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An excerpt from Observer

Observer RD3 cover comp


When Caro walked out of the hospital administrator’s office, her legs felt wobbly. She stiffened them and, head held high, did not glance back at the doctors seated around the conference table. None of them followed her out—giving her time, a courtesy she recognized but did not appreciate. These people had just destroyed her future.

In the corridors of Fairleigh Memorial Hospital she willed herself to walk steadily, to return the impersonal nods of a resident, a medical student, two administrative assistants. The elevator was full; she took the fire stairwell. Its emptiness, silent except for the ring of her shoes on metal steps, was welcome.

She was catastrophizing, she told herself. There were other hospitals.

Not here, not for her talents.

She could have not reported Paul Becker.

No. She’d done the right thing.

She could have not asked Maisie to speak at the hearing.

But that one was still too painful to think about. Caro had thought that Maisie was a friend. She’d thought a lot of things that, it just turned out, weren’t true.

What do you do when everything you’d wanted had been in clear sight and then slipped through your highly-trained fingers?

At the bottom of the stairwell, Caro pushed open the heavy door and walked past the restrooms. And there, seated on a backless ottoman that was supposed to discourage lobby sitters and never did, was the last person Caro wanted to see.

Ellen jumped up. “Caro…oh! The hearing went against you.”

Her sister could always read Caro, even when no one else could, even when Caro didn’t want to be read, or even seen. “Ellen, I don’t want to talk about it.”

“Of course you don’t. You never do. But you have to, it will just be worse if you bottle it all up.” Ellen believed in never bottling up anything. In keeping a positive attitude. In finding the bright side. Which was remarkable, considering what Ellen’s life had become. Caro’s respect for Ellen was enormous, but now her sense of unreality about what had just happened took on another layer: disbelief that she and not Ellen was the one in trouble. It belied their entire childhoods, girlhoods, adult lives.  Their playbook had been written early: Ellen floundered and big sister Caro rescued. Today, along with everything else the day meant, was a reversal of fact that upended the universe.

“You’re coming with me,” Ellen said. “Now.  No, don’t tell me you have a patient or a meeting or a surgery, because I know you have the rest of the day free, you told me so yesterday. We’re getting in my car, which is illegally parked out front, even if I have to physically drag you there.” And then, in a different voice, “Caro—you know how hard it was for me to make arrangements to get here?”

Caro knew. She knew, too, that Ellen was capable both physically and emotionally of carrying out her threat. Ellen was built like a linebacker; Caro weighed 126 pounds. 

Ellen never minds whom she embarrasses.  I cannot teach that child restraint.

“All right, I’m coming,” Caro said.

The lobby teemed with people: a nurse pushing a smiling, home-going patient in a wheelchair, an entire happy family trailing alongside. Dr. Trilling from Radiology, in a tremendous hurry. Two med students carrying paper cups of Starbucks coffee. One said, “Hello, Dr. Soames-Watkins,” and then went on talking to the other. A normal conversation: the students didn’t know what had just happened to her. Theoretically, no one would know because hospital ethics hearings were not public, but after four years of medical school, years of neurosurgery residency with research, and her year of fellowship, Caro knew that hospitals did not work like that. Nothing stayed secret for very long.

Ellen’s car had been ticketed. She shoved the ticket in her purse without looking at it and drove several blocks to an ersatz Irish bar.


“In the middle of the afternoon?” Caro said.


“You need a drink.”


“I don’t.”


“You can’t tell me that the… oh, all right. You can have an iced tea or something.” 


The bar was dim and nearly empty. Vaguely Celtic music played, one wordless song blending into the next. They slid into a booth with hard wooden benches. Ellen, whose shaggy dark hair needed not only cutting but combing, said to the server, “Two iced teas, please.”

From Ellen, this was equivalent to surrendering her sword and bending the knee. Caro forced a smile, and then all at once she was glad that Ellen had brought her here, where she could unburden herself to the person she most loved and trusted. 

Ellen said, “So the disciplinary committee didn’t believe you?”

