Lie Still (34 page)

breathing.”

252

DAVID FARRIS

I paused to catch my breath. “Two. The shot. I never insisted on giving him anything. He apparently has needed epi before, got good results, and now both he and the staff think that’s what he needs. He has no patience for inhalers. Probably why he’s always in the ER, won’t use them at home, either. So, in truth, Robin came to me asking for an order for sub-Q epi. She told me that’s what it had taken before, that in fact he
wanted
a shot, and being as weird as he was, we’re all better off if he’s home from the ER.”

“Why do you say he’s weird?”

“Her words. Not mine.”

“Was he weird to you?”

“Well, exhibitionism at thirteen, pseudo-seizure syndrome, and he apparently likes getting needles.”

“Do you think this supposed weirdness got in the way of his getting good care?”

“Oh Jesus! He got excellent care.”

She was staring at me.

I took a deep breath. “The facts now: Subcutaneous epinephrine is still the best, most immediate, most effective treatment for an acute exacerbation of asthma. Sure, we’d rather get it under control with lesser treatments, but when you don’t have time, because the kid’s too sick, or reason to think the lesser treatments are not likely to work, as in Henry’s prior ER visits, it is perfectly acceptable to ‘jump,’

if you will, straight to the gold-standard treatment. So, no, I’d say Henry got excellent care, despite his ‘weirdness.’ ”

“Tell me about pseudo-seizure syndrome.”

I recounted what I had read about the intractable course and progressive nature of the disease. When I ended with the predictability of early death, Sally Marquam sat staring blankly. Finally Valerie leaned over and pointed to something in Ms. Marquam’s notes. She looked up. “What about the names?”

“The what?”

“Slimeball, loser . . .”

“I did not ever use those words about Henry. Actually I kind of felt bad for him even while I was trying to treat his LIE STILL

253

asthma. He seemed neglected. God knows names like those are pretty common in ERs, especially with patients who seem to live there. Maybe she figured I must have used them. One of your nurses used the term ‘loser.’ ERs are the last refuge for people with inadequate personalities, and we all get pretty jaded. But like I said, I don’t think I used those terms about Henry.”

She was again still. Again Valerie pointed to something in Sally’s notes, but she shook her head. After a few seconds Marquam asked, “Why do you think it happened?”

“I really don’t know. There’s a long list of physiologic events that can give kids sudden dying spells: laryngospasm, bronchospasm. Epiglottitis for crissakes. Unfortunately it’s all guessing. We have no evidence, no data. Not a single physiologic fact we can rely on.”

“What about an allergic reaction?”

“No one is allergic to epinephrine. It’s the body’s internal signal for ‘red alert.’ It jacks up all the control dials to Max.

It’s a naturally occurring hormone,” I said. “Everybody has it. It’s probably the same chemical compound from earth-worms on up. Hell, we use it to
treat
allergic reactions. Real ones.”

“What about the other, the nebulizer?”

“Albuterol is chemically related to epinephrine. Maybe it’s possible but I’ve never heard of an allergic reaction to it. Besides, he’s used it a thousand times without problems and got into trouble well after the neb.”

She nodded, staring beyond me. There was an odd pause.

She suddenly looked at her watch, then said, “It’s late. I need to return some calls. I think we’ve covered what I needed. I will present your explanations to the Executive Board tonight.” She rose and gave me her hand to shake.

“We’ll be in touch. Let’s be sure to continue to work together on this. Not make enemies of each other.”

“Sure,” I said with a hint of sarcasm. Then, despite myself, “As soon as your people quit lying.”

Sally Marquam turned stony, then pivoted on her heel and disappeared.

254

DAVID FARRIS

Valerie and I stared at each other. She said quietly, “A reporter’s been calling.” She rolled her eyes toward her boss.

“She promised him she’d call before five.”

I mustered a tin smile. “A reporter? Like—news reporter?”

She nodded.

I wanted to die.

15

Four weeks ago I did an odd thing: a nine-to-five work shift.

