Past Lives

Three

Kansas City

USA

Macandrew left Tony Francini with Saul Klinsman still trying to pacify him while he went to examine Jane. What the hell did Francini mean by “not his wife”? One of the nurses saw him as he approached the recovery suite and came over. She said. ‘Mr Francini was here Mac; he was very abusive.’

‘I’ve just seen him,’ replied Macandrew. ‘What’s going on?’

The nurse shrugged and looked uncomfortable. ‘Mrs Francini seems totally disorientated. She’s conscious but doesn’t recognise any of the nurses; she didn’t know her husband; I don’t think she even knows herself.’

‘What does that mean?’

‘She insists her name’s not, Francini,’ said the nurse.

Macandrew entered the recovery room where Jane Francini lay. It was a small, quiet room with subdued lighting in line with hospital policy that patients should come round after their operation in a calm and reassuring environment. Any medical paraphernalia associated with emergency resuscitation was stowed in cupboards behind the patient or out of their line of sight. Jane Francini had opened her eyes to a large print of Kansas corn fields at harvest time hung on a wall of sky blue but, at the moment, she was throwing her head from side to side on the pillow in a state of great distress.

Macandrew watched her shrug off the attentions of the nurse who was with her. She growled angrily at the woman and spoke what sounded to Macandrew like a stream of gibberish. The look in her eyes however, suggested that she thought the nurse should understand and respond to what she was saying. The nurse stepped back to allow Macandrew to take over. She seemed relieved.

He could see that Jane did not recognise him or anything to do with her surroundings. Her eyes flitted all over the room and she mumbled almost continuously. It disturbed him that even her voice seemed different to what he remembered. He recalled a pleasant, quietly spoken, reserved woman who had thanked him for explaining her condition to her and outlining the course of her operation.

Despite the seriousness of her problem, she had kept her sense of humour and had commented on his name, saying that she felt safe in the hands of a “fellow Scot”. She herself was the daughter of second generation immigrants; her maiden name was Campbell. Macandrew remembered wondering at the time why such a pleasant woman had come to marry the brash Tony Francini and had put it down to opposites attracting.

Jane now had a deep rasping voice. Her eyes had changed too; he couldn’t quite put his finger on it but there was something about her expression that alarmed him. She sounded deranged but her facial expression suggested intelligence rather than madness.

‘Mrs Francini, do you remember me?’ asked Macandrew firmly but gently. ‘I’m your surgeon. You’re in hospital. You’ve just had a serious operation but you’ve come through it well.’

Jane Francini’s head stopped moving and her face turned towards him. He saw that she was afraid. She started to speak again and a torrent of unintelligible words swamped Macandrew. Jane Francini’s hands reached up to grab the lapels of his white coat as if imploring him to do something, but what?

‘Take it easy,’ he soothed. ‘There’s nothing to worry about. Everything’s going to be all right. Just relax and get some rest. You’ll feel better real soon, I promise.’ Macandrew gave her a sedative.

In an almost seamless transition, the look in Jane Francini’s eyes changed from fear to puzzlement; her voice also changed. She now spoke in a soft young voice, as if she was a little girl but quite coherently. She looked appealingly at Macandrew. ‘I have to get back now. It’s getting dark. My mother will worry if I’m not home soon.’

‘Where’s home, Jane?’

‘Fulton Grange.’

Macandrew looked to the two nurses who shook their heads but before he could ask Jane anything further, she grew very tired as the drug took effect and her head fell back on the pillow.

‘I’ve given her enough to keep her out for a while,’ said Macandrew. ‘This business isn’t going to do her heart condition any favours.’

‘What’s wrong with her?’ asked the younger of the two nurses in the room.

It was a simple question and Macandrew found himself wishing he had a simple answer other than, ‘I don’t know.’

With Jane sedated and sleeping peacefully, Macandrew returned to Saul Klinsman’s office, albeit with some trepidation. He wasn’t looking forward to another verbal assault from Tony Francini. When he entered, he found Francini sitting in Klinsman’s green leather armchair, nursing a drink; he could smell it on the air; it was brandy. He appeared to have calmed down although Klinsman was still speaking to him in appeasing tones, assuring him that nothing had gone wrong at the operation. The tumour had been removed cleanly and without complications but he had to understand that his wife might still be very ill; it all depended on what the lab report said about the tumour itself.

