Lie Still (44 page)

And the breakdown products, the succinyl part and the choline part, occur naturally throughout the body. Not traceable.”

“The perfect murder weapon,” Angela said.

“Well, not entirely. If the coroner suspects it, they can do an assay on a tissue sample from the injection site and pick up the parent compound, even in the small trace residuals likely to be left.”

“But they have to be looking for it,” Gene said.

“Yeah. And,” he paused, “the guy’s got to be dead.”

“To get a tissue sample?”

332

DAVID FARRIS

“No, to stop the circulation. If the blood keeps flowing to the tissue area, all the sux gets pushed into the bloodstream soon enough and it
all
disappears.”

A pause. “Seems you’ve given this some thought,” I said.

Gordon smiled. “Anesthesia
is
a controlled poisoning.”

“You hope so,” Angela said. “I mean, you hope it’s controlled.”

Gordon smiled again. “That’s why it’s a whole specialty all by itself. We only get paid for bringin’ ’em back alive.”

He went on, “One of my Attendings, a short and very curvaceous Filipino woman who specializes in treating cancer pain—she can put a needle in places I never knew existed—carries in her purse a big syringe loaded with sux. She says if some asshole is going to rape her in the parking lot, he’d better be done in one to two minutes.”

We laughed. “Wait a sec,” Glenn said. “She’s going to inject—what?—five, ten cc’s? IM? Before this hypothetical rapist can fend off a short woman with big tits and a syringe?”

“Well, it is an interesting defense weapon,” he said.

“But I’m serious. What’s the usual concentration?”

“Twenty milligrams per cc.”

“So, say this is even a small rapist. Say he’s a hundred and twenty-five pounds—sixty kilos.”

Gordie nodded. “Okay.”

“And what’s the dose?” Glenn said.

“Four milligrams per kilogram.”

“He’s to get four per kilo? Two hundred and forty milligrams? Twelve cc’s?”

Gordon smiled. I pictured his buxom Attending pushing a horse syringe into a combative rapist. “How big a needle she got?” I said.

“Never asked,” Gordie said. “But now that you mention it, a fourteen would be best, unless you could find a twelve.”

He turned to Angie. “Remember that.”

“Nobody’s going to be raping me!” she said.

“Carry some sux and you can make sure of it.”

“Maybe I’ll try it out on you.”

“You want me totally paralyzed?”

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333

“Might be fun,” she said, reaching up and taking him by the chin, turning him to look directly into her eyes.

Gordon started to say, “Naw, you’d have to do mouth-to-mou—” but was stopped when she covered his mouth with hers. The rest of us sat and watched, apparently rendered mute by the shower of stray pheromones not intended for us.

Gordon put his arm around Angela and it seemed we should all be getting out of the way.

I wasn’t through with pharmacology, though. “Aren’t there any other concentrations of sux available?” I asked.

“Not premixed,” he said idly. His focus on drugs was tenuous.

“What? A powder?”

“Yeah. ‘Flo-Pack.’ A thousand milligrams of the stuff in a little plastic squeeze bottle. We use it to mix up sux for continuous drips. You can run it continuously through short cases and have patients awake and moving right away at the end, it wears off so fast.”

“A gram,” I said mostly to myself. “How concentrated can you make it?”

“No idea,” he said, his eyes regaining normal focus. “We usually put it in a five-hundred-cc bag so it’s the same as the bottled stuff—twenty per. We also usually put in a couple cc’s of blue dye and label the thing up and down the IV line so some bozo doesn’t use it to start the IV in presurgery.”

“That happens?” Angela asked.

“Well, at least once. That’s how they got the idea for the blue stuff.”

“They’re fast learners,” I said to Angela. To Gordon: “But there’s no problem mixing them together? The sux and the blue dye?”

“Most things that will dissolve in an IV solution
are
com-patible with one another.”

I tried to picture the shapes of the molecules, bouncing around in solution, and imagine what might make them somehow cling together and inactivate each other.

