Past Lives

One

Kansas City

USA

October 2000

John Macandrew got out of bed and walked over to the window in bare feet. He opened the blind and blinked at the early morning sunshine. The sky was blue and the leaves on the trees across the street had finally made the transition from green to gold, something he had been monitoring for the last three weeks with growing pleasure. Summer in Kansas City could be hotter than hell and winter could freeze your eyes but the Fall however, was pleasant.

This was especially true on days like this, when the sun shone down from a cloudless sky and the wind held its breath. The city, sprawling astride the Kansas, Missouri state line, could lay no great claim to beauty but when the trees turned colour and their leaves carpeted the sidewalks, a dreamer could narrow his eyes and pretend he was in New England rather than the featureless plains of the mid-west.

Macandrew decided that, today, he would walk to the Medical Centre and leave the car in the garage. He turned away from the window and switched on the radio before padding through to the kitchen to load the coffee grinder. He smiled as he heard the announcer report the success of the Chiefs in their pre-season game; they had won by more than thirty points.

Macandrew hadn’t had much interest in football before taking the job in Kansas City but now he was a regular at the Chiefs’ home games out at Arrowhead Stadium. He found diversion in the game. There was something therapeutic about watching two teams of athletes face up to each other in a contest of pace and strength. It afforded him some respite from the demanding precision of his own job. Macandrew was a neurosurgeon and jobs didn’t come any more demanding than that. For much of his working life he was within millimetres of disaster. Mistakes were not permitted in his line of work. Society was happy to accept that everyone had an off day except for surgeons and maybe airline pilots. Yes, definitely airline pilots.

As he poured his coffee he heard a time check say that it was a quarter after seven; he glanced at his watch. He had lots of time; the operation was scheduled for ten o’clock and it would only take him thirty minutes to walk to the Med Centre. Unlike most of the staff, who stayed outside the city in the pleasant avenues of suburbia, he had made a conscious decision to live inside city limits. It was an unfashionable choice but, being unmarried, he felt that he was a wife and a couple of children short of the requirements for living the American dream. Apart from that, he disliked suburbia: he saw it as society on a life-support system — comfortable but barely alive. Instead, he rented the top floor of an old colonial style house on Cherry. It had seen better days and was in the early stages of not so genteel decay but it was less than two miles from the Med Centre and the landlord and his wife, the Jacksons, didn’t bother him much. They spent most of their time visiting a nation-wide diaspora of grand-children. They were up in Michigan at the moment with their youngest daughter and her family but were due back next Wednesday.

Macandrew thumbed back the catches on his briefcase and took out a clear plastic file of notes on the patient he would be operating on this morning. He took them over to a seat by the window and sipped his coffee as he flicked through them. Jane Francini was thirty-four years old, two years younger than he himself and had been suffering from increasingly severe pain behind her eyes. She had been treated for migraine by her own physician for several weeks before finally being referred to the Med Centre where a battery of tests had revealed the presence of a tumour in her pineal gland. This morning Macandrew was going to remove it.

Normally, the surgical aspects of this procedure would present no special problems but Jane Francini had a history of heart trouble and had undergone cardiac surgery less than three years before. There was a question mark over her level of general fitness to undergo major surgery but only an academic one. The operation was essential. The tumour had to go.

Jane’s husband, Tony Francini, a successful businessman who sold farm machinery all over the mid-west, had been keen for her to have the operation done at one of the big teaching hospitals on the West Coast, but Saul Klinsman, chief of neurosurgery at the Med Centre, had persuaded him that Kansas City could handle the job. Francini had finally agreed but only after an aggressive inquisition of Macandrew on learning that he would be the surgeon doing the operation.

Macandrew’s background of Columbia Medical School and subsequent positions in several prestige-name hospitals and clinics back east seemed to satisfy Francini whose bluntness had culminated in the question, ‘So what the hell are you doing here?’

Although he did not suffer from the paranoia of some of his more senior colleagues, Macandrew was irritated by Francini’s attitude. He was typical of the type of man who thought financial success an acceptable excuse for a total lack of charm and manners. Macandrew was well aware of his nation’s lack of esteem for the mid-west, assuming that, because its people had the reputation of clinging to the values of a bygone age, science and the arts must be stuck in a similar time warp. They were not entirely mistaken but KC Med Centre was good by any standards.

