Godplayer (26 page)

“I have heard one or two things,” mused Ballantine. “One of the residents commented on a tremor. He didn’t realize I was behind him in the hall. What exactly has Thomas been taking?”

“Dexedrine to keep awake and Percodan or Talwin to calm down.”

Dr. Ballantine strode over to the window and stared into the surgical lounge directly opposite. Turning back to Cassi, he cleared his throat. His voice had not lost any of its warmth.

“The availability of drugs can be a severe temptation for a doctor, particularly if he is as severely overworked as Thomas.” Ballantine moved back to his desk and eased into his chair.

“But availability is only part of the story. Many physicians also have a sense of entitlement. They take care of people all day and feel they deserve a little aid themselves if they need it. Drugs or alcohol. It’s an alltoo-common story. And since they have been trained to be self-sufficient, instead of talking to another doctor, they medicate themselves.”

Cassi was enormously relieved that Dr. Ballantine absorbed the news about Thomas with such composure. For the first time in days she felt optimistic.

“I think the most important thing is that we keep this to ourselves,” said Dr. Ballantine. “Gossip could be detrimental to both your husband and the hospital. What I will do is have a diplomatic talk with Thomas and see if we can’t take care of the problem before it gets out of hand. Having seen this kind of thing before, I can assure you, Cassi, that Thomas’s difficulties are minor. He has been carrying his usual surgical load.”

“You’re not worried about his patients?” asked Cassi. “I mean, have you seen him operate recently?”

“No,” admitted Dr. Ballantine. “But I would be the first to hear if something were amiss.”

Cassi wondered.

“I’ve known Thomas for seventeen years,” Ballantine said reassuringly. “I’d know if there was something seriously wrong.”

“How will you bring up the subject?” asked Cassi.

Dr. Ballantine shrugged. “I’ll play it by ear.”

“You won’t mention that I spoke with you, will you?” asked Cassi.

“Absolutely not,” said Dr. Ballantine.

Carrying a handful of irises that she’d purchased in the hospital flower shop, Cassi walked down the eighteenth floor corridor to room 1847. The door was open about halfway. She rapped and peeked in. A figure was lying in the single bed holding a sheet up to his eyes. He was shaking in apparent terror.

“Robert!” laughed Cassi. “What on earth .

Robert bounced out of the bed dressed in his own pajamas and robe. “I happened to see you coming,” he said. Eyeing the flowers, he asked, “Are those for me?”

Cassi surrendered the small bouquet. Robert took the time to arrange them carefully in his water pitcher before placing them on the nightstand.

Glancing around the room, Cassi could see she wasn’t the first. There were a dozen bouquets blooming on every surface.

“Kinda looks like a funeral,” said Robert.

“I don’t want to hear that kind of humor,” said Cassi, giving him a hug. “There is no such thing as too many flowers. It means you have a lot of friends.” She settled down on the foot of the bed.

“I’ve never been a patient in a hospital,” said Robert, pulling up a chair as if he were the visitor. “I don’t like it. I feel so vulnerable.”

“You get used to it,” said Cassi. “Believe me, I’m a pro.”

“The real problem is that I know too much,” said Robert. “I can tell you, I’m terrified. I’ve convinced the anesthesiologist to double up on my sleep meds. Otherwise I know I’ll be up all night.”

“In a couple of days you’ll wonder why you were nervous.”

“It’s easy for you to say, dressed in street clothes.” Robert held up his wrist with its plastic name tag. “I’ve become a statistic.”

“Maybe it will make you feel better to know that your courage has prodded me into action. I’m being admitted tomorrow.”

Robert’s expression changed to one of compassion. “Now I feel foolish. Here I am worried sick over a couple of teeth while you face eye surgery.”

“Anesthesia is anesthesia,” said Cassi.

“I think you are doing the right thing,” said Robert. “And I have a feeling that your operation is going to be a hundred percent successful.”

“What about your own chances,” teased Cassi.

“Um ... fifty-fifty,” said Robert, laughing. “Hey, I got something to show you.”

