Flashback

CHAPTER SEVEN

Disturbed by a cart clattering past the door of her hospital room, Suzanne Cole rolled onto her back, floating in the twilight world between sleep and wakefulness. For a time, she struggled to complete a dream she had been having — a romantic, storybook dream, in which Jason Mainwaring, dressed head to foot in ebony armor, sitting astride a coal-black stallion, was jousting with a knight clad equally spectacularly in gold. Again and again, the men sped past one another, their lances exploding off their opponent's shield. With each encounter, one or the other came close to falling from his mount, but each time, the stricken knight recovered and swung about for another pass. Suzanne herself was seated in the grandstand, wearing a flowing gown of pink silk and clutching a single white rose. Who are you? she called again and again to the gold knight. Who are you? What do you want from me?

As the dream faded, the knight turned toward her and lifted the visor of his golden helmet. Like flashing neon, the face of the man kept changing. One moment it was Zachary Iverson, and the next, Paul Cole — the pathologically self-possessed physiology professor who had picked her out of a crowded lecture hall during her second year in medical school and had swept her up in a whirlwind of flowers and parties and romantic weekends in the country. Less than a year later they were married. If there were signs of the man's sickness during those months, she had missed them completely. Later, when the recreational drugs, and the erratic behavior, and the lies-"misunderstandings, " Paul had called them-began to surface, she had chosen to ignore them, to rationalize them away. By the time she knew that her efforts to hold their marriage together had been a mistake, there was Jennifer. The years she spent trying to accommodate Paul for her daughter's sake had nearly cost Suzanne her career, and perhaps even more than that. Why? she pleaded again. What do you want from me?

"Dr. Cole, it's morning."

Why?… "Dr. Cole?"

The nurse's gentle voice, and the touch of her hand, began to dispel what remained of the dream. The colors began fading into a sea of white.

How long had it been since Paul had last forced his way into one of her dreams? The arguments, the guilt trips, the hang-ups when she answered the phone, the missing prescription pads, the visits from the glib, condescending drug enforcement agents… Why had she given the man so goddamn many benefits of the doubt?

"Dr. Cole…"

Suzanne opened her eyes a slit. "Hi, " she murmured. Instinctively, she reached up and touched her breast, dreading the thick bandages she expected to find there. "It's seven-fifteen, " the nurse said. "Time for your pre-op meds." Pre-op. Damn, she thought. It was not over at all. It was just starting. Why was this happening? Life in Sterling had been everything she had hoped it would be-so peaceful, so uncomplicated, so good for Jen. Now, suddenly, everything seemed to be unraveling at once.

Why?

She opened her eyes fully. "Seven-fifteen?"

"Uh-huh. You're on call for twenty minutes from now. This is some atropine and Demerol."

Atropine… Demerol. One to dry up secretions, and the other to help one not give a damn about the prospect of being disfigured, or worse.

What wonderful potions we doctors have at our fingertips, she thought acidly. What wonderful potions, indeed. She turned onto her side and winced as the needle pierced her buttock. Then she rolled onto her back and smiled up weakly at the nurse. "Nicely done, " she murmured. The nurse, a kind, elderly woman named Carrie Adams, patted her hand.

"You're going to do fine, " she said. "I've had a couple of cysts removed, and so has my daughter. The hardest part is the waiting to get it over with."

"I'll try to remember that."

Once again, this time in spite of herself, Suzanne reached up and touched her breast. It was all so crazy. This sort of thing happened to other people-to patients. She was trained to help them through their medical crises, not to go through one herself. She had bounced back so far, put so many pieces of her shattered world back together. Now this.

Helplessness… panic… rage… her emotions, held in check over the weeks since that terrifying moment of discovery, swirled about like windblown snow. Where in the hell was the acceptance that the textbooks all wrote about?

"That Demerol should start to work in just a few minutes, " the woman said, as if reading her thoughts. "Good."

"And here are your earphones."

"Oh, yes, " Suzanne said, taking the set and placing it on the bed beside her. "What's on today?"

