Across The Red Line: Stories From The Surgical Life

3. Fate

3 Fate There are times in medicine when I feel like a bystander watching a traffic accident. I have no direct influence over events; I cannot make widespread cancer disappear or restore function lost to a bullet’s capricious path. But I try hard to force the foul ball fair with lots of body English and hope and careful attention to detail. Still, there are times when coincidence is so eerie and a patient’s fortune is so inexplicable that there seem to be larger forces at work. This last year, the story of a man and his father has been unfolding with just this kind of frightening certainty . Bill’s father, Bill senior, died about 18 months ago. He had a cancer in the upper part of the stomach. He checked into a private hospital in town, got operated on and died. Bill senior was a prominent man in state government and then, later, he made lots of money in this town’s biggest business. Everybody seemed to like him, and at the time I was vaguely aware of his difficulties because friends of mine would tell me about their friend, dying in another hospital across town. I heard that Bill senior had had the upper part of his stomach removed and then the remaining esophagus and stomach were sewn together. That hookup , or anastomosis, broke down and an abscess developed and required draining. Bill’s father’s weight faltered, then dwindled, and then his intestines became blocked by inflammation and pus. He died without ever eating again. 33 And so it was not surprising that when Bill junior had some difficulty swallowing during this ordeal he ascribed it to “nerves.” But after his dad’s funeral the symptoms persisted and Bill’s wife and mother persuaded him to see a doctor. The family was now wary of the “carriage trade” hospital. They wouldn’t say that anything had been done wrong, but they obviously wondered if Bill senior wouldn’t have done better if he’d gone to the M. D. Anderson Hospital & Tumor Institute in Houston or Memorial Sloan Kettering in New York. Bill junior seemed as popular as his dad. He’d been captain of the state university’s football team, he was a talented lawyer and he knew everyone his father knew plus a generation of his own friends and acquaintances. If something was wrong with Bill, he wasn’t going to be treated without some inquiries. That much was certain. Executives at Bill senior’s company made it clear that Bill junior had access to the company jet, that no stone would be left unturned for him. If he needed anything, just let them know. But first a doctor had to be found to make the initial investigation . The family ultimately came to a well-known gastroenterologist at the university. He coaxed Bill into an endoscopic exam and that Thursday morning a stunned fatherly doctor looked through a fiberoptic tube and stared directly at a cancer in Bill junior’s upper stomach. It was just like his father’s. This just couldn’t be. Bill was only 42, an athlete. He was the son, not the patient. After some frenzied national consultation, Bill came to me. The family was anxious. The memory of Bill senior’s illness, his operation, all the complications , the false hope, the prayers had not yet faded. Bill’s wife and his mother had lots of questions. Bill, the 34 Chapter Three still fit ex-football player, sat among the women, listening, reserved. They loved him and he knew it and he heard the answers to their questions. He kept their counsel, I could tell. I wanted the honor of being chosen as the surgeon of choice by a family that knew something about what they were getting into. But I had already learned about the extra worry and trials that attend caring for prominent people. If things do not work out, the failure is even more public than usual. So I didn’t push him. But I was pleased when they chose me. After lengthy preoperative discussions about risks and recovery, early one morning almost a year ago he was anesthetized. I opened his abdomen first. As expected I could just barely feel the cancer at the top of the stomach. Most of it extended up the esophagus into the chest. We carefully freed up the lower stomach...