Past Lives

Twenty One

‘The wanderer returns!’ exclaimed Saul Klinsman as Macandrew came into his office. ‘I guess you were having such a good time over there that you didn’t want to come back, huh?’

‘Something like that,’ smiled Macandrew.

‘How are you feeling?’

‘Just fine.’

Macandrew sensed that his reply was inadequate: Klinsman needed more. ‘I’m itching to come back. Saul. I think I’m okay for surgery again.’

‘That’s what I wanted to hear,’ said Klinsman, who looked as if he genuinely meant it. ‘How do you want to play it?’

‘I thought I’d ease myself in with some cadaver work down in Pathology.’

Klinsman nodded. ‘Good idea. Talk to Carl Lessing. He’ll know what the situation is with donated bodies. I’m sure the Med school could spare a few in a good cause.’

Macandrew had coffee with Klinsman who wanted to know all about his trip to Scotland. Macandrew confined what he told him to his success in finding the graves of his ancestors. With contact re-established and pleasantries exchanged, he went down to Pathology where he went through the same again with Carl Lessing who welcomed him back and assured him that he would make cadavers available. He could start next morning if he had a mind to. ‘You can have the small autopsy room all to yourself. You can probably do without an audience.’

Macandrew spent the rest of the morning saying hello to friends and colleagues and generally playing the role of the staff member just back from vacation. He thought he was doing well until he had lunch with Karen Bliss down on the Plaza and she saw through him.

‘So you had a really good time, huh?’

‘Sure did.’

‘And you’re real glad to be back?’

‘Sure am.’

‘Want to go for three in a row?’

Macandrew smiled and conceded the point. ‘All right, I had a nightmare time. I’ve been through hell and nearly lost my life but I don’t want to talk about it right now. I wouldn’t know where to begin. The good bit is that I met a French woman and I’ve fallen in love with her. I’m already missing her like crazy. How’s that to be going on with?’

‘The falling in love bit doesn’t sound so bad. Does she know you’re in love with her?’

‘I think so.’

‘You think so! Didn’t you tell her?’ exclaimed Karen.

‘Not exactly.’

‘I may be a psychiatrist but sometimes I think I’ll never understand men,’ said Karen. ‘What’s her name?’

‘Simone.’

‘And you just walked away and left her?’

‘It wasn’t quite like that,’ said Macandrew, growing uncomfortable with the cross examination. ‘Simone’s a research scientist with a career to think of... and I’m not sure of anything just yet.’

‘Oh,’ said Karen. ‘Sorry, that was insensitive of me, but you’re going to be fine, Mac; I know it.’ She took his hands in hers. ‘Tell me all about her. What kind of research does your lady do?’

‘Biomedical. It’s a long story — one I’ll get round to telling you soon — but the bottom line is that she’s come up with a way of treating certain kinds of brain-damaged patients. If things work out the way we hope they will, we’re going to collaborate in running a clinical trial on the new technique — but of course, that all depends on me being able to operate again.’

‘That sounds exciting,’ said Karen.

‘I’ll need your help in coming up with a list of patients who might be suitable candidates.’

‘What kind of brain damage are we talking about here?’

‘Altered personality.’

Karen looked at him questioningly but didn’t say anything although her train of thought became evident when she said after a long pause, ‘Mrs Francini won’t be on the list. Her husband moved her out of Farley Ridge three weeks ago. He’d heard about some new clinic up in Michigan where they turn water into wine.’

‘You have to admire his devotion.’

‘What about the paperwork?’ asked Karen. ‘Won’t this all take time to set up?’

‘I’ve checked. What we’re planning won’t come under experimental surgery,’ said Macandrew. ‘I just need the relatives’ permission.’

‘That’ll certainly make life easier,’ said Karen. She looked down at Macandrew’s hands. ‘How do they feel?’

‘I’ll probably have to retire a bit early from surgery and I guess I can look forward to arthritis in old age and when the weather gets cold but I think they’re okay. Either way, I’m going to find out in the morning.’

‘I’ll be rooting for you, Mac, and I’ll start checking out possibles for your trial.’

