Public Anatomy (8 page)

Without hesitation, Eli said, “Hunter. John Hunter.”

He had never used an alias before. Never had the need for one. But his name had been all over the papers a few weeks before and the biotech company would not want him as a workshop participant, he felt sure. He wanted to remain anonymous as long possible. The fake name rolled out so effortlessly, even he was surprised by it. Then he realized that the name he had chosen was anything but anonymous. John Hunter was the influential surgeon in the mid-1800s who brought science into the surgical discipline.

Well, at least the name would be anonymous to them. He let the clipboard woman search her list of registered names. A little anxious, she crossed and recrossed her skirt-bound legs.

“Is there a problem?”

“Well,” she said and glanced at her partner. Eli knew that most if not all of the workshop participants would have traveled from out of town and therefore were preregistered.

“We can’t find your name and we don’t have your registration fee of four hundred fifty dollars.”

“Yeah,” the other one said, “four hundred fifty.”

“My assistant mailed in the registration and the fee several weeks ago.”

The girls scrambled to the list again, flipping pages, searching their desk for lost paperwork.

“I’m sure you’ll find it.” Eli was already moving toward the conference hall.

“But you need a name tag, sir.”

Eli winced at the “sir” and grabbed a name tag. “I’ll fill it out,” he said, holding it above his head as he disappeared into the meeting room.

Except for the PowerPoint presentation on a large central screen, the room was dark. Eli let his eyes adjust and took an open seat in the back row between two attendees riveted on the screen who did not acknowledge his presence. Seven rows of linen-covered tables filled each side of the room. Most of the seats were occupied. He guessed the room held between fifty and seventy-five people.

In the center of the room, the tables were pushed to the side, making room for a plastic drape suspended from poles, a rectangular indoor tent. It appeared to hide a large object beneath. Behind the lit podium, a man in a business suit and slicked-back gray hair advanced the next slide.

“I’m Michael Bass, CEO of Renaissance Robotics. You’ve been watching a brief presentation about our company. Now, I am pleased to tell of our contribution to the history of robotic surgery.” The next slide was bulleted for emphasis.

•
The first in the Southeast to bring robotic technology into the operating room.

•
A leader in robotic hysterectomy.

Bass flipped through slides on the history of robotics. A bit on the theory behind robotic technology, aspects of robotics that made robotic surgery such a powerful innovation with its three-dimensional precision movements. Bass even made reference to a potential use of the technology in the military: robotic devices to disarm bombs, unmanned vehicles to rescue soldiers wounded in combat.

Eli noticed a conspicuous absence of any reference to RBI, the parent company of Renaissance Robotics. An intentional disguising, he suspected, due to RBI’s recent negative publicity and its desire to establish Renaissance Robotics as a separate entity. Of course, there was no mention of the recent operative death, or the death six months ago, both during robotic hysterectomy, the pioneering procedure of the company. Eli wondered if any of the attendees knew about the failures yet.

A few minutes later the presentation ended and the lights came on. Full light revealed the space to be a ballroom, chairs of blue linen with
gold accents and long draperies framing floor-to-ceiling windows. Bass moved down the stairs from the podium carrying a handheld microphone. The attendees sipped coffee and watched him stop next to the tent-covered structure.

“Now let’s get to what you’re all here for,” he said. “Nathan, please unveil our instrument.”

His assistant untied a single rope and the plastic covering dropped gently to the floor.

“This, ladies and gentlemen, is the new Veritas surgical robot complete with the very latest in robotic engineering.”

The entire module was set up to simulate a real operating room. A mannequin lay supine on an operating table, four stainless steel trocars piercing its abdomen. Two large plasma video screens were positioned on each side of the table to receive transmission from the intraabdominal camera. The screens revealed the stationary trocars inside the abdominal cavity, beset with anatomically accurate organs—liver, gallbladder, and uterus. Fifteen feet from the mannequin sat the robotic console, resembling a space-age flight simulator, with screen, hand controls, and custom-fitting seat inside the cockpit.

“We have simulated an actual OR environment with cameras inside the dummy’s abdomen. The robotic movements will be projected on high-definition screens.”

Bass pointed these out for the audience.

“Many of you have seen the previous model of Veritas, and some of you may be utilizing it already in your own practices for robotic surgery. A show of hands for those of you who have used the Veritas.”

Out of the entire room, three hands went up, then a reluctant fourth.
So most had come just to see what robotic surgery was all about. But they, unlike me
, Eli thought,
were here to see the advantages it could offer for their surgical practices, not to investigate what could go wrong
.

“I’ll start with the basics,” Bass said as his assistant exchanged his handheld microphone with a headset unit, allowing the company’s CEO to more freely demonstrate the technology.

He then explained the efficiency of the self-contained robotic console
and how it could translate coarse, unrefined, two-dimensional human movements into a fine, three-dimensional, symphonic choreography. Eli thought that the dance reference was a bit exaggerated.

In his seat, Eli sketched the arrangement on a pad of paper the hotel provided for each attendee. He drew the robotic console, and several feet away from it, the patient. He filled in the position of the scrub nurse next to the patient, and a medical student and a surgical resident hugging the table as in a traditional operation. Away from the table, he filled in the space for a circulating nurse. He counted six surgical personnel in the “operating room.” Then he sketched in the seventh person, the surgeon, sitting at the robotic console. He imagined Liza French there, her back arched, intensely watching the movements on the screen.

Eli wondered how it had all gone down the day her patient died. Who first noticed a problem? Was there any warning at all? Maybe it was a deceptively quiet and calm operation, suddenly giving way to chaos.

