Lie Still (19 page)

“wake up”—not likely in itself—she would be permanently locked into a personal hell: awake but absolutely paralyzed, ventilator dependent for eternity, and completely unable to communicate with anyone—not by voice, not by hand, not by encoded eye blinks.

Mary Ellen had been quite persistent in wanting to let Nancy die of her lung failure. The consulting neurologist was noncommittal. He said, “Let’s see where we are after 136

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the lungs clear up.” Mary Ellen said, “It’ll be too late.”

Translation: The stroke would kill neither her higher brain nor her body, just the connection between the two. The lung disease was the way to let her go. Mary Ellen asked the professor if they could get the hospital ethics committee involved. He gave her a flat “No.”

No one had asked the family what they wanted. Mary Ellen explained everything to them in detail and broached the idea of letting go. She was, no doubt, graceful in leading them to the idea, but Mom went nuts when she realized what Mary Ellen was getting at. That’s always a risk you take when you bring it up, but if you don’t bring it up you may be assuming the wrong thing.

The mom vented to the PICU social worker. He passed it up the ladder. Mary Ellen’s professor then went nuts, even writing a letter of reprimand for her file. All for caring enough to be involved.

As feared, at two weeks the girl’s lungs had recovered.

She would have been completely off the ventilator, but none of her muscles could be made to move. I saw her from time to time in the hospital: The girl lay in her bed and stared, or seemed to stare, at the ceiling. Mom learned to get her into an electric wheelchair and strap the portable ventilator underneath the seat. They went for tours of the lobby and the wards. When it was cool out they went to the parking lot. Nancy had the face of abject apathy. If there was more cooking behind the mask, no one could have known. Eventually they took her remains home, everyone the poorer for it.

As it was playing out, Mary Ellen vented to me. Unfortunately my sympathy was matched only by my impotence to help, but she said it was helpful to talk. After our talks she would get eerily quiet, put on a veneer of fuck-you determination, and go back for more. She could be scary.

Mary Ellen still sees the girl for routine care in her own follow-up clinic. She won’t let her go. She said to me, “She needs me.”

“How does the mom treat you?” I asked.

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“Oh, pretty fair. She acts like we never had a problem. We chitchat about men. She got divorced after the girl went bad.”

“Don’t they all?”

“Well, most.”

Unfortunately, Mary Ellen’s view of me had been tainted by the little ménage à trois in the Pediatric ICU involving Mimi, Mary Ellen, and me. Still, I needed her. I paged her as soon as I got to the hospital.

“Suppose,” I said, “you were teeing up a nice young woman for an operation you did not think your Attending could do well.”

“Which Attending? Or should I say, ‘the Witch Attending?’ ”

“Never mind that.”

Long pause. “Can the Attending do it at all?”

“Well, the grapevine says that said Attending makes a complete hash of it.”

“Sounds bad. How’s your relationship with said Attending?”

Long pause. “Mixed.”

Another pause. “And I assume there’s serious risk to the patient or you wouldn’t be calling.”

“All the usuals: brain damage, death, extreme disability.”

“Like what?”

“Like . . . extreme disability. Like being buried after a nice funeral.”

“Malcolm, why are you being so coy? You’re usually full of details.”

“I can’t really go into detail, Mary Ellen. That’s part of the problem.”

“Malcolm. Hello. It’s me.”

“Oh hell, Mary Ellen. I can’t. Can we leave it at that?”

“Yeah. If that’s what you want. We can leave it at that. But I don’t think I can be much help if I don’t know what you’re up against.”

“It’s a shitty ethical thing.”

“You know how much I love ethical dilemmas.”

“Sorry. But it’s where I’m living right now.”

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“It’s certain you’re not living at home. Got a new HO?”

“HO” was Mary Ellen’s term for “Hot One,” a romantic prospect.

“Mary Ellen, I’m sworn to secrecy. But it could be the radiology resident with the long black hair.”

“The Chinese woman? You thought she was untouch-able.”

“I’ve been wrong before. I’ll be wrong again.”

“Well, who is Lisa? She’s left a really cute message.

Sounds like a high schooler. You’re getting worse, you know.”

