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“It’s common practice everywhere,” said another general surgeon.

“Make your point, Janet,” Mike said.

“There’s a national backlash against the procedure and now we’re advertising. It makes no sense. It’s become elective surgery and a patient in our hospital damn near died. Stop Otherson now!”

“Be reasonable,” said Thoracic.

“Don’t suggest I’m unreasonable because I’m the only one to bring to this committee what everyone knows. It’s not a good treatment. And it’s expensive. And it almost killed someone. And if I hadn’t brought it up, every one of you would have been happy to let it pass.”

“Not me,” said Oral Surgery.

“Please sit down, Janet . . .” Mike began.

“I don’t want to sit down!”

“I was there. The complication was laparoscopic, and had nothing to do with gastric bypass.”

“She wouldn’t have been on the table if she hadn’t signed a consent for bypass surgery. She expected weight loss. She almost lost her life.”

Janet’s point was valid, but her remedies were off the mark and too severe. He was losing tolerance. “If indications for bypass surgery are a problem, Janet, we’ll deal with that separately. The report is about a single complication. I’ve talked to Otherson. He’s agreed to more training with laparoscopy.”

“And he’ll stop operating?”

“He’s agreed to do open procedures until he’s finished with the training on laparoscopic surgery.”

Janet looked around the table. “That is not satisfactory. I move to revoke privileges to operate.”

Mike waited.

“Second,” said ENT.

“Call the question,” Thoracic said.

Mike allowed for discussion. The room was silent. Janet had stirred up a mood of hostility among the surgeons that discouraged supporting her on any issue. He pressed on.

“All in favor,” he began. Two ayes. Seven nays.

“Motion is defeated.” Clayton was saved from any immediate surgical restrictions on operations for obesity. His technical improvement using laparoscopy would be his own responsibility through attending training from national experts.

Janet sat. “It still doesn’t address the advertising. He’s promising more than can be expected.”

She wouldn’t let go. It was her need for confrontation – against everything, not just Clayton or surgeons. “We’ve voted,” Mike said. “That’s an issue for the next meeting.”

“Morbid obesity is a nationwide problem and growing,” Oral Surgery said immediately, to prevent a motion to adjourn. “We have to deal with it!”

“What do you know about it?” a general surgeon snapped. “Fucking dentist,” he mumbled, but all heard.

Janet grinned and nodded. “He knows what I know . . . and that’s a hell of a lot!”

“I’m on the ethics committee,” Ophthalmology said. “There’s concern. He’s operating with a very low threshold for indications.”

“Don’t be trivial,” the general surgeon said.

“Morbid obesity is hardly trivial,” Ophthalmology countered.

“That’s why we operate, you idiot,” the general surgeon said.

“A lot of well-founded suspicions of preventable complications caused by bariatric surgery are simmering in every clinic in this hospital.”