Flashback (1988) (16 page)

Please, God
, Suzanne whispered to herself as the fluorescent lights flashed overhead,
let it be nothing. Let it be benign
.

Jason Mainwaring met her in the operating room, his blue-gray eyes intent from between his aqua mask and hair cover. Suzanne pulled off her earphones. The same lovely piece she had been listening to filled the operating room.

“Welcome to my world, Suzanne,” he said.

Suzanne smiled weakly.

“I wish I could say I was pleased to be here.”

“I understand.” He patted her arm reassuringly. “We’ll take good care of you. Don’t you worry.”

“Thanks.”

“How do y’all like my music?”

“It … it’s beautiful.”

“The most beautiful music ever written, I think. It’s called
Fantasia on Greensleeves
, an’ it’s by an English composer named Ralph Vaughan Williams. I begin every single case with it, an’ then go on to some other pieces of his. If you want, I’ll make a tape of it for you.”

“That would be very nice,” she managed.

Jack Pearl, the anesthesiologist, appeared at Mainwaring’s side. Together with a nurse, they helped her from the litter onto the chilly operating table. Then, in a maneuver so quick and painless she barely realized it was happening, Pearl slipped an intravenous line into a vein at her left wrist.

Next, a broad strap was pulled across her abdomen and tightened.

A final pleasantry or two from Mainwaring, and they were ready to begin.

Jack Pearl came into Suzanne’s field of vision, held up the rubber stopper of her intravenous line, and slipped in a needle attached to a syringe full of anesthetic.

Please, God
, she prayed once again,
let Zack be right. Let it be okay
.

“All right, Suzanne,” Jack Pearl said. “This is just some Pentothal.” He depressed the plunger, emptying the contents of the syringe into her intravenous line. “All you have to do now is count back from one hundred.”

From the speakers overhead, Ralph Vaughan Williams’s flowing fantasy filled the room.

“One hundred,” she said thickly. “… ninety-nine … ninety-eight …”

Above her, the huge, saucerlike operating light flashed on.

“Ready,” she heard someone say.

Takashi Yoshimura was one of seven Orientals living in Sterling, New Hampshire. The other six were his wife and five children. Though Japanese by birth, and, in fact, by birthplace, he had been raised and educated in lower Manhattan, and spoke both English and Japanese with a pronounced New York accent.

Like a number of the new Ultramed physicians Zack had met since his return to Sterling, Yoshimura, a pathologist who insisted on being called Kash, was young, well trained, and exceedingly capable.

It was just after eight in the morning. Yoshimura, diminutive, with close-cropped hair and Ben Franklin glasses, sat at his desk, with Zack peering over his shoulder. Before them, in a stainless-steel pan, was the fleshy, silver-dollar-sized mass that had just been removed from Suzanne Cole’s right breast.

Zack watched in tense silence as the man maneuvered the tissue about beneath a bright light and magnifying glass. A floor above them lay Suzanne, adrift in the dreamless netherworld of general anesthesia. In minutes, the unimposing little pathologist would sent word to the O.R. of his interpretation of the cells in the frozen sections of the specimen, and Suzanne would either have her incision sewn up, or a large portion of her breast and the surrounding lymph nodes removed.

If Kash Yoshimura was the least bit nervous about the awesome implications of this facet of his work, it certainly did not show in his face. He hummed a soft, almost tuneless melody as he scanned the surface of the mass, searching for any telltale dimpling or discoloration. Then, with a final,
satisfied arpeggio, he used a scalpel to produce a thin slice from the core, and handed the pan with the exposed specimen to the histologist.

“Okay, George,” he said to the tissue technician, “do your thing.”

“Well?” Zack asked, after the technician had left.

“What do I think?”

“Uh-huh.”

“You are, perhaps, familiar with the immutable medical law of eighty-five/fifteen?”

Zack shook his head.

“I’m surprised,” Yoshimura said, “your being Harvard-trained and all. Well, simply put, the law states that every probability in medicine is either eighty-five percent likely or fifteen percent likely. Proper application of the law means one can never be wrong, as long as one knows whether the event in question seems remotely likely or not so remote.”

Zack smiled. “I take it you scored well on your boards.”

Kash Yoshimura nodded. “I did okay,” he said.

“And the biopsy is eighty-five percent likely to be …”

“Benign. An adenoma, I would guess.”

“Wonderful.” Zack pumped his fist.

“At this point, you may be eighty-five percent enthusiastic,” the pathologist cautioned. “No more.”

“I understand.”

Yoshimura reached across and patted Zack understandingly on the shoulder. “We’ll have the answer in just a few minutes,” he said. “Meanwhile, all I can tell you is that our mutual friend is in remarkably capable hands.”

“Mainwaring?” Zack flashed on his initial, unpleasant encounter with the man.

Kash nodded. “I watched him work a number of times when I was a student and resident. He is a superb technician.”

“So I’ve heard. He’s a little short on tact, though. In the first five minutes after we met, he managed to say something snide about virtually every aspect of my life.”

“Perhaps he finds a new neurosurgeon in town threatening to his ego.”

“Perhaps. Where was it you trained?”

“Hopkins.”

“Mainwaring was at Hopkins?”

“He was. No small fry, either. A full professor, if I’m not mistaken.”

Zack was surprised. “I wonder what on earth he’s doing up here in the boondocks,” he said. “Especially the northern New England boondocks. That accent of his puts him well below the Mason-Dixon line.”

