“I’m already over a month behind on my patient schedule,” said Thomas. “There isn’t that kind of demand for teaching cases. There aren’t enough patients to fill the current teaching slots.”
“Don’t worry,” said George. “We’ll find the cases.”
Thomas knew what the real issue was. George, and most of the others, were jealous of the number of cases Thomas did and how much money Thomas earned. He felt like getting up and punching George right in the face. Glancing around the room, Thomas noticed that the rest of the doctors were suddenly busy with their notes, papers, or other belongings. He could not count on any of the people present to back him up.
“What we all have to understand,” said Dr. Ballantine, “is that we are all part of the university system. And teaching is a major goal. If you feel pressure from some of your private patients, you could take them to other institutions.”
Thomas’s anger and frustration made it hard for him to think clearly. He knew, in fact everybody knew, that he could not just pick up and go to another hospital. Cardiac surgery required a trained and experienced team. Thomas had helped build the system at the Memorial, and he depended on the structure.
Priscilla Grenier spoke up, saying they might be able to add an additional OR room if they got an appropriation for another heart-lung machine and perfusionist to run it.
“That’s a thought,” responded Dr. Ballantine. “Thomas, perhaps you’d be willing to chair an ad hoc committee to look into the advisability of such expansion.”
Thomas thanked Dr. Ballantine, struggling to keep his sarcasm to a minimum. He said that with his current workload it was not possible to accept Ballantine’s offer immediately, but that he’d think about it. At the moment he had to worry about putting off patients who might die before they had OR time. Patients with a ninety-nine-percent chance of living long, productive lives if they did not find their OR time sacrificed to some sclerotic wino whom the teaching service wished to experiment on!
On that note the meeting was adjourned.
Struggling to keep his temper under control, Thomas went up to Ballantine. George had, of course, beat Thomas to the podium, but Thomas interrupted.
“Could I speak to you for a moment?” asked Thomas.
“Of course,” said Dr. Ballantine.
“Alone,” said Thomas succinctly.
“I was heading over to the ICU anyway,” said George amiably. “I’ll be in my office if you need me.” George gave Thomas a pat on the shoulder before leaving.
To Thomas, Ballantine was the Hollywood image of the physician, with his soft white hair combed back from a deeply lined but tanned and handsome face. The only feature that somewhat marred the overall effect were the ears. By anyone’s standards they were large. Right now Thomas felt like grabbing and shaking them.
“Now, Thomas,” said Dr. Ballantine quickly. “I don’t want you getting paranoid about all this. You have to understand that the university has been putting pressure on me to delegate more OR time to teaching, especially with the Time article. That kind of publicity is doing wonders for the endowment program. And as George pointed out, you have been controlling a disproportionate amount of hours. I’m sorry you had to learn about it like this, but…”
“But what?” asked Thomas.
“You are in private practice,” said Dr. Ballantine. “Now if you’d agree to come full-time, I can guarantee a full professorship and…”
“My title as Assistant Clinical Professor is fine with me,” said Thomas. Suddenly he understood. The new schedule was another attempt at pressuring him into giving up his private practice.
“Thomas, you do know that the chief of cardiac surgery who follows me will have to be full-time.”
“So I’m to look at this cut in my OR time as a fait accompli,” said Thomas, ignoring Ballantine’s implications.
“I’m afraid so, Thomas. Unless we get another OR, but, as you know, that takes time.”
Abruptly Thomas turned to go.
“You’ll think about coming aboard full-time, won’t you?” called Dr. Ballantine.
“I’ll consider it,” said Thomas, knowing he was lying.
Thomas left the teaching room and started down the stairs. At the first landing he stopped. Gripping the handrail and closing his eyes as tightly as possible, he let his body shake with sheer anger. It was only for a moment. Then he straightened up. He was back in control. After all, he was a rational individual, and he’d been up against bureaucratic nonsense long enough to deal with it. He’d suspected that Ballantine and George were up to something. Now he knew. But Thomas wondered if that were all. Maybe it was something more than the OR schedule change because he still had the anxious feeling something else was going on that he should know about.
Three
Cassi always experienced a degree of apprehension when she dipped the test tape into her urine. There was always the chance that the color of the tape would change and indicate she was losing sugar. Not that a little sugar in her urine was all that big a deal, especially if it occurred only once in a while. It was more an emotional thing; if she was spilling sugar, then she was not in control. It was the psychological aspect that was disturbing.
The light in the toilet was poor, forcing Cassi to unlatch the stall door in order to get a good look at the tape. It had not changed its color. Having gotten so little sleep the night before and having cheated that afternoon with a fruit yogurt snack, she wouldn’t have been too surprised to see a little sugar. Cassi was pleased that the amount of insulin she was giving herself and her diet were in balance. Her internist, Dr. Malcolm McInery, talked occasionally of switching her to a constant insulin-infusion device, but Cassi had demurred. She was reluctant to alter a system that seemed to be working. She did not mind giving herself two injections a day, one before breakfast and one before dinner. It had become so routine as to be effortless.
Closing her right eye, Cassi looked at the test tape. There was just a vague sensation of light as if she were looking through a wall of ground glass. She wished that she didn’t have the problem with her eye because the idea of blindness terrified her more, in some ways, than the idea of death. The possibility of death she could deny, just like everyone else. But denying the possibility of blindness was difficult with the condition of her left eye there to remind her each and every day. The problem had happened suddenly. She’d been told that a blood vessel had broken, causing blood to enter into the vitreous cavity.
As she washed her hands, Cassi examined herself in the mirror. The single overhead light was kind, she decided, giving her skin more color than she knew it possessed. She looked at her nose. It was too small for her face. And her eyes: they curved unnaturally upwards at the outer corners as if she had her hair pulled back too tightly. Cassi tried to look at herself without concentrating on any single feature. Was she really as attractive as people said? She’d never felt pretty. She had always thought that diabetes was indelibly stamped in bold letters across her forehead. She was convinced that her disease was a major flaw that everyone could see.
It hadn’t always been that way. In high school Cassi had tried to reduce it to a small aspect of her life. Something she could compartmentalize. And although she was conscientious about her medicine and diet, she did not want to dwell on it.
Yet this approach made her parents, mostly her mother, understandably concerned. They felt that the only way she would be able to maintain the discipline the disease required was to make it her major focus. At least that was the way Mrs. Cassidy had dealt with the problem.