Scalpel, page 23
Jack and Janet met me in the hall. They had had no luck with Mrs. Nelson. The Empress wouldn’t budge. She was going to wait for Dr. Gleeson.
“Okay,” I said. “I’ll have to give her a shot and knock her out.”
“Can’t we wait a little while?” Jack asked. “We’ve got to hear from him shortly.”
“I’ll wait only till the ambulance gets here,” I said. I was getting a little short-tempered. All I could think of was: what happens if Dr. Gleeson doesn’t show up? What then? Jesus, I didn’t want to think about that. I couldn’t.
“I’m going to call Julia,” Janet said. “What’ll I say?”
“Tell her and Huffy to get down to the hospital as quietly as possible,” I said. “Leave Helen and General Ritter to handle things at the party. No reason to cause an uproar.” She moved into her father’s room to telephone and I said to Whitfield: “You come in with us.”
We went back into Mrs. Nelson’s room. She was grim and tough and there was defiance in her face; and now that the morphine had deadened the pain, she was the authoritarian, the woman of inflexible will who had built an empire. She wasn’t going to the hospital until Dr. Gleeson said so and that was that.
I reached into my bag and got the hypodermic and an ampule. “Get on the other side of the bed, Whitfield,” I said. “Move in here, Jack. Pin her down. Hold her.”
They were aghast.
Mrs. Nelson exploded. “How dare you! How dare you!”
“I’m not going to argue with you any more,” I said to her. I showed her the ampule. “This is sodium pentathol. I’m going to give you a shot of this. Sixty seconds after you get it you’ll never know what hit you. We use this on hysterical cases. When people are afraid. Now, am I going to give you this or are you going to behave and do exactly as I say?”
“Afraid? Who said I was afraid?” she said.
“Stop arguing,” I said. “Do I have to give you a shot of this or don’t I?”
“Of course you don’t,” she said.
The senior son-in-law and the butler relaxed...
2.
When the ambulance got Mrs. Nelson to the hospital she was in shock and near collapse. While they were taking her up to her room I had the switchboard operator check with the exchange and with Mrs. Gleeson about the doctor. Finding Dr. Gleeson now became all important. But no Dr. Gleeson. He was still between that last call and his house. Where the hell had that last call been—Bermuda? What the hell kind of monkey business was this—an hour to get from the last call to his home. Where the hell was he? Mrs. Nelson was his patient, not mine. She didn’t want me on this job, she wanted him.
I wanted him on this job too. This was not right. For how many years had he been collecting his retainer at no less than $20,000 a year? He’d collected a fortune and all he’d done was prescribe a few pills and now that she really needed him, he wasn’t available.
I began to sweat some more.
The operator said that Mrs. Curtis was calling.
“Try to find me—but don’t,” I said.
I went up to Mrs. Nelson’s room. Eustace was there with two of the staff nurses, Hampton and Zorndorff, and the lab man, Awalii. Mrs. Nelson was having a severe pain spasm and when it had passed the first thing she said to me was, “Where is Dr. Gleeson?”
“I’m hoping he’ll be here right away,” I said, and that was no lie. “But until he does there are a few small things that have to be done. I intend to do them—one way or the other. Will you try to help me?”
“Yes—” she said.
I started an intravenous, five per cent glucose in saline; and had Awalii take the blood for counting and typing. I had the portable X-ray brought up to make a flat plate of the abdomen. Then came the fun, trying to get the Levin tube down her, the nasal gastric suction tube. This is a terribly uncomfortable procedure to the patient and she fought like a tigress. She wouldn’t listen to reason, and I certainly was in no mood to do very much arguing. All I could think of was what would happen to me if she died. I made ready to give her a shot of sodium pentathol. This took some of the fight out of her; and we finally got the tube down.
I asked Hampton to keep checking on Dr. Gleeson and Eustace and I went out into the corridor.
