Sisterhood (7 page)

With that, he strode into the shower room, calling out just before he turned on the water, “You play tennis, David? We have to get together and hit a few before the weather closes in on us.”

“It’s often hard to distinguish between my tennis and my weight lifting,” David said softly enough to be certain Huttner couldn’t possibly have heard. He thumbed through the article. Printed in a rather obscure journal, it advocated radical breast, ovarian, and adrenal surgery for patients with widespread breast cancer. The concept was nothing revolutionary. In certain instances it was accepted. However, as horrible as the disease was, seeing the radical surgical approach laid out in print, scanning the tables of survival, brought a tinge of acid to David’s throat. Survival. Was that really the bottom line? He slapped the journal shut and shoved it back in Huttner’s locker.

The page operator was announcing the eight o’clock end to visiting hours when the two surgeons started
making rounds on the floors in the West building. Earlier David had seen the patients he had in the hospital—a ten-year-old boy in for repair of a hernia and Edwina Burroughs, a forty-year-old woman whose factory job and four pregnancies had given her severe varicose veins, gnarled and twisted as the roots of a Banyan tree.

Wallace Huttner had more than twenty-five patients scattered over three different buildings. Almost all of them were recovering from major surgery. On every floor Huttner’s arrival had immediate impact. Horseplay around the nurses’ station stopped. Voices lowered. The charge nurse materialized, charts in hand, to accompany them on their rounds. Replies to Huttner’s occasional questions were either stammered monosyllables or nervous outpourings of excess information. Throughout Huttner maintained an urbane politeness, moving briskly from one bedside to the next without so much as a hint of the fatigue David knew he must be feeling. The man was absolutely one of a kind, he acknowledged to himself. A phenomenon.

Before long, a comfortable pattern had evolved to their rounds. Huttner allowed the charge nurse to lead them to the doorway of a room. Then he took the patient’s chart from her and proceeded to the bedside. David, the charge nurse, and often the staff nurse on the case followed. Next, Huttner handed the unopened chart to David, introduced him to the patient, and gave a capsule history of the initial problem, operative procedure, and subsequent course of treatment, couching details in medical jargon that no one except a physician or nurse could possibly have understood.

Finally he conducted a brief physical examination while David flipped through the record, using a spiral-bound pad to record pertinent lab data as well as Huttner’s overall approach and plan for the case. For the most part, he tried to remain inconspicuous, speaking
when addressed, but keeping his questions to what seemed like an intelligent minimum.

From time to time he glanced at Huttner. As far as he could tell, the man seemed satisfied that his charges were being left in capable hands. Before long, though, David began feeling uneasy. Despite the legends, the backup residents, and the unquestionable—perhaps unparalleled—surgical skills, Wallace Huttner was sloppy: progress notes were brief and often lacking some piece of information; some abnormal laboratory results went undetected for several days before they were noticed and a recheck ordered. Small things. Subtle things. But the pattern was there, unmistakable. It was not the kind of carelessness that would affect every case, but inevitably it would be manifest somewhere—in a prolonged hospital stay, a second operation, even a death.

He must know, David thought to himself. He knows, but so far he just hasn’t found any way of dealing with the problems. It wasn’t lack of pride or caring or skill—Huttner clearly possessed all three. The man was simply spread too thin, David decided. Too many cases. Too many committees, panels, and teaching obligations. How much could a man do in one day? Sooner or later he must either draw lines or make compromises or … get help. Maybe Lauren was right, he realized excitedly. Maybe Huttner
was
looking for a partner. Or maybe, David laughed to himself, Huttner had chosen him to cover the practice believing that of all the surgeons in the hospital he was the least likely to notice these inadequacies. No matter. The oversights and omissions were small ones. He would go through the charts the next day and fix it all up.

Just keep your mouth shut, he told himself. Only a few cases to go, then you’re on your own.

Minutes later, David’s decision to keep silent was challenged. The patient was a man in his late fifties, a
commercial fisherman named Anton Merchado. He had been admitted to the hospital several weeks earlier for an abdominal mass. Huttner had drained and excised a cyst on the pancreas and Merchado was recovering nicely when he developed symptoms of an upper respiratory infection. In a telephoned order, Huttner had put the man on tetracycline, a widely used antibiotic.