“Okay,” Gordie said, pulling his arm off of Angela’s shoulders. “Greatest sux story ever. Supposedly—I mean 334

DAVID FARRIS

these legends are never verifiable—supposedly an anesthesia resident at God’s Own Hospital in Boston is by himself early one morning in the workroom, setting up a bunch of shit for a long day. And he’s making up a sux drip. He’s hurrying. He
bites
the cap off the little squeeze bottle, pulling on it, and—unintentionally—gives it a good squeeze. He realizes, to his own horror, he’s just inhaled about half a gram of sux. Drops all the shit on the floor, runs and pulls the fire alarm, then grabs a laryngoscope and a breathing tube, lies down on the floor and sets these on the middle of his chest, praying someone will get there before it’s too late.”

We all grinned.

“What happened?” Angela asked.

“Doesn’t matter,” Gene said. “The story is about thinking under pressure.”

“And being on the other end of the stick,” Gordie said.

“But what did happen?” I asked.

“I dunno,” he said. “Probably nothing. The sux molecule is very polar, so it probably isn’t even absorbed.”

“He probably could have just rinsed out his mouth,” I said.

“Yeah. But I’ve always wondered,” Gordon said, “how long would you lie there wondering?”

I smiled. Sitting in The Longhorn, knowing I would still be breathing ten minutes hence, I could afford to smile.

Then, though, I imagined being the one lying still on a cold basement OR floor wondering how much longer I would be breathing on my own. I pictured a blue mixture running into me. But something was trying to get my attention again. The something that had been moving at the edge of my vision when I read Mary Ellen’s reports of nefarious nurses.

It hit me—the moving piece—potassium and digoxin mixed in Indiana; sux and blue dye mixed in the Maricopa OR.

Sometimes I think there should be an annual awards cer-emony, televised live from Hollywood, for those vacuous failures to perceive the obvious that reach epic proportions.

LIE STILL

335

I could make a fawning speech and get a little gold statuette.

Maybe shaped like a vacuum cleaner—the “Hoovies.”

I said to myself,
The epi syringe needs to be tested. For
second
drugs.
If a paralyzing drug had been mixed
with
epinephrine, in the dog model I’d still see only the epi effect. The dog was already paralyzed; she couldn’t get
more
paralyzed.

I said to Gene, “I need to order a lab test.”

He made a face. “Go phone it in.”

“Nope. I wish I could.” My mind was churning. I needed someone with a research account number to order a proper analysis on the contents of the syringe in my refrigerator.

My only friend in such a high place was Dr. Richard Hebert.

I said to Gene, “You’re on Trauma, aren’t you? You got Dr. Hebert’s pager number memorized?”

“Yeah, but I wouldn’t be paging him right now.”

“Why not?”

“He’s hosting at that faculty thing over at Frost. It’s that Grand Old Man in from Chicago, one of Hebert’s old professors.”

I frowned. I said, “I’ll just have to go blend in.”

On the way out, I ran into Mary Ellen, finally out of her white coat, hair down and inviting. “Gotta run,” I said.

She looked me up and down. “So much for buying me dinner.”

“I have to talk to the Old Man. Hebert’s at a faculty shindig over at Frost,” I told her.

“Hey, Tequila Breath,” she said, “I’m sure whatever it is can wait. You’re tired and probably half drunk. Don’t be stupid.”

“Too late.”

“You might want to wait and be your old impressive self again.”

“No, it can’t wait. I’ll have to be impressive enough as I am.”

I kissed her on the head and left.

Outside Frost Lecture Hall was a placard announcing the Bi-annual Schaecher Memorial Lecture. Marie, Dr. Hebert’s 336

DAVID FARRIS

secretary, was sitting just outside the hall, listening through the open door, a stack of program handouts on her lap. The room was dark but for the projected image on the screen.

The speaker was well under way.

“Is Dr. Hebert in there?” I whispered to her.

“Way up front.”

I frowned. “Who is this guy?” I said, pointing to the podium.

“Franklin Weigand, MD, PhD,” she whispered back, “a muckety-muck neurophysiologist.”

I looked at the program. It said, “Practical Education in Neurophysiology.” I rolled my eyes. She smiled.

I crept in. As I cast about for a seat, several heads turned, bored faces seeking new stimuli. I sat next to a fleshy middle-aged woman I remembered as a dietary consultant I had met while rotating on Trauma. She smiled at me.

