Lie Still (12 page)

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map. Then they have the out-and-out gall to launch this attack on me. And over an aneurysm! Like God himself could make an aneurysm come out clean.”

I bought back in: My boss, my
Captain,
was being unfairly persecuted, at least in part, it seemed, because of her gender. That pissed me off. When she again suggested we have dinner together, I had no trouble accepting: The intrigues of my superiors were even more hypnotic than any thought of bedtime escapades.

We picked up as if we’d not missed any beats. Good food, good wine, a late hour, and the aura of a beautiful woman in distress made it easy to emotionally re-up. My self-awareness was numb. Once figuratively in bed together against a common enemy, making the metaphor real, translating one type of ardor into another, brought firework results.

As I said, I’d heard tales of Mimi’s mistakes. But I knew the beast Reputation to be an odd and capricious companion.

Anyone doing cases runs into problems. The old saw in surgery is “If you don’t get complications you aren’t doing enough cases.” The surrounding people make assumptions about causes and frequency, never having the full picture.

The cases that go well don’t register in memory.

I’d heard of an ENT surgeon whose very first case in private practice, the eight-year-old daughter of a firefighter, died after a routine tonsillectomy. She had, what I have since learned, is the classic story: Uneventful operation, goes home, eats her ice cream, getting back to normal and—

boom—eight days out the healing tonsillar bed breaks open and starts, literally,
pumping
out blood. She bleeds to death in the back of an ambulance. Everybody medical knows this happens with one in a gazillion tonsils, and probably, just on a karmic basis, will never happen again to this surgeon, but at that point his average is lousy. Who wants to send him his next case? What parents, if they heard the horror story, would show up for the appointment?

So I could not judge Mimi. Objectivity? I had no criteria, no experience, no rules, and only one bad outcome. Besides, 84

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my potential judgment, like that of many a poor boy before me, was addled by the animal logic of erection.

Having re-upped for the team, I naturally thought to defend the leader. I got mentally up in arms about Dr. Ryan.

He seemed, from what I could see, to be a reasonable person, but we were well past the time one could spout de-meaning or discriminatory epithets over surgical drapes. He might have been a true regressionary who just hated accomplished women. That sort is not yet extinct, even in medicine, which is as close to a true meritocracy as one can find.

The next day, when Mimi had left me alone to finish up the skin closure and paperwork for a routine laminectomy, I quietly asked the nurse who had scrubbed the case what she knew about Dr. Ryan. I got: “Charlie? He’s a sweetie.”

“Doesn’t hate women?”

“Oh, God no!” This from a young, pretty, and moderately buxom, blonde woman with a faint Texas accent. Not even a fanged Neanderthal would have shown her his misogyny.

“Never any hint of racism?” I asked.

“No. Why would you think that?”

“Oh, I don’t think it. I just heard something that made me wonder, is all.”

“Well, that’s pretty ugly.”

“Yeah. That’s why I asked. I figured it just didn’t fit.”

“Well, Charlie is one of our favorites. He’s a great doctor and a gentleman, too.”

I finished my charting. A full frontal approach to my questions was only going to get me into my own tar pit.

That night I phoned a senior anesthesiology resident, Dawn Stelfox. When I was an intern on the trauma service, she had twice saved my butt by leaning over the ether screen to whisper clues to me about what I might want to be paying attention to instead of whatever it was I was paying attention to. These made me look good to my Attending at the time. I already owed her, but I figured a phone call wouldn’t put me too much further into debt.

“I need a woman’s opinion,” I began.

“Qualified,” she said.

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“The Anesthesia Department. Everybody treated pretty fair?”

“Hmmm. Pretty much. We all get the same amount of call.

We all get the same rotations. We all have to work with Goldin the same amount.”

“Who’s he?”

“She. An Attending at the VA. Not really bad, not dangerous or anything, but she has this idea that any drug drawn up in a syringe should be in the patient. She’ll come in your room and start pushing stuff into the IV while she’s telling you some story from her days back in England. She talks all the time. Yammer, yammer, yammer.”

