The Hurricane Years: A Novel Page 2

  His coat on, he automatically inventoried pocket bulges. Finding his stethoscope missing, he picked it up from the desk, flipped the OUT card on the door, and started down the hall, grimacing as he anticipated being confronted in Emergency with the mangled victim of another automobile accident.

  County Memorial Hospital, only three miles from a Pennsylvania Turnpike interchange, was the focal point for maimed bodies dragged in from a seventeen-mile span. This was one of the drawbacks that he had overlooked on that day eleven months ago when he had come down from New York to be interviewed for a position that had then seemed a heaven-sent opportunity to find a happier and more rewarding life than he had known during his two years with the Allison Clinic, or in his prior situation as Chief of the Cardiovascular Section of the Berringer Research Institute. Two weeks before, not entirely by chance—he had been scanning the classified columns in medical journals for the past month—he had seen an advertisement describing a position so perfectly fitted to his needs that he could hardly believe what he read. But there it was: “small but completely modern and fully equipped community hospital, located in a beautiful rural section of Pennsylvania” was looking for “a fully accredited internist to serve as a constantly available consultant to a staff of general practitioners.” His duties, the advertisement had promised, would be “exclusively diagnostic, with no requirement to serve as a resident physician.” What had most intrigued him was that concluding “unusual opportunity for a qualified internist desiring a light enough work load to permit research, writing, or similar activity.”

  The nine days that he had waited for a response to his letter had been all but unendurable, and when a reply had finally come from County Memorial Hospital, signed by Jonas Webster, Chief of Staff, suggesting that he come over for an interview at his earliest convenience, he had boarded a bus that very afternoon. A bus, he had found, was the quickest way to get there, but with all the stops it had still been a five-hour trip, a cruelly extended anticipation of probable disappointment. Every few miles he had reread the letter from Dr. Webster, and each time his eyes had settled upon the left-hand margin of the letterhead where the names of the staff doctors were listed. All were, if not unmistakably Anglo-Saxon, at least threateningly Christian. He had been a fool, he thought, not to have made it clear in his original letter that he was a Jew.

  When he discovered, as he did early in his interview with Jonas Webster, that the Chief of Staff had known from the beginning that he was a Jew—Berringer Institute had been the giveaway—hope had risen to a crescendo of desire. Everything he saw and heard sustained it. The rolling Pennsylvania countryside, a green valley seen in the bloom of early May, offered such peace as he had never before dared think attainable. The hospital was an architectural gem, fresh enough in design to be assuringly contemporary, yet completely at home in a countryside of lovely old stone farmhouses. Inside, it was no less appealing. The laboratory, although small, was beautifully equipped, really a little showplace, and the adjoining X-ray department looked as if it had been lifted directly from one of the color pages in a General Electric catalogue.

  He had failed to note on that first visit that the laboratory was staffed only by a technician, a dull-witted girl who could not be trusted to do anything beyond the few routine tests that she had learned to perform by rote, and that the X-ray department was the semi-private domain of Dr. Mallaby, whose only qualification as a roentgenologist was a brother-in-law who had been instrumental in securing one of the federal grants that had financed the hospital’s construction. Nonetheless, even though he had known all this, Aaron Kharr would not have been deterred. He was fully qualified, if necessary, to read his own X-rays, and whether necessary or not, always preferred to do his own laboratory work.

  County Memorial was the result, he now knew, of a rebellion against a little clique of city-based specialists who, through their tight control of Marathon General Hospital, were exacting a galling tribute from all of the general practitioners in the northern half of the county. These country doctors, denied staff privileges at Marathon General, were being forced to relinquish their primary hold on any patient requiring major surgery or extended hospitalization. Earlier, when there had still been some element of competition among the Marathon specialists, fee-splitting had kept the situation reasonably tolerable, but when the surgeons got together and decided that their union was strong enough to stop this deplorably unethical practice—and, by no means incidentally, keep all of that perfectly good money in their own pockets—the country doctors were goaded beyond endurance. Jonas Webster had led the rebellion.