The Messengers and the Suttons were waiting. They were on needles and pins and tried not to show it. That made five of us on needles and pins and trying not to show it. I said to them: “We’ll know in a few minutes. Try not to worry,” thinking what gall I had to tell people not to worry.
Eustace and I went out onto the fire escape. The night was cool. It was very cool to me, the way I was sweating. Two million sweat glands in the human skin. The book said so. I wish somebody could have counted mine...I could hear the rise and fall of traffic, automobile horns. Could one of these be Dr. Gleeson? No. Not yet. This was my show. All along I had had the feeling that it would be. The irony was perfect. Dr. Gleeson would come when the performance was over. That was the kind of situation this was. God was in His Heaven and all was right with the script writer.
“...are we going to wait for Gleeson?” Eustace was saying.
“I don’t see how we can,” I said.
“We could depend on the tube and watch her—”
I shook my head. “No. I feel there’s strangulation.”
“Well, I dunno—”
“I think so,” I said. Thought? I knew. Unerringly, I knew. It had to be. Else there would have been no situation. It wasn’t a matter of diagnosis, which occasionally can be wrong; it was a matter of mathematics, which can never be wrong. Mrs. Henry Nelson being what she was and Dr. Tom Owen being what he was, the fatefulness was so absolute it was mathematical. The Bellyache That Nipped A Fine Surgical Career In The Bud, I thought. Nothing serious. Take your little black bag and rush over to Fair Oaks. No ambitious doctor could pass up such an opportunity. I would be very happy to attend Her Majesty. With a lift of her finger she could make a cigarette, a cosmetic, a champagne—or a doctor. But what I had completely forgotten was that by a lift of the finger she could also break a cigarette, a cosmetic, a champagne—or a doctor.
An intestinal obstruction. My God.
...the white blood count was 22,500 with 95 per cent polys.
Of course.
Eustace and I went to the X-ray lab and had a look at the wet plate. The plate confirmed my diagnosis of intestinal obstruction.
“Well, you may be right,” Eustace said. “It may be a volvulus.”
Of course.
I told the Messengers and the Suttons that my diagnosis had been correct. I said I’d have to operate at once. They nodded and I asked them to go in with me and help break the news to Mrs. Nelson.
She was still rugged. She left no doubt in anybody’s mind that she thought I didn’t know what I was talking about. They tried to convince her that I wasn’t guessing, that the X-ray had confirmed the diagnosis and that it was very, very serious.
My nerves buckled. I leaned over to her. “You want to die?” I said.
“What a stupid question,” she said.
“All right,” I said. “Get her to surgery,” I said to the staff.
I went out.
Janet Messenger followed. She said: “Tom, pay no attention to her. There’s nobody in the world we’d rather have do this than you.”
“Thank you—” I said quietly.
God was in His Heaven and all was right with the script writer...
I was scrubbing my nails with a stiff nylon brush. I was born scrubbing my nails. I was raised scrubbing my nails. All of me had to be clean, but the fingernails were what counted most. SCRUB YOUR NAILS. It was a roar that had boomed down through four generations of miners—it was a symbol of emancipation from the slavery of the carboniferous caves. How far had I been emancipated? In spite of my pretense, how far had I jumped? From a scrub brush and a bar of laundry soap to a stiff nylon brush and an alcohol solution. How far was that? I will tell you how far was that. Four feet, eight and one-half inches. That is how far—the width of the railway tracks.
“...spinal, Doctor?”
I looked around. The anesthetist had his head in the door. “I’d rather not,” I said. “She’s been in shock. Make it a general.”
I moved into surgery. Lasher was capped, gowned, masked and gloved. She handed me a sterile towel and I dried my hands on it and tossed it into the corner. She held up my gown and I got into it. McNally, the circulating nurse, came in from the corridor door and moved to tie me off.
“The Exchange still hasn’t heard from Dr. Gleeson,” she said.
“He’s in Bermuda,” I said.
“Sir?” she said.
“He’ll be here,” I said.
Of course.
Lasher held out my gloves for me and I worked my hands into them and followed her into surgery.
