A TEST OF SURVIVAL

C H A P T E R 2 (continued)
Gretchen remembered pushing her way out of a drugged sleep, like a fish through a gelatin sea, to catch Alta studying the chart at the foot of the bed. When Alta asked about the operation, Gretchen led with the only good news. The tumor appeared to have been confined to the head of the pancreas, she told Alta. Porterman had cleared it out along with half her small intestine and some surrounding tissue.

Oh thank God, Alta said. So they got it all? To which Gretchen replied, with a bright, accomplished cynicism that was not in Alta’s nature to detect: “A chance to cut is a chance to cure.”

It was the standard surgical mantra, abused and unreliable. How ironic that one month into her new life as a surgeon, Gretchen herself was a candidate for cutting, but likely not for curing. An impatience with not being able to fix patients was why she had made the switch from internal medicine to surgery in the first place. All the glamorous, Albert Schweitzer ideals about medicine she had picked up from Gus, that she had fooled herself and him into believing she shared, had been crushed under the reality of her overbooked practice, a dreary day-to-day haul with a rare chance to tough out a quirky diagnosis and even then, the follow-ups were invariably messy and never-ending. Give the lifestyle lecture: fat people, depressed people, smokers. Push pills. Out the door they go and here they come back again, sicker or with something new, or something ponderously related to the old. Surgery was the ticket, she had reasoned: here’s a problem with well-defined margins, they need you like crazy, cut it out, stitch it up and if it’s cancer, well, you’ve given them your best shot and now the oncologists take over. Surgeons were the happiest of the medical lot. No messy hangover of medical problems tagging along with every chart; no cycling of the same patients again and again.

Now she was the messy problem. She could see it in the eyes of her colleagues the whole week she fought over whether she’d be operated on, and how.

The nightmare began with that time-stopping moment back in November. Herb Porterman had been mentoring Gretchen in her switch from internist to general surgeon. He was The Man in Milwaukee and took her on for the novelty of it, this woman who proposed to breach the city’s male bastion of general surgery. She closed up a kidney case, her third solo surgery with him assisting. They were off in the corner, stripping their masks and gloves, when Herb said it. Hey, Gretchen, you look off today. Your color is off.  If anything, the lights in the O.R. should have pinked her skin, but she was looking jaundiced. Gallstones, Porterman said. Not to worry.

She failed the ultrasound and the test for gallstones, and passed the CT scan for cancer.

A disorienting three days later, she found herself in Porterman’s office, engaged in a surgical consult. He spun his hand-tooled globe with one hand and with the other, smoothed a bent corner of her radiographic film. He mastered eye contact, he took all the time she wanted, but he was wedged between pity and aggravation: all the time he had put into her, wasted. Gretchen fought the urge to apologize.

“I’m resectable, Herb. It’s in the head of the pancreas and there’s no portal vein involvement.”

“None we can see on the scan.”

Gretchen experienced a rare glimmer of sympathy for ordinary patients who didn’t know their insides from a sausage-grinder and had even less of a clue how to weigh their risks. She concentrated on reining in her panic and her mouth. Porterman was skilled and decisive in the O.R She needed him.

Gretchen shrugged out of her suede jacket as if it were too warm in his office. She wore snug black jeans and a turquoise cashmere sweater. She wanted him to appreciate her breasts, her health, her wholeness. She wanted him to stop writing her death certificate.

Porterman frowned. “It could be studded all over the place.” He looked away from her, put a double-jointed thumb on Africa and gave the world a turn. He seemed to be struggling with the right tone for this doctor-patient sitting across from him: how blunt should he be? How solicitous?

“It’s a notoriously fatal type of tumor, regardless,” he said. “You know that.”