Lie Still (21 page)

“Yes, please.”

“Scotch?”

“Sure.” I poured two drinks. He said, “Every surgeon gets himself into jams. You know that.”

“I know I do, but tell me again what
you
do.” I said.

“I get help. It’s not that hard.”

“But where is the point when you say to yourself . . . what does it take to say ‘I can’t do this’?”

He rubbed an eye. “Okay. Here’s one you haven’t heard before. Last year I was going in for a simple abdominal hysterectomy. Fibroids. Bleeding and painful. Simple. I did what you’re supposed to, though, I looked and felt all around and lo and behold the poor woman had a lump in her descending colon. You know I’ve done hundreds of bowel operations, probably dozens of partial colectomies. But she’d not been worked up for cancer. I don’t do surgical oncology anymore.

It all gets sent to Lincoln or Denver. But I was facing a woman, in the flesh, anesthetized, with her belly open.”

“Who is there to come help you in Hooker?”

“You know, Malc, we got phones here a couple of years back. I got her covered up, broke scrub, and got on the phone. The guy in Lincoln I send cancer patients to was off fishing or something, but I had a nice chat with the man covering for him. He told me what biopsies she would need for staging and to go ahead and do a wide resection with a primary anastomosis. Of course I could sew two ends of a colon together. It’s basic surgery. I suspect even you have mastered that by now.”

“Yes, Dad.”

“But when I was doing this kind of work I would never have done a primary anastomosis for a cancer patient.

Everybody got a colostomy. But times change.

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“I went out and told her husband what I thought we should do. He agreed, of course. And she got what she needed—two fairly simple operations at one go-round. She didn’t need a second admission, a second anesthetic, a second incision, any of that.”

“And she did okay?”

“Cured of both problems. Not every surprise cancer is such a happy case, though. I’ve also had to close up and send patients on down the road by ambulance. That’s more hum-bling. Not sure I told you about each of those.” He drank.

“So those guys in Lincoln aren’t thinking you should be quitting surgery altogether.”

“They think I do okay. When you call another doctor for help—if you’ve been careful up to that point—not been stupid in thinking you can do an operation you have no business doing, or burned an anatomic bridge inside the patient before you realized what you were up against—a good surgeon, a good doctor, will help. There’s no judgment—it’s about the patient. Sure, you’ll be explaining step-by-step how you got to where you are, but if your logic is sound you get the patient taken care of and you can still live with yourself.”

I said, “Of course.”

“Your pride isn’t worth a gnat on your ass compared to the patient’s well-being.”

“I know that.”

“And your pride will be ultimately better off with healthy patients, anyway.”

“I know that, too.”

“I know you know that. But you asked me.”

“Yes. But what . . . ,” I said, “what if you can’t do an operation you are supposedly trained to do?”

“Well, now, that’s a totally different ball game. I’m sure you’re not talking about yourself, because you’re not finished training, yet.”

“No, it’s my Attending.”

“Your current Attending? What service are you on?”

“Neuro.”

“A neurosurgeon.”

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“Yes.”

There was a silence. “What can’t he do?” he asked.

“She. She can’t find her way around deep inside the brain.”

“Malcolm, think about what you’re saying.”

“Dad, I have thought about it. I have thought about nothing else for the past week and a half. She gets lost. That’s what she told me. Her words. She told me it’s always been this way. She does her homework. Studies the scans. Sits and thinks and tries and tries and I guess just nothing comes.

She can’t, in her mind, put one slice on top of the other and make it look like brain, see it from different angles.”

“That’s not . . . She’s a trained neurosurgeon, for God’s sake.”

“Dad. I’ve seen it. I didn’t know what it was at first, but I’ve seen it.”

Another pause. “Give me a case.”

“She’s been known to open the wrong side of the head or start a laminectomy at the wrong level, though I haven’t seen that myself.”

“Carelessness. Unacceptable, but just simple human care-lessness. Not some deep flaw.”

