Shedrow (2 page)

Brenda Byrne was functioning as the circulating nurse, coordinating the needs of the patient and the surgical team and working outside of the sterile field around the operating table. She answered in a husky voice that betrayed her long term smoking habit. “Sure, what do you have in mind?”

“Oh, I don’t know…how about something classical to start with.”

“Uggh,” Rosen said, “Nothing worse than classical music at this hour of the morning.”

“Too bad, Dr. Rosen,” Brenda replied. “The surgeon is captain of the ship, you know.”

“All right, so here’s the story,” Rosen went on undaunted.

Blue surgical drapes were placed over the patient, and the scrub nurse and surgical assistant took their positions around the operating
table. Directly opposite Gianni was Dr. Willard Drew, who would act as first assistant on the case. Drew stood on a stool that boosted him eight inches. He remained quietly focused on the surgical site, now draped off and painted bright orange with betadyne, ready for the incision.

“Okay to begin?” Gianni asked.

“He’s quiet as a puppy,” Rosen said. “Go for it. Start time… 8:10 AM.”

Gianni began with a single, smooth cut four inches in length. As blood oozed into the wound, Dr. Drew used the cautery to zap the bleeders.

“Great, Will, keep up with those.”

“So these three kids are in their third grade class,” Rosen started.

“Clamp, please.” Dr. Drew continued to clamp off and cauterize the bleeders.

“And the teacher says, ‘Who knows the definition of fascinate?’ She says, ‘You have to use the word properly in a sentence.’”

The surgeons were already through the skin and underlying structures, almost ready to expose the tumor in bone.

“The first kid says, ‘I can do it…I can. When I see a bird fly, it fascinates me.’ So the teacher says, ‘That’s good, Mary, that’s good. Let’s have another.’”

A Mozart piano concerto diluted Rosen’s chatter, and Gianni spoke to Drew. “The tumor has broken through the bone right here, and based on the CT scan I think the margin of our resection should be over here.”

“So the second kid says, ‘The full moon in a clear sky is
fascinating.’”

“We’re ready for the surgical saw now,” Gianni said.

Rosen continued, “So then the third kid chimes in with his answer. ‘Well, last Christmas we got this sweater for my Aunt Sharon. And it had twelve buttons. But she’s so fat and her boobs are so big that she could only fasten eight.’”

Dr. Rosen let out a big belly laugh, but it was drowned out by the whine from the surgical saw as it cut through the diseased bone. Brenda and the scrub nurse groaned.

“You like that one, Anthony?”

“I think I heard it before,” he said, passing the saw across to his assistant to complete the second cut, which would allow them to take out the tumor-filled bone and place a metal plate to bridge the defect.

Dr. Drew shifted his stance on the footstool and placed the saw tentatively. The beam from his headlight darted back and forth as he looked from the wound to the x-ray viewbox, then back again. “Here? What do you think, Anthony?”

“Well, you have to be sure you get all the diseased bone, so you have to be pretty high up, but we don’t want to bag the maxillary artery. I can probably reach it from this side if you want, Will.”

“No, I should do it, I’ve got a more direct line of vision on it.”

Rosen stood up from his stool at the patient’s head and peered into the surgical field. “Everything okay, boys?”

“Making good time,” Gianni replied.

Drew began the cut and within seconds the entire field filled with bright red blood, as if a faucet had just been turned wide open. Drew froze.

Gianni spoke calmly but loudly now. “Two inch packing, lots of it and quickly please.”

Drew recoiled somewhat unsurely, and Gianni spoke again. “There are four hands in this wound now, and they all need to be put to use. Will, suction.” As quickly as he suctioned the field became completely filled with blood, the faucet still turned on full blast.

“Back to basics,” Gianni said, “We pack the site and wait ten minutes.”

Rosen looked at the suction canister filling with blood. “Okay, boys, from the looks of that canister we just lost about three units of blood. I’m calling for two units and some fresh frozen plasma. His pressure is down and we have a pulse of 130, sinus tach.”

Blood continued to pour into the canister as Gianni packed several feet of gauze into the wound, like an accordion. It took several feet to completely pack the site. When the last of the gauze was pushed into the wound to tamponade the bleeding vessel, Gianni applied some hand pressure to the outer portion of the pack, and looked up at Drew.