The condition must have improved, David thought, because there was no further mention of it in Huttner’s brief notes. However, the tetracycline order had never been rescinded. It had been in effect for nearly two weeks.

Anxious to speed up rounds, Huttner was giving his capsule review of the man’s history while he examined his heart, lungs, and abdomen. David stood off to one side, his attention focused more on the chart than on what the older surgeon was saying.

On the day before Merchado was to be discharged from the hospital, he had developed severe diarrhea. Huttner’s initial impression was viral enteritis, but over a few days the condition worsened beyond what a simple viral infection would cause. The early signs of dehydration began to appear.

David flipped from the progress notes to the laboratory reports and back. Huttner’s mounting concern was mirrored each day in an increasing number of orders for laboratory tests and diagnostic procedures, all unrevealing. Efforts intensified to keep pace with Merchado’s deteriorating condition, but there could be no doubt that the man was on a downhill slide.

As David read, the germ of an idea took root. He scanned page after page of laboratory reports, looking for the results of the stool cultures that had been ordered on several successive days.

“Well, what do you think?” Huttner said, turning to David. “David? …”

“Oh, sorry.” David looked up. “I noticed the man
was still on tetracycline and was just looking to see if he might have somehow developed staph colitis secondary to the treatment. It doesn’t happen often, but …”

“Tetracycline?” Huttner interrupted. “I called in a stop on that order days ago. They’re still giving it to him?”

Behind Huttner, in David’s line of vision, the charge nurse nodded her head in vigorous confirmation.

“Well, no matter,” Huttner said, hesitating slightly. David could almost hear him asking himself whether he had actually called in the stop order or had just meant to. “The culture reports have all been negative. Why don’t you write an order to take him off tetra. Go ahead and get another culture if you want to.”

David was about to comply when he noticed a culture report at the bottom of the lengthy computer printout that listed all results obtained on the patient to date. It read

“9/24, STOOL SPEC:
MODERATE GROWTH, S. AUREUS,
SENSITIVITIES TO FOLLOW.”

Staph aureus
, the most virulent form of the bacteria. David closed his eyes for a moment, hoping that when he looked at the sheet again the words would be gone. He took several seconds in making the decision to say nothing about his discovery and to correct the problem later. The hesitation was too long.

“What is it, David?” Huttner asked. “Have you found something?”

“Dammit,” David cursed to himself. A dozen possible responses poured through his mind, were evaluated and rejected. There was going to be no comfortable way around it. No place to hide. Out of the corner of one eye he saw the two nurses standing motionless at the end of the bed. Did they know that in the next few
moments the success of the evening and possibly of David’s career might vanish?

The whole scene became strangely dreamlike for him. The hand slowly passing Merchado’s chart to Huttner, the finger pointing at the offensively impersonal line of type—they were someone else’s, not his.

The look David had last seen directed at the O.R. scrub nurse sparked in Huttner’s eyes. They locked with his for a fraction of a second, then turned on the nurses. He thrust the chart at the charge nurse.

“Mrs. Baird,” he growled, “I want you to find out who is responsible for failing to call my attention to this report. Whoever it is, nurse or secretary, I want to see her in my office first thing Monday morning. Is that clear?”

The nurse, a stout veteran who had engaged in her share of hospital wars, looked at the page, then shrugged and nodded her head. David wondered if Huttner would actually follow through with what seemed so obvious an attempt to produce a scapegoat.

“Come along, Dr. Shelton,” Huttner said curtly. “It’s getting late and we still have several more patients to see.”

It was nearly ten o’clock when they arrived on Four South to see the last of Huttner’s patients, Charlotte Thomas. For the first time all evening Huttner deviated from the routine he had established. Taking the chart from the charge nurse, he said, “Come and sit down in the nurses’ lounge for a bit, David. This next patient is by far my most complicated. I want to take a few minutes to go over her with you in some detail before we see her. Perhaps someone could bring us each a cup of coffee.” The last remark was transparently addressed to the nurse, who managed a faint smile of acquiescence. “Light, no sugar for me, and for Dr. Shelton …?”