I moved to the table. Lasher had draped the patient. Everything was ready.
I directed McNally to adjust one of the lights to remove a bad halation on the instruments, and I got comfortable on the balls of my feet and stretched my hands inside the rubber gloves.
Lasher held out the scalpel. I kept on stretching my fingers inside the rubber gloves. Go ahead and take the knife, you four-flusher, I said to myself. What’re you waiting on? There’s no reprieve now. There’s the Empress, prone and waiting for you to commence the operation she didn’t want you to perform. Take the knife and pull the switch on yourself. This is no tonsillectomy, this is no appendectomy, this is no small thigh-stitching job on a dame who was accidentally gashed with a No. 5 iron; this is the Big One. This is the Empress. An adequate job won’t do. Pretty good won’t do. Excellent won’t do. Maybe plain magnificent will get you by. Anything less than plain magnificent and you’re on your way down the drain to the mighty Ohio, you and your precious Utrillo. Maybe Mom was right. Maybe ambition was something a coal miner’s son shouldn’t have.
I took the scalpel, glancing at Lasher. Our eyes held. Did she know? She must have. Couldn’t she smell me sweating? Even I could...
I turned back to the patient and made a lower mid-line incision from the umbilicus to the symphisis pubis, going through the skin and fat. Eustace clamped the bleeders and I tied them off.
Lasher handed me wound towels and I applied them to the margins of the incisions, and then I developed my incision down to the peritoneum. A bluish discoloration was now evident. I went through the peritoneum and there was an immediate escape of bloody fluid. Lasher had the aspirator ready. It cleared away the fluid and I saw the sigmoid. It was enormously distended and gangrenous.
Eustace said: “Should we bring it through the incision and deliver now?”
“I don’t want to risk a rupture,” I said. Damn right, I didn’t...
Lasher handed me the needle to aspirate the sigmoid. She had anticipated me. She was always anticipating me. She was doing her best to make me look good. She attached the suction to the needle and the gas and fluid were drawn off. With the distension lessened, I brought out the sigmoid.
It had a 180-degree volvulus, black and lusterless.
“You were right, Doctor,” Lasher said quietly.
“Indeed he was,” Eustace said.
I untwisted the volvulus and stepped back. I gave the sigmoid a chance to improve its color, but there was no improvement. “Hot pack,” I said. I put the hot pack on. “I’ll give this fifteen minutes,” I said.
...in fifteen thousand million minutes there still was no improvement in the color; and even before I said that I was going to resect, Lasher handed me the rubber-shod clamps and I clamped off the nongangrenous portions of the sigmoid. She had the Payr clamps waiting. I put these on and took the scalpel from her and resected an eighteen-inch section of the gangrenous sigmoid and anastomosed the two ends of the bowel. I sutured over the Payr clamps to avoid spillage, and then removed them.
I was closing the abdominal wall when the nurse came in and said that Dr. Gleeson was outside and wanted to know if he could come in.
Of course. Somebody else right on cue.
“Are we ready for inspection, Lasher?” I asked.
“I think so, sir—” she said.
I thought so too.
“Doctor Owen,” the nurse said again. “May Doctor Gleeson come in?”
“By all means. By all means,” I said.
Dr. Gleeson could come in. Dr. Gleeson could bring with him the House of Delegates of the A.M.A., the faculty of Heidelberg, all the Fellows of the R.C.S., and all the assorted society columnists of the Eastern seaboard.
That he could.
The Dowager Empress was safe.
The Lord High Chamberlain could now issue the bulletins.
I felt fine and mellow. Wonderful, wonderful night. Hack or mediocrity, it mattered not now. They all looked the same in the record book. This made me Big. The Dowager Empress...
“—she’s fine for the moment,” I said to the Suttons and the Messengers, quietly professional, as if sigmoid resections were something I did every night, in wholesale lots. “Of course, nobody knows which way these things’ll jump, but—”
Dr. Gleeson interrupted to say that I was much too modest. He assured them that Mrs. Nelson would be as good as new. He said my diagnosis had been perfect and that I had done an exceptionally skillful job. He told them that by no stretch of the imagination could Mrs. Nelson have been in better hands.
