For the first time, I am sharing "Last Case," my short story published in The Examined Life Journal: A Literary Publication of the University of Iowa Carver College of Medicine, Volume 11 (released 2/7/2024).
Almost everything I have published to date is "creative nonfiction," a genre where the writer promises to "stick to the facts," while exploring real events and moments. This piece, however, is different. Although you might see hints of my life here and there, this story is fiction.
As far as I can tell, the story will not be available in digital format from the journal. I did communicate with one of the editors who asked me to wait until the story was in print before adding it to my website.
The Examined Life Journal is one of my favorite literary journals and is edited by some amazing people. I encourage you to purchase your own copy of the current issue here.
I hope you enjoy reading this short story as much as I enjoyed creating it. There might be more fiction on the way.
Last Case
Bruce H. Campbell, MD FACS
“This one says I was the Best Doctor Ever!!! Three exclamation points.” Gene holds up the retirement card. “Not true, but nice to read, nonetheless.”
He has dreaded this day. The crowd is thinning, He continues to open the cards and shares some of them with Therese. She shakes her head. “C’mon. They always loved you. You know they did.”
He thumbs the stack, pausing to read the handwritten messages. “Hmm. They’re all past tense.” Retirement decorations adorn the walls of the third-floor conference room where he sat through dozens of operating room committee meetings and grand rounds presentations over the years. The garbage cans overflow with paper plates, plastic forks, napkins, and cups. He sets down the stack of cards and massages the knuckles of his right hand.
One of his surgical colleagues approaches and wraps him in a hug. “Congrats, Gene! Gonna miss you!” She lets go and nods. “Seriously. We all try to ‘Be Like Gene,’ y’know. We’ll take good care of your patients.” She looks to the group of the young operating room nurses and techs who are standing with her. “Right?” Gene, not a hugger by nature, goes around the circle, thanking them all by name, at least the ones whose names he can remember and the ones whose ID badges are visible. Good God, he thinks. I used to know everyone but I’m batting around .400 today. He watches as they walk across the room to pick through the last of the food, and feels an unexpected twinge somewhere deep, realizing he won’t see many of them ever again. He wishes he was home.
Have I made a mistake? Throughout his career, he reveled in the mental gymnastics needed to get through a tough operation. Even during his final cases, he still marveled how time telescoped; entire days flew by. He even loved the intimacy of the office, listening to patients’ stories and accompanying them on their journeys. Despite the intensity, his work was rejuvenating.
Now his career is done. He sees no easy path forward. Some of his old colleagues have not done well in retirement and he is not certain how he will adjust.
Therese is wielding a plastic knife, surgically dissecting frosting off a thick piece of sheet cake. Over the past two years, unless she was seeing her oncologist, she has rarely set foot inside this building where Gene spent his entire career. Happily for Gene, she was the center of attention all afternoon. She asked people’s names and made connections. Whenever someone hinted having him around the house might be a challenge, she grinned and responded, “I’ve added lots to his to-do list.” Therese will be in charge of distracting him as he copes with never stepping into an operating room—his sanctum sanctorum—for the first time in forty-two years.
She joins him to watch the OR staff head out the door. “Yeah,” she says. “You know you have a fan club here.” Therese sets down her plate and gives him a hug. “Just don’t let it get to your head. Hard enough to live with you as it is.”
He grins. “You don’t think I’m special?” He picks up a plaque, taps the inscription, and hands it to her. “Here,” he says. “Read this. Out loud, please.”
She steps back and adjusts her glasses. “Congratulations on Your Retirement Eugene Traynor, MD. Surgeon Extraordinaire! You are amazing! We will all miss you!” She peers over her frames. “Did you write this?”
“You’ll never know.” He holds his hands next to his ears and simulates his head progressively expanding. His face softens. “I know I should’ve retired when I turned sixty-five and you were diagnosed. I just couldn’t pull the trigger. I dunno. I think I’m ready now.” He picks up his cake and frowns. “Is this from Costco?”
“Which? The plaque or the cake?” She studies the inscription again. “Probably both. What? You think you deserve treats from Dominique’s Pastry Paradise?”
