Lie Still (4 page)

Wandering about the ER, I passed in front of the motion detectors over the ambulance-entrance doors. They slid open, offering an automated invitation outside. I stepped into the sun, warm and pleasant in the late-winter afternoon, for a time to think. The view across the parking lot was a golf course. I heard a
thwack
and a curse. Beyond the artifi-cial greenery were low red mountains shielding Glory golfers from the snarl of Phoenix.

Had I known what caused Henry’s arrest, I would have written it down in big letters. When you don’t know, you enter the many stages of analysis and reconstruction, an un-scientific process of untestable theorizing and conjecture by dozens of doctors and nurses who were not involved.

This I knew: His arrest made no sense. Though I could not 20

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have claimed great experience with the nuances of asthma, I certainly knew how to treat it, a disease so common it’s boring to most pediatricians. Nor was I an expert in pseudo-seizures, but there was no link in pathophysiology connecting pseudo-seizures to cardiac arrest.

I went back in. If there was going to be reconstructing done, I wanted to have copies of whatever data there were.

Even scanty evidence might be useful. I made photocopies of the code sheet, the nurses’ notes, and my own chart notes, then went back to Henry’s room to see if I could think of anything else.

But for the tubes and wires he would have looked pink and healthy, just asleep. Roger had brought in a ventilator to breathe for him. One of the nurses had wrapped him in a thick cotton blanket to keep him warm on his ride into town.

The room was cluttered with torn paper and plastic wrappings, a few bloody gauzes, partly emptied syringes, and long strands of EKG printout. On the counter by the sink was a scattering of syringes and needles. I gingerly poked through them and found the one Robin had used for the sub-Q injection just before the code. It was the smallest; the only one-cc tuberculin syringe in the detritus, still full to the eight-tenths mark, with a brown glass ampule, minus its top and its contents, taped to the side of the syringe. The ampule said, “EPINEPHRINE (adrenaline) 1 mg/cc.”

As I was reading it Robin came in. I thought she saw me staring at the syringe. I looked up at her, but she had turned to fuss with Henry’s IV drips.

The ambulance people came in. “We’re ready to go, aren’t we, Doc?” Roger said from the head of the bed.

“Sure,” I said. I smiled wanly at the paramedics.

I didn’t really think about why I was doing it, but I went around the corner and out of sight to the med room, found a small Baggie marked “Specimen,” and put the syringe in it.

At the desk I found a big brown interdepartmental envelope, put the Baggie in it, rolled it up, taped it, wrote my name on it, and put the package in the drug refrigerator back in the med room. It was pure reflex.

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As the gurney was being wheeled past—Vickie steering it from the foot end, Roger squeezing the breathing bag—

Robin set on top of Henry’s legs a big plastic bag, like a dis-count store shopping bag. It had in it the shreds of Henry’s clothes. It said on it, “Thank you for choosing Providence of Glory Medical Center, Glory, Arizona.”

2

That was almost seven years ago.

Now I am “home.” In Hooker, Nebraska, my point of origin.

I practice medicine in the Hooker ER and places like it. I work the hours the other doctors don’t want.

Hooker, population 9,858, is the only town in an eighty-mile radius with a hospital. There’s a one-doctor clinic over in Othello, but that’s a really tiny town, twenty-seven miles from Hooker, and they lock down on nights and weekends.

From 7 P.M. on any Friday until 7 A.M. on the following Monday, the only doctor the ill or injured can see is me, or somebody like me.

My Henry Troubles in Arizona left me practicing medicine as an itinerant physician. I camp on weekends in ERs like Hooker’s, scattered across the plains, for sixty hours at a stretch, for an hourly wage, currently forty-three dollars. I am, or so it says on my papers, only partly trained.

The hospital in Hooker has the kind of noncommittal name they seem to like in generic small towns—Hooker County Community Memorial Medical Center. HCCMMC. A medical center, not just a hospital mind you, that commemorates the community. My guess is it had the least chance of being controversial when the Board of Trustees had to pick.

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I grew up in Hooker, an age ago. It seems it is my home again. Relocation by default.

