A Show of Hands
by Olaf Kroneman
part 1
The beauty of my surgeries is in the eye of the beholder. To many, it is an ugly destruction of human anatomy. I use nearly microscopic thread-like stitches, just a bit larger than an ant’s antennae, to connect a small, delicate vein to a thick artery. To me, it’s a thing of beauty. It is a marriage of the weak to the strong.
I manipulate the veins and arteries in a patient’s arm to construct a sturdy blood vessel as prominent as the veins of an MMA fighter or even a thoroughbred racehorse. My painstaking work for those with thin arms looks like a snake is coiled around their forearm. The serpentine vein is an umbilical cord for attachment to a kidney machine. Kidney dialysis is not for the weak.
Despite rain, sleet, hail, or snow, my patients — none weak in the slightest — make their way to a strip-mall dialysis clinic three times a week to pay homage to Big Dialysis. Some walk, but many use wheelchairs or walkers. A few come on stretchers.
A poorly constructed vein will blow like that of a heroin user. My careful work makes their life a bit easier. I am glad I can help them. At times, though, I wonder if I am complicit with the Big Dialysis corporations. To be complicit is so easy. It frightens me.
I am very skilled at making this vessel. It is a complicated and tedious procedure, more so than heart or brain surgery.
Hospitals sold their dialysis clinics to the Big Dialysis conglomerates. The hospitals abandoned the care of patients with kidney disease but enriched themselves through the sale, and they didn’t think twice about being complicit.
The clinics are no longer attached to hospitals and are located in less desirable areas. They are sandwiched between liquor stores, pawn shops, check cashing, and payday loan outlets.
The unit I visit today is no different, perhaps a little worse.
I park nearby. I step over empty liquor bottles, hypodermic needles, spent condoms, and used diapers both adult and baby.
The sign on the door alerts me: NO FIREARMS.
In the waiting room, a Black woman is rubbing her ankle. I walk over and examine her swollen foot. “What happened?”
“I was walking toward the clinic, stepped in a hole in the concrete, and fell. I heard a snap.”
I examine her swollen foot. “You’ll need to get X-rays,” I say. “It could be broken.”
“I’ll need to return to the slave ship first,” she says. “Then I’ll go to emergency.”
“What?”
“The slave ship. How come everybody in the clinic is Black?” she asks me. “There must be a reason.”
“There is.”
“How long have they known the reason?”
“A while,” I say.
“Just as I figured. They’re keeping it on the down-low. Too many people are making too much money keeping us on dialysis.”
Thoughts of my being complicit return. For doctors, it is an easy trap.
“Make sure you go to the hospital after your treatment.”
She shakes her head. “Soft bones, bad kidneys, almost blind and diabetes. I must be soft in the head to put up with this and make other people rich. But I want to live.”
“Make sure you get an X-ray.”
I am a vascular surgeon. I intimately and organically understand arteries and veins and how to salvage arms and legs. For me, it is instinct. It can’t be taught. I often find myself bailing out non-surgeon medical doctors who took a three-week course in maintaining the vessels for dialysis. I studied surgery for six years, and these doctors perform the procedure after only three weeks of training.
Forty years ago, I worked in the surgical department that developed the ability to reattach severed limbs. Dr. Ronald Malt of Harvard Medical School was the pioneering doctor who advanced microvascular surgery by severing the tails of anesthetized rats and using microscopic surgery to reattach them.
The rats got their tails back. He was anxious to expand the technique to humans.
An opportunity arose when a woman arrived at the General Hospital on a Sunday with half of her hand severed from operating the meat slicer in a delicatessen. Dr. Malt was a surgical resident at the time. He called his friend, an anesthesia resident, to provide anesthesia. They took the patient to surgery and successfully reattached her hand. This clandestine act was done without senior supervision or informed consent. It would not be allowed today, and the woman would have a useless stump rather than a hand.
Had they failed, their careers would likely be over. But the procedure was a success. Later, Dr. Malt gained national recognition, not to mention a large spread in People for saving and reattaching the severed arm of a young boy. The kid went on to become a tennis player with a heck of a two-handed backhand.
I wanted to pursue vascular surgery and salvage limbs.
When I completed my surgical training, I left Boston for my hometown, a Rust Belt manufacturing city known for producing automobiles, as well as the resultant factory accidents that required reattaching severed fingers, hands, and the occasional foot.
Upon my return, I was welcomed by the medical community, but I soon ran into problems: I was a threat. Local surgeons wanted to replicate my surgeries, but they needed more training. Their attempts were disasters. I tried to instruct them, but they were impatient. Their attitude was: see one, do one, teach one. Bad surgeons were teaching other bad surgeons.
I had to do something. It was a time when I believed that “do no harm” was inviolate. I was not afraid. I was naïve.
I approached the chief of surgery. “Doctor, your surgical department has a problem.”
The chief of surgery was revered in this community hospital. His reputation was beyond reproach. I was sure he would comprehend the problem and its ethics. One surgeon was particularly bad. Most, if not all, the complications were due to his incompetence.
“The surgeon you are referring to is my partner and my friend.”
“Then you are aware of his outcomes. You are the chief of surgery. You must prevent this.”
“We are a very close-knit department. We don’t need a hotshot outsider telling us what to do.”
“I’m not an outsider. Unlike most of your staff, I was born and raised here. I have a personal interest in this city. I went to high school down the street from here.”
“Like I said, the man is my friend and partner.”
“It’s not about friendship. It’s about patients, who trust us, who are getting hurt or dying. Why are you protecting him?”
