Public Anatomy Read online

  PUBLIC ANATOMY

  Also by A. Scott Pearson

  Rupture

  PUBLIC ANATOMY

  A NOVEL

  A. SCOTT PEARSON

  Copyright © 2011 by A. Scott Pearson

  FIRST EDITION

  All rights reserved. No part of this book may be reproduced in any form or

  by any electronic or mechanical means, including information storage and

  retrieval systems, without permission in writing from the publisher,

  except by a reviewer who may quote brief passages in a review.

  This book is a work of fiction. Names, characters, businesses, organizations,

  places, and incidents either are the products of the author’s imagination or are

  used fictitiously. Any resemblance to actual events, businesses, locales, or

  persons, living or dead, is entirely coincidental.

  ISBN: 978-1-60809-009-9

  Published in the United States of America by Oceanview Publishing,

  Longboat Key, Florida

  www.oceanviewpub.com

  2 4 6 8 10 9 7 5 3 1

  PRINTED IN THE UNITED STATES OF AMERICA

  FOR ROBIN

  PUBLIC ANATOMY

  Title Page, First Edition, Vesalius, Andreas.

  De Humani Corporis Fabrica Libri Septem.

  Basel: Johannes Oporinus, 1543.

  CHAPTER ONE

  Minutes from completing another successful operation, Dr. Liza French made the final cut. In an operating room designed specifically for her, she’d performed the entire procedure without touching the patient, a distinct advantage, in her mind, for any gynecologist. Surgical gloves weren’t needed because her hands did not touch a drop of blood. Never one to conform, Dr. French wasn’t even wearing shoes. From the start, she had slipped off her sling-back, open-toed, two-inch heels and scooted them aside.

  Barefoot in her own operating room, she knew the only way to improve on this procedure would be to perform it from the living room of her Victorian mansion, Rachmaninoff crashing in the background, an iced vanilla latte for the finale.

  All in due time, she thought. Just finish this case.

  Five yards of glistening tile floor separated her from her patient. She sat within a stainless steel console in a corner of the operating room and stared at a video screen. Delicate movements of her fingertips were transferred robotically to instruments that her chief resident had inserted an hour earlier through tiny incisions in the patient’s lower abdomen. A single flicker of Dr. French’s thumb generated precise movements on the screen, magnified exponentially. Robotic surgery—a computer-driven, three-dimensional, precision-controlled operation performed from a million-dollar console detached from the patient.

  The console was comparable in many ways to a flight simulator for pilots with Dr. Liza French and her team on the final approach. The circulating nurse stationed herself in front of a computer documenting the time of procedure, title of the operation, and personnel involved. By this point, the patient’s anesthesia was mostly controlled by autopilot and both the anesthesiologist and anesthetist were bored with watching the video screens and listening to the monotonous beep-beep-beep of the monitors.

  Liza glanced at the operating table. Her scrub nurse stood with gloved hands folded and resting gently on the drape, a sure sign that things were going well. Just a few more bands of scar tissue and the patient’s diseased uterus would be out. Everyone was relieved.

  Liza’s bare feet worked the foot pedals at the base of the robotic console. She liked the feel of her toes on the controls. Skin to metal. She had tried it in stocking feet—high heels definitely didn’t work—but even nylon diminished the sensation of touch. I don’t like anything between me and what I want to feel. She smiled devilishly, her face hidden deep in the high-priced instrument.

  At the patient’s side, chief resident Thomas Greenway was scrubbed, as was medical student Cate Canavan. Thomas was responsible for maintaining the exact position of the instruments that traversed the patient’s abdomen. The student’s job was to hold the steel camera instrument at the start of the operation while the robotic instruments were inserted through the patient’s abdominal wall and then at the end of the procedure while the instruments were being removed. Cate had been instructed by Dr. French in how to hold the camera steady while it was not secured by the robotic arms. This had been accomplished, and a lens on the tip of the camera transmitted the image of the uterus to the screen.

  With the two nurses and two-person anesthesia crew, seven medical personnel occupied Liza’s operating room, a typical number for this type of operation. But this was no typical operating room.

  Another nonmedical team milled about carrying shoulder-mounted cameras hooked to portable video screens. As video computer techno-types, the team was somewhat less accustomed to hospital scrubs and the need for a sterile environment. The Internet film company, SurgCast, had dispatched a dozen of its best personnel to film Dr. French and her surgical robot, an operation for which the week’s premier viewing spot was reserved.

  Surgical Webcasting. Log on to your computer and watch real operations live from the OR. Cardiac surgery, obesity surgery, even breast augmentation.

  Bigger, better, faster.

  The ultimate reality show.

  Only part of the production centered on viewing an operation. Real-time communication through viewers’ e-mails offered the hot marketing tool. Prospective patients could “call in” their questions, experience an exchange of information, and soon have an appointment with the surgeon on their computer screen for a visit preliminary to their own surgery. For what was basically an hour-long commercial, Gates Memorial Hospital was more than happy to contract with SurgCast.