Macandrew’s original, unashamed career plan had been to work for three years on the East Coast and then head for California in search of big bucks and the good life. He had surprised himself when a job came up in Kansas City and he had applied for it, arguing to Kelly, his girlfriend at the time, that it would be invaluable in adding to his all round experience of American medicine.

The real reason however, was somewhat different and had much to do with his family background. His great grandfather, after emigrating from Scotland, had settled in the mid-west in a place called Weston, Missouri. For reasons, which he himself could not properly explain, he felt that he wanted to follow in his footsteps and reinforce a link with this part of the States. Kelly had made it clear that Kansas was not for her or her planned career in obstetrics. They had kept in touch through phone calls and letters for a while but even that had largely stopped. Kelly had moved on to Johns Hopkins University Medical Center in Baltimore and a different world.

Macandrew saw on the duty schedule that Mike Kellerman would be the anaesthesiologist today. Despite having an off-hand manner, Macandrew knew that he was good. He had worked with him in the past and had never had a moment’s worry over patient stability. He didn’t ask for anything more. He finished reading through Jane Francini’s notes without learning anything new; he hadn’t expected to; he had just been making sure that he hadn’t missed anything.

As he put them down, he became conscious of the radio again. The presenters — two of them, working in tandem — were engaged in a local news round up. The way they fed each other lines and laughed at their own jokes irritated him — a sure sign that he was becoming edgy but then, he always was before an operation.

His walk to the Med Centre followed a route parallel to 39th Street, avoiding the main thoroughfare until it became unavoidable. The sidewalks were in bad condition but he was used to that. No one walked anywhere in Kansas City unless they were too poor to do anything else and therefore didn’t matter in the great scheme of things. Home — car — office, office — car — home was the routine for the overwhelming majority. The lack of people however, made the walk more pleasant — although it was necessary to run the gauntlet of an occasional guard dog, straining at its leash as he passed. The dogs were trained to regard anyone on foot with grave suspicion.

He crossed 39th Street near the intersection with Rainbow Boulevard and entered the Med Centre through the swing doors. Just before he did however, he took off his topcoat in preparation for the warmth he knew would hit him like a wall.

‘Good Morning Doctor Macandrew,’ smiled one of the nurses. ‘Miss Givens has been paging you.’

‘Thanks,’ replied Macandrew mechanically, glancing at the clock on the wall. It was a few minutes after nine. He approached Reception and a woman in her early fifties, wearing ornate glasses, perched on the end of her nose, smiled at him and handed him a piece of paper that she tore from the pad in front of her. ‘Mr Francini would like a word Doctor,’ she said in the manner which fifty-year old women wearing ornate glasses regarded as “gracious”.

Macandrew looked at the paper and saw that Francini had been put in G4, one of the rooms on the ground floor used by staff to give out news of progress or lack of it to friends and family of people brought into the Emergency room. As he passed G3, Macandrew looked in through the small glass panel in the door and saw a Hispanic woman sitting there with a white handkerchief pressed to her face; he could hear sobbing. He hoped Francini couldn’t.

‘Good morning Mr Francini. What can I do for you?’

Francini got up from his chair and smoothed back his shiny black hair with both hands. His suit, silk tie and Gucci shoes spoke of money but his swarthy features said Italian peasant stock.

‘I know Janey’s got to have this operation, Doc, but I just thought I would remind you to be careful with her. She’s the only wife I got.’ Francini laughed at his own joke but it was forced and his eyes remained hard.

‘Of course, Mr Francini.’

‘Shit, I don’t know how you guys do it,’ said Francini affecting a broad grin, which showed off expensive dental work. ‘You’re about to take somebody’s life in your hands and you’re Mister Cool. I gotta hand it to you. You guys are somethin’ else.’

‘It’s my job,’ replied Macandrew. ‘It’s what I’ve been trained to do. I don’t think I’d be very good at selling harvesters.’

Francini snorted and laughed. He said, ‘Hell, anyone can sell harvesters in Kansas. Now, selling harvesters in Boston? That might be different...’ He laughed again.

Macandrew smiled and glanced at his watch. It had the desired effect. Francini said, ‘I won’t hold you back any longer. Just remember what I said, huh?’

‘I will. I promise.’

Macandrew escorted Francini to the front door and then went upstairs to his own office. He phoned and checked with the head nurse that Jane Francini had been given her pre-med on time and that there were no hitches.