“Isn’t that a little dangerous?”

“Naw. The senior residents clue you in. You learn before you go to the VA to draw up exactly what you want the patient to get. The other stuff you keep in the drawer. She never goes into drawers.”

“I knew you guys were high scientists,” I said.

“Yeah,” she laughed. “Cause and effect. We’re on it.”

“But, in your department, do women get a fair shake?”

“Well, yeah. We got plenty of women faculty and residents.”

“Any ill treatment? Anybody there seem to be, I dunno, rude, mean, biased?”

“Who?”

“Well, I don’t know. I’m asking you.”

“No. I think the attitude from the top down is, pretty much, ‘If you can give a good anesthetic and not let the surgeons bully you around, I don’t care what color you are, what you eat for dinner, or if your sex is one of the usual two or something altogether new.’ I know our chair has a thing right now about one of the female residents.

She’s close to getting kicked out. If that’s what you’re asking about, let me say I’d have thrown her out months ago. She’s ham-handed and can’t anticipate the next problem. Her anesthetics are always playing catch-up.

She scares me.”

“Why hasn’t he thrown her out?”

“Don’t know for sure. Probably an ego thing. Dr. Miekle 86

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probably thinks he’s good enough to make an anesthesiologist out of anybody.”

“What about Charlie Ryan?”

“Charlie? I don’t know that he feels one way or the other about her.”

“How is he toward you?”

“He’s great. He’s always been fun to work with, a good teacher, especially when his mood is good.”

“He’s got nothing going about women in medicine?”

“Charlie? I was told he was pushing my name for Chief Resident. I didn’t get it, they gave it to that idiot Scoponich because he kisses their butts, but it was nice to be nominated.”

“Is Dr. Ryan married?”

“Yeah, I think his wife’s a doc, too. In fact, I think I heard she’s a radiologist over at St. Elizabeth’s. Probably pays all their bills. But why are you asking about him?”

“I heard a rumor that he’s this old-fashioned knuckle-dragger who thinks women belong at home.”

“Jesus. If that’s Charlie he’s a damn good actor. I work with the guy and he’d be about the last one I’d lay that on.

Besides, he pretty much says what’s on his mind. Who’s laying out garbage like that?”

“Well, I’m on neurosurgery this month. My Attending is Miriam Lyle. She had—”

“And she thinks Charlie Ryan is out to get her?”

“No. Let me finish. There’s a stink going on over a guy who died after an aneurysm operation. Apparently the stink started when your chairman, Ted Miekle, sent a letter to the Chair of Neurosurgery, Joe Kellogg. Dr. Ryan was the anesthesiologist on the case. There wasn’t any resident. It’s been suggested that Dr. Ryan doesn’t like women in high places.

I’m just trying to ask around.”

“Well, you’re noble for defending Dr. Mimi, but she’s another one who scares me.”

“How so?”

“All the stuff I’ve heard.”

“I’ve heard a lot, too. But that’s what bothers me. She’s got a reputation.”

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“She sure does.”

“But that’s what I’m wondering about. It’s like an ‘Everybody Knows.’ ‘Everybody Knows’ she’s a problem. So when a case goes bad, which is apparently pretty common in brain surgery, people say, ‘There it is again.’ But when a case goes bad for a, you know, ‘good’ surgeon, people say, ‘Oh, it must have been a really tough one. They happen.’ ”

She said, “I’m sure there’s some of that, but mostly I think people deserve their reputations.”

“I suppose so, for the most part. But still, how can you hang somebody over a single case?”

“I guess you can’t.”

“Yeah. Thanks for the info. I will say, though, if she gets any more paranoid about the Anesthesia Department, she’s going to have me doing her anesthetics.”

“Now that would be scary.”

“Yeah, especially for me.”

“Always remember, Ishmail, like I showed you, ‘half the big syringe, all the little.’ ”

“I thought it was the other way around.”

“Whatever,” she said.

“I guess you have to draw up just what you want given,”

I said.

“You’re getting it.”

