The Death Committee

The Death
Committee

Noah Gordon

Again, for Lorraine:
the girl I married
and the woman she became

In Acknowledgment

Many people showed me kindness while this book was being written. The physicians who suffered my unending questions and gave freely of their encouragement and information must in no way be held responsible for my views or for any errors which may be discovered in my work. They have always had my respect; now they have my gratitude.

I should like to offer thanks to Andrew P. Sackett, M.D., Commissioner, Boston Department of Health and Hospitals, and James V. Sacchetti, M.D., Deputy Commissioner, for making it possible for me to receive instruction and experience at Boston City Hospital as a volunteer surgical technician; to Miss Mary Lawless, R.N., Boston City Hospital Operating Room Supervisor, for teaching me how to behave in the operating room; and to Mr. Samuel Slattery, Operating Room Medical Worker, for causing the research experience to be such a memorable one for me.

In answer to the inevitable question, Suffolk County General Hospital is a product of my imagination and is not modeled after any actual institution, nor is the medical school mentioned in this novel modeled after an existing school.

I am grateful to Lawrence T. Geoghegan, M.D., former Boston City Hospital Chief Surgical Resident, for enabling me to follow his house officers in afternoon rounds, and, for the same privilege, to Mayer Katz, M.D., who became Chief Resident when Dr. Geoghegan went to Vietnam, where Dr. Katz, in his turn, followed.

For allowing me to attend Mortality Conferences in their respective hospitals, I wish to thank Paul Russell, M.D., Director of Transplantation Surgery at the Massachusetts General Hospital; Samuel Proger, M.D., Physician-in-Chief at the New England Medical Center Hospitals; and Ralph A. Deterling, Jr., M.D., Surgeon-in-Chief at New England Medical Center Hospitals and Director of the First (Tufts) Surgical Service, Boston City Hospital.

Because so many people were generous with their help, and because records and memory are imperfect, I wish to apologize to anyone whose name should appear on this page and does not. For their help and cooperation, I wish to thank Paul Dudley White, M.D.; Robert Kastenbaum, Ph.D.; Lester F. Williams, M.D.; Anthony Monaco, M.D.; Don R. Lipsitt, M.D.; Carl Bearse, M.D.; Miriam Schweber, Ph.D.; Blaise Alfano, M.D.; Robert M. Schlesinger, M.D.; Benjamin E. Etsten, M.D.; Richard A. Morelli, M.D.; Rabbi Hilel Rudavsky; Mr. Patrick R. Carroll; and Atty. Charles J. Dunn.

Richard Ford, M.D., Medical Examiner of Suffolk County, who long ago, with tact and sensitivity, introduced a young reporter to his first autopsy, allowed me to stand at his elbow again and proved that the years have made him no less patient and skilled an educator.

A special word of thanks is due to Jack Matloff, M.D., and to John Merrill, M.D., who gave generously of their time and knowledge and who, along with Susan Rako, M.D., performed the added kindness of reading my manuscript.

For her help in preparing the manuscript, I am grateful to Mrs. Ernest Lamb, Jr.; for general assistance, to Miss Lise Ann Gordon; and for their assistance and courtesy, to the staffs of the Framingham Public Libraries, the Framingham State College Library, the Boston Medical Library and the Francis A. Countway Library of Medicine.

For their continued unquestioning support and invaluable judgment, I thank my literary agent, Miss Patricia Schartle, and my editor, Mr. William Goyen. With Lorraine Gordon, they made this book possible.

N. Gordon

1966–1968

“A person

gives money

to the physician.

Maybe

he will be healed.

Maybe

he will not be healed.”

—The Talmud
Tractate Kethubot: 105

“A resident

enters one end

of a tunnel,

something happens

on the inside

and

gradually,

after

six or seven

more years,

he emerges

as a surgeon.”

—Medical World News
June 16, 1967

Prologue

By the time Spurgeon Robinson had been riding the ambulances thirty-six hours on and thirty-six hours off for three weeks, the driver, Meyerson, had long since gotten on his nerves and he was shaken by the gore and troubled by the traumas and didn’t like the duty even a little bit. He found that sometimes he could escape by using his imagination, and on this trip he had just about convinced himself that it wasn’t an ambulance, it was a goddam space ship. He wasn’t an intern, he was the first black man in orbit. The wail of the siren was the jet stream turned into sound.

But Maish Meyerson, the clod, refused to cooperate by acting like a pilot. “Wehr fahrbrent,” he snarled at the operator of a stubborn Chrysler convertible, hurling the ambulance around it.

In a city like New York they might have had trouble locating the construction job but in Boston there were still only a few really tall buildings. Because of the red steelmill paint on the naked metal the skeletal structure jabbed into the gray sky like a bloody finger.