‘She’ll be ready for you Doctor,’ replied the nurse.

At nine thirty, Macandrew drained the last of his coffee from a paper cup and went along to surgery to begin scrubbing up. He found Mike Kellerman already there.

‘And how’s Mac the Knife on this fine morning,’ asked Kellerman with a smile.

‘Fine, Mike. How are you?’

‘A man barely alive,’ replied Kellerman with mock solemnity. ‘What that woman demanded of me last night ought not to be allowed, and they call them the gentler sex!’

Macandrew smiled as he lathered his forearms. ‘Let’s hear what you remember of the patient’s notes?’

‘Thirty-four year old female, undesignated pineal tumour with a cardiac history, weight one thirty eight pounds, no known allergies, I looked in on her yesterday afternoon.’

‘What did you think?’

‘Seemed strong enough to me,’ replied Kellerman. ‘No worries from my point of view.’

‘Good.’

‘She told me her husband owns Francini Farm Machinery. Think we could be on a bonus if we do a good job?’

‘It could be a horse’s head on the pillow if we don’t,’ replied Macandrew.

‘Francini, Italian? Of course. I think you’ve just got yourself one very alert colleague.’

‘Good,’ replied Macandrew, elbowing off the faucets and accepting a sterile towel from the nurse in attendance. ‘I’d like to get this over as quickly as possible.’

As Kellerman did the same he asked, ‘You don’t really think her husband’s... “Family” do you?’

‘Mr Francini sells tractors,’ smiled Macandrew. ‘On the other hand, I’m pretty sure he doesn’t write poetry or go to the ballet much.’

‘A man’s man eh?’ said Kellerman, putting on an exaggerated male voice. ‘Boy, is he in the right place!’ Kellerman was a Californian.

‘The guy comes on a bit strong but I guess he’s just worried about his wife,’ said Macandrew.

‘Who’s the OR nurse?’ asked Kellerman.

‘Lucy Long,’ replied Macandrew.

‘Good. I thought it might be my “friend”.’

Macandrew smiled. Kellerman’s ‘friend’ was Sylvia Dorman, the other OR nurse working in neorosurgery. She and Kellerman didn’t get along. Dorman was very serious nurse with a Florence Nightingale complex. She saw her career as a Christian vocation. Kellerman’s black humour offended her and he knew it. It inspired him to greater heights, or depths depending on how you looked at it. Macandrew didn’t like working with the pair of them together. An operating room was no place for personality conflicts. He and Kellerman gowned up and left their masks hanging loosely round their throats as they entered the operating room.

‘How are we doing?’ Macandrew asked Lucy Long.

‘All ready.’

Macandrew ran his eye over the instrument trays while Kellerman connected Jane Francini to the equipment he would use to monitor her condition throughout the operation. Green pulses started to chase each other across the face of an oscilloscope and a regular bleep followed the steady beat of the patient’s heart. Macandrew felt comfortable. This was his world: the sights and sounds put him at ease. He supposed it must be the same for truck drivers getting behind the wheel or office workers slipping in behind their desks to begin the day’s work. Familiarity could be such a comfort.

He paid particular attention to the lighting arrangements for this operation. The normal overhead, shadowless lamp would not be sufficient; he would be working close to the patient’s face so he needed angled illumination. Two small ancillary spotlights mounted on the main lighting gantry, which he eased into position, would supply this. The standard route for surgery on the pituitary and pineal glands was through the bone at the corner of nose and eye. There would be no need to shave the patient’s head and very little visible scarring afterwards.

‘How is she doing?’ Macandrew asked Kellerman.

‘More stable than I am,’ came the reply.

‘A comfort... She’s deep enough?’

‘Right on the button.’

Macandrew made a last adjustment to his mask and made a visual inspection of the point of the drill he planned to use before checking the motor function. Its angry insect whine filled the room. He put it back on its stand and asked for a scalpel. It was slapped into his palm. With a slight nod to everyone, he made the first incision. ‘Showtime.’

Sixty minutes later, Jane Francini’s pineal gland lay in a glass dish beside her sleeping form, its normal pine-cone shape distorted by the tumour, which had almost doubled its size.

‘Nasty,’ said Kellerman. ‘But it looks like you got it all.’

