The Chairmen Read online

  Serkin suppressed a sigh. None of this was particularly important, because the OR’s had been operating in exactly this way for years. Patel was annoying. The Department covered three different hospitals, Staunton, Easton and St. Agnes, a small place downtown that did primarily plastic surgery and orthopedics. Serkin’s goal was to take these three disparate parts and meld them into a coherent whole.

  Patel’s viewpoint was too narrow, Serkin thought. Patel lacked vision.

  “And your solution?”

  “We need an OR Manager, somebody with some authority to get things done.”

  Serkin considered this idea for a brief instant and gave a decisive shake of his head. “No way. I’m not going to add another layer to the departmental bureaucracy. And besides, good OR’s run themselves.”

  Patel stared at him. He cleared his throat.

  “Yes?” Serkin said.

  Patel looked away. “Nothing.”

  “Bring your concerns to the Executive Committee. The Executive Committee is the decision making body of this department. We can discuss it on Wednesday.”

  Patel drew a deep breath. “Okay,” he said.

  “Anything else?” Serkin said.

  “No.”

  Serkin smiled coldly. “Then thanks for stopping by.”

  Kurtz, way back when, had been the point guard on his high school basketball team and, in his senior year, backup quarterback on the football team. A height and weight of six feet, two inches tall and 220 pounds had been distinct advantages for both positions. In addition to his physical gifts, Kurtz was blessed with speed, quick reflexes, a facility for sizing up a situation and a conviction that appeasement only encouraged bad behavior. His time in the army, where he had clerked for CID, had done nothing to change his convictions. “What do you mean, I can’t do my case?”

  “Jerry Doyle has a hot gallbladder in the ER,” Patel said. “He says the case can’t wait. Yours is the first open room.”

  “A hot gallbladder?” Kurtz stared at the phone in disbelief.

  “That’s what he says.”

  Kurtz had a breast biopsy scheduled for 11:00 AM. It was now 10:15. “I’ve never heard of a hot gallbladder that couldn’t wait for an hour.”

  “He’s a surgeon,” Patel said. Patel, the clinical director of anesthesiology at Easton, knew his surgeons. So did Kurtz. Doyle was most certainly a surgeon, the sort of surgeon that gave other surgeons a really bad name. “He’s got the right to declare a case an emergency,” Patel went on. “If he does that, we have to bump the first available room.”

  “But he’s full of shit.”

  “Probably. But I’m an anesthesiologist. I’m not going to tell a surgeon that his surgical judgment is full of shit. He’s supposed to be better at surgical judgment than I am.”

  “Well, he’s not better at it than I am,” Kurtz said. “What’s the name of this hot gallbladder?”

  “Susan Baum.” Even through the phone, Kurtz could practically see Patel smiling. “Good luck,” Patel said.

  “Thanks.”

  Five minutes later, Kurtz was in the ER. The secretary at the admitting desk was a bleached blonde with big hair. She smiled at Kurtz. “You have a patient here named Susan Baum, Mary?”

  Mary’s smile grew wider. “Room Five,” she said.

  “Thanks.” Susan Baum’s chart was sitting in a small bin outside Room Five. Kurtz smiled. Ordinarily, it would have been a violation of the Health Insurance Portability and Accountability Act (HIPAA) for any health care provider who was not directly involved in a patient’s care to look through her chart. This patient, however, had been declared to be an emergency, which meant she was, by definition, in serious distress. Serious distress meant that the resources of the institution had to mobilize around the distressed patient. Serious distress was an allowable exception. So…forty- three-years old, complaining of intermittent right upper quadrant pain. No other medical problems. Vital signs stable. Big deal, Kurtz thought. Big fucking deal. Just then, a small, balding man wearing a bowtie walked down the hallway. He stopped when he saw Kurtz.

  “Hey, Jerry,” Kurtz said with a smile.

  “What are you doing here?” Doyle said.

  “I thought I’d come down here and give you a little hand. I heard you were having some trouble with a hot gallbladder.”

  Doyle blinked at him. “Trouble?”

