Lie Still (29 page)

I nodded.

Henry’s nurse poked her head into the cubicle to tell me the Rojelios had returned and she had asked them to wait for me in the private family room.

I mumbled to Monty, “Speaking of no fun.”

She took the cue to turn back to her own troubles, but not before giving me a sympathetic shake of her head. “You’ll
love
them,” she whispered. On my way to the nurse’s desk I pilfered some of their overcooked coffee in one of the ubiq-uitous Styrofoam cups.

I tried to prime myself for what a cynical med school classmate had dubbed a “compassionate moment.” You’re supposed to have simultaneous professional detachment and deep personal empathy. An oxymoron carrying, in this case, very high stakes. I was coming up blank about what I could actually say. The Rojelios knew me only as the party responsible when their son nearly died.

Empathy. A laugh. How could I empathize with a parent whose child had just suffered a near-lethal event? I, who was years from having children or even a romance I would be willing to tell my mother about?

Styrofoam coffee in hand, I ventured to the family waiting room where the Rojelios waited. Such rooms ought to be soundproofed and have rubber walls. They are the places of wailing and gnashing of teeth. This one was like most: poorly furnished, with plaid-clothed and multi-stained chairs and sofas, proffering the faint but unmistakable aromas of body odor, old cigarettes, and what was probably aged vomitus.

I found an apparent mother and father, a school-aged boy, and three children under five. The adult male had to be Daniel, Henry’s father. He was leaning on the far wall, arms crossed, scowling, and tapping one foot with a machine-gun pace. The only light in the room was a fluorescent bank in the middle of the ceiling.

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Henry’s mother had barely made eye contact with me before looking to Daniel for action, but it was long enough to convey her fear. He sneered at her ever so briefly before turning to me. “Yes?” he said.

“I’m Dr. Ishmail. I was the physician at the Glory Emergency Department who treated Henry last night. We didn’t get to meet then. I guess you had left.”

“Yes. I do that. He goes to your ER all the time. You never make him better. Anymore I just drop him off.”

I sat down and looked back and forth between the two of them, not struggling for words, but wondering how much to tell them, and where to begin. They took the chairs opposite mine, shooing away two small children. Apparently Daniel was the source of the cheap cologne in Henry’s cubicle.

I leaned forward in my chair, wanting soothing words to flow right out, but they didn’t. They never do. It’s always forced. There was an awkward pause, then finally I used the standard opening: “He’s going to be fine.” It’s better to stretch the truth than kill the hope, we’re told.

“They said he quit breathing,” Daniel said.

“Yes, that’s true. He did quit breathing, though we don’t know exactly why.”

Henry’s mother blew her nose.

“But then you . . .”—Daniel waved his arms—“you revived him, shocked him back, whatever. You got him back again.”

I explained Henry’s code in short form. Henry’s mother spoke to Daniel in Spanish. He turned to me and said, “She wonders when he wakes up.”

“Your son . . .”

“Stepson,” he corrected me. “My name is Mendoza. He is Rojelio.”

“Your stepson,” I said, “is, well, his brain is sick. Injured. He’s in a coma.” Henry’s mother obviously understood the term. Her lip began trembling. “It is very early, though. Many times such patients wake up fine.” Daniel’s eyes narrowed.

I went on, “Frankly I’m not entirely sure what happened to Henry. As you probably know, asthma is a severe con-216

DAVID FARRIS

striction of the tiny muscles around the small air passages inside the lungs. It’s an overreaction to something. Something inflammatory, like a virus or a pollen or something.”

I was making my hands into tubes and squeezing them progressively tighter. “Patients don’t move enough air. They get into trouble from lack of oxygen. Some get into serious trouble. Some die. It’s called bronchospasm. Spasm of the bronchioles, the tiny airways.”

“Yes, we have heard all this.”

I took a deep breath. “In any case, your son had stopped breathing, and I’m afraid his heart had stopped also.” It made me feel better to unburden even this much.

Daniel’s eyes were ice. “They did not tell us this. That his heart stopped.”

“We got it back. We did CPR—chest compressions.” I put my hands together and mimicked pushing on my own sternum. “It was a little rough, but we got his heart going again.”

He said something to his wife in Spanish. She replied, casting glances at me. “Did he have a heart attack?” he asked.

