Past Lives (2 page)

Macandrew's background of Columbia Medical School and subsequent positions in several prestige-name hospitals and clinics back east seemed to satisfy Francini whose bluntness had culminated in the question, 'So what the hell are you doing here?'

Although he did not suffer from the paranoia of some of his more senior colleagues, Macandrew was irritated by Francini's attitude. He was typical of the type of man who thought financial success an acceptable excuse for a total lack of charm and manners. Macandrew was well aware of his nation's lack of esteem for the mid-west, assuming that, because its people had the reputation of clinging to the values of a bygone age, science and the arts must be stuck in a similar time warp. They were not entirely mistaken but KC Med Centre was good by any standards.

Macandrew’s original, unashamed career plan had been to work for three years on the East Coast and then head for California in search of big bucks and the good life. He had surprised himself when a job came up in Kansas City and he had applied for it, arguing to Kelly, his girlfriend at the time, that it would be invaluable in adding to his all round experience of American medicine.

The real reason however, was somewhat different and had much to do with his family background. His great grandfather, after emigrating from Scotland, had settled in the mid-west in a place called Weston, Missouri. For reasons, which he himself could not properly explain, he felt that he wanted to follow in his footsteps and reinforce a link with this part of the States. Kelly had made it clear that Kansas was not for her or her planned career in obstetrics. They had kept in touch through phone calls and letters for a while but even that had largely stopped. Kelly had moved on to Johns Hopkins University Medical Center in Baltimore and a different world.

Macandrew saw on the duty schedule that Mike Kellerman would be the anaesthesiologist today. Despite having an off-hand manner, Macandrew knew that he was good. He had worked with him in the past and had never had a moment's worry over patient stability. He didn’t ask for anything more. He finished reading through Jane Francini’s notes without learning anything new; he hadn’t expected to; he had just been making sure that he hadn't missed anything.

As he put them down, he became conscious of the radio again. The presenters - two of them, working in tandem - were engaged in a local news round up. The way they fed each other lines and laughed at their own jokes irritated him - a sure sign that he was becoming edgy but then, he always was before an operation.

His walk to the Med Centre followed a route parallel to 39th Street, avoiding the main thoroughfare until it became unavoidable. The sidewalks were in bad condition but he was used to that. No one walked anywhere in Kansas City unless they were too poor to do anything else and therefore didn't matter in the great scheme of things. Home - car - office, office - car - home was the routine for the overwhelming majority. The lack of people however, made the walk more pleasant - although it was necessary to run the gauntlet of an occasional guard dog, straining at its leash as he passed. The dogs were trained to regard anyone on foot with grave suspicion.

He crossed 39
^th
Street near the intersection with Rainbow Boulevard and entered the Med Centre through the swing doors. Just before he did however, he took off his topcoat in preparation for the warmth he knew would hit him like a wall.

'Good Morning Doctor Macandrew,' smiled one of the nurses. 'Miss Givens has been paging you.'

'Thanks,' replied Macandrew mechanically, glancing at the clock on the wall. It was a few minutes after nine. He approached Reception and a woman in her early fifties, wearing ornate glasses, perched on the end of her nose, smiled at him and handed him a piece of paper that she tore from the pad in front of her. 'Mr Francini would like a word Doctor,' she said in the manner which fifty-year old women wearing ornate glasses regarded as 'gracious'.

Macandrew looked at the paper and saw that Francini had been put in G4, one of the rooms on the ground floor used by staff to give out news of progress or lack of it to friends and family of people brought into the Emergency room. As he passed G3, Macandrew looked in through the small glass panel in the door and saw a Hispanic woman sitting there with a white handkerchief pressed to her face; he could hear sobbing. He hoped Francini couldn't.

'Good morning Mr Francini. What can I do for you?'

Francini got up from his chair and smoothed back his shiny black hair with both hands. His suit, silk tie and Gucci shoes spoke of money but his swarthy features said Italian peasant stock.

