Authors: David Farris
Lie Still (28 page)
To the question of my having used cocaine, they politely wrote that there was insufficient evidence to act. I heard sec-ondhand, though, that one of my crusty old inquisitors had commented, “No low-life resident—an admitted druggie—is going to bring down the reputation of a highly respected ac-204
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ademic surgeon.” Given the chance, I would have pointed out, again, that they were mixing unrelated issues. They would have, again, ignored me.
The coincidence of their annual process and my morass was, for them, perfect timing. I got the notification of nonrenewal and the effective end of my career as a surgeon by registered mail exactly forty days from the last time Mimi Lyle and I—and I use the term advisedly—fucked each other.
H E N RY RO J E L I O , DAY T W O
Henry Rojelio, my asthmatic unfortunate from Glory, on the morning after his “event”—“event” being a common medical understatement for “cataclysm”—lay in the Pediatric ICU at my old “home,” Maricopa, in a coma, on a ventilator, theoretically alive.
I’d found Glory simply for employment. After the banish-ment of being “nonrenewed” in my surgical residency, I entered a written appeal to Maricopa and made applications to half a dozen other training centers, but no one was crying for a tainted, one-third-trained young doctor. The process was going to take a long time.
Though unemployment meant more sleep and exercise and less grease in my diet, I needed to eat and pay my rent.
The work most readily available to licensed doctors with no firm specialty was then what it is today: hourly coverage in ERs, especially those in the smaller towns where there is often little to do. The hospitals must pay an hourly rate to keep a doctor there, and can’t be overly choosy if they are going to keep their costs in line. A gold-plated residency and board certification are not required.
When my “nonrenewal” came, I called two of my former 208
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Maricopa coresidents who were known to moonlight, Gene Woods and Darryl Reichley. Sometimes guys are tight-lipped about their sources of cash, but these two recognized my dire need. They not only gave me names and numbers but put in phone calls on my behalf.
Through these two I was given a somewhat reluctant interview with the lead doctor in the Glory Emergency Department. Mustering all the eloquence I could to explain my current professional hiatus, I landed a “trial” position. This seemed to me the perfect place to gain experience and keep a low profile, while staying close enough to Phoenix that I could avoid another uprooting and keep on top of my appeals and applications to other residencies.
And it worked, until Henry Rojelio.
Day Two in the Debacle of Henry began for me, appropriately, with minor malfeasance. Henry’s “event” kept me awake most of what was left of that night. Since internship I’d been able to collapse into sleep given any opportunity, even on the tail of running codes. Most codes, though, are merely the flailing endpoints of predictable diseases, not in-explicable “events” materializing out of the ether.
At 0740, when I was finally getting some REM in the call room, the Glory hospital housekeeper banged on the door wondering if it would be a good time to change the sheets.
She was apologetic—noisily so—and offered to let me sleep. Once freed of my shift, however, I wanted utterly to be someplace—anyplace—else. I dressed and shuffled off to the parking lot half asleep, but remembered I’d left something in the ER. I trundled back in to retrieve from the med refrigerator my packaged adrenaline syringe from Henry’s code. I slipped it into my duffel, barely remembering, given my lack of sleep, exactly why I’d wanted it. “It’s the Rosetta Fucking Stone,” I mumbled to myself.
Back in Phoenix my half of our town house was its familiar wreck. Mary Ellen was long gone to the ’Copa. I stumbled around the stacks of mail, the piles of laundry, and the equipment residue from a photographing trek up in the LIE STILL
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Mogollon Rim completed three weeks prior. I stashed the syringe in the refrigerator and opted to sleep the rest of the morning.
When I got up, there was a knot in the impossible-to-reach muscles running from under my left shoulder blade up into my neck. I tried unsuccessfully to stretch it out, loaded up on ibuprofen, and went for a painful and halfhearted workout. Post-shower I went over to check on Henry.
I knew I’d be free to visit Henry at the ’Copa, if not exactly welcome. No hospital in the world is going to keep a licensed doctor from visiting a patient he has referred there.