  The patient, of course, was unaware of all this at the moment. A fifty-three-year-old dental hygienist, she was so appreciative of having been selected from the three-month waiting list for robotic hysterectomy, she would have consented to almost anything. Asleep, flat on an operating table fifteen feet from her surgeon, she was completely covered by a surgical drape except for a two-foot-square patch of abdominal skin. Black, pencil-thin robotic arms, each covered with its own sterile drape and aimed at her abdomen, pierced her skin and reached deep into her pelvis to grasp her uterus.

  Now, images of her dangling organ were broadcast live for anyone with an online computer connection to see. The doctors, the nurses, and certainly the patient were carefully selected for these online dramas. The operating team even had scripts to follow. But a film crew cannot control for unexpected scenes.

  As chief of OB/GYN at Memphis’s busiest hospital, Dr. French had performed over two hundred hysterectomies. Only the last twenty had been accomplished robotically. She was especially relieved that of all those twenty, this one was going the most smoothly. After one botched operation six months before, her Program of Robotic Surgery, the first of its kind in the Southeast, was on probation, the detail of every subsequent operation under harsh scrutiny.

  The revenue from her program alone had helped lift the hospital’s bottom line from the red to a healthy surplus. The administrators of Gates Memorial Hospital were eager to get Dr. French’s lucrative robotic program up and running again. Each operation after the one disaster had been a complete success. This operation, the first since the probation was lifted, had to be successful for her program to continue.

  So far, so good.

  Throughout the procedure, Liza narrated each step for SurgCast’s audience. She described the robotic instrument, how it worked, and how robotic surgery was so much better for the patient than traditional surgery performed through a gaping incision. She described how this patient suffered from a diseased uterus, the bleeding and pain, and how much b
etter she would feel after the operation.

  During this final portion of the operation, Liza looked up from her console, curious to see if the video cameras still focused on her. Glad to see one camera seeking a full facial shot, she winked over her mask and gave a quick head shake so her silver loop earrings would jangle and flash. The camera panned down, lingering ever so briefly at her waistline, and continued to the floor. Liza glanced at the monitor to see her naked feet.

  “This is an important part of the robotic controls,” she said. “With the foot pedal, I can manipulate two instruments at once.”

  She had anticipated that the cameraman might want to show this portion of the apparatus, so she’d prepared for it with a pre-op pedicure from her favorite salon. Her toenails were painted a glossy brown with a little yellow smiley face on each nail. She checked the monitor and wiggled her toes, the little faces performing a wavy dance.

  Dr. French’s narration, along with her camera-friendly intraoperative flair, created a logjam of viewer e-mails. The company’s advertising specialist estimated the number of communications-per-episode to be up by 50 percent, a veritable windfall for the company. At first, the film crew kept up with each question received at “command central,” a techno-modified work bench with a computer in the corner of the operating room. From this vantage point the whole filming process was controlled, from camera angles to audio control to an open phone line connected to company headquarters, where external image transmission was continuously monitored.

  Most of the questions came from interested patients.

  Should I have a hysterectomy?

  Does the robot procedure cost more?

  How do I make an appointment?

  After screening for appropriate content, chief resident Greenway read each e-mailed question aloud for all viewers to hear. For a moment, the film crew focused on him. At six foot three, his athletic build and tanned face were attractive features for the camera, even though mostly hidden by surgical garb. The resident answered the questions as best he could, with additional color commentary added by Liza French. Each unanswered e-mail was catalogued and archived for a later individual response.

  The release of tension toward the procedure’s completion let a bit of frivolity seep into the room, and the rigid e-mail screening process relaxed.

  “We have time for one more e-mail,” Greenway announced, and he read the last question verbatim.

  “My wife wants to have this operation and I was wondering if it changes the way, you know, how we make love.”

  After a moment’s hesitation, the resident finished the message.

  “She was the one who told me to ask the doctors.”

  Except for a few muffled laughs, the room fell quiet, then gave way to audio-detectable snickering.

  Poised and waiting for the next prompt, SurgCast’s crew hoped to move forward from this entertaining but awkward moment.

  Dr. French brought the focus back to the operation at hand.

  “The final step before closure will be removal of the already detached uterus itself.”

  She directed the chief resident to clamp the dangling organ and remove it. Then she returned to the viewer’s e-mailed concern.

  “I appreciate your question. Your wife will be the same woman she was before. I hope that’s what you want.”

  After that last comment, Greenway shot her a wide-eyed glare.

  Liza shrugged, temporarily pulled down her mask, and mouthed back, “Well?”

  To complete the operation, Greenway began to remove the robotic instruments from the patient’s abdomen.

  During the distraction, Cate, the medical student, began watching her mentors instead of the telescopic camera she was holding. She accidentally banged the resident’s uterine clamp with her instrument.

  Cate quickly readjusted the camera. The resident readjusted his clamp, their rapid movements brushing against the sterile drapes.

  Liza twisted inside the console to see what was happening at the operating table. Her bare foot slipped off the pedal. When she looked back at her screen, a pulsating geyser of arterial blood covered the field.

  “What the hell?”

  The SurgCast crew kept filming. A precipitous decline of the monitor’s tone indicated the patient’s heart rate was plummeting.

