“Dinner’s ready,” Alex called after pushing through the back door with a red-and-white box of fried chicken and slaw from a fast-food chain off Central Avenue, only a couple miles from their new home. He heard the clatter of Natalia’s nails on hardwood as she scrambled for traction, and visualized her puppy paws going all-out, her body staying stationary. She came skidding around the corner, followed a moment later by Lisa. Lisa’s work shirt was paint spattered, but her jeans seemed to have avoided even one smear. She wiped her hands on a rag before stuffing it back into her rear pocket. Alex knelt down to give Nat some behind-the-ear scratches. In return she gave him several wet doggie kisses. He opened the door for her to go out into the back yard.
“Great timing. Just finished the window trim.”
Alex set the boxed chicken on the table while Lisa brought two glasses from a cabinet. “Real plates or paper?” Before the moving truck arrived, they’d been using paper plates.
Both of them dropped into chairs at the kitchen table, exhausted. According to plan, they had arrived three days before the moving truck’s scheduled delivery. They’d devoted the intervening days to stripping wallpaper and painting rooms. Nights were spent in Dr. Garrison Major’s guesthouse. At the risk of offending their gracious hosts, they declined to dine with them for fear of being an imposition and a nuisance. Plus, they wanted to orient as quickly as possible to the new city before Alex became swamped with work. Alex believed if you were forced to find restaurants and stores, you learned the geography more quickly.
The moving truck had arrived that morning, and by afternoon they’d assembled their bed and unpacked just enough clothes and kitchenwares to make the house livable until they could completely unpack. The other goal for the day had been to finish painting. By the next morning all the fresh surfaces would be dry and the house aired out. Tonight would be their first in the new home, a milestone marking the beginning of a new life for them.
“We’ll use paper,” Lisa replied. “The thought of cleaning up dishes makes me ill. In fact, once we finish dinner, I think I’m going to fill the tub and soak for an hour or two. My muscles haven’t ached so much since that aerobics class I took. Did you remember to pick up a bottle of wine?”
“Does the Pope shit in the woods?” He triumphantly produced a bottle of cabernet from one of the bags. “I did. But they didn’t have much I recognized. We’re going to have to scout out a good wine store.”
He filled the two glasses with tap water, brought them to the table, and grabbed two wine glasses from a moving box while Lisa opened the container of slaw. They divvied up the two plastic forks and napkins that came with the chicken. Famished, he grabbed a chicken leg and started in.
They ate ravenously, not bothering with the nicety of dinner conversation. With most of the chicken and a good portion of the slaw devoured, Lisa sat back to lick her fingers. “Boy, was I a piggy at the trough! Didn’t realize how hungry I was until I caught a whiff of the food.”
Alex licked his fingers too. “Oh man! Make that two piggies at the trough.”
They leaned back in their chairs and laughed. After a moment of silence, Alex started in on the corkscrew. “One more week before I officially start. I was toying with the idea of driving in tomorrow afternoon to attend teaching conference, learn how they run things here. You mind?”
She dabbed her lips again with the napkin. “Not at all. That actually works out well because Betty invited me to a luncheon at a friend’s home. I was going to ask if you mind being on your own for a few hours.” She glanced around, then continued. “Slowly we’re getting things in shape. Wouldn’t hurt if we both get a break from this place. At least now we know about that Kroger.” The supermarket anchored a small mall about a half mile outside the Central Avenue gates to The Garden.
The phone rang and Alex picked it up.
“Alex?”
He didn’t recognize the voice. “Yes?”
“What the fuck did you do with the data in your lab?”
Ah, Dick Weiner. Alex hesitated. How to answer … He wouldn’t put it past Weiner to be recording the call. Besides, there was no upside to admitting anything. “What data?”
“You know exactly what I’m talking about. All the lab books. Karen claims they were in the lab the day before you left.”
“Are you suggesting I took them?”
“Who else would do that?”
“If you remember, you changed the locks to my office and my lab. How the hell could I get them?” When in doubt, deny, deny, deny.
That seemed to slow Dick up. “Fair warning, Cutter. Return them.”
“Or what?”
Weiner hung up.
Alex found the Baptist Central main auditorium after several minutes of wandering the first-floor halls. Two of the six doors remained open, so he slipped in silently. Alex figured the room could comfortably seat two hundred people. He chose a seat toward the back, settled in, and glanced around. The wedge-shaped room with dark, wood-paneled walls funneled to a small stage on which sat a multi-panel X-ray view box. The first two rows of seats were occupied with residents, nurses, and a handful of attending physicians. Reynolds sat on the center aisle with Garrison directly behind him.
A resident slapped the last of a series of CTs in the blackened view box, then flipped on the switch to light one panel before turning to the group. “Next case is a forty-five-year-old, right-handed black female with a history of bilateral, bitemporal headaches.”
After the resident finished presenting the patient’s history, Reynolds turned to scan the audience for candidates to question, noticed Alex in the back of the room, and said, “Dr. Cutter, come on up here next to me. Group, I want y’all to meet Dr. Cutter, the surgeon who I mentioned is fixin’ to join us.”
Embarrassed at the attention, Alex walked down to the front row. As he was just about to sit, Reynolds said, “Before y’all sit down, Alex, take a look at that scan and tell us your thoughts on this patient and how y’all would handle it.”
Alex stepped closer to the view box and flicked on all the panels, backlighting the CTs that included a normal series alongside a contrast-enhanced series. Contrast enhancement occurs when an X-ray opaque material is infused into the blood stream to help visualize the vessels. Normally, the contrast agent remains in the vessels, but inflammation from tumors or infection allows it to cross into brain tissue, making the abnormalities much more apparent. Alex suspected Reynolds was using the opportunity to evaluate his clinical judgment. Being trained by Waters, and given Waters’s reputation as a conservative surgeon, Reynolds undoubtedly wanted to assess the level of Alex’s conservatism.
