Harvest (5 page)

"Dr. Wettig did?" Abby couldn't help a surprised laugh. "To be honest, I'm never quite sure what he thinks about my performance."

"Well, that's just the General's way. Spreading a little insecurity around in the world."

The other men laughed. Abby did too.

"I do respect Colin's judgment," said Archer. "And I know he thinks you're one of the best Level-Two residents in the programme. I've worked with you, so I know he's right."

Abby shifted uneasily on the couch. Mark reached for her hand and gave it a squeeze. That gesture was not missed by Archer, who smiled.

"Obviously, Mark thinks you're pretty special. And that's part of the reason we thought we should have this discussion. I know it may seem a little premature. But we're long-range planners, Abby.

We think it never hurts to scout out the territory in advance."

"I'm afraid I don't quite follow you," said Abby.

Archer reached for the brandy decanter and poured himself a scant refill. "Our transplant team's interested in only the best. The best credentials, the best performance. We're always looking over the residents for fellowship material. Oh, we have a selfish motive, of course. We're grooming people for the team." He paused. "And we were wondering if you might have an interest in transplant surgery."

Abby flashed Mark a startled look. He nodded.

"It's not something you have to decide anytime soon," said Archer. "But we want you to think about it. We have the next few years to get to know each other. By then, you may not even want a fellowship. It may turn out transplant surgery's not something you're even vaguely interested in."

"But it is." She leaned forward, her face flushing with enthusiasm. "I guess I'm just... surprised by this. And flattered. There are so many good residents in the programme. Vivian Chao, for instance."

"Yes, Vivian is good."

"I think she'll be looking for a fellowship next year."

Mohandas said, "There's no question that Dr. Chao's surgical technique is outstanding. I can think of several residents with excellent technique. But you have heard the saying? One can teach a monkey how to operate.The trick is teaching him when to operate."

"I think what Raj is trying to say is, we're looking for good clinical judgment," said Archer. "And a sense of teamwork. We see you as someone who works well with a team. Not at cross-purposes. That's something we insist on, Abby, teamwork. When you're sweating it out in the OR, all sorts of things can go wrong. Equipment fails. Scalpels slip. The heart gets lost in transit. We have to be able to pull together, come hell or high water. And we do."

"We help each other out, too," said Frank Zwick. "Both in the OR and outside of it."

"Absolutely," said Archer. He glanced at Aaron. "Wouldn't you agree?"

Aaron cleared his throat. "Yes, we help each other out. It's one of the benefits of joining this team."

"One of the many benefits," added Mohandas.

For a moment no one spoke. The Brandenburg Concerto played softly in the background. Archer said, "I like this part," and turned up the volume. As the sound of violins spilled from the speakers, Abby found herself gazing, once again, at Death versus the Physician. The battle for a patient's life, a patient's soul.

"You mentioned there were... other benefits," said Abby.

"For example," offered Mohandas, 'when I completed my surgery residency, I had a number of student loans to pay off. So that was part of my recruitment package. Bayside helped me pay off my loans."

"Now that's something we can talk about, Abby," said Archer. "Ways we can make this attractive to you.Young surgeons nowadays, they come out of residency at thirty years old. Most of them are already married with maybe a kid or two. And they owe - what? A hundred thousand dollars in loans. They don't even own a house yet! It'll take 'em ten years just to get out of debt. By then they're forty, and worried about college for their kids!" He shook his head. "I don't know why anyone goes into medicine these days. Certainly not to make money."

"If anything," agreed Abby, 'it's a hardship."

"It doesn't have to be. That's where Bayside can help. Mark mentioned to us that you were on financial aid all the way through medical school."

"A combination of scholarships and loans. Mostly loans."

"Ouch. That sounds painful."

Abby nodded ruefully. "I'm just beginning to feel the pain."

"College loans as well?"

"Yes. My family had... financial problems," Abby admitted. "You make it sound like something to be ashamed of."

"It was more a case of... bad luck. My younger brother was hospitalized for a number of months and we weren't insured. But then, in the town where I grew up, a lot of people weren't insured."

"Which only confirms how hard you must have worked to beat the odds. Everyone here knows what that's like. Raj here was an immigrant, didn't speak English until he was ten. Me, I'm the first in my family to go to college. Believe me, there are no goddamn Boston Brahmins in this room. No rich daddies or handy little trust funds. We know about beating the odds because we've all done it. That's the kind of drive we're looking for in this team."

