Riding the Red Horse (48 page)

Standing in the hospital room, he listened silently as a student nervously presented the chief complaint. “The p-patient presented with abdominal p-pain, blood tests w-were incon…inconclusive, b-but abdominal ultrasound and CT were consistent with diverticulitis. There was evidence of leakage and possible rupture…” The student continued with the surgical findings and treatment plan for the patient. Toby gave a slight smile and nodded as she demonstrated a clear understanding of the particular challenges presented by the patient. The Chief Resident continued with the questions to both patient and student while Toby watched and observed.
Good kid, gaining confidence as she goes.
Toby thought.

Toby was not a particularly demonstrative person—he preferred quiet correction to outbursts of anger. During a minor surgical procedure in the outpatient clinic, a first-year resident got confused and closed an incision with the wrong type of stitches. The Chief Resident was preparing to yell at the inexperienced doctor, but Toby merely whispered “not in front of the patient” and stepped in to fix the wound closure.

“Have you ever seen how a plastic surgeon does a subcutaneous suture?” he asked both doctors. When they both responded in the negative, he winked at the patient and replied “Watch this, then. You'll like how this heals up with minimal scarring,” and proceeded to instruct both residents while calmly reassuring the patient.

As he was leaving the clinic later, Toby overheard the senior resident talking to the younger one. “See why I try to get his shift?” and he hid a smile behind a false cough.

Even if there was disagreement even with a colleague, he preferred to move to an available conference area and calmly discuss with all parties involved rather than allow argument in front of patients, family or even other colleagues. Most of his students and colleagues knew that the only sign of stress or anger they were likely to see out of him was when he started rubbing his hands back and forth across his scalp and through his buzz-cut hair. He always did his best to keep any pressure he was feeling under control…and inside.

The conference room door, just off the surgical floor, opened. Standing at the door, the Chief of Surgery, Johannes Geuiszlerr motioned and asked, “Tobias. Do you have a minute?” The German accent made it sound like an order.

Johannes Geuiszlerr had started his education in a very strict German medical college, and never called him just 'Toby.' It was always 'Tobias' even though Geuiszlerr himself insisted on being called 'John.' Toby had known the Chief of Surgery for years, though, and they'd become good friends. Geuiszlerr's mode of address no longer struck him as being formal, but more of an affected habit.

“Just a moment, John, let me check on the afternoon appointments.” He checked the schedule entries on his phone—at least 40 minutes until he needed to be in the outpatient clinic. “Sure, I've got probably thirty minutes.”

“Good. Let's use my office.” Geuiszlerr led the way to the corner office in back, while larger than the others, it was still rather plain—functional, rather than ostentatious—much like Toby's own. The two of them were alike in many respects, and Toby was pretty certain that he knew what John wanted to discuss.

“John, if this is about…” he started as Geuiszlerr closed the office door.

“Actually, I was going to tell you that the Dean gave his approval for internal funding of Phase Three. What did you think I wanted?” Geuiszlerr sat behind the desk, looked intently at Toby and raised his eyebrows.

“Oh. Well, I figured Jany had called you again. I swear I can't get her to stop tapping into the security logs. I'm not her problem anymore, she made that very clear.”

“Now that you mention it, Tobias, I
have
heard from her, but only because Liese had lunch with Janine last Friday. She is still concerned, you know. From what my wife tells me,
your
wife believes you are still having recurring nightmares.” Geuiszlerr started looking through the papers on his desk, clearly searching for something.

“Ex-wife, John, she's not my wife anymore.” Toby crossed his arms and glared at his superior until John looked up from his search.

“Ah, that's not quite true, Tobias. I happen to know that Janine has not actually filed anything yet. Liese does not gossip, but she knows when to tell me everything I need to know about my surgeons.”

Toby looked away as John returned his stare with the exact same intensity. He started to brush one hand through his hair, pushing down on the short stubble, moving it back and forth like the bristles on a brush. He looked down at the two business cards his superior held in his hands. “Close enough, it's just a matter of time. So what's that?” he nodded toward the cards.

