Implant. Part 2

"Duncan!"

"Well, it's true. If I'd known defenestration was in his future, I wouldn't have taken such pains with him." Gin thought she was used to his dark sense of humor, so often skating along the line between mordant and sick. But sometimes he did veer over the line.

He pressed his elbow against a chrome disk in the wall and the OR doors swung open. "Hurry up. Another of the kakistocracy's finest awaits us." Gin glanced at the clock. Another minute to go with her scrub.

She felt a warm flush as she remembered yesterday's chance encounter with Gerry Canney, and wondered if he'd call. Not the end of the world if he didn't, but it would certainly be nice. She reviewed the obscure words she'd collected to spring on Duncan today, and then her thoughts probed the enigma that was Duncan Lathram.

When they first met nineteen years ago he wasn't a plastic surgeon.

At age ten she woke up in a hospital with everything hurting.

Struggling through the maze of her jumbled thoughts was the memory of horsing around with two of the neighborhood boys, proving to them that she could ride a bike as well as they could, and matching any dare they wanted to try. Suddenly she was in the middle of Lee Highway with a panel truck screeching and swerving toward her. She remembered the pale blurs of the driver's bared teeth and wide, shocked, terrified eyes through the dirty winds.h.i.+eld as he stood on his brake pedal and tried to miss her.

Pain shoved the memories aside . . . pain and fear ... Where was her mama and who were these strange people bustling around her? Who was this big doctor bending over her and pressing his fingers into her tummy? Some deep part of her subconscious must have felt her life slipping away. She remembered asking him if she was going to die, and how he'd looked so shocked that she was conscious. Most of all she remembered the giant doctor going down on one knee beside the gurney so that his face was only inches from hers, squeezing her hand and saying, "Not if I've got anything to say about it. And around here, what I say goes." Something about his supreme confidence soothe her. She believed him.

She closed her eyes and slipped back into unconsciousness .

That big doctor had been Duncan Lathram. And Duncan Lathram had been a vascular surgeon then. Not just a run-of the-mill type who spent his days doing varicose-vein strippings, but a gonzo with a scalpel, unafraid to take on any vascular catastrophe, the messier the better.

Like hers. The impact with the truck had ruptured her spleen and torn her renal artery. Duncan had removed her spleen and repaired The gus.h.i.+ng artery, saving her kidney and her life.

Gin remembered being absolutely infatuated with the man. He became a demiG.o.d in her eyes. From age ten on she sent him a card every Christmas. Even went to work for him at sixteen as a part-time clerk in the record room of his office in Alexandria. She learned how hard he worked, putting in fourteen- and sixteen-hour days in the hospital and office, and often being called to the emergency at one or two in the morning to repair leaking or severed arteries damaged by everything from atherosclerosis to car wrecks to knife fights. He could be gruff, self-absorbed, even arrogant at times, but Gin didn't mind. After all, wasn't that part of being a demiG.o.d? His stamina amazed her, his dedication and boundless enthusiasm for his work inspired her so much that when she registered as a freshman at Princeton, she chose premed biology as her major. The course of her life had been set.

Eleven years later she returned to the D. C. area as a board eligible internist and was shocked to learn that Duncan Lathram was no longer the gung-ho, life-saving surgical whirlwind she had left behind, somehow he had metamorphosed into a cosmetic surgeon who devoted his abbreviated workdays to prettifying the rich and powerful of Was.h.i.+ngton society.

From gonzo to dilettanteor something close to a dilettante. What had happened during those seven years? Gin had tried to piece it together but got nowhere. No one who knew was talking.Only Gin seemed to care. Something was missing. Duncan used to fight bleeders, now he fought wrinkles. If he'd been specializing in tummy tucks instead of vascular repair nineteen years ago, she might not be here today. So Gin's perspective differed from all the youth-chasing ninnies who flocked to Duncan to help them turn back the clock. They wors.h.i.+ped this man who could help them escape the unsightly dues that nature , nurture, genetics, and lifestyle demanded they pay.

Duncan had become someone else's G.o.d.

"Morning, Gin, " said a voice behind her.

Over her shoulder she saw Duncan's younger brother Oliver delivering a sterile tray of implants to the OR. He smiled and waved as he pa.s.sed.