Macandrew went through his normal pre-op ritual of scrubbing up and gowning and masking properly before entering the autopsy suite just because he needed the trappings of normality. He needed to embrace the routine. The cadaver of a forty-three year old man who had died from lung cancer had been laid out for him on the table by Lessing’s staff in the small room usually reserved for performing autopsies on dangerous bodies — containment of bacteria and viruses was easier here. He picked up a scalpel from the steel instrument tray and immediately felt vulnerable, pausing before making the first incision, knowing that it was yet another milestone moment in his life. Finally, he brought the knife round in a smooth confident sweep and started to feel better.

He had set himself a series of ordered tasks, starting with large organ removal and proceeding to more demanding dissections where he would have to work for progressively longer periods within millimetre margins of neighbouring tissue that he had determined he mustn’t damage. On a corpse, it didn’t matter. On a living patient, a nicked artery could turn the whole world red and spell disaster for both surgeon and patient.

He was working on his third cadaver of the day, a thirty-seven year old woman who had been killed in a car crash up on the interstate, when Saul Klinsman came into the room and watched him work in silence for a few minutes. Finally, he said, ‘It’s after seven, Mac.’

‘I didn’t realise it was that late.’

Klinsman moved in closer. ‘Supposing I were to tell you, Doctor, that this patient has a tumour the size of a pea three centimetres to the right of where you’re working and lying at a depth of one and a half centimetres...’

Macandrew took a fresh scalpel and forceps and exposed the area swiftly and skilfully. He said, ‘I’d say you were misinformed.’

Klinsman grunted and made to leave. He turned as he got to the door. ‘Welcome back.’

Macandrew returned to scheduled surgery the following Monday after Klinsman had worked out a wind-down schedule with the locum who had been covering for him in his absence. It was agreed that Macandrew would return with a light workload, which would increase over the coming weeks until a complete handover had been effected. It had been a tough day for him but one that had gone well and now, at the end of it, he knew that he was back in business. He was still feeling good when he phoned Simone in early evening to tell her the news.

‘I’m so glad, Mac. I wish I was there to give you a big hug.’

‘Me too,’ said Macandrew with heartfelt feeling.

‘Does this mean that we can go ahead with the trial?’

‘I think it does,’ replied Macandrew. ‘I spoke to Karen Bliss, one of our staff psychiatrists: she’s going to come up with a list of patients she thinks might be suitable. She’ll get back to me soon.’

‘I’ll start preparing the activator.’

Two days later, Karen Bliss appeared in Macandrew’s office with the case notes of seven patients suffering from altered personality that she thought he should consider. He stayed on in the evening to go through them.

He eliminated two almost immediately because their brain scans showed that they were damaged in areas outside the region behind the pineal gland. The other five however, did show signs of damage in this area. He eliminated one more because of complicating factors in the patient’s medical history, which made any kind of further surgery inadvisable, but that still left four good candidates.

It took a further week to secure the consent of the patients’ relatives — although they didn’t take much persuading. It was more difficult to convince Saul Klinsman that brain surgery for free was a good idea.

‘Call it an investment in the future, Saul.’

‘And if it should go wrong?’

‘The relatives know the risks and have signed papers to that effect. They’re prepared to take the chance because they feel they haven’t got anything to lose. These patients do not have any kind of quality of life at all. They’re kept sedated out in Farley Ridge because they’d end up committing suicide if they weren’t. Being a semi-comatose vegetable isn’t my idea of life. I suspect it isn’t theirs either, if only they could tell us.’

‘You’re sure about the permission situation?’

‘I’ve checked thoroughly and it’s been agreed that the surgery is not experimental.’

‘Then I wish you luck. Who’s first?’

‘George Elroy — been up in Farley Ridge for eight years after suffering severe head trauma in an accident on the farm he worked on.’

‘Elroy?’ said Klinsman thoughtfully. ‘I think I remember him. I did the remedial surgery myself if I’m not mistaken.’

‘You did,’ agreed Macandrew. ‘It’s in his records. When he got sent home, his wife maintained that he’d become hell to live with and that he simply wasn’t the George she had known and loved for more than twenty years. He got worse over a period of time and in the end was taken into Farley Ridge and kept under sedation after trying to cut his wrists a couple of times. His wife never divorced him though; she always hoped he’d get better one day. She was more than happy to give her permission when we approached her.’

Klinsman nodded. ‘I hoped you didn’t build her hopes too high.’

‘I told her the truth — that I didn’t know what the chances were.’