‘How is she?’ Klinsman asked as Macandrew came into the room.

‘Sleeping. I’ve sedated her.’

‘What’s wrong with her?’ asked Francini. His earlier aggression had been replaced for the moment by vulnerability. His eyes appealed for answers.

‘Quite frankly Mr Francini,’ said Macandrew softly, ‘I haven’t come across anything quite like this before.’

Francini slumped forward in the chair and then re-donned his tough guy mantle. ‘I should have taken her to LA,’ he said to no one in particular. ‘Letting some hick with a knife loose on Janey wasn’t the brightest thing I’ve ever done.’

Macandrew took the insult stoically. The man was hurting. Klinsman moved uncomfortably in his chair behind the desk as Francini went on to slate the Med Centre as if no one was present. ‘Fucking two-bit hick dump...’

‘Mr Francini,’ began Macandrew in controlled fashion.

Francini looked up from the floor and Macandrew almost recoiled at the dislike he saw there in his eyes. ‘Your wife is sleeping; she’ll be out for some time. Why don’t you go home and get some rest? We’ll call you if there’s any news.’

Francini got up slowly and came towards Macandrew. Macandrew held his ground and did his best to remain motionless when, in reality, his brain was warning him to take some defensive action. Francini stopped short in front of him and stabbed his finger into his chest. ‘If I lose her...’ he warned. ‘If I lose her...’ Francini turned and walked out of the room.

Klinsman let out his breath in a long sigh and Macandrew slumped down in a chair and closed his eyes. ‘I thought he was going to hit me.’

‘He might still,’ said Klinsman. ‘Just don’t hit him back. We’re in enough trouble.’

Klinsman’s comment had not entirely been concerned with ethics. Macandrew was a surgeon but he was built like a light-heavyweight boxer. He was at least six inches taller than Francini and probably weighed fifty pounds more. Although his features were refined and his manner gentle, he’d always felt his size was a disadvantage in his chosen profession. Joe public preferred that neurosurgeons be slim and studious — preferably with a mid-European accent and wearing rimless glasses. To be tall and broad was fine for a lumberjack but in the operating room, people started equating size with clumsiness and wondering about dexterity. Even his name was wrong; John Macandrew sounded more like a ranch owner than a doctor. Operate on my kid? The hell yuh will...

‘I really don’t know what’s going on,’ said Macandrew wearily. ‘I only hope it’s some weird reaction to anaesthesia and she’ll be OK when she wakes up.’

‘You and me both,’ said Klinsman. ‘The Med Centre can do without this right now.’

‘What do you mean by “this”?’ asked Macandrew, displaying uncharacteristic paranoia.

Klinsman looked at him dispassionately and said, ‘I have to think of the Med Centre’s reputation, Mac. Mistakes can lead to damaging publicity, not to mention lawsuits.’

‘There was no mistake,’ Macandrew insisted. ‘It was a textbook operation. The tumour was removed cleanly and in its entirety. There was no damage done to any other area of the brain. We haven’t had a full path report yet, but there was no surgical damage. Period.’

Klinsman held up his hands as if in self-defence. ‘I’m not suggesting you screwed up Mac,’ he said. ‘Believe me. It’s just that I’m sitting in the hot seat and we have a patient who appears to be, for the moment at least, post-operatively damaged.’

Macandrew calmed down and thought for a few moments before deciding that there was no point in continuing the conversation. He got up to leave.

‘Keep me informed,’ said Klinsman.

Macandrew paused for a moment outside in the corridor, suddenly feeling very alone. On the way back to his office, he felt sure that people were looking at him accusingly out of the corner of their eyes. He told himself it was probably his imagination — and it was — but he was still relieved when he reached his office and closed the door behind him. After a few minutes of just sitting at his desk with his chin resting on his folded hands, he picked up the phone and called the path lab. ‘Any word on the Francini case?’