The music swelled to its finale. The last chord of trumpets and strings faded away. Archer shut off the stereo and looked at Abby.

"Anyway. It's something for you to think about," he said. "We're not making any firm offers, of course. It's more like talking about a, uh..." Archer grinned at Mark. "First date."

"I understand," said Abby.

"One thing you should know. You're the only resident we've approached. The only one we're really considering. It would be wise if you didn't mention this to the rest of the house staff. We don't want to stir up any jealousy."

"Of course not."

"Good." Archer looked around the room. "I think we're all in agreement about this. Right, gentlemen?"

There was a general nodding of heads.

"We have consensus," said Archer. And, smiling, he reached once again for the brandy decanter. "This is what I call a real team."

"So what do you think?" Mark asked as they drove home.

Abby threw back her head and shouted deliriously. "I'm floating! God, what a night!"

"You're happy about it, huh?"

"Are you kidding? I'm terrified."

"Terrified? Of what?"

"That I'll screw up. And blow it all."

He laughed and gave her knee a squeeze. "Hey, we've worked with all the other residents, OIL> We know we're recruiting the best."

"And just how much of this was your influence, Dr. Hodell?"

"Oh, I put in my two cents' worth. The others just happened to be in complete agreement."

"Right."

"It's true. Believe me, Abby, you're our number one choice. And I think you'd find it a terrific arrangement, too."

She sat back, smiling. Imagining. Until tonight, she'd had only a fuzzy notion of where she'd be working in three and a half years. Toiling in an HMO, most likely. Private practice was in its dying days; she saw no future in it, at least, not in the city of Boston. And Boston was where she wanted to stay. Where Mark was.

"I want this so badly," she said. "I just hope I don't disappoint you all."

"Not a chance. The team knows what it wants. We're all together on this."

She fell silent for a moment. "Even Aaron Levi?" she asked. "Aaron? Why wouldn't he be?"

"I don't know. I was talking to his wife tonight. Elaine. I got the feeling Aaron isn't very happy. Did you know he was thinking of leaving?"

"What?" Mark glanced at her in surprise.

"Something about moving to a small town."

He laughed. "It'll never happen. Elaine's a Boston girl."

"It wasn't Elaine. It was Aaron who was thinking about it."

For a while Mark drove without saying a word. "You must have misunderstood," he said at last.

She shrugged. "Maybe I did."

"Light, please," said Abby.

A nurse reached up and adjusted the overhead lamp, focusing the beam on the patient's chest. The operative site had been drawn on the skin in black marker, two tiny x's connected by a line tracing along the top of the fifth rib. It was a small chest, a small woman. Mary Allen, eighty-four years old and a widow, had been admitted to Bayside a week ago complaining of weight loss and severe headaches. A routine chest x-ray had turned up an alarming find: multiple nodules in both lungs. For six days she'd been probed, scanned, and x-rayed. She'd had a bronchoscope down her throat, needles punched through her chest wall, and still the diagnosis was unclear.

Today they'd know the answer.

Dr. Wetfig picked up the scalpel and stood with blade poised over the incision site. Abby waited for him to make the cut. He didn't. Instead he looked at Abby, his eyes a hard, metallic blue over the mask.

"How many open lung biopsies have you assisted on, DiMatteo?" he asked.

"Five, I think."

"You're familiar with this patient's history? Her chest films?"

"Yes, sir."

Wetfig held out the scalpel. "This one's yours, Doctor."

Abby looked in surprise at the scalpel, glittering in his hand. The General seldom relinquished the blade, even to his upper level residents.

She took the scalpel, felt the weight of stainless steel settle comfortably in her grasp. With steady hands, she made her incision, stretching the skin taut as she sliced a line along the rib's upper edge. The patient was thin, almost wasted; there was scant subcutaneous fat to obscure the landmarks. Another, slightly deeper incision parted the intercostal muscles.

She was now in the pleural cavity.

She slipped a finger through the incision and could feel the surface of the lung. Soft, spongy. "Everything all right?" she asked the anaesthesiologist.

"Doing fine."

"OK, retract," said Abby.

