A spoonful of coffee . . . hot water . . . so far, so good. Now some milk and half a spoonful of sugar . . .

It had been a long night, and he was tired, but that wasn’t unusual. He stretched his long limbs, ran his fingers through his dark curling hair, then massaged his temples. Wake up! he told himself.

The coffee would help. He reached for a plastic spoon and was stirring with vigor when the intercom spoke his name. “Dr. Rose . . . Dr. Eric Rose, emergency room! Stat!”

“Damn!”

He gulped at the coffee, then set it back down on the makeshift counter in the residents’ lounge. Just once, he thought, I’d like to finish a cup of coffee while it’s still hot.

Female heads turned, and he hurried across the corridor into the ER. Eric Rose was considered a catch: tall, slim, and good-looking, a skilled surgeon, and best of all, single. As the senior surgical resident in one of the country’s most prestigious hospitals, he sensed he was well-placed for a bit of dalliance. But he was smart enough to realize the kind of trouble on-the-job romance could quickly produce. This catch was determined to remain uncaught.

He entered the emergency room at a dash, his experienced eye taking in the usual carnage, and headed for the small busy group swarming around an unseen figure on a transport stretcher.

“What have we got?” he called across the room. A tall red-haired woman in a white smock smeared with blood turned toward him in relief. People usually felt relieved when Eric appeared. Though just past his twenty-eighth birthday, he had an innate ability both as a diagnostician and as a surgeon, without the overblown ego which all too often accompanies such gifts.

“Car crash,” the woman told him. “Some guy hit him and he jumped the divider. They had to cut him out.” She turned her attention again to the figure being transferred onto the ER gurney.

“You heading up the FDR Drive, you better bring something to read,” offered the ambulance driver. He and his partner rolled the bloody transport stretcher out the back door toward their vehicle as Eric began to examine the stricken man.

“Name’s Abbott,” the redhead told him, checking the information on a clipboard someone had hung off the end of the gurney. “James Thomas Abbott. Fifty-two years old. His wife’s on her way over.”

“Didn’t they give him anything for pain?” Eric asked, studying the man’s tortured features, his blue eyes soft with concern.

But James Abbott’s face was contorted not with pain, but in pure fury. He considered himself an exemplary driver. He hadn’t had a ticket for years. Well, parking tickets, sure, but they didn’t count. And now, because of some speed-hungry young asshole who thought fifty was too slow for the fast lane of a forty-mile-per-hour highway, he was bleeding all over the emergency room of New York General Hospital. Thank God he was covered.

A young doctor, too young, leaned over him, touched him, spoke to people he couldn’t focus on.

“Hey, listen,” he tried to tell the doctor, “I don’t want anyone operating on me.”

“You’re badly hurt, Mr. Abbott,” Eric said. “But you’re gonna be OK. We’ve called your wife. Now we’re going to make you sleep.”

“Wait . . . remind my wife. . . . The older man was forcing the words out in desperation. “It’s OK, only tell her . . . remind her I’m covered!”

Eric had to smile. A time like this and the poor bastard was worried about paying.

“No problem,” he said, “We take checks, credit cards, your kids. . . .”

“No . . . no,” Abbott protested. “You don’t understand. I’m covered!”

Half an hour later, having diagnosed and then sedated his patient, ordered the necessary tests, and reserved the OR for emergency surgery to remove what he was certain was a ruptured kidney, Eric, his eyes smudged with weariness, made his way to the visitors’ lounge. A woman sat quietly twisting a handkerchief between her fingers. She looked up anxiously as he entered.

“Are you Dr. Rose?” she asked. He nodded, seating himself across from the chair on which she tentatively perched.

“I’m Mrs. Abbott,” she said softly. “They called me from emergency.”

They should hire special people to talk to relatives, Eric thought to himself. I’m no good at it. He forced himself to look at the tall, well-dressed woman in front of him.

“I’m the senior surgical resident. Your husband . . . well, he has some internal injuries.”

“Will he . . . is he . . . ?” Michelle Abbott was controlling herself well, but the strain and fear showed clearly in her pretty face, and made her soft Belgian accent more pronounced.

