Lie Still (26 page)

I imagine I did wait too long to ask for help. Someone from the OR suggested later that I had been several hours trying to find the aneurysm but I’m certain
it was not so terribly long. They can be so mean. Next
time I will call you sooner.

LIE STILL

189

I do get lost—sometimes have trouble constructing
things in my mind in three dimensions. I study the
scans and the angios, then go look into the brain, and
I cannot for the life of me picture where the thing lies
or a way to it. I was just born that way. It’s not really
anybody’s fault. It’s kind of a secret shame.

Fortunately, with the help of dear friends such as Ed
Adams and you, we can get these difficult situations
handled and help save these patients.

It’s a shame your practice doesn’t bring you to
Maricopa more often. I would like to see more of you.

Call me sometime soon. I could make you dinner.

Fondly,

Mimi

I slowly raised my eyes to Dr. White’s, fighting the urge to smile. I said, “She mentioned this.”

He nodded. “I was not married then. Not even attached. It occurred to me more than once to follow up on that, well,

‘invitation,’ but I never did. Probably all for the better, but right now I do kind of regret some of my scruples.”

I said, “A remarkable thank-you note.”

“Extremely so. Imagine a neurosurgeon who cannot navi-gate inside the brain. Ah, the ramifications! Brain surgery is about precision.” He sat forward again. “Precision, Malcolm.

Those gray and white lobes in your way when you’re looking for something are all damned important to your patient. This is not
belly
surgery where you can bag up all the chitlins and swing them off to the side so you can get a clamp around the aorta. Or put your entire hand around some tumor before you lop it out.”

I nodded.

“To be a good neurosurgeon—hell, even an adequate neurosurgeon—you don’t have to be lightning fast. But you do have to be
precise
. Expedient. This is not goddamned fishing. You have to know exactly where you’re going, how you’re going to get there, what you’re going to do, and how 190

DAVID FARRIS

you’re going to get back out. And if you don’t know those things before you start, you sure as hell aren’t going to get some miraculous
vision
halfway there.”

I nodded. I looked again at the letter. “Extraordinary. It’s almost like a Freudian slip.”

“Hell, Malcolm, it looks and reads to me like she was legs-in-the-air drunk when she wrote it. It’s more than Freudian. It’s confessional. She let out her deepest secret.

She
unburdened
herself.”

I nodded. He sipped his drink. “Would it be all right for me to get a copy of the letter?” I asked.

“Hell, take it. I want it gone.” Then, “I know what you’re thinking, too. ‘How come the old fuck squirreled this away for so long?’ Unfortunately it’s a simple question with a very complex answer.

“The short version is, I had nothing to gain and everything to lose. If the world sees me as attacking the reputation of a peer, my reputation suffers, not hers. On top of that, it would be said, by her lawyer, that I did it for monetary gain. Technically we were competitors, according to the law. She could get some prick trial attorney and try to take everything I’ve ever earned. Malpractice insurance doesn’t cover restraint of trade, Malcolm. And at the time, my daughters were at Cor-nell and Bowdoin. And they’re vastly more important to me than Mimi Lyle. No other neurosurgeon could be seen as completely impartial, but no one but a neurosurgeon could know the difference, or could tell her to stop or change her practice. Quite a bind.”

“A catch-twenty-two.”

“Yes. Worse. With deadly implications.”

“But now you don’t mind if I . . .”

“Malcolm, I’m through with practice. I’m going to be dead in six months. Mesothelioma.
Abdominal
mesothe-lioma. Even heard of it?”

“No, sir.”

“Neither had I. They’re giving me all their cis-platinum goddamn poisons and buck-up platitudes, but I’m dying.”

“I’m so sorry, sir.”

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191

“Yes, we all are.” He looked at me. “You ever study the stages of dying? All that happy horseshit?”

I nodded.

He nodded back. “I’m having a hell of a lot of trouble with it, Malcolm. I hurt like hell and I puke a lot. Losing weight daily. All those years of medicine. Watching people die. I always said if someone told me I had cancer they couldn’t cut out with a scalpel, I’d say ‘Fuck you all’ and hit the road.