  Banding together with five other country doctors, and staging a vigorous assault not only upon the public coffers of Harrisburg and Washington but also upon the private purses of community residents, Webster had brought the hospital into being. Later, he had attracted George Garrison, a retired Army doctor looking for a rural retreat, a capable if somewhat eccentric surgeon who, as Aaron Kharr now knew, had been responsible for creating the opening that he had been called in to fill. It was Garrison’s low regard for the diagnostic skill of the other doctors on the staff that had inspired the unorthodox idea of hiring a staff internist, so radical a departure from normal small-hospital organization that he had been able to sell it to the others only by using the argument that avoiding the necessity of sending difficult cases to Marathon specialists would mean that their own pocketbooks would be fattened rather than thinned. As Garrison had set it up, the Chief Internist—he had invented the title—would be on salary and would accept no fees himself, and their practices would be protected from pilferage by a clause in his contract that prohibited him from ever hanging out his own shingle anywhere in Marathon County.

  On that initial visit to County Memorial, Aaron Kharr had been interviewed by only Webster and Garrison, both of whom had struck him favorably, and they in turn had quickly decided that he was the man they wanted. They had obviously been impressed by his biographical outline in Who’s Who in American Medicine—no doctor on the staff of Marathon General was even listed—and the number of his papers was greater than the combined total published by all members of the Marathon County Medical Association.

  Rather quickly, the high glow of Aaron Kharr’s initial expectation had become somewhat tarnished. County Memorial had not proved to be, as he had imagined, a desirably scaled-down version of the hospitals he had known in New York. In truth, it was little more than a medical motel serving a group of resolutely independent doctors who recognized no authority other than their own self-interest. In a free spirit of live-and-let-live, there was no review of case records, no inquiry into questionable practices, and most assuredly no attempt at professional discipline. When, on rare occasions, there was a staff meeting, it was exclusively devoted to financial matters. Aaron Kharr’s idealization of the small-town G.P. as a warmhearted and largely selfless healer, the antithesis of the impersonally self-serving doctors he had known in New York, had been seriously challenged if not largely destroyed. The pecking order at Community General was no less determined by annual income, and it was solely on that basis that, in a few weeks now, Harmon Teeter would displace Jonas Webster as Chief of Staff.

  Harmon Teeter was very much on Aaron Kharr’s mind as he left his office and started down the corridor toward Emergency, acutely conscious that if Teeter had been on duty this evening, as the hospital’s duty schedule required, Kharr himself would have been spared this interruption. This was no new problem. He had been initially assured that he would not be called upon to serve as a resident physician, told that one member of the staff would always be at the hospital, each serving his turn as resident physician for the day. He had questioned this arrangement in his original interview with Webster—actually, he had been more than a little shocked to discover that County Memorial had no resident staff at all—but Webster had assured him that it worked very well and explained that there was a built-in motivation. The doctor on duty picked up for himself all the emergency cases that turned up—unless, of course, the patient of another County Memorial doctor was involved—and the turnpike was constantly producing what Webster described with a shrug as “some very desirable cases.” Webster had been right—it was indeed a powerful motivation—but all too soon some of the staff doctors, Teeter the first and most frequent offender, had discovered that by getting Aaron Kharr to cover for them, they could skip several hours of duty, occasionally the whole day, and still pick up any juicy plums that dropped while they were away.

  At first, anxious to get along with new colleagues, Aaron Kharr had been unwisely accommodating. Since he was always in the hospital anyway, it was difficult to refuse to “keep an eye on Emergency.” But this extra duty, coupled with the things that he had to do simply to make up for a lack of ordinary competence—Carruth, for example, was still incapable of getting a simple I.V. going—had quickly become so great that, in his first two months, he had added only fourteen pages to the manuscript of his book. Enlisting the sympathetic support of George Garrison, who was no less up in arms because of the hospital’s failure to supply a competent anaesthetist, there had been a showdown with Webster. As a result, Garrison had been told to find and hire the man he wanted, and Aaron Kharr had been authorized to bring in a young intern who could at least take over some of the scut work. The authorization came easier than its fulfillment.