  The anesthesiologist, quiet the entire procedure, announced, “I’m losing her pressure up here.”

  Cate scrambled to reposition the camera, again. But the lens was submerged in a sea of blood.

  With no visualization of the abdominal cavity, Liza stared, paralyzed, at red waves splashing her screen.

  “She’s bleeding out,” Greenway yelled. “We have to open her.”

  Nurses scrambled to get blood for transfusion.

  The last words the online viewers heard were Dr. French’s. “Cut the damn cameras.”

  She dashed to the operating table and watched her resident grab the scalpel, cut a long skin incision, and turn an elective, highly publicized operation into a last-ditch effort to save the woman’s life.

  Throughout the nation and around the world, each viewer’s computer screen faded from red to black.

  CHAPTER TWO

  “Dr. Branch?”

  Silence.

  “Dr. Eli Branch? Are you in here?”

  Eli Branch squinted at a bright column of light filtering around a large figure in the doorway.

  “You-hoooooo, Dr. Branch.”

  The call room was big enough for only a bed and a nightstand. The bed was a gurney he had rolled in from one of the exam rooms. He just hoped the sheets had been changed since the last patient. Before sneaking away from the nurse’s desk for a few minutes of sleep, Branch had cranked the thermostat way down. In contrast to the sizzling one hundred degree temps that had plagued the River City for over a week, the sheets, dirty or not, were now icy cold.

  The heat wave, combined with a sixty-year record drought, tested the civility of Memphis citizens, their dispositions often frazzled on the best of days. Adding more burn to the heat, the city’s sanitation workers decided to strike, leaving heaps of festering garbage along the curb of every apartment complex, residential community, and restaurant across the city. Hot, dry, and putrid were not the top three descriptors that the Chamber of Commerce would have chosen to advertise the metropolitan center of the Mid-South. More than forty years ago, the city had witnessed the tragic climax of its first sanitation workers strike: an assassination on the balcony of the Lorraine Hotel that sent the nation into turmoil. At the moment, Eli wished to ignore all this, as well as the nurse at the door, but as sure as the rain would stay away, she would not.

  “Don’t think I can’t see you under those covers.”

  She shifted in the doorway, and the slender column of light switched from one side of her to the other.

  A digital clock on the nightstand read 2:34 a.m. Five hours to go in his twelve-hour shift. Branch was accustomed to waking up for surgical emergencies at Gates Memorial—gunshot wounds, a perforated bowel—but since his scalpel-induced hand injury just a few weeks ago, he had been forced to take ER call in this small community hospital in White-haven, just south of the downtown medical center. It provided his only income.

  Middle of the night, he thought. No telling what this could be. Something serious like a myocardial infarction, or fleeting like gas pains. Or suicidal ideations, a middle-of-the-night death wish. He could only hope it was something surgical, like a deep, nasty laceration.

  “Don’t make me come tickle you out the bed.”

  This brought him bolt upright.

  “Yes, I’m here,” he told the nurse.

  “Sorry to wake you, doc, but we’ve got a walk-in.”

  Eli was fully awake now. He flipped on the bedside lamp and checked his pager. No calls missed.

  “I don’t use pagers. Easier to come knock on your door.”

  “What is it?”

  “Male, early sixties, says the top of his head is crawling.”
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  Eli ran a hand through his hair. “What?” Top of his head crawling?

  The nurse stepped back and let the door start to close. “I don’t know, doc. Probably some nut case.”

  “Okay, be right there.”

  She left, and Eli rubbed his face and stood. A month ago he was the new hotshot recruit at the University of the Mid-South Medical Center. An academic surgeon poised to rise to the top. Now, he was the doctor of choice for nocturnal crazies that roamed south Memphis.

  Branch pulled a white coat over his wrinkled scrubs and threaded his splinted hand through the sleeve. Squinting under bright fluorescent lights, he approached the examination area. Outside curtain three, the charge nurse handed him a clipboard. He read the name.

  Norman Felts.

  “Do we know him?”

  “Norman? He’s here at least once a week.”

  Eli scanned the sheet and found a list of psychiatric meds. “Once a week?”

  “Yeah, but we don’t call him Norman.”

  Playing her game, Eli asked. “What do we call him?”

  “He’s known to the staff here as Tobogganhead.”

  Eli gave her an odd look. “Toboggan? As in wool cap?”

  “You’ll see.”

  He brushed the curtain back to see Norman sitting on the gurney, legs dangling, a blue stocking cap pulled low over his ears. The day before, the temperature had topped out at one hundred and three degrees. Today’s prediction was a Memphis cool front, dropping to ninety-nine. Eli couldn’t imagine anyone wearing a wool toboggan.

  Eli extended his hand. “I’m Dr. Branch.”

  “He is?” Norman looked at the nurse. “And handsome too.” Rather than shake Eli’s hand, Norman ran his fingers across Eli’s palm, as though reading the lines.

  “Just tell him what’s wrong, Norman,” the nurse said.

  “I’m getting to that, Janice.” He said her name loudly, then looked Eli up and down. “He’s new, isn’t he?”