‘Screw your chemofuckingtherapy. It’s been nice, see ya round.’ But goddamn if I ain’t in there on their schedules getting shot full of that crap. All to try to buy just a little more time. See, Malcolm, my younger daughter’s been trying to get pregnant. And she thinks she might be—finally. So if I can hold on for eight more months, I just might get to see my first grandchild.” He coughed a long racking spell. “Ha, with luck the kid’ll be premature! Ha! Shit . . .”

I was silent. He had a few tears in his eyes from the coughing jag. “So what they say about your time scale for what’s important changing on you is sure as hell true. It surely is, Malcolm. Things that matter to me now are very near term and
very
long-term. Cancer is like that. Besides, it will be hard for them to sue a dead man.”

“Yes, sir.”

“So have a drink with me. They told me to lay off but I told them to fuck off.” He laughed.

“No, thank you. I’d love to but I think I need a pretty clear head.”

“Yes, I suppose you do.”

“Maybe a rain check?”

“Anytime, Malcolm. You’re welcome back anytime.”

“I’d enjoy it. I really would.”

11

Timing—usually bad timing—is, logically, the lifeblood of
emergency medicine. Accidents, by their nature, are all
about bad timing, often on more than one level. Like Henry’s
asthma choosing the wrong day to act up.

Last week in the Quiet Little ER of Ogallala, Nebraska,
another of my regular stops, we had a little girl with “Failure to Fly.” While there probably is no good time to have
your two-year-old daughter wriggle out of her car seat and
open the car door, one of the worst has to be when you’re
taking a curve too fast, with her on the outer arc. She may
think she’s flying, but it won’t last.

By the time Dad, who was driving, got stopped and ran
back to the would-be Amelia Earhart, she had regained consciousness and was bawling appropriately.

The local medics brought her to me for a good going-over.

The nurse and I peeled her off her dad long enough to de-termine, despite Dad’s inability to do much more than stammer, that she had apparently been launched with enough
velocity to have cleared the gravelly part of the roadway and
made it straight to the grass. Our evidence, besides the grass
stains, was her complete lack of any injury worse than a
good goose egg on the side of her head. Still, one is compelled to get a CAT scan.

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193

While my little Sally Ride was in the scanner her mom arrived in my ER. Not fully hysterical, but significantly louder
than Dad had been. That’s when things got interesting.

Seems they don’t like each other. Stood along opposite
walls and worked entirely on blame issues. Lawyers’ names
came up. Neither was wearing a wedding ring.

The little girl checked out completely and I sent her on
her way. Mom had a pretty good grip on her. I learned by
observation a Useful Maxim of Marriage: The worst time to
launch your two-year-old daughter out the backseat of a
moving vehicle is when you’re in the middle of a custody
fight. There’s bad timing.

T H E B O O K O F M I M I , C H A P T E R N I N E

Now, mercifully, I can end
The Book of Mimi
.

After meeting Steven White, I went straight back to Maricopa for a unique kind of rounds: In the ER office I photocopied Mimi’s thank-you note. In the library I scrawled out three pages of recitations and explanations addressed to Marshall Bullock. At the ICU nurse’s station I made photocopies of the whole package—a set for Joe Kellogg and one for me. In the OR Business Office I sealed theirs into interdepartmental mail envelopes and dropped them in the “Campus Mail.”

I checked with my intern. All was quiet. I went home.

I spent the evening staring out the window of my town house. I pictured the faces of nameless professors at my upcoming meeting with the GME Committee. A Give-’em-hell call from Dr. Hebert would have been nice, but unlikely. Re-calling his advice to come out firing, I sat down to plan strategy.

In outline form I wrote lists of everything “Mimi” I could remember: her phone numbers, the personal artifacts one would find in her condo living room, her kitchen, her bathroom, her bedroom, certain nonobvious aspects of her anatomy. From my Surgeon’s Case Log and personal date-194

DAVID FARRIS

book I found a few clues to prod my shoddy memory. I was able to construct a passable list of our ventures to restaurants, each of which I knew to have been paid for with a Platinum Visa in the name “M M Lyle, MD, PC.” I found the receipt for my silver belt buckle still tucked under the cotton in the gift box. I added it to my file.