Who would have thought I could do it? Eight hours. We even
had a regular lunch hour and a sort of coffee break. The horror, again.

This playing Pandora and peeking into the Box of my past
has unsettled me enough that I’m thinking I might be able to
make some changes, shift the end results a bit. Figuring I
was qualified to do “urgent care” kinds of things, I called
the woman who runs the family clinic in little Othello,
twenty-seven miles due west of Hooker, wondering if they
needed any part-time help.

Turns out they were looking to expand their hours. Their
doctor, Annie Parrott, knew I had the reputation in the area
as the local boy with all the potential. She kindly left out the
local intonations about my having blown it along the way.

She had heard good things about my ER work. Maybe we
could try a couple of midweek days. She sounded pleased. In
my shoes it was flattering.

When I met with Annie and the clinic director, Cathy
Schendt, I made no bones about my lack of training in primary
care. They said half of what they did in the clinic was identical
to my ER work. Which was to say that most ER work in a small
town is primary care. The rest would be preventive counsel-256

DAVID FARRIS

ing—which most patients would ignore—and long-term management of usually stable conditions like hypertension and diabetes. We all acknowledged I didn’t know enough—yet—to be
independently functional, but Dr. Parrott would mentor me
along. She would work with me side by side for the first few
weeks, then be available by phone for an undefined stretch of
weekdays if we all wanted to keep up the program.

In the outback of the prairies, full printed credentials apparently aren’t necessary if you seem to know basic medicine and have someone to back you up.

Even the first day I had a Case Worth Talking About. Mrs.

Jenny Gabrekiewicz, though eighty-three, did not present
much of a physiologic challenge. She came into town from
her ranch for—her words—“a little poke and a prod.” She
said, “I left them boys out there with all them cows, so God
awmighty knows what’s going on.” Then, in anticipation of
her pelvic and Pap smear: “Doctor—hell, you ain’t old
enough to be no doctor—you better get me up on the rack
and check the dipstick. And no funny stuff.”

I explained we would do that last; I needed to go in order,
top down. As I was looking in her ears she said, “I’m down
to one tit, you know. They lopped off the left one some twenty
years ago. Hell, you was probably in diapers.”

“Naw, I was, let’s see, well, it’s a good guess I was in
school. Now I’m gonna listen to your chest, so don’t talk.

And take deep breaths, please.”

“Aw hell . . .” She waited until I took the stethoscope from
my ears.

“You can talk now,” I said.

“Good. I hate it when I can’t talk.”

I smiled at her. “I might have guessed that.”

She grinned.

Her exam was entirely unremarkable except for the mas-tectomy scar. The older operations took most of the underlying muscle, and the deformity and weakness are impressive.

I wrote the prescriptions to refill her medicines. “Guess
you’re all okay for now. Come back and get your blood pressure checked in a few months.”

LIE STILL

257

“You married?”

“Not yet.”

“Well, my granddaughter is getting a divorce. Coming up
from Colorado Springs next week. Her and the baby. You
oughta get on her dance card pretty quick, young man, ’cuz
she is a real looker.”

I smiled.

H E N RY RO J E L I O , DAY F O U R ( C O N T I N U E D )
From Sally Marquam’s meeting-turned-trial, I stormed out of the Glory administrative wing, mouthing silent epithets to myself as I went. As painful as the allegations in Robin’s report had been, there were just enough grains of truth underneath to make them extraordinarily dangerous, however false the implications.

Slow to respond? As I said, I may have paused a second or two. Professional machismo à la Cheryl Hemminger.

Still, nothing I would want to try to explain to the Glory Powers That Be, nor a jury.

Bungled the intubation? Threw the blade on the floor? Or salvaged a bad situation to save a life? Some invasive procedures go so well they look deceptively easy. The tip of the big needle finding the center of the jugular vein in one light poke while the surgeon is telling a ribald joke. Michael Jor-dan draining game-winners in the playoffs or Jack Nicklaus knocking a 2-iron pin high. Easy. Some procedures never get accomplished despite great blood, sweat, and tears from all parties. Most are in-between. Maybe the doctor on the Glory Executive Committee would relay that to the others.

