Lie Still (13 page)

Only once did I try to transform our relationship into something “more.” That effort left a scar with a sore spot underneath.

Romances left over from college rarely last long. Three thousand miles of separation and a disgustingly handsome campus fireman back at the Old School were quickly lethal to mine. I went on a regimen common among medical students—flings both quick and cheap, interspersed with long weeks of longing. Mary Ellen was kind enough to give no sign of knowing what I was up to, but her amused smile when she caught me begging a phone number from a gro-cery clerk in Del Mar reminded me how unattractive are the desperate.

So I probably should have known she would shoot me down. At the end of second year we found ourselves on a blanket by a fire on the Del Mar beach, late at night, left alone by tired friends, each of us months past any romance and each pretty beered up. We were sitting close. I turned her head to me. I looked into her eyes. I thought I saw some hint of “yes.” I moved to kiss her.

She said, “Hey, Don Juan. Trying to fuck up a really great relationship?”

“I won’t do it again,” I said. “Scout’s honor.”

Ever after I tried to avoid repeat embarrassments. I’ve held religiously to the first rule of that kind of “really great relationship”—no kissing. The second rule became: Any re-spectable dalliance for either of us was to be a source of mutual happiness, not jealousy. That was the theory.

At the end of medical school comes a sad time when 92

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once-fast friends must move on for internship and residency, scattering like dandelion fluff. Mary Ellen and I decided to try to hang together, aligning our applications geographi-cally. Fate smiled. The computer match that shuffles the puppies put us both in Phoenix. I suggested to Mary Ellen that we rent a place we could afford. It seemed efficient, I said. And friendlier. She nodded. We found a town house. It was natural and all organic.

As it worked out, of course, we saw little of each other.

Internship means never having to say you’re home.

Nonetheless our paths crossed at work and often enough in the town house, or at least the parking lot, that we could keep up with each other’s major doings, including any significant romantic possibilities.

My affair with Madame Lyle, though, was, of course, off-limits even in the general, making-conversation sense.

When it became apparent that Mimi and I were going to be sleeping together as often as not, Mimi insisted we develop a detailed cover story with Mary Ellen in mind. I told her Mary Ellen and I barely saw each other and only talked about our love lives when seeking advice. I told Mimi I could not imagine needing advice from Mary Ellen about her.

I warned Mimi I had always been bad at carrying off a lie.

She said that was all the more reason to plan ahead: She fabricated a “cover” girl. Mimi called my house at odd times and left messages from “Lisa.” Usually something girlish, like, “Hi, it’s Leese. Just thinkin’ of you. See you tonight.”

Mimi even grilled me on “Lisa”: “How old is she? Where does she live? What does she do? Where did you meet her?

Is she from here?” She told me, “Have your facts so they’ll be there when you need them.”

I told Mimi that Mary Ellen never would have asked all of those questions, and with our hours usually in complete asynchrony, our few communications were by notes on the refrigerator. I erased the telephone messages as soon as I could get to them.

Still, when I thought about it I knew I was again embar-LIE STILL

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rassing myself, whether Mary Ellen saw it or not. The rule of
omerta
required to play the Game with Mimi necessitated more than one lie to Mary Ellen, a violation of our friendship that left me more ashamed than anything else I did with
la Profesora
.

One evening there came a baby to rub my face in my own mess.

A newborn was brought to the ER; the mother said he quit breathing for no apparent reason. Physical examination of the baby showed the problem: There was massive bruising on the top of the head and easily felt fractures around the rim of the skull where a hat would touch. Someone had hit the baby straight down on top of his head and broken the skull like an eggshell.

The ER doctor got the infant on a ventilator, put in an IV big enough for a major resuscitation, and called the Pedes team—

Monty at the helm. Protocol for head injuries said she would need a consultation from the neurosurgeons. In a hopeless case it should have been a formality.

The mother was a girl of seventeen sporting the attire and tattoos of one of the more vicious gangs. She spent her time in and out of drug houses. In a wheelchair. She had broken her spine at the mid-chest in a car wreck seven months earlier. Her ER X-rays then showed a tiny assemblage of bones growing in her uterus—she had been unaware she was pregnant. During her stay in the rehab hospital she and her sister were arrested for assaulting the staff.

