Public Anatomy Read online

  “I’ll start with the basics,” Bass said as his assistant exchanged his handheld microphone with a headset unit, allowing the company’s CEO to more freely demonstrate the technology.

  He then explained the efficiency of the self-contained robotic console and how it could translate coarse, unrefined, two-dimensional human movements into a fine, three-dimensional, symphonic choreography. Eli thought that the dance reference was a bit exaggerated.

  In his seat, Eli sketched the arrangement on a pad of paper the hotel provided for each attendee. He drew the robotic console, and several feet away from it, the patient. He filled in the position of the scrub nurse next to the patient, and a medical student and a surgical resident hugging the table as in a traditional operation. Away from the table, he filled in the space for a circulating nurse. He counted six surgical personnel in the “operating room.” Then he sketched in the seventh person, the surgeon, sitting at the robotic console. He imagined Liza French there, her back arched, intensely watching the movements on the screen.

  Eli wondered how it had all gone down the day her patient died. Who first noticed a problem? Was there any warning at all? Maybe it was a deceptively quiet and calm operation, suddenly giving way to chaos.

  “I don’t know about you, but I think this robot surgery is a bunch of crap.”

  Startled, Eli looked up at the man beside him.

  “I like to feel the tissue in my hands, know what I’m saying?” The man was squeezing his hands, open and closed, as if testing farm produce. Eli wondered what training program had allowed him to slip through and become a surgeon. As the man continued to rant about the ills of robotic surgery, Eli noticed that the workshop participants had moved out of their seats and were gathering around the robotic simulator. The CEO, Bass, had called everyone up for a “live” demonstration. Eli stood and took the long way around the conference tables, hoping to lose his chatty neighbor. The man tracked him anyway.

  What followed next was a robotic dog and pony show. The assistant sat inside the console and maneuvered the hand controls. Tiny movements of his fingertips were translated to the intraabdominal trocars and materialized on the high-definition screens. Bass narrated the show while specifying the details with a laser pointer.

  “Nathan is demonstrating the three hundred sixty-degree range of motion that’s so easily attainable with the robotic controls. Those of you close to the console step up and observe the minute hand movements that translate into such fluid motion.”

  Eli stepped forward and watched the assistant, introduced as Nathan, work the controls. The young man watched a screen inside the console that showed a picture identical to that displayed on the audience’s freestanding screens.

  “How many of you perform cholecystectomy in your surgical practice?”

  Not surprisingly, nearly every hand went up. Removal of the gallbladder was one of the most commonly performed operations.

  “Wait until you see the ease of robotic cholecystectomy. You’ll never want to go back.”

  Eli watched the president of Renaissance Robotics. He definitely knew his stuff—the technology, the instruments. But he was a little too smooth—a bit too much the used car salesman.

  “With the robotic system, you can lock a trocar in place for retraction of the gallbladder fundus; another lock on the infundibulum, and you start the dissection. Without an assistant, if you like.”

  Nathan demonstrated these moves, then switched to another hand control. But as he did this, one of the trocars dislodged and ripped the gallbladder off the surface of the liver. Several of the attendees around Eli gawked at each other in surprise. Throats were cleared. If this had been a real patient, the bile duct would have been injured and the liver would be bleeding like hell.

  For a moment, even the president of Renaissance Robotics was without words.

  Eli’s newfound buddy leaned closer to him, so close he could feel the guy’s breath on his ear.

  “Told you this robot surgery is a crock of shit.”

  The assistant, carried on as though nothing had happened. Because the cholecystectomy had been completed, albeit violently, they moved on to the next demonstration.

  “Now let’s switch gears and show you how easy it is to remove the spleen.”

  A few attendees snickered. Eli heard one say, “Yeah, right.”

  The splenectomy did in fact go very smoothly, and Eli was impressed with the advantage afforded by the robotic technology over traditional methods.

