Sisterhood (6 page)

Her knuckles whitened around the receiver. “Oh, ah, yes, Aunt Evelyn,” she managed, “hold on for a minute, can you? My nursing director is here.” She set her arm down on the counter of the booth. Even then she could feel it shaking.

“Christine, are you all right?” Dalrymple said in a tone that seemed too bland, too matter-of-fact. “You look a little pale.”

How much explanation does she want? Christine wondered. How much of a lie? “Oh, no, I’m fine, Miss Dalrymple. It’s my aunt. My Aunt Evelyn.”

Dalrymple shrugged. “As long as you’re all right. You nearly jumped out of your skin when the phone rang before. Then, when you didn’t come back, I became concerned that perhaps something had …”

Christine cut her off with a laugh that felt far too forced. “No, everything is fine. It’s … my uncle. He had an operation today and I was waiting to hear. Everything’s fine.” Lies, one after another. She couldn’t remember the last time she had lied.

“Tell your aunt I’m glad everything is okay.”

“I’ll just be another couple of minutes, Miss Dalrymple.” She could barely speak.

“No problem, take your time.” Dalrymple gave her a perfunctory smile and headed down the hall. Christine felt as though she were going to be sick. The notes on Charlotte Thomas were a crumpled ball in her fist.

“Evelyn, are you still there?” she said weakly.

“Yes, Miss Beall. Can you continue now?”

Christine thought, No, but said, “Yes … yes, I’m okay. I mean, just a second while I arrange my notes.” Her fingers felt stiff, unwilling to respond. First Peg’s phone call, then the agony of John Chapman’s wife, then Charlotte, and now Miss Dalrymple showing up on this, of all days, and seeming to be watching her more than any of the other nurses. Barely connected or unconnected events, yet suddenly she was nearly paralyzed, her imagination braiding a cord of panic that tightened around her chest and throat. Awkwardly she smoothed the notes on the counter, fighting to regain control.

“The … the home health agency. Did I tell you about the home health agency?” The sound of her own voice began to loosen the fear.

“Yes, you did,” Evelyn said patiently.

“Oh, okay. Let’s see. Oh, yes, I was here.” The words blurred in and out of focus. “Mrs. Thomas has been on hyperalimentation through an in-dwelling subclavian line for nearly two weeks and is still on intravenous antibiotics, hourly pulmonary therapy, and continuous oxygen.” At that moment she realized that she had skipped a whole page. In fact, she was not certain what she had already covered. “Evelyn, I … I seem to have passed over some things. Is it all right to go back?”

“It’s all right to do anything, dear. We’ll be able to
figure things out. Now just relax and give me what other information you have.”

The woman’s first warm words had an immediate effect. Christine took a deep breath and felt much of her tension vanish. “Thank you,” she said softly. Evelyn’s reassurance had reminded her: she was not functioning in isolation. She was part of a team, a movement committed to the highest good. If her role was difficult, at times frightening, so were those of the rest of her sisters. For the first time a note of calm appeared in her voice. “What I left out was that shortly after her surgery she had to be operated on again for drainage of an extensive pelvic abscess. One week ago she developed pneumonia, and last night a nasogastric tube was inserted because of the possibility of an intestinal obstruction.”

She was still shaking, but now the words came more easily.

“Recently she developed a large, painful sacral pressure sore and is now requiring around-the-clock Demerol as well as the usual local therapies. The physician’s notes in her chart as of yesterday state that her pneumonia is worsening. Despite all her problems, she has been designated a full resuscitation should she arrest.” Almost done, she thought. Thank God. “Mrs. Thomas is married, has two children and several grandchildren. That is the end of my presentation.” She sighed deeply.

“Miss Beall,” Evelyn asked, “could you please tell me if there is documented evidence in her record of the spread of her tumor to other organs?”

“Oh, yes, I’m sorry. I missed part of a page. There was one thing. An X-ray report. It’s a liver scan dated last week. The report from the radiologist says, ‘Multiple filling defects consistent with tumor.’ ”

“When was the last case that you handled?”

“The
only
case. Nearly a year ago. Mrs. Thomas would be my second.” It wasn’t like this the last time,
she thought. That was beautiful, not an ordeal. Her legs felt boneless. Instinctively she looked about for a chair.

