Sisterhood (12 page)

It said, “Christine, I’ve left. Maybe for good. Feel free to call, but only when you have something significant to say. Jerry.”

D
avid began his first day as Wallace Huttner’s replacement by identifying a Berlioz piece as Mendelssohn, but bounced back moments later by correctly sensing that outside his window a day of change was developing.

There was a dry chill in the air that kept him from working up the heavy sweat he liked during his run by the river. To the east an anemic sun was gradually losing its battle for control of the morning to an advancing army of heavy, dark clouds, each with a glossy white border. The day mirrored his mood: the difficult evening rounds with Huttner had left him with a vague sense of discomfort and foreboding that neither a night of fitful sleep nor his morning workout had totally dispelled.

He had planned to make morning rounds along the same route he and Huttner had taken the previous night, but once in the hospital, he succumbed to a growing impatience to see how Anton Merchado was doing on his new treatment regimen.

The fisherman’s bronzed, weathered face broke into a wide grin as soon as David entered his room. With that
Single smile David’s apprehension about the day evaporated.

“I had a turd, Doc!” Merchado’s gravelly voice held all the pride of a mother who had just given birth. “This morning. One beautiful, plop-in-the-water turd. Doc, I can’t thank you enough. I never thought I’d ever have one again.”

“Well, don’t get too excited yet, Mr. Merchado,” David said, barely able to control his own enthusiasm. “You certainly look better than you did last night, but I don’t think the diarrhea is gone for good. At least, not just yet.”

“My fever is down, too, and the cramps are almost gone,” Merchado added as David probed his abdomen for areas of tenderness and listened for a minute with his stethoscope.

“Sounds good,” David said, placing the instrument back in his jacket pocket, “but still no solid food. Just sips of liquids and several more days of the new antibiotic and intravenous fluids. You can tell your family that you’ll be in the hospital for another week if things keep going well. Maybe even a little longer than that.”

“Will you be my doctor when I get out?” he asked.

“No, only for a few days, then Dr. Huttner will be back. You’re fortunate to have him, Mr. Merchado. He’s one of the finest surgeons I’ve ever seen.”

“Maybe … and then again, maybe not.” Merchado’s squint and wise smile said that he would push the matter no further. “But you leave your card with me just the same. I have a bunch of relatives that are gonna be beating down your door to get you to do some kind of operation on them. Even if they got nothing wrong.”

With a grin that understated his delight, David left the room, then looked at the list of patients he had to see that morning. The names filled both sides of the file card on which he had printed them. Joy sparkled through him. For so many years he had not allowed himself
even to daydream of having such a case load. As he neared the end of the hallway, he gave a gleeful yip and danced through the stairway door. Behind him, two plump, dowager nurses watched his performance, then exchanged disapproving expressions and several “tsks” before heading pompously to their charges.

David’s rounds were more exhilarating than anything he had done in medicine in years. Even Charlotte Thomas seemed to have brightened up a small notch, although simply seeing her with the benefit of daylight may have had something to do with that impression. Her bed was cranked to a forty-five-degree angle and an aide was spoon-feeding her tiny chips of ice, one at a time. David tried several ways to determine how she was feeling, but her only response was a weak smile and a nod. He examined her abdomen, wincing inwardly at the total absence of bowel sounds. No cause for panic yet, but each day without sounds made the possibility of yet another operation more likely. For a moment David toyed with the notion of stopping even the ice chip feedings, then, with one last look at Charlotte, he decided to leave things as they were.

At the nurses’ station he wrote a lengthy progress note and some orders for maneuvers he hoped might improve her situation. By the time he finished it was nearly one o’clock. He had twenty minutes for coffee and a sandwich before he was due in his own office. Five and a half hours had passed in what seemed almost no time at all. He tried to remember the last time it had been like this and realized it had probably been eight years. Not, he reflected ruefully, since the accident.

Even his afternoon office hours, at times embarrassingly slow, were made pleasantly hectic today by frequent phone calls from the hospital nurses to clarify orders or discuss problems.