He shakes his head and takes too large a bite. “I don’t know. Maybe.” He covers his mouth, then wipes at frosting stuck to his lips using a napkin too stiff for the task. “I mean, this was their only opportunity to say goodbye to me.” His eyebrows drop. “Seriously, though, I’m glad to be going out on my own terms. I always said I would retire two weeks before I got kicked out or had a huge complication. Maybe I did.”
He reaches under the table and retrieves a cardboard box full of items from his office. “I grabbed the stuff off my desk. Sharon offered to pack up the rest and save it for me until we get back from our trip.” He sets the plaque and the stack of cards into the box. “Let’s get out of here. Ready?”
Therese points at the food table. “Wait. I’ll grab some cake and cookies. The kids said they might stop by the house tonight.”
He wipes his fingers with a fresh napkin then points at the table. “Hey! Grab that corner piece. The frosting’s the best part.” He holds up his hand, displaying the persistent green and yellow stains. Therese rolls her eyes.
As he watches her, a young couple approaches. “Doctor Traynor?”
He glances up and smiles. Another twinge. He does not recognize either of them. He surreptitiously glances at their IDs. The man is a nurse, and she works in the lab. They don’t look even vaguely familiar.
“Hey, hello!” he says, feigning familiarity. “Thanks for coming to say goodbye to the old guy. Grab some cake before my wife packs it all up.”
“We will. Congratulations, Dr. Traynor,” says the man. He shifts his weight back-and-forth. “So, you won’t remember, but we’ve all met before. I’m Sanjay, and this is my wife, Erin. It was a long time ago.” Sanjay smiles. “You actually took out our tonsils right here in the hospital twenty-five years ago. When we were kids.”
Gene’s eyes widen. He laughs and scratches his head. “Huh? Really?”
“Yep. We figure we both had surgery within a few weeks of each other when she was six and I was eight.”
Gene shakes his head and leans against the table. “Seriously? Both of you? I did? And now you’re married, right? What are the chances? My, my! Sorry I don’t remember. Hope everything went okay.”
Erin smiles. “Well, I remember! I had a terrible sore throat afterwards. It was awful. But I also remember you stopping in to see me the next morning. You put your hand on my forehead and told me I was being very brave. You smiled and laughed, like you did just now. I remember that like yesterday.”
“Yeah, our memories are really similar,” Sanjay says. “I’d been having sore throats every couple of months. Surgery was bad, but I remember your smile the next morning, too. Oh, and I remember coughing up some blood about a week later. My mom drove me to the ER.”
“Oh-oh. Really?”
“By the time we met you there, the bleeding stopped. You took a look and said it would be okay and it was. No more bleeding. After I healed up, I did fine.”
“Well, that’s good. Sorry about the bleeding. About two percent of kids bleed afterwards. Occasionally, it is serious. Despite all the years and all the fancy new technology, the bleeding rate is still about the same today as it was back then.”
“Umm.” Erin pauses. “Dr. Traynor, may we ask you a question?”
“Sure. Anything.”
“Well, we know you’re retiring, but our son, Jacob, is seven and has sore throats every month or so. He’s miserable and he’s missed so much school. The pediatrician says getting his tonsils out will help his sore throats and probably his snoring.”
“Sounds like he needs the same surgery his mom and dad had. Has he seen anyone? I know some people in the business.” “That’s just it,” says Sanjay. “We saw one of your partners and didn’t connect at all.”
“Really? Who?”
Erin points across the room where one of Gene’s young colleagues is talking to a group of people from Children’s. Marissa? he thinks. His eyebrows go up. “Oh, I’m surprised. She’s excellent. Great surgeon. Smarter than me. Fellowship trained and everything.”
“Well, she rushed in, didn’t say hello, barely looked in Jacob’s mouth, told the nurse to schedule the procedure, and left before we could ask any questions. The nurse practitioner pushed the consent form at us and said someone would put him on the schedule in about four months. Jacob cried all the way home. It was all so incredibly cold.”
Gene bites his lip. “That’s too bad.”