“Thank you for your call,” Evelyn said, “and for your excellent case presentation. The Sisterhood of Life Regional Screening Committee will evaluate this patient and contact you within twenty-four hours. In the meantime, as you know, you are to take no action on your own.”

“I understand.” It was almost over.

“Oh, one more thing, Miss Beall,” Evelyn added. “The name of this patient’s physician?”

“Her physician?”

“Yes.”

“It’s Dr. Huttner. Wallace Huttner, the chief of surgery here.”

“Thank you,” Evelyn said. “We’ll be in touch.”

D
avid Shelton drummed impatiently on the arm of his chair and leafed through a three-month-old issue of
The American Journal of Surgery
. His excitement and anticipation at making evening rounds with Wallace Huttner had been dulled by a wait that had now grown to nearly three quarters of an hour. Huttner must have encountered unexpected difficulty in the operating room.

For a time David paced through the deserted surgeons’ lounge, closing locker doors—a gesture that seemed, inexplicably, to restore some order to the situation. Forty-five minutes in an empty locker room had hardly been part of his scenario for the evening.

With mounting concern that Huttner might have forgotten their appointment altogether, he took off the suit he had resurrected from the recesses of his closet for the occasion and changed into a set of scrub greens, then slipped paper shoe covers over his scuffed loafers and tucked the black electrical grounding strip in at the back. He considered putting on his own green canvas O.R. shoes, but rejected the notion, fearing that the shoes, a clean, new pair, might give the impression,
however accurate, that he had not spent much time in the operating room of late.

The ritual of dressing for the O.R. had an immediate buoying effect on his flagging morale. Donning a paper mask and hair guard, he began absently humming the opening bars of “La Virgen de Macarena,” a melody he had first heard years before, heralding the arrival of the matador at a Mexico City bullfight.

Suddenly he realized what he was singing and laughed out loud. “Shelton, you are really off the wall. Next thing you’ll do is demand two ears and a tail for a successful appendectomy.” Stopping before a mirror, he stuffed several protruding tufts under his cap, then stepped onto the surgical floor.

The Dickenson Surgical Suite, named after the first chief of surgery at the hospital, consisted of twenty-six rooms, devoid of windows, and occupied the entire seventh and eighth floors of the East building. Ubiquitous wall clocks provided the only hint of what life might be doing outside the hospital. In atmosphere, politics, social order, even language, the surgical suite was a world within a world within a world.

From his earliest days as a medical student, and even before, David had dreamed of being a part of that world. He loved the sounds of machines and hushed voices echoing down the gleaming hallways, the tension in hours of meticulous surgery, the seconds of frantic action in a life-or-death crisis. Now, for the second time in his life, the dream was becoming reality.

Scanning the lime-tiled corridor, he saw signs of activity in only two of the operating rooms. The others had been scrubbed down and set up for the first cases of the next morning, then darkened for the night.

He bet himself that Huttner would be working in the room on the right and lost a weekend in Acapulco with Meryl Streep.

“Can I help you?” The circulating nurse met David at
the doorway. She wore a wraparound green scrub dress that fell short of concealing her linebacker’s build. Turquoise eyes appraised him from between a paper mask and a cloth, flower-print hair cover.

Assert yourself, David thought. Show some nice, crisp consternation at not being recognized. He was trying to formulate an intimidating response when Huttner looked over from his place at the right side of the table.

“Ah, David, welcome,” he called out. “Edna, that’s Dr. Shelton. Will you get him a riser, please. Put it, ah … over there behind Dr. Brewster.” He nodded toward the resident who was assisting from across the table.

David stepped onto the riser and looked down into the incision.

“Started as a simple oversew of a bleeding ulcer,” Huttner explained, unaware—or, at least, not acknowledging—that he was late for their rounds. “We encountered a little trouble when we got in, though, and I decided to go ahead with a hemigastrectomy and Bilroth anastomosis.” David took note of Huttner’s choice of pronouns and filed the insight away in the back of his mind.

Within a few seconds the rhythm in the room, disrupted by David’s arrival, was reestablished. It became rapidly apparent to him that Huttner’s concentration, deftness, and control were extraordinary. No wasted words or motion. No outward evidence of indecisiveness. Although others in the room were playing their parts, he was clearly both conductor and principal soloist.