  “Yeah. I heard it was an urgent case. Patient in distress, blood pressure dropping, probably septic, couldn’t wait for me to do my breast biopsy. That sort of trouble.”

  “Oh,” Doyle said.

  “I guess I was wrong though, wasn’t I?” Kurtz held the chart out. Doyle took it between a thumb and one forefinger, as if it smelled bad.

  “It is urgent,” Doyle said. “She’s in pain.”

  “Intermittent pain. Sounds to me like she already passed the stone.”

  Doyle drew a deep breath. “Okay,” he said. “Maybe.”

  “You can do her after I do my breast biopsy. Right?”

  “Right,” Doyle said reluctantly.

  “Thanks,” Kurtz said. “I knew you’d understand.”

  Dolye sniffed. He looked like he was about to say something, evidently thought better of the impulse, then shrugged. “Sure,” he said. “You bet.”

  How many people have you trampled on to get to the top? How many careers has your ambition ruined? You’re going to pay for the people you’ve harmed along the way. I’m going to make certain of that.

  Offhand, the Dean couldn’t think of anybody he had either trampled on or ruined, though he was aware that not everybody would see it in quite the same way. He was a Dean, after all, and before becoming Dean, he had been the Chairman of Pathology at Seattle, positions that some, no doubt, would envy.

  “Hmm,” he muttered. He had received a couple of notes like this about two years before, both from a student who thought that he was being funny. The student had been suspended, sent for counseling and then reinstated. The Dean had followed his progress with some curiosity. He was now a first-year pediatrics resident in Syracuse, said to be doing well and not likely to be trying for a repeat performance of his youthful idiocy.

  Carefully, the Dean opened the center drawer in his desk and placed the note inside. In a month or so, if there was no repetition, he would throw it out.

  Chapter 4

  Stewart Serkin was staring into space, thinking deep thoughts, when his secretary walked in, put a thick envelope down on the desk and walked out. Serkin smiled in satisfaction at the secretary’s retreating back. He had instructed the staff that they were not to talk to him when he was in his office unless they had something important to say. The mail could be delivered without extraneous comment.

  Stewart Serkin was pleased with himself. His plans for the department were coming along nicely. Form follows function, process determines product. Serkin believed strongly in both form and process, and bureaucracy, in his opinion, was an impediment to both. Since arriving at Staunton, Serkin had deliberately set about destroying the departmental bureaucracy. Patel, for instance, had to go. This had been obvious for months. Mahendra Patel had been the clinical chief at Easton for more than ten years. He was seen by both the department and the administration as someone with authority, as a separate decision making entity. Inefficient, at best, and quite possibly dangerous. Serkin wanted one department, not three. He wanted one chairman, himself, not three mini-chairmen.

  It was not that Patel made bad decisions. He didn’t. The problem was that he made decisions. Patel was accustomed to command, and that was a threat to the smooth and efficient running of the department.

  Vinnie Steinberg, though he didn’t know it yet, was the perfect replacement. A man with no administrative experience was not going to pretend to be a seasoned administrator. The hospital and medical school administration would have no confidence in him. He would look, talk and even act like the face of the department but the power would inevitably flow where it belonged, to the Chairma
n. Satisfied with this conclusion, Serkin opened up the packet and began to read.

  Almost seventy applications were ultimately received, most of which were quickly weeded out, the majority being from recently promoted Associate Professors with a moderate number of papers, little managerial experience and no academic reputation. At least twenty were from more senior Associate Professors with a reasonable amount of administrative experience under their belts, either as chiefs of service or division heads. To his surprise, Kurtz found himself agreeing with the chairmen more often than not, at least when it came to the junior guys. What made them chairman material, anyway, except ego? Not much. Of course, you could only tell so much from the CV. An ability to see all sides of an issue and reach either consensus or a reasonable conclusion was not a trait likely to be apparent on a résumé.

  The remaining fifteen or so were from applicants that the chairmen on the committee, along with the pharmacologist, the biochemist and the Chief of Cardiology, regarded as the serious candidates: full professors with fifty or more papers to their credit and a solid history of funding. Perhaps ten of these had administrative experience. At least six of the ten, to Kurtz’ certain knowledge, had reputations as overbearing, egotistical shitheads.