If Duncan was a rack of baby-backs, Oliver was a roast beef, rounder, heavier, with thinning hair, thick hornrimmed gla.s.ses, and a protective layer of fat. Also softer, gentler, far more easygoing than his older brother. A sweetheart. He made sure all the women on the staff received flowers on their birthday. And when Joanna's son got arrested for joyriding, Oliver was there to bail him out. Everybody loved him.

Gin rinsed, shook, and entered OR-1 just as Marie, the nurse anesthetist, said, "He's out." Gin took in OR-1 as Marie tied her mask and Joanna helped gown and glove her. Smaller than anything at Tulane, but the skill and professionalism here could hold their own against any tertiary medical center. Odorlessthe laminar airflow kept it that wayand cold. Duncan liked to work under almost arctic conditions.

She approached the table where a middle-aged man, fiftyish or so, lay supine, his face covered except for the lips, chin, and throat, which were prepped for surgery. He looked something other than human with his skin stained yellow brown from the Betadine and his chin and throat marked up with the lines Duncan had drawn to guide his surgery.

Gin had met him last week when she'd done his pre-op history and physical, Senator Harold Vincent. Another member of the recently revived joint committee.

Like Congressman Allard.

She was struck by the coincidence, but only for a moment. h.e.l.l, half of Was.h.i.+ngton's officials or their wives had been Duncan's patients at one time or another since he'd started in plastic surgery, and the other half probably were on the waiting list. Not surprising, really.

His technical skills were second to none and he saw to it that peoplewho considered themselves V.I.Ps were treated accordingly, they got absolute discretion, and, thanks to his brother, he had exclusive use of an innovative technique that halved the healing TIME greatly reduced.

"Ready to begin, Gin? " Duncan said. "The senator is getting impatient.

He's got a bunch of lobbyists camped out in his office with pockets full of cash. We don't want to keep them waiting, do we? " Joanna t.i.ttered behind her mask.

Duncan made his first incision under the chin, carefully following the natural lines of cleavage, then began the delicate task of dissecting away and tr.i.m.m.i.n.g off portions of the stretched musclethe platysmathat gave the senator's neck a sagging, aged look. Senatot Vincent had a particularly large amount of excess tissue, giving him a Tom-turkey wattle that fluttered when he spoke and flapped back and forth when he walked.

"Senator Impatience here couldn't wait, " Duncan said as he worked.

"An emergency, he told me. Had to have it immediately. Any one care to guess what the emergency is? " "Has to be TV, " Marie said from her spot at the top of the senator's head.

"Bingo. Give that woman a cigar." Marie didn't miss a beat, "Not while the o2 is running, thank you."

"It's the Joint Committee on Medical Ethics and Practice Guidelines, of course, " Duncan said.

Gin stifled a groan. Here we go again. The joint committee was on Duncan's Permanently-Ticks-Me-Off list. He hated it and everything it was set up to do. He could go on for hours. Today the subject was a particularly uncomfortable one for Gin, what with no word from Senator Marsden's office, and her pending interview with Congressman Allard tomorrow.

"I've seen Senator Vincent on TV plenty of times, " Gin said, sponging the blood that began pooling in the incision.

"Sure. C-SPAN. But who besides you and I watches CSPAN? This boy has his eye on a much larger audience. Suction. Daily sound and video bites for all the network news shows, even looking for some live prime-time coverage. And our self-styled Champion of the Working Person' wants to look pretty for the nation. Clamp." Gin glanced at Joanna who rolled her dark eyes as she slapped the handles of the clamp into Duncan's gloved palm. He' olf to the races.

All right, so Duncan had a few fixations. Everybody had one or two.

His just happened to be the Old-Boy network in the federal government and its intrusion into the practice of medicine. But even from his ramblings you could learn something.

"Some champion, " he continued. "Voted himself a thirty-one-thousand-dollar pay raise during the recession, not to mention a government-issued Diners Club Card. Hand me the curved hemostat. That's the one. Here he is, vocal supporter of the Equal Pay Act, the Age Discrimination in Employment Act, the Occupational Health and Safety Act, and the National Labor Relations Act, as he'll remind you at every opportunity. But what he doesn't say is that behind closed doors he voted to keep the U. S. Senate exempt from all those acts. Suction." He was silent as he made another incision.

Gin continued to marvel at the grace and precision of his scalpel work.

He made it look so easy.

Gin knew it was anything but.

