The Society Read Free

planning on being on it someday.”
    “All right,” Katz said, “let’s get on with this. Will, it’s a good thing you enjoy your work, because you certainly do a heck of a lot of it.”
    Jim Katz had seven patients in the hospital, Susan and Will three apiece, and Gordon Cameron, who had already gone home, two, including the case he and Will had done earlier in the day. The trio of surgeons that included Steve Schwaitzberg had another five. Schwaitzberg had signed his three out over the lunch hour, and the other two would do so by phone. Twenty patients in all—a load by modern standards. Insurance restrictions had seen to it that most of them had received their pre-op evaluations as outpatients, and had been operated on before they had even seen their rooms or met the nurses who were going to be their caregivers. The moment after their surgery was completed, they were being primed for discharge. Actuarial tables compiled by the managed-care and insurance industries had demonstrated that such policies saved money without causing a significant rise in post-op complications. Will’s experience with his own and many other practices had shown that a good number of patients would gladly beg to differ with those statistics.
    At Susan’s urging, they saw Jim Katz’s group first. He would never complain about his workload or diminishing physical capabilities, but the three younger members of the group had each seen evidence that layers were peeling off his stamina and abilities in the OR, and they sought to protect him in any way they could. All went well until the last of Katz’s patients, a sixty-three-year-old diabetic man whose gallbladder Katz had removed the morning before.
    “So, Mr. Garfield,” Katz said, checking the four small incisions he had made into the man’s abdominal cavity, and nodding approval of the way they looked, “is your wife on her way here to get you?”
    “She just called from the parking garage, I shouldn’t worry,” Garfield said.
    “Good, good. And the nurses have given you my discharge instructions? Good.”
    Will didn’t like anything about what he was seeing and hearing. Stuart Garfield was doing his very best to mask it, and maybe he didn’t even realize it was happening, but he was experiencing some shortness of breath. Susan nodded minutely that she had noticed the same thing. The managed-care companies decreed that a night in the hospital or even less was to be the standard of care for the laparoscopic removal of a gallbladder. Katz did not consider that the man’s diabetes was reason to argue for more, and it wouldn’t have been except for the distension of the veins alongside the man’s neck and the slight bluish cast to his lips—both subtle signs of evolving trouble.
    Nonchalantly, Will sidled over to the bedside, slipped his stethoscope into his ears, and listened through the man’s back to the base of his lungs. Rales, the crackling sounds made by fluid filling the small air sacs, were most definitely present. Stuart Garfield was in early heart failure—a potentially serious condition in any patient, but even more so in a diabetic who, with little warning, perhaps by the time he and his wife had reached the highway, could be in full-blown pulmonary edema—a terrifying, life-threatening emergency. Will motioned Katz over to the doorway. There was no easy way to present the findings, and with a physician as forthright and honorable as Katz, it wasn’t smart to try.
    “Jim, he’s in some congestive heart failure,” Will whispered. “Neck veins distended, rales at both bases, a little blue around the gills.”
    Katz sagged visibly, crossed to the bedside to listen, then returned to the doorway.
    “I knew I shouldn’t have been rushing him out,” he said, shaking his head in dismay.
    “Listen, don’t be hard on yourself. We’re making rounds together as a team. This sort of thing is why we do it. Thanks to our friendly neighborhood insurance companies, the