After a few more minutes, Drew seemed to have regained his composure. He said, “The bleeding has slowed to a trickle, but we need to just sit tight for a few minutes now.”

Gianni removed his hand from the top of the packing. “Ten more minutes by the clock,” he said. “Countdown begins now, 8:40 a.m.”

“Can’t you clamp the damn thing?” Rosen asked.

Gianni loved it when the anesthesiologist suddenly became a surgeon. “Probably not, Larry. It’s inaccessible to begin with, and it usually retracts up under the bone when it’s cut. But with the pack we can stabilize things, and worst case scenario, we leave it in and return
to the OR in forty-eight hours to remove it.”

“Can you tie off the carotid?” Rosen asked.

“Won’t help. Too much collateral flow from the opposite side of the neck.”

“I once saw them tie off both sides,” Rosen said.

Now Brenda apparently couldn’t resist and added, “You can’t do that because then the poor patient would end up with a brain like yours, Dr Rosen.”

“Actually, it’s the internal carotids that supply the brain,” Gianni said. “But you’ve got a point there, Brenda, about Dr. Rosen I mean.”

Once a cacophony of sound, the room was now silent. The operating room had no windows, and the only link to the outside world was an intercom on the one of the four white walls. The Mozart CD had ended but no one requested more music.

A man’s voice on the intercom interrupted the silence. “Dr. Gianni, do you have a time estimate?”

“No I don’t,” Gianni said emphatically.

“Okay, just checking.”

Rosen had hung the blood for transfusion, and it trickled into the patient’s vein. The surgical pack was soaked bright red with blood, but no new blood appeared around the packing.

“This may just work, Will,” Gianni said.

“I’m saying my prayers, that’s about all we can do for the next few minutes,” Drew said.

“We can at least have some music,” Gianni said.

Brenda selected another classical piece, and this time Rosen kept his comments to himself. His eyes were fixed on the patient and on the suction canister. Chopin played in the background now, a nice
selection, Gianni thought, serious but not too gloomy.

“Okay, Will, it’s 8:52. What do you think?” The pack remained bright red, yet still, no new blood was evident around the margins of the pack.

“Gently we go…easy, easy,” Gianni said. He grasped the end of the gauze packing with a forceps and pulled it slowly, straight out of the wound, carefully unwinding the folds of the accordion a few inches at a time. When the end was finally withdrawn, all eyes moved to the surgical site.

“Good,” Gianni said. “It looks good. Let’s just sit tight a little longer to make sure. And I’ll need some Avitene hemostatic, several sheets, please.”

After another few minutes of watchful waiting, Gianni and Drew were able to place a titanium plate to bridge the gap left after the tumor was excised. The wound was finally closed with a delicate, essentially invisible subcuticular stitch.

IT WAS 11:15 IN THE MORNING when Gianni returned to the surgeons’ lounge. He had spoken with the patient’s family after surgery, and he was slouched now in one of the well-worn lounge chairs, a bit worn himself for such an early hour. His day had really just begun. From the pocket of his scrub top he pulled out an index card that listed all of the calls he should be making today. The card was full, and the first three were all consulting physicians for some of his upcoming surgical cases next week. They could wait, as he didn’t feel quite up to those in light of the earlier excitement. The fourth note, written in his own small script the night before, said “Call BRH.” Bradford Randolph Hill. That was one he could readily handle right
now. It would be a welcome diversion, they could talk about horses.

“Dr. Gianni calling for Mr. Hill, please.”

“One moment.”

“Anthony! Expected I might hear from you today.”

“Listen, I was able to get Stu to meet you for dinner some night soon. You know he rarely does that much anymore, seems to have all the clients he needs, but he does want to meet you. I guess he likes what he’s heard.”

“Anthony, thank you, I really do appreciate that. Now which of the two-year-olds did you say you like?”

As Gianni spoke, he picked at a small hole in the arm of the upholstered chair. “Well, I’ve taken a twenty-five percent stake in Chiefly Endeavor. As far as I know, there is still at least one share left. So maybe we can have some fun with that one. Go to the Derby together, right?”

“Of course, isn’t that what every owner of a reasonably bred two-year-old says?” Hill asked.

