Lie Still (24 page)

Still, the stakes of the game had gone beyond my means.

“The committee is not obligated to identify sources,” he said.

“Do I have a choice?”

“Of course you do. I cannot make you micturate into a specimen container, can I?”

“But . . . surely there’s a catch there,” I said.

“A refusal is a direct and willful violation of your terms of employment and, given the nature of the issue and the extent of the accusations, I believe your employment would be terminated very soon indeed.”

“I’d be presumed guilty.”

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“Not precisely, but the net result would likely be identical.”

“I’m clean, Dr. Goodbout.”

“I surely hope so.”

“But I object to this process.”

“Unfortunately, there is no better. Your vindication, of course, would be quickest with full cooperation.”

I held out my hand. He got a urine cup from the exam room cupboard and stiffly handed it to me. I reached for the door latch.

“No, no, Dr. Ishmail. Here.”

“Here?”

“Unless you would prefer that we walk together into the lavatory at the end of the hall, which I imagine would be significantly embarrassing for you, in front of the clinic nurses, and all, and may well begin a flood tide of rumors.”

“Better not to do that,” I said.

Dick in hand, self-consciously working not to overfill the cup or spill, I had a flashback to the occasion of a similar posture in the same building, Mimi kneeling in front of me, sucking me into total submission. At that moment in the surgery clinic, picturing the scorched earth that would come from whatever version we chose of the final battles, even that memory was rendered painful.

Once I had peed into the cup under Doug Goodbout’s gaze, the rest of the clinic seemed entirely banal. As soon as I signed off the last patient I bolted home and grubbed through my boxes of files and papers that had been forgotten in the corner of my bedroom. Miraculously I was able to dig up my employment contract and the papers I’d been given on Day One covering Rules and Policies. Finding it was a painful victory.

At least it was entertaining: Under the heading “Unprofessional Conduct shall include,” it said, “. . . (d) Habitual intemperance or excessive use of cocaine, morphine, codeine, opium, heroin, alpha- or beta-eucaine, marijuana, novocaine or any of the salts, derivatives, or compounds of the foregoing substances, or of alcohol or alcoholic bever-LIE STILL

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ages, or of any other habit-forming drug or substance. I had to look up eucaine. I could imagine no recreational use for novocaine. I wondered what use of cocaine they would consider to be not excessive, but thought it best not to ask.

I left a message at the office of a Dr. Anita Montoya, a gastroenterologist who chaired the GME Committee, asking her for a meeting as soon as she could spare me ten minutes, and would it be possible to get copies of whatever she had about me in writing?

I thought about trying to get a lawyer but I had no money and probably no case. From my reading of the contract, Section VI, “Employment at Will,” pretty much gave them the right to fire me any minute of any day for any reason they chose or for no reason at all: “. . . may dismiss at any time without notice and without specific cause . . .” I found that painfully convincing.

Dr. Montoya’s secretary paged me at precisely 9:00 the next morning. Dr. Montoya was hoping I could get away from whatever I was doing at noon so we could chat. When I asked my Attending on the Vascular Services if I might be excused for a time for “an administrative matter” it was clear from his facial expression and tone of voice he was at least as aware of the details as I.

Dr. Montoya could not have been nicer, but the message was still brutal. We first danced around who my accuser was; I wanted to look surprised that Mimi Lyle would have anything bad to say about me.

Of course I was hoping for confirmation that my urine test had been negative, but here the acting was even more important—I had to pretend I knew it would be. She did not mention it.

Next we reviewed the way my ass was hanging by a thread: “From my reading of my rights,” I said, “you could fire me this instant for, say, wearing brown shoes.”

“Technically, yes,” she said, “I guess you could put it that way. It’s part of everybody’s employment contract here.”

“You have the same clause?”

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“I think everyone employed by any government body in Arizona has it. That does not mean, though, that you do not get heard. We are ethical.”

“So, ethically, I get due process,” I said.

