Lie Still (18 page)

I went naked and shivering into the bathroom, avoiding contact until I could at least crank up my defenses. I took my time peeing so I could run through what each of us had done and said and convince myself before I had to speak that it had not been my own special nightmare.

I managed to reemerge with an upright, seemingly self-confident stride despite my covering of gooseflesh and my shriveled and hiding manhood. As I pulled on my jeans and boots she handed me a mug of the coffee and a toasted bagel. We tried some friendly small talk revolving around the lighthearted notion of “Boy, didn’t we have a great one last night.”

We were made prisoners in our private canyon by the real LIE STILL

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possibility of seeing someone we knew should we venture up into Globe. We spent the day on a pair of short hikes. We wandered among the cottonwoods up the little stream, took a nap in the sun on the patio, then did a second stroll down the stream. The springtime sunset came late enough that it was still daylight when we realized we needed to venture at least as far as a supermarket to avoid going hungry. Reason-ing that her car might be as recognizable as either of us, our only choice was for the hostess to go to town for the steak, leaving me to stay back to build and tend a fire in the out-door
chimenea
.

Time alone, recovering from an epic debauch, poking burning logs with a bent stick of cottonwood, is an experience in self-hypnosis. Lying on a wooden bench by the out-door fireplace, I drifted along the edge of sleep. The embers radiated their searing heat and every spectral color from white to gold to blood red. I caught myself wondering how Sister Edith dealt with her mustache. More awake, I reasoned that I had been pondering hell, because it was the graphic description of hell in second grade by Sister Edith that always made me most apprehensive, and if I had been staring at combustion and thinking of Sister Edith, I had certainly been considering hell.

Fortunately Mimi brought back enough wine that we were able to contentedly avoid any substantive conversational topic, sticking instead to sex, drugs, religion, and politics. Bedtime was an asexual collapse.

In the car ride back the next day, I laid claim to a moderate hangover. Really I just wanted some silence. Mimi, too, was still bleary-eyed. She copied my excuse, fatigued even to the point of letting me drive.

On the route down from our borrowed mountain, the junipers thinned out, giving way to sage. As we approached Phoenix the sage gave way first to some misbegotten cotton fields, then to a few ragged, bullet-ridden saguaros left there to herald one’s return to the Land of Subdivisions, the Valley of the Sun and its suspect claim to civilization. I wanted nothing more than to be able to turn her Mercedes around 130

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and go only north. Someplace relatively sane: Flagstaff. Las Vegas. Death Valley.

We got to her condo by early afternoon. Our goodbye was brief. From there I drove straight to my home, which was, thankfully, empty. My sorry secrets would remain safe from my better half for at least one more day.

I did my laundry, sat down and read four pages of a chapter in a surgery text, managing to rally myself before falling completely asleep. I went running and cleaned out my car.

Evening came. I was finding solitary time pleasant: I had no urge to go back to Madame Lyle. Our lust was spent—tired and flaccid. I went to the supermarket for a fish steak and a bottle of white. There a brunette was smiling at me. She was slightly overdressed, apparently on the make, but I wanted a new entanglement, even a short one, like I wanted syphilis.

Denial is a wonderful thing. I guess I was hoping we could muddle through, at least until the end of my rotation. Maybe not have to go trekking deep inside anyone’s head while I was still the witness. Nonetheless, when the new workweek began with a pair of routine operations, I found myself double-checking everything I could: which wrist needed the nerve released, which side and exactly what level the lumbar disc was offending, and what palpable landmarks a gloved hand might feel to be sure to find the proper vertebra on the first try.

At first it seemed to work. Things went smoothly. I began to believe the warning in the canyon would, after all, dry up and blow away in the desert winds. I told myself that giving it any significance was just my own version of a self-flagellating nightmare. The guilt of a recovering Catholic after a weekend of sin.

In clinic the second day I kept looking for another Darla Winthrop; someone we could rescue from the jaws of Death, someone who would go forth, reanimated, singing our names. Instead I saw a man in for his routine post-op visit.

