Lie Still (33 page)

My voice was rising, so I took another breath. “I think I was on the phone,” I said, “and I may have been skeptical about her report, but I essentially got right up and went to the patient.”

“Essentially?”

“I was on the phone. I probably said, ‘Gotta go.’ I looked for my stethoscope. I
essentially
ran right in.”

“Why, if you had to guess, would she have written that you were slow to respond?”

I was silent. All I could think of was a conceit I had been taught about the diagnostic skills of nurses. When I was a junior medical student just beginning my clinical rotations, Cheryl Hemminger had passed down, in didactic format no less, a bit of wisdom I thought at the time to be rather chauvinistic. As Chief Resident of the medical service, hers was a mountainlike enlightenment that seemed lifetimes beyond LIE STILL

245

us. She chided me once for relying on a nurse’s interpretation of the breath sounds of an old man with emphysema.

She said I should rely on my own. “Nurses are many good things,” she said, “but they are not trained diagnosticians.

You are.” I knew I wasn’t, yet, but I also knew I wanted to be like Cheryl. I definitely acquired the attitude. It was part of the course.

I said, “I have no idea why she would have written that.”

I also thought to myself,
And I’m thinking seriously of giving up women.

“What do you mean you were ‘skeptical about her report’?”

“She said the kid was turning blue. It seemed so ludicrous I’m sure I thought she was wrong. I maybe made a face.”

She paused. “How long would you say it was between the instant she came to get you and you got to the patient?”

I thought. “Ten seconds. Fifteen max.”

“You had been on the phone. Do you remember who you were talking to?”

“Does it matter?”

She shrugged. “Whoever it was might be able to corrobo-rate how quickly you got off the phone. That’s the kind of thing that may not seem important now but could be later.”

“It was a friend. An an ex-girlfriend, actually. Shelley Batista, a nurse at Maricopa.”

“Could we contact her?”

“I imagine.”

“Do you remember what you were talking about?”

“Her ex-husband. She was telling me what a ‘dickhead’

he was, still wanting to see her.”

“If it’s too personal . . .”

“And her periods.” I was emotionally flailing. “Problems with heavy flow, and days of cramps . . .”

She cut me off. “Dr. Ishmail, I understand your being upset about all this. Any of us would be. The only reason to ask to reconstruct the conversation here is to be able to refresh her memory later. If she doesn’t remember the specific instance of talking to you that evening, I could say, ‘You were talking 246

DAVID FARRIS

about your ex-husband the dickhead and some problems with your periods and at some point in that conversation the ER

nurse apparently interrupted to say that a boy was turning blue. Do you remember that? And then about how long was it until Dr. Ishmail hung up?’ Do you see?”

I laughed a little. “Yeah, I suppose that might tweak her memory.”

“Apparently this Miss Batista and I could have quite a conversation. I believe ‘dickhead’ is the universal term for ex-husbands.”

I smiled. “Wouldn’t know.”

“Trust me.”

“All right, this delay, alleged delay, was fifteen seconds max. Half of which was spent getting from point A to point B. What else am I accused of?”

“She wrote, ‘I suggested Code 99.’ ”

“Well, I guess maybe she did. So what? It’s not like I was looking around wondering what to do. That’s the implication here, isn’t it? That I had no idea what to do? I was assessing the patient, trying to decide the proper course of action. She could have suggested high-dose vitamin C and a coffee enema. She could have suggested we skip out for a drink. I’d like to think I would have decided that a code was the better choice.”

“Again, it will seem from what she wrote that there was an inordinate delay.”

“There wasn’t.”

“Again, how long would you estimate? How long did you take to assess the patient and decide the proper course of action?”

I took a deep breath. “It always seems longer than it really is. I guess it would have appeared that I was standing and looking for ten or fifteen seconds again. But I was feeling for breathing, feeling for a pulse. To anyone else it might look like you’re just standing there.”

“Were you doing anything? I mean, physically. Moving in any way? Anything that another person could have seen?

Something besides thinking.”

LIE STILL

247

“Well, little things with my hands. To feel for a breath you put the back of your hand under the nose, but then you stand really still. The unwashed of the world may not see what you’re doing. Really, I was maybe praying or cursing to myself.”