“Yes, I know. But the deep flaw is there. It first came up in an aneurysm case. Supposedly fairly routine for an aneurysm. Anterior communicating artery. I scrubbed and held hooks till she got them all bolted to the table. Then I sat for hours blinking into the microscope. Dad, she was lost. I didn’t realize it at the time, but it went on for hours. She had the dura open for over ten hours. And they say that’s not her record. There was even an inquiry over this case.” I told him about Mr. Coles’s death and Drs. Miekle, Ryan, Kellogg, and Bullock. “In the end they just said, ‘Bad disease, bad outcome. What do you expect?’ Then, after her exoneration, in a moment of, I guess, uninhibited self-awareness, she told me she gets lost and it’s always been that way.”

He rubbed his face. “She told you this?”

“Yes, Dad.” I looked away. “She was feeling vulnerable.

Weak for a moment.”

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He stared at me. “She trusts you.”

“Yes, Dad.”

I was afraid he would want to know why, but he stuck to the clinical issue. “She needs to get a second surgeon. Someone to help her.”

“That’s what eventually got us out of there. After that endless wait they finally called in another surgeon and, bang, it was done. So when we were setting up another patient for a deep-sea expedition—this time a tumor but practically in the same place—I suggested she get another surgeon to scrub at the outset, and she about threw me out of the clinic. The operation . . .” I was talking too loud. “Dad, it was so painful. It was like being stuck in the sand. Wheels turning and nothing happening. I knew she was lost again. I asked her if we should call Dr. Kellogg—the Chief. He had even stopped in the OR earlier to say he was available. She almost killed me.”

“And what happened?”

I described the culmination of the operation. “And after rounds I left for here. No excuses made. I’ll tell them I was dying with the flu and couldn’t get to the phone. It’ll be a black mark against me but I don’t care.” I paused, then said,

“I imagine the patient will be okay. They say most are.”

He nodded and sipped his drink.

“Dad, she was put at real risk. Aren’t we supposed to try to minimize risk? Where we can?”

“Of course, Malcolm. That’s our job.”

“And one of the next ones won’t be lucky.”

We were quiet a moment. I said, “How did she get this far?”

“Well, I imagine she can take blood clots off the surface of the brain. From what you’re saying that wouldn’t provoke her deficit.”

“No, not as long as you pick the correct side of the head.

I could probably do those by myself by now. You cut off part of the skull and it’s right there in your face.”

“Don’t be flip.”

“Okay, but you know what I mean.”

“Yes, I do.”

I went on, “And she can drill straight down on a spine and LIE STILL

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usually find the chunk of disc rubbing on the nerve. She can probably find most aneurysms. You look under the right—

the correct—lobe and there it is. It’s when it’s a little around a corner she has trouble. She gets lost.”

“So most of her patients do fine.”

“Exactly, Dad. Except aneurysm patients. Most of them do lousy, anyway. Everybody knows that.”

He said, “Look at it this way. All we have as scientists are probabilities. You took statistics in medical school.”

“Sure.”

“So you learned about coin flips as the basis for everything in medicine.”

I laughed a little. “Well, that’s not how they put it.”

“But, have you ever told a patient or his family you knew for sure how something was going to come out?”

“No.”

“Of course not. Because you know all we have in medicine are probabilities—coin flips. Or rolls of the dice. But each individual patient gets only one. You know it’s a single patient lying in front of you. One case at a time. Some patients buck the odds, some succumb. That’s what we doctors do. We don’t have yeses and noes. So we try to make the odds as favorable as we can for our patients.”

“And the odds she gives aren’t good enough. That’s what I’m up against.”

“Right,” he said, “but when a case goes bad she can say it was just the odds. A run of bad luck. If she’s getting lost in there on the tough ones, who would know?”

“Me.”

He nodded. “Do you know of any other cases? Like the aneurysm? I mean is this a pattern?”

“No. I mean I know other cases like that one have happened. She’s kind of a legend around the OR. But I don’t have specific names and dates of birth.”

“Do you think she’s hurting patients?”

I hesitated. “I’m not a brain surgeon.”

“You’re a doctor. You have your patients to think of.”

“Yes. Dad, I
think
she’s hurting patients. I know, if that’s 156

DAVID FARRIS

true, as I understand the problem, that it is preventable. But I can’t prove it’s true.”

“Do you believe it’s true?”