Madame Lyle had worked on his lumbar spine a week before I joined her team. The pain and weakness in his legs LIE STILL

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had, unfortunately, grown worse since the surgery. This is a known possibility, clearly explained to every patient before they lie down for us, but my faith in Mimi Lyle as a technical surgeon was, like my lust, withered.

Mid-afternoon I met Susan McKenzie, the woman who would unwittingly make painfully apparent the exact depth of the mire I was in.

Our doctor-patient relationship began like any other. I pulled a nascent chart from a slot and read the intake nurse’s notes: A thirty-two-year-old mother of three, referred by Gyn Clinic for a suspected pituitary adenoma. Three years after weaning her last child she had spontaneously resumed lactat-ing. They got a brain CAT scan, which showed quite clearly a tumor at the front of the base of the brain, obliterating a pocket of bone that would normally cradle the pituitary glands. It was almost certainly a benign growth that kicks out a hormone, in this case the one that tells breasts to make milk.

She was stoutly built, blonde, and fair-skinned almost to albinism. In our conversation, besides the relevant history of her symptoms, I learned she once participated in rodeos but now chased her children and made quilts in front of the TV

when they were asleep. She had come in alone because her husband had just found a job at a construction site sixty miles away. Her readily visible anxiety gave our conversation an extra urgency.

Benign tumors often grow in very malignant places. The pituitary sits just beneath the point where the optic nerves cross and comingle on their way to the back of the brain.

When Ms. McKenzie was seen in Gyn Clinic three weeks earlier, the gynecologists tested her vision and found it completely normal. On my exam, however, she had clearly lost parts of her peripheral vision, more on the right than the left.

The adenoma was apparently growing very quickly, pressing on the optic nerve fibers.

I presented the case to Dr. Lyle. In the classic format for a medical description, probably first prescribed by Hip-pocrates, I told her the few pertinent identifying data, why Ms. McKenzie had come to see us, and a complete descrip-132

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tion of her symptoms, all in maybe two run-on sentences.

Then the pertinent past medical history, social history, review of systems, and a detailed description of her physical exam—completely normal except for the visual field cuts and freely expressible breastmilk. I would have described the findings on the CT scan, but Mimi had already put them on the viewbox and had pored over them all the time I was talking.

“Pretty clear-cut,” was all she said, and opened the door to Ms. McKenzie’s exam room.

When the conversational niceties were again uncomfortably cut short, Susan began looking at me as if I could save her. It occurred to me maybe Mimi did not like women. She cut directly to the You-need-an-operation part, and described how we would work up through her nose, cut away the bone at the base of the brain, and pluck out the tumor. The “vision nerves” were right there and blindness was a possibility, but Susan “shouldn’t worry about it.” I almost dropped the chart. I’m sure my mouth fell open.

Fortunately this was not entirely new to the patient. Her earlier doctors had given her the overview, and she was bright and aggressive enough to have found some information on her own. She had even arranged for a month off from her receptionist job, beginning a week hence, knowing this was coming. “Better make it two months,” Mimi said bluntly.

Back in the hallway, where most clinic decisions are made, Mimi was curt: “Book it. Trans-sphenoidal resection of pituitary adenoma. Five hours.” Turning away from me, I’m certain she said, “God, here we go again.”

I went back to Ms. McKenzie to go over the pre-op details—the consent, the tests, the diet proscriptions. She looked confident, expectant, innocent.

When I called the OR scheduler, asking where we could fit a major case in—soon—she said their computer database showed Dr. Lyle averaged well over eight hours for this type of operation, and she would be required to block out a full day. I wondered if their database had not mixed in aneurysm LIE STILL

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operations. One or two fourteen-hour cases could seriously skew one’s profile. Having already lost every OR scheduling argument I ever started, though, I said only, “Whatever works.” Fortune smiled: The scheduler moved a vascular case to another room and came up with an available slot the next Tuesday, a week away. I gave the date and time to Mimi’s assistant.

When lunch break came Mimi was on the phone, being syrupy with someone, discussing a grant proposal. Open on her desk was a thick file marked “NIH.” She waved me away.

On my way into the cafeteria I met one of my internship classmates, Gene Woods. We had become good friends while sharing a rotation in the ICUs. Gene was born with the cynicism one needs to succeed in surgery. He called neurosurgery “spudification.” He was headed for a professorship somewhere. “How goes brain surgery?” he asked. “Turned anybody into a potato yet?”

