Lie Still (39 page)

I said.

As they left, Will striding with athletic grace and Ken trundling with effort, I knew they expected me to cough up something incriminating, but I had nothing to give them. I envisioned them rehashing every inflection and word choice I’d made, wondering what I was hiding and how they would smoke it out of me.

18

Dad had a spill a couple of weeks ago. Since he is essentially nonverbal, it’s impossible to know if he just lost his
balance or passed out or something in between. Doesn’t
look like he had another stroke, but the old coot broke his
nose, of all things. I was on the far side of the Sandhills
taking pictures when it happened, so I was of no immediate use.

In the Hooker ER they wanted to call Dr. Kudamelka, the
chump who bought Dad’s practice, the only doctor in town
who saw broken bones. Mom quietly refused. She called
Dad’s internist. He came and checked what needed to be
checked—physical exam, blood work, X-rays. They told me
in the ER he looked up nasal fractures in their text, then said
to Dad, “This is gonna hurt,” and muscled the hash of car-tilage and bony bits back into something of a straight line.

Dad’s eyes teared profusely.

Mom called my motel only after they were back home. It
seemed that all was medically okay, but they were both tired
and she was scared. I drove all night.

The next night, after dinner, after we got Dad to bed, I
brought up the idea of getting him to a nursing home. There
was a long silence. I pointed out to Mom that she would not be
physically able to care for Dad too much longer, and if she
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killed herself trying to keep him in one piece it would do neither of them any good.

Still just silence. “You always told me, Mom, if a situation
is bad, you have to change it.” She blinked. I went on, “You
said, ‘If you’re not working for change, you apparently must
like things the way they are.’ ”

She looked up at me. “I never meant you should change it
to something worse.”

“No, of course not . . .”

“And your father hated those places. It would kill him.”

“If seeing Brant Kudamelka in his own office didn’t kill
him, he’s beyond death from disappointment.”

She stared at me. “He thinks you’re going to make that
better.”

“Me? How?”

“He thinks you will.”

“He doesn’t think anything of the kind.”

“You go ask him.”

“Mom, he doesn’t respond to anything I say. He sits and
blinks.”

“You’re not saying the right things.”

I went up to his room and sat him up. It took me a while,
but I got around to “Dad, are you still hoping I’ll be able to
practice here?”

Of course there was silence. I looked at his eyes. He seemed
clear. Clearer, anyway, in his facial expression than I thought
he had been since the stroke. He looked like my father.

H E N RY RO J E L I O , DAY S I X

Watching the Mesa detectives drive away, I felt a hint of panic creeping around my throat. My pain litany now included a threat to my freedom to walk the streets based on the fate of a missing woman who apparently wore at least two faces. I had little doubt Henry’s outcome would weigh in as well.

I was suddenly sure I had shared too much with those 294

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two. “Divulger’s Remorse.” Sometimes I seem to have the unjustified optimism of a daffodil in spring. Sleep that night was fitful.

Henry, Day Six, began at five o’clock, with a repeat drive to Tucson. I decided it’s a better trip in the dark.

Finding coffee, finding parking, and getting my bearings in the medical center complex took, of course, longer than I had allowed. I got to Dr. Emmerick’s office ten minutes late.

Alphonse was at least six foot five with board-straight posture. I guessed he’d had a large piece of stainless steel attached to his spine at a young age to arrest scoliosis. He was not happy, though, so there was no small talk. “Dr. Ishmail, we’re planning on starting our runs at eight-fifteen. On schedule. I hope you can be quick with whatever this errand is.” He was thin, dark skinned, had broad glasses and a frequent blinking tic.

“Yes, I’m pretty sure . . .”

“Let me show you in.” He got up and led the way, practically trotting. Without turning back toward me, he said, “Dr.

Hebert thinks this is all pretty cute, I guess.”