At precisely five o’clock, as the door closed behind the last patient, David’s office nurse, Mrs. Houlihan,
yelled, “Dr. Shelton, there’s a call for you from Dr. Armstrong. Her secretary is putting her on. You can pick up on three.”

“Very funny,” David shouted back from his office. He had only one telephone: its number happened to end in three. It was good to see Houlihan enjoying the unaccustomed busy day as much as he was.

“I’m off to cook up some hash for my brood. Good night, Doctor,” she called out.

“Good night, Houlihan,” David answered.

Moments later, Dr. Margaret Armstrong came on the line. As the first female chief of cardiology at a major hospital, Armstrong had earned nearly as much of a reputation in her field as had Wallace Huttner in his. Of all those on the medical staff of Doctors Hospital, she had been the most cordial and helpful to David, especially during his first year. Although she referred her patients to cardiac surgeons almost exclusively, or, where appropriate, to Huttner, she had, on several occasions, sent a case to David, taking pains each time to send him a thank-you note for the excellent care he delivered.

“David? How are things going?” she asked now.

“Busy today, but enjoying every minute, Dr. Armstrong.” Perhaps it was the regal bearing, the aristocratic air that surrounded the woman, perhaps it was the twenty or so years difference in their ages—whatever the reason, David had never once had the impulse to address Margaret Armstrong by her first name. Nor had he ever been encouraged to.

“Well, I’m calling to see if I can make it busier for you,” Armstrong said. “To be perfectly honest, I called Wally Huttner’s office first, but I was pleased to hear that you’re covering for him.”

“Thanks. Fire away.”

“It’s an elderly gentleman named Butterworth—Aldous Butterworth, if you will. He’s seventy-seven, but bright
and spry as a puppy. He was doing fine for a week following a minor coronary until just a little while ago, when he suddenly started complaining about tingling and pain in his right leg. His pulses have disappeared from the groin on down.”

“Embolus?” David asked, more out of courtesy than any uncertainty about the diagnosis.

“I would think so, David. The leg is already developing some pallor. Are you in the mood to fish us out a clot?”

“Happy to.” David beamed. “Have you gone over the risks with him?”

“Yes, but it wouldn’t hurt for you to do it again. David, I’m a bit worried about general anesthesia in this man. Do you think it might be possible to …”

David was so excited about capping his day with a major case that he actually cut her short. “Do him under local? Absolutely. It’s the only way to fly.”

“I knew I could count on you,” Armstrong said. “I am most anxious to hear how things go. Aldous is a dear old friend as well as a patient. Listen, there’s an Executive Committee meeting in an hour, and as chief of staff in this madhouse I have to attend. Could I meet you somewhere later this evening?”

“Sure,” David said. “I have several patients to see before I head home. How about Four South? I’ve got a woman to see there with total body failure. Maybe you can even come up with some ideas.”

“Glad to try,” Armstrong said. “Eight o’clock?”

“Eight o’clock,” David echoed.

Hands scrubbed and clasped protectively in front of him, David backed into Operating Room 10, then slipped into a surgical gown and began making preparations to orchestrate and conduct his own symphony. Aldous Butterworth seemed small and vulnerable stretched out on the narrow operating table.

David ordered Butterworth’s right foot placed in a clear, plastic bag to keep it visible without contaminating his operative field. The foot was the color of white marble.

Using small injections, he deadened an area of the man’s right groin. With no pulse to guide him, he knew that the femoral artery could be an inch or more away from his incision. A miscalculation, and he faced an operation so difficult that a second incision might be the only solution. Focus in, he thought. See it. Hidden beneath his mask, the corners of his mouth turned up in a thin, knowing smile. He was ready.

“Scalpel, please,” he said, taking the instrument from the scrub nurse. He paused, closed his eyes, and breathed in the electricity of the moment. Then he opened them and surveyed the expectant faces watching him, waiting for him. With a slight nod to the anesthesiologist and a final glance at Butterworth’s bloodless foot, he made his incision. The taut skin parted, immediately exposing the femoral artery. “Bull’s-eye,” he whispered.