“No. That is entirely different. That is when one of the arteries to the heart gets blocked off. There is no sign Henry’s heart muscle has suffered any lasting injury. For a while we had him on a drip—a continuous infusion through the IV—

to stimulate the heart, but they’ve been able to turn that way down and off now.”

He began to translate to Henry’s mother but she nodded, staring only at me. “Then why he is not waking up?”

“Well, that’s not entirely clear right now. For some period of time—a short period, but we can’t say exactly how long—there was no blood flow to the brain, then during the CPR, the rescue work, there is some flow, but it’s less than normal. The brain needs constant oxygen. It may have been injured. Possibly permanently. How much, we won’t know for a while.”

“A stroke?”

“Well, something like that.”

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“We have a lawyer, you know,” he spat at me.

“Well, no, I did not know, but okay, now I know.”

Lawyers are not generally helpful in ICUs, but there was nothing I could say.

“Ted Priestly. Perhaps you have heard of him.” Apparently Daniel wanted me to feel fear.

“Will he be involved in any decisions?”

“What do you mean, decisions?”

“Well, decisions about how to proceed. How far to go.

Your boy is critically ill. He could need surgery. He could need care for many weeks. Even years. Ultimately he may not live. You may have to—at some point—decide . . . decide how far to go, when to let go,” I said, realizing only too late that much less would have been more than enough.

Henry’s mother jumped from her chair, swallowed a loud sob, and began pacing the little floor space available.

Daniel’s face was impassive, though. He stared at me and narrowed his eyes. Mrs. Mendoza crossed herself and prayed to the ceiling as she paced. Daniel spoke to her and she froze.

She turned to bore into me with her eyes and said, “
No
máquinas.
” No machines. I nodded very slightly.

Daniel said, “Sit down,
corazón
.” His tone was cold. She continued looking at me. I nodded again. He made an emphatic gesture to the chair. She sat.

Daniel turned to me. “You will not let him die.”

“Of course not.” I said. “First of all, I’m no longer his doctor. The Maricopa doctors are in charge now. You will be talking with them. But I can assure you they are doing everything possible, everything imaginable to help your boy.

The main doctor in the ICU will be Dr. Montgomery. She’s a friend of mine. You can trust her completely.” I was aware my reassurance was empty since they had little reason to trust me.

“Can we see him?” his mother asked in halting English.

“Yes, you’ll be able to see him almost any time,” I said.

My beeper went off. It was a number I didn’t recognize.

The door opened and a man in a clerical collar came in.

Henry’s mother jumped up and ran to him. They clasped 218

DAVID FARRIS

their four hands together between them. He murmured something to her, then said to me, “I’m Father O’Donnell, the parish pastor of the Mendozas.”

I introduced myself. “I was just explaining to the Mendozas what we think might have happened.” Daniel barely looked up at the priest.

“They can fill me in. I’m here mainly to pray with them, anyway.”

“Yes, I’m sure that will be helpful for them. I was just finishing—gotta go answer a page. Mrs. Mendoza asked about visiting in the Pedes ICU. They can go in almost any time but the nurses always want you to ask if it’s an okay time. There’s a phone by the door. Sometimes they need a few minutes to get him taken care of, sort of ‘tucked in.’ ”

There was a silence. I rose to leave. I said, “I’ll try to be around to help keep you up on any developments as things change, but, like I said, the Maricopa doctors are now making the decisions.”

Daniel glared at me, then looked away.

My belated rapport-building was a four-star failure. We’d gone from mild suspicion to poorly suppressed acrimony.

To get out the door I had only a second lame cliché: “Let me know if there’s anything I can do for you.”

They stared.

Reentering the PICU, I kicked at the slow-moving automatic door but missed.

Mary Ellen was writing in a chart at the nurses’ station.

I said to her, “Thought you’d want to know: Seems I started a fire in the waiting room.” She looked up. “Let’s just say Henry’s family seems a bit hostile right now. And Dad—Stepdad—made it a point to tell me they have a lawyer already.”

She shook her head, looked back at the chart in front of her, and said, “A lawyer, huh? Maybe he’s cute.”

“Hey, no cruising for HOs on my disaster.”

“Sweetheart, hot ones are few and far between. A girl’s got to get ’em where she can.”