I’m a terrible liar; I had forgotten about Mimi’s prefab cover story. “She was a mistake. Never should have shown any interest.”

“Well, tell her. She seems to think you’re in love.”

“Yeah, I will.”

“And call me again when you want to talk to me.”

“Yeah, I will.”

I hung up, lonelier than I had thought possible.

I prayed that in Mimi’s clinic I would see only patients with

“simple” problems. Of course, if you’re seeing a neurosurgeon, your problems are not simple, but some are easier than others. Entrapments of peripheral nerves. Even low back pain. It’s the bane of life for any orthopedist, neurosurgeon, or even a family practitioner, but, figuring it never killed or blinded anyone, I was hoping for only back-pain patients.

First on my schedule that morning was an easily forgotten lecture on state-of-the-art treatments for metastatic prostate cancer. The professor could have made it very short: They all die, slowly and painfully. As he droned I conjured what might have been another option for Ms. McKenzie: I could phone her with a not-quite-anonymous warning: Me: “I’m not sure you remember me. Dr. Ishmail, the resident you saw with Dr. Lyle.”

Her: “Yeah.”

I imagined an uncomfortable pause. “This call is entirely LIE STILL

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unofficial. No one knows I’m making it, and it would be a really good thing if you could forget my name and face.”

She might chortle. “Sounds kinda serious, Doctor.”

“I guess it is. I’m calling with, um, a suggestion. Some serious advice.”

“What?”

“The operation I booked you for . . .”

“You don’t think I should have it?”

“Oh, no, you really need the operation. But you need to find someone else to do it.”

A silence, then, “I don’t have a choice. We don’t have insurance. We go to the County Hospital. And they said I would get a professor from the university there.”

“Well, you did,” I would say. “And she’s smart. Really smart. But in certain types of deeper operations she has a lot of trouble. More trouble than just about any other neurosurgeon would have. It’s an unusual kind of problem she has, but your brain, your sight, is not something somebody should be messing around with.”

“But they already scheduled me. What would I do? You can’t do this!”

“Please try to be calm, ma’am. I’m just trying to help you.

I have a lot of respect for Dr. Lyle, but you really want somebody else to be doing your specific operation.”

“How? How could I do that?”

“Get a second opinion. Find another brain surgeon. Use the yellow pages if you have to, but get someone else to see you. Say you just want a second opinion. Then stick with that surgeon. Listen, that happens all the time with second opinions. Patients tend to go with whom they saw last. No one will think anything of it.”

“But we can’t pay for that! That’s why we go to the damn County.”

“I don’t know what to say about that, ma’am, but you have to try.”

“I’ll talk to my husband.”

“Yes, of course. And, if you could, forget we had this conversation.”

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She would not have said “Thank you.”

In fact, she probably would have decided that I, the learner on the team, was just a miserable lout out to cause trouble. With no financial resources, she would have ended up back at Maricopa, back with Mimi Lyle, but now doubly frightened. She probably would have reported me to anyone and everyone who would listen. Then she would have sailed through the operation unmarred, and, in repayment for her extra anxiety, would have hunted me down and set me on fire.

The days progressed. Slowly and painfully.

I told myself I would find the right time to go see Joe Kellogg. A moment’s lapse in the schedule, an operation canceled. Something.

But nothing intervened. In afternoon clinic the day before the scheduled operation, I realized why I was avoiding the meeting. Joe Kellogg would no more hear bad things about his star recruiting success than he would about his own mother. I would inevitably be the one wearing shit.

At Mimi’s that night I spent my last dollar: “You remember what you told me in clinic the other afternoon,” I began.

Her face became wooden. “About pituitary cases turning into nightmares?” No response. “I was wondering . . . well, it occurred to me, if they can go so bad, maybe you could get another neurosurgeon to help us with the case, to, just in—”

“Do not ever, ever, bring that up again,” she said, very quietly. I sat silently. “I am fully capable of getting a pea out of its pod.”

I nodded.

She went on, slowly, distinctly: “I’m not sure what you think you heard me say. But I have no problem whatsoever with this kind of case. I have never said otherwise.”

Again, I nodded.