“Believe it or not, we want to treat you fairly. Primarily, though, you and I are meeting to discuss process. How the allegations will be handled.”

“Okay.”

“And first on that list”—she checked some notes—“I am to go over the allegations.” She handed me a copy of a letter. “Dr. Miriam Lyle, your Attending recently on Neurosurgery, has made this formal complaint.”

It contained nothing surprising:

Dear Dr. Montoya and Members of the Committee:
I wish to bring to the attention of the Committee on
Graduate Medical Education a most disturbing and
inappropriate set of actions by Dr. Malcom Ishmail, a
PGY-2 resident in general surgery.

For a period of six weeks, Dr. Ishmail was the resident
on my service. This, of course, entailed working closely.

I was polite and pleasant. I would be guessing were I to
attempt to say how Dr. Ishmail could have mistaken this
for even simple flirtatiousness, but apparently he did.

On or about the third week, Dr. Ishmail began to
ask me for dates. Because of our faculty-resident relationship, this was, of course, extremely inappropriate
and I politely but firmly declined all invitations and
told him directly that his requests were inappropriate
and unwelcome.

By the fifth week, however, Dr. Ishmail’s “tactics”

had changed. When otherwise alone in my office or in
clinic, he several times put his hand around my waist
or on my hip and made verbal suggestions of ever-increasing explicitness. This happened several times
despite my telling him on each occasion that his behavior was inappropriate and unappreciated.

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The last straw came during the final week in clinic
when we were momentarily alone. He came up behind me, put his hands on my shoulders, and said
very quietly, “I’ve got two grams of pharmaceutical
freebase and a very lonely hot tub at my condo. Want
to fuck?”

I should have slapped him, and now wish I had. I
have since learned that “freebase” refers to crack cocaine.

Between that incident and this writing I have been
able to avoid being with Dr. Ishmail in any more private situations. It is my sincere hope that Dr. Ishmail’s
behaviors be dealt with promptly and forcefully; I do
not believe immediate termination from the residency
would be too harsh a measure.

Respectfully yours,

Miriam Lyle, MD

When I looked up Dr. Montoya was watching me intently.

I tried to look puzzled, knowing I’m not enough of an actor to have succeeded at looking shocked.

“All right,” I said with a deep sigh. “Process. Do I answer this now? To you?”

“No. Well, I mean, you can, but you’ll probably want to give it a little thought.” She explained my options under the University Discipline Policies. I told her I wanted the short-est course to exoneration. She smiled and nodded.

“The full GME Committee is set to meet next week. We could give you a hearing then.”

That night at home I got a surprise call from Dr. Dick Hebert, Chief of the Trauma Service and Chair of Surgery—

my boss. He and I had hit it off well when I’d come to Maricopa as a fourth-year medical student to interview for the residency. He was the main reason I had chosen Maricopa over the better-known hospitals in California.

Dr. Hebert was, in his version of events, a “Cajun castoff,”

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someone his swamp brethren would not take back into the family once he got a couple of degrees “out West” in Texas.

He told us his only choice was, like a vagabond of the last century, to keep heading west. He eventually found Phoenix, where Texas credentials were at least preferable to those from either coast.

He would speak among his personal favorites with a thick twang, then turn it off in favor of thoroughly proper academician’s diction and pronunciation when he had to face—

again in his terms—the “unwashed.” We residents rapidly learned that the twang meant you were on his team and in favor. If it stopped, you were about to get a new bodily orifice or the equivalent of a pink slip.

He was still in Washington and—most important—still twanging:

“Ishmail, boah, what the hell kinda trouble you causin’?”

“I—”

“Neva mind. I know what kinda trouble you causin’. I heard all about it. I’m not sure you know the size o’ the gator you done grabbed onto. That woman, shit, son, she had a gun I’m thinking she might try to keel you.”

“Yes, sir. I obviously . . . felt pretty strongly that she was . . . has a problem. . . . And ethically—”

“Son, I would hate to lose you. Especially over her. She ain’t worth it to you or me or anybody else. Now I dictated a letter to the damn committee. Told them you were a goddamn shining star of surgery, never had a problem, excellent reports from all your rotations, promising future, all that.”