‘One moment please.’

Macandrew glanced out at the reddening sky while he waited. It would be dark soon. Not exactly the perfect end to a perfect day.

‘Mac, it’s Carl,’ said the voice of Carl Lessing, Chief of Neurological Histopathology. ‘I was just about to call you. I’ve been looking at the Francini sections. Sorry for taking so long but it’s bad news, I’m afraid. The tumour was malignant and pretty aggressive too. If you have a moment maybe you could come down? There’s something I’d like you to see.’

‘On my way,’ said Macandrew.

Macandrew took the elevator to the basement where the Pathology Department was situated. His eyes watched the floor indicator but his mind was on other things. Jane Francini’s pre-op scans had only shown up a single tumour but in view of what Lessing had just told him about the tumour’s aggressive nature, maybe there had been small secondaries that hadn’t shown up or worse still, had been so small that he’d missed them. This would be one explanation for her condition.

Lessing, a thickset middle aged man with a mane of white hair and a goatee beard sat at his microscope with his glasses pushed up on his forehead. The fingertips of his left hand adjusted the fine focus control of the instrument while he made notes on a spiral-bound pad with his right.

‘What have you got?’ asked Macandrew.

‘Take a look at these two tissue sections. Tell me if you see a difference.’

Macandrew took Lessing’s place and widened the binocular eyepieces a little before looking down. After a few minutes he said, ‘Both are malignant.’ He sounded surprised. He had expected one to be normal.

‘No difference?’

‘Stain colour maybe.’

‘Exactly,’ said Lessing, pleased that Macandrew had picked up on it. ‘The one on the left is Jane Francini’s tumour but the haematoxylin staining is a different colour from the more normal reaction of the other one although, as you say, both are malignant. That’s what caught my attention. The colouring’s unusual and it rang a bell from way back: I think the Francini tumour is a Hartman’s tumour.’

‘A what?’

‘This is not a big gap in your knowledge,’ said Lessing. ‘It’s only the second I’ve come across in twenty years. It was named after the first patient to present with it, Mona Hartman. The tumour cells produce some kind of acidic chemical that affects the staining process in the lab. That’s what brought it to mind — that and the fact that some guys over in Europe did some research on it a couple of years ago and I remembered reading about it. How’s the patient doing anyway?’

‘Not good. I was confident I’d got it all out but the way she’s behaving says there’s something really wrong... maybe there were secondaries that didn’t show up on the scan — or I didn’t pick up on them...’

Lessing could see that Macandrew was worried. ‘Would it help if I was to have a look at the scans?’ he asked.

‘I’d be grateful.’

Lessing asked one of his technicians to fetch Jane Francini’s brain scans. Macandrew told her where to find them.

‘Coffee?’

They went next door to Lessing’s small and cluttered office and he poured coffee from a large flask sitting on a hot plate on top of a filing cabinet. Lessing lit a cigarette.

‘These things will kill you,’ said Macandrew in a weak attempt at humour when he didn’t feel in the least humorous.

‘Something’s going to for sure,’ replied Lessing, displaying the philosophy of a long-serving pathologist.

The technician returned with the scans and Lessing clipped them up on a light box. He examined them for a good five minutes — occasionally employing a small magnifying lens — while Macandrew sipped his coffee and watched.

‘Just the one, as far as I’m concerned,’ announced Lessing.

Macandrew let out his breath in a long slow sigh. ‘Thanks Carl. I didn’t think I’d missed anything but you never know...’

‘I’ll see what I can dig up on Hartman’s tumours,’ said Lessing. ‘I’ll give you a call.’

Macandrew went back upstairs and called Klinsman from his office. Diana French answered. ‘I’m sorry, Mac, Saul has gone for the day.’

Macandrew called Klinsman at home but there was no reply and he decided not to leave a message on the answering machine. He thought about contacting Tony Francini personally to tell him the bad news about the tumour but decided against it. There was still a slim chance that Jane might come out of it OK. He would wait until she surfaced from her sedated sleep before saying anything to anyone. He looked at his watch. With the schedule he had written her up for, Jane Francini would be out for another eight hours at least.