“I don’t know about you, but I think this robot surgery is a bunch of crap.”

Startled, Eli looked up at the man beside him.

“I like to feel the tissue in my hands, know what I’m saying?” The man was squeezing his hands, open and closed, as if testing farm produce. Eli wondered what training program had allowed him to slip through and become a surgeon. As the man continued to rant about the ills of robotic surgery, Eli noticed that the workshop participants had moved out of their seats and were gathering around the robotic simulator. The CEO, Bass, had called everyone up for a “live” demonstration. Eli stood and took the long way around the conference tables, hoping to lose his chatty neighbor. The man tracked him anyway.

What followed next was a robotic dog and pony show. The assistant sat inside the console and maneuvered the hand controls. Tiny movements of his fingertips were translated to the intraabdominal trocars and materialized on the high-definition screens. Bass narrated the show while specifying the details with a laser pointer.

“Nathan is demonstrating the three hundred sixty-degree range of
motion that’s so easily attainable with the robotic controls. Those of you close to the console step up and observe the minute hand movements that translate into such fluid motion.”

Eli stepped forward and watched the assistant, introduced as Nathan, work the controls. The young man watched a screen inside the console that showed a picture identical to that displayed on the audience’s freestanding screens.

“How many of you perform cholecystectomy in your surgical practice?”

Not surprisingly, nearly every hand went up. Removal of the gallbladder was one of the most commonly performed operations.

“Wait until you see the ease of robotic cholecystectomy. You’ll never want to go back.”

Eli watched the president of Renaissance Robotics. He definitely knew his stuff—the technology, the instruments. But he was a little too smooth—a bit too much the used car salesman.

“With the robotic system, you can lock a trocar in place for retraction of the gallbladder fundus; another lock on the infundibulum, and you start the dissection. Without an assistant, if you like.”

Nathan demonstrated these moves, then switched to another hand control. But as he did this, one of the trocars dislodged and ripped the gallbladder off the surface of the liver. Several of the attendees around Eli gawked at each other in surprise. Throats were cleared. If this had been a real patient, the bile duct would have been injured and the liver would be bleeding like hell.

For a moment, even the president of Renaissance Robotics was without words.

Eli’s newfound buddy leaned closer to him, so close he could feel the guy’s breath on his ear.

“Told you this robot surgery is a crock of shit.”

The assistant, carried on as though nothing had happened. Because the cholecystectomy had been completed, albeit violently, they moved on to the next demonstration.

“Now let’s switch gears and show you how easy it is to remove the spleen.”

A few attendees snickered. Eli heard one say, “Yeah, right.”

The splenectomy did in fact go very smoothly, and Eli was impressed with the advantage afforded by the robotic technology over traditional methods.

At the end of the demonstration, the attendees broke for lunch and filed out of the conference room. The company had reserved a large room at the Rendezvous Restaurant a few blocks away. Eli knew that many in the group would taste real Memphis barbecue and dry-rubbed ribs for the first time. He envied them, but he stayed behind to ask the company’s CEO a few questions. But when Eli located him, Bass was walking out at the head of the group, the two young women from the registration desk at his side. Soon, Eli was alone in the room except for Nathan, who was wrapping an extension cord into a tight coil.

Eli approached him. “I enjoyed the demonstration.”

“Yeah?” he said and continued to loop the cord over his hand and around his elbow. “Glad you liked it.”

Eli noticed a tattoo of three slender animals, like rodents, on his bulging bicep. Nathan looked more like a roadie than employee of a biotech firm.

“I can certainly see the advantage of the robotic technology,” Eli said, trying to warm up to him.

Nathan said nothing.

“I was wondering, is there ever a disconnect between the surgeon’s movements and what the robot delivers?”

Nathan moved to one of the digital screens and began lowering it on its tripod base.

Eli tried again. “It seems that one misplaced trocar or one errant move could—”

The assistant turned to Eli and said calmly, “I just load the truck, okay. You’ll need to ask my boss questions like that.”

Liza stopped in the doorway of the executive conference room on the fifth floor of Gates Memorial Hospital. Three men sat watching her from the far side of a heavy oak conference table. Two of the men wore dark suits. She knew one of them. Robert Largo, chief of staff at the hospital. He addressed her first.

“Have a seat, Dr. French.”

The third man wore a light tweed jacket over a button-down shirt. No tie. Liza recognized his signature look from the newspaper. Gordon Daffner, president of the University of the Mid-South.

Dr. Largo had called Liza to tell her of the meeting. They expected a swift lawsuit from the deceased patient’s family and wanted to waste no time in getting the facts down. The chief of staff motioned to a chair opposite the three of them.

Liza had been in this conference room before to present her Program of Robotic Surgery to the board of trustees. She remembered being comforted by the rows of books in dark-paneled cases along the wall. This time as she took her seat she felt no comfort at all.

Largo began with brief introductions. “Dr. French, you know our president, Dr. Daffner.”

Daffner rose, extended a hand across the table. “Doctor.”

Liza started to say “president,” then, “Dr. Daffner.” In an awkward moment, she said nothing.

Largo cleared his throat. “This is attorney Mitchell Downing, head of legal affairs for the hospital.”

Downing didn’t get up. He nodded, then opened a legal pad as a signal he was ready to start transcribing.

Largo began the meeting. “The events of the past twenty-four hours have been most unfortunate, as you know. Not only did we suffer an intraoperative death, but—”

At this he stopped, as though he didn’t yet accept what had happened.