Through college in Boston and medical school in San Diego, I told friends Nebraska was a great place to be from, emphasizing the “from.” There was mild dishonesty in participating in the clichéd bashing of a place I loved, but it helped shut off the stupid jokes from people at the edges of the continent about how backward everyone knew us Mid-landers to be.

Luckily I had a Nebraska medical license before the Troubles began. Licensure requires medical school, internship, and the National Board Exam, not a residency.

Near the end of my internship in Arizona my father ha-rangued me into doing the paperwork to get my Nebraska medical license. Dad was planning on my taking over his practice when I finished residency, and he was getting impatient. When he started the practice thirty-odd years before my internship, he was the only doctor in an eighty-mile radius. It was catching up with him.

I made it clear I had little interest in either a generalist’s practice or a life on the prairie, but for the cost of a license fee I figured I would be able to get him off my back for at least the duration of the residency.

Getting a license, however, was a happy event. Pre-Henry I was a jauntier soul; the future was boundless. While home for a week vacation I made rounds with Dad every morning.

With my shiny new License to Practice the hospital was willing to give me “courtesy” privileges, and I got to scrub an appendectomy with him. He actually let me do the operation, though my deliberate manner, under the eyes of thirty years of proficiency, must have seemed plodding. It created palpable impatience at the operating table. Nonetheless I count it as a trophy memory.

Though he didn’t entirely approve of my choosing to be a full-time surgeon, he did understand that no one, these days, could do it all, the way he had. He was a throwback to the days before every doctor did a residency; a living, breathing General Practitioner. He still did routine operations and deliv-24

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ered babies. In those days of hubris I told him he was a living fossil. I also pointed out that a fully trained surgeon, should he be so inclined for some silly reason, could take over the majority of Dad’s practice, whereas a fully trained internist or family practitioner could not. He nodded and smiled, believing I would still find just such a silly inclination.

My next visit—after my failed residency, after Glory, after Henry—was the antithesis of the Proud Homecoming.

Tail between my legs, unable to explain in sufficient detail, Nebraska was a hideout, my sanctuary. Jauntier days looked quaint.

For gainful employment I checked on the hometown ER, hoping to pick up some hours. They said to call Western Acute Health, Inc.; they “had the contract.” Western Acute was the cash-flow brainchild of Mel Steele, an ER doc in Cheyenne. Mel figured out he could develop an income stream by holding contracts to supply doctors for ER coverage at tucked-away little towns few doctors would otherwise find. Western gets paid by hospitals like Hooker County to keep a licensed doctor available in the ER for the entire weekend every weekend. So the local family docs don’t have to cover all the hours of the day and night. So they don’t get too fried and pack away like moths to the lights of the city.

It started out as a way to pay my bills while I waited out my appeals and applications. I would work weekends but get the uncrowded weekdays to be skiing in Colorado or fishing or hunting in Wyoming. It became a habit.

The work can be good.

The waiting can be brutal.

The hospital in Hooker is at the western edge of town.

Sometimes I stare out the window of my second-floor call room—“The Penthouse”—watching, just across a gravel road, beef cattle graze. Hooker has no golf course, and no low mountains. But then, there’s nothing that needs to be hidden.

Watching the sky is the best. Clouds of hospital cotton float overhead on sunny summer days, and the blackest, LIE STILL

25

most malevolent thunderheads roll across grassy dunes just before sunset. The better ones kick up all kinds of flotsam with their opening salvos, then pelt it back to earth with fishing-sinker raindrops or, on a good evening, hail that sounds like glass slowly shattering.

Recreation inside a hospital is cramped. Sixty-hour shifts, mostly spent in the on-call quarters, reading, watching some game-of-the-week on the tube, sleeping, eating cafeteria fried foods. Since Henry and my time in Glory, flirting with nurses has lost much of its allure. But the time is not all a waste. I do study my area of medicine. I mix literature into my often-pedestrian reading list, and for at least part of every weekend I get paid forty-three dollars per hour for sleeping.

