Lie Still (41 page)

“Please ask him—”

“Who is this?”

“Oh, sorry. This is Dr. Ishmail, calling from outside Tucson. Let him know I’m—”

“Dr. who?”

“Dr. Ishmail. Malcolm Ishmail. He came to see me at my town house in Phoenix a couple of days ago.”

“Will he know what this is about?”

“Yes. Very much so. Please tell him I’ve decided—”

“Is there a number where he can reach you?”

“What? I mean, well, no. I’m calling from a pay phone. . . .”

“Honey, it’s gonna be hard for him to call you back if I can’t give him a number.”

“He wanted me to take a lie detector. I’ve decided to do it.

As soon as he wants to. Tomorrow. Today. I want to get it—”

“Uhh . . . He’s off the phone. I’ll put you through.”

Will said, “You’re in Tucson? I thought you weren’t leaving town.”

“Tucson hardly counts. I think it’s a suburb. Besides, I’m coming right back.” I repeated my offer to Detective Borden.

He said, “You’re doing the right thing, coming in.”

“Yeah. I seem to be stuck on that lately. It’s a curse.”

We set a time for two o’clock that afternoon.

308

DAVID FARRIS

*

*

*

I got to Maricopa just after eleven. I figured I had time to take care of Mary Ellen’s homework project as ordered.

With my old ID for cover, I ambled into the Maricopa Bio-medical Library.

Despite being off in a corner of an upper floor, out of the way of any Seething Masses, and an oasis of calm, it was not a popular draw. Scattered around the stacks and computer terminals were only three other young doctors; two were asleep and the third was reading a newspaper and loudly slurping a large coffee. I worried that pulling texts and journals would give me up as an alien.

In the text section, I grubbed through the recognized bible of pediatrics, fishing for the True Physiology of Henry. I looked up
aarrhythmia, allergy, asthma, bronchospasm, epinephrine, laryngospasm, pseudo-seizures,
and
Ritalin.
The epinephrine subchapter contained nothing pertinent I didn’t already know, but I photocopied several pages. I thought I could use them to support the idea of Henry’s heart running away from him after the shot.

While it was speculative, that scenario just might be accepted by a Glory administration hungry for ways to exonerate their staff. It was just plausible enough that I could present it in earnest. It was more plausible than an allergic reaction. What would be left unsaid was it was all I could come up with.

Standing at the copier, picturing the nefarious possibilities I would be asked about during the upcoming session strapped to Will Borden’s polygraph, I hit a still untapped topic: poisons.

Figuring no medical gathering ever starts on time, I went back to work. In the reference texts I found lots of chapters on poisons and poisoning. Chapters and subchapters on general approaches to evaluation and treatment, a chapter on lye—drain cleaner resembles candy to toddlers and is hell on the esophagus—lead, arsenic, other heavy metals, organophosphates (insecticides), and toxic plants. I found a section on “evaluating for the presence of unknown LIE STILL

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toxins” but it was mostly about kids who had gotten into the wrong cabinet. In short, nothing pertinent.

I got to the Pediatrics conference room by twelve-fifteen, but Henry’s Care Conference was already going. A middle-aged man in a jacket and tie stopped speaking in mid-sentence when I ungracefully barged in. It felt like most of the gathered family and staff were staring at me as if I were vermin creeping onto the picnic blanket. I was about to mutter an apology, but stopped when I saw the man’s stare. With grating politeness he said, “I’m sorry. This is a family Care Conference,” implying I should back away quietly.

“Yes,” I said. “I’m sorry. I’m Dr. Ishmail. I was the boy’s physician in the Emergency Department in Glory.”

“Oh. I see.”

Mary Ellen spoke up: “I invited him. Malcolm was a resident here. He knows most of the staff. I’d like him to sit in on the conference.”

The speaker said, “Well then, if you’re one of the boy’s physicians . . .” he nodded to a seat.

I said, “I’m sorry I’m late. I was told it was going to be at around—”

Monty said, “Sorry, Malcolm. Everyone was here so we started. I wasn’t sure you were going to be able to make it.”

Then to the group: “I’ve been in daily contact with Dr. Ishmail. He’s been following the case closely, of course.” To me: “I think you know who everyone is. . . .” She gestured about her. I realized from the grim and sweaty expressions that silent, respectful nods would be my best greetings.