The pathologist shrugged. “Beats me. Apparently, he doesn’t deem pathologists threatening enough to insult. Aside from my reporting biopsies to him, we haven’t had more than a one- or two-word conversation since he arrived a year or so ago.”

“Actually,” Zack said, suddenly anxious to learn more about the man Guy Beaulieu claimed was helping to drive him out of practice, “it was closer to two years. Did you ever tell him you watched him operate at Hopkins?”

“As a matter of feet, I did. Once, shortly after he got here.”

“And what did he say?”

“Nothing, really. He glared at me for a moment with that steely look that I think surgeons practice in front of a mirror to use on nurses and anesthesiologists and the like.” He grimaced. “I mean
some
surgeons,” he qualified. “Then he just said, ‘That’s nice,’—something like that—and walked away.”

“And no mention of that since?”

Yoshimura shook his head.

“How weird. Mainwaring seems very much the old-boy type. I’d expect him to go out of his way for someone from
his
college or
his
hospital—especially a prestigious place like Hopkins.”

“Believe it or not,” Yoshimura said without rancor, “there are still those about, even in our lofty profession, who are … uncomfortable with certain aspects of certain anatomies.” He gestured toward his eyes. “Whatever the reason, the social circle Jason Mainwaring runs in certainly does not include the Yoshimuras.”

“Well, I’d enjoy it very much if mine did,” Zack said.

Kash Yoshimura eyed him for a second, and then he smiled. “I think we would like that, too,” he said.

The histology technician announced his return with a soft knock on the doorjamb.

“Ah,” Kash said. “This is the moment we turn our eighty-five/fifteen into something quite a bit more certain. Good sections?”

The technician nodded proudly, and set down a cardboard holder containing a dozen or so glass slides.

Zack was struck by the remoteness of the unfolding scenario from the woman whose quality of life, and even, perhaps, whose very existence, was at the center of the drama—a marked contrast to the immediacy and intimacy of surgical medicine.

Still, he knew, in the moments to follow, Kash Yoshimura would hold as much power, as much responsibility, as if he were the man in the operating room with the scalpel.

The pathologist slid the first of the sections onto the stage of the dual-view teaching microscope, and motioned Zack to the second pair of oculars.

Silently, Zack watched, barely breathing as the multicolored cells slid through the brightly lit field.

One by one, Yoshimura worked his way through the slides. With the fifth or sixth one, he had resumed his humming. Finally, he stopped, and looked over at Zack.

“You have an opinion?” he asked.

Zack nodded. “Uniform cell type, uniform pattern, no obvious foci of necrosis,” he said. “I can’t put a name on it, but I can say that it sure as hell looks benign.”

Yoshimura nodded. “Should you ever tire of neurosurgery, Dr. Iverson, I would say you have quite a future as a pathologist.”

He picked up the phone and dialed the operating room. “This is Dr. Yoshimura calling from pathology,” he said. “You may inform Dr. Mainwaring that he has excised a totally benign, fibrous adenoma. Thank you.”

Zack pumped the mans hand as if he had been the cause of the tumor being noncancerous, rather than merely its interpreter.

Before it had really even begun, Suzanne’s nightmare was over. Anxious to be at the bedside when she awoke, Zack hurried to the recovery room.

One story above, in operating room 3, Jason Mainwaring received the news of the biopsy impassively, and then looked over at his anesthesiologist.

“So, Jack,” he said, “if it’s all right with you, we are ready to close.”

Jack Pearl, a ferret-like man in his mid-forties, smiled at the surgeon from beneath his mask. Then he glanced down at the serene face of their patient.

“Everything is better than all right, Dr. Mainwaring,” he said. “In fact, it’s perfect. As always. Absolutely perfect.”

Subtly, unnoticed by anyone else in the room, Jason Mainwaring returned the smile and nodded his approval.

At that moment, both men were focused on precisely the same thought:
Four hundred ninety-one down. Only nine to go
.

10

Over the more than thirteen years that Zack had spent as a medical student and surgeon, Suzanne represented, without doubt, the most striking recovery from general anesthesia he had ever encountered.

He was already in the recovery room, waiting by the nurses station, when she was wheeled in from the surgical suite. She was awake, smiling, and totally alert. Her jubilant thumbs-up sign to him made clear that she was also well aware of the results of her operation.

“That is the most amazing wake-up I’ve ever seen,” Zack commented to one of the recovery room nurses as Suzanne, with very little help, transferred herself from the litter to her hospital bed. “It’s hard to believe she was ever really asleep.”

The nurse, an animated young redhead whom Zack knew only as Kara, beamed with pride.

“Oh, she was out, all right,” she said. “Isn’t it wonderful? Almost all of Dr. Pearl’s cases come out of the operating room looking like that.”

“Mine didn’t,” Zack said, recalling the prolonged, but quite typical recovery of his cervical disc case.

“Pardon?”

“Nothing. I’m just really impressed, that’s all.”

“Everyone around here is,” the woman said. “Part of it may be Dr. Mainwaring, too. He demands that his patients be anesthetized just so, and Dr. Pearl is the only one he’ll allow to work with him. I used to scrub before I got the job in here, and I tell you, they are quite a pair. Things have really taken a turn for the better at this place since they teamed up.”

Across the recovery room, Zack saw Jack Pearl peering through an ophthalmoscope, examining the nerves and vessels on Suzanne’s retinae while one of the nurses checked her vital signs. He was a slight, sallow man with a pencil-thin moustache and a broad, high forehead that dominated his nondescript eyes.