John looked down, almost as if in surprise at what he held. “Oh, these. One is someone to whom you should talk. I do not wish to discover that you are writing prescriptions for yourself.” Toby tried to protest, but John waved it off and handed Toby one of the cards. “You would not be the first to decide that medication works for the doctor as well as the patient. The other is a message from General Odle, who wants to see you next week. You must promise to do the first before I will give you the second.”

Toby thought a moment. “And if it's Phase Three that is responsible for the other?”

“Then you will need to see our friend first, before you see the General,” Geuiszlerr said. “You must promise me in any event. I am concerned about you, Tobias. You should go take some time at my cabin. Walk in the woods and sit by the stream. Maybe bait and toss a hook, too. It would do you well.”

"I understand," replied Toby. He paused again, then reached for the cards. "I promise. After surgery tomorrow I don't have clinic for two days. I will see if he can fit me in, then we'll see about the General. As for the other…well…we'll see."

The schedule of a trauma surgeon was never entirely predictable. Where possible, the Surgical Service scheduled planned surgical procedures for a single day of the week for their surgeons, with two clinical days and two on-call days to handle the aforementioned emergencies. Too many calls came in late in the day or in the middle of the night asking for Toby to come in and patch up an accident victim transported to University Medical Center for immediate treatment. Today was a 'standard' surgical day for Toby with the first of four surgeries scheduled to start at seven AM.

After his now customary jolting wake-up, Toby tried to get a few hours more sleep before heading into the hospital. Despite having forgotten his promise to John Geuiszlerr a week ago, Toby had decided to moderate the balance between sleep and caffeine. Even though his primary job was to direct the microsurgical robots, he still occasionally needed to actually wield a scalpel. Still, the temptation to write a 'scrip for nicotine patches was growing, particularly since he found himself getting irritated at the higher than normal traffic on his drive in. As it was, he almost missed the news headline before his exit: "Comet Slowing, Scientists Can't Explain."

He let the residents handle most of the patient rounds this morning as he checked the case notes for today's procedures: microvascular repair—post-amputation; microvascular repair—amputation sparing; tissue repair with microvascular complications—gastrointestinal; myocardial repair. Without even looking at the history-and-physical, he could just about categorize the cases: soldier, one each—well, the first two anyway, the third could have been an unfortunate civilian catching a gunshot, and the fourth could be a heart attack. He knew that one from personal experience. On the other hand, since the surgeries were scheduled and not emergencies, they were probably soldiers. Ever since the Army had supported his development of the nanosurgical robots, he'd become their principal referral surgeon. The fact that his hospital was practically next door to a major staging base for deploying and returning troops played a role as well.

He checked to make sure he had the coded scans and targets for each of the patients, and downloaded them to a chip that he would insert into the control console in surgery. The 'bots would do most of the fine work, but he needed to direct them and be able to take over if things went south. The residents and his fellows attending would handle opening and closing, so he'd likely need just a couple of hours per patient. Time for more coffee, and then go scrub in.

Before he left the office, two messages popped up on his screen. One was from Billy: "Dad, I'm fine, quit worrying, you don't have to text me every other day. In fact, I should be back in a few weeks. Command is rotating us home soon. Best, -Billy."
Ah, good. That's better, even if it won't stop the nightmares.
Unconsciously, he raised both hands over his head, intertwined the fingers and started to brush his hands through his hair. At least it wasn't Billy on the table in this morning's dream—although the cyborg-like creature wasn't much of an improvement. Speaking of which… The second message was from Sheila, the departmental administrator manager. She handled appointments for the faculty, and it was a notice that he had an appointment with a Ms. Guerra at 11 AM Thursday morning.
Oh. That's right
, he'd promised Geuiszlerr. John must have gotten tired of waiting and scheduled it for him. Okay, he'd go—he'd meant to in the first place.