  “How about…” Moller peered down at a CV, “John Allen Kaplan? Anybody know him? Richard?”

  Kurtz shook his head. “He has a good CV,” he said. “I don’t know him.”

  “Anybody?”

  “I concur,” Nash said. “Sixty-seven papers, fifty-two abstracts, over three million in grant money.”

  “Corporate grants,” Christina Pirelli said. “Not NIH grants.”

  Serkin puffed up his cheeks and nodded.

  “He’s been Director of Thoracic for two years,” Kurtz pointed out.

  “True,” Moller said. “I vote to interview.”

  Serkin gave Moller a cool glance, then shrugged. Christina Pirelli reluctantly nodded. Moller looked around the table but nobody else spoke up. He turned to the secretary. “Get in touch with Dr. Kaplan,” he said. “Let’s bring him out here.” He looked back down at the pile in front of him. “How about Thomas Henry Harris?”

  “Extremely well qualified,” Nash said.

  “I certainly agree,” put in Castillo.

  Kurtz looked at Castillo in disbelief. Castillo was a PhD, a pharmacologist. He had never taken care of a patient in his life but still, Thomas Henry Harris was the very essence of a research clown: two hundred and thirty papers, eight million in NIH funding and no experience whatsoever in actually running anything outside of his lab.

  Kurtz did not want to get a reputation as the odd man out, even if he was. The odd man out tended to be ignored, but Thomas Henry Harris, in Kurtz’ opinion, was not the man for the job. Period. There was a long silence. Finally, steeling himself, Kurtz opened his mouth to speak, but before he could say anything, Todd Dunn spoke up. “This is a guy who, ten years ago, would have been a shoo-in, but today, I don’t know.”

  “You don’t know?” Castillo said. “What do you mean, you don’t know?”

  “The Dean specified a good clinical manager. Does this guy spend any time in the OR at all?”

  Serkin looked at him. “He’s a scholar. An eminent scholar. His CV is fantastic.”

  Dunn shrugged and sat back in his chair.

  “Anybody else?” Moller said. Castillo shrugged and looked into space. Christina Pirelli doodled on a pad and seemed not to be following the conversation. “All right, let’s vote on it,” Moller said. “Stewart?”

  “I vote to interview,” Serkin said.

  “John?”

  “Interview.”

  Moller shrugged, wrote something on the applicant’s folder, and looked up at George Linn, who said, “I think we should put him aside for the moment.”

  “What do you mean?” Castillo asked.

  “Let’s see who else applies. We have applications from highly regarded researchers who also have administrative experience. We can make the Dean happy and make ourselves happy, too. Why settle?”

  Moller smiled at him. “I agree,” he said.

  Somewhat to Kurtz’ surprise, this motion was adopted. Maybe, just maybe, Kurtz reflected, the Dean knew what he was doing when he picked this committee.

  “Okay,” Moller said. “How about”—he looked down at the pile of CV’s—“David Leslie Johns?” Moller cocked his head at Christina Pirelli. “He’s from Wake Forest, your old place. Anything you can tell us?”

  “Forget it,” Christina Pirelli said.

  Castillo looked at her, surprised. “How come? He looks good.”

  “I used to sleep with him and he dumped me. He’s an asshole.”

  “Oh,” Castillo said. Nash looked up at the ceiling. Serkin gave another shrug.

  Moller scratched his head. “Anybody else?” he asked. Nobody spoke. “Okay then, forget about David Leslie Johns,” Moller said. “Timothy Fischer…?”

  And so it went for another forty-five minutes. At the end, they had eliminated twelve applicants, tabled two and identified three who looked good enough to interview. Not bad, Kurtz thought. He glanced at his watch. Time for a little lunch before a gastric banding at 1:00 PM. A surgeon’s life, he thought…a nice, routine, boring day, and nothing wrong with that.

