Noble Vision (13 page)

“You probably didn’t spend more than five minutes with her, so you could zip on to the next poor slob.”

“Why don’t you try understanding for a change, instead of launching one of your self-righteous attacks?”

“All hell was breaking loose in her head. Were you waiting for a coma before you did anything?”

“You always have to be right, don’t you? Hindsight is great!”

“It’s not hindsight, Marie. Anticoagulants, trauma, and bleeding paint a picture any med student would see.”

“Any med student would also know that migraines explain headaches much more often than hemorrhages.”

“Not in Eileen Miller’s case. She had a head injury!” He could feel his voice rising.

“Why can’t you leave me alone? You always have to find fault!”

“You treated a migraine headache that she didn’t have and missed a cerebral hemorrhage that nearly killed her. Don’t you find fault with yourself?”

“Everybody misjudges a patient occasionally. Even you, David.”

“It’s not occasionally with you. What about Charles McIntyre?”

“Are you going to throw that in my face again?”

“You sent him for physical therapy, which he could have had till doomsday without correcting the weakness in his legs. If he hadn’t crawled into my office and I hadn’t removed the ruptured disc fragment pressing on his spinal cord, your patient, who’s normal today, could have become a paraplegic.”

“I did what I could. I spent hours preparing his case for quality assurance review, but the committee wouldn’t approve a referral to a neurosurgeon. They wanted to try physical therapy first.”

“So you did what a committee that never met your patient told you to do. But was it
right
?”

“You did what they told you
not
to do. You operated on him without authorization, and instead of getting paid, you got fined. Was that right, David?”

He did not know why he wanted to press on, to convince Marie, when an inner voice warned him that it was futile. “Was it right to tell Helen Pennington that she, too, had migraines, when her headaches and temporary paralysis resulted from a blocked carotid artery about to cause a stroke?”

Marie’s face reddened. “Sometimes migraines
can
cause temporary paralysis. Was it right to examine
my
patient without my permission? Was it right to rush her to the hospital, to demand that the technicians test without authorization? Was it right to throw a temper tantrum, to do the damn test yourself, then to rush her to surgery to open the artery without consulting anyone, without asking, without explaining your case to the certifications officer?”

“Was the main artery to her brain ninety-eight percent blocked or not?”

“There has to be a better way to make your point.”

“Was Helen Pennington going to have a massive stroke at any minute or not?”

“Why do you have to make enemies everywhere you go?”

“Was it right to save her life or not?”

“Was it right to embarrass me with your hotheaded attitude, with your uncivilized behavior, with the way you practice medicine?”

“The way
I
practice embarrasses
you
?”

“What would you have me do, David? Become a misfit, too?”

“Those patients of yours needed surgery, Marie, not aspirins and sweet words.”

“But my hands were tied! Their treatment was fixed by the guidelines.”

“But is it
right
, Marie?” he asked quietly.

“Is it right to perform those surgeries without permission?”

“I got permission—from the patients.”

“A lot of good that did you!” she laughed mirthlessly. “Tell me if you got paid!”

He did not answer.

“In fact,
you
paid the state. And you’re lucky that fines are the worst penalty you’ve gotten so far. It’s bad enough that you’re destroying your career, but now you want to drag me down, too. You want me to practice the way you do, to ignore the rules, to do unapproved tests, to make unauthorized referrals, to stick my neck out. Soon you’ll be paying out more in fines than you’re getting from surgery. Then who will pay the bills? Who’s paying most of them now?”

He had no answer.

“David, I’m doing the best I can. It’s not as if I have a choice in the matter. Do you think I do?”

A wave of guilt overpowered him. It was true, wasn’t it? She had no real choice, did she?

“It’s hard for me. I’m under a lot of pressure. You can’t imagine!”

He knew there were demands on her. Surely she did not like the situation any more than he did. How could he blame her for the way she bore the unbearable? What did he want from her, anyway?

“Why are you making things worse for me?” she asked, echoing his thoughts. “You’re so protective of your brother. You want Randy to walk a straight line and never break the rules or get in trouble. Then why do you want
me
to?”

It was true, he had to admit to himself. But an inner voice warned him that somehow Marie and Randy were different.

“Your demands on me aren’t fair, David.”

It was true, he thought; he was not being fair. He was causing the heated arguments burning a hole through their marriage. He wondered about the strange circuit of anger and guilt that he could not break. He rubbed his eyes, as if trying to erase the bloody image of Eileen Miller.

“All right, Marie,” he said softly. “I understand that you didn’t have a choice.”

“There, that’s better now,” she whispered calmly.

The wind filled the curtains of the French doors, blowing them into the room like starched white sails. Reaching her robe, the gentle breeze lifted it to reveal more of her legs. She rose and walked behind his chair. Sweet scents from the garden mixed with her perfume. She threw her arms around him, her hands touching his chest, her face leaning over him, her mouth brushing his hair. She had always been drawn to the tall, muscular body, the striking features, and the subtle sensuality of the man who was her husband. She wanted him in a way that went beyond the raw need that his body stirred in hers. She somehow wanted to unleash in him a feeling that he could not control, to see him helplessly in her power, even if just for a few convulsive moments, as a kind of victory over him, over something in him that she could not reach.

“David,” she whispered, “let’s have a drink on the porch and watch the storm.”

She sat on the desk, facing him. She waited for the signs she knew well—eager eyes that traveled over her, exquisitely sensitive hands that caressed her, a warm mouth that covered hers. She saw none of them.