We wound around the research wing to a stairway and down to the secured basement. Alphonse barely nodded to the bored security man at the steel doors. The animals in the lab sections need constant protection from the wackos. The man reached under his desk. The electric lock clicked. We ended up in a back laboratory, through a door marked

“Anesthesiology.”

“We stole their lab,” Dr. Emmerick said, pointing at the sign. “They never did much of any consequence with it, anyway.”

In the center of the room, strapped on her back on a large wooden bench, was a big brown dog with the hair and coloration of a Doberman and the size and shape of a retriever.

There were two plastic lines running to blood vessels in the dog’s groin and a plastic ventilator tube running straight down her throat into her trachea. She was asleep, presumably anesthetized, certainly not moving. A bank of dials and digital readouts stood beside her, along with a stack of mon-LIE STILL

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itor modules atop an eight-channel continuous printout polygraph. Three of the needles twitched with each heartbeat; one swooped lazily with each cycle of the ventilator.

The paper was imperceptibly rolling forward and into a neat stack in a basket at the bottom of the machine.

Alphonse introduced me to the man at the table, Miguel, adding, “Dr. Hebert wants the young doctor here to run a quick sample of something to see what happens. You can help him, if you don’t mind. Just don’t let him take too long. We’re still on for the planned runs.” Dr. Emmerick left.

Miguel was young and smooth. He had a slight nodding motion most of the time, giving the impression he was hearing faint music inaudible to those of us who were less hip.

He said, pointing to the dog, “She’s about ready. I mean real stable vitals. You going to need anything special?”

I looked blank.

“Any blood draws? Metabolics? Hemodynamics?”

“Uh, no, guess not.” I pointed to the slowly turning roll printer. “Is that printing out blood pressure and pulse? That’s about all I’ll need.”

“Yeah. That’s on the polygraph.”

“Is she asleep?”

“Oh yeah. She’s breathing Ethrane. It’s real cheap. Works fine. And she’s on a continuous infusion of vecuronium.”

“Is Ethrane the anesthesia gas?” I asked, dredging my mental records of ancient lectures.

“Yep. New and improved ether, though they got way better stuff for humans.”

“And the vecuronium is for paralysis . . .”

“Yeah. Non-depolarizing muscle relaxant. The new cu-rare. Muscle paralysis without the nasty side effects of the old drugs.”

“Like respiratory depression?” I asked.

“Oh no. Lots of respiratory depression. Muscle relaxants relax all the muscles, Doc. If you left out the respiratory muscles you’d have the dog pushing on her diaphragm and belly. Wouldn’t work.”

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DAVID FARRIS

“And ‘non-depolarizing’ means what again?” I asked. I had my face screwed up, trying to find lost records.

“Curare and all the ones like it disconnect the muscles from the nerves. They block the connection without setting it off. The muscles don’t fire. Now, succinylcholine is a depolarizing drug. It sets off the muscles right when it hits them. Makes ’em twitch. It’s too short acting, though, for something like this. We don’t use it much,” he said.

I nodded. “Okay to start?”

“She’s all yours.”

I looked over the setup. Hanging on the side of the polygraph was a beat-up clipboard holding the data on that dog.

“Number fourteen” weighed 28.3 kilos. Ten micrograms of epi per kilo would be more than enough to send the vital signs flying. Three hundred mikes—three tenths of a cc.

I asked Miguel, “Can this print out faster?” He reached over to the polygraph and tore off the end and tucked it into the catch basket. He pushed a button and the paper picked up speed.

I tore open an alcohol swab and wiped off the rubber nipple on the IV line near the dog’s groin. I bent close to the clear plastic line and pushed the hair-thin needle through the rubber, injecting the plunger slowly from the “0.70” mark to the “0.40” mark. A tiny air bubble came out of the beveled tip of the needle, then a small stream of fluid, visible only as waves of different refractive index, like the shimmers above distant blacktop in the summer.

I opened the plastic roller clamp on the same line, high up near the bag of fluid. The bubble accelerated down the tubing, around two bends, and disappeared into the dog. I read-justed the clamp, then watched the polygraph.