“The X-rays and test results should be up in a little while, and then we’ll have a better idea of what we’re dealing with.”

Mrs. Abbott had started to cry softly.

Eric fumbled with the charts on the table. God, how he hated this part of the job.

“Mrs. Abbott,” he said, “I’m pretty sure there’s been serious injury to the left kidney. I understand your husband lost his right kidney to a cancerous tumor . . . uh, five years ago?”

Michelle Abbott nodded.

“Well, I’m going to need you to sign this consent paper so I can remove the left one too.” Mrs. Abbott’s sobs grew audible, and Eric found his own eyes brimming too. Other doctors had told him he identified too much with his patients - “Learn some detachment!” they urged. But although it made his job more stressful, he just didn’t know any other way.

“Look, Mrs. Abbott,” he said, “if a man has two kidneys and he loses one, he can live on the other. But both . . . well, unless he wants to spend the rest of his life on and off a dialysis machine, he’s going to need a transplant, and fast. And even then, transplants fail. They often fail.”

There. He’d said it.

He glanced back at the woman; had she fainted? How he hated this part of doctoring. To his amazement, she was smiling. Dear God, smiling! Was the woman mad? Had she misheard him?

“A kidney transplant? And then he’ll be better? That’s easy! Let me make a call.”

Easy. Right.

“Uh, Mrs. Abbott, transplants, this kind of transplant, it has to come from someone whose tissue is genetically compatible with your husband’s. Someone like a brother, a sister. Even a cousin might be too far away physiologically.”

“I know all that,” said Mrs. Abbott, now brisk and efficient. “Jim has a brother and I know he’ll want to give Jim a kidney. I’ll call him now.”

Eric stared at her. Incredible. In his experience, few people would donate an organ even after they were dead.

“That’s wonderful!” said Eric, putting as much enthusiasm into his voice as he could. “But please, be prepared for disappointment. Many people offer organs when everyone’s healthy, but when they actually have to go through with it. . . . And of course the chemistry, even with a brother, might be off. He might be sick, or . . .”

“No, Dr. Rose, he won’t be sick. And he won’t refuse. That’s what we have the coverage for.”

“I’m not talking about money, Mrs. Abbott.”

“Neither am I. Please show me a phone I can use.”

 

Dr. John Harris strolled down Park Avenue toward his private office - hours Wednesday and Friday by appointment. Here and there along the Park Avenue divider, skinny sticks of grass were sticking their heads up out of the mush of the spring thaw, looking around at the grime, and wondering if it was worth the effort.

At East Seventy-second Street Harris paused, admiring the pattern the clouds made against the sky; a surgeon didn’t get much chance to enjoy the changing of the seasons. Sometimes, coming out of the hospital into the sun or the rain, he found himself staring around him like a tourist at a world he’d completely forgotten existed.

He pushed through the heavy oak door to his office. He knew everything within would be quiet, well-organized. It was. Mrs. Riley was on the case.

Mrs. Riley ran a tight waiting room. You signed in, took a magazine, sat down, and waited. No chitchat with the other nurses. No sneaking in ahead of anyone else. Mrs. Riley gave the lie to the popular misconception that only men enjoy war. Mrs. Riley had been an army nurse for twenty-two years. Give her a good war any time.

Mrs. Riley had been Dr. Harris’s private nurse/receptionist for twelve years now, and she worshiped him. He was smart, he was disorganized, and he needed her.

“Good morning, Doctor. Here is the list of your appointments today. Mr. Ginsberg is here, Mrs. Bateman is going to be late. And a Dr. Benjamin Talmidge called. He said he had good news.”

“Great! Get him for me first, would you, Mrs. Riley?”

Harris went straight to his inner office and pulled a pencil and pad from his desk drawer. Good news! That had to mean a kidney. Just in time too; Abbott was doing very poorly on that dialysis machine. Mrs. Riley followed him inside.

“From Barcelona,” she said.

“Excuse me?”

“Dr. Talmidge called from Barcelona.”