  Garrison had eventually dug up a young Malayan, Chang Lee, and guided by that example, Aaron Kharr had gone to New York and prevailed upon a young Indian, Chavan Raggi, to follow his internship at Bellevue with six months at County Memorial before returning to India. Raggi was proving a great help, but a burden as well. Since he was, in effect, serving a residency, Aaron Kharr had shouldered not only a teacher’s role but also a substantial measure of res
ponsibility for his medical judgments. The worst aspect of the new situation was that, with Raggi available, the doctors on the staff were more inclined than ever to cheat on their days of duty. Teeter, he was quite sure, had not been in the hospital since early morning.

  Nevertheless, despite his annoyance with Teeter, and as distasteful as he found the prospect of handling another gruesome accident case, Aaron Kharr strode purposefully down the corridor. For all of County Memorial’s shortcomings, his eleven months here had greatly enhanced his confidence in himself as a competent all-around physician, and late in life though it was—he was forty-four—he felt that he had finally found himself. There was something of this satisfying discovery in his quick stride, self-confidence at a level where there was no need for a slow-paced cultivation of professional poise.

  Raggi was waiting for him at the door of Emergency, characteristically tense and somber, and Aaron Kharr greeted him with an exaggeratedly casual “Good evening, Dr. Raggi,” hoping that it might suggest the professional composure that the young Indian so badly needed. “What’s up?”

  “I hope, sir, that this time I have not again inconvenienced you unnecessarily,” Raggi said, a reference to a case last night where he had mistakenly suggested a diagnosis of coronary occlusion.

  “Don’t worry about that,” he said, relieved by this suggestion that it was a heart case, the area in which he felt himself most completely qualified. “Cardiac disorders are sometimes difficult to differentiate. They fool the best of us at times.”

  “This time I am thinking I have not been fooled,” Raggi said, tautly earnest, handing him the admission card.

  He glanced at it, scanning the meticulously inscribed: male … white … 44 … Director of Advertising and Promotion … Crouch Carpet Company …

  Inescapably, his mind was drawn back to his typewriter, and then by obvious association, to the subject of the chapter on which he was working. Quickly, guiltily, he caught himself up, curtly asking, “Where is he?” and assuring himself that he was long past the stage where he needed any more case studies to establish mid-forties stress as a causative factor in under-fifty coronaries.

  “Here, sir,” Raggi said, leading the way, opening doors.

  Aaron Kharr stopped in the doorway, caught in mid-stride as he saw the patient flat out on the examining table, an oxygen mask on his face, electrocardiograph leads connected, a nurse standing by with the EKG tape looped in her hand. He curbed a flash of temper, quickly excusing Raggi, blaming himself for not having impressed upon him before the seriously traumatic effect of hitting an unprepared patient with this brutally blunt evidence that he had suffered a heart attack. As he knew only too well from his years at the Berringer Institute, the country was full of men who had physically survived heart attacks only to remain mentally crippled by blundering doctors who, in their organic preoccupation, were carelessly unaware of the mental damage they so often inflicted. He would have to talk to Raggi about this—but later.

  Inquiring eyes watched him over the top of the mask, and he responded with what he hoped was a confidence-inducing smile. “I’m Dr. Kharr,” he introduced himself, taking out his stethoscope. “Let’s see what’s going on in this belly of yours.”

  He opened the shirt wider, starting low on the abdomen, sustaining the pretense that the heart was not his prime concern, following the same course that had dictated the use of belly instead of heart, the same reasoning that had restrained him from beginning his examination with a heart-associated taking of the patient’s pulse. With a half-dozen quick moves of the stethoscope bell, he worked up toward the chest area. But what he heard was of far less importance than what he had already seen. Faster than any possible process of conscious thought, his brain had reacted to simultaneously registered visual impressions, so quickly producing a diagnosis that it seemed more intuitive than reasoned. But he continued listening for a moment, warning himself that his God-given keenness of perception was a gift not to be flaunted before a young resident to whom diagnosis must still be a process of deliberate step-by-step deduction.