"I don't know, " the woman replied, "but Dr. Mainwaring's on channel..

" She took a three-by-five card from her uniform pocket."… three."

The system-tapes picked by the surgeons to be played in the operating rooms and broadcast to earphone receivers-was designed to reduce patient anxiety levels. Over the few years it had been in place, the innovation had received high marks from surgeons and patients alike.

Suzanne flipped the dial on the phones to 3, and held one up against her ear. "Greensleeves, " she said. "Pardon?"

" Greensleeves. That's the music. A really beautiful version of it.

Here, listen."

She passed the earphones up. The nurse politely listened for a few seconds, and then returned them. "Very pretty, " she said. "Well, I'll be back in a little while. Meanwhile, you just relax. Oh, by the way, there's an envelope for you on the bedside table. Perhaps you'd better read whatever's inside it before that medicine I gave you takes effect."

Suzanne thanked the woman, and then waited until she had left the room.

The envelope, with the Ultramed-Davis heading and logo, read, Dr.

Suzanne Cole. She peeled it open, knowing it was from Zack. Throughout much of the evening, he had sat there with her, reading out loud from magazines and newspapers, laughing, sharing stories of his life, and, when there was nothing to say, just holding her hand. He had been as open, as tender, and as understanding as any man she had ever met. She wondered if he realized the resentment she was feeling at his intrusion into her life. Silently, she cursed herself for using him the way she had. She had no intention of allowing a man close enough to ruin her life again-not now, at least. Possibly not ever. Zack had said they could make love with no strings attached, but she knew damn well that there were always strings. When the operation was over, regardless of the outcome, she would do what she must to put distance between them.

For a moment, the fear of what might be growing within her breast seemed pale next to the fear that she might never again be able to trust. Dear Doc-It's now 2 a. m. The sleeper they gave you seems to have worked, because you've been out fairly solidly for about an hour. I'm going to leave now, and hope that you don't wake up until a minute or two before they bring you down to the O. R. I just wanted to thank you for Wednesday night, and even more, for letting me share this evening here with you. I don't know if my being here helped you, but it has surely helped me. It's not much of a secret that I think you're pretty special.

I know how frustrating and frightening this is for you-partly because it's frustrating and frightening for me, too. Just know that whatever happens, I'll be with you as much and as closely as you want me to be.

If there's a good, working definition of "friend, " maybe it's someone who helps us find the tools to get through this kind of shit when we can't seem to find them for ourselves. Regardless of what happens, you've got one in me. It's going to be benign. That's all I can say.

It's going to be benign, and everything's going to be okay. Be strong.

You have an appointment on my mountain as soon as this is over. Zack "I'm sorry, Zack, " Suzanne whispered as she slipped the note back into its envelope, tucking it between the pages of the novel she had been reading for the past two weeks. "I'm sorry I wasn't stronger…"

She settled back onto her pillow and slipped on the earphones. Her mouth had become uncomfortably dry from the atropine, but the Demerol, too, was having its effect, so she did not really care.

Carrie Adams and an orderly wheeled a stretcher into the room and helped her slide onto it. Please, God, Suzanne whispered to herself as the fluorescent lights flashed overhead, let it be nothing. Let it be benign. Jason Mainwaring met her in the operating room, his blue-gray eyes intent from between his aqua mask and hair cover. Suzanne pulled off her earphones. The same lovely piece she had been listening to filled the operating room. "Welcome to my world, Suzanne, " he said.

Suzanne smiled weakly. "I wish I could say I was pleased to be here."

"I understand." He patted her arm reassuringly. "We'll take good care of you. Don't you worry."

"Thanks."

"How do y'all like my music?"

"It… it's beautiful."

"The most beautiful music ever written, I think. It's called Fantasia on Greensleeves, an' it's by an English composer named Ralph Vaughan Williams. I begin every single case with it, an' then go on to some other pieces of his. If you want, I'll make a tape of it for you."