Still, it was a relief to see my parking pass was still functional, and, with my ID badge and white coat for camou-flage, I felt almost at home skating through the main lobby—forever known to the residents as the Lobby of the Seething Masses. As far as Maricopa security would know without looking in some obscure file, I still worked there. I went into the Admitting area to find a phone.
I paged my housemate. On Henry, Day Two, Mary Ellen was my only true confidant, though our friendship was still suffering from the chill of my need to hide my affair with Madame Lyle. When I paged her she might have been anywhere on the hospital campus. As a third-year resident, about to “graduate,” her responsibilities when rotating on the in-house service ran her from the ward to the PICU to the ER and sometimes to the clinics if a kid needed to be admitted from there. While the interns were supposed to be responsible for the sick kids, doing the dirty work, making the decisions, talking to families, practicing for a practice, she was the one directly responsible for
them
. Often not a pretty spot.
The phone rang back almost immediately.
“Dr. Montgomery?” I said.
“Oh, Malcolm. I was expecting Horrible Harry.”
Harry Upchurch was a prominent pediatrician, successful if somewhat officious. “He’s coming to Admitting?” I said.
“Well, I’m expecting him in the ER. He insisted he lay eyes on this dehydrated little prune before I admit him.”
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“VD?” I asked.
She humored me. “Yes. You’re cute. Vomiting and diarrhea, Doctor. A pediatrician’s lifeblood. Also has a fever to 104 so I sicced my intern, sweet little Michelle, on a spinal tap.”
“You gotta love a screaming baby.”
“Actually, this kid is pretty quiet. Sick, you know.”
“Sounds bad. When they’ll lie still for a needle in the spine, they’re not feeling too awfully well, I suppose.”
“About it,” she said. “Like I’m thinking ICU for this kid.”
“I was about to head up there. I came over to check on my work from last night. Any changes?”
“Not that I would know. I haven’t had time to check on him. I asked his nurse when I ran through there this morning and she said ‘Stable.’ ”
“Stable” is a medical descriptor with no real meaning and had long been a joke between us. Dead people are “stable.”
“Sorry,” she continued, “I knew you’d want to know, but it’s been the usual frantic Monday.”
“Mary Ellen, it’s not Monday,” I said.
“Really? Who knew? Sure feels like a Monday.”
“Well, I doubt they’ll throw me out of the Pick-U. I’ll go up and view the damage.”
“I’ll be up there if this ditzy twerp with the big eyelashes can ever get us some spinal fluid.”
“Want me to come over? I still have the strong arm of a surgeon, you know.”
“No, thank you very much. I think we little old pediatricians can muster the strength to overcome a two-year-old.”
“At least a lethargic one.”
“Yes, at least—uh-oh. The kid is seizing.” The line clicked off.
The world has nicer pediatric intensive care units. The one at Maricopa was created from an old ward the hospital didn’t need when cost containment became a battle cry and they stopped keeping patients around until they actually felt well. The county couldn’t afford a down-to-the-studs makeover, but they put in enough money to at least get par-LIE STILL
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titions and doors so each patient would have privacy. That was a big improvement, I was told, from the original unit, where kids were packed in next to each other like an old-fashioned charity ward, replete with ventilators alarming all at once, and IV lines seeming to braid from patient to patient.
With my old UAMMB name badge clipped to my pocket, I knew no one would challenge my visiting Henry. The chart rack was, as always, empty, contents scattered to the winds.
I found the name Rojelio on the grease board—Bed 2. I walked into his cubicle. The room smelled of antiseptic and cheap cologne. I scanned the traces on the monitor and smiled at the nurse there, whom I did not recognize. She barely acknowledged me.
I plopped open Henry’s chart on the bedside table. There was little in that day’s entries to suggest he was seriously ill.
I read, too, all the narrative notes of the others who’d been called to help. After a disaster you always wonder if they’re saying bad things about you, soon to be replayed in court.
Some grand old professor writing “thirteen-year-old asthmatic nearly killed by bungling incompetent in referring ER” would be painful, as well as false, but the worst you ever see are vague generic references to prior caregivers. It’s tempting but pointless to try to read between the lines.
Henry’s nurse was eyeing me. Critical care RNs, working with only one or two patients for eight or twelve hours straight, can get highly proprietary.