“You mean today?”

“Well, this week.”

“No, but it’s only Tuesday.” Then I got a shiver—Susan McKenzie.

“Talk to me next Wednesday, though,” I said.

He wondered what I was getting into, but I had already said too much. I changed the subject but could not shake the foreboding.

Before diving back into the afternoon patients, I went to talk to Mimi. She was standing just inside her private office.

“Excuse me, Dr. Lyle,” I began. “That woman this morning.

What did you mean about ‘Here we go again’?”

She gave me a vague though stern-faced look. “Nothing.

I didn’t mean for you to hear that, Malcolm.”

“But . . . Is there something here . . . something more . . .

problematic?”

“No. These are difficult cases. Always. I’ve seen them turn into nightmares, is all, but that’s part of the job. It’s un-avoidable.” She gently closed her office door in my face.

Standing alone in the corridor I replayed our explanations 134

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to Susan McKenzie. Of all the absurd doctorly inanities I had heard, Mimi’s mention and simultaneous dismissal of blindness was memorable. When I remembered the look on Susan’s face, I was not certain I could play my part again with the necessary professional wall. I felt dishonest.

As soon as I finished with the next patient—another walking (poorly) proof that the evolution of the human lumbar spine is far from complete—I called the operator and asked her to page Dawn Stelfox, my friendly anesthesiology resident. Five minutes later, when Dawn’s voice announced from my hip an in-house extension, I found a secluded phone to make the call.

“So what do you know about Dr. Mimi doing pituitary cases?”

“Never had the pleasure,” she said.

“Any way to ask around? Quietly? Say, for a hypothetical patient needing a hypothetical pituitary adenoma taken out.”

“A purely hypothetical patient?”

“A purely hypothetical young mother of three. Trans-sphenoidal approach—straight up through the nose. You know, leaving no externally visible evidence you’ve been there.”

“I’m sure I can get an informed opinion, in a hypothetical sense. I’ll call you back.”

Two hours later I had the answer I most feared. Dawn was working that afternoon with an ENT resident who had heard a tale from two of his seniors. Once upon a time there was an extended flog wherein the ENT folks had done the trans-nasal exposure without a glitch, then waited five hours for Dr. Miriam Lyle, using the finesse, in his words, of “a bull elk fucking a cow,” to remove the little bugger and, miraculously, leave only one side blind in her wake. She had not, in this instance, solicited help from any other neurosurgeon.

That night, at 3:15 A.M. I was suddenly wide awake. I had been dreaming about going blind from watching Mimi mas-turbate on cocaine. I lay there for a half hour before I could again drift off, only to be slapped awake by the clock radio.

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Until then, I had not, since starting my internship, been awake while lying down for any period longer than a minute.

In the shower that morning, I realized I wanted help even if Mimi Lyle did not. In times of trouble I had a close and highly reliable resource: Mary Ellen Montgomery.

Mary Ellen and I were used to crossing the Styx together.

I’d once been her sounding board through a confrontation with an Attending, albeit in less explosive circumstances.

It’s still a touchstone case. Nancy Madsen, an eleven-year-old girl, had had a brain tumor removed when she was nine, but had not been “right” ever since. She was admitted to the Pedes ICU during a bout of nonstop seizures. An unusual complication of severe brain dysfunction is pulmonary edema—water in the lungs—which Nancy developed in spades.

While her doctors scratched their heads about the diagnoses and prognoses, she was teetering on the brink of dying from her lung disease. After three full days of innovative heroics with Nancy’s ventilator, Monty convinced one of the cowboy-souled anesthesiologists to help her shoulder portable, full-scale life support and get the girl to the MRI scanner—a block away—and back. That by itself was a nail-biting feat, but the pictures they got proved to be critical in their decision making.

Most of the girl’s brain stem had somehow lost its blood supply and infarcted—died—a particularly awful kind of stroke. Except for vision, smell, and hearing, all sensation was permanently lost. All movement and outward expression were equally obliterated. This meant, if she were to