Macandrew operated on Elroy on the second Monday after his return to surgery. He used the least invasive route to reach the pineal gland, entering at the corner between nose and right eye and then introduced a length of plastic, 3 millimetre tubing to give access to the region of the brain immediately behind. When the scanner told him that the end of the tube was in exactly the right position, he injected a small quantity of activator into the space and let the fluid bathe the area for fully two minutes before draining it off into a steel bowl and closing up.

Macandrew left the patient in the charge of the nurses and went down to see Elroy’s wife, Ethel, and her eldest son who’d accompanied her, in the waiting room on the ground floor. He assured her that the surgery had gone well. The only thing they could do now was wait and hope for the best. It was a ritual he’d gone through hundreds of times before but this was the first time that he had been more anxious than the waiting relatives. During the recovery period, he paced up and down his office, occasionally sitting down to try and work but always getting up again after only a few minutes to resume pacing. He snatched at the phone when it rang.

‘Mr Elroy is coming round,’ said the nurse.

Macandrew hurried down to the recovery room.

‘Where...?’ groaned Elroy.

‘You’re in Kansas University Med Center, George,’ said Macandrew, kneeling down to be beside the patient’s ear. ‘You had an accident.’

‘The baler... it hit me. I was crossing the yard and I tripped over that damned fool dog, Duke — that mutt’s got less brains than a fence post. Chuck didn’t see me lying there when he came out the barn... Damned thing hit me... Jesus!’

Macandrew realised that Elroy was talking about the accident on the farm. ‘It did George but you’re okay now. Do you remember anything about what happened after that?’

Elroy looked blank. ‘No... not a thing. How long have I been out?’

Macandrew felt the correct answer might be around eight years but he settled for, ‘Quite some time, George.’

‘Ethel... can I see Ethel?’

‘You certainly can.’ Macandrew nodded to one of the nurses who went to fetch his wife. Ethel Elroy looked extremely nervous when she came into the room on the arm of her son. Macandrew stood back to let them come to the bedside.

‘George, how are you?’ she whispered.

‘Just fine, honey,’ replied Elroy. ‘That was a real dumb thing to do, falling in front of the baler like that...’

Ethel turned and looked up at Macandrew before starting to sob quietly into her handkerchief. The look in her eyes brought a lump to his throat. Words failed her but the nod of her head was all the thanks that Macandrew needed.

He returned to his office: he needed to be alone for a few minutes. In recent times he’d plumbed the depths of despair but now he was riding a high and he liked the feeling. He didn’t want the moment to end. The treatment worked! It really worked! He called Simone in Paris with the news and smiled when she broke into a torrent of excited French.

‘I know; it’s absolutely wonderful,’ he said when he managed to get a word in. ‘Let’s hope it works for the others.’

It worked just as well for the next two patients, prompting Saul Klinsman to suggest that Macandrew invite Simone over to the US for the final operation. The university would be happy to pay in view of the positive publicity the success of the new technique was going to generate. Simone arrived in Kansas City four days later — on the evening before Macandrew was due to operate. He picked her up at the airport where they had a happy reunion before he took her to her to the Best Western hotel near the Med Centre on Rainbow Boulevard where Saul Klinsman’s secretary had reserved accommodation for a “distinguished guest of the university”.

‘God, it’s so nice to see you again,’ said Macandrew as the porter left the room.

‘And you too, Mac. God, you went through such a lot and they hurt you so badly.’

‘No looking back. It’s all over,’ said Macandrew, wrapping his arms around her. ‘My god, the nights I’ve spent thinking about you.’

‘Really?’ murmured Simone, trying hard to suppress a smile. ‘Now why would that be?’

‘You’ve no idea?’

‘I just can’t imagine what you’re talking about, Doctor...’

Macandrew kissed her hungrily.

‘I thought neurosurgeons might have a strict rule about no sex before an operation,’ said Simone.

‘Only during one.’

‘Idiot.’

The operation next day was another success story and Saul Klinsman threw a party at the hospital to celebrate the breakthrough and to honour Simone’s research achievement. Both she and Macandrew had to insist that the new treatment would not be applicable to all cases — in fact, only to those with damage in the pineal area — but even at that, it was still going to make a big difference to a number of otherwise hopeless cases. The world seemed full of people who wanted to congratulate them.

‘When will you publish?’ Klinsman asked Simone.

