Lie Still (10 page)

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DAVID FARRIS

I sometimes wonder if I’ve forgotten how to breathe. I
have not had a significant romance since leaving Phoenix.

Instead I have “friends.” Most senior among them is Cheryl,
an intensive care nurse, now living in Flagstaff, whom I
have known since internship. She is soft-spoken, has a cute
nose and slightly wide hips under a small waist, extraordinarily round breasts, and a short, boyish haircut. We use
each other shamelessly, guiltlessly, expertly. When one of us
can make the full day’s journey to the other, we couple to exhaustion. She calls it aerobic intercourse. When months go
by without union, we sometimes lie in our distant beds
naked, phone held in only one hand.

I like her. She’s funny. I find her conversation interesting.

And that seems to be enough for her. I wonder why it has
been enough for me. It occurred to me the other day, in
retelling my history, that Mimi Lyle and her cohort may have
made me paranoid about women, though I think of myself as
smarter than that.

I fear I am growing middle-aged, though Cheryl and I differ on the threshold for that distinction. Friends and family
think I should give up my desperado lifestyle. I say to them,

“What? Take up working on weekdays like most of the rest
of the world? Ski when the lift lines are longest?”

On my last head-down sprint across the sands, I noticed I
needed to stop and sleep more often and I cramped more
easily. Conceivably it is time to start getting motel rooms
along the way. The horror.

T H E B O O K O F M I M I , C H A P T E R T H R E E

In my six-week-month with Meems, my progress in the art and science of brain surgery seemed forgotten at times next to my growing experience in matters sexual and my extracurricular knowledge of the female body. As a trained clinician I could tell early on that hers had, at least once, carried and delivered a LIE STILL

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baby. There are physical signs produced by nothing else. But we never once spoke a word about it. Things like that don’t come up in conversation, particularly between a pair joined only physically. What would I have said? “Hey, Mimi, what became of the kid?” Like a lover’s silicone implants, it’s safest to pretend you don’t notice.

As if regular sex—I suppose we could have called it “dating” for a laugh—between a junior resident and his professor/Attending weren’t far enough out of bounds, she took our trysts to places I had only read about, or, ironically, heard about in the best-attended lectures in medical school,

“Sexual Variations.” She introduced me to penetration
in
ano,
which seemed to be something new, even to her. She told me she had tried it before but her other half at the time was a klutz, it hurt, she had panicked, and aborted it. Under her direction, we moved very slowly. She bit her lip through the painful bits but nodded encouragement. She eventually got a faraway look and sound to her, very regressionary on the scale of evolution. I was feeling animalistic myself.

After extensive mutual heaving and grunting and sweating, we climaxed within seconds of each other and collapsed in a jumble. I was instantly lost in a reverie, half sleep, half intoxication. When I came around she was lying beside me, a tear drying on her temple, still as a corpse. For a moment I thought she had died, and there I’d be, bare-assed in my professor’s bed, my semen in her rectum, doing one-rescuer CPR while awaiting the ambulance and sheriff.

I brushed her cheek. She slowly opened her eyes. She was reassuring without saying a word: She just shook her head slightly and laid her index finger on my lips. She wouldn’t talk to me. She just squeezed my chest and sobbed softly.

Before rising she said, “It was the intensity, the vulnerability,” and would say no more about it.

Two nights later she wanted to do it again. Same sequence, roughly speaking. It became a recurring theme. I found it simultaneously the pinnacle of naughtiness, intimacy, and thrillingness, an internally contradictory and mysterious trinity of simultaneous being, vaguely reminis-70

DAVID FARRIS

cent, as I sat and thought about it during an otherwise boring lecture on surgical repair of vascular trauma, of fourth-grade catechism. But this wondrous bit of creation you couldn’t even talk about to your friends, much less get raked over by nuns.

As I said, Keith Coles was effectively dead within twenty-four hours of his operation. The final declaration and physiologic passage, though, took many hours longer. Death, I believe, is never a thing of grace and beauty, at least not to those left behind, but when the affected are a young family, hours are eras.