Ten hours later he'd finished all four procedures and still managed time to eat and take care of essential functions. He felt dirty and sweaty and needed to clean up before heading home—not to mention a shower would help to keep him awake for the drive home. There was no hurry, no one else would be there anyway, so he headed for the surgeon's locker room, tossed the soiled scrubs in the laundry return and went to stand under the scalding hot water. The procedures had gone well, and he'd called it exactly right, this morning. Three bomb victims, one gunshot, all four were soldiers that he'd ensured would live to fight another day. He'd managed to save the leg, and the amputee would now be suited to accept prosthetics; he'd repaired the pericardium and the kid who'd been gut-shot would live the rest of his life with three fewer inches of small intestine—but they all would live.

He did good work. It was essential—he saved people, soldiers and civilians alike, gave them back 'quality of life.' He kept telling himself that.

Silvia Guerra came to his office promptly at 11. The Medical Center had a policy of providing in-office counseling for faculty with therapists that didn't scream 'shrink' when they showed up for their 'consultation.' Toby appreciated the discretion, but it wasn't as if everybody in the academic offices didn't know everyone else's business anyway.

He'd been dreading the meeting, because he knew exactly what she would decide—that he had lost 'it'—the motivation, drive they makes a surgeon the best in his field. He'd felt it this morning on the drive in. Normally a precise, focused driver, he'd been distracted, drove right past a patrol car at too fast a speed, then almost panicked when the officer turned on his flashing lights and went past him chasing a car that had been going even faster. The news headline didn't even get a second glance this morning: "Not a comet? Signs of Intelligence, Say Astronomers."

"Ms. Guerra?" Toby greeted his visitor and directed her to a pair of comfortable chairs set away from his desk. "Or is it Dr. Guerra?"

"It's Doctor, Dr. Greene, but actually I hope you will call me 'Sylvia'," the counselor said as she sat in one of the chairs.

"Very well, Silvia. In that case, it's 'Toby'" he said taking the other chair. "Although if you've been talking to John Geuiszlerr, he probably has you inclined to say 'Tobias,' and I'd really rather you didn't." Silvia laughed. It was a nice laugh. She was older than he was, with a full head of white hair and smile lines around the eyes. Toby might even have relaxed, if he hadn't been dreading this meeting so much.

"To start with, I am very glad we're not talking across a desk. I find that we have a more relaxed conversation without a symbol of authority in the way." She gestured at the neat desk, and then the plaques and framed certificates on the wall. "Although the main reason for meeting in
your
seat of power is to put you more at ease… and you're not at ease, Toby."

"I'm not entirely sure I want my head shrunk, Doctor. I have my hands inside enough patients that I'm not that comfortable with having someone else in my head."

"So it's back to Doctor, is it?" The laugh came again, then she turned serious. "Toby, I'm not here to psychoanalyze you, 'bench' you or make you give up coffee." She stopped at his expression, smiled, and continued. "Oh, come on, you
do
realize I've counseled a few surgeons before, right?" The smile was genuine, and Toby realized she was trying hard to project a 'kindly grandmother' aura… and it was working.

"Let me start with what I already know. You are 55 years old, widely regarded as the top trauma surgeon in the state, if not the country. You and your wife separated 6 months ago after 28 years of marriage. You have two children, older daughter—married, giving you two grandchildren—and a younger son in the Army. And you feel grief because your subconscious puts your son's face on every single soldier you lose on the table and guilt for every one you send back into combat."

Toby said nothing, just stared back at her, his face slack.

"So now you have nightmares every night, get too little sleep, drink too much coffee and you're thinking about taking up nicotine again because you're too proud and stubborn to think about prescription drugs. And that, young man, is a good thing, because if you prescribed them for yourself, we
would
have to bench you."

Toby thought for a moment. All he could think of for an answer was "Yes, Ma'am" because she really
did
remind him of his grandmother the time she had caught him in his grandfather's study, reading the books that were 'too old' for him. He sighed. "Yes, I know. John… and Jany are worried. I just can't shake the feeling that this just isn't right." He paused as she looked intently at him. "Oh, not that it's wrong patching these kids up, but that so many of them just go back into combat."