Caro said, a superhuman effort. “They didn’t want to.  Same outcome.”

“But you had a witness! You told me that other doctor, your friend Maisie Somebody—”

“Not my friend. Not anymore.” Then the hurt under the six simple words broke to the surface and Caro put her hands over her face.

Gently, Ellen puled them down. Caro’s right hand tightened on Ellen’s and did not let go. Ellen said, “Sissy?”

“The hearing came down to he-said, she-said. Maisie wasn’t a direct witness, no one else was upstairs at the party when Paul—Dr. Becker—dragged me into that bedroom. I insisted that Maisie be called to the committee because she’d seen that Becker was pretty drunk, and she knew that we were among the last to leave the party because our Uber didn’t show up. Also that I went upstairs to get my coat and came down upset and with a button torn off my shirt, and I told Maisie the same night what had just happened. She knew. But in the disciplinary hearing, right after Becker denied everything, Maisie did, too. She said that she saw nothing and I told her nothing.”

“She lied?” said Ellen, who never lied. “Why?”

“She was protecting herself, of course. I don’t think you realize how influential Paul Becker is. He’s not only Chief of Neurosurgery, he has a brilliant international reputation, and he’s the best surgeon I ever saw. A rock star. Last week I watched him tease out a glioblastoma multiforme with no clean surgical plane, one that no one else could have so much as debulked, let alone never touch the brain tissue. He—”

“I don’t care. He’s an asshole. He tried to rape you.”

“I don’t think it would have gone that far. He was just getting some cheap and drunken gropes. Although you’re right—that’s enough to make him an asshole.” Caro tried to smile, a failure. “If I’d actually been raped, I’d at least have physical DNA evidence.”

“You shouldn’t need it! You should go to the cops and file charges!”

“I’m not going to do that. I’d lose, just like I lost at the hearing. He said, she said. But maybe…maybe at least the hospital might watch him more carefully now.”

The server brought the iced teas. Ellen said, “And two Scotches, please. Neat.”

This time Caro didn’t object. After the server left, Ellen blurted, “Sissy, why aren’t you angry?  Why aren’t you furious?”

“I am furious. She leaned across the table toward Ellen. “But I can’t show it, not at the hospital…you don’t understand. I’ve trained myself not to. It isn’t that I don’t in the operating room, you can’t show emotion.” And a whole lot of good that had done her. But she wasn’t going to say—not even to Ellen—that in the operating room, Caro thought of herself like a fighter pilot. Control was a necessity. Steadiness, calm, unflustered detachment. But saying that aloud sounded grandiose, possibly even ridiculous. Besides, there was never any point in trying to convince Ellen to value calm. Caro plunged into the rest of the mess.

“This means that after my Boards I can say good-bye to my chances of getting hired at Farleigh. It just won’t happen. And there are no—”

“But you’re a rock star, too! You told me that your evaluations or whatever they are—”

“Yes, but—”

“And your research! You did that brain-mapping thing that even got published in—”

“Listen to me…I need you to listen. I’m good, yes. Very good.” 

Caroline is so full of herself. I cannot teach that child humility. 

Caro continued, “That’s part of the problem. Because I’m cross-trained in both neurosurgery and research and have done both, the only place I can work, would want to work, is a big hospital that runs clinical trials of new neurological developments. And there are no other hospitals like that in this city. Or in this state.”

“I see,” Ellen said. They sat in silence until the scotches came. Ellen drank off half of hers. “It’s not fair, Caro.”

“No.  It’s not.” Which was why she’d thought that these doctors that she’d worked with, learned from, admired, would believe her. At the end of the hearing, Caro had looked at Dr. Borella, the only other woman in the room besides the treacherous Maisie, and Vera Borella had dropped her gaze to the polished conference table and not raised it again.