Projected on the screen was a daunting table of numbers and Greek letters. The title said, “Classes of Neurons.” The professor was saying, with a Germanic accent, “This we also show, of course, to our students; you’ve all seen this many times. The type A fibers, the large diameter, myelinated, rapid-conducting fibers to muscle bundles; the type C

nerve fibers, unmyelinated, much slower . . .”

I was sure I’d seen the chart up on the projector screen before, probably in medical school. It hadn’t been very interesting then; it was less so now. But then, the subtleties of asthma weren’t very interesting then and, I had to admit, were now perversely fascinating.

I said to myself,
Someday this knowledge could save a
life.
It was something we used to say to each other with mock seriousness throughout second year. It had seemed that all lecturers in the long parade of specialists, from der-matologists to a research endocrinologist who hadn’t treated a patient in fifteen years, had begun their talks with an explanation, usually statistical, of how much suffering their particular disease inflicted on humanity, the implication being that they were important and we had better pay attention. After a few months we all decided we had better beLIE STILL

337

come specialists, too, or we would inevitably kill someone because we had missed the wrong inflection in a lecture.

“Someone will die because I fell asleep in your lecture, sir,” I remembered one of my friends offering up to the ceiling late one night in the donut shop. We all laughed, but partly in nervous fear.

Basic physiology. For six days I’d been thinking I’d missed something elegantly simple with Henry. Physiology is like that—when you know it cold it is elegant. And it can seem simple.

I closed my eyes. Maybe I’d been digging in the wrong end of human pathology: the cardiopulmonary. Maybe I needed to move up the body to the head.

I felt myself getting too comfortable in the chair and my eyelids getting heavy. I mentally shook myself awake. I needed to be analytic. Cover all the bases.

It was possible someone had put something in Robin’s hands. If anyone were trying to hurt Henry, for whatever reason, it was almost a certainty I had the “weapon” in my refrigerator.

The GI tract was theoretically possible—the oral route, a favorite of centuries past. Not very glamorous. Not very effective, either. Very few poisons would have worked that fast, and the only oral poisons I could think of—like cyanide—produced a total metabolic disruption that would not have responded to any code on earth. Definitely not an oral poisoning.

I opened my eyes, glanced at Dr. Weigand’s current slide, a high-powered microscope’s view of a tangle of nerve endings, and decided I was better off with them closed.

How else can you give drugs? Under the tongue. Or nasally, or through the skin. There are only very few drugs that are absorbed via any of those routes, and they move slowly. None of those seemed possible.

The same would be true for the rectal route. Major problems with absorption, not to mention premature elimination.

I pictured Robin giving a boy a poison suppository. It didn’t fit. She’s not the anal type, I thought. Definitely oral.

338

DAVID FARRIS

I realized I was falling asleep in a lecture again. With a belly full of Mexican soporifics, slouching in a padded lecture hall chair, it was probably inevitable. I didn’t particularly care. It was a time-honored tradition among interns and residents as well as medical students.

Half asleep, I found Robin’s oral tendencies far more compelling than neuro-physiology, practical or not.
Be analytical,
I told myself.
Maybe I enjoy the oral parts of lovemaking because the rest of my life is so fucking
anal-retentive,
I thought with a smile.

I saw myself naked on her bed, gushing a smile just as I had during her fellatio. I kept on smiling and smiling as she arose and walked away, returning in a lab coat, though it was cut from yellow silk. She had it buttoned to the neck because there was nothing underneath. I tried to speak but couldn’t—

I was paralyzed. But she wasn’t going to operate on me, just run tests.

Robin held up a tiny key. She fitted it to the edge of a book, which sprung open. She took a one-cc tuberculin syringe from it and held it to the light for a few seconds. Satisfied with its contents, she found the rubber injection port in my IV line and put the tiny needle through it. She slowly injected part of the syringe contents, then turned loose the roller clamp on the line to flush the drug in.

We could see the drug’s advance toward me because there was a tiny air bubble, just large enough to fill the lumen of the IV line, moving toward me. I knew such a little bubble would not do me any damage—the capillary bed in my lungs would hold it until all the gas was absorbed—but its passing marked the moment the drug—whatever it was—entered me.

BANG!

I sat forward with a start. Someone had fired a gun.

My disorientation was overwhelming. On the stage, Professor Weigand was facing and pretending to fight one of the junior faculty, who was holding a small revolver in her hand and laughing in embarrassment.