I went out and made ten more copies of Dr. White’s note. I made up a list of the committee’s probable questions, tried to think of all the angles they might take, then think through the implications of every possible answer and select tactics that would build my case. I tried to prepare my arguments, to anticipate Mimi’s unspoken counterarguments, to plan for anything they might throw at me. Both barrels.

When the day came I thought I was prepared. I was not, of course, calm. If there exists a medical resident—in actuality still a schoolboy despite years of full biologic adulthood—

who could be calm in such a setting, he—not I—should be drug-tested.

Dr. Montoya was politely professional, almost friendly, pointing me to my chair and introducing each inquisitor individually, smiling.

“You know why we’re all here,” she said.

One of the Unknowns, Dr. Aaron Kerlin, a graying man with half-glasses perched at nose tip, interjected, “We have charges of cocaine—”

Dr. Montoya cut him off. “Aaron, please. Dr. Ishmail, you’ve read Dr. Lyle’s letter. We would like to hear your version of these events.”

“Thank you, Dr. Montoya.” I looked about the group and took a deep breath. From my folder I took my yellow pad and flipped several pages to my final outline. It said at the top, “Slow down!”

I recounted my weeks as a faux-neurosurgeon. When I got to the faculty inquiry over the Keith Coles case, I said, “Initially I sided with her—we were, well, on the same side. We talked a lot about the case. Tragic as it was, though, it LIE STILL

195

seemed to us to be just another bad outcome in brain surgery. It seems to happen all the time. You all know, I presume, the investigation cleared Dr. Lyle in the case. That might have been the end of it but for something Dr. Lyle said to me after the inquiry was finished.” I looked around at the faces. “She told me the reason those types of operations go so badly for her is she gets lost inside the head.”

Some committee members were staring at me. “Her words: ‘Lost inside the head.’ At first . . . well, at first it scared me. I mean, lost in someone’s brain. But I more or less shrugged it off. Everyone has self-doubts. Especially after a patient dies.”

I then described Susan McKenzie’s case, working my way to, “I heard Dr. Lyle say to herself ‘Here we go again.’

I got scared again. I remembered what she had told me. I asked around among the OR people. They told me about a similar operation she had botched a few years ago. I tried to get her to seek some help with the adenoma—asked her directly—but she wouldn’t hear of it.”

“Yes,” one muttered.

“I tried to rationalize away my fears. I couldn’t come up with much else I could do. The operation went ahead but it didn’t go particularly well. We spent a lot of time spinning wheels. I realized in that OR that she was again lost.” I looked around again. “I sat and watched and realized that was exactly what was going on. ‘Having trouble constructing things in her mind in three dimensions’—again, her terms. It also explained the Coles case.

“I gave this a lot of thought. Believe me. But I had to do something. I felt I had to bring forth Dr. Lyle’s troubles with three-dimensional thinking. It occurred to me that someone with this kind of relative deficiency probably shouldn’t be cutting into people’s brains, at least not too deep. I set up an appointment with Marshall Bullock, the Chair of all U of A Neurosurgery, in Tucson. I told him all of this, exactly what she’d said and what I’d seen. I felt she needed some kind of surgical help, or backup, or a restriction of privileges, or something.”

196

D AVID FARRIS

“What did he say?” a stout woman asked.

“He told me he would, you know, take it under advise-ment. I did think it made something of an impression, though nothing seems to have changed. He seemed interested in maintaining her reputation.”

Two of them nodded. I went on, “I didn’t really feel I had done enough, but it was all I could do.”

“And since then? Have you heard anything more?”

“The next thing I heard was Dr. Goodbout knocking on my door in clinic for a urine specimen.” Two of them began leafing through the folders they each had in front of them. I saw one pull out a hospital lab printout, no doubt the report on my drug test. I kept my poker face.

Dr. Kerlin was finally allowed to speak: “There are written allegations from a respected faculty member that you proposed a date with her, saying you had some ‘pharmaceutical grade cocaine’ to share with her.”

I nodded.