‘I think so,’ replied Macandrew. ‘Nice and firm, no break up.’ He turned to one of the nurses and said, ‘Get this to Pathology, will you.’

Gloved hands spirited the dish away and Macandrew got on with ending the operation. ‘Still OK?’ he asked Kellerman.

‘Absolutely fine.’

‘Just what I wanted,’ said Macandrew, ‘A smooth, clean, quick job with no complications. In, out, no messing about.’

He had scarcely left the operating suite when he heard himself being paged. He called in to be told that Mr Francini had been making the staff’s life a misery by demanding constant updates on his wife’s condition. He was insisting on speaking to Macandrew personally the minute the operation was over.

‘I’ll come down.’

Francini jumped up the moment he saw Macandrew approach and rushed over to meet him. ‘How is she, Doc?’ he demanded. ‘She’s OK isn’t she?’

Macandrew had to raise his hands to keep Francini at bay. ‘The operation went well Mr Francini. The tumour has been removed and sent to the path lab for analysis. We’ll know the results in a few hours. Your wife’s in recovery right now. You’ll be able to see her as soon as she comes round.’

‘Thank Christ!’ exclaimed Francini. ‘I don’t mind telling you Doc, Janey means everything to me.’

‘I sort of guessed,’ said Macandrew.

‘You’ll be staying with her?’ asked Francini.

‘That won’t be necessary Mr Francini. She’s in good hands. The nursing staff will take excellent care of her. Now if you’ll excuse me, I’m going to get out of these clothes.’

‘Of course, of course,’ said Francini backing away a little. ‘I can’t tell you how grateful I am, Doc.’

Macandrew felt uneasy. ‘Mr Francini,’ he began cautiously, ‘Jane’s tumour has been removed but we haven’t had the lab report on it yet. A lot depends on that... She’s not out of the woods just yet.’

‘Yeah, but you got rid of the bastard didn’t you? You got all of it out?’

‘I think so but...’

‘Of course you did. I feel it. Janey’s gonna be fine.’

The fact that the operation on Jane Francini had gone well and that the sun was still shining brightly when he walked out through the hospital doors put Macandrew in a good mood. He was whistling as he walked up to the junction of 39th street and Rainbow, trying to decide where to eat lunch. Eating in the Med Centre itself was something he had long given up on. What large institutions did to food was something he no longer subjected himself to. He opted for a quick sandwich at WENDy’s; this would give him time to have a pleasant walk in the sunshine afterwards.

As he waited in line for his sandwich, he became aware of someone smiling at him out of the corner of his eye. It was Lucy Long, the OR nurse. He smiled back and, seeing that she was on her own, took his tray over to join her.

‘I didn’t think neurosurgeons ate junk food,’ said Lucy.

‘What did you think we ate?’ retorted Macandrew.

‘Ambrosia,’ replied Lucy with a straight face.

‘What did I do?’ asked Macandrew, feigning hurt.

‘Not you Mac,’ replied Lucy thoughtfully. ‘But some of your colleagues are a different story.’

‘As long as they’re good at their job,’ said Macandrew, raising his hands slightly to signify he didn’t want to get into this kind of conversation.

‘I suppose so,’ said Lucy. ‘I guess people forgive a surgeon anything if he’s good at his job. It’s just that some of these guys make it a bit hard sometimes!’

Macandrew smiled and nodded. He knew that surgeons were not the easiest of people to get along with. There was often a conflict of interests between what was professionally necessary and what was socially desirable. They had to be supremely self-confident in their own ability but, as a consequence, were often self opinionated and egotistical — or as Lucy Long would have it — “a pain in the ass”.

Nice guys were the exception in the profession because being nice usually went with being self-critical and sensitive to alternative points of view. Surgeons had to make instant decisions, believe them to be right, and act without fear of contradiction — great in OR, not so endearing at the dinner table. The fact that Macandrew recognised the problem made him one of the exceptions. He was just as confident as the next man in OR but knew when to keep his mouth shut outside it. As a consequence, he was generally popular at the Med Centre.

‘You did a good job this morning,’ said Lucy. ‘Everyone was impressed.’

‘Thanks but it was textbook stuff.’

‘What made you come to KC, Mac?’

‘Not you as well!’ replied Macandrew. ‘This is a good Med Centre!’