It beckoned them right up to the scene of the accident. Spurgeon slammed the door just as the siren whimpered into silence, and the knot of men unraveled around the figure on the ground.

He squatted. The unscathed half of the head told him the patient was a young man. His eyes were closed. A tiny trickle of fluid dripped from the fleshy lobe of one ear.

“Somebody three floors up dropped a spanner,” a man with a paunch, the foreman, said in answer to the unasked question.

Spurgeon parted the matted hair with his fingers and beneath the lacerated flesh felt the fragments of bone move loose and sharp like bits of shattered eggshell. It was probably cerebrospinal fluid leaking from the ear, he thought. There was no point in trying to debride the injury while the poor guy lay on the ground, he decided, and took a sterile gauze dressing and dropped it on the wound, where it turned red.

The man’s fly was open and his penis was exposed. The fat-bellied foreman saw Spurgeon noticing. “He was taking a leak,” he said, and Spurgeon could see it, the workingman easing his urgent bladder and gaining wry satisfaction from christening the building he was helping to raise; the wrench falling, falling, falling with unerring accuracy, as if God were remonstrating against dirty little human acts.

The foreman chewed his unlighted cigar and looked at the injured man. “His name is Paul Connors. Again and again I’ve told these bastards wear your helmets. Is he going to die?”

“We can’t tell much from here,” Spurgeon said. He lifted a closed eyelid and saw that the pupils were dilated. The pulse was very thready.

The fat man looked at him with suspicion. “Are you a doctor?”

Black boy?

“Yes.”

“You going to give him something for pain?”

“He doesn’t feel any pain.”

He helped Maish bring out the litter and they loaded Paul Connors into the ambulance.

“Hey!” the foreman yelled as he started to close the door. “I’ll ride with you.”

“Against the rules,” he lied.

“I’ve done it before,” the man said uncertainly. “What hospital are you from?”

“County General.” He pulled at the door and let it slam. Up front, Meyerson started the motor. The ambulance lurched forward. The patient was breathing in shallow gasps, and Spurgeon fixed the black rubber otopharyngeal airway tube in his mouth so it wouldn’t let his tongue interfere and then turned on the respirator. He placed the mask over the patient’s face and the positive pressure oxygen began to be fed in quick short bursts that made noises like a baby burping. The siren gave a small groan of resumption and once more began to unwind a thick ribbon of electronic sound. The ambulance tires whirred against the roadbed. He began to think of how he could orchestrate the incident as a piece of music. Drums, horns, reeds. You could use everything.

Almost everything, he thought as he adjusted the oxygen flow.

You wouldn’t want violins.

Dozing with his head on his arms, Adam Silverstone leaned against the hard desk-top in the Chief Resident’s office and dreamed it was a bed of dry, tight-curled leaves, the accumulation of many past leaf-falls, on which once he had lain as a boy and peered into a quiet brook-pool in the woods. It was in the late spring of the year he was fourteen, a bad time for him because his father had taken to answering his grandmother’s indignant Italian curses with drunken Yiddish insults of his own, and to flee both Myron Silberstein and the old vecchia he had simply taken to the highway one Saturday morning and traveled three hours by thumb, without destination, heading only away from the smoke and grit of Pittsburgh and what it represented, until he was dropped off by a motorist on a section of road which ran through woods. Later he had tried half a dozen times to find the place, but he could never remember exactly where it had been, or perhaps by the time he had gotten back to it the forest had been raped by a bulldozer and had spawned houses. Not that it had been anything special; the woods were sparse and scraggly with fallen trees, the trickle of a stream had never housed a trout, the pool was a deep clear puddle. But the water was cold and sun-dappled. He had stretched out on his stomach in the leaves, smelling the odors of cool forest mold, his stomach beginning to feel hunger, conscious of the fact that soon he would have to begin hitch-hiking back, but caring about nothing as he lay and watched little Jesus-bugs walking on the water. What had he experienced in the half hour he had stayed—before the insistent spring dampness crept up through the dry leaves and made him take his shivering leave—that would cause him to dream of the little pool for the rest of his life?

Peace, he decided years later.

That peace was shattered now by the ringing of the telephone, which, still asleep, he answered.

“Adam? Spurgeon.”

“Yo,” he said, yawning.

“We may have a kidney donor, pal.”

He was less sleepy. “Yeah?”

“I just brought a patient in. Compound depressed skull fracture with lots of brain damage. Meomartino’s assisting Harold Poole with the neurosurgery right now. He said for me to tell you the EEG showed no electrical activity at all.”

Now he was wide awake.

“What’s the patient’s blood type?” he said.

“AB.”

“Susan Garland is AB. That means this kidney goes to Susan Garland.”

“Ah—Meomartino says to tell you the patient’s mother is in the waiting room. The name is Connors.”

