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I’m really having trouble believing any capable surgeon would take a normal infant and perform major surgery without a confirmed diagnosis, or at least a second opinion by a qualified consultant,” she groaned. “This pains me deeply!”

      “Mary, they don’t even know the cause of this disease, and that’s what makes this whole thing such a neat con-job if these doctors are completely free to do whatever they want for more bucks.”

      “I agree, and it really scares me when my staff tells me McGrath is God’s gift to children - how can we be so blind?”

      As tears filled her eyes, she quickly forced them back, turning her head to regain her composure. Her sensitivity had always been obvious to Bill, and it was easy to understand why people liked her so much. You always knew where she was coming from because she was at all times an open book, and that’s what Bill respected most about her - besides also being a very attractive and likeable person.

      “Mary, I feel just as you do. I don’t know how any ethical human being could feel any different. Here, let me read their final decision to you.” Eventually, the CDC confirmed the high rate of CS as being attributable to inaccurate diagnoses, rather than an epidemic.

      Mary looked squarely at Bill. “My God,” she cried. “Just how am I going to approach this mess? This is a medical staff disaster, for which it appears their doing nothing about.” Glaring defiantly out the window, she looked confused.

      “Sure it’s a medical staff disaster,” Bill quickly responded. “But you can still demand basic standards be met. And you should also require the medical staff to provide accurate supportive information such as comparative skull measurements, or at least documented evidence of the progression of the disease over time, before you schedule any more of these major CS surgeries.”

      Looking at his watch, Bill suddenly realized they’d talked away most of the morning as he signaled the waitress for their check.

      After the waitress left, he continued. “Mary, you need to confirm that all CS cases have been validated by X-ray, and that all supportive subjective and objective information is recorded in the patient’s chart. In fact, each surgeon should be asked to provide a written plan of accomplishment, clearly stating the specific type of surgery they intend to perform to resolve the problem, before you schedule anymore CS cases.”

      Pausing, Bill thoughtfully bit at the inside of his cheek. “Mary, the fusion of one single sagittal suture should never justify a total removal and reshaping of the entire skull, let alone the forehead of any infant. And more importantly, the hospital needs to define what research is, and then document and approve all these major surgeries before they’re ever done. I feel any Total Calvarial Reconstruction is just too damned risky and extensive, and each procedure needs to be clearly defined and monitored - I’m not sure if your hospital’s policy also requires an unbiased second opinion by another qualified neurosurgeon with that type of major surgery, but it sure as hell should. And that’s what you’ll need to enforce. You need to put those regulations back in place.”

      “Okay,” Mary said with conviction, quickly wiping a last tear from her cheek.

      Taking Mary’s hand, Bill squeezed it tightly, trying to ease her agitation. “That’s enough discussion on the good doctors and this fallacious epidemic.”

      Neither spoke as they both thought about the impact this was going to have on the hospital. Finally Bill said, “You might as well accept the fact that McGrath is going to retire wealthy, right on the heels of Hanes if this continues, all because the consumer remains so damned submissive and uneducated about their own well being and the importance of having trustworthy physicians and standards in medicine. Corrupted physicians know better, but some of them just can’t deny their voracious appetites, which they’ll never satisfy. Taking advantage of the sick and disabled is nothing more than that same old Witch Doctor Syndrome we suffered from years ago.”

      Mary gave Bill’s hand a final squeeze before she blew her nose.

      “You’re right. I wonder what ever happened to those doctors that entered medicine with the high ideal of helping the sick. I know my husband was one,” she said, sliding her chair back so she could stand up.

      “There just aren’t too many of those left anymore,” Bill replied. “And yes, your husband surely was one. But we still have to educate the patient so they can at least become aware of those few bad apples, and that’s why I’m writing.”

      As Bill picked up the receipt for brunch he continued, “Well, unless we plan to eat dinner here we better quit for the day. It sure seems like old times, working weekends to improve the system.”

      As they left, Bill said, “I guess we both have a little better understanding of CS.”

      “Yes, I think I finally understand it. In fact, I think I now understand it too damn well,” Mary scoffed.

      “With that photographic memory of yours, I bet you do. Why don’t you tell me what you’ve stored on CS in that head of yours, while we walk home?”

      “Okay, let me think a moment,” she laughed, as Bill pushed open the massive Mexican door. Once Mary read something, she had almost one hundred percent recall, and as they started to walk home, she said, “Alright - let me see - at birth, there are four sutures or fissures of the skull that separate the five membranous bones on the top of the head. And because the infant’s skullcap is very flexible at the time of delivery, it provides nothing more than an elastic type cranial vault that surrounds and protects the brain. And those four major sutures serve an important function in resisting the separation of the five bony skull plates, while allowing for brain growth.” After hesitating a moment she continued. “It’s also important to remember that the brain’s largest growth period occurs during the first three years of an infant’s life - and the premature closure of any one of those sutures potentially results in this very rare birth defect, called CS disease.”

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