Noble Vision (25 page)

As he walked along, breathing the stagnant vapors of Manhattan in August, long-forgotten events flashed before him. He admonished himself for looking back, feeling that the present should concern him, but the stubborn intruders that were his memories refused to be dismissed. In some way he had to acknowledge them, for they were the signposts on the journey that had led him to Nicole’s surgery.

He had grown up in the residential community of Oak Hills, New York. From his earliest recollections, his childhood had been divided into two different worlds. The first and overwhelmingly larger sphere included his mother and most other people. He remembered having to accompany his mother on gatherings with her friends, as well as on trips to the health club, the beauty salon, and the department stores—all of which left him with a lasting distaste for shopping and small talk.

Mrs. Lang had enrolled her elder son in special instructions of all kinds, such as piano lessons, acrobatics, and horseback riding, but David had dodged the classes imposed on him.

“I’m giving you wonderful opportunities, David,” Mrs. Lang would remind her recalcitrant son.

“Who says they’re wonderful?” he would reply.

“I do.”

“Then why don’t
you
play the piano?”

“Don’t talk back to me, young man!”

David derived little more from these experiences than boredom.

School was of marginal interest to the boy. He was a bright student, but despite his mother’s urgings, he declined to join clubs or teams. One teacher described what she called the boy’s aloofness: “David does what is required scholastically but gives nothing of himself to anyone.”

“Including me,” Mrs. Lang added sadly.

However, there was another world in which David traveled that emitted a light bright enough to eclipse the rest of his universe. To David, this realm was more spellbinding than the greatest adventure story or the fastest roller coaster. It contained no policemen, firemen, sports champions, movie idols, or other typical heroes of young boys, only one solitary figure who performed superhuman feats as a matter of quiet routine. This was the world of the young neurosurgeon who was David’s father.

David could pinpoint no moment in his life when he chose to become a doctor, because he could not recall ever desiring anything else. As immediate as his own heartbeat, the world of medicine was a continuous driving force within him from the beginning.

At age six he was riding in the family car when his father stopped on the highway to aid the victim of an automobile accident. The unconscious man had no pulse or respiration. To David’s horror, the man’s flesh was turning blue. Kneeling on a patch of grass on the side of the road, the victim’s wife and young daughter cried in fear. Before that day, death to David had been merely an event in the movies. As he trembled in the chill evening, he realized how terrible that same encounter would be in real life. He watched his father work fiercely, compressing the man’s chest and breathing into his mouth, but to no avail. The unfortunate man remained limp and cold. The stunned mother clutched her daughter, dreading the worst. David’s father worked relentlessly, until his voice finally broke through the gloom with four whispered words: “I have a pulse.” A flush of pink returned to the man’s face. Pride brightened David’s features as he gazed in awe at the hero of his childhood.

The next week in school, David’s teacher asked the students to describe the most exciting moment they had ever experienced. His classmates could think only of the movies, recounting horror stories, murder scenes, car chases, and fistfights from the screen. But David chose to relate the real-life drama at the accident site, which he described as “bringing a dead man back to life.”

When he was eight, his father gave him a plastic replica of the human brain, explaining its removable parts and their functions. The brain immediately became David’s favorite toy. However, Mrs. Lang did not share her son’s enthusiasm when she found the four subdivisions of the cerebrum drawn with a black marker on the hair of her six-year-old son, Randall. She had to wash his blond hair repeatedly until the black writing faded. Despite David’s apology and offer to wash Randall’s hair, Mrs. Lang insisted that the brain be thrown in the garbage—until Dr. Lang rescued it. “At least David didn’t shave Randall’s head, dear. Besides, the frontal, temporal, parietal, and occipital lobes were perfectly placed—and spelled!—so the boy deserves some credit.”

That same plastic brain later accompanied David to medical school and then to his office, where he employed it in countless discussions with patients. When the well-worn brain finally reached retirement, David gave it a distinguished spot in a lighted cabinet, displayed as others would exhibit a museum piece.

Mrs. Lang’s anger flared again on the day when David’s collie died of old age—and the boy dissected it. David’s explanation was simple: He loved the dog, but considering that it was dead, he wanted to see what was inside it.

Aghast, Mrs. Lang complained to her husband: “You grew up to be a doctor, but you didn’t do revolting things like dissecting your own pet, did you?”

“I wasn’t as gifted as David.”

Later that year, Dr. Lang took his son to the animal laboratory where he conducted experiments. “If the boy’s intent on dissecting animals, he should at least do it properly,” said the father. In the lab, David watched with marble-faced attention while his father dissected a rat.

The next year, Dr. Lang took his son to the pathology department of Oak Hills Hospital.

“This is crazy,” protested Mrs. Lang. “Nobody takes a ten-year-old kid to a morgue.”

“We’re going to the pathology department.”

That morning David watched his father’s friend, a pathologist, perform an autopsy on a human body. That afternoon David missed a classmate’s birthday party to stay in his room, filling a sketchpad with drawings of body parts as if they were carburetors and gas tanks. To his mother’s dismay, he hung the gruesome pictures on the wall like artwork.

More events followed that embarrassed Mrs. Lang, such as the time when she was entertaining the wife of a congressman and a cow’s eye from David’s dissecting kit slipped out of his pocket and onto her silver serving tray.

When David was eleven, his father took him to the operating room. With the patient’s permission, the boy watched his first human surgery. Dr. Lang explained the procedure: “Today, I’m going to clip an aneurysm in the patient’s brain. An aneurysm is a weakness in an artery that causes it to stretch like a balloon from the pressure of the blood running through it. This weak point is dangerous because it can burst like a balloon stretched too thin, causing a hemorrhage, which can kill the patient. Today I’m going to choke off the aneurysm with a metal clip around its neck, so blood will never again run into it and threaten the patient.”