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“Yeah, perfect. On the tails of my disaster he’ll get rich on a contingency fee from a settlement for a life sentence
and
lucky with you. Maybe I can give him a blow job, too.”

“Malcolm, I’ve never even laid eyes on the guy. Don’t be so paranoid.”

“Paranoid? Any reason you can think of I might be paranoid right now?”

“Sorry, Malcolm. You have been having a bad run lately.”

“Yeah. Maybe the
Book of World Records
has a category for Medical Black Clouds.”

She smiled her sympathy.

I picked up the phone beside her and answered my page.

When I hung up I sighed. Mary Ellen asked me what it was.

“The Glory Hospital administration,” I said, “kindly requesting I find a time in the next few days to sit down with one of their higher-ups and ‘make some notes’ about what happened to Henry Rojelio.”

She gave another sympathetic look.

“So be sure to let me know if you figure it out,” I said. “I could use an answer or two.”

I didn’t want to leave just yet. Being at Maricopa, bent to a tough case with Mary Ellen, was still more “home” than our town house. “What else you got in here?” I said.

She looked up at me. “Celia Weatherill is back.” She nodded over her shoulder to the middle cubicle.

I peeked around the partition. There lay an infant, wide-eyed, puffy-cheeked, and hooked to a ventilator via a tracheostomy.

“She’s the ex-preemie you’ve been talking about?”

“Uh-huh. Brain hemorrhages. Went home, despite her bad lungs, for all of eight days. Got respiratory syneytial virus, went on to bronchiolitis obliterans.”

“Wherein . . . your terminal bronchioles . . . ?” I waved my hand in a circle.

“Get obliterated . . . Right. And she suffocates internally.”

“Might as well smoke,” I said.

“Yeah, but this is like four packs a day for fifty years.”

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“You know, I think you’re kind of a magnet for these kinds of cases.”

She eyed me. “We all have our talents.”

I nodded.

“She hasn’t been free of some flavor of pneumonia—nor home, mind you—for the seven months since then. We had her over to the St. Elizabeth’s home for about five days, on a portable vent, but she bounced.”

“Seven months?” I said.

“She was only supposed to have been born four months ago. But here’s the good part: Single mom. Dad was none too sure about this fatherhood thing to begin with. Took a powder when the going got tough. She has a new man and . . .”—she leaned toward me—“I think he’s trying to whore her out.”

“Lovely. And why are we doing this?” I said, motioning toward the baby.

“You know, that’s exactly what Dr. Frank asked me not more than two hours ago.”

“Who’s he?”

“He’s the pedes infectious disease guy. We haven’t even consulted them formally, but he knows what bugs every kid in the hospital is growing out ’cuz he goes and checks on all the cultures.”

“Yeah, I remember him,” I said, picturing him in my mind, a tall, gangly professor with a short beard, thick kinky hair, and eyes that sparkled when he was discussing an interesting germ.

“Well, on his way through here, while we were writing up notes and orders after rounds, he kind of grabbed me by the elbow, jerked his head toward Celia, and said, ‘Why are we doing this?’ I just kind of shrugged. He said, ‘She ever going to get out of here?’ I said, ‘No. Not in my lifetime.’ He said,

‘Just a tragedy. Seems she ought to die, doesn’t it?’ I nodded. He turned to go, but then he turned back. He said, ‘Almost forgot. The sputum culture you got on her two days ago is growing resistant stuff. Why don’t you put her on gent and ticarcillin? Better get peak and trough levels, too,’ and he left.” She stared at me.

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I nodded and smiled. “The great medical oxymoron.”

“Exactly,” she said. “We’re doing the wrong thing keeping her alive, but here’s the right antibiotic to kill off her pneumonia. It’s classic. The drugs are accomplishing the wrong ends, but it’s all we know how to do. We’ve lost our ability to not treat things.”

“Nah. I don’t think we ever had it. It’s a primitive reflex we can’t suppress,” I said.

“Pure brain-stem? Maybe. But I thought there was a rumor going around that we had evolved.”

“Only our feet,” I said.

She laughed. “You know it used to be said that pneumonia was ‘the old person’s friend.’ ”

“Sure, but I imagine our ancestors would have happily killed a lot of pneumonia if they’d had ticarcillin,” I said.