I recognized most of the faces around the table: On one side were Henry’s mother and stepfather, Mary Ellen, and one of the PICU nurses. On the other side were Ted Priestly, the lawyer, Mary Ellen’s intern with the big eyelashes, smiling, again looking unaware, and another nurse.

At the head end of the table sat Monty’s HO priest, Father What-a-Waste. Next to him, the speaker, who looked vaguely familiar. When Monty introduced him as “Dr. Levi Strand, the consulting neurologist on this case,” it came 310

DAVID FARRIS

back to me: Dr. Strand had been the Attending who had argued with Monty over Nancy Madsen, insisting on keeping her lungs alive when her brainstem was gone. I sat down as quietly as I could and folded my hands.

Dr. Strand resumed speaking. “Well, then . . . Actually we’re nearly finished, I believe. We have explained to the Rojelios, er, the Mendozas, about brain edema—the swelling we’d been talking about—and how their son may regain more function as the swelling resolves. As Dr. Montgomery probably told you, the EEG is not definitive for brain death.

There remains some activity. The imaging studies, the CAT

scans, show some loss of cortical mass.” He gestured in a swirling motion over his head. “We had placed the boy on some heavy sedation when he arrived, to control the seizure activity. Some of those drugs have been, well, hanging around. The levels, though, have been coming down progressively and we are confident that we will be able to do the bedside determination—the examination of the most important reflexes for the life support functions—in the morning.”

I nodded. Mary Ellen said to me, “Apnea challenge.

Calorics.” I nodded again.

The priest spoke, beaming his blue eyes around like searchlights. “I want to say again, we—the Mendozas, Mr.

Priestley, I, our congregation—all trust you doctors and nurses completely. We know the Lord’s hand will guide you to do the right thing.” Dr. Strand nodded. Mary Ellen looked like granite.

The lawyer was staring at me. He looked around, then said, “I know all these considerations are very emotionally charged. As I said before, I’m here only as a friend of the family. I know Daniel wants nothing more than his son’s survival. If I can be of any help at all here, it will be in that—

helping my friend express his . . . his needs, his wants, and those of his family, of course.”

Dr. Strand echoed, “Of course.”

“The Mendozas want their son back . . .”

“Of course.”

“. . . any way the Lord will give him to them.”

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La Señora Mendoza bit her lip but didn’t speak. She looked angry.

One of the nurses had been looking at each speaker and nodding her sympathy; the other was staring at the table. Dr.

Strand looked about the group, silently asking if anyone else wanted to speak.

The conference room was linoleum-lined like a kinder-garten. It served as the arts-and-crafts center for the children fit enough to do projects. The walls were covered with fresh paintings of roadrunners and Gila monsters in primary-colored tempera. I said quietly, “What about the other children? Henry’s brothers and sister?”

Dr. Strand squinted at me. “What do you mean?”

“What do they need?”

Monty was shaking her head slightly. Ted Priestley looked at Father O’Donnell and then at Henry’s parents, then at me. “They are children,” he said.

“Precisely so,” I said. “They’re not here at this meeting because they are children, but their needs may be greater than anyone else’s.”

He looked askance. “They will be completely taken care of. I’m sure if you asked them they would say they only hope to have back their brother.”

“I’m sure that’s true,” I said, intending to elaborate on the difference between the real and the expressed needs of children, but I paused when I noticed Mary Ellen glower-ing at me.

Dr. Strand cut me off: “I’m afraid we have to concern ourselves with the welfare of our patient here first. I believe we are all agreed upon the plan and we know tomorrow will be a difficult day no matter which path the Lord shows us.” He nodded to Father O’Donnell. “So unless anyone else feels the need to speak . . .” He looked about.

Everyone was silenced. He rose slowly and people scuf-fled out.

Mary Ellen and I made eye contact, signaling each other we needed to talk, then stood and waited by the door until everyone had gone. She insisted we sit back down.

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DAVID FARRIS

I said, “Sorry I missed the main event, but I think I got the flavor. Seems the disaster may live on.”