"But I'm thankful I'm only his plastic surgeon. Can you imagine being his proctologist? " He looked up and winked at her. "I mean, where to begin? ' Marie guffawed.

"As always, ' Duncan said, "laws imposed to a.s.sure fair play among the const.i.tuency do not apply to the kakistoc . .

racy.

Gin didn't want to, but felt compelled to ask. "All right, I give up.

What's this kakistocracy you're always talking about? I can't find it in the dictionary. ' "You won't unless you use an unabridged edition.

The kakistocracy reflects the anomie of our times."

"Oh, that helps a lot." '"It is rulers.h.i.+p by the worst." Perfect time to spring one of my own words for the day, Gin thought.

'"I guess then you might say that the members of the kakistocracy excel at casuistry." She saw Duncan smile behind his mask. "Very good! "

Marie turned to Joanna. "Great. Now neither of them are speaking English." Gin said, "I'm merely partic.i.p.ating in the lingua franca.

' Two! she thought. I got two of them in!Duncan's eyes sparkled as he turned to Marie and Joanna. "Casuistry is the rationalization of matters of conscience, but I wonder if we can presume that the Senator Vincents of the world even have a conscience.

' He held out a gloved hand. "The implant, Gin. Time's a-wasting. "

'"Oh sure. Sorry." Joanna uncovered the sterile tray, revealing the implants, tiny cylinders, soft, s.h.i.+ny, and slightly curved, looking like sausages or hot dogs. Hot dogs for a Barbie Doll. They came in all sizes. These on the tray were the mediums, twenty millimeters long, maybe five millimeters in diameter, each filled with Oliver's "secret sauce, " an enzyme solution that promoted healing, reduced edema, and r.e.t.a.r.ded scar formation.

Here was the real key to Duncan's phenomenal popularity. He had the best hands in the business, but that was only part of his appeal.

These implants did the rest, allowing his patients the fastest recovery time, speeding them back into circulation to show off their new faces.

The brainchild of Duncan's younger brother, the implants were a crystal-protein matrix consisting of magnesium and alb.u.min. Shortly after Gin came on staff, Oliver had shown her serial magnetic-resonance images of the implants after surgery. Each successive MRI showed a shrinking, shriveling membrane as the implant released its enzyme contents into the subcutaneous tissues to reduce scarring and post-operative edema. The final MRI a few weeks post-op showed nothing, After the implant had done its work, the crystals dissolved and the body's enzymes broke down the alb.u.min to its component ammo acids, those were absorbed along with the magnesium into the surrounding tissues and eventually into the bloodstream, leaving no trace.

With a probe, Gin nudged one of the implants onto the special narrow, oblong spoon Duncan had custom-made after too many implants ruptured in the grip of an ordinary forceps. She reached over and gently deposited it in the incision. Duncan used a probe to position the implant where he wanted it, then signaled for another. When he had four of them placed deep in the incision, he moved his field closer to the surface.

"He looks younger already, ' Gin said.

Right, Duncan thought as he trimmed a wedge of platysma. Just what I want to do, make this b.a.s.t.a.r.d look younger.

What he really would have liked to do was restructure Vincent's features into a configuration that reflected the man within. Not too hard with Vincent . . . slant the eyes, tilt up the nose, spread thenostrils, flare the lips . . . and find some way to make him say "I'm Senator Harold Hogg, potentate of the pork barrel.

He smiled under the mask. He'd had so many of Congress's Old Boys on the table, he could have changed the face of American politics by nowliterally.

I could be Dr. Moreau in reverse. Instead of vivisecting animals into men, I'd recast pols into the animals and reptiles they emulate. I could wear a mask and skulk through the halls of the Capitol, Duncan Lathramthe anti-Moreau, demon doctor of devolution, Phantom of the Longworth Building, scourge of the Senate shuttle. A peal of insane laughter now and I'll be ready for Hollywood .

He sighed. Nothing so melodramatic for Senator Vincent. But Duncan did have definite plans for him.

Don't worry, Senator. You'll get yours. Trust me.

As he was placing the final implants he heard Gin's voice but didn't catch what she said.

"Hmmm? " "I said, what is it exactly that so irks you about the joint committee?

Gin's dark, dark eyes were fixed on him expectantly, as if his answer mattered very much to her. Under that cap and mask was a sultry Mediterranean beauty with wild, glossy black hair, full lips, high cheekbones, and flawless skin. A narrow waist and a perfect bust.

