Lie Still (22 page)

Certainly I feared for my career. Medical academics, like everyone else, do not like having their major mistakes exposed. Even messengers can get killed and in my case I might be mistaken for more of a problem than a messenger.

More aching, though, was the loneliness. It was not as acute and searing as being dumped by a lover, but more pervasive.

Even more formidable. Intellectually, after a breakup, one knows the pain is finite—there will be another lover. This, on the other hand, might never go away. Always—high school, college, med school, internship, and residency until now—I had been able to rely on my
compañeros
in times of trouble.

There had always been those among whom there were no secrets, no lies.

I stopped for a sit-down meal and a cheap motel. I wanted to call Mary Ellen.

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*

*

*

When I got to Phoenix Sunday afternoon, I went to Maricopa to check on Susan McKenzie. I found her chart and read Dr. Lyle’s notes. Mimi’s tone was completely self-satisfied.

The patient was not in her room, but her nurse said her husband had taken her for a walk. Maybe a good sign. I found them just outside the cafeteria. Her husband, looking aged since I had met him in the presurgery room, was pushing her IV pole. I spoke briefly to both of them. It was obvious she did not remember me. It was unclear whether she knew her husband.

Her acute mental vacancy, while not necessarily permanent, was frightening. Much of the good stuff of brain function—memory, personality, sexuality, impulse control, sense of humor—lives where we’d been pressing. It sometimes takes weeks or months to reappear. Sometimes parts of it are gone forever, the gaps invisible to the doctors who do not know the subtleties of the person.

The calendar having ended our academic relationship, my tour with Madame Lyle was over. There was neither party nor speech. There never is—residents come, residents go, easily forgotten. I had ended our personal relationship with my in-subordinate absence from the last few days of clinics and rounds. I’m sure we both knew that any further words between us must necessarily begin with an apology from me, something I was not planning. If she wanted to lodge a complaint or add a nasty letter to my file, I would deal with it as I could.

Monday at 0700 sharp I stopped being a faux–neurosurgeon, transforming instantaneously into a faux-vascular surgeon. After morning rounds I made my scraping apology for having to leave for most of the day on an administrative matter. My Attending snorted. “Hell of a way to start a new service, Ishmail.”

“I know, sir. But I have to meet with the Chairman of Neurosurgery. It’s pretty serious.”

He gave me a hard look but waved his hand dismissively.

160

DAVID FARRIS

*

*

*

The interstate out of Phoenix, south to Tucson, cleaves vast expanses of dust speckled with the occasional chancre of industrial farms and a seemingly random smattering of abandoned farmhouses and roadhouses, anachronisms in the age of the sixteen-row tractor and the interstate highway. It invites a heavy accelerator.

The only remarkable thing about Dr. Bullock’s office was his Executive Assistant. A woman best described as

“huge,” sporting a tower of lacquered hair, but with eyes sparkling from beneath the folds of flesh. She was kind and grandmotherly and called me “Dear.” She insisted on getting me coffee, then brought cookies along for good measure. I waited in the relative warmth and safety of her maternal domain. When I was almost asleep in the armchair she gently called my name and nodded me in the correct direction.

I faced the office door. I paused and steeled myself before knocking. The portal to purgatory, I discovered, looks just like something you see every day.

Marshall Bullock was sitting sideways to his desk, bent over an old typewriter. I remembered having seen him at Maricopa once, being led around by a stiff-looking team of doctors and their hangers-on, each gussied up in something more formal than usual, each in a brightly clean white lab coat. He looked to be of above-average height with broad shoulders and a thick, athletic neck. His face was tanned and lined, his reddish hair sun-streaked.

Before I could sit down he asked, “What brings you to Tucson?” He did not look up. I hesitated. “I don’t want to be rude,” he continued, “but our report on Dr. Lyle is all written.

And the Chief Resident has made a mess of this paper we were to have in press next month. If I don’t get it in the mail by four-thirty this afternoon, the editor is going to come out here from Yale just to have a go at me with a switch.”

I smiled. One could sell tickets to such a meeting. “Sorry, sir. It’s not really a straightforward thing.” I sat. “Since I LIE STILL

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talked to Dr. Kellogg two weeks ago, I’ve been thinking about the implications of what he was asking me.”