Macandrew didn’t feel like cooking when he got in. Instead, he fetched a packet meal from the freezer and put it in the microwave. When it emerged, it bore little or no resemblance to the appetising delight depicted on the pack. “Delicious Cod Steaks in a light wine sauce” had become amorphous yellow goo. He got a Bud Light from the fridge, picked up a fork and settled himself in front of the television to watch the news while he ate. His attention span only lasted as long as the goo. He picked up then channel changer and started hopping through the stations. Nothing could hold his interest. He couldn’t get Jane Francini out of his mind.

At first, he found his preoccupation hard to bear. After all, he wasn’t an intern wrestling with his first brush with failure. He was a seasoned surgeon who knew and understood the score. Dealing with life and death was part of the job. He was good at his job but he wasn’t a miracle worker. He didn’t pretend to be. So why couldn’t he come to terms with the Francini case? Maybe it was her husband who was bothering him? Listening to him hadn’t been pleasant but then people said all sorts of hurtful things when they were upset and Francini had certainly been that. His wife, as he had put it, was everything to him.

It wasn’t Francini’s behaviour, he concluded, it was Jane herself. He had come across patients who had lost their minds before but Jane Francini was different. Something her husband had said kept coming back to him. He said that she looked like Janey... but she wasn’t.

The more he thought about it, the more convinced Macandrew became that he was right. She just wasn’t Jane Francini any more...

Macandrew didn’t have an operation scheduled for the following day so he permitted himself a couple of large Bourbons. He needed a good night’s sleep and the alcohol would help. Normally he would sleep late when he wasn’t operating, take a leisurely shower and read the morning paper over breakfast but tomorrow he wanted to get into the Med Centre early. He wanted to be there when Jane Francini came round. Please God she would have recovered but somehow he feared that this was wishful thinking. He tried looking up Hartman’s Tumour in his textbooks but failed to find any mention. If Carl Lessing didn’t come up with something, he would take a trip to the Med Centre library.

Jane Francini regained consciousness shortly after six thirty am. For a few brief moments Macandrew thought that things were going to be fine; she appeared relaxed and sleepy and the sounds she made were soft and feminine as she moved her head on the pillow. But as he came closer to listen to what she was saying, he realised that all was not well. Jane was speaking in the little girl voice that she had lapsed into on one occasion yesterday.

‘Jane!’ whispered Macandrew in her ear. ‘Can you hear me?’

‘Why are you calling me Jane?’ replied Jane, without opening her eyes.

‘Because that’s your name,’ continued Macandrew gently.

‘Don’t be silly, it’s Emma.’

‘Emma who, Jane?’

‘Emma Forsyth. Stop calling me Jane! Where’s my mother? She said she would take me to town today.’

‘Town?’

‘To get me a new dress. Daddy’s coming home soon and she wants me to look pretty for him.’

‘Where has your father been Emma?’

‘Fighting the enemies of the King. He’s very brave.’

‘The king, Emma?’ asked Macandrew. ‘What king?’

‘There’s only one king, silly,’ said Emma. ‘He’s...’ The words froze on Jane Francini’s lips and for a moment she appeared to have gone into a trance then slowly she opened her eyes and recoiled when she saw Macandrew leaning over her. She behaved as if she’d never seen him before. Her tone of voice had completely changed too as she let out a torrent of meaningless words.

Macandrew backed away from the bed and a nurse murmured, ‘That lady has a problem...’

Jane Francini had now surfaced from the sedation she had been under and was clearly a seriously disturbed woman. Macandrew became aware that the nurse was waiting for him to say something. ‘I’m going to have a psychiatrist take a look at her.’

‘Yes Doctor,’ replied the nurse.

‘For the record,’ said Macandrew without turning round, ‘Mrs Francini’s tumour was both malignant and aggressive.’

‘Tough break,’ said the nurse.

Macandrew returned to his office and picked up some coffee from the machine on the way. He sipped it while he waited for Tony Francini to arrive, half hoping that Saul Klinsman might arrive first but recognising that this wasn’t likely. The head of surgery usually arrived late and left early: this was written in the stars. The phone rang.