"That would be very nice, " she managed. Jack Pearl, the anesthesiologist, appeared at Mainwaring's side. Together with a nurse, they helped her from the litter onto the chilly operating table. Then, in a maneuver so quick and painless she barely realized it was happening, Pearl slipped an intravenous line into a vein at her left wrist. Next, a broad strap was pulled across her abdomen and tightened.

A final pleasantry or two from Mainwaring, and they were ready to begin.

Jack Pearl came into Suzanne's field of vision, held up the rubber stopper of her intravenous line, and slipped in a needle attached to a syringe full of anesthetic. Please, God, she prayed once again, let Zack be right. Let it be okuy. "All right, Suzanne, " Jack Pearl said. "This is just some Pentothal."

He depressed the plunger, emptying the contents of the syringe into her intravenous line. "All you have to do now is count back from one hundred."

From the speakers overhead, Ralph Vaughan Williams's flowing fantasy filled the room. "One hundred, " she said thickly."… ninety-nine… ninetyeight…"

Above her, the huge, saucerlike operating light flashed on. "Ready," she heard someone say. Takashi Yoshimura was one of seven Orientals living in Sterling, New Hampshire. The other six were his wife and five children. Though Japanese by birth, and, in fact, by birthplace, he had been raised and educated in lower Manhattan, and spoke both English and Japanese with a pronounced New York accent. Like a number of the new Ultramed physicians Zack had met since his return to Sterling, Yoshimura, a pathologist who insisted on being called Kash, was young, well trained, and exceedingly capable. It was just after eight in the morning. Yoshimura, diminutive, with close-cropped hair and Ben Franklin glasses, sat at his desk, with Zack peering over his shoulder. Before them, in a stainless-steel pan, was the fleshy, silver-dollar-sized mass that had just been removed from Suzanne Cole's right breast. Zack watched in tense silence as the man maneuvered the tissue about beneath a bright light and magnifying glass. A floor above them lay Suzanne, adrift in the dreamless netherworld of general anesthesia. In minutes, the unimposing little pathologist would send word to the O. R. of his interpretation of the cells in the frozen sections of the specimen, and Suzanne would either have her incision sewn up, or a large portion of her breast and the surrounding Lymph nodes removed. If Kash Yoshimura was the least bit nervous about the awesome implications of this facet of his work, it certainly did not show in his face. He hummed a soft, almost tuneless melody as he scanned the surface of the mass, searching for any telltale dimpling or discoloration. Then, with a final, satisfied arpeggio, he used a scalpel to produce a thin slice from the core, and handed the pan with the exposed specimen to the histologist.

"Okay, George, " he said to the tissue technician, "do your thing."

"Well? " Zack asked, after the technician had left. "What do I think?"

"Uh-huh."

"You are, perhaps, familiar with the immutable medical law of eighty-five/fifteen?" Zack shook his head. "I'm surprised, " Yoshimura said, "your being Harvard-trained and all. Well, simply put, the law states that every probability in medicine is either eighty-five percent likely or fifteen percent likely. Proper application of the law means one can never be wrong, as long as one knows whether the event in question seems remotely likely or not so remote."

Zack smiled. "I take it you scored well on your boards." Kash Yoshimura nodded. "I did okay, " he said. "And the biopsy is eighty-five percent likely to be…"

"Benign. An adenoma, I would guess."

"Wonderful." Zack pumped his fist. "At this point, you may be eighty-five percent enthusiastic, " the pathologist cautioned. "No more."

"I understand."

Yoshimura reached across and patted Zack understandingly on the shoulder. "We'll have the answer in just a few minutes, " he said.

"Meanwhile, all I can tell you is that our mutual friend is in remarkably capable hands."

"Mainwaring? " Zack flashed on his initial, unpleasant encounter with the man. Kash nodded. "I watched him work a number of times when I was a student and resident. He is a superb technician."

"So I've heard. He's a little short on tact, though. In the first five minutes after we met, he managed to say something snide about virtually every aspect of my life."

"Perhaps he finds a new neurosurgeon in town threatening to his ego.

"Perhaps. Where was it you trained?"

"Hopkins."

"Mainwaring was at Hopkins?"