Erin looks down. “All we could think of was how comforting you were to each of us the morning after our tonsillectomies,” she says. “Sanjay and I decided that if Jacob needs surgery, we want someone like you caring for him.”
“That’s so kind. Here, let me give you another name.”
“Thanks, but would you be willing to take out his tonsils before you retire?”
“Wait, wait.” Gene leans back and looks at the ceiling. “Really? No, no. I’m done! I mean, I cleaned out my OR locker yesterday. Look! Here’s a box of stuff from my office! Therese and I are leaving on a trip to California in a few days.”
“But would you consider it? Please?”
Sanjay adds, “We’re serious. Just tell us when to bring him in. We’ll work around your schedule. This week or when you get back. Whatever. Whenever you’re available.”
Gene looks at the young couple. Oh, my goodness. This is really nice, he thinks, but it’s just a complication waiting to happen.
Finally, he says, “No. No. I’m really touched, but I am done. Finished. Finito.”
Erin sighs. The corner of her mouth curls into a smile. “You know,” she says, “Dr. Abramovich was my mother’s OB when I was born. And then he delivered both of our kids.” She cocks her head. “That worked out well, right?”
Gene laughs. “Well, clearly, even old Sandy Abramovich got lucky once in a while. He’s a character.”
“Well,” she says, “you’ll be lucky, too.”
“Wow. Okay.” Gene sighs and looks back-and-forth at them. “Let me think about it. Give me your number. Since you saw Marissa, I assume the office has all of Jacob’s information. I’ll call you one way or the other.”
Erin pulls out her phone. “Oh, here’s a picture I took yesterday. Just imagine reassuring him the next morning that everything is fine.”
Gene gets their number and looks at the boy’s open, happy smile. “Well, no one stays overnight anymore unless there’s some sort of problem. But he’s a good-looking young man, that’s for certain. I’ll be in touch.”
Erin and Sanjay thank him and head toward the door. The room has emptied, and Gene hefts the box. He walks over to the food table where Therese has finished packing up cake.
“Did you see that young couple I was talking to?”
“Yep. More members of your Fan Club?”
“Worse. Postop Club. I yanked the tonsils on both of them when they were kids. Now they want me to do the same for their boy.”
“What did you say? That’s crazy, don’t you think? Besides, we’re leaving on Monday.”
Gene sighs. “Yeah, you’re right.” He takes in the room one last time, settling on a sign that reads, Over the Hill and Picking up Speed. He nods toward the door. “Now can we get out of here?”
***
The next morning, Gene sits at the kitchen table and calls his young colleague, hoping to catch her before she scrubs in for her first case. “Here’s the bottom line, Marissa, the kid needs his tonsils out, but you scared him. His parents, too.”
“Oh, God!” she says. “I remember that day. My schedule blew up. I had been in the OR half the night with an unbelted kid in a horrific car crash and had to wait for neurosurgery and ortho to finish up before I could piece her face back together. By the time I finished talking to the family, I was about ten patients behind. I never caught up.”
“Well, that makes sense. I had plenty of days like that over the years. The Marissa they described is not the Marissa I know.”
“Thanks for saying that. I know they were short changed. Look. What if I call them? I’ll see him on a non-clinic day and give them all the time they need. Diane can arrange it. I know there was a cancellation so I should be able to get him into the OR next week.”
“Yeah, worth a try. Mom and Dad both had tonsillectomies. Dad even had a postop bleed.”
“A bleed? Bad juju.” She pauses. “Okay. I’ll text Diane as soon as we hang up.” Her voice quiets. “Thanks for letting me know. I’m still striving to ‘Be Like Gene,’ y’know.”
“Nah. You’re better than me. I tell everyone you’re amazing. Call me if there is anything I can do. The ball’s in your court now.”
“Got it. Hey, you doing okay? I thought the celebration was great.”
“Heh. This retirement thing hasn’t sunk in yet. But, yeah, all good. Therese’s taking care of me.”
“Glad to hear it. She’s amazing. Tell her, ‘hi.’ Thanks again, Gene. Keep in touch.”
“No, no. Thank you. You’re the best. Bye.”
