligan shifted his weight, trying to find a comfortable position. He could barely move with all the bloody tubes, to say nothing of the straps around his wrists and ankles that kept him from getting at them.

“Mr. Gilligan, hold still now. It won’t do you any good to pull out your breathing tube.”

Gilligan blinked, trying to focus through the dim light on the woman, who was backlit from the outside hallway. She spoke with a heavy accent, though not one he immediately recognized. He waved at her with one hand as best he could.

Pain medicine. If you can’t run some bloody fag smoke down this tube, at least give me some more pain medicine so I don’t have to think about it.

“I’m from anesthesia, Mr. Gilligan,” the woman said gently. “I’m here to give you some medicine to help you sleep before your surgery tomorrow.”

Well, it’s about friggin’ time.

The woman came closer. She was wearing a long white coat, a mask, and something covering her hair. From what he could see, her eyes looked nice enough, and her voice, not much more than a whisper, was soothing. She had a syringe full of the sleeping medicine in her hand.

“Just hold still, now, Mr. Gilligan,” she said. “You’ll be feeling better in just a short while.”

She slipped the needle into the IV tubing and emptied the syringe.

Bless You, Sister. Bless you.

“Sweet dreams.”

Almost before he realized it, the woman was gone. Still there, though, was her perfume. Odd, Gilligan thought. Of all the many nurses and woman doctors who had cared for him, none had worn any perfume that he could remember. He forced himself down into his pillow and waited.

How long did she say it was going to take to work? How long has it been?

Suddenly, a strange, unsettling emptiness filled his chest and throat—the sensation of his heart flip-flopping.

“Somebody go in and check on Gilly,” he heard one of the nurses say. “He’s starting to have runs of extra beats. They look ventricular.”

Extra beats. Now what in the hell does that—?

“Quick, Becky, Gilly’s fibrillating!”

The extra beats in Gilligan’s chest exploded into a terrifying vacuum, and he knew, well before he lost consciousness, that his heart had stopped beating.

“Code ninety-nine, room seven! Call it in!”

Hurry, girls, hurry!

“Get the cart. Molly, call Dr. Dakar!”

“Code ninety-nine, Surgical Seven ICU! ... Code ninety-nine, Surgical Seven ICU! ...”

Hurry!.. . Fix me! ... I’m dying!

“He’s still in fib.”

“Give me three hundred joules. Get ready to defibrillate!”

Oh, God, please ...

“Three hundred!”

Oh, God ...

“Okay. Ready, everyone ... Clear! ...”