In minutes the artery, stiff and heavy with clot, was isolated and controlled with two thin strips of cloth tape placed two inches apart. David made a small incision in the vessel wall between the tapes. Gently he eased a long, thin tube with a deflated balloon at the tip down the inside of the artery toward the foot. When he determined that the tip was in position, he blew up the balloon and carefully drew it back through the incision. Two feet of stringy, dark clot pushed out before David lifted the balloon free. Repeating the procedure in the opposite direction, he removed the thicker clot that had caused the obstruction in the first place. An irrigation with blood thinner, and he was ready to close. He tightened the cloth tapes to prevent blood flow through the artery, then closed his incision in the vessel with a series of tiny sutures.

For the second time in less than twenty minutes David shared a momentary gaze with each person in the room. He then took a silent, deep breath, held it, and released the tapes. Instantly, Butterworth’s foot flushed with life-giving color. A cheer burst out from the team. Textbook perfect. The whole case, textbook perfect. In absolute exhilaration, he called out the good news to Butterworth, who had slept through the entire procedure.

“That was
really
fine work, Dr. Shelton. That was really
fine
work, Dr. Shelton. That
was
really fine work, Dr. Shelton.” David repeated the words of the veteran scrub nurse over and over, trying to reproduce her inflection exactly. “Maybe you should give her a call and ask her to say it again so you can get it just right,” he advised himself. He had dictated an operative note, showered, and dressed. Now he was headed down the corridor of Four South to share the news of Butterworth’s successful operation with Dr. Armstrong.

He glanced at his watch. Ten of eight. His second straight late evening in the hospital. A first for him since joining the surgical staff more than eighteen months before.

Margaret Armstrong had already arrived on the floor and was seated at the nurses’ station sharing coffee and relaxed conversation with Christine Beall and the charge nurse, Winnie Edgerly. As David approached the group, his eyes were drawn to Christine. Her eyes and her smile seemed to be saying a thousand different things to him at the same time. Or maybe they were his words, his thoughts, not hers. Lauren’s jewel-perfect face flashed in his mind, but faded as the tawny eyes tightened their hold.

Dr. Armstrong’s voice pulled him free. “Yo, David,” she called out merrily. “Word is sweeping the hospital about my little man’s new foot. Bravo to you. Come, we
shall toast your successful operation with a cup of this coffee.” She glanced in her cup, grimaced, then added, “If, in fact, that is what this is.”

She wore a black skirt and light blue cashmere sweater. A simple gold butterfly pin was her only jewelry. Her white clinic coat, unbuttoned, was knee length-the type reserved unofficially only for professors or those with sufficient seniority in the teaching community. Her dark wavy hair was cut short in a style perfect for her bright blue eyes and finely carved features. There was an air about her, an energy, that commanded immediate attention and respect. An article written six years before about her contributions to her field had dubbed her the Grande Dame of American Cardiology; she had been only fifty-eight years old at the time.

As David took in the scene at the nurses’ station, he couldn’t help but reflect on the easy, animated relationship that existed between Armstrong and the two nurses. Quite the opposite from Dr. Wallace Huttner, even allowing for the fact that Dr. Armstrong was a woman. The contrast became even more striking when she got up and poured him a cup of coffee.

She introduced him to the nurses as the “hero of the day,” and, with a mischievous wink at Christine, added that David was, to the best of her knowledge, single. He blushed and covered his eyes in genuine embarrassment, but realized at the same time that he was carefully avoiding any further eye contact with Christine. Seconds later, Armstrong had him describing Butterworth’s operation in detail. For the moment the danger had passed.

Rona Gold, a practical nurse, joined the group as David used red and blue pens to sketch pictures of the procedure he had done.

It seemed clear to David that Armstrong already knew the details, probably from one of the O.R. nurses. Still, she encouraged him at every chance to continue.

“Well,” she said finally, “I stopped by the recovery room to see Aldous and he doesn’t remember a thing. Snoozed his way through the whole ordeal. Here he is in danger of losing a leg or worse and he sleeps through the procedure. That is my idea of good local anesthesia, what?”

“I think I put him to sleep while I was trying to explain what I was going to do to him,” David said.

Armstrong shared an appreciative laugh with the three nurses, then said, “David, you mentioned something about having a complicated patient here on four South. Charlotte Thomas?”