“Then what? I mean, what did you do?”

I shrugged a little. “She asked if he was breathing. He wasn’t.”

“And what did you do then?”

“What did I do then? I did mouth-to-mouth breathing. I put my mouth on the boy and blew, just like they teach in CPR.”

“Wasn’t there some kind of apparatus there in the ER?”

“It wasn’t there. We got to that when the RT got there and found us one. But he needed a couple of breaths. I was there.

I breathed for him.”

“It was not there? You looked?”

“There was a piece of tape hanging on the wall where it normally lives. No breathing bag. I looked rather hard. I expected to find mouth-to-mouth unpleasant, and I was right.”

She frowned at Valerie, who nodded that she had indeed gotten that down. Someone in the ER would be hearing about reloading supplies.

She turned back to me. “When did you call the Code Blue, or Code 99, or whatever?”

“Code Blue. At least, west of the Rockies. I think Code 99

is an East Coast thing.”

“Okay. Code Blue.”

“Calling a code is like calling an army. You get four times as many people as you need. You might need a big response, in theory. But you don’t want to call for one if you’re not sure. Besides your looking like a jackass, you’ve taken a lot of people in the hospital away from other work, some of which might actually be important to other patients. And you’ve called wolf. Next time they walk slower. Time after that a few don’t show up at all.”

“So you delayed?”

“No I did not delay. I was assessing. He needed basic 248

DAVID FARRIS

CPR first. Calling a code is not the first step. Basic resuscitation is.”

“Okay,” she said, “but, again, time frame, if you can. How long did you do basic resuscitation before calling the code?”

“Less than sixty seconds. He didn’t have a pulse, he did not get a pulse right back, so we called the army.”

“And the rest . . .”

“The rest, I guess, is what’s on the Code Sheet. Continuous CPR. An IV. Drugs. Blood to the lab. Intubation. EKG

strips. Drugs. All the usual shit. We were about to quit, like I said, but that ‘one more time’ seems to have worked. At least for his heart.”

Sally drew a deep breath, then asked her assistant for “the report.” She plopped on the desk a stapled stack of several sheets, the top one a hospital form of some type.

“I’m afraid it gets worse. This is Robin Benoit’s full report,” she said. “Formally, it is an incident report—that’s the form on top—but she attached a two-page narrative. She gave it to me at our earlier meeting. It is, I’m afraid, very damning of you, your management of the emergency and all.”

I began to read, but she continued, “I made notes of the main points. Some of it brings up the earlier . . . allegations, but in more detail. If I may . . .”

“Go ahead,” I waved my hand.

“Robin begins by saying she hardly knows you, being here only a month and a half, but she had several concerns about Henry Rojelio’s care and, especially considering the bad outcome so far, she felt compelled to make a report.”

I closed my eyes and nodded, wondering how I had managed to end up in bed with another pathological liar.

“The first item of concern is this ‘apparent reluctance’ on your part to respond. . . . We already addressed that, but if you have anything to add . . .”

I shook my head.

“She repeats that you were—quoting—‘very slow to comprehend the situation and, even scarier, slow to think of what to do.’ She goes on, ‘At one point I actually had to LIE STILL

249

point out to Dr. Ishmail that the patient was not breathing.’ ”

She looked at me.

I looked back. “We’ve covered that, too. I was assessing.

I made conclusions. I began treatment. What else?”

She gave me a long look, then returned to her notes. “She described you as hesitant and unsure of protocols in running the code.”

I shook my head but made no other response.

“Could you respond to that, please?” she said.

I bit my lip. “Protocols are written to take thinking and decision making out of the loop in a crisis. They are not an end in themselves. I know enough from the protocols to help me make decisions. The nurses wanted to give certain things, I guess because they’ve been told ‘we always give them.’ Narcotic reversal to treat overdoses. Glucose to treat hypoglycemia. I hesitated. I said, ‘Okay, if you want to,’

knowing they were just a waste of time. It was clear that kid was not OD’d on heroin or insulin. Then one of them suggested a high-dose epinephrine regimen she had just read about. It’s new. She knew about it, I didn’t. We adapted the dose to his size and gave it a shot. That seems more like good teamwork to me.”

