CHAPTER 1

"Drained."

"Wiped."

"Fried."

"Burnt."

"Oh, that's a good one."

"Okay, whose turn is it?"

"Dr. Cameron's."

"Hell no, lass. Not me. I just did tuckered out."

"Then it's Dr. Grant's turn."

From his position across the operating table from his partner, Will Grant surveyed the three nurses and, finally, the anesthesiologist.

"You sure?" he asked.

"It's you, all right," the scrub nurse said.

"I can't think of any more."

"Well you damn well better, laddie," Cameron said, his Highlands brogue as dense as it had been when he moved to the States a decade and a half ago. "Give me a sponge on a stick please, would you, Mary? Thank ye. Now, Will, today's word was your idea. T'would be a travesty for you to lose the whole shibickie and end up buyin' the beers for this motley crew."

Before he could reply, Will yawned widely enough to displace his paper surgical mask off his nose.

"Seems like I should have picked some word other than exhausted," he said as the laughter died down. He turned his head to allow the circulating nurse to reposition his mask. "But it was the only one I could think of."

"No surprise there," Cameron said. "We should allow 'Dr. Will Grant' as a legal answer to this one because, laddie, you define the term. I couldn't believe it when I heard you were covering again tonight."

"Four days of alimony."

"What?"

"Every extra call night I take from you guys translates into four days of alimony paid—more if I get a case."

"Which you almost always do. Well, we're getting ready to close. Sir Will, my trusty assistant, do you have any reasons why we shouldn't go ahead and sew up this lucky bugger?"

"Stomachs R Us," Will said. "You did a really nice job getting that tumor out, Gordo."

"You forgot to add 'as always.' "

"As always. How about prostrate?"

"Debbie did that already," the circulating nurse said. "I've been keeping track. Fatigued, winded, frazzled, run down, wilted, sagging, flagging, weary, sucking wind, tired, overtired, dog tired, dead tired, worn out, prostrate, whipped, spent, leaden, run down, pooped, too pooped to pop, baked, toasted, enfeebled, haggard, tuckered out, plumb tuckered out, drained, wiped, fried, and burnt. You only have until Dr. C. gets the last clip in."

Will flexed his neck muscles, which, after a three-and-a-half-hour case, felt as if someone had injected them with Krazy Glue. It was only a slight exaggeration to say that the last time he hadn't been some form of exhausted was eighteen years ago when, at twenty-three, he started medical school. Med school, internship, surgical residency, vascular fellowship—he often wondered if he had known, really known, about the call schedules; and the interminable hours in the OR; and the early morning emergencies; and the office practice; and the continuing-education responsibilities; and the staff meetings; and the mushrooming malpractice premiums; and the ambulance chasers, and the diminishing financial returns brought about by managed care; and ultimately the divorce and supplementary nights on duty to make ends meet, would he do it all again the same way. The answer, as always, was yes—except, of course for the managed-care part.

"Last clip coming down, laddie," Cameron announced, lowering the final surgical clip dramatically toward the incision.

"Petered out," Will blurted at the last possible second.

Silence held sway as those in OR 3 polled one another.

"We'll give it to you, Will-boy," Cameron said finally, "as long as you assure us your answer isn't merely a description of your sex life."

Fredrickston Surgical Associates was a four-person group, headquartered in the Medical Arts Building, a block away from Fredrickston General Hospital, a fully designated trauma center thirty miles southwest of Boston. The four surgeons rotated call with three others, although in any given seven-day stretch, Will would take on one or even two nights in addition to his own. Today, Tuesday, he finished seeing patients in the office, then trudged back to the hospital through the raw, gray afternoon. James Katz and Susan Hollister met him for sign-out rounds outside the surgical intensive-care unit. Katz, now in his late sixties, was the patriarch of the practice, if not the entire hospital. He was as stiff in his manner and speech as he was in his posture, and to the best of Will's knowledge, no one had ever mentioned him telling a joke. Still, the man was universally beloved and respected for his dignity, his skill in the operating room, and his ability to teach residents and other physicians.

"Weren't you just on call, Will?" he asked.

"That was two nights ago, and it was incredibly quiet. Steve Schwaitzberg wants to chaperone some sort of overnight with one of his kids' classes."

"Is he going to pay you back with a night?" Katz pressed.

Whether it was his liberal politics and interests, his relaxed dress and manner with the patients, or his inability to keep his marriage together, Will sensed he had, for some time, been Katz's least favorite of the three younger associates. Still, the two of them had always been on decent terms, although there was invariably some tension when the subject of Will's extra call nights came up.

"He probably will pay me back," Will said, knowing—as doubtless did his senior partner—that the truth was being stretched.

"Don't you see the twins on Tuesdays?" Susan asked.

As reserved and conservative as Gordon Cameron was flamboyant, Susan had preceded Will into the practice by two years. A competent surgeon, she was quite slender and attractive in a bookish way, but to the best of Will's knowledge had never been married. For several years, she had been dating a businessman—at least according to her she was. Will had never met the man, nor had Gordo. And from time to time, Cameron would speculate that Susan's businessman was, in fact, a businesswoman. Regardless, Susan had gone from being reserved and somewhat distant from Will before his divorce to being a concerned friend, worrying about his health, his children, and even his social life. One of the rare times Will had allowed himself to be fixed up was with a former Wellesley College roommate of Susan's. Had he taken years of acting lessons, he couldn't possibly have been less himself than he was that night.

I'm just not ready, he reported to Susan after the spiritless evening. We didn't have anything in common. She was a human being.

"I do have the kids, yes," he said, "but tonight's our regular night at the soup kitchen, so I'll just take call from there until I bring them home. Speaking of the Open Hearth," he added, determined to divert the subject from his taking too much call, "we're always looking for volunteers to serve."

"When I resign from the symphony board, I just might take you up on your invitation," Katz replied sincerely.

"Me, too," Susan added with more sparkle.

"I didn't know you were on the symphony board," Will said.

"I'm planning on being on it someday."

"All right," Katz said, "let's get on with this. Will, it's a good thing you enjoy your work, because you certainly do a heck of a lot of it."

Jim Katz had seven patients in the hospital, Susan and Will three apiece, and Gordon Cameron, who had already gone home, two, including the case he and Will had done earlier in the day. The trio of surgeons that included Steve Schwaitzberg had another five. Schwaitzberg had signed his three out over the lunch hour, and the other two would do so by phone. Twenty patients in all—a load by modern standards. Insurance restrictions had seen to it that most of them had received their pre-op evaluations as outpatients, and had been operated on before they had even seen their rooms or met the nurses who were going to be their caregivers. The moment after their surgery was completed, they were being primed for discharge. Actuarial tables compiled by the managed-care and insurance industries had demonstrated that such policies saved money without causing a significant rise in post-op complications. Will's experience with his own and many other practices had shown that a good number of patients would gladly beg to differ with those statistics.

Copyright © 2004 by Michael Palmer