Even though there was some risk of my attempting to throttle Robin if I saw her, I thought I could contain myself enough to go ask her what the fuck she was up to. She was to be on duty in the ER. Her shift was less than two hours old and probably not even good and warmed up yet. I found a bathroom and splashed some cold water on my face, then shambled into the back of the ER.

258

DAVID FARRIS

There was no one in sight. I checked the patient log. A seventeen-year-old girl had just come in with a headache.

Robin was probably checking her in. I sat at the doctor’s desk, folded my arms, closed my eyes, and waited.

“Hey, Malcolm.” Adam McEwan, another part-time ER

doctor, was walking in.

“Hi, Adam. Keeping things quiet?”

“You know. The usual.”

Robin came out of an exam room. She stopped moving and clenched her face down tight as soon as she saw me. We stared at each other. Adam looked from face to face. I said,

“Hello, Robin.”

She said, “Hello, Dr. Ishmail.”

“Is that the way it’s going to be?”

She shot me a glare. “Is
what
the way it’s going to be?”

I gave Adam a wan smile. To her: “Hot one night? Cold the next?”

“Look, I don’t think this is very professional. Coming to bother me when I’m trying to work.”

“I didn’t come to bother you.”

“What did you come for?”

“I’m trying to find out what the hell you think you’re doing.” My voice was rising. “Why you wrote out those goddamn lies about me. Especially after last night!”

“Last night! You—you practically raped me! You—”

“I what? You practically raped me!”

I looked at Adam, palms upward, offering my incredulity.

He looked like he’d really rather be in Philadelphia.

Robin said, “I think you should leave.”

I said, “I think you should tell me what you’re trying to do to me.”

She said, “You leave or I’m calling Security. Right now.”

I looked about. I realized that nothing was going to be salvaged from that meeting. “Fine. I’m going. But I’m not through with you. I
will
get an answer.” To Adam: “Sorry.

Sorry, but watch yourself around her. You can’t be sure what she’s going to say about you.”

*

*

*

LIE STILL

259

I drove back to town, quietly raging in my head. I replayed our night together. The quaint seeds of paranoia Robin had shown before dinner apparently had taken root and grown to full flower: She was going to make the whole debacle my fault before anyone could even accuse her of a mistake.

A light was on in our town house; Mary Ellen was home.

Thinking I couldn’t show her my sullied self, I got back in my car. Interestingly, in Phoenix all roads lead to the ’Copa, or at least they do on my internal autopilot.

Once in the parking lot, I thought to go up to see Henry. I was still his referring doctor—legitimate enough reason to see how he was faring. In my current mood, though, it seemed the risk of tripping into more trouble, say, offending a priest or a lawyer, should one happen to be there, was far greater than the chance of doing anything that helped anyone’s cause, especially Henry’s.

Rather than burn gas wearing ruts in the streets or sit in the parking lot staring at my steering wheel, I walked the perimeter of the hospital campus. I watched the night sky for a while. Clouds were blowing through, reflecting the glare of the city back down as they passed. Lightning flashed in the west and the wind started gusting in circles, whipping sand and dust and trash into my face. I wished it would rain.

I ducked into our old bad habit, The Longhorn, thinking I could avoid potentially painful encounters with old friends by sitting at the bar and keeping my head down. Maybe some food and a beer would help my outlook.

Barely into a
cerveza,
though, I was visited by a ghost of long hours past. Two stools over was a nameless fellow pil-grim, nursing a beer and a shot, sporting a gauze head bandage just beginning to show a medallion of blood over the left ear. Sticking out of his back pocket was a triplicate form I recognized as a Maricopa Emergency X-ray requisition. Apparently he knew from experience the best place to wait out the queue.

Putting my head up long enough to admire the man’s situational awareness, though, made me visible. Gene Woods, my former surgery mate, spotted me as he came by from the 260

DAVID FARRIS

john. He slapped me on the back and said, “Holy living shit, look who’s back. Just couldn’t stay away?”