Well, thought Harris, there’s a Paris, Texas, and a Rome, New York. “Let’s call him back anyway,” he said with a twitch of a smile.

A beep, then Mrs. Riley’s voice came through the phone intercom. “Dr. Harris, Dr. Talmidge is on the line.”

“Hello, Dr. Talmidge.”

“Dr. Harris. Good news. The brother’s offered to donate a kidney.”

“Health?”

“Excellent.”

“Age?”

“Eleven years younger than your patient.”

“Wonderful! How soon can he be here?”

“Uh, that’s the snag.” Dr. Talmidge paused. “The brother will only donate if the operation takes place here.”

“Here? Where is ‘here,’ Doctor?”

“My hospital, just outside Barcelona.”

“Barcelona as in Spain?”

“Sí, señor,” said Dr. Talmidge.

Oh, great, thought Harris. A comedian.

“You can’t be serious,” he said. “Surely you’ve explained the risks involved in moving a man as sick as Abbott. Three thousand miles across an ocean will probably kill him. Doesn’t the brother understand?”

“Oh, I don’t think the risks are that great, not with medical attendants. Besides, he insists, and frankly, I wouldn’t risk losing the kidney by trying to convince him otherwise.”

“Of course that’s a factor, but surely . . .”

“I assure you, Dr. Harris, my hospital is small but extremely well-equipped. We have performed a large number of transplants in our time.”

Have you indeed? thought Harris. I’ll look into that.

“Of course we’ll coordinate the aftercare with you,” Talmidge offered. Did Harris only imagine the patronizing tone?

“Yes, we’ll need to monitor him for rejection,” Harris agreed. “You’ll be using cyclosporine?”

“Oh, I don’t believe an antirejection drug is called for in this case,” said Talmidge.

“Not called for?”

“Well, the man’s recently recovered from cancer.”

“Not so recently, Five years ago. Antirejection drugs won’t be a problem for him now.”

“Possibly. In any event, we’ve developed our own technique for this sort of thing. There’s no need for immune suppression. We do things differently here.”

“Sounds like you do things dangerously there.”

“Doctor.” Talmidge’s voice was quite hard. “Let me assure you of one thing. This operation happens at my hospital, my way or not at all. Do you understand?”

Dr. Harris was silent. He could understand Abbott’s brother insisting that a particular doctor do the surgery; presumably Abbott’s brother knew Dr. Talmidge. But that didn’t seem to be the issue, somehow. And he resented the implication that New York General wasn’t up to an operation of this sort. By God, New York General had a good transplant record too. He was also deeply troubled by Talmidge’s decision not to use an immunosuppressant. Surely the man knew it was perfectly safe, so many years after the cancerous kidney had been removed. Without such drugs, the chances of rejection were practically guaranteed, whatever Talmidge’s new technique might be.

“Don’t threaten me, Doctor,” Harris said at last. “I will advise my patient of our discussion, and tell him that he is in no condition to undertake such a journey. I will ask him to call his brother, to talk to him. There is no reason why the kidney cannot be implanted here. With immune suppression.”

Dr. Talmidge laughed. “You talk to him, yes. It’s his decision, after all. I think you’ll find he agrees with his brother.”

“Dr. Talmidge, I don’t know what your interest is in this matter . . . money, glory, or just pure cussedness, but a wrong decision here could cost a man his life.”

“Yes, that’s it exactly, Dr. Harris. So glad you understand. Spread the happy news!”

A click. Talmidge had disconnected.

Slowly Dr. Harris lowered the phone. He was angry. But he was also puzzled. Something had been tickling in the back of his mind for some days, and now it came forward.

He hit the intercom. “Mrs. Riley, would you bring me Mr. Abbott’s records please?”

It’s not possible, he thought as he waited. I must be wrong.

He took the buff-colored folder from Mrs. Riley almost reluctantly and held it for a moment before opening it and sliding out the medical-history sheet.

Name. Address. Phone Number. Wife’s Name. Allergies. Previous Operations. Parents: living. Children: two. Sisters: none. Brothers: none.