“Goddammit.” The task of securing legal permission for transplantation was left to the Chief Resident and the Surgical Fellow. Invariably, he had noticed, Meomartino, the Fellow, was busy with other urgent duties when it came time to talk with the next-of-kin. “I’ll be right down,” he said.

Mrs. Connors was sitting with her pastor, only slightly prepared by the fact that her son had been given Extreme Unction. She was a life-worn woman with a talent for disbelief.

“Ah, don’t be telling me something like that,” she said, with filled eyes and a tremulous smile, as if she could reason him out of the entire thing. “He isn’t,” she insisted. “He isn’t dying. Not my Paullie.”

She was technically correct, Adam thought. By that time, to all intents and purposes, her boy was already dead. The Boston Edison Company was keeping him breathing. Once the electric respirator was switched off, within twenty minutes he would be gone entirely.

He could never tell them he was sorry; it was so inadequate.

She began to weep, achingly.

He waited the long interval until she had regained some control and then as gently as possible he explained about Susan Garland. “Do you understand about the little girl? She’ll die, too, unless we give her another kidney.”

“Poor lamb,” she said.

He didn’t know whether she meant her son or the girl.

“Then you would sign the permission slip?”

“He’s been torn up enough. But if it will save some other mother’s child . . .”

“We hope that it will,” Adam said. The permission secured, he thanked her and fled.

“Our Lord gave up his entire body for you and for me,” he heard the priest say as he walked away. “For Paul, too, for that matter.”

“I never said I was Mary, Father,” the woman said.

Depressed, he felt it would help his spirits to see the opposite side of the coin.

In Room 308 Bonita Garland, Susan’s mother, sat in a chair and knitted. As usual when the girl saw him from her bed she pulled the sheet up to her neck over nightgowned acorn-breasts, a gesture he carefully refrained from noticing. She was propped against two pillows and reading Mad, which somehow relieved him. Weeks earlier during a long sleepless night when she was hooked up to the splashing dialysis machine that periodically washed her blood free of the poisons accumulated because of her ruined kidneys, he had seen her leafing through Seventeen and had teased her about reading the magazine when she was scarcely fourteen herself.

“I wanted to be certain I got to it,” she had said, turning a page.

Now, ebullient with good news, he stood at the foot of her bed. “Hi, luv,” he said. She was going through a fervent emotional involvement with English musical groups, an infatuation to which he prostituted himself shamelessly. “I know a girl says I look like the character who’s always on the cover of that magazine. What’s his name?”

“Alfred E. Neumann?”

“Yeah.”

“You’re ever so much better looking.” She cocked her head to look at him and he saw that the dark rings had deepened under her eyes and that her face was thinner, with pain-lines around the nose. When first he had seen the face it had been vibrant and impish. Now, even though the freckles showed starkly against the sallowing skin, still it was a face that promised great adult attractiveness.

“Thank you,” he said. “You’d better be careful about paying me compliments. Howard might come after me.” Howard was her boy friend. They were forbidden by her parents to go steady, she had confided to Adam one night, but they went steady anyway. Sometimes she read him portions of Howard’s letters.

He knew she was trying to make him jealous of Howard and was touched and flattered.

“He’s coming to see me this weekend.”

“Why don’t you ask him to make it next weekend, instead?”

She stared at him, alerted by the chronic patient’s invisible warning system. “Why?”

“You’ll have good news for him. We have a kidney for you.”

“Oh, God.” Bonita Garland’s eyes were exultant. She set down her knitting and looked at her daughter.

“I don’t want it,” Susan said. Her thin fingers bent the covers of the magazine.

“Why not?” Adam asked.

“You don’t know what you’re saying, Susan,” her mother said. “We’ve been waiting so long for this.”

“I’ve become used to things the way they are. I know what to expect.”

“No, you don’t,” he said gently. He took her fingers away from the magazine and held them between his hands. “Unless we operate things will become worse. Much worse. After we operate, things will be better. No more headaches. No more nights spent hooked up to the damn machine. In a little while you can go back to school. You can go to dances with Howard.”

She closed her eyes. “Will you promise me nothing will go wrong?”

Jesus. He saw her mother, smiling with painful understanding, nod at him.

“Of course,” he said.

Bonita Garland went to the girl and took her in her arms. “Darling, it’s going to be just fine. You’ll see.”

“Momma.”

Bonita pressed her daughter’s head to her breast and began to rock. “Susie-Q,” she said. “Oh, thank God, we’re lucky people.”

“Momma, I am just so scared.”

“Don’t you be silly. You heard Dr. Silverstone give his word.”

He went out of the room and walked downstairs. Neither of them had asked where the kidney was coming from. Next time he saw them, he knew, they would feel ashamed about that.