She nodded, then looked at Valerie, who nodded to sig-nify she had recorded my explanation. Sally said, “She says you failed in your first two attempts at tracheal intubation, at one point dropping the laryngoscope on the floor. Then picking it up and reusing it without washing it or calling for a new—”

That was it. I blew: “That’s just fucking beautiful,” I said loudly to the ceiling. They were silent. “It’s a perfect example—one sees the glass half full—the other . . . goes and pisses in it. In a high-stress, literally life-and-death situation . . . Can you imagine if the parents saw that?”

“They shouldn’t be able to,” Sally said.

“Well, I should certainly hope not. You know, two people watching that entire code—one could walk out to the parents and say, ‘Dr. Ishmail is such a putz. He nearly blew the intubation and your son would have died.’ And the second 250

DAVID FARRIS

could walk out and say, ‘Dr. Ishmail saved your son’s life.’

And you know what? They’d both be right.”

Sally took a deep breath. I realized I was bouncing in my chair, so I consciously stilled myself, then looked up. “What else?”

“She claims you made several derogatory comments about the boy, referring to him as a ‘loser’ and a ‘future slimeball of America.’ She says the nursing team ultimately instituted a protocol of high-dose epinephrine, which you had apparently never heard of, and it was this that brought back his heart. You addressed that . . .” She flipped her note page.

“In the final paragraph she says she still wonders if the whole event might not have been avoided if you had not insisted on giving the epinephrine. She says she asked you if that might be not a good idea in a patient on such a high dose of Ritalin, but you told her not to worry.” A long pause.

“Is that it?” I asked, eyes closed.

“Yes.”

I scooted back in the chair and leaned forward onto my knees. “And what becomes of this report?” I asked. “I mean, it’s obviously damning. It’s totally false. I feel like throwing up, like I’ve been kicked in the kidneys. I have to know, though, to whom or I guess in what form I have to respond.”

“For now, to me,” she said. “It is my job to investigate all serious or potentially serious incidents and allegations.”

“But then what?” I said. “I mean, I suppose my job here is on the line, but you don’t—no disrespect intended—you don’t have that final authority.”

“No, that’s true. But I am required to report immediately to the Executive Committee any situations I believe should be dealt with immediately.”

“Who is on the Executive Committee?”

“Jerry Schteichen, the CEO, Stu Bernhard, the President of the Board, and Morris Cunningham, the President of the Medical Staff.”

“When does the full board next meet?” I asked.

“This needs to be dealt with immediately, Doctor. I know you’re scheduled to work most of next week. As you know, LIE STILL

251

you were taken on here on a conditional basis. Your credentials are not sterling and it will not take much for the medical staff officers and the board to terminate the arrangement.”

“So, I give you my response right now? She takes notes?

This is it? Judge, jury?”

“We’re just trying to find out what happened. Any actions will only be taken based on what happened.”

“Lovely,” I mumbled. I straightened up. “Okay, I’ll respond. But I want the notes to say, too, that I don’t think this process is fair. At all. I was invited here to discuss the events and make mutual notes. Now I am to answer charges. I should have time to give a more complete, better-prepared response.

I mean, I want the right to add, to change, later.”

“So noted.” Sally nodded to Valerie, who just went on scribbling as fast as she could.

“Jesus, where to begin . . . One,” I ticked my finger, “Ritalin. She never said a word to me about Ritalin. I don’t think I ever knew he was on it. You should check my chart notes . . .”

“They’re there,” Ms. Marquam said, pointing to the stapled stack.

“Well, you check them. Believe me, I write thorough notes. If Ritalin came up I would have mentioned it.”

“Shouldn’t you have known all his meds?”

“I’m sure I did. That is, I’m sure I checked. He’s a pretty disturbed adolescent and he may not have told me everything. His parents weren’t there. Ms. Benoit
never
said a word about it to me. More important, though, it would not have made a twig of difference. Not one iota. If a kid’s asthma is bad enough to need sub-Q epi, he gets it with or without Ritalin. For that matter Ritalin and epinephrine are chemically related. In one sense Ritalin might do some of the same things. In any case, I’ve never heard of that as a contraindication, but if I had more time I could research that for you. But I do know for sure breathing comes first, and asthma, when severe, is a state of not . . . fucking . . .