‘I came up with some stuff on Hartman’s tumours,’ said Carl Lessing. ‘Not that it’s very encouraging, I’m afraid. From the few recorded cases I managed to find, the prognosis is bad. None of them ever recovered.’

‘Secondary invasion?’

‘Strangely enough, no. Removal of the primary tumour seemed to stop the cancer in its tracks. It was more a case of being left with residual brain dysfunction.’

‘What level of dysfunction are we talking about here?’

‘Euphemism level,’ said Lessing. ‘They were out of their trees: they were all committed.’

Macandrew closed his eyes and screwed up his face. It sounded as if the clinical picture in Jane Francini’s case was matching up to Lessing’s information.

Francini arrived in the Med Centre a little after seven fifteen to find that his wife had been put under sedation again — Macandrew had written her up for this before leaving her to come upstairs. The nursing staff relayed the message to Francini that he should go straight on up to Macandrew’s office.

‘How come she’s still out?’ demanded Francini without any preamble.

‘She came round a short time ago,’ said Macandrew softly. ‘She was very disturbed. I put her under again.’

Francini looked at Macandrew in silence for a moment. At first his expression was questioning, and then it changed to accusation. ‘What are you trying to tell me?’

‘Sit down Mr Francini.’

‘I don’t want to fucking sit down,’ retorted Francini. ‘I want to know what’s wrong with my wife!’

‘Your wife is a very sick lady, Mr Francini. Her tumour was malignant and it’s a very aggressive kind of cancer. The pathology lab made the diagnosis last night.’

‘But you removed the damn thing. You said everything went well.’

‘It did from a surgical point of view,’ said Macandrew. ‘But it so happens that this particular kind of tumour tends to leave patients brain-damaged. We’re not sure why. There may be hidden secondaries or damage we can’t see on the scan. There hasn’t been enough research done on it. It’s a very rare type.’

‘Damaged?’ whispered Francini as if he was scared of the word. ‘What the fuck do you mean, damaged?’

‘The few similar cases we’ve been able to trace were left very severely confused with regard to cerebral function.’

‘You mean Janey is nuts?’ asked Francini, suddenly wide-eyed and vulnerable.

‘I’d like one of our psychiatrists to see her before we make any kind of formal assessment.’

Francini suddenly buried his head in his hands and started to sob. ‘Oh Christ,’ he wept. ‘What the hell am I gonna do?’

‘I’m very sorry,’ said Macandrew, suddenly feeling for the man. ‘I assure you, we’ll do our very best for her.’

Francini suddenly jerked his head up and spat out, ‘No you won’t! You assholes have done enough to Janey. I’m calling in a real doctor.’

‘I’m sorry you feel that way, Mr Francini,’ said Macandrew. ‘But I don’t think you’ll find any comfort in a second opinion.’

Francini stifled his reply as the door opened and Saul Klinsman came in. ‘I was just telling this guy here that I don’t want any of you hicks touching Janey any more. I’m calling in some brains.’

Klinsman shot Macandrew a questioning glance and Macandrew said, ‘Mrs Francini’s tumour was malignant and aggressive — a Hartman’s tumour. I’ve told Mr Francini that it wouldn’t be right for us to reach any firm conclusions on her condition without his wife being seen by a psychiatrist,’ said Macandrew.

‘That would be sensible,’ agreed Klinsman.

‘And I was saying, I don’t want you guys touching Janey,’ interrupted Francini. ‘I’m calling in my own people.’

‘That is your prerogative of course,’ replied Klinsman, ‘but that will probably take a few days if you’re going to bring in someone from out of town. Surely it would be in your wife’s best interests if we were to continue caring for her?’

‘No!’ insisted Francini. ‘I don’t want you bastards causing any more damage. She’s not to be given anything, especially not the knock-out drops this guy’s been using to shut her up.’

Macandrew bit his tongue and said, ‘It’s important that your wife should not be allowed to get over excited, because of her heart condition. That’s why I sedated her.’