'I know Janey's got to have this operation, Doc, but I just thought I would remind you to be careful with her. She's the only wife I got.' Francini laughed at his own joke but it was forced and his eyes remained hard.

'Of course, Mr Francini.'

'Shit, I don't know how you guys do it,' said Francini affecting a broad grin, which showed off expensive dental work. 'You're about to take somebody's life in your hands and you're Mister Cool. I gotta hand it to you. You guys are somethin’ else.'

'It's my job,' replied Macandrew. 'It's what I've been trained to do. I don't think I'd be very good at selling harvesters.'

Francini snorted and laughed. He said, 'Hell, anyone can sell harvesters in Kansas. Now, selling harvesters in Boston? That might be different . . .’ He laughed again.

Macandrew smiled and glanced at his watch. It had the desired effect. Francini said, 'I won't hold you back any longer. Just remember what I said, huh?'

'I will. I promise.'

Macandrew escorted Francini to the front door and then went upstairs to his own office. He phoned and checked with the head nurse that Jane Francini had been given her pre-med on time and that there were no hitches.

'She'll be ready for you Doctor,' replied the nurse.

At nine thirty, Macandrew drained the last of his coffee from a paper cup and went along to surgery to begin scrubbing up. He found Mike Kellerman already there.

'And how's Mac the Knife on this fine morning asked Kellerman with a smile.

'Fine, Mike. How are you?'

'A man barely alive,' replied Kellerman with mock solemnity. 'What that woman demanded of me last night ought not to be allowed, and they call them the gentler sex!'

Macandrew smiled as he lathered his forearms. 'Let's hear what you remember of the patient's notes?'

'Thirty-four year old female, undesignated pineal tumour with a cardiac history, weight one thirty eight pounds, no known allergies, I looked in on her yesterday afternoon.'

'What did you think?'

'Seemed strong enough to me,' replied Kellerman. 'No worries from my point of view.'

'Good.'

'She told me her husband owns Francini Farm Machinery. 'Think we could be on a bonus if we do a good job?'

'It could be a horse's head on the pillow if we don't,' replied Macandrew.

'Francini, Italian? Of course. I think you've just got yourself one very alert colleague.'

'Good,' replied Macandrew, elbowing off the faucets and accepting a sterile towel from the nurse in attendance. 'I'd like to get this over as quickly as possible.

As Kellerman did the same he asked, 'You don't really think her husband's . . . "Family" do you?'

'Mr Francini sells tractors,’ smiled Macandrew. ‘On the other hand, I'm pretty sure he doesn't write poetry or go to the ballet much.'

'A man's man eh?' said Kellerman, putting on an exaggerated male voice. 'Boy, is he in the right place!’ Kellerman was a Californian.

'The guy comes on a bit strong but I guess he's just worried about his wife,' said Macandrew.

'Who's the OR nurse?' asked Kellerman.

'Lucy Long,' replied Macandrew.

'Good. I thought it might be my 'friend'.'

Macandrew smiled. Kellerman's 'friend' was Sylvia Dorman, the other OR nurse working in neorosurgery. She and Kellerman didn't get along. Dorman was very serious nurse with a Florence Nightingale complex. She saw her career as a Christian vocation. Kellerman's black humour offended her and he knew it. It inspired him to greater heights, or depths depending on how you looked at it. Macandrew didn't like working with the pair of them together. An operating room was no place for personality conflicts. He and Kellerman gowned up and left their masks hanging loosely round their throats as they entered the operating room.

'How are we doing?' Macandrew asked Lucy Long.

'All ready.'

Macandrew ran his eye over the instrument trays while Kellerman connected Jane Francini to the equipment he would use to monitor her condition throughout the operation. Green pulses started to chase each other across the face of an oscilloscope and a regular bleep followed the steady beat of the patient's heart. Macandrew felt comfortable. This was his world: the sights and sounds put him at ease. He supposed it must be the same for truck drivers getting behind the wheel or office workers slipping in behind their desks to begin the day's work. Familiarity could be such a comfort.