Robert stood up and went over to the nightstand. Picking up a folder, he joined Cassi on the edge of the bed. “With the help of the computer, I collated the data we have on the SSD cases. I found some interesting things. First of all, as you suggested, all of the patients were on IVs. In addition, over the past two years, the cases increasingly involved patients who were in stable physical condition. In other words, the deaths have become more unexpected.”

“Oh God,” said Cassi. “What else?”

“I played around for a while with the data, punching in all the parameters for our study except surgery. The computer spat out some other cases, including a patient by the name of Sam Stevens. He died unexpectedly during cardiac catheterization. He was retarded but in excellent physical condition.”

“Was he on IV?” asked Cassi.

“Yup,” said Robert.

They stared at each other for several minutes.

“Finally,” said Robert, “the computer indicated that there was a preponderance of males. Curiously enough, where the information was available, the computer pointed out an unusually high number of homosexuals!”

Cassi looked up from the papers to Robert’s friendly gaze. Homosexuality had never been mentioned between them, and Cassi felt a reluctance to discuss it.

“I went to pathology to visit you this morning,” she said, changing the subject. “I missed you, but I did find some of Jeoffry Washington’s slides. When I looked at the sections taken from the IV site, I found white precipitate along the inside of the vein. At first I thought it was artifact, but they were present on all but one of the sections. Do you think they might be significant?”

Robert pursed his lips. “No,” he said finally. “Doesn’t ring any bells. The only thing I can think of is that when calcium is inadvertently added to a bicarbonate solution, it causes a precipitation, but that would be in the IV bottle, not the vein. I suppose the precipitation could run into the vein, but it would be so apparent in the bottle that everyone would see it. Maybe I’ll have an idea when I look at the section. Meanwhile, enough of this morbid stuff. Tell me about the party last night. What did you wear?”

Cassi glossed over the evening. There was a chance Robert would hear what had happened on the hospital grapevine, but she didn’t want to bring it up. In many ways Cassi was surprised Robert hadn’t noticed her reddened eyes. He was usually so observant. She decided he was understandably preoccupied with his admission to the hospital. Promising to visit the next day, Cassi left before she was tempted to burden him with her own troubles.

Larry Owen felt like a piano wire drawn out to its limit, ready to snap at the slightest increase in tension. Thomas Kingsley had arrived late that morning and was furious that Larry had waited for him to physically appear before beginning to open the first patient’s chest. Even though Larry completed the procedure with record speed, Thomas’s foul mood had not changed. Nothing pleased the surgeon. Not only had Larry done a piss-poor job, but the scrub nurses weren’t handing him the instruments properly; the residents weren’t giving him adequate exposure, and the anesthesiologist was an incompetent son of a bitch. As chance would have it, Thomas was given a faulty needle holder, which he’d thrown against the wall with such force it had snapped in two.

Yet Larry had weathered this kind of abuse before. What was making him crazy was Thomas’s operative performance. It had been obvious from the moment he began work on his first patient that the surgeon was exhausted.

His usually flawless coordination was off and his judgment faulty. And worst of all, Thomas had an uncontrollable tremor. It almost gave Larry heart failure to watch Thomas bend over the heart with a razor-sharp needle and try to direct the instrument to the dainty piece of saphenous vein he was attempting to sew to the minute coronary vessel.

Vainly Larry had hoped the tremor would lessen as the morning progressed, Instead it got worse.

“Would you like me to sew this one on?” asked Larry on several occasions. “I think I can see a bit better from my position.”

“If I want your help, I’ll ask for it,” was Thomas’s only reply.

Somehow they got through the first two cases with the bypasses sewn reasonably in place and the patients off the heart-lung machine. But Larry was not looking forward to the third case, a thirty-eight-year-old married man with two little children. Larry had opened the patient’s chest and was waiting for Kingsley to return from the lounge. The resident’s pulse was racing, and he had begun sweating heavily. When Thomas finally burst through the OR door, Larry felt his stomach knot with fear.