The phone clicks.
Therese looks at him from the kitchen sink. “She’s going to call the parents? Seems like a good idea.”
“Yeah. I think that will solve things. Marissa says to greet you, by the way.” He looks at her. “I wonder if I should call the family, too? I’ve passed it off to Marissa now. What do you think? I don’t want to muddy things.”
“Maybe wait a couple of weeks. After he’s recovered from surgery.”
He smiles. “Wise words.”
Therese wipes her hands with a towel and hangs it carefully on the rack. “So, I figured you would operate on that boy.”
Gene’s eyebrows go up. He chuckles. “I was tempted. After we got home, I even dialed the OR to see if I could get him on the schedule tomorrow. Changed my mind.”
“Really. Why?”
He looks down at the table, squeezes his lips together, then looks up at her. “Well, the logistics would have been a bit complicated. I already gave up my OR time. I’ve said goodbye to everyone so showing up again would have been weird. And I absolutely guarantee he would have had a complication.”
Therese sits down, facing him. “What? What makes you say that? You’ve done hundreds of tonsillectomies over the years!”
“Well, perhaps everything would have gone fine, but here’s the thing: If a younger surgeon had a complication, everyone would say, ‘Well, too bad. Complications happen.’ But, if something bad happened when I operated on that boy, everyone—including me, mind you—would say, ‘Well, there you go. Traynor’s old and he screwed up. What was he thinking? His hands aren’t as slick as they once were.’ I didn’t want to deal with that.”
“Your hands?”
He taps the deck of cards still on the table from their nightly Cribbage game. “Dumb stuff. Dealing cards, for instance. Handwriting. Tying knots. My joints aren’t what they used to be. Everything takes more time. I’ve compensated.”
They sit in silence for a few moments. He realizes he is wearing jeans and a sweatshirt on a Thursday morning for the first time in decades. He looks up. “I mean, you just never know, right?”
“Yeah. You just never know.” Therese gets up, retrieves the pot, and refills their coffee cups.
“Thanks.” He takes a sip and smooths the sweatshirt’s frayed cuff. “Perfect.”
“So, what are we going to do today?”
He cocks his head. “You might not have heard this, but I’m retired. I have nothing on my agenda.”
“So, finish your coffee and find your jacket. Let’s go for a walk.”
He smiles. “I would like that. Very much.”
***
He awakens with a start and reaches blindly to silence his phone on the unfamiliar nightstand. In his anxiety to not awaken Therese, he knocks the phone, his book, and his glasses to the floor. He leans over the edge of the mattress to retrieve his things, fumbles with his glasses, and silences the phone. It is 4:15 AM.
“What the hell?” he mumbles. “It’s the middle of the frigging night.”
“Is it one of the kids?” Therese rolls over and props up on her elbow.
He grimaces as he sits up, his knee still sore from the ambitious hike to the waterfalls yesterday.
“Hang on,” he says. “No. No, it’s from Marissa.”
“Marissa? Really? What does she want?”
Gene taps the screen. “Ah. She’s operating on that kid this morning. Here: ‘I’m taking out Jacob’s tonsils today. His mom asked me to let you know and to say thanks. They’re putting him to sleep right now.’ Guess Marissa doesn’t realize we’re a few time zones west of home.”
“So, no emergency. That’s good.” She rolls over. “I’m going back to sleep.”
He debates how to respond, finally choosing the Thumbs Up emoji. He sets his glasses and the now-silenced phone, screen side down, back on the nightstand. After closing his eyes, rearranging the pillow a couple of times, and rolling side-to-side, he sighs, rubs his eyes, massages his knee, and climbs out of bed.
He eases the bathroom door shut before turning on the light. The lodge’s accommodations are nice but not luxurious. After flushing the toilet, he steps to the sink to wash his hands, then drops the towel onto the counter. Marissa is probably scrubbing right now, he thinks.
His eyes are drawn to the sink. The porcelain bowl empties and, as the water slips down the drain, it is replaced with an outline—and then a view—of a boy fast asleep in the OR. It is Jacob, wearing a disposable blue paper hat, with his eyes taped shut and the breathing tube secured to the center of his lower lip. Gene’s fingers and knee soften.