“I just want to finish my work and go to sleep.”

“In the guest room again?” she stood up abruptly. “Maybe the trouble with our marriage isn’t what I’m doing in my office, but—”

“If that’s all, Marie—”

“How long can you hold a grudge? Don’t you want to do something for pleasure?”

“I am,” he said, and gestured to the journal, lifting his pen to resume his work.

Instead of leaving, Marie returned to her seat, circling the desk slowly, as if trying to dissipate her anger. “Actually, David, I wanted to talk to you about something else—about John Carter’s post being up for grabs.”

So that explained her visit, he realized. Surely she had not come to discuss Eileen Miller, a subject that she had avoided all weekend.

“I think that being chief of neurosurgery at Riverview will be very good for you. It’ll put your career back on track, and that’ll help us get along better. If you want John Carter’s position, surely Randy can pull strings to get you approved.”

“It would allow me to finish my research, but—”

“Your research? Are you still chasing that windmill?”

“Isn’t that why you mentioned John Carter’s post?”

“What does that have to do with your research?”

“Carter has permission from the BOM to do animal research. That permission would transfer to his successor.”

“Oh,” she said disappointedly.

“When you said the director’s post would put my career back on track, didn’t you mean it would enable me to finish my experiments?”

“God, no, David! Your research only spells more trouble for us, more controversy. I meant that if you became chief of neurosurgery, you’d be forced to do things differently. You couldn’t continue to be at war with everybody. And I wouldn’t have to cringe every time your name cropped up in one of my committee meetings.”

He looked away, losing interest in the conversation.

“David, my career is booming. I don’t want you to drag me down; I want you to be more like me.”

A hot rush of anger hit his face. “You mean you want me to be incompetent?”

She jumped up, her hands on her hips, her mouth twisted. “How dare you? Maybe
you’re
the one who’s incompetent. Maybe you shouldn’t practice medicine at all. Maybe we’d both be better off if you opened a hardware store in Brooklyn!”

“That’s it!” he cried, leaping out of his chair, his eyes looking through Marie to an image of their own.

“What are you talking about?”

“Why didn’t I think of it?”

“Think of what? Where are you going?”

He did not seem to hear her. The pages of the journal brushed shut as he left the room.

*
  
*
  
*
  
*
  
*

The wind had grown more menacing by the time David’s car hit the graveled driveway of his brother’s nearby house. A gust stirred the loose pebbles into a hissing gray funnel. A hanging pot of geraniums swung wildly from the porch. A streak of nearby lightning threw a jagged beam on the tall silhouette of Randy, who was waiting on the porch after receiving his brother’s call from the car.

“I thought of a way I could accept the director’s job.” David called in the darkness as he got out of the car.

“How?” Randy asked, approaching.

“I’ll stop practicing medicine for a year or so. Not entirely, but I’ll drastically restrict my surgeries to those I’m sure the inspectors will allow. There has to be a way to take only the easy cases, the ones without controversies or complications to drive up the costs and the fines. Other surgeons do it all the time. I’ll shuffle the paperwork, run the department, and focus on the lab work. The less I see of the OR, the better off I’ll be.”

“But, if you stop accepting the hard cases . . . who will take them?”

David had no reply.

Randy stared vacantly into the distance, his voice low. “What will happen to those troublesome patients . . . the really sick ones that no one wants anymore?”

David’s head dropped slowly, his eyes blank, his mouth grim. “I can’t be the chief of neurosurgery if I don’t stop doing neurosurgery.”

A roar of thunder seemed to underscore the remark. Their hair flew wildly in the wind, but their eyes met and held steady.

“Okay, David, then it’s settled.” Randy smiled, but there was no joy in it.

“Not quite. If you want to help me, I’ll accept your backing for the director’s post. I’m prepared to make the necessary promise to the board and to keep it. But there’s one condition. You have to make a promise to me, a solemn vow.”

“What?”

“If something unforeseen happens and I get in trouble with the hospital, you must promise to abandon me. You must publicly withdraw your support and denounce me. And you must do it wholeheartedly, so the board will believe you. I absolutely insist. I want your word on that.”

“David, really—”

“You intend to keep your job for a long time, don’t you? I’ve heard you promise your family that they can count on you. Then promise me what I ask.”

“But I also want to help you. For my own sake, I want you to finish your research, so we can lay the groundwork for our new institute. It’s not a sacrifice to back you, David. It’s one of the few things I want to do, so I’m prepared to take a risk, too.”

“I can’t allow that. You have to promise that if I screw up, you’ll throw me to the wolves, you’ll recommend my dismissal as director, you’ll even revoke my staff privileges if you have to—”

“David, come on. I’d have to betray my own mind—”

“Then forget the whole thing. I have a feeling we’re better off dropping this crazy idea.” David squeezed his brother’s shoulders affectionately, and then turned to go.

“All right, David, all right! I’ll agree.”

“Shake on it,” David demanded.

He held out his hand to Randy. Lightning that seemed alarmingly close flashed against his outstretched palm. Randy extended his hand to grasp his brother’s. With the first drops of rain splattering over them, the two shook hands.

“I promise, brother. I’ll do what you ask.”

“If I get in trouble, you’ll denounce me.”

“It would be like denouncing myself—”

“I want you to say it—and mean it,” insisted David.

“Okay, if you get in trouble, I’ll denounce you. But don’t make it come to that, you hear?”