Simone was at first surprised and then annoyed at herself for not having seen the question coming. ‘Soon,’ she replied, moving away to avoid any further talk along these lines. She found Macandrew and linked arms with him to steer him to a quiet corner. ‘Your boss just asked me about publication,’ she said. ‘He’s right, you know. We will have to publish.’

‘We just have to stick to the facts,’ Macandrew assured her.

‘Which are?’

‘Some cases of multiple personality disorder are due to damaged cells located behind the pineal gland and in some instances, these damaged cells can be reactivated using a simple surgical procedure and a chemical that you will have to describe in some detail. As for the normal function of these cells in the human brain... well, that’s conjecture and, as such, has no place in a medical journal.’

‘I love you,’ whispered Simone. ‘You’re so devious.’

‘It’s a man thing.’

‘Better not be.’

Simone gave a seminar to the medical and science faculties about the new technique and received a standing ovation from an academic audience that was clearly delighted that a mid-western university was playing such a pivotal role in such an important medical advance. Macandrew struck while the iron was hot and persuaded Saul Klinsman that he should have some more time off in order to take Simone to Boston to meet his family and spend Christmas there before she returned to Europe.

‘I guess the locum can cover again if he’s agreeable. You two are pretty serious about each other, huh?’

‘We are.’

‘Does that mean we’ll be losing you?’

‘You were always straight with me Saul: I don’t know right now. You’ll be the first to know when I do.’

‘Maybe you could persuade Simone that Kansas City isn’t that bad? I’m sure the faculty could be persuaded to offer her every facility to continue her research...’

‘Maybe.’

Macandrew had just left Klinsman’s office when he heard himself being paged with a request that he go to his own office. Feeling puzzled, he opened the door to find Tony Francini standing there. The nurse with him said before leaving, ‘Sorry, Mac, he insisted.’

Macandrew’s blood ran cold. Just looking at Francini brought back the nightmares. His hands started to ache just at the very thought of the car door: the happiness he had been feeling seemed to evaporate in an instant. ‘You’ve got a nerve,’ he said.

Francini swallowed and said, ‘I know that. Christ, I don’t even know what to say to you.’ He put his hand to his head and let a sob escape.

Macandrew remained dispassionate.

‘The word is you’ve been helping folks like Janey...’

‘We’ve been conducting a clinical trial of a new treatment. It won’t work on everyone.’

‘But it would work on Janey?’

Macandrew swallowed before finally saying, ‘It might.’

‘Christ knows I’ve no right to ask you this, but I don’t have an alternative. I love her so much. I’ll pay anything. Will you...?’

Macandrew was looking into the eyes of a desperate man — the eyes of a man faced with a steel cable and nothing but a blunt sword to cut it with. He relaxed his face muscles. ‘Have her here at the Med Centre tomorrow afternoon.’

Francini was about to be effusive in his thanks but Macandrew stopped him. He had no wish to associate with the man any longer than absolutely necessary. He recoiled from contact.

Simone agreed that Macandrew should delay their departure to Boston to operate on Jane Francini, saying that this was exactly what he should do.

Jane Francini’s operation proved to be just as successful as the others. She came out of the anaesthetic as the Jane Francini Macandrew had known before the first operation. Like the others, she remembered nothing of what had happened after going into surgery the first time. Macandrew left the recovery room before Tony Francini was allowed in, not wanting to see him again, but he did go back to visit Jane when her husband had left and she was being settled down for the night.

‘I’m so grateful to you,’ she smiled.

‘It’s good to see you looking well,’ said Macandrew. ‘I just thought I’d come and say good-bye to a fellow Scot.’

‘You’re going away? Tony will be so disappointed. He really wanted to thank you personally. Where are you off to?’

‘Christmas in Boston. I’m taking the lady in my life to meet my folks.’

‘I’m so happy for you.’

Macandrew could see that Jane was very tired but she was also very much at peace with herself and the world around her. He said, ‘I have a little present for you.’

‘For me?’

Macandrew opened his briefcase and took out the doll he’d brought back from Scotland. ‘It’s very old,’ he said. ‘You’ll have to be careful.’

Jane reached out and took it from him, her eyes showing a mixture of surprise and bewilderment. ‘You know,’ she said. ‘I’ve got the strangest feeling I’ve seen this before...’