“Thank you, Dr. Hebert.”

“Well, it’s the by-God truth. But it ain’t gonna be worth a fuck if they think anything she is sayin’ about you is true.”

I swallowed. I said, “Well, she seems to be pretty good at lying.”

“Mostly, way I hear it, she been lyin’ about why her patients ain’t doin’ well.”

“That’s what I’ve been trying to get—”

“You got any ammunition?”

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“Ammunition?”

“She’s tryin’ to fuck you, son. You gonna sit in front of the GME Committee pissants and say, ‘No, no, no, I never done it?’ ’Cuz if that’s all you bring to the party they’ll shit-can you right on the spot. You better be firin’

both barrels. You better be explaining
why
she’s tryin’ to fuck you.”

“Yes, sir.”

“And Malcolm . . .”

“Yes, sir?”

“I will not be able to snatch your ass back from the fire if the GME Committee says AMF.”

“AMF?”

“
Adios,
Mutha Fucka.”

“Yes, sir—er, no, sir.”

Fortunately, or unfortunately, I spent the next day, a Saturday, helping Brett Elliott, a part-time faculty member, do a portacaval shunt, a particularly long and dreary operation done to reroute blood away from a cirrhotic liver, usually on alcoholics. Such shriveled livers allow little blood flow through them and the back-pressure in the gut becomes its own problem, leading eventually to massive bleeding into the GI tract. Given the dismal prospects of people with liver failure regardless of our interventions, surgeons have vehement and entertaining arguments over the value of such operations.

I was well removed from that specific fray; my entire role was to pull—hard—on the pickled liver so the real surgeon could see under it. Most of what I saw for six hours was the large brown mole on the back of Dr. Elliott’s neck. It was mindless, stupefying. My own problems resumed their rightful place in my vision.

Dr. Hebert said I would need both barrels. I didn’t have a single barrel.

It was not difficult to figure out the new Game. A direct denial from Mimi could only go so far; she needed to dis-credit the report. Her twisted version of our relationship—

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me a suitor, offering drugs, spurned and hurt, now wreak-ing his revenge—recolored my accounting of her. And just mentioning drugs guaranteed an overblown response.

While she probably figured we were too far out from our trysts for my urine to light up, it cost her nothing to roll my dice.

All of which nicely turned the tables. Just like her, I would be left, after denying every red-blooded act back to and including masturbation in puberty, having to satisfy my judges that her version of me was all smoke screen and deflection.

What to do? I couldn’t have backed off if I had wanted to.

My only hope lay in substantiating my claims about her.

Brett Elliott’s mole bobbed and waved in front of me.

Stupor can be productive. Notions at the lost edges of consciousness can leap forth: What do you need to make a case? Witnesses.

Other than OR staff, who, as nonphysicians, would carry no weight, there
were
two possibilities: Ed Adams and Dr.

Dreamboat.

At home that night, despite the late hour, I typed out my formal denial, though I knew it to be lame from the start. In any dance, after all, each partner must keep step:
Dear Dr. Montoya and Members of the Committee:
It is with shock and dismay that I read the heinous accusations you have before you. The members of the
Committee may or may not be aware of the recent investigation of Dr. Lyle’s clinical abilities. It seems she
has fabricated these charges as retribution for my participation in that process.

All I can offer at this point is my most fervent denial
of any such unwanted sexual advances, of any “groping,” of any such lewd suggestiveness, and of anything
to do with any illicit drugs!

I beseech the Committee to conduct its investigation
thoroughly but also promptly. I want my name cleared
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as expeditiously as possible, but also want the falsehood of these accusations brought to light and these
lies dealt with appropriately.

Respectfully,

Malcolm D. Ishmail, MD

The next day, Sunday, I found a Faculty Directory on the ward during rounds. I phoned Dr. Adams’s home.