Lucy shrugged. ‘Yeah, sure, but I mean, you were working in Boston. Coming here is not exactly an award-winning career move!’

Macandrew smiled. ‘I felt claustrophobic in Boston. I went to school in Boston; I went to college in Boston; I went to Med School in Boston. I could have lived and died in Boston but I didn’t want to.’

‘Just the gypsy in your soul,’ smiled Lucy.

Macandrew smiled.

‘Do you intend moving on at some point?’

‘Sure, I’ll head west when the time is right.’

‘You sound like a pioneer!’

Macandrew nodded and said, ‘I’ve got the genes. My great grandfather came to the USA from Scotland and headed west. He ended up in Missouri, a place called Weston.’

‘I take it you’ve been to see it?’ asked Lucy.

‘I even found his headstone.’

‘Must have been a strange feeling?’

‘A bit like an episode of Star Trek.’

Lucy smiled and looked at her watch. ‘I’ll have to get back.’ She dabbed at her lips with a paper napkin. ‘You?’

Macandrew shook his head. ‘I’m going to take a walk,’ he said. ‘I’ve got nothing until four.’

When Macandrew returned to the Med Centre at three thirty he felt relaxed. He had enjoyed the walk and now felt ready to face the case study meeting called by Saul Klinsman at four. There was just time for him to take a shower and freshen up. As he stepped into the elevator that would take him up to his office he saw the nurse at Reception look up and recognise him. She raised her arm as if to attract his attention but the doors slid shut before he could hit the button. When he stepped out into the second level corridor, the public address system chimed and its female voice asked that Dr John Macandrew contact Dr Saul Klinsman immediately.

Macandrew picked up the phone on his desk and called Klinsman’s extension. ‘What’s the problem?’

‘Can you come up to my office please, Mac?’

‘Something wrong?’

The phone went dead.

Macandrew tried to think what could have caused the abruptness in Klinsman’s manner but failed to come up with anything as he headed for the elevator and took it right to the top floor. The top floor was where the heads of departments and administration chiefs had their suites and offices. The carpeting on the floor of the corridor deadened footsteps and made it seem unnaturally quiet in comparison to other areas of the hospital. It was the one place in the whole of the Med Centre that did not smell of anaesthetic or antiseptic because it had its own special air conditioning system. He entered Klinsman’s outer office and said, ‘Hello,’ to Diana French, his secretary. ‘Once again I stand before you, spellbound by your beauty.’

Diana French let him know with a barely perceptible shake of the head that this was not the time for banter. ‘Go right in Mac, he’s expecting you.’

Macandrew had hoped to get a clue from Diana what this was all about but she diverted her eyes and continued working at her keyboard. He tapped lightly on the polished mahogany door with the brass nameplate on it and entered.

‘How did the operation on Jane Francini go this morning?’ Klinsman asked without preamble.

‘Like clockwork. Why?’

‘Something’s wrong, Mac. She isn’t recovering well.’

‘In what way?’

‘The nurses say she’s confused and behaving strangely. They managed to reassure her husband that this was often the case when a patient came out of deep anaesthesia and suggested he come back in a couple of hours but the truth is that she hasn’t improved any. Are you absolutely sure that nothing went wrong in OR this morning?’

‘Of course I’m sure!’

‘All right, all right, don’t get on your high horse,’ said Klinsman holding up his hands, ‘but I need hardly tell you that Mr Francini isn’t going to take this quietly if it turns out that something unforeseen has happened to his wife.’

‘I’d better get down there,’ said Macandrew getting to his feet. Klinsman was about to say something when the sound of raised voices from the outer office interrupted him. The door burst open and Diana French, looking red-faced and harassed, said, ‘I’m sorry Doctors.’

Tony Francini pushed past her into the room. He came up to Macandrew, clenching his fists. ‘Straightforward, huh? A routine procedure, huh? What kind of an asshole are you? What the fuck have you done to my wife?’

‘Mr Francini, I’ve just this minute come back to the hospital. I haven’t been down to see your wife yet, but let me assure you, the operation this morning went very well. There were no complications and I’m sure that whatever’s alarming you is probably just some temporary reaction to the anaesthetic.’

Francini moved up even closer and poked his forefinger into Macandrew’s chest. He said in menacing tones, ‘Now let me tell you something, Doctor. You’d better be fucking right because I’ve just been down there and the woman in that bed... is not my wife.’