When she delivered the boy at thirty weeks gestation he weighed two pounds, nine ounces. After yeoman work by doctors, nurses, and techs and hundreds of thousands of tax dollars, he had been discharged. All of a week later he came to us via the ER.

By the time I got to Maricopa that night, the little boy was

“tucked in” in the PICU. I found the CT films of his head on the viewbox. It was ghastly. The fractures were eerily sym-metric. The brain underneath had lost all signs of structure.

It had been rendered gelatin. Indeed it looked as if the top of the head had been flattened with a frying pan, though the 94

DAVID FARRIS

child abuse text we consulted showed a drawing of a human fist doing the deed, hammerlike.

The PICU social worker told me Mary Ellen had already called the police. When I came into the family waiting room to find her and see where we stood, the baby’s aunt was shouting at the mother, “I told you you shoo’t’na brought your baby to no motherfuckin’ hospital. They’re gonnna take him away from you! No fuckin’ shit!”

Mary Ellen was standing like a statue, unwilling to be cowed despite the woman’s superior size and indubitable experience in matters violent. Nonetheless she seemed relieved to see me.

“Who the fuck are you?” the aunt yelled at me.

“I’m Dr. Ishmail. I’m a resident working with the neurosurgeons—the brain surgeons. We’ve been asked—”

She turned back to her sister and said, “Did you call a brain surgeon?”

“No, I didn’t call a brain surgeon,” she shouted from her wheelchair. Then, to Mary Ellen, “What I’ve been trying to tell you is the baby fell, from my lap, when I was changing his diaper. From here to here. And he hit his head. He hit his head here on the leg rest of my motherfuckin’ wheelchair.

Do you hear me?”

“Was the floor carpeted?” Mary Ellen asked. “Where your son’s head hit?”

She looked at her sister. “Yes, it’s carpeted, but he had hit his head here, on the leg rest.”

The aunt moved around behind the wheelchair and started to leave. “I’m not going to stand here and listen to more of this bullshit. It’s goddamn bullshit. You all think she hurt her
own
son!” And they were gone.

Monty and I looked at each other. “Bullshitter,” I said.

“Yeah, right. You know me.”

“What did you say to them?”

“I told them we were concerned that someone had hurt the baby, intentionally, and the police would be asking them some questions. You heard the rest.”

When we went back to the Unit, Mimi was leaning on a LIE STILL

95

counter by the scans, reading the chart. She looked up at us. She got a look of recognition; I was not sure if she knew Mary Ellen or felt somehow that she had caught me in infidelity.

She looked down her nose to read Monty’s name badge.

“I see—Dr. Montgomery is it?—that you have met my resident.” The way she said it made me feel like chattel.

“Yes, I know Dr. Ishmail.”

“Good. I’ll be having him write the orders, then, on this baby. This unfortunate little . . .
abortion
. How, do you suppose, they could have let this unfit . . .
child
. . . in a wheelchair . . . take home a tiny infant?” Her tone was accusatory.

“I’m sure I don’t know, Dr. Lyle. But we were not interested in transferring the infant to your service. Pedes will still be writing the orders. We called you because we needed your opinion on the chart, confirming what we thought—I mean I’m not trying to put words in your mouths—but it seemed pretty obvious that this was a fatal head trauma.

We’ve already called the organ donor team. But we need to have on the chart—”

“If you know the answer why call me in?” Mimi said.

I spoke, hoping to prevent further inflammation: “Dr.

Lyle, I can write—not write—whatever they want. Unless you think we should operate on the baby. If we operate I think they would understand if we wanted to assume primary responsibility, like always. . . .”

She shot fire all around. “We will not be operating, Malcolm. There’s nothing surgical here. The baby’s brain has been crushed.”

To gain closure I needed to venture another question. “Is it our opinion then that this is a fatal injury?”

She said, “Yes,” and turned on her heel and left the Unit.

I blinked and glanced at the ceiling. Mary Ellen said, “Oh my God. Do you have to put up with her every day?”

“Mostly she’s not like that. She gets stressed around pediatric stuff.”

“Well, this case is as shitty as they come. None of us is real happy around a dead baby.”