“Black,” David answered. For a split second he had almost said “bleak.”

“Here you go, Doctor,” Huttner said, sliding the chart across to David. “Leaf through it while we’re waiting for coffee.”

Before reading a word, David could tell that Charlotte Thomas was in trouble. Her hospital record was voluminous. He thought back to his residency and a tall, gangly New Yorker named Gerald Fox, who was one year ahead of him. Fox had achieved immortality, at least in White Memorial Hospital by Xeroxing a three-page list of cynical maxims and definitions entitled, “Fox’s Golden Laws of Medicine.” Among his axioms were the definition of Complicated Case (“When the combined diameters of all the tubes going into a patient’s body exceeds his hat size”), Gynecologist (“A spreader of old wives’ tails”), and Fatal Illness (“A hospital chart more than an inch thick”).

Coffee arrived just as David had begun to scan the admission history and physical examination. He heard Huttner say, “Ah, Miss Beall, thank you. You’re an angel of mercy.”

He looked up from the chart. It was not the nurse with whom Huttner had placed their order, but a far younger woman David had never seen, or at least had never noticed before. For several seconds his entire world consisted only of two large, oval, burnt umber eyes. He felt his body flush with warmth. The eyes met his and smiled.

“So, are you with our lady Charlotte again?” Huttner asked, oblivious to the silent meeting that was taking place.

“Huh? Oh, yes.” Christine broke the connection and turned to Huttner. “She’s not looking too well. I asked to bring the coffee in because I wanted to talk to you about …”

“How rude of me,” Huttner interrupted. “Miss Beall this is Dr. David Shelton. Perhaps you two have met?

“No,” Christine said icily. She was well acquainted with Huttner’s lack of regard for the insights and suggestions of nurses. Over the years she had given up even attempting to share hers with him. But Charlotte’s situation was distressing enough for her to try. If Huttner would only agree to let up on his aggressive treatment, to cancel the resuscitation order, she might not intervene even if the Screening Committee approved her proposal. So she had tried, and predictably the man had cut her off—this time with an inane social amenity. Still, she felt determined to speak her mind. It was
his
tube that was sticking into Charlotte’s nose.
His
order to prolong her suffering no matter what. He could play puppet-master with his other patients, but not with Charlotte. He would listen or … or have his strings to her cut. Christine swallowed the bone of anger that had begun sticking in her throat.

Huttner took no note of the chill in her voice. “Dr. Shelton will be covering all my patients, including Mrs. Thomas, for a few days,” he said.

Christine nodded at David and wondered whether he might have the authority to back off on Huttner’s overzealous approach to Charlotte, then realized there was no chance the surgical chief would permit that. “Dr. Huttner,” she said flatly, “I would like to talk to you about Charlotte for a few minutes.”

Huttner glanced at his watch. “That would be fine, Miss Beall,” he said. “Why don’t you let us finish reviewing Charlotte’s case and examining her. Then you can go over things with Dr. Shelton here. He’ll know exactly what I want for this woman.” Huttner looked away before the first of the daggers from her eyes reached him. David shrugged his embarrassment, but Christine had already turned on one heel and left the room.

Huttner took a sip of coffee, then began speaking without so much as a word or gesture toward the nurse who had just left. “Mrs. Thomas is a registered nurse. In her late fifties, I think.” David glanced at the birth-date on the chart. She was nearly sixty-one. “Her husband, Peter, is a professor at Harvard. Economics. She was referred to me by an internist because of a suspected cancer of the rectum. Several weeks ago, I performed a Miles’s resection on the woman. The tumor was an adenocarcinoma extending just through the bowel wall.

“However, all the nodes I took were negative. I feel there’s a very good chance that my clean-out may have gotten the whole thing.”

David looked up from the coffee stain he was absently erasing with his thumb. The five-year survival rate after removal of a rectal cancer with such extension was under 20 percent. A chance? Certainly. A “very good chance”? He leaned back and wondered if it was worth asking Huttner to clarify the reasons for his optimism. It would not, he decided, be wise to question him about anything.