  But he was also preoccupied with the making of a decision. Made, he quickly implemented it, stepping around behind the patient, stealing a quick glance at the admission card to pick up his name, saying, “Mr. Wilder, I think we’ll relieve you of this nuisance,” lifting the oxygen mask from his face.

  Raggi gave him a stricken look, thinking himself again convicted of an erroneous diagnosis. But that was less important for the moment than the reaction of the patient who, the instant his lips were freed, burst out with “I knew it wasn’t my heart!”

  The vehemence of the outburst startled Aaron Kharr. He had assumed that the important need would be the usual one of lifting the patient out of the peculiarly depressed state commonly associated with coronary occlusion—that was why he had removed the oxygen mask, why he had made no move to look at the electrocardiograph tracing—but he guessed now that the problem here was of a different order. This man was refusing to believe that his heart was involved. It could be a sign of strength, evidencing a will to fight back that would be all in his favor. On the other hand, it might evidence a psychic barrier against fear that, once breached, would loose an overwhelming terror. But there was still another possibility, no less dangerous. No coronary patient was harder to rehabilitate than the man who, ostrich-like, stubbornly refused to believe that he had really had a heart attack, hiding the truth from himself. He was the man who too often left the hospital only to go plunging ahead down the same suicidal path that had brought him there in the first place.

  Undecided, Aaron Kharr searched the patient’s face, hunting for some clear indication of character and personality, acutely aware that he knew nothing about him except what could be drawn from his being a corporation executive, and even more revealingly, perhaps, engaged in advertising and promotion, an area of business activity that was not only notably stress-producing, but also one that attracted men of a type more than ordinarily susceptible to psychogenic influence.

  “Just this damn belly of mine,” the patient said, again explosively insistent.

  “You’ve had this same trouble before?” he asked, a testing question, intently watching the man’s face, searching for any hint of what lay behind those belligerently narrowed eyes.

  “My own fault,” the patient said, angrily self-critical. “Grabbed a couple of cheeseburgers. Should have known better. Always does it—this damn belly—” He winced sharply.

  “Still feeling some pain, are you?” he asked, noting from the card that Raggi had already given him morphine. “When did this start, Mr. Wilder? How long ago?”

  “Ten after seven,” was the instant reply, the quick and precise response of a man who lived by the clock, a significant indicator of the precoronary syndrome. “Be all right in a minute or two.” He tried to prove it by starting to sit up.

  Aaron Kharr reached out, restraining him with a hand on his shoulder, testing the strength of his resistance, finding it significantly weak.

  “This belly trouble you’ve had, Mr. Wilder—how serious has it been? Ever had an ulcer?”

  “No, nothing like that. It’s just—”

  “How did this pain hit you?” he asked, guided by Raggi’s note that the patient had been picked up at Sam’s Diner. “You said you’d eaten these cheeseburgers at the diner—”

  “No, that was back on the turnpike. I’d just come off—”

  “You were in your car—driving?”

  “Yes, I—”

  “This may seem a foolish question, Mr. Wilder, but it may help me get at what’s wrong here. You were driving along—this pain suddenly hit. Now what was your first reaction? What did you do—stop immediately?”

  “No, I—had to drive on a little ways—find a place where I could—get off the road.”

  “Then what? Did you sit there in your car for a while, feeling as if you were paralyzed, as if you couldn’t move?”

  “I knew what it was, just this damn belly. I got out—tried to walk it off. Then I saw the diner—thought maybe I’d get some Alka-Seltzer—”

  “I understand,” he interrupted, saving the patient from the effort of further speech, positive now that his diagnosis was correct. That first walk-it-off reaction was the classic symptom of coronary occlusion, differentiating it from an anginal attack. “Have you ever had any reason, Mr. Wilder, to think that there might be anything wrong with your heart? Have you been worried about—?”