Caro had been naïve.  No, it had gone deeper than that. The doctors at her hearing were faced daily with profound unfairness: the child who comes down with leukemia. The young father of three whose benign meningioma grows not in the pia mater of the right frontal lobe, where it would be easy to remove, but on the brainstem, where it destroys nerves and paralyzes him. The experimental drug that helps patients A, B, and C but unaccountably kills D.  Somehow Caro had expected that physicians who experienced this profound unfairness every day would try to compensate with greater justice in their dealings with each other.

The hospital’s self-interest meant it hadn’t worked like that. Or, looked at another way, it hadn’t worked liked that because faced with Becker’s denials, the others at the hearing had no evidence to go on, nothing tangible. He said, she said. 

A sudden, profound sense of loss swept through Caro. If only she’d left the party earlier. If coats and sweaters had not been left upstairs. If she hadn’t bantered the last few weeks with Paul Becker, a banter which she’d seen as collegial friendliness, a relaxing of rank because after her Boards she would be his full colleague, and which he’d apparently interpreted as an invitation. If only just one thing of many had been different—but no, only a single “if-only” mattered here, and Ellen startled Caro by voicing it.

“If only he wasn’t such an asshole,” Ellen said. “Because that’s what you were thinking, isn’t it, Sissy? That this mess is somehow your fault, because you’re supposed to be able to control everything. You can’t.”

Caro was silent. If Ellen had known anything about neurosurgery, she wouldn’t say that. Caro understood completely how many things she could not control. Inoperable spinal injuries,  glioblastoma multiforme impossible to remove completely, arterial aneurysms that burst in the ambulance on the way to the ER. The difference between Caro and Ellen was that Caro fought to control each of them and counted it as a personal failure when she could not. Whereas Ellen, from some mysterious mixture of courage and fatalism, accepted whatever life threw at her.

Caro said, “How’s Angelica?”

“The same.”

Angelica would always be the same, until one day she wasn’t anything, and no longer defined Ellen’s life and the life of her other daughter, Kayla. They were all the family that Caro had, and she would do anything for them—although that’s what she thought she’d been doing, and now she’d screwed up. 

“I’ll miss you,” Ellen said, “because of course you have to move where you can do your best work. My sister the hot-shot sawbones.”

Despite herself, Caro laughed. “Nobody says ‘sawbones’ anymore.”

“Skull wizard. Brain editor. Gray Matter Cowboy.”

“Where do you get these terms?”

Ellen smiled mysteriously. Then she grew serious. “I can manage, Caro.  I will miss you dreadfully, but I can manage.”

“I know.” Her sister managing, better than nearly anyone else could have done in her situation, but with a good salary someplace else, Caro could still send Ellen money. Ellen needed it. Social services provided inadequate help for Angelica, Kayla outgrew her clothes as fast as Ellen could get them from Goodwill, and nobody including his parole officer had received word—or money—from Ellen’s deadbeat husband in over a year. But what Ellen needed at least as much as money was adult companionship to relieve her terrible daily routine, and so few people besides Caro could stand to be in the house with Angelica.

Ellen said, “Where will you apply for a job?”

“Dunno yet. I have to start looking. Boards are next month.”

“Well, right now I have to go to the ladies.”

Alone, Caro pushed away her defeatist thoughts. After all, she sliced into thought every time she sent a microscope or a knife or a laser beam through the soft gray jelly of a living brain. Cutting through memories, through perceptions, through capabilities to move and speak and think. All as fragile as snowflakes, as easily dissolved in a slip of the knife, a tear of a nerve. Thoughts changed nothing; only action did. The party had happened, the hearing had happened. Both lay in the unrecoverable past, and now Caro would go forward. To a different city, a different life from the one she wanted, and she would travel back as often as she could to see Ellen and the kids. She could do this.  She always had. The worst was over.

Ellen had left the second half of her Scotch undrunk. Caro hadn’t touched hers. While Ellen was in the restroom, Caro got up from the booth, found the server, and paid for the liquor and iced tea so Ellen wouldn’t have to. Then she pulled Ellen’s purse toward her, fished around until she found the parking ticket, and stuck it in her pocket before Ellen could realize the ticket was gone.

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