Guess this is my case to do. The scrub tech hands Gene a tonsil gag, which he guides into Jacob’s mouth and clicks open until the throat is fully exposed. The tech moves the instrument stand closer, and he hooks the end of the gag onto its edge, suspending the instrument. The familiar and reassuring sounds of the OR—the monitors, the chatter, the intercoms, the ventilator—fill the room. He aims his headlight into Jacob’s mouth. Nice tonsils, he tells the tech. Piece of cake.
All is ready. Curved Allis. The tech places the clamp in his outstretched hand. He feels the coolness of the handle and then the click-click-click of the ratchet as he tightens the clamp into the substance of the right tonsil.
He creates the incision in the mucosal lining, then locates the dissection plane between the tonsil and the muscle. His hands are steady and responsive as he pushes, cuts, and cajoles the tonsil out of its bed. He works top-to-bottom and front-to-back. There is a bit of bleeding but nothing worrisome. A perfect case.
The right tonsil is out. He hands the clamp and tonsil to the tech who trades him for a tonsil sponge on a hemostat. Suction cautery, please. His toes locate the foot control pedal. He dabs at the tonsil bed with the sponge and steps on the pedal, hearing the crackle, noticing the faint smell of burning tissue, and watching the tonsil bed blacken in response to the cautery. He alternately dabs and cauterizes. When he is satisfied that there is no more bleeding on the right side, he repeats the process and removes Jacob’s left tonsil.
He checks to make certain that everything is as it should be. With the tonsils out and the throat rinsed, he watches for several seconds. Jacob’s throat looks fine.
Okay! You can wake him up. The anesthetist throws a lever, shutting off the ventilator. She adjusts the dials to replace the anesthetic gas in Jacob’s lungs with oxygen.
Jacob coughs and starts breathing on his own as soon as the tube comes out. Gene notices the familiar, sweet odor of the anesthetic gases escaping the boy’s lungs. Jacob, still unconscious, is moved from the OR table to a transport cart while Gene types postop orders into the computer.
When Gene turns back toward Jacob, he fully expects to see the boy groaning and rag-doll limp. Instead, Jacob is wide awake and waving at Gene, signaling him to come over. Transfixed, Gene pulls down his surgical mask and stares at the boy. He walks to the transport cart and reaches to touch the boy’s cheek. “You’re awake?”
Jacob smiles and takes hold of Gene’s right hand, massaging his knuckles. “You’re going to be just fine,” Jacob says. “All is well.” As Gene stares, Jacob returns to unconsciousness, his hands slowly releasing Gene’s and slipping to the mattress. His eyes drift half-shut and he moans. The cart rolls out the door toward the Recovery Room.
Everything goes quiet. Gene looks up and sees his reflection in a bathroom mirror framed with rustic knotty pine boards and silhouettes of deer, wolves, and fox. The drawer handles are fashioned from tree roots. He hangs his towel on the rack, flips off the bathroom light, and limps back to bed where Therese is fast asleep. As he slides back under the quilt, his phone vibrates on the nightstand.
“Everything’s fine. Minimal blood loss. Going to talk to the parents now. Thanks again.”
The clock reads 4:45. He rereads her message, then taps out a response. “Tell them I was thinking of Jacob.”
Gene is wide awake. He picks up his book and, in the early morning light, settles into the room’s only armchair. Before turning on the lamp, he imagines that Jacob is, right now, reuniting with his parents. The boy smells of anesthesia. He sobs and leans into his mother. The next few days will be miserable, but he will turn the corner. Erin and Sanjay will watch for bleeding. When Gene calls the parents a couple of weeks after he and Therese return home from their trip, they will tell him that Jacob did just fine.
In an hour or so, Therese will wake up. They will have a leisurely breakfast in the lodge, and head out to see the wildflowers. They will both be grateful that Therese’s cancer has been under control for over a year. Gene will gripe about his knee and find some Advil in the gift shop. And that longing for his old life as a surgeon will have begun to fade more quickly than he could have ever imagined.