He remained silent and picked up a surgical journal, pretending to read.
I got nowhere. I went to the chief of medicine and the chief medical officer.
“You never attack a surgical department,” the chief of medicine said.
“The surgeons make the most money for the hospital,” the chief medical officer added. “Sometimes you must compromise. This hospital doesn’t like dissent from the ranks.”
“But patients are being hurt, killed.”
I spoke out only to receive a letter of dismissal. I was labeled a disruptive physician. I was removed from the staff with no chance of appeal.
Initially, I believed it to be ignorant institutional malpractice, but later, I viewed it as a crime scene.
I went to other hospitals to obtain privileges. But word had got out. I was blackballed in my hometown.
I should have left the city, but I wouldn’t run. I wanted my city to have the same level of care as Boston, Chicago, New York, and other major cities.
The incompetent surgeon continued to operate, protected by his friend and the other administrators.
Three years later, the malpractice attorneys caught on, and the results were so bad that the vascular limb salvage clinic was shut down. Lawyers, not doctors, were able to stop the incompetent doctor.
I assumed the hospital, now enlightened, would realize I was an honest broker who had tried to work within the system to correct a problem. I thought I would be welcomed back.
No luck: I remained a pariah.
The malpractice attorneys made a lot of money. The hospital lost a lot of money.
Out of necessity, I opened private surgical clinics. I became successful and rich.
But for me, it wasn’t about the money. I always longed to return to the hospital. The closest I got was working in the dialysis clinics. The Big Dialysis centers appreciate what I can do. I keep their patients, referred to as “profit units,” fit for the dialysis machine.
I long to expose what happened decades ago.
I often meet with the attorneys of the Big Dialysis companies. They have excellent antitrust lawyers to protect their monopolies, and they continuously rewrite my contract to circumvent the Department of Justice and the Federal Trade Commission. My contract changes as the rules change. They are the artful dodgers.
In chatting, I tell an attorney about what happened when I first came to the city.
“You can’t sue the hospital; the statute of limitations has expired.”
“I know, but I tried to warn them. I tried to get them to stop. Many patients were injured or died.”
The attorney thinks for a moment. He rubs his chin.
“What was the mortality rate when that doctor operated?”
“Eighty percent.”
“When Dr. Thumbs operated, it was more likely than not that the patient would die.”
“Yes.”
“Doctor Thumbs” makes me smile. That was a good name for him.
“Well, there is no statute of limitation on murder. You could make a case that this is first-degree murder. It is a stretch, and you must get an unusual prosecutor. But there are many unusual prosecutors running around now.”
The thought swirls in my mind. There was an eighty percent mortality rate when Thumbs operated. The case could be made that it is first-degree murder. There is no statute of limitations.
I leave the attorney and think. Our conversation opens a way to expose the doctor and the equally guilty accomplices.
I call a malpractice attorney. You can get their names off the billboards. Our rust belt city doesn’t manufacture much anymore, but with the decline of industry, malpractice attorneys flourish. When a city fails, personal injury attorneys seem to sprout up like mushrooms, living off the dead. “There is no fee unless we collect.”
I see them as predators, relishing in the misfortune of others, but I suspect they can help me, that is, if the money is right.
I call their toll-free line. A recorded voice instructs me to leave a message after the beep. “I know where there is a mass grave of malpractice victims.”
I get a call back.
“Did you call about a malpractice mass grave?”
The voice is rough and not very friendly.
“Yes,” I say, “that was me.”
I hear him gulp, something I assume is coffee.
“Where is the mass grave?”
“In the suburbs.”
I hear him breathe in the phone. It is an exhale of disbelief.
“Where in the suburbs?”
“In the hospital records room.”
“What?”
“I will explain in person.”
“How many bodies?”
“Forty-one”
“You better not be wasting my time.”
“I’m not.”
“Let’s meet.”
I went to the law offices of The Challengers. They call themselves this because in their words, they always fight the establishment, and they always win. They help the underdogs.
A very attractive young secretary escorts me to the corner office of Mr. William Burns.
“Have a seat. I’ll tell Mr. Burns you are waiting for him.”
I sit in front of an ornate desk with carvings on the legs and front. There is gold leafing marking the edges. I scan the room. Artwork surrounds me. I feel like I’m in an art museum. I recognize a sculpture on his desk, The Pugilist at Rest.
Attorney William Burns enters. His black suit is meticulously tailored to distract from his short, pudgy stature.
I smell bourbon, not coffee.
He wears a lot of gold. His right hand is tucked into his vest like Napoleon.
Mr. Burns is the oldest malpractice attorney in the state. In commercials, he is called “Bill Burns the Battler.”
His firm uses a boxing glove logo.
“I am a busy man,” he says. “This better be worth it. I have bills to pay.”
“I will let you decide.”
I divulge the name of the hospital and the doctors involved.
He shakes his head. “We sued those doctors and that hospital years ago.”
“Okay,” I say. “But the bad surgeon got off, and the other medical and surgical administrators that covered for him were never exposed. Eighty percent of that guy’s patients died.”
“The statute of limitations has expired,” he says.
“I was told there is no statute of limitations for first-degree murder.”
“I never knew the mortality rate was that high. They didn’t tell me. Yours is a clever but ridiculous argument.”
“I have the statistics. I’ve saved them all these years.”
He shakes my hand with his left. He removes his right hand from his vest. It is a knob, a scarred stump missing all the fingers except the thumb.
Copyright © 2025 by Olaf Kroneman