He paid particular attention to the lighting arrangements for this operation. The normal overhead, shadowless lamp would not be sufficient; he would be working close to the patient's face so he needed angled illumination. Two small ancillary spotlights mounted on the main lighting gantry, which he eased into position, would supply this. The standard route for surgery on the pituitary and pineal glands was through the bone at the corner of nose and eye. There would be no need to shave the patient's head and very little visible scarring afterwards.

'How is she doing?' Macandrew asked Kellerman.

'More stable than I am,' came the reply.

'A comfort . . . She’s deep enough?

'Right on the button.'

Macandrew made a last adjustment to his mask and made a visual inspection of the point of the drill he planned to use before checking the motor function. Its angry insect whine filled the room. He put it back on its stand and asked for a scalpel. It was slapped into his palm. With a slight nod to everyone, he made the first incision. ‘Showtime.’

Sixty minutes later, Jane Francini's pineal gland lay in a glass dish beside her sleeping form, its normal pine-cone shape distorted by the tumour, which had almost doubled its size.

'Nasty,' said Kellerman. 'But it looks like you got it all.'

'I think so,' replied Macandrew. 'Nice and firm, no break up. He turned to one of the nurses and said, 'Get this to Pathology, will you.'

Gloved hands spirited the dish away and Macandrew got on with ending the operation. 'Still OK?' he asked Kellerman.

'Absolutely fine.'

'Just what I wanted,' said Macandrew, 'A smooth, clean, quick job with no complications. In, out, no messing about.’

He had scarcely left the operating suite when he heard himself being paged. He called in to be told that Mr Francini had been making the staff's life a misery by demanding constant updates on his wife's condition. He was insisting on speaking to Macandrew personally the minute the operation was over.

'I'll come down.’

Francini jumped up the moment he saw Macandrew approach and rushed over to meet him. 'How is she, Doc?' he demanded. 'She's OK isn't she?'

Macandrew had to raise his hands to keep Francini at bay. 'The operation went well Mr Francini. The tumour has been removed and sent to the path lab for analysis. We’ll know the results in a few hours. Your wife's in recovery right now. You'll be able to see her as soon as she comes round.'

'Thank Christ!' exclaimed Francini. 'I don't mind telling you Doc, Janey means everything to me.'

'I sort of guessed,' said Macandrew.

'You'll be staying with her?' asked Francini.

'That won't be necessary Mr Francini. She's in good hands. The nursing staff will take excellent care of her. Now if you'll excuse me, I'm going to get out of these clothes.'

'Of course, of course,' said Francini backing away a little. 'I can't tell you how grateful I am, Doc.'

Macandrew felt uneasy. 'Mr Francini,' he began cautiously, 'Jane's tumour has been removed but we haven't had the lab report on it yet. A lot depends on that . . . She’s not out of the woods just yet.'

'Yeah, but you got rid of the bastard didn't you? You got all of it out?'

'I think so but . . .'

'Of course you did. I feel it. Janey's gonna be fine.'

The fact that the operation on Jane Francini had gone well and that the sun was still shining brightly when he walked out through the hospital doors put Macandrew in a good mood. He was whistling as he walked up to the junction of 39th street and Rainbow, trying to decide where to eat lunch. Eating in the Med Centre itself was something he had long given up on. What large institutions did to food was something he no longer subjected himself to. He opted for a quick sandwich at WENDY'S; this would give him time to have a pleasant walk in the sunshine afterwards.

As he waited in line for his sandwich, he became aware of someone smiling at him out of the corner of his eye. It was Lucy Long, the OR nurse. He smiled back and, seeing that she was on her own, took his tray over to join her.

'I didn't think neurosurgeons ate junk food,' said Lucy.