  At the end of the demonstration, the attendees broke for lunch and filed out of the conference room. The company had reserved a large room at the Rendezvous Restaurant a few blocks away. Eli knew that many in the group would taste real Memphis barbecue and dry-rubbed ribs for the first time. He envied them, but he stayed behind to ask the company’s CEO a few questions. But when Eli located him, Bass was walking out at the head of the group, the two young women from the registration desk at his side. Soon, Eli was alone in the room except for Nathan, who was wrapping an extension cord into a tight coil.

  Eli approached him. “I enjoyed the demonstration.”

  “Yeah?” he said and continued to loop the cord over his hand and around his elbow. “Glad you liked it.”

  Eli noticed a tattoo of three slender animals, like rodents, on his bulging bicep. Nathan looked more like a roadie than employee of a biotech firm.

  “I can certainly see the advantage of the robotic technology,” Eli said, trying to warm up to him.

  Nathan said nothing.

  “I was wondering, is there ever a disconnect between the surgeon’s movements and what the robot delivers?”

  Nathan moved to one of the digital screens and began lowering it on its tripod base.

  Eli tried again. “It seems that one misplaced trocar or one errant move could—”

  The assistant turned to Eli and said calmly, “I just load the truck, okay. You’ll need to ask my boss questions like that.”

  CHAPTER TWELVE

  Liza stopped in the doorway of the executive conference room on the fifth floor of Gates Memorial Hospital. Three men sat watching her from the far side of a heavy oak conference table. Two of the men wore dark suits. She knew one of them. Robert Largo, chief of staff at the hospital. He addressed her first.

  “Have a seat, Dr. French.”

  The third man wore a light tweed jacket over a button-down shirt. No tie. Liza recognized his signature look from the newspaper. Gordon Daffner, president of the University of the Mid-South.

  Dr. Largo had called Liza to tell her of the meeting. They expected a swift lawsuit from the deceased patient’s family and wanted to waste no time in getting the facts down. The chief of staff motioned to a chair opposite the three of them.

  Liza had been in this conference room before to present her Program of Robotic Surgery to the board of trustees. She remembered being comforted by the rows of books in dark-paneled cases along the wall. This time as she took her seat she felt no comfort at all.

  Largo began with brief introductions. “Dr. French, you know our president, Dr. Daffner.”

  Daffner rose, extended a hand across the table. “Doctor.”

  Liza started to say “president,” then, “Dr. Daffner.” In an awkward moment, she said nothing.

  Largo cleared his throat. “This is attorney Mitchell Downing, head of legal affairs for the hospital.”

  Downing didn’t get up. He nodded, then opened a legal pad as a signal he was ready to start transcribing.

  Largo began the meeting. “The events of the past twenty-four hours have been most unfortunate, as you know. Not only did we suffer an intraoperative death, but—”

  At this he stopped, as though he didn’t yet accept what had happened.

  President Daffner put his fingers to his lips in the shape of a triangle. The lawyer, pen poised to paper, stared at Liza, eagerly awaiting her reaction.

  Largo continued. “The complication, at least the initial chaos, was broadcast on the Inte
rnet.”

  The chief of staff shook his head in obvious regret of the decision to contract with SurgCast. “We are receiving numerous calls from patients.”

  “Calls?” Liza asked.

  “Yes, calls, Dr. French. Patients are canceling their appointments and their operations. And it goes beyond just the OB/GYN department.”

  Downing removed a newspaper from his briefcase, slid it across the table. It came to a stop in front of Liza. On the front page, in bold letters:

  Second Operating Room Death at Gates Memorial Hospital

  The subheading was even more damning:

  Botched Procedure Broadcast Live on the Internet

  Liza blew out a pent-up breath.

  She knew this would be the end of her robotic surgery program. She couldn’t yet fathom what this meant for her career, much less the reputation of the hospital.

  Largo reached across the table for the paper. He handed it back to Downing and said, “We want to hear from you what happened in the operating room.”