  Surgery, as every medical student soon comes to know, is fun. A chance to cut is a chance to cure. Everybody loves to operate. It’s what goes along with operating that’s the problem. You had to be able to put up with hours that were both long and unpredictable. You rarely had a weekend off. The work was physically demanding and emotionally draining.

  Some get used to it. Some, even after years of practice, do not, and these are the ones who contribute most markedly to the notoriously high rates of alcoholism, divorce and suicide that go hand-in-hand with the profession.

  Kurtz, after four years in practice, was used to it. He didn’t necessarily love it, but he was used to it. Or so he told himself. It was harder to maintain his objectivity after forty hours of a forty-eight hour call shift.

  Midnight. The witching hour. Kurtz did most of his cases at Easton but took call at Staunton at least twice a month, one of the requirements for maintaining privileges at the school. He had finished a perforated diverticulum only twenty minutes before. He was sitting in the locker room, bone tired, thinking about getting dressed and heading back home, when the fire alarms went off. He winced. Hospital fire alarms were deliberately set on sensitive. They went off frequently, almost always for no particular reason, occasionally for something minor like too much smoke in the kitchens, and at least twice, that Kurtz could recall, from some idiot smoking in what was supposed to be a “smoke free” hospital. Then, of course, there was the case not too long ago when a neurosurgery patient’s drapes caught on fire, set off by an electrocautery. Unfortunately, in that case, a nurse who wasn’t thinking too clearly had sprayed a fire extinguisher into the patient’s brain. The fire had gone out; so too, had the brain.

  Fire alarms were annoyingly loud but usually stopped after a few seconds. Not this time. This time, as Kurtz put his pants back on, the faintest whiff of smoke came to his nostrils.

  He felt a tingle in his fingertips. His tired muscles abruptly unwound. In a real fire, he reflected, the job of the surgical staff was to evacuate the OR and get all the patients out into the street. You closed every wound you could and packed the rest but one way or another, you got them out of there. Luckily, there were no patients in the OR at the moment, only the one post-op in recovery.

  The fire alarms stopped. The scent of smoke did not, but neither did it seem to be getting worse. Gingerly, Kurtz poked his head out of the locker room and into the hall. The ER was at the other end of the hall. This was a standard arrangement; the OR and the ER should ideally be in close proximity, so that severely traumatized patients can first be worked up and stabilized, then wheeled quickly into the OR. A faint haze of smoke hung in the air of the corridor. Kurtz could hear shouting. Abruptly, th
e overhead paging system began to sound, “Code M, Emergency Room. Code M, Emergency Room.”

  Code M. The “M” stood for manpower, hospital jargon for someone running amok, usually a patient undergoing a psychotic attack or out of their mind on drugs or delirious secondary to head trauma. Sometimes it turned out to be a relative or a friend whose only method of dealing with bad news was to start smashing things. When Security heard the page, they were supposed to come running.

  The smoke was definitely beginning to dissipate. The shouting grew louder. Kurtz glanced at his watch as a slow smile spread across his face. The parking lot was outside the ER. He had to go through the ER to get out of the building. So why not see what was going on?

  Anyway, Code M’s were almost always entertaining.

  The ER was divided into four segments: the administrative offices where physicians did their paper work and new patients were checked in, the lounge where family and friends could wait for news, the routine examining rooms, and the shock-trauma room, which was equipped just like a miniature ICU. The noise was coming from shock-trauma. Kurtz poked his head in through the door.

  It looked like a hill, a hill composed of human bodies rippling and heaving and moving back and forth across the floor. Most of the bodies wore uniforms. One or two wore surgical scrubs, along with wide-eyed expressions as if they didn’t quite know how they came to be down there on the floor and were sincerely regretting the impulse that had put them there. Occasionally, one of the bodies was shaken off the pile. When this happened, Kurtz could see that at the bottom lay a man who looked like a rogue biker. He must have been at least six and a half feet tall and about three hundred pounds. His head was shaved bald. He wore a sleeveless denim jacket without a shirt, black denim pants, and a gold skull on a gold chain around his neck. A constant torrent of curses and hoarse, incoherent screams came from his mouth.