When things fell apart I told Dad the final outcome and a smattering of the details. Naturally, he was angry with all concerned. He wanted to bring legal action. Afraid the law might have something to say to me, too, I silently demurred.

I told him about certain clauses in Arizona employment contracts that would make a suit pointless. These gnawed at him, too.

Two months ago I was back in Arizona. Though I am persona non grata there to the medical establishment, they have not yet set up border barricades.

Mary Ellen Montgomery, my former housemate and the doctor who took Henry Rojelio off my hands that night in Glory, called, via my parents, saying she had something for me. I made it to Phoenix in thirty-six hours.

While there I called a criminal attorney, Gerry deLee, and made an appointment. A cop I know recommended him. His office was in a bank tower in central Phoenix. It smelled of cigarettes and sweat. The view from the lone window was of a city block across the street, sandy and completely vacant but for three broken-off palm trees and an equally topless concrete foundation.

Mr. deLee’s face had redundant folds of the upper eyelids that made him look half asleep most of the time. From the questions he interposed, though, it was obvious he was 26

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listening, acutely. I retold Henry’s story. I rambled. It ran to two hours. He rendered professional judgment: The statute of limitations was running out on minor things, and for major things the situation was too murky and the time too long ago for any DA with an ounce of sense to want to pursue it.

Apropos the events, there can be no certainty.

Also apropos the events, I am going to act on the knowledge I possess: I have a certain freedom to speak.

My would-be career as a surgeon was castrated so long ago it is irrecoverable, and to me, through the years, a vanishing concern. Still, these events were real. They redefined my life.

I will tell two stories: Neither means a thing without the other. They are separated in time by ten months.

Though they are nearly seven years old they are clearer to me than my last weekend ER shift. Both happened in the Phoenix area. They call it “Valley of the Sun.”

Some may see crimes or insufficiencies in my manifest acts. Certain omissions trouble me more. Major parts are played by individuals believed by most to have known better. Most of the cast is still about, playing their parts, grease-paint intact.

Ergo, my story.

THE BOOK OF MIMI

3

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

My having crawled into Glory, Arizona, where I met Henry on Day One, was a consequence of having known, slightly too long and unquestionably too well, Miriam M. Lyle, MD, Associate Professor of Surgery, Division of Neurosurgery, University of Arizona, Maricopa Medical Branch, Phoenix, Arizona. She was a brain surgeon. What I eventually tripped over was that Mimi Lyle, professionally speaking, was, if not actually incompetent, less than sterling at the operating table, despite being well regarded at the academic level.

Such a conclusion comes, however, only through pain and suffering; all the early impressions were far more favorable.

We cub residents were given to believe she had a reputation as a bright young academic tigress in the stultified world of professors of neurosurgery. It was said this was based on some esoteric research she had published prior to moving to the desert. The move itself was poorly understood. It was said she left a plum fellowship without finishing the course.

No one expected a rising Eastern or even Midwestern star to relocate to the land of golf courses and tennis courts. That usually happened as a prelude to retirement. The rumors 30

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around Professor Lyle generally invoked themes of sexual intrigues or inordinate salary offers. Neither was true.

No one had to tell us she was tall, classically beautiful, and, from my testosterone-hardened viewpoint, undeniably sexy. I had seen her in the hospital, striding down the long corridors of linoleum and buzzing, garish lights. In silk blouses, all types of skirts, open white coat, and pumps, she was—visually at least—the lone Rose amidst the bands of wandering and grubby Gypsy doctors.

She eschewed the low-maintenance short-cropped hair considered mandatory for any woman in a surgical specialty.

Hers was long and a deep auburn. It didn’t flounce and bounce like a TV model’s; she generally had it braided and wound up on top of her head, but with her perfectly sculpted neck it looked elegant. She had a long thin nose, thinly arched eyebrows, and pale blue eyes. She usually wore fitted clothes, so there was ample evidence to believe that her body was everything a woman’s body, in the tightly closed eyes of a twenty-seven-year-old, often lonely male, should be. Despite her being at least a dozen years older, my Y