“Yes. I believe it is. It all fits.”

“It fits the data.”

“Yes, it’s the only explanation for what I have in front of me.”

He said, “Is there a need to act?”

Again, I hesitated. “Most wouldn’t,” I said.

“You’re not most.”

He had spent his entire life winnowing integrity from natural tendencies. That was why I’d come. “Yes, I believe there is.”

“Have you thought about your options?”

“It seems the only thing left is to go to the heads of her department.”

“It seems. But think it through, Malcolm.”

“I will, Dad.”

“And don’t ever forget how proud we are of you.”

“Thanks. I won’t.”

The next morning I called the Maricopa Surgical ICU. The charge nurse told me Ms. McKenzie was waking up, though slowly. She was still on the ventilator but there were no gross neurologic deficits. Her family had been in to see her.

I clicked off and sat with the receiver in my lap until the piercing tone came on to remind me the phone was off the hook. I would have done anything to help Susan McKenzie, but her die had been cast. I said to the ether, “For the next one, then.”

I needed an appointment for a meeting.

I little relished the idea of a second session of incestuous politics with a Professor of Brain Surgery. Having tried Joe Kellogg with little to show for it, I would have to go to Dr.

Marshall Bullock, the über-boss, and from everything I’d heard, a real fingers-in-the-light-socket kind of guy.

His reputation among the U of A medical students was unique. He was said to be an exemplary gentleman teacher LIE STILL

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to medical undergrads—tolerant of relative ignorance, patient with uncertainty, and never failing of manners. Apparently, though, the initials “MD” behind a name made a man or woman fair game for any and all sorts of embarrassment and invective. It was said that newly minted interns were regularly reduced to blubbering under his withering assault of obtuse questions, mid-level residents clambered over one another to avoid him, and chief residents survived by memorizing his personal repertoire of physiologic fine points like kindergartners learning the Pledge of Allegiance.

I called Cynthia Blachly, our residency coordinator, my Mom-away-from-Mom. Besides being the one who could arrange my sit-down with Dr. Bullock, she would have been the first to know about my having gone AWOL from Mimi.

Expecting a shocked response I said, “Hi, Cynthia. Malcolm Ishmail.”

She said, “Hi, Malcolm. What’s up? You sound far away.”

“It’s a cheap phone.”

She said, “What can I do for you?” in a normal tone. Apparently I was still alive as far as the Residency Office knew.

I inhaled deeply and asked if I could meet with Dr. Bullock early the next week.

“Rethinking your story?” she said.

“I just thought of something I need to add.”

“Disclaimers?”

“You’re such a help.”

“Dr. Bullock is in Tucson, honey.”

“I know.”

“He’s not coming to Maricopa any time soon.”

“I was thinking I should go to Tucson.”

“Well, I can try to set it up, but I don’t have direct access to his schedule and your schedule is not exactly wide open.

Besides, Dr. Kellogg was supposed to be handling anything that comes up here. He was a little testy, I understand, about not being in on every interview and every message that came out of his backyard. You sure you don’t want to meet with him?”

“I already did.”

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She sighed. “Wanna pick up a phone? You don’t want to drive to Tucson. It’s an ugly drive.”

“I’ll risk it.”

When I called her back Cynthia had set up an appointment for me the next Monday afternoon. She still gave no sign that Dr. Lyle had ever mentioned my absence. Maybe Mimi was happy to be rid of me.

For two days I lived in Hooker. I went to Dad’s office. The locals—all shapes and sizes—came and went, some jaunty, some on crutches, some hunched over walkers, all smiling.

I hiked along the river. I ran on the high school’s oval track. I did push-ups and sit-ups. I ate home cooking. I caught up on my sleep. I made no excuse to Cynthia nor Mimi nor anyone else for missing most of the last week of my time as a brain surgeon.

That Friday I left on the return trek. I intended to perform my usual head-down sprint, but somewhere on the eastern slope of the Rockies, driving in the dark, I began to cry. It didn’t interfere with my momentum, steering on the interstate being practically foolproof, and no one could have seen, so I just let it flow, examining, as they came up, the no-tions and images that made it throb.