Nothing at all like the pimply, pudgy adolescent who'd worked in his file room a dozen or so years ago. In fact, when she'd shown up last June looking for part-time work as a physician, and told him who she was, he'd half considered having her investigated as an impostor.

The ugly duckling had returned as a swan. A dark swan. A cygnet.

But if he had been twenty minutes later in getting to that emergency room nineteen years ago, she wouldn't be anywhere now. That had been the great perk of his former life, saving someone who might make a difference in the world.

And he loved the way she'd started coming up with new words for him.

One day she'd stump him, but that was all right.

Seems I did us all a favor when I put your insides back together,Gin.

Not for the first time, he questioned having changed his field of practice, but only for a heartbeat. The choice had been made for him.

No going back.

But where was Gin going with all her brains and hardwon education?

"What irks me? " he said slowly as he began restructuring Vincent's trimmed platysma. "I don't think too much of the Joint Committee on Medical Ethics and Practice Guidelines." He made a point of enunciating the committee's name in its entirety. Simply saying the joint committee didn't do justice to the pretentiousness of its t.i.tle.

"I don't like its name, I don't approve of its mission, and I think it is staffed with arrivistes, parvenus, Pecksniffs, and b.u.mptious ... yanoos He watched Gin's dark eyes crinkle at the corners.

I made her smile.

'"Hey, don't hold back, " she said. "Tell me what you really think. '

He would have liked to tell her the truth about what they did to his life, his family, but that would serve no purpose.

Never complain, never explain.

"Do you know what they're up to? " he said.

"Well, I understand it was the president's idea to revive the old McCready committee." Duncan straightened and paused in his suturing.

He didn't trust himself with a scalpel in his hand and McCready on his mind.

"Alas, our dear president didn't get his health-care plan, so he's taking it out on the medical profession. A medical guidelines bill wasn't good enough7 wasn't broad enough. No. Now it's mandates on medical ethics." Duncan closed his eyes to control his fury.

"Can you imagine it? Mark Twain said there's no distinct American criminal cla.s.s except for Congress. And yet this collection of edacious, minatory pharisees is going to deliver ethical guidelines to a profession'that has had a code of ethics since the time of Babylon." "We're not all so perfect, either, ' Gin said.

'"If all you've got is larceny in your heart, you don't spend four years in premed, four years in med school, three to ten years in postgraduate training working hundred-hour weeks at slightly more than minimum wage, all for the privilege of being six figures in debt by the time you hang out your s.h.i.+ngle."

"Of course not, " Gin said. "You do it SQ you can work seventy-hour weeks for the rest of your life." Duncan smiled and felt his muscles relax. My dear cygnet. It's good to have you around.

He'd finished resecting and tightening the platysma. Time to close.

He asked for 6-o gut on a curved needle. Using a continuous subcutaneous technique, he began suturing.

"Anyway, " she said, "since Senator Marsden is McCready's successor, he's been asked to chair the joint committee. Got any dirt on him? '

Why was she so interested?

"Actually7 no7 Duncan said. "But he hasn't been around all that long.

Give him TIME You know what the committee's up to, don't you? "

"Holding public hearings to gather information to help them write the bill? " "Their stated purposeat the president's behestis to set rigid standards for medical practice. What they're really out to do is parade a bunch of horror stories before the public present a lot of one-sided testimony on the worst cases of negligence and medical malfeasance they can find and paint the whole medical profession as a cartel of reckless, irresponsible, knife-happy, money-grubbing brigands who must be brought to heel."

"Um? don't you think you sound just a little paranoid? " With good reason7 he thought.

"Even paranoids have real enemies7 Gin. They're out to get uspure and simple. I know how that sounds, but that's how I see it. They're at the bottom of the heap in public confidenceand they want to draw attention away from their own unwillingness to police themselves. "

'"But their ethics committees go after people all the TIME" Duncan laughed. "Congressional ethicsthere's an oxymoron for you. Only on those rare occasions when the press turns up the heat, only when their backs are to the wall and they have to do something."

"Well, whether we like it or not, I kind of think the shape of medical practice in the future is going to be decided at these hearings. So I'd like to be an aide on that committee. In fact, I had an interview at Senator Marsden's office yesterday mornmg.

Duncan froze and stared at her, and found Gin staring right back.