‘I want her conscious and alert when a real doctor gets here, not acting like some spaced-out zombie!’

‘I’ll need you to sign something to that effect Mr Francini,’ said Klinsman. ‘You could be putting your wife’s life in danger.’

Francini snorted and said, ‘Danger? After what you assholes did to her? That’s fucking rich!’

Macandrew knew he was in danger of losing his temper. He appreciated that Francini was very upset but the man was pushing things too far. His wife’s condition had been fully diagnosed. The tumour had done the damage to her, nothing else. There had been no mistakes, no overlooked secondaries, no incompetence and he was not keeping her sedated to cover up his own blunders. He was doing his level best to keep her stress levels within reasonable bounds. He looked away so that Francini would not see the anger he felt. He was going to keep his temper if it killed him.

‘When will she come round?’ asked Francini.

Macandrew took a deep breath. ‘Without any more sedation, she should be fully alert in four hours,’ he said.

‘See that she is,’ said Francini, getting to his feet and leaving the room without another word.

Macandrew thumped his right fist into the open palm of his other hand. ‘Christ, that guy is crossing the line!’ he exclaimed.

Klinsman nodded. ‘Mr Francini does lack a certain basic charm.’

‘I really think that Jane might be in danger if we withdraw sedation completely,’ said Macandrew.

‘It’s Francini’s call. We can’t risk him taking us to court,’ replied Klinsman. ‘He may not be the brightest guy in the world but he’s rich and that’s all you need to be to hire the legal brains who’ll crucify us in court whatever the rightness of our cause.’

Macandrew sighed and said, ‘Maybe just 50mg Valium? Who’d know?’

Klinsman nodded. ‘OK, but no more.’

‘Do you think we can rely on Francini staying away for a few hours?’ asked Macandrew.

Klinsman looked surprised at the question. ‘I got the impression he wouldn’t be back until his wife came round. He’ll probably be on the phone most of the morning, making arrangements for some fat cat from LA or Frisco to come out here and teach us to suck eggs. Why?’

‘I’d really like to have someone from psychiatry take a look at Jane Francini. What do you think?’

Klinsman folded his hands in front of him on the desk and thought for a moment before saying, ‘Well, I don’t suppose that could be construed as administering any kind of therapy to the patient. As long as we put it through as an internal matter and don’t add it to Francini’s bill I guess it’ll be OK. Anyone in mind?’

‘I thought maybe, Karen Bliss?’

Klinsman nodded. ‘Good choice. Dr Bliss does seem to have brains.’

Macandrew smiled. Klinsman’s lack of regard for psychiatrists was something of a legend in the Med Centre. He returned to his own office and left Macandrew to call Karen Bliss. She wasn’t in her office and didn’t respond to her bleep. Macandrew left a message for her to call him when she got in. She called an hour later.

‘So you finally got round to asking someone how the thing you cut up all the time really works?’ said the female voice.

Macandrew smiled and said, ‘I thought maybe between us we could come up with something.’

‘What can I do for you, Mac?’ asked Karen.

Macandrew told her about the Francini case. ‘I keep thinking she’s not deranged in the usual sense. There’s more to it but I can’t say what.’

‘From what you say, it sounds like a gross personality change post surgery,’ said Karen. ‘It wouldn’t be the first time. But I’m intrigued. What kind of tumour did you say she had?’

‘Hartman’s. It’s a pineal gland tumour.’

‘The third eye,’ said Karen.

‘What d’you think?’

‘Okay, I’ll take a look at her,’ said Karen.

‘Good,’ said Macandrew. ‘There’s just one little problem.’ Macandrew told her about Jane Francini’s husband.

‘I’m not so sure I like the sound of this any more.’

‘He’ll be gone for the best part of the morning,’ said Macandrew. ‘I was a bit conservative about when Janey would come round. I told him four hours but the truth is she should be starting to come round by eleven. I’d particularly like you to see her at that point. If you could come down about then you should have a clear hour with the patient and map the changes in her.’

‘Okay, see you a little before eleven.’

‘Bring some recording equipment with you. I don’t think we’ll get a second chance.’