  They waited for her answer.

  It was hard for her to even think about the operation without seeing flashback images of uncontrolled hemorrhage, the ensuing chaos, her looking at the clock to pronounce the time of death. She knew these men represented the interests of the hospital and the university, but Liza did not feel as though she was among allies.

  “The case was proceeding very well,” she began. “A routine hysterectomy, really.”

  Downing cleared his throat, the first of many interruptions. “How many of these,” he stopped and made double quotations with claw-like fingers, cases have you performed, Dr. French?”

  She knew where he was going with this. He obviously wanted to invoke the incident from six months ago.

  “Mr. Downing, I have completed over two hundred hysterectomies, if you must know.”

  French and Downing locked in a stare down.

  “And how many with the robot?”

  After a brief hesitation, “Twenty.”

  A grin appeared on the attorney’s face as though entertained by his next question.

  “Does that number include only the patients that lived?”

  Largo put both hands firmly on the table. “That’s enough. We’re all aware of the death that occurred a few months ago. Fortunately, we moved past that without a scratch. Let’s focus on this case, shall we?” He glanced at Downing. Then he said, “Please, Dr. French, continue.”

  “I had removed the uterus and was about to start closing. My assistants began removing the instruments from the patient’s abdomen.”

  Liza stopped.

  They waited.

  “All of a sudden, there was blood everywhere.”

  “Blood, everywhere?” Downing repeated. “Can you be a bit more specific, Dr. French?”

  “We had not yet removed the camera from the patient’s abdomen. I saw a flash of blood. Then, the entire screen was red.”

  “Where were you at that moment?”

  “I was in the OR, of course.”

  “What I meant was,” Downing clarified, “where in the operating room?”

  “I was at the robotic console, monitoring the procedure. What are you getting at?”

  “Is monitoring the same thing as supervising?”

  Irritated with his questions,” Liza asked, “What?”

  “Were you in control of the operation, Dr. French?”

  “Yes, I was.”

  Downing hesitated a moment. “What else was going on in the room?”

  “The nurses had begun to count the instruments, usual proceedings for the close of an operation.”

  Until now, the president of the University of the Mid-South had not spoken a word. “Were personnel from SurgCast still present?”

  Liza immediately knew the focus of his concern. A hospital-related death was one thing. A worldwide Internet preview of the death, boasting the university’s seal, was leagues above the concern of one individual or one family.

  “Yes, sir,” Liza answered, “they were filming the procedure.”

  President Daffner closed his eyes, pressed his fingers together so tightly beneath his chin that the skin turned white.

  Downing struck again. “Why did you not supervise removing the trocars?”

  “That is a routine part of the procedure. I allow the surgical resident to remove the instruments.”

  “Doesn’t sound routine to me, Dr. French. Isn’t this when the patient died?”

  Liza had already answered this question before. Or thought she had.

  “Describe to us how this could happen, please.”

  “I don’t really know.”

  “You don’t know? You’re the attending surgeon. Your patient dies on the table, and you don’t know what happened?”

  Liza was hesitant to speculate. After the death, she had drilled Thomas Greenway, her chief resident, with these same questions. Cate, the medical student, was still too traumatized to give any detail.

  “The autopsy should define the injury,” Liza added.

  Largo leaned forward. “Humor us, Liza. What do you think happened?”

  “One of the trocars must have injured an artery. It hardly seems possible because the trocars were being withdrawn, not plunged deeper into the abdomen.”

  “What were you doing at the exact time the instruments were removed?” Largo asked.

  Since Downing had already posed that same question, he gave Largo a what-the-hell kind of look.

  But Liza gave a very different answer to Largo.

  “I was answering an e-mail question from a prospective patient.”

  Largo leaned forward, looked as though he might throw up. “An e-mail?”