Dr. Lang lifted the small body dressed in baggy hospital scrubs so that David could see the diagnostic films on the view box.

“Yesterday, this aneurysm burst, but the patient’s life was spared when the natural coagulating action of the blood temporarily sealed the tear with a clot. The patient passed out and was rushed to the hospital, where I examined him. Today’s surgery is urgent, because a second rupture is possible and could be fatal. In order to clip the aneurysm before the artery bursts again, I need to clear away the blood clot. You see, I have to remove the clot in order to get to the aneurysm, but removing the clot increases the risk of the aneurysm’s bursting before I’m in a position to clip it. So that’s the challenge we face, son.”

The predicament rendered David speechless; however, his father spoke in the matter-of-fact manner of a farmer talking about the need to clear a field.

A nurse wrapped the boy in a sterile gown winding twice around his slim body. With his arms tucked underneath, he looked more like a mummy than a would-be doctor. To raise his height, the nurse helped him onto a small platform positioned next to his father. He was forbidden to move his feet or arms or to do anything more than breathe, which was difficult through the oversize mask engulfing his small face.

The boy watched his father and a resident enter a brain swollen and red from the patient’s hemorrhage. The two men used a suction device to evacuate the coagulated blood, piece by tiny piece, the way a vacuum cleaner picks up trash. The process was slow, tedious, and uneventful, until the small bulge of the aneurysm, covered with clot, came into view. As the resident tried to suck up more of the clot, the dreaded thing happened: the aneurysm burst.

A sea of blood suddenly and furiously filled the brain and splashed onto the floor. The men worked feverishly to suck off the blood, but it was gushing too forcefully to clear the field.

“Blood pressure’s dropping,” reported the anesthesiologist. “One hundred . . . ninety . . . eighty . . . sixty.”

“Give me a temporary clip,” Dr. Lang said calmly. “We have to cut off the main trunk of the artery.”

David watched his father clip a large artery, an act that stopped the bleeding at once.

“We’ve got four minutes to find the aneurysm and clip it. Keep track of the time,” said Dr. Lang.

To stop the hemorrhage, Dr. Lang had cut off the blood supply to the patient’s brain, a state that could not continue for more than four minutes without permanent brain damage. David watched his father work quickly to trace the path of the artery and to uncover the neck of the aneurysm.

“Thirty seconds . . . sixty seconds,” said the nurse who was counting. A deadly silence and palpable tension gripped the OR.

“I found the neck of the aneurysm,” his father reported. “Let’s try a straight clip.”

“Ninety seconds . . . two minutes.”

The scrub nurse handed Dr. Lang the desired clip. Although it sealed off the aneurysm, the clip also hit the main part of the artery, which meant it would interfere with the blood supply, so that clip had to be removed.

“Let’s try a clip curving downward,” Dr. Lang said. The scrub nurse gave him the requested clip.

“Two minutes thirty seconds.”

The clip curving downward pinched off the aneurysm, but it pinched a vital function of the brain as well, so that clip also could not be used. Dr. Lang removed it.

“Three minutes fifteen seconds.”

“Let’s try a clip curving upward,” said Dr. Lang.

After picking up the proper clip from her tray, the scrub nurse dropped it on the floor. She gasped.

“Three minutes thirty seconds.”

“It’s all right.” Dr. Lang tried to calm her. “We still have time.”

The scrub nurse searched for another of the same kind of clip on her tray.

“Three minutes forty seconds.”

She gave the clip to Dr. Lang. He applied it. The clip sealed off the neck of the aneurysm. He checked to see that no other structures of the brain were impaired by it.

“This one works. Now give me a clip remover for the temporary clip on the main trunk,” said Dr. Lang. He had to take away the clip from the main section of the artery to restart the blood supply to the brain.

“Three minutes fifty seconds.”

There were a variety of clip removers on the instrument tray. The scrub nurse reached for one.

“Not that one,” said Dr. Lang.

The nurse reached for another clip remover, which Dr. Lang approved.

“Four minutes.”

Dr. Lang removed the temporary clip that he had placed on the main trunk of the artery four minutes earlier. Blood charged through the brain once again. The permanent clip on the aneurysm, which would remain in the patient’s brain, held firm; there was no hemorrhage.

“This patient’s going to be all right,” Dr. Lang announced. The OR team collectively sighed.

The small witness to this event forgot his physical discomfort and even his very existence in the chilling four minutes that held him spellbound. When the crisis was over, he wanted to jump and cheer; however, he confined himself to a breathless “Wow” uttered from beneath his mask. That day the boy wrapped in a surgical gown discarded the clothing of childhood. Never again would he be content playing juvenile games after entering an arena in which life and death themselves were battling. No toy could ever again interest him after he had seen the intricate vessels, nerves, and convolutions of the stubbornly palpating human brain in its indomitable struggle for survival.

If he wanted a life’s work that demanded the skill of splitting the atom, the precision of a bombardier, and the daring of a tightrope walker, David knew the only work that could qualify. At age eleven,
he
knew
. As he gazed up at his father with a smile that was a salute, the father knew, too. He winked at the child in answer.

Walking to the Manhattan offices of the New York Bureau of Medicine, David was gripped by a sudden longing for the man in the OR who had winked at him on that final day of his childhood. He reproached himself, feeling it was silly for a grown man in a time of crisis to wish for his father. However, that presence in his life was inextricably linked to his career and to the meaning of Nicole’s surgery.

He approached an old brick building with a plaque above its entrance that read
To serve the public interest above all other concerns—this is the noble work of medicine
.

The quotation was attributed to the secretary of medicine. David stared at the inscription long after reading the words. The man who had made that statement was the man he loathed more than any other, the man who wanted to destroy him and Nicole.