At first, things went reasonably well, although Thomas’s shaking was no better and his frustration level seemed even lower. But the open-heart team, wary after the first two cases, was careful not to cross him in any way. The hardest job fell to Larry, who tried to anticipate Kingsley’s erratic movements and do as much of the actual work as Thomas would allow him. The real trouble didn’t begin until they’d started sewing the bypasses in place. Larry couldn’t watch and turned his head away as Thomas’s needle holder approached the heart.

“Goddammit,” shouted Thomas.

Larry felt his stomach churn as he saw Thomas yank his hand from the operative site, the needle buried in his own index finger. Inadvertently Thomas also pulled out one of the large catheters that took blood from the patient to the heart-lung machine. As if a faucet had been turned on, the wound filled with blood and in seconds began soaking the sterile drapes and dripping onto the floor.

Desperately Larry plunged his hand into the wound and groped blindly for the clamp holding the suture around the vena cava. Luckily his hand hit it immediately. Deftly he pulled up on the tape and the blood loss slowed.

“If I had decent exposure this kind of problem wouldn’t happen,” raged Thomas, pulling the needle out of his finger and dropping it on the floor. He stepped back from the table nursing his injured hand.

Larry managed to suck out the blood from the wound. As he reinserted the catheter from the heart-lung machine, he tried to think what he should do. Thomas wasn’t fit to operate anymore that day, yet to say anything risked professional suicide. In the end Larry decided that he could no longer stand the tension. When he’d secured the operative site, he stepped away from the table and joined Thomas, who was being regloved by Miss Goldberg.

“Excuse me, Dr. Kingsley,” said Larry with as much authority as he could muster. “This has been a trying day for You. I’m sorry we haven’t been more on the ball. The fact of the matter is that you are exhausted. I’ll take over from here. You needn’t reglove.”

For a moment Larry thought Thomas was going to slug him, but he forced himself to continue. “You’ve done thousands of these operations, Dr. Kingsley. No one is going to fault you for being too tired to finish one of them.”

Thomas began to shake. Then, to Larry’s astonishment and relief, he snapped off his gloves and left.

Larry sighed and exchanged glances with Miss Goldberg.

“I’ll be right back,” said Larry to the team. With his gloves and gown still on, Larry left the OR. He hoped that one of the other staff cardiac surgeons would be available and was relieved when he saw Dr. George Sherman coming out of OR No. 6. Larry took him aside and quietly related what had happened.

“Let’s go,” said George. “And I don’t want to hear a word about this outside of the OR, understand? It could happen to any one of us, and if the public learned about the incident it would be disastrous, not just for Dr. Kingsley, but for the hospital.”

“I know,” said Larry.

Thomas was angrier than he had ever been. How dared Larry suggest he was too tired to proceed? The scene had been a nightmare. It was the haunting fear of such disaster that had originally forced him to take an occasional pill to sleep. He’d been perfectly capable of finishing the operation, and if he hadn’t been so upset over Cassi’s infidelity, he certainly would not have left. Furiously he stomped into the surgical lounge and used the phone by the coffee machine. He called Doris to make sure there were no emergencies and asked her to reschedule his afternoon patients for another day. He was already late, and he didn’t think he could stand to see patients. Doris was about to hang up when she remembered that Ballantine had called, asking if Thomas would stop by his office.

“What did he want?” asked Thomas.

“He didn’t say,” said Doris. “I asked him what it was in reference to, in case you’d need a patient folder. But he said he’d just like to see you.”

Thomas told the nurse at the main desk that he’d be in Dr. Ballantine’s office in case there was a call. To steady himself and relieve his headache, which had gotten steadily worse, he took another Percodan from his locker. Then he donned a white lab coat and left the lounge wondering what the meeting could be about. He did not think the chief would call him in to discuss the scene at the party with George Sherman, and it certainly couldn’t have anything to do with the episode with Larry Owen. It must have something to do with the department in general. He remembered the trustee’s odd comment the night before and decided Ballantine was finally going to let Thomas in on his plans. There was always the chance that Ballantine was thinking about retiring and wanted to discuss turning over the department to Thomas.