“Are you consulting, Dr. Ishmail?” She was looking at my ID badge.
“Not really. Not currently,” I said. “I saw him in the ER
when he came in. Just following up.” She lost interest.
“He doing okay?”
“Stable,” she said. I smiled.
“Stable good or stable bad?”
“Well, BP and pulse and the like have been just fine. Neurologically he’s kind of stable bad. He had a couple of seizures as soon as he got here, but none since they got him loaded with meds. Not exactly waking up, though.”
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“It’s still really early, though,” I said. Such optimism may be cliché but it is too often all we have:
He’ll get better. The
swelling will go down.
“Yeah. Well, plus he’s young, too.” A second cliché:
The
young aren’t brittle. He’ll get better. Who knows? Maybe
he’ll grow a new brain.
She said, “I think they expect he’ll do okay.” She put a dollop of eye protectant gel in each eye, opened and closed each lid twice, then left.
Intensive care, properly done, reduces human existence to bare physiology; the parts of it you cannot describe in numbers are of little use and soon forgotten. The sickest, longest-term patients get physically inundated with tubes and wires, tubes and wires, and more tubes and wires.
Henry was not yet that bad. The monitor screen hanging on the wall verified, via numbers and waveforms, Henry’s
“stable” normal cardiovascular status. His heart, lungs, liver, and kidneys were working, according to the numbers on the chart. He had his share of tubes and wires: the big tube in his mouth, two IVs—one of which was capped off—a blood pressure cuff, EKG wires, a pulse oximeter wrapped around a finger, a gastric tube down his nose, and a urinary drain in his penis—straightening it. Still, he appeared to be sleeping, and he had a little color in his cheeks. This was a far cry from the hair’s-breadth code of eighteen hours earlier. His heart, at least, was recovering.
I went back to the central station, planning to wait for Mary Ellen. Henry’s nurse had his chart there doing her paperwork.
“Any family around?” I asked her. I still needed to sit with them for my explanation of Henry’s plight. I knew if I didn’t soon put a face to my name, their suspicion that I was the devil incarnate would gradually solidify.
“Mom and Dad were in not long ago. They seemed kind of in shock. Pretty angry, too. Didn’t stay too long, but said they’d be back before lunchtime.”
The door to the Unit whirred open to let in a sorry parade: At the center of a full-sized ER gurney lay a flaccid infant.
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Surrounding her was a committee of hospital folks. At the foot were a nurse and a respiratory therapist. At the head Dr.
Montgomery was disgustedly fussing over a bright-faced young blonde woman with too much eyeliner and fake eyelashes, the short white coat of an intern, pockets a-bulge with crib notes, squeezing the breathing bag like she feared it would squeeze back. Bringing up the rear was Harry Upchurch, looking as distinguished as a man can in a seer-sucker suit and bow tie.
Monty saw me and just shook her head slightly as her platoon passed the desk. I followed them in and stood against the back wall as they got the baby moved to the hospital’s chrome-plated crib on shopping-cart wheels, changed over from the transport monitor to the wall-mounted version, and connected him to his ventilator.
Keeping an eye on the hubbub, Monty backed up to stand beside me.
“Sodium one-twenty-two,” she said.
“Rice water?” I asked.
“Yep. Just like always. Long time vomiting and diarrhea, then just replace precious bodily salt water with a little carbo-water and you, too, can seize.”
“Well, you ought to have the admit note memorized by now,” I said. She made a face.
“How’s your boy doing?” she asked.
“Practically off all drips. Not waking up. Stable,” I said, making a face myself.
“I still don’t understand what happened to that kid,”
she said.
“Well, I’m open for ideas.”
“Yeah. But I don’t have any. Do you think he aspirated?”
she asked.
“Well, it would be a reportable event in the pediatrics journals if he didn’t. There was plenty of stomach content there where it didn’t belong. I sucked out the pharynx as much as I could.”
“What did you see below the vocal cords?”
“Frankly, my dear, I was just damn glad just to see the 214
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cords. This was not the slickest tracheal intubation you’ve ever seen,” I said.
“No, I’m sure it wasn’t fun. It doesn’t matter much. If it’s in the lungs it’ll blossom and rear its ugly head by tonight.”