Over the next several days, I continued to ask, as discreetly as I could, some of the OR people I most trusted about Mimi’s reputation and who her enemies might be. Nurses, techs, and other doctors alike—all were ready to recite the same stories I’d heard at the outset—wrong side, wrong level, hours and hours deep in a hole—but little new. There was a consistent thread that if she booked an aneurysm the OR staff would all call in sick or find themselves indispen-sable somewhere else. But real data were hard to find. The beast of Reputation was clearly riding around on my mis-tress’s back.

Time with Mimi began to feel surreal. Most minutes of my days were entirely focused on very real patients with po-88

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tential neurosurgical problems, so my clinic hours didn’t have clocks melting off dead trees, but our personal time began to have the taste of a siege. Over dinner or curling into bed, we the oppressed verbally abused, in their absence, her supposed tormentors. Charlie Ryan and Ted Miekle were the obvious villains, but Joe Kellogg and Marshall Bullock were certainly on the edge of suspicion.

One night, as she dangled her hair in my face, again loaded on wine, riding me with a savoring slowness that invited free association, my deeper imagination saw us as jungle-bound comrades in army fatigues and berets, struggling to overthrow the Oppressor, spouting immortality-bound slogans, only taking a well-earned break to fuck for the Cause.

6

From here in Nebraska, way beyond being too late, it’s easy
to see signs that might have steered me away. Walter
Bryant—one of the more miserable and bitter bastards I
ever met—tried to warn me.

Walt was Chief Resident on the surgery team at the San
Diego VA when I came on service as a third-year medical
student. On Day Four of the rotation, when he found out I
wanted to grow up to be a general surgeon, he told me, employing a few expletives for color, what foolishness that
would be. This from a man not three months from the end of
a six-year general surgery residency.

“You’re supposed to be excited,” I said. I still was.

“More like relieved, after this, but the next few years don’t
look any better, anyways,” he said.

“Where are you headed?”

“An ER job.”

“What?”

“There are no surgery jobs in San Diego County.”

“What about opening an office—what do they call it?

Hanging out a shingle?”

“Starving to death for two to five years, borrowing yet
more money to pay office staff? In a town already over-doctored by about a hundred percent? Not me.”

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“So why not move? Bay Area? LA? Hell—Iowa?”

“LA is worse than San Diego. And any farther than that
and I’d never see my kids. They are two and four and they
live with their mom. In fact, that’s the single shittiest thing
about what this six years of residency cost me—my marriage. She’s a wonderful woman, and we have two great
kids, but she hated being alone all the goddamn time. And
she did something about it.”

“Sorry to hear that. I’m not married yet,” I said.

“Don’t. If you’re thinking about surgery.”

“I heard there’s a program back East that won’t even accept married residents.”

“True. But it’s in North Carolina. And there’s the one in
Houston where a guy in his fourth year—he’d made the
years of cuts and everything—was doing his month in the
Surge-ICU—and at this place you are forbidden, for the entire month, to leave the building. But one Sunday things are
quiet so he meets his wife in the hospital parking lot for
about twenty minutes. The Chief finds out about it and shit-cans him right there. Over. Kaput.”

Still believing I was a born surgeon—my professors
said so—I knew my track would be different. But I did
make a mental note to avoid Houston when looking for a
residency.

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

As my fortunes rose with Miriam Lyle, so they fell with the other woman in my life, Mary Ellen Montgomery.

Mary Ellen—better known in our medical school circle as Monty—and I had been best friends since I stood behind her in the lunch line at med school orientation two days before classes started. Through four brutal years we relied on each other for academic help and advice, occasional meals, sleep-overs, odd loans, rides, and more advice on the opposite sex LIE STILL

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than one would ask of an in-house Ann Landers. We were never romantically involved.

Not that I was not attracted to her—quite the opposite.

Though shorter and a little rounder than the magazine ideal, her face was classically pretty and her hair was striking—

long and flaxen with a natural curl that was difficult for her to control and for us men within her aura to avoid touching.

Best, though, was her smile. When she had it on, the world felt right as a Norman Rockwell painting. Pure magic.