“About Dr. Lyle.” His voice had an unnerving booming quality.

“Yes. I thought about the nature of the questions and all.”

Silence but for the typewriter. It occurred to me that if I quietly left he might not be certain I’d ever been there. I ventured on: “It seemed the issue was probably bigger than just the Coles case.”

He typed on, but finally said, “It may have been. In some people’s minds.”

“Actually, Dr. Bullock, something came up. She said something to me that got me worried about another patient. . . .”

He glanced up briefly. “A particular patient.”

“Yes, sir. I mean, as an example of the problem . . .”

“Someone . . . in the hospital? The ICU?” He turned toward me.

“No, sir, not exactly. She’s in the hospital, was in the ICU.

A woman I saw in clinic and scheduled for surgery. We did the case last Tuesday.”

“A completed case?”

“Yes, sir. But something she said . . .”

“What kind of case?”

“A pituitary adenoma. Trans-sphenoidal approach.

Thirty-two-year-old mother of three.”

He rocked back in his armchair but stared at me intently.

I got the impression I might have touched a sore spot.

I said, “Something Dr. Lyle said, too. I mean we both felt bad for the Coleses, and she was kind of getting down on herself. . . .”

“That’s a natural reaction for a good surgeon,” he said.

“Oh. Of course,” I said. “I’ve been wondering ever since his operation if I could have done anything differently, you know . . .”

He waved his hand. “Of course.”

“But she said a couple of things that got me wondering.

And it’s been like a rock in my shoe ever since.” He waited.

162

DAVID FARRIS

It was time to shoulder the load, but I stumbled. I said, “In clinic she said, ‘Here we go again.’ ”

He frowned. I scrambled: “Since I met with Dr. Kellogg and he pointed out how long Keith Coles’s operation had taken—I mean, fourteen hours—how she had ultimately needed help, and all that, I got to wondering if this might turn out the same way. If that was what she meant.” His frown tightened. “I checked around with some OR people and they told me about one of these adenomas she did a few years ago that turned into a disaster and left the man half blind.”

“You were concerned about this woman being made blind.”

“Well, yes, sir.”

“Dr. . . . Ishmail, is it?”

“Yes, sir.”

“We all know Dr. Lyle does some operations slowly. All of us like to be meticulous.”

“Yes, sir.”

“And the OR people do not like slowness,” he boomed,

“unless it’s their own.”

“Yes, sir.”

“And blindness is a known complication of that operation.

It’s in the texts. It’s part of the explanations we give these patients ahead of time. It’s not like that man was the first.”

“No, sir.” A pause. Sink or swim. I blurted Mimi’s secret:

“But what else she said was, ‘I get so lost inside the brain.’ ”

He looked up slowly. Our eyes met. I went on, in a slow careful tone: “She said to me, ‘I memorize the CTs, cut by cut, but I can never stack them up again to re-create the whole. I can’t roll things around in my mind in three dimensions and see what’s on the other side. I never could. I just don’t think in three dimensions. Ever.’ ” He stared at me.

“She said it’s a ‘daytime nightmare.’ Apparently recurring.”

There was a long silence. I sat still. Dr. Bullock was leaning heavily on his elbows on the desk, but said nothing. He had both hands cupped over his chin.

“I tried not to think much about it at the time. But then LIE STILL

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Ms. McKenzie came into clinic. I was the one who worked her up for Dr. Lyle. It really began to bother me. I realized that, well, if there’s one place you really need three-dimensional thinking, it’s got to be brain surgery. Maybe surgery inside the heart, too, fixing a valve, but . . .”

“Yes. Quite.” He cut off my nervous prattling. There was silence as he stared. “She told you she cannot reconstruct anatomy in three dimensions. Mentally.”

“Yes, sir.”

“She said she ‘gets lost in the brain.’ Her words.”

“Yes, sir, essentially.”

“ ‘Essentially’ or exactly?”