The ticks of the needles gradually came faster. The digital readout under “Heart Rate” rose from 82 to 110, that under “BP” rose from 115 to 177.

“There should have been a dip in pressure,” I said, mostly to myself.

“Here,” Miguel said, pointing to the paper. The graph showed a definite dip in both the top and bottom of the sweep of the blood pressure trace, but it was extremely LIE STILL

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short; there was an almost immediate rise in both. “It was quick, but it’s there,” he said.

I just stared. He said, “You would have missed it without the printout.”

I watched the dog’s vital signs drift toward their earlier values, then looked at Miguel.

“Epinephrine,” he said in a tone implying it was obvious.

I nodded, looking blank.

Miguel ran the printout through the rollers, tore it off, folded it over, and handed it to me.

“Prairie shit,” I mumbled.

19

Annie Parrott dubbed last Wednesday in the Othello Clinic

“Minor Trauma Day, Squared.” “Minor trauma to minors.”

The day started with broken bones. A nine-year-old girl was
hanging upside down from the family treehouse to make her
toddler brother laugh. She fell, banging up her face up and
breaking both bones in her right forearm just above the
wrist, creating a disquieting swan’s neck out of her arm.

Annie turned her over to me. I checked the usual things and
did a simple splint to keep the pain down while her folks
took her on down the highway to an orthopedist. I imagined
the brother, being both blessed and cursed with a Y chromosome, found the whole show to be quite a hoot.

Then, mid-afternoon, I got to show off my holistic version
of laceration repair. There’s nothing quite like a bleeding
four-year-old, especially a little princess in her going-to-a-birthday-party pink dress, to get a pair of parents wound up
like watch springs.

A drinking glass had broken on a counter above her and
the big heavy piece found the inside of her forearm en route
to the floor. Fortunately the gash was only through the skin.

There were no tendons, arteries, or nerves involved, and I
had clean, straight edges to work with. As a bonus it ran
across, rather than parallel to, the underlying muscle. This
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means the tension of the muscles helps pull the edges together, not splay them open. Your repair will be free of underlying stretch and the scar will end up very faint.

I love these. The kid has sobbed herself into a dither. The
mom and dad know in their minds it’s only a flesh wound,
but in their hearts their daughter is bleeding and wailing
and they can’t fix it alone.

The key to emotional success is to be sure to get all the
painful stuff out of the way almost as soon as you see the
kid. And lay in the local anesthesia for all you’re worth.

Some ER people try to soak in a cocktail of anesthetic stuff,
but it takes forever and often just plain doesn’t work. Besides, with the microscopic needle I use for the local, she’s
hardly crying during the injection more than she was when
I gently peeled back the bandages to view the damage.

After the local, wait. Maybe ten minutes. See if they’ve got
a Squirt. “The local takes a little time to work completely,”

I tell the folks, thinking to myself,
And everybody’s breathing can return to normal.

In some of the ERs they pull out a papoose board to lash
the kid down like Gulliver in Lilliput. I tell them, “Naw, just
have the kid and the mom lie on the gurney together.” Mom
holding Kid in a bear hug may not be as effective as a total-body mummy board, but it usually does the job, and besides,
Mom feels like she’s doing something to help, and Kid feels
like this surely is the best place in the world. This instead of
the instant terror the mummy board creates in child and parent alike.

Do the sterile wash with a gentle, rhythmic stroke, more
like a massage than a scrub prep. Keep up a quiet prattle—

anything. Ask about the birthday party. Was there a clown?

Any balloons? ’Cuz I like balloons. What kind of cake? Start
sewing in mid-answer. What songs did you sing? Will you
sing it for me? If you got the local right, the sewing is all
part of the massage.

On little girls I use really fine suture and a kind of double
stitch that leaves the least scar. Boys get twine and baling
wire. I figure they ultimately want a certain amount of dec-300

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oration to show off when drunk—they’re the ones who wake
up from benders with big tattoos.