Suddenly a pair of scissors slipped off the side of Huttner’s hand as the scrub nurse passed them to him. They hit the floor with a clatter that might have been a small explosion. The surgeon’s gray-blue eyes flashed. “Goddammit, Jeannie,” he snapped, “will you pay attention!”

The nurse stiffened, then muttered an apology and
carefully handed over another pair. David’s eyes narrowed a fraction. From his vantage point the pass had seemed quite adequate. He glanced at the wall clock. Seven thirty. Huttner, he realized, had probably been operating for the better part of twelve straight hours.

A minute later, Huttner surveyed his results then rotated his head to relieve the tightness in his neck. “Okay, Rick, she’s all yours. Go ahead and close,” he said to the resident. “Standard post-op orders. I don’t think she’ll need the unit, but use your judgment when she’s ready to come out of the recovery room. If there are any problems, contact Dr. Shelton. He’ll be covering for me while I’m down at the vascular conference on the Cape. Any questions?”

David thought he saw a flicker of heightened respect and interest appear in the eyes of the scrub nurse. Real or imagined, the look immediately rekindled his excitement about what the next three days held in store for him.

Huttner stepped back from the table, stripping off his bloodstained gown and gloves in a single motion, and headed for the lounge with David close behind. Rather than collapsing in the nearest easy chair, as David expected, Huttner walked casually to his locker, withdrawing his pipe and tobacco pouch. He filled, packed, and lit the elegant meerschaum before settling into a thick leather couch. With a wave of his pipe, he motioned David to join him on the sofa.

“Turnbull should have referred that woman for surgery two days ago,” he said, commenting on the internist who had failed to stop the bleeding ulcer. “I’ll bet I wouldn’t have had to take her stomach if he had.” Huttner closed his eyes and massaged the bridge of his nose with carefully manicured, porcelain fingers.

In his early sixties, a tall, angular man an inch or two over six feet with dark hair appropriately gray at the
temples, Huttner appeared every bit the patrician depicted by his press clippings.

“I’ve been hearing some nice things about your work from the nurses in the O.R., David,” Huttner said in his well-cultivated New England accent.

Nice things. David spent several seconds evaluating the compliment. It was a reflex reaction, born of nearly eight years of condescending interviewers and pseudo-solicitous colleagues. David disliked the trait, but had come to expect it. Huttner’s flattery was genuine, he was sure.

“Thanks,” he said. “As you saw tonight, some of them don’t even know me yet. I mean, one major case every week or two is hardly the best basis for judging.” His words were not bitter—merely a statement of fact. David knew that Huttner might perform fifteen or more major operations for each one of his own.

“Patience, David, patience,” Huttner said. “I recall telling you that when you first came to see me about applying for staff privileges. You must remember that, just as physicians are constantly hoisted up on pedestals, so are they also under continuous, magnified scrutiny.” He tapped his fingertips together, carefully selecting his words. “Problems such as … ah … have befallen you are not quickly forgotten by the medical community. They are a threat, pointing up a vulnerability that most doctors don’t want to admit they have. Just keep doing good, conscientious work the way you have been, and the cases will come.” He sat back pontifically and folded his hands around the meerschaum.

“I hope so,” David said, his smile a bit forced. “I want you to know how grateful I am for your trust and acceptance. It really means a lot to me personally.”

Huttner brushed the compliment off with his pipe, although his expression suggested that it was expected and would have been missed. “Nonsense, I’m the one who is grateful. It’s a relief to know that my patients
will have a bright young Turk like you looking after them while I’m gone. As I recall, you trained at White Memorial, didn’t you?”

“Yes, sir, I was chief resident there once upon a time.”

“I never could seem to get accepted into that program,” Huttner said, shaking his head in what might have been wistfulness. “And it’s ‘Wally.’ I get enough ‘sirs’ every day to fill King Arthur’s Court.”

David nodded, smiled, and stopped himself at the last possible instant from saying, “Yes, sir.”

Huttner bounced to his feet. “A quick shower, then I’ll sign out to you on the floors.” He tossed his scrub suit into a canvas hamper, then took a journal from his locker and handed it to David. “Take a look at this article of mine on radical surgery for metastatic breast disease. I’ll be interested in what you think.”