The ribs were spread apart, widening the incision. The ventilator pumped another burst of air, and a small segment of lung tissue ballooned out of the incision. Abby clamped it, still inflated. Again she glanced at the anaesthesiologist. "OK?"

"No problem."

Abby focused her attention on the exposed segment of lung tissue. It took only a glance to locate one of the nodules. She ran her fingers across it. "Feels pretty solid," she said. "Not good."

"No surprise," said Wettig. "She looked like a chemotherapy special on x-ray. We're just confirming cell type."

"The headache? Brain metastases?"

Wetfig nodded. "This one's aggressive. Eight months ago she had a normal chest x-ray. Now she's a cancer farm."

"She's eighty-four," said one of the nurses. "At least she had a long life."

But what kind of life? wondered Abby as she resected the wedge of lung containing the nodule. Yesterday, she had met Mary Allen for the first time. She had found the woman sitting very quiet and still in her hospital room. The shades had been drawn, the bed cast in semidarkness. It was the headaches, Mary said. The sun hurts my eyes. Only when I sleep does the pain go away. So many different kinds of pain... .

Please, doctor, couldn't I have a stronger sleeping pill?

Abby completed the resection and sutured the cut edge of lung. Wetfig offered no comment. He merely watched her work, his gaze as chilly as ever. The silence was compliment enough; she'd learned long ago that just to escape the General's criticism was a triumph.

At last, the chest closed, the drain tube in place, Abby stripped off her bloodied gloves and deposited them in the bin labelled: contaminated.

"Now comes the hard part," she said, as the nurses wheeled the patient out of the OR. "Telling her the bad news."

"She knows," said Wettig. "They always do."

They followed the squeak of the gurney wheels to Recovery. Four post-op patients in various states of consciousness occupied the currained stalls. Mary Allen, in the last stall, was just beginning to stir. She moved her foot. Moaned. Tried to pull her hand free of the restraint.

With her stethoscope, Abby took a quick listen to the patient's lungs, then said: "Give her five milligrammes of morphine, IV."

The nurse injected an IV bolus of morphine sulphate. Just enough to dull the pain, yet allow a gentle return to consciousness. Mary's groaning ceased. The tracing on the heart monitor remained steady and regular.

"Post-op orders, Dr. Wettig?" the nurse asked.

There was a moment's silence. Abby glanced at Wetfig, who said, "Dr. DiMatteo's in charge here." And he left the room.

The nurses looked at each other. Wetfig always wrote his own post-op orders. This was another vote of confidence for Abby.

She took the chart to the desk and began to write: Transfer to 5 East, Thoracic Surgery Service. Diagnosis: Post-op open lung biopsy for multiple pulmonary nodules. Condition: stable. She wrote steadily: orders for diet, meds, activity. She reached the line for code status. Automatically she wrote: Full code.

She looked across the desk at Mary Allen, lying motionless on the gurney. Thought about what it would be like to be eighty-four years old and fiddled with cancer, the days numbered, each one filled with pain. Would the patient choose a kinder, swifter death? Abby didn't know.

"Dr. DiMatteo?" It was a voice over the intercom.

"Yes?" said Abby.

"You had a call from 4 East about ten minutes ago. They want you to come by."

"Neurosurg? Did they say why?"

"Something about a patient named Terrio. They want you to talk to the husband."

"Karen Terrio's not my patient any longer."

"I'm just passing the message along, Doctor."

"OK, thanks."

Sighing, Abby rose to her feet and went to Mary Allen's gurney for one last check of the cardiac monitor, the vital signs. The pulse was running a little fast, and the patient was moving, groaning again. Still in pain.

Abby looked at the nurse. "Another two milligrammes of morphine," she said.

The blip on the EKG monitor traced a slow and steady rhythm.

"Her heart's so strong," murmured JoeTerrio. "It doesn't want to give up. She doesn't want to give up."

He sat at his wife's bedside, his hand clasping hers, his gaze fixed on that green line squiggling across the oscilloscope. He looked bewildered by all the gadgetty in the room. The tubes, the monitors, the suction pump. Bewildered and afraid. He focused every ounce of attention on the EKG monitor, as though, if he could somehow master the secrets of that mysterious box, he could master everything else. He could understand why and how he had come to be sitting at the bedside of the woman he loved, the woman whose heart refused to stop beating.