'You're doing better and better, Mr.Miller,' Harry said. He turned to the resident. 'No one does this anymore, huh?Well, we do, Sam,' he said. 'Especially when someone's hematocrit is aselevated as this man's. Just because a method's not high-tech doesn't mean itsuseless. Trying to get fluid off him with diuretics often isn't as effective aswhat we're about to do. And in someone whose blood is already thisconcentrated, diuretics are quite a bit more dangerous. Any fluid you get offwith diuretics will just concentrate his red cells even more. If those redcells get thick enough, sooner or later a vessel could clot off. Pressure,please?'
'Holding at eighty. Easier to hear,' thenurse said.
Harry nodded to Steve Josephson, who insertedthe large phlebotomy needle into a vein with a dexterity belied by his thickfingers. Instantly, a column of blood glided down the tubing and began to fillthe plastic collection bottle.
The reversal of Clayton Miller's pulmonaryedema was spectacular.
'I … I'm breathing … a … little.. better. .,' he managed after just a minute or so.
'What do you think, Steve? Another hundredcc's?'
'If his pressure stays up, I would saymaybe even two hundred.'
Harry adjusted the needle slightly, andthe flow of blood increased. For another minute, there was only silence.
'Oh my God,' Miller said suddenly, fillinghis lungs with a long, grateful swallow. 'Oh my God, I'm better. . muchbetter.'
He was still breathless, but much less so.The cardiac pattern on the monitor had slowed to one hundred. The shape of thecomplexes now appeared quite normal. Two nurses exchanged looks of exuberantrelief. The resident stepped between the two GPs.
'This is incredible,' he said. 'I don'tknow what to say. Mr. Miller, Dr. Corbett and Dr. Josephson really came throughfor you — for me, too.'
The older man managed a weak thumbs up.'Listen,' the resident went on, 'I heard about that committee they formed toalter your privileges. If you need me to write them about what went on herethis morning, I'll be happy to.'
'It may be a little late for that,' Harrysaid, 'but why don't you drop Dr. Sidonis a note just the same. He mightactually read it, as long as it starts with the greeting 'YourGrace.''
There was a soft noise behind them. Thethree of them looked toward the doorway just as a stony-faced Caspar Sidonisturned and stalked off toward the amphitheater.
Chapter2
'Green Dolphin Street.' The Wes Montgomeryarrangement. The tune started up in Harry's head almost as soon as he hadsettled into a seat in the last row of the amphitheater. 'Green DolphinStreet.' Harry tapped out a riff with his fingers on the metal armrest. Heloved music of all kinds, but he was a fanatic for jazz. He had played basssince junior high school and still sat in with a combo when he had the time.Over the years, he had come to appreciate that 'Green Dolphin Street' tended topop into his head when he was keyed up — tense, but ready for action. He hadhummed it heading into organic chemistry exams, and later on throughout hisfamily practice-boards. And of course, during the war, it seemed he was alwayslistening to it either on tape or in his imagination. Now, for the first timein a hell of a while, it was back.
'Full house, Harry,' Doug Atwater said,gesturing toward the rapidly filling amphitheater. 'You'd think they weregiving away free stethoscopes.'
MMC was the largest of the three hospitalscontracting with the Manhattan Health Cooperative. As the vice presidentresponsible for marketing and development of the rapidly expanding HMO, Atwaterhad an office at each of them. He had come to the company six or seven yearsbefore from someplace in the Midwest. There were many, including Harry, whobelieved that without Atwater's creative energy and business sense, theCooperative and its hospitals might well have gone under some time ago.Instead, Manhattan Health had captured a decent share of the market and becomea real force in the business. Like Harry, Atwater was a devoted jazz fan,although he didn't play himself. The two of them managed to hit a club everythree or four months. And from time to time Doug would stop by C.C.'s Cellarwhen Harry was sitting in with the combo that regularly played there.
'Did Sidonis or anyone on his committeespeak to you about all this?' Atwater asked.
'Of course. Dan Twersky, the psychiatrist, got assigned to interview me. You know him? He couldn't havebeen more pompous or condescending if he had tried. He wanted to know how MarvLorello could have sewn up that guy's thumb so badly. I told him that as far asI could tell, Marv didn't sew up anything badly. Twersky asked why Lorellodidn't call in a hand surgeon. I told him that all anyone could do was clean upthe gash and suture it closed. The most skillful hand surgeon in the worldmight easily have gotten the same unfortunate result Marv did. Sometimescirculation to a wound isn't all it should be, and there is some tissue loss.He said I sounded a bit defensive of GPs. I told him that a thousandtimes out of a thousand I would choose to repair that cut without calling in ahand surgeon, and that nine hundred and ninety nine of those times the twohalves would heal perfectly. Twersky just sat there and smiled. It was an
Atwater reached over to give him asupportive pat on the shoulder.
'Harry, you're a hell of a doctor,' hesaid, 'and nothing Sidonis or his committee can do is going to change that.'
Steve Josephson maneuvered down the row,nodded a greeting to Atwater, and settled into the seat next to Harry.
'They just took Clayton Miller up to theunit,' he said. 'The man's doing great. A save of the highest order. After youleft, once his breathing was back near normal, he started talking baseballnonstop. He was a pro — a teammate of Satchel Paige in the Negro baseballleagues. And get this: apparently his son works for the Yankees. He says thatany time you or I want tickets, we've got 'em.'
'My kind of patient,' Harry said.
'What gives?' Atwater asked.
Harry deferred to Josephson, who detailedthe event with all the drama of a fighter pilot recounting a dogfight. Atwaterlistened, enthralled.
'Too bad Sidonis doesn't know what youdid,' he said.
'He does. I don't think he's impressedenough to call off the vigilantes, though. In fact, I don't think he'simpressed at all.'
'Well, just the same, you guys are reallysomething. I listen to you and I honestly wish I could be on the front linesinstead of sitting up there pushing pencils. Say, Harry, what's the story withEvie?'
'She's coming in later this week. Probablythe day after tomorrow.'
Atwater pulled out a black memo book andwrote down Evie's name and
'She's a hell of a gal,' he said. 'I knowshe'll do great.'
Evie's headaches, which she had firstattributed to allergies, then to stress from her job, and finally to stressfrom Harry, had proven to be caused by something far more structural andvirulent. Harry spent several frustrating weeks trying to convince her to see adoctor and get a CT scan. Finally, she ended up on the neuro ward, with thickspeech and a weak right arm. The tests revealed a large berry aneurysm on heranterior cerebral artery, which had bled and then sealed over. Evie was lucky.Rapidly, her neurologic symptoms had resolved. A period of rest coupled withserial CTs was her neuro-surgeon's recommendation. Now, it was time for thebulge in the vessel wall to be repaired.
'Harry,' Atwater said, 'be sure and let meknow if there's anything Anneke or I can do to help the two of you out.'
'Anneke?'
Doug's smile was mischievous. When he andHarry went out to hear music, he invariably showed up with a date — always adifferent one, and each, it seemed, younger and more attractive than the last.