Gianni said, “An infamous Kentucky horseman once said, ‘No one ever committed suicide with an untried two-year-old in the barn.’”

“I’ll remember that.”

Perhaps that line coined by the legendary Colonel Phil Chinn summed up the appeal of the thoroughbred game for Gianni— diversion, excitement, and potential, always lots of pure, unbridled potential. On this particular morning, it lightened the residual tension from the operating room.

Dr. Gianni quickly dressed and walked through the hospital corridor to his office in the adjacent Doctors’ Pavilion. He had a long stride that made it difficult for others to keep up with him, and there was always a rhythmic bounce in his heels, causing his
head to bob just slightly as he walked.

“IS HE HERE YET?” Janice Gianni shouted as she entered the reception area of her husband’s plush Manhattan office. She was dressed in a leather mini skirt, Prada stiletto heels, and a tight blouse open well down her ample pectorals. She had a deeply tanned complexion and large brown eyes. Tiny gobs of mascara clung to her eyelids, and along with the dark shadow she had applied, seemed to spoil her natural beauty.

The receptionist finally recognized her as Dr. Gianni’s wife, though she might as well have been the Strip-O-Gram girl who just wandered in the wrong door. “Well, he is
here
, but he is
very busy.
”

“Not too busy for my anniversary surprise,” Janice replied. “Five years today.”

The two patients in the small waiting area looked up nervously from their magazines.

“I’m going back,” she said, and in an instant she was through the closed door and into the treatment area.

Dr. Gianni stood outside one of the exam rooms, reviewing a chart. He looked up at her with a combination of anger and embarrassment on his face. “Janice? Why are you here? Dressed like…
that
?”

She flung her arms back, hitting one of the many elaborate diplomas adorning the hallway walls. “Happy Anniversary, baby!” she sang out, apparently oblivious, for the moment, to his dissatisfaction.

The past five years flashed before him, a kaleidoscope leaving him with the cold realization that, apart from some incredibly good sex, he had nothing in common with the woman before him. That was
painfully clear to him now.

As Janice slowly read the expression on his face, her voluptuous smile faded to a frown, then to tears. She charged out the back door of the office, and Anthony retreated to his private office to collect himself yet again.

Bradford Hill Jr. strode down the steps and into the foyer of Michael’s Restaurant, glancing at his Patek Philippe watch.
6:30 p.m. Right on time
. Hill lived in a penthouse apartment on East 65
^th
Street in Manhattan, and he owned a mansion on the water in Newport, Rhode Island, complete with fifty-two foot custom sailing vessel. The twenty-five years he’d spent in publishing had been good to him. A few of his friends owned racehorses, and the concept intrigued him. Dr. Gianni had told him about Bushmill Stable, and had arranged the meeting with Stuart Garrison Duncker, its venerable founder.

Michael’s Restaurant was the media place to be, but Stuart Duncker would have much preferred the ‘21’ Club, where he might have pointed out the Bushmill colors on the jockey at the entrance, or even Gallagher’s, where his caricature was featured in the artist Peb’s mural on the bar wall.

Hill turned to the small sitting area at the restaurant’s entrance where a few leather chairs surrounded a table with an assortment
of glossy magazines. Duncker put down his copy of
Hamptons
magazine. This was, coincidentally, one of Hill’s publications, though Duncker didn’t know it at the time, nor would he have particularly cared if he had.

“Mr. Duncker, this is a pleasure. Glad to see you found some good reading,” he chortled with an artificial grin. The two men now stood face to face, their prominent chins pointed at one another. They peered with matching and slightly inauthentic smiles, more like fencing partners than new friends.

“Oh, yes,” Duncker replied politely, “I did.”

“Well, shall we be seated?”

Hill was dressed in a perfectly tailored, blue Brooks Brothers suit, club tie, expensive loafers. Duncker had settled on a blazer and his version of the club tie featuring the blue and white racing silks of Bushmill Stable.

Both men looked tanned and fit. They were escorted to a quiet table near the far wall, just as Hill had requested. He sat first, facing the crowd, and then invited Duncker to sit opposite him.

The waiter appeared seconds later. “May I offer you gentlemen a drink?”

Hill smiled with recognition at the waiter and said, “I’ll have a Bombay Martini, extra,
extra
dry, three olives.”

“And you, sir?”