Even as we made rounds the morning after his operation, data were accumulating that he might have been pushed over some invisible line. First, he was not waking up. Waking up after such an operation is highly variable and always slower than we want it to be, but he was making no moves at all in that direction.

Then, about mid-afternoon, his blood pressure shot up.

The nurses paged me and I ordered a continuous drip of the preferred “knock-it-down” drug.

An hour later they called to say we had hit the other extreme, they had already hung their favorite “prop-it-up” drug and would I please write the order to make it legal. I let Mimi know we were in trouble and went over to the Unit.

Given her antipathy toward the patient’s wife, I was happy to handle it alone.

By the time I got there he had started pouring out pints of waterlike urine, a sure sign that a deep part of the brain that is supposed to regulate the kidneys had checked out.

We ran him over to X-ray for a repeat CAT scan. This confirmed everyone’s suspicion: massive brain swelling, suggesting that we had, in our attempts to find the aneurysm, cut off blood flow to big parts of the brain. It was now looking like a fatal event.

Back in the ICU, I did the bedside tests for brain function.

The answer for each was negative.

I told Ms. Roberts things looked grim. She wanted to LIE STILL

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call together the family to hear the details. Late that evening she, Keith’s mother, a brother, and a sister sat with me while I gave them the news. I laid out the facts, as tact-fully as I could. They all cried, though most verbalized nothing. They asked that we support him until the next day.

The next morning I steered Mimi away. Ms. Roberts brought in the two daughters. She and her mother tearfully told them their father was not coming home. My eyes welled up, too.

We shuffled everyone in for hugs, kisses, and tears. Abbie Roberts stayed when the others filed out. The nurse and I pulled all the curtains. She got into bed with him and held him as tightly as I have imagined anyone ever held. She sobbed until the bed was bouncing. I turned off the ventilator, slid out his breathing tube, wiped off his face, and without looking back quietly went into the nearest bathroom to bawl alone.

Fifteen minutes later, hiding my sniffling, I sat on a low stool filling out the death certificate and signing his body over to the nameless and invisible people of the basement who clean up our messes. The chief surgery resident, a truly graceless and cynical man, who apparently witnessed parts of the end, leaned over me and whispered, “She going for it, you know, one final time?”

He was my superior and I knew he was trying to be funny or distracting. Still, I said, “Fuck you.”

Within a week the rumor went around that the new Chairman of Anesthesiology, some hothead with a Stanford Phi Beta Kappa, decided he should be the arbiter of quality of care and got anal and agitated over the case. He fired off a letter to the Chairman of Neurosurgery seeking some sort of an investigation on competency issues.

Incompetence in doctors is like pain in patients. We know it’s real, we know it’s a serious problem, and we know people have a right to expect meaningful solutions, but it’s still absurdly hard to pin down. Doctors are trained to be scientists and we don’t trust things we can’t measure.

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It is always relative, never gross or obvious. Were there a surgeon who was regularly cutting into the wrong organs or failing to control major bleeding, I suppose he would get gang-tackled in a big hurry. But in a highly specialized field like brain surgery, where the differences between surgeons are all but invisible even to the other doctors in the room, who can say? Only other specialists in that field. Problem is they’re all wondering when their next case will go way far south on them. And who will be looking over their shoulders when it does.

When I heard there was a high-level stink it didn’t occur to me that the slime would get on us all the way down at the bottom of the totem pole. Nonetheless, not even ten days after Mr. Coles’s operation I got a page from the Residency Secretary, Cynthia Blachly.

We house staff all lived and died according to Cynthia. She ran our schedules, handed out the monthly allotment of meal tickets, and was the immediate source of our paychecks. We were all nicer to her than we were to our own mothers.

“Were you scrubbed on the Coles aneurysm case?” she asked.

I hesitated. “Not if I can help it.”

“You can’t. The nurses’ notes say you were scrubbed.”

“It could have been a different Dr. Ishmail.”

“Sorry, Charlie. There’s only one of you. When can you meet with Dr. Kellogg?”

“The Chairman of Neurosurgery?”