“You don’t know the half of it.” She looked more concerned for me than for her patient. “Old Smiley, the lawyer over there, just before you came in, was telling of us about a

‘somewhat similar’ case in Pennsylvania he had read about where the DA had pressed manslaughter charges.”

“What? Are you serious?”

“Oh, he was all apologetic for even bringing it up, the slimeball, but said he wanted to be up front that he had ‘received information’ that could—
could
—turn this into a criminal case, especially if the boy dies. At one point he said something implying, in his roundabout Gee-I’m-sorry-to-have-to-mention-this way, that any decision to withdraw support could turn this into a murder.”

I closed my eyes and took a deep breath. “What kind of

‘information’ did he have?”

“He didn’t exactly say. Said he knew of a report on file at the hospital he was going to try to see, though.”

“It’s protected. If it’s the one I know of, it’s part of Quality Assurance and protected from discovery.”

“Malcolm, what the hell have you gotten into?”

I took a deep sigh. “Mary Ellen. I wish I knew. I went out there, to Glory, two days ago, to go over the risk management stuff with the Glory administration and found out the nurse on the case had written up a report saying I’d fucked it up from top to bottom.”

She looked incredulous. “You’ve got to be kidding. What a bitch!”

“Yeah. She made a laundry list of everything I supposedly missed in the workup, of things I didn’t know during the code, of how I struggled with the intubation, then—poof—

she’s gone. Jesus, she made it sound like I was a butcher.”

“You’ve never butchered anything in your life.” I gave her a smile. “Why would she do that?”

“Well, that’s the question.”

“Covering her own fuckup?”

“Yeah, that’s what I’m thinking.” Since Mimi, I was accus-LIE STILL

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tomed to keeping things from Monty. There in the warmth of her fire, though, I could think of no good reason to keep all my current troubles secret, too. “There are detectives looking for the nurse, too,” I said. “She’s disappeared.”

“Well, who could blame her for running and hiding? She must have done something fairly heinous.”

“Yeah. Hit and run. Though I kind of get the sense these detectives are wondering if I know something about her disappearance.”

She stared at me. “That’s gotta be a joke. You’re still half altar boy. You wouldn’t squash a cockroach. You have those detectives call me. I’ll set their asses straight.”

She was doing to me what she had done dozens of times, at key points in my life: notching me up a rung in my own understanding of who I was. We locked eyes. I smiled.

Then I sighed. I said, “So, back to reality. The nurse’s report must be the information he’s not supposed to know about, but does. But it’s part of QA, so it should be protected.”

“It’s protected from discovery in a malpractice action, Malc. I’ll bet you dinner it’s usable in a criminal action.”

“Oh shit. You’re probably right. That would be just fucking beautiful.” I looked at the ceiling.

She leaned toward me and took my hands. “You can see why I thought you should keep a low profile about letting the kid go. It might be best for everyone if he hangs around, regardless of how many neurons are firing.”

I shook my head. “What did Mom and Dad say?”

“That was the interesting part. They really didn’t say much. The lawyer and the priest did the talking for them, saying they want everything possible done. Though come to think of it, I didn’t hear the priest use that language.”

Now I was getting angry. “Let me get this right,” I said,

“if Henry ‘lives,’ for lack of a better term, the potential settlement goes up, what, tenfold? An annuity for eternal care?

And he’s in line for a fat percentage? Is there a conflict of interest here?”

“Might be. Hey, calm down. I didn’t invite him. All I can 314

DAVID FARRIS

do is play hostess for the Big Meeting while my Attending oils everybody up.”

“You think the family really wants the full vegetable treatment? Lifelong ventilator? Tube feedings?” I said.

“Well, that’s not exactly how they put it.”

“But that’s how you need to put it if they can’t see the darkness at the end of the tunnel.”

“Malcolm. Stop. It’s too late. I tried. Herr Doktor Professor at the head of the table isn’t about to take a stand.

He’s just going to play along. If Henry’s brain-dead we’ll be able to let him go. If he’s not, it looks like we carry on, regardless.”

I bit my lip and nodded. I turned to her for a second, then closed my eyes, then opened them and forced a smile.

“Well,” I said, “you can be proud of me. I went to the library and did my homework.”

“What did you find?”

“I read every printed word I could find about epinephrine and asthma and damn if we didn’t get a good education.