"He was. No small fry, either. A full professor, if I'm not mistaken."

Zack was surprised. "I wonder what on earth he's doing up here in the boondocks, " he said. "Especially the northern New England boondocks.

That accent of his puts him well below the Mason-Dixon line."

The pathologist shrugged. "Beats me. Apparently, he doesn't deem pathologists threatening enough to insult. Aside from my reporting biopsies to him, we haven't had more than a one or two-word conversation since he arrived a year or so ago."

"Actually, " Zack said, suddenly anxious to learn more about the man Guy Beaulieu claimed was helping to drive him out of practice, "it was closer to two years. Did you ever tell him you watched him operate at Hopkins?"

"As a matter of fact, I did. Once, shortly after he got here."

"And what did he say?"

"Nothing, really. He glared at me for a moment with that steely look that I think surgeons practice in front of a mirror to use on nurses and anesthesiologists and the like." He grimaced. "I mean some surgeons," he qualified. "Then he just said, That's nice, — something like that-and walked away."

"And no mention of that since?"

Yoshimura shook his head. "How weird. Mainwaring seems very much the old-boy type. I'd expect him to go out of his way for someone from his college or his hospital-especially a prestigious place like Hopkins."

"Believe it or not, " Yoshimura said without rancor, "there are still those about, even in our lofty profession, who are… uncomfortable with certain aspects of certain anatomies." He gestured toward his eyes.

"Whatever the reason, the social circle Jason Mainwaring runs in certainly does not include the Yoshimuras."

"Well, I'd enjoy it very much if mine did, " Zack said. Kash Yoshimura eyed him for a second, and then he smiled. "I think we would like that, too, " he said. The histology technician announced his return with a soft knock on the doorjamb. "Ah, " Kash said. "This is the moment we turn our eighty-five/fifteen into something quite a bit more certain.

Good sections?"

The technician nodded proudly, and set down a cardboard holder containing a dozen or so glass slides. Zack was struck by the remoteness of the unfolding scenario from the woman whose quality of life, and even, perhaps, whose very existence, was at the center of the drama-a marked contrast to the immediacy and intimacy of surgical medicine.

Still, he knew, in the moments to follow, Kash Yoshimura would hold as much power, as much responsibility, as if he were the man in the operating room with the scalpel. The pathologist slid the first of the sections onto the stage of the dual-view teaching microscope, and motioned Zack to the second pair of oculars. Silently, Zack watched, barely breathing as the multicolored cells slid through the brightly lit field. One by one, Yoshimura worked his way through the slides. With the fifth or sixth one, he had resumed his humming. Finally, he stopped, and looked over at Zack. "You have an opinion? " he asked. Zack nodded.

"Uniform cell type, uniform pattern, no obvious foci of necrosis, " he said. "I can't put a name on it, but I can say that it sure as hell looks benign."

Yoshimura nodded. "Should you ever tire of neurosurgery, Dr. Iverson, I would say you have quite a future as a pathologist."

He picked up the phone and dialed the operating room. "This is Dr.

Yoshimura calling from pathology, " he said. "You may inform Dr.

Mainwaring that he has excised a totally benign, fibrous adenoma. Thank you."

Zack pumped the man's hand as if he had been the cause of the tumor being noncancerous, rather than merely its interpreter. Before it had really even begun, Suzanne's nightmare was over. Anxious to be at the bedside when she awoke, Zack hurried to the recovery room. One story above, in operating room 3, Jason Mainwaring received the news of the biopsy impassively, and then looked over at his anesthesiologist. "So, Jack, " he said, "if it's all right with you, we are ready to close."

Jack Pearl, a ferret-like man in his mid-forties, smiled at the surgeon from beneath his mask. Then he glanced down at the serene face of their patient. "Everything is better than all right, Dr. Mainwaring, " he said. "In fact, it's perfect. As always. Absolutely perfect."

Subtly, unnoticed by anyone else in the room, Jason Mainwaring returned the smile and nodded his approval. At that moment, both men were focused on precisely the same thought, Four hundred ninet-one down. Only nine to go.