Alex tapped his index finger on the obvious tumor. “This tumor is likely a meningioma for the following reasons,” he said, slipping into teaching mode. “First, it seems to originate from the falx as seen by the flat surface here along the falx.” He pointed with his index finger. “The bulk of the mass pushes into the mesial frontal lobe. In a woman this young, you need to worry that it might be more aggressive than meningiomas usually found in older females. As you can see by the contrast enhancement,” moving his finger to the same view in the enhanced series, “slight edema is in the brain immediately adjacent to the tumor. This isn’t a good sign.”
He turned to the group. “There are two—actually three—ways to deal with these tumors. First, watch and wait. Repeat the scans every six months to see if it grows. The downside is you’re wasting time if it is aggressive. The bigger the tumor, the more difficult the removal and the less likely the odds of achieving total resection. It’s important to keep in mind that these tumors can only be cured by total resection. The second option is to radiate it. The downside, of course, is that radiation won’t produce a cure, because they don’t shrink and go away. And, of course, there’s always the risk that the radiation will only piss it off.” A few of the residents chuckled at that. “That happens, you’ve made things worse. The third option is to go after a total removal now while the chances of cure are best. Bottom line is that if this were my mother, I’d push for surgery.”
“I agree,” Reynolds said with a vigorous nod. “But before you sit down, tell us your approach.”
Alex studied the scans more, absentmindedly pinching the back of his neck, visualizing how best to get at the entire tumor.
“I’d position her in the lateral decubitus position,” he said, indicating her side. “I want the right hemisphere down. I’d incline the table slightly with the head above the feet and have a lumbar drain in place. I wouldn’t open the drain until I was ready to open the dura. My bone flap would cross the sagittal sinus.” This was a large vein running front to back in the dura between the hemispheres. “Cutting the bone flap across that sinus is the riskiest part of the operation, because if you accidentally open that puppy, you could be in a world of hurt. Stay out of it. Once I started to open the dura, I’d begin to drain off spinal fluid to allow me to retract the frontal lobe with as little pressure as possible. In fact, the whole point of having her on her side is to let gravity retract it for you. I’d preserve the sagittal sinus if possible, but since you’re in the anterior third of the sinus, if absolutely forced to, you can sacrifice it. But only if absolutely necessary.”
Reynolds smiled, his hand on his chin. “Lateral decubitus position. Never would’ve considered that. We’d usually put the patient brow up with the head rotated away from the side of the tumor. Lateral decubitus position … hmm!” He turned to the residents. “Good suggestion. Y’all need to think about what Dr. Cutter just said. Might be better than what we’re doing.”
Alex sat down, glowing from Reynolds’s words of endorsement. This wouldn’t happen where he came from, especially with Weiner now in command. There, he was a non-entity, the junior faculty member. Here, he now felt the stature of being a professor and surgeon, capable of expressing new thoughts and bringing fresh skills to a deeply inbred training program. This move might become one of the best things to happen to his career. He glowed.
After conference, he walked out of the auditorium with Reynolds. At a T in the hall, Reynolds stopped at the bank of elevators. “Going upstairs to check on a couple post-ops. Great to have you here, Alex.”
“I have a question for you. Know of any squash courts in town?”
“Squash?” Reynolds rubbed his chin. “There’re a couple over at the University Club. I have a membership, so y’all let me know if you want me to sponsor you. Garrison has one, too, so I’m sure he’ll be happy to support you.”
Wonderful. He wanted to begin a routine of regular exercise again, assuming he’d be able to wedge it into his busy schedule, whatever that turned out to be. “Take you up on the offer soon as we get more settled and I have time. Appreciate it.”
Reynolds seemed to remember something. “I appreciate the fact you’re not officially working yet, but I have several matters in need of settling. You mind dropping by the office tomorrow?”
The only things he had on his plate for the next day were several honey-dos around the house, getting some final touches done while he still had his days to himself. An excuse to break away would be welcome. “No problem. What time?”
“Late morning works best for me, say between ten and eleven? Tomorrow’s my day at the university office, and I’ll make sure to be available round about then.”
“I volunteered for the decorations committee for their annual black-tie affair,” Lisa said with as much enthusiasm as Alex had heard in years. “I did it more as an act of self-preservation than desire. What they really want are volunteers for the procurement committee. I did that once before and hated it. I just don’t feel comfortable walking into businesses and asking for donations, especially being new in town and not knowing a soul.”
They were in the TV room with the news on but the volume turned low, enjoying a glass of chardonnay before another take-out dinner of fried chicken and slaw. Tomorrow one of his many tasks was to rehabilitate the gas barbeque in the back yard. It sat under a large oak tree and was covered with pollen, sap, and debris. By the looks of it, it hadn’t been used in a year or more. On the drive back from the conference, he noticed a barbeque dealer on Central Avenue so planned to stop in on his return trip after meeting with Reynolds tomorrow.
“Think you’ll enjoy working on that?” he asked Lisa.
“Yes, but I was so embarrassed. I showed up in my denim skirt, which would’ve been okay back home. All the other woman were in dresses. I felt totally out of place. I need new clothes if I’m going to be going out. Nothing I have fits in here.” She paused to sip wine. “Oh, how’d your meeting with Reynolds go?”
“Great. I finally feel like a real professor instead of a senior resident. It’s forcing me to think the move might actually be good for me. For you too, from the sounds of it.” He checked their glasses. “One more small glass before we eat?”
“Sure. Why not. Oh, I tell you, I was sooo embarrassed today.”