“Yes, that Dr. Kellogg. Though actually he’s a sub-chair, or I guess vice-chair, in charge here at The ’Copa. He answers to Marshall Bullock in Tucson, chair for all the UA af-filiates.”

“What does he want me for?”

“Your good looks.”

“See, you do have the wrong guy.”

“He needs a little information on the Coles operation from those who were there, darling. He’s put aside a few hours each of the next three days to get this going. He wants to get it done with. I do too.”

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We set up a time, then I asked, “Any clues on your end as to how a simple country boy from Nebraska could play this and come out still in possession of his testicles?”

After a second she said, “Leave them at home.”

If Joe Kellogg had the kind of simmering intensity just under the skin that one normally expects in a brain surgeon, he apparently had the burner turned down for my visit. What I had feared would be a quarter hour with my fingers in a light socket turned out to be more like a paternal chat about a fishing trip.

For a hotshot professor Joe Kellogg didn’t have much of an office. Maybe twelve by twelve feet. A battered oak schoolteacher’s desk, metal bookshelves packed with journals and texts, the aroma of coffee spilled long ago, manila folders of assorted thicknesses sprouting among the books, many of these sprouting pages torn from medical journals.

The only art was a trite motivational poster in a dime-store frame.

Dr. Kellogg was gray-haired, I guessed prematurely, and had a bony neck and face. His white dress shirt had a collar cut for a neck thicker than his and frayed corners. His tie was crooked. Before I could even sit he asked what I thought of “all this codswallop.” He had some residual accent. I guessed New Hampshire.

“You mean . . . this case?”

“Yes. All this fuss.”

I did what any good resident knew to do with a loaded question—I ducked. “Well, sir, I don’t know what to make of it.”

“In Dr. Miekle’s letter he referred to it as ‘excruciating,’

‘Mr. Coles and his excruciating operation.’ What did you make of it?” He had on the desk Keith’s patient chart, laid open to the graphic anesthesia record. He winced slightly as he motioned to it. “Four pages. Fourteen hours, all told,”

he said.

Caution lights were flashing before my eyes. “Um, what I remember,” I began stupidly, “was basically that it took a 74

DAVID FARRIS

really long time because there was bleeding and Dr. Lyle couldn’t get a good view of the aneurysm. She was really frustrated. I mean, who wouldn’t have been. This guy was seriously stroked and she’s torquing on his frontal lobes and can’t see the aneurysm.”

“Yes, that’s what they’ve already told me,” he said, “but what I’m trying to get at was why she couldn’t see it, or why she couldn’t get a better view. This seems to be the great damned mystery.”

I’m sure I looked pained. “I don’t really know the different techniques of exposure, you know. I’m just a general surgery resident. . . .”

“Yes, of course. Nobody’s expecting you to comment on her technique of getting exposure.” He hesitated. “Did she say anything?”

“It was pretty quiet after about the first hour inside the head. Up until then she had been explaining what we were doing, kind of a running narrative, and seemed pretty into the whole thing, but when we got in to a certain depth, well, I guess she expected to see the aneurysm at a certain angle and it wasn’t there.”

“What did she do then?”

“Well, she kept trying.”

“But how?”

“Well, she’d move the retractor a little one way and then suck out the blood, and reposition the microscope and look and then move the retractor a little the other way.”

“Again, did she say anything?”

I knew I was walking through a minefield. “I guess not much. After a while she maybe was cussing a little, just quietly.”

“Did she try another approach?” he asked.

“I remember once, she looked up from the scope, kind of stretched her neck and took a really deep breath, then closed her eyes for a second. She mumbled something about her stockbroker once saying, ‘If you’re losing money, try thinking differently.’ Then she went to the viewbox.” He waited.

I continued: “Actually, she stepped away several times.

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She would go look at the CT pictures on the wall. Study them and turn her head and all. Then she’d come back and sit down again and say, ‘It’s right there. I know it’s right there. Why can’t I see it?’ Maybe halfway through the whole thing she said, ‘Okay, it’s just left of center. You go look at the scans,’ she said to me, ‘You go look at the scans and tell me which side of the artery the damn thing is on.’