  “Yes.” By the looks on their faces, the men did not know that e-mailed questions were allowed during operations webcast by SurgCast. “We had time for one more question. I was answering it when the problem occurred.”

  Downing dropped his pen on the legal pad. “We might as well write the check. Pay them whatever they ask for.”

  They wanted him to explain.

  He did.

  “We can’t defend this. Our surgeon is playing talk-show host while a trainee finishes the operation? And I mean finishes it.”

  He glanced at Largo, then the president. “Hope you have millions in malpractice reserve. That’s what it’s going to take.”

  Liza wasn’t ready to concede. “I believe the surgical instrument contributed to the death.”

  “Excuse me?”

  “This had to be a malfunction of the robotic equipment.”

  “Dr. French, I reviewed your statements after the first death, six months ago,” Downing said. “You claimed device failure in that case as well.”

  “That’s right and—”

  Downing cut her off. “I have researched the company’s records. They have had no other such claims. Their quality control is excellent. Spotless, actually.”

  This squeaky-clean talk made Liza nauseous. “I’d like to switch to different equipment for future robotic operations.”

  “Future operations? You don’t get it, do you, Dr. French?”

  Liza sensed they weren’t telling her something. Something big. She had expected her robotic program to be in jeopardy. And suggesting an alternative plan was her only hope for saving it.

  Largo delivered the news. “We’re forced to withdraw support from your program, Liza. There’s no way to continue the program given the negative press. Besides, we have larger issues to face.”

  Largo hesitated briefly, but just long enough for Downing to take over.

  “We received a call yesterday. Criminal charges have been pressed against you and the hospital.” Downing allowed a slight grin to cross his face. “Your little incident has attracted the attention of the FBI.”

  CHAPTER THIRTEEN

  Fourth-year medical student Cate Canavan unlocked the deadbolt and entered the Poplar Avenue Free Clinic. Behind her, a line of patients ten deep waited to enter the
same concrete structure that, for years, had supplied the same clientele with discount beer and tobacco. Some of those now gathered had slept there through the night, at the edge of the parking lot, asphalt still baking from the previous scorcher.

  She saw a couple of familiar faces. Foster, the kind man who came to the clinic more out of habit than medical necessity. He’d never embraced the reality that the beer and tobacco store was no more. Beside Foster stood The Meatman, four of his left fingers chopped off at a slant from an improperly wielded meat cleaver. Most people called him Meat. Cate thought The Meatman sounded more proper.

  It was twenty minutes after six o’clock in the morning. The clinic usually opened at eight. By then, the temperature would be soaring to near ninety degrees, and Cate’s homeless patients were already hurting. She turned to face the line and saw others crossing the four-lane avenue toward the clinic. Cate watched Mary Macklin pushing her shopping cart across the pavement, mumbling to herself as usual. In her path stood Joey the Flicker, named for the cigarette lighter in his left hand that he nervously flick, flick, flicked. The tip of his left thumb was a seared leather rind. Mary banged the cart into his leg and Joey stepped aside.

  To no one in particular, Cate called out, “Just give me a few minutes.” Then she closed the door behind her. She felt the immediate rush of cool air. Even though the city had mandated that lights and air conditioners be turned off in unused buildings, she was glad she had left one of the window units on overnight. She knew the clinic would soon be full of bodies trying to escape the heat. She turned the unit on high.

  A young man, mid-thirties, his hair long and dirty, stood at the window with vacant eyes fixated on her. She gave him an unconvincing smile and turned away.

  Since the clinic had opened six months before, this morning marked the first time Cate was there alone. The free clinic was a project she and a handful of students had imagined their first year of medical school. It was their way of righting the injustices of health-care disparity among the uninsured poor. Now, three years later, after raising money to buy the building, gaining the support of a few medical school faculty members, and fighting a court-ordered injunction citing the building code, the Poplar Avenue Free Clinic opened. Finally, it was gaining a reputation as a compassionate emergency room alternative for care of the city’s most indigent.