“Well, I guess exactly. ‘I get lost inside the brain.’ What I just said. It’s kind of seared in my head.” He stared through me. “And I think it’s accurate,” I said. “It explains the kinds of problems that have . . . that have been reported. It seems to fit what happened to Mr. Coles. And maybe others, I guess, from what I’ve heard. And I think she thinks she’s being fair to the patient. She said she tried for ‘a couple of hours’ before calling for help. I think she believes that. But at least in the Coles case it was what—over ten hours with the dura open?”

He sat in thought. Again, I waited. His eyes were focused on things I could not see. He massaged his upper lip. I was sure that he was well aware of Mimi’s reputation around the OR. I imagined he was thinking through the implications.

Clinical. Political.

“What is this woman’s name again?”

“Susan McKenzie.”

He scratched it on a notepad. “And how did the case go?”

“Well, it was sort of mixed, I guess. It began okay, but then it turned into that same sucking and buzzing and sucking and buzzing and nothing happening. Just like in the Coles case. It was déjà vu.”

“Did she get help?”

“No. I sort of suggested it, but she . . . didn’t appreciate the suggestion. Eventually, kind of suddenly, she got into the tumor area and started shelling out what she said was 164

D AVID FARRIS

the adenoma. Then she closed up. There was a lot of bleeding, though, really suddenly. Bright red. And we were into the CSF.”

“How did she handle that?”

“There was some yelling. The suction quit at the worst time but she handled it. Started buzzing a lot and finally put in a clip. The bleeding stopped.”

“And the patient?”

“So far, no overt stroke. Slow to wake up, though. Pretty vacant.”

“She will clear,” he said.

I sat. That is a brain surgeon’s favorite prediction. After a second I said, “I mean she’s walking but she’s not there.

They’re optimistic, but she’s certainly not as awake as some patients are at this stage, and from what I understand a lot of the frontal lobe stuff is subtle. Personality things.”

“Sometimes subtleties have to be sacrificed to save the greater portion.”

“Yes, but not if they don’t have to be.”

He glared. I said, “This woman is the mother of little kids.”

“Each of our patients is important to someone.”

“Yes.” I said. I almost added “Precisely so” but thought better of it.

I felt I was about to be dismissed. I wasn’t going home with any unfired shots. “It even occurred to me I should have sent the woman away. Told her to get another ‘opinion’ from somebody and not to come back to Maricopa.”

“You would have told her that?” Thunderheads swirling between his eyes.

“No. I did not. It occurred to me, but I knew that wouldn’t be right. But I’m feeling like I would have to if I saw another complex case walk into her clinic. That’s why I’m here. I feel like I have to try to do something.”

“You’re thinking you know more about brain surgery than your professor!”

“No, sir. Not at all. But I mean I am a doctor. This woman was my patient, too. And I had knowledge about potential LIE STILL

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harm. Harm that might, for all we know, have been done.

And might have been avoided. At least made less likely.

What should I do? I know I can’t send away one of Mimi’s patients. Or at least I shouldn’t. Or maybe I should. I did ask Mimi if, considering what she had said about ‘Here we go again’ and the Coles trouble and all, if she might not ask someone to help her, or even send this woman on to another surgeon.”

“What did she say to that?”

“She made it pretty clear that that was not an option and that I should never bring it up again.” I was sitting up very straight. “So I had no choice but to come to you.”

He glared.

I said, “Dr. Lyle even has insight into her own problem.

But she’s not going to stop, not on her own. Maybe Ms.

McKenzie will be perfect in six months, but some patients aren’t going to be lucky. How could I do anything else?”

“You’re suggesting, Dr. Ishmail, that a respected professor of neurological surgery has some kind of innate flaw, some absence of ability—of even normal everyday ability—to think and see things in three dimensions.”

“Well, sir, it’s what she herself described to me. And it fits the other . . . the events . . . in the OR.”

“Does your diagnosis have a name?” he sneered.

I was well inured to belittlement. I said, “There are all kinds of apraxias. Some inabilities to do a specific task would be obvious, some would be subtle.”

“She’s a brain surgeon, for God’s sake.”

“Yes, sir.”

“She does not have an apraxia. It’s impossible.”

I said nothing.

“And the operation is finished. The patient is recovering.”

“But what about the next one?”

“Oh for crissakes.” He was silent, then said, “Does she know you’re here?”