I thought: an opinion not even approximately shared by me an hour ago. “Thank you, Doctor,” I said. “As I explained—I waited for you as long as I could—”
“You did perfectly right, Doctor,” he said. He looked at me and there was some puzzlement in his face and he said: “Oddest thing. Tonight, I bowled. In my whole life I’ve never before bowled—but tonight I bowled.”
Suddenly, I felt cold all over and heard a rush of wind and felt space around me: Tonight, he bowled. In his whole life he’d never bowled before—but tonight he bowled. From far away I stared at him and began to realize that what I microscopically saw in his face was not puzzlement but incomprehension, as if he had for a flash been permitted to glimpse the materialization of some kind of potent mysticism. And I felt that too, because a man who in his whole life has never bowled just does not go bowling at a time like that for no reason at all: his psychic apparatus has responded to something. The sensation was transitory, but seizable—and then I was back in the corridor with them, smiling, saying to him that he’d have to do some tall talking to square me with Mrs. Nelson, that I’d had to threaten her with sodium pentathol to get her to the hospital, and that to get her into surgery I had very nearly had to put a headlock on her. He laughed and said he thought he could square me, and I laughed and said I hoped so...and wondered if he too was still trembling a little from the why of his bowling.
Jack Messenger said that Beau Pittsburgh was on the way down and that the newspapers had been tipped off and had called and wanted some kind of a statement. I deferred to Dr. Gleeson in this matter, but not too obviously. Nice and smooth. God was in His Heaven and all was well with the script writer. Dr. Gleeson said Jack should tell the newspapers exactly what had happened, and Jack said he would; and Dr. Gleeson said to me: what about lunch tomorrow?
“You and I and Dr. Kinkaid,” he said. “He’ll want to meet you and be with us when we look in on Mrs. Nelson.”
“I thought Doctor Kinkaid was in Canada,” I said.
“He is. Hunting moose.” Dr. Gleeson gave me a broad wink. “But he’ll be back if they have to get him out of the woods with a helicopter.”
Everybody laughed. They knew what he meant. I thought: He needn’t hurry. It’s too late to lock the stable now.
Jack said all right, he’d tell the newspapers and then we’d shove off. The party had closed out at his place and the remnants had moved to Helen’s apartment and they were carrying on there. They were waiting for us. We’d go by and have a nightcap.
“Good,” I said. “I could use one.”
Dr. Gleeson begged off. He said he thought he’d better get on home. He’d have his girl call when he heard from Dr. Kinkaid.
“Do that—” I said.
I told Janet and Julia that I’d see them at Helen’s, and went on down to the locker room. Awalii was there, and Eustace, who was just getting out of the shower.
Eustace said: “You have to use the smelling salts on Gleeson?”
“He’s bearing up pretty well—for a man who just lost his gold mine,” I said. “But what the hell...he’s been skimming the cream off the top for twenty years. He’s got his—”
“He better have,” Eustace said.
Out of my locker I took the bottle of Scotch that was positively against regulations to have; and Eustace and Awalii and I had several straight shots. They did not toast, but I did every time: once to God, with thanks; and once to the script writer with thanks...
Red, the colored attendant, saw me coming down the steps into the garage. Smiling broadly, the inevitable blue dusting rag in his hand, he moved towards me. “Well, Doctor, sir, congratulations on the operation,” he said. “I’m sure glad it turned out good.”
I was a little surprised. “How do you know how it turned out?”
“I can tell.” He nodded vigorously. “I been here a long time. I seen too many doctors come down them steps not to know. I see ’em go up and I see ’em come down. I can tell. You ain’t the same doctor that went up ’em a little while ago.”
I smiled. “That’s for dead sure, Red,” I said. “I had a right to be worried. You know who my patient was?”