The subject was changed and we miraculously carried on as if it had never been brought up. At bedtime I was feeling anything but sexual, but I think she wanted to reassert the underlying premise of our relationship. Once she fellated me LIE STILL

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to attention I obliged her with a thrashing performance she apparently mistook for passion. I then left for my own town house, fabricating enough detail in my cover story to show my professor I was learning.

Once home I showered.

On the appointed Tuesday morning Mimi and I met for morning rounds just as we always did, large coffees in left hands, pens in right hands. We left notes and orders on our patients, then found Ms. McKenzie alone in the Pre-Surgery Holding Room, looking scared, lying still under a sheet and two thick cotton blankets.

“All set?” I asked her.

She said only, “Mm-mm.”

“Will any family be here, waiting for you?”

“My husband is just getting the kids over to their grandmother’s, then he’ll be here. I was hoping he’d be here before they take me.” She looked past me toward the door.

“The kids wanted to be here but I knew I couldn’t take that.”

Dr. Denny, the assigned anesthesiologist, came over to the gurney. “I’m holding off on giving her anything until her husband gets here,” he said, letting me know we would be waiting for him.

I said, “I’ll tell Dr. Lyle about the minor delay.” I went to the back room and paged Mimi. I told her to go to her office and work; I would call her when she was needed. I did not want her getting inflamed. I hoped she could again be optimistic for at least the beginning of the operation.

Ultimately Ms. McKenzie was thoroughly sedated, wheeled into the neuro OR, anesthetized, and cannulated in all the right places. For a major case this can take an hour.

Then a team of three from the ENT Division—an Attending, a resident, and a medical student—did the first shift, spelunking their way, headlights and all, up the nose to the thin plate of bone that separates the mucus from the brain.

“All yours,” they said. “Page us when you’ve got it out.” And they were gone. I called Mimi in her office.

She smiled at me as we scrubbed, then settled in behind 142

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the operating scope humming very softly, just as I had heard before. At that point I buoyantly believed that my earlier worries had been ill founded.

Our view in the scope, once it was irrigated and suctioned, was bone. We stared at it. She seemed hesitant to break through it. Even to me it was obviously the next step.

After fussing about the way the scrub nurse had certain instruments arrayed on her stand, she finally, with an audible sigh, began sticking long-handled bone crunchers up Ms.

McKenzie’s nose and chipping away.

The hole in the base of the skull grew one small chip at a time. My view of the proceedings, through the 90-degree teaching arm of the operating microscope, looked like an indeterminate stew of soft pink lumps dotted with frequently changing sharp edges of white bone, all bathed by lipstick-red blood alternating with a clear wash.

When Mimi was through the bony layer, she put in long thin brain retractors. It wasn’t long until the humming stopped and, having been through it before, I sensed the early return of the familiar, palpable sense of frustration. Dr.

Denny’s face was impassive, stony. Terrie, the scrub nurse, was staring at the wall.

Time passed but the view in the scope stood still.

Mid-morning Joe Kellogg ambled into the room, tying up his mask as he came to the table. Mimi’s eyes—all of her face I could see—told me his arrival had locked her ponder-ous steps into ice.

“How’s it going?” he asked.

“Oh, I think it’s going just fine,” she said without looking at him. “We’re getting there in bits and pieces, you know.

Muddling through, despite ourselves.” It was the overstated modesty of the highly skilled, misapplied.

Dr. Kellogg came to my side and nodded to me—my signal to get up. He sat and looked through the scope for a couple of minutes, then stood. He went to the wall and studied the CT pictures on the viewbox, then looked around the room like he was lost.

He said, “Well, Mimi, I’m around all morning if . . . if it LIE STILL

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gets interesting. I’ve just got a straightforward laminectomy down the hall.” A pause. “We don’t see a lot of these.” Another silence. “You know Ed Adams is in England—that visiting professorship. . . . Call me if it gets interesting.” He left. I stared after him.

By noon Mimi had already gone to the viewbox twice to study the scans. What I could see through the microscope had not changed in at least an hour.

We were in the middle of another cross-country trek without a compass. She was muttering to herself again. Making tiny adjustments in the retractors and angles of view, then undoing them. It was, for me at least, a horrifying déjà vu.