‘He have anyone else serious?
‘Not that I know of.’
‘No,’ said Beradino thoughtfully. ‘I can’t imagine they’d have been too happy with him playing happy families with his ex, whatever the real story.’
‘But I doubt he ever lacked female company. He was handsome, he was smart, he was successful.’
‘And arrogant.’
‘Yes, and arrogant. Most surgeons are. It comes with the territory. You ask them, they’d call it self-confidence. Patients like a surgeon who’s sure of what he’s doing. The last thing you need when someone’s about to open you up is to find they’re suddenly iffy about the job.’
‘He was a good surgeon?’
‘One of the best. A real pioneer, always looking for new techniques, new ways to make things better. There are people walking round Pittsburgh today who are still here because of Michael Redwine; not just because he saved their lives, but because he did so with methods and equipment which simply didn’t exist several years ago, and which he helped bring into being.’
‘He ever make mistakes?’
For the first time, Bianca paused.
The house was suddenly quiet, which in Patrese’s experience was an event about as frequent as Halley’s Comet. If it wasn’t Sandro’s endless practicing – he was a violinist with the Pittsburgh Symphony – it was the noise generated by three kids blessed with the kind of energy that ought to be illegal.
Vittorio was in ninth grade, Sabrina seventh and Gennaro sixth, and Patrese loved them all to bits. Acting the goofball uncle with them, taking them to Steelers games, playing touch football with them in the backyard till sundown – and telling them that Gramps and Gran were now in heaven, and holding them close when they cried.
‘All surgeons make mistakes,’ Bianca said eventually.
‘You sound very defensive about that.’
‘Yes, well…Listen, people expect doctors to be perfect, get everything absolutely right every time. But it doesn’t always work like that. We’re human, our knowledge is imperfect, some symptoms aren’t always clear-cut.’
‘I don’t think Mark intended it to be a value judgment,’ Patrese said softly.
Bianca might have been his big sister, but he was still protective of her; that was the Italian male in him.
And he understood her defensiveness, too. Doctors were no different from cops – they looked out for one another. You dissed one, you dissed them all; that was how they saw it.
So they covered each other’s backs. Like most professions, medicine was in essence a small world; you never knew when you might need someone to help you out, so you didn’t go round making unnecessary enemies. And old habits died hard, even when the person you were protecting was no longer around.
‘I’m just looking for why someone might have wanted him dead,’ Beradino said.
Bianca nodded. ‘I understand. I’m sorry.’
‘No need.’
‘OK. Every time you lose a patient, you consider it a mistake, even when you know deep down you couldn’t have done anything more. That’s just the way you feel. And Mike had his fair share of those. I mean, brain surgery, the stats aren’t that great. You don’t open up someone’s skull unless things are pretty bad to start with. But those ones, I’m not counting; they’re not mistakes, not really.
‘Then there are the ones where, perhaps, if you’d done something different, you might possibly have saved them. But in those cases you don’t know till it’s too late anyway, and you can drive yourself mad if you dwell on it. If everyone’s vision was as good as their hindsight, every optician across the land would be out of work.’
‘People sue you for those ones?’
‘Sure. If you could have done something different, they’ll say you should have done. So the lawyers get involved, everyone starts slinging writs around, and if you can, you settle before it gets to court, goes public and damages your rep. Comes with the turf, doesn’t mean you’re suddenly a crappy surgeon.’
She paused again.
‘And?’ Patrese said, not unkindly.
‘And then there are the real fuck-ups.’
‘Redwine have any of those?’
She nodded. ‘One.’
The technical term was ‘wrong-site surgery’, which barely hinted at how catastrophic such incidents were, and how insultingly, ridiculously amateur they seemed.
Wrong-site surgery was, in essence, when the surgeon operated on a perfectly healthy part of the patient’s anatomy, and left the offending area untouched.
The consequences tended to fall into two categories: drastic, and fatal.
Redwine had been scheduled to remove a blood clot from the brain of Abdul Bayoumi, a professor of philosophy at the University of Pittsburgh.
It was a routine enough operation, especially for a surgeon of Redwine’s standing; he’d done hundreds in his career.
The clot had been on the left side of Bayoumi’s brain.
Redwine had cut into the right-hand side.
Only when he’d got all the way through the skull did he realize his mistake.
He’d immediately closed up the incision, made another one on the correct side, and removed the clot.
In 99 per cent of cases, that would have been it; a near-miss, a bureaucratic snafu, and a story on which the patient could dine out when he’d made a full recovery.
But Bayoumi had suffered complications – Bianca wasn’t sure of the exact details – on the side of the brain where Redwine had made the first, erroneous, incision.
The complications had spread, multiplied, and worsened.
Within six hours, he was dead.
‘How the hell can that happen?’ Beradino asked. ‘Don’t you guys,’ he caught himself – ‘sorry; isn’t it standard procedure to have a checklist or something, so this kind of thing gets caught before it occurs?’
‘Sure it is,’ Bianca said. ‘There’s a three-step procedure, the Universal Protocol, which is absolutely standard. First, you check the patient’s notes and make sure they tally with the surgery schedule. Then you use indelible markers to spot the site where the surgeon’s going to cut. Finally, the entire operating team takes a time-out before the start and agrees that this is what they’re supposed to be doing.’
‘So how can something like this happen?’
‘Because a system is only as good as the people using it.’
‘And?’
‘And in an operating theatre, the surgeon is God. He’s captain of the ship; his word goes. So if he says we cut on the left, we cut on the left. And if the notes say otherwise, who’s going to tell him, and get yelled at, or worse? Shoot the messenger, you know. Everyone stands around looking at each other, and no one does a thing.’
‘Redwine was one of these surgeons?’
‘One of them? He was the archetype. He prided himself on not marking sites, as he claimed he could always remember. He didn’t think he needed to write things down, like the rest of us mortals.’
‘Christ on a bike,’ Patrese said.
‘Don’t blaspheme, Franco,’ Beradino