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“No. But you’ll see her better side tomorrow. She can be charming.”

“Charming?”

I blinked. “Yeah.”

She stared at me. “Malcolm . . . you’re defending a witch.”

I looked at the CT pictures.

“Malcolm . . .”

“She’s not so bad. You’re seeing her at her worst.”

“If she’s the reason you haven’t been home at night, I’ll never speak to you again.”

I said, “Oh, yeah, right.”

Mary Ellen said, “Just try to keep her out of my ICU.”

Omerta,
self-protective for Mimi, would be self-protective for me, too.

The next morning the infant was declared brain-dead. His heart went in an ice chest to LA, there to be implanted into a different kind of trouble. There were no takers that day for a liver or kidneys so small. The remainder was autopsied on the infant’s due date. The mother was later arrested on suspicion of murder and the aunt was arrested on an outstand-ing warrant for assault and battery.

As I stood in the PICU wondering what to do for a dying infant, feeling the mutual repulsion between the leading women in my life drive them simultaneously out of my sight, I had a glimpse of a certain line of logic: Anyone despicable to Mary Ellen must be despicable to me.

Another part of me argued it down, though: As I’d said to Mary Ellen, Mimi had shown only the raw nerves. Surely Mary Ellen was caught up in the Reputation game. Being closer to the core, I could better see the truth: It was a persecution.

The next day, five days after my meeting with Dr. Kellogg to discuss Mimi’s handling of the Coles case, came tangible proof of the other side of Dr. Miriam Lyle: the second Case of Extraordinary Teaching. I saw Mimi—I LIE STILL

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think—save a child’s life. I believe, from what I had seen of other such cases, another neurosurgeon might have failed.

We were bogged down in afternoon clinic, about an hour behind the schedule, when the ER paged me about a kid with a head conk. All calls went first to me, the resident on neurosurgery, even if they knew good and well they were going to need the Attending in short order. That’s what residency is: You get to play doctor with a real patient in front of you and real doctor behind you.

The ER resident was playing it cool, telling me without saying so that he wasn’t really too wound up about this kid, but her mental status was a little funky and he thought he’d get a CT and call us just to cover all the bases. And then, also without saying so, the potentially life-and-death decision of whether to admit her for observation by expensive professionals or send her home for observation by Mom would fall neatly to us.

Mimi asked me what the call was. I told her the little I knew: a nine-year-old girl, on her bike, struck by a delivery van going a reported twenty-five miles per hour. Banged her head. There apparently was no loss of consciousness, and her vital signs were okay, but she was now perseverating, asking over and over again where her grandpa was.

“Normal CT?” she asked.

“In process.”

“Are you concerned?” she asked.

I hesitated. “Well, the ER resident wasn’t too concerned.

He’s the one who’s seen her.”

“Right. You need to see her. Go.”

“I was in the middle of the post-op for your Mrs. Bourke, cervical fusion six weeks—”

“I know her. Go. I’ll handle it. Call me as soon as you’ve seen the CT.” I turned to go. I accelerated my pace when she called after me, “And don’t let them fuck around. This kid is now
their
first priority.”

The ER was on the other side of the campus from the clinic building, effectively a block and a half away. I walked 98

DAVID FARRIS

at about half “intern speed,” about as fast as most people would go if the bank were about to lock them from their money for the weekend.

I found the girl on a gurney, lying at a cocked angle, half tangled in a sheet. I got to her at the same time the X-ray tech did, ready to wheel her off to CT.

“Hold just a sec,” I told him. He scowled.

Her mother was there, holding the girl’s hand, her face flushed and her eyes red-rimmed but dry. “What’s her name?” I asked softly.

“Darla,” she said without looking up at me.

“Darla,” I said loudly. Nothing changed for a few seconds, then the girl kicked her legs and shifted to her other side.

“Has she been responding to you?” I asked the mother.

“Yeah, pretty much, but she’s been confused like. She’s been asking for her Pa-Pa. He been dead two years.”

“Darla,” I said, louder. Nothing. I picked up her hand and felt the pulse in her wrist. Slightly on the slow side. I pressed hard on a fingernail bed. She flinched and pulled her hand away, but said only something like “ahmm, ahmm, ahmm.”