Lie Still (46 page)

“Same,” she said.

“Stable?”

“Uh-huh.”

I flipped out that day’s bedside flow sheet. It’s a chart cen-terfold—three continuous pages per twenty-four hours of minute-to-minute minutiae. His showed the bare minimum number of vital sign entries, all close to normal. He was off the life support drugs. His heart, lungs, liver, and kidneys had become boring.

“Waking up at all?” I asked.

“No, not quite waking up,” she said.

“But what?” I asked, looking only at the flow sheet, trying to adopt the barely awake tone of the disinterested resident.

“But he’s getting some reflexes back.”

“What? Which ones?”

“Some cough, some breathing. When I suction him.

Weak, but there.”

Not brain-dead. Not alive. “Any gag? Corneals? Pupils?”

I asked.

“I don’t check all those,” she said.

I walked around to Henry’s right side. I pulled open one eyelid, then the other. His pupils were about half dilated and did not move with the change in light.

I needed more. “Got a penlight? Or an otoscope or anything?” Most med students compulsively carry around pocket penlights for such exams, but residents have generally become imperious enough to ask the nurses to find them one.

“There,” she said, pointing at a common flashlight standing on its face.

“High tech,” I said.

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DAVID FARRIS

I repeated the exam, this time swinging the beam directly into each eye just after opening it. The pupils didn’t change no matter how many times I moved the light.

I found a cotton-tipped swab and pulled off about half the cotton, twisting the trailing fibers into a long flame shape. I stroked each cornea as lightly as I could with the single cotton fiber. There was no response on the left, but there was a slight flinch on the right.

“Nothing,” I said.

She was draining the urine bag. Apparently satisfied that I was only going to do a thorough and boring neuro exam, Jeanie left.

I knew how to do the bedside breathing test—disconnect the ventilator and wait to see if the patient makes any visible effort to breathe. There are certain preconditions that must be met, but I had seen in the flow sheet enough of Henry’s data to know that was covered. The patient also should have lungs full of oxygen to keep it safe, but I accomplished that with a quarter turn of a single dial.

I waited through a dozen breaths, then disconnected the ventilator hoses from his breathing tube. The machine began squawking almost immediately, but a button on its face bought two minutes of silence. I stared, for the second time, at Henry Rojelio’s chest and belly, waiting for any motion there to convince me he was breathing. This time, though, I was hoping for none.

Within about fifteen seconds his abdomen bulged upward.

It was weak but real. He did it again after five more seconds, and again another five seconds after that. It wouldn’t keep him alive, but it was breathing effort. Muscle effort prompted by nerve signals generated in the lowest part of the brain.

I reconnected the ventilator.

Taped to the wall above his bed were nearly a dozen photographs of Henry and his family. Optimism in the face of reality. Attempts to remind him who he had been, of who had loved him. His baby brother, in one particular shot, took the prize for the A-Number-One Heartbreak Look of the lot.

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Curly dark hair, entirely uncombed, berry-stained baggy T-shirt, still in a diaper. Looking straight up to the camera, eyes like big gooey chocolate drops, offering up to the photographer, presumably just for a lick, the half-eaten, just-beginning-to-drip prize of a strawberry ice cream cone.

Able only to stand and stare at Henry, I was not sure what I had come for. I recognized no piece of information there.

No clues. No vital signs of interest. No look back at causa-tion, no look forward to prognosis. I stood like a pillar of salt for a full minute.

Then I remembered my homework: I needed to recheck old lab values from Day One. I found Henry’s chart on the bedside table. It was gaining weight like a newborn walrus.

I took it back to the control desk.

Any time a patient is transferred from one hospital to another, photocopies of the most significant records from the transferring hospital are put into the new chart in the tabbed

“Miscellaneous” section.

In this case, there were photocopies of my ER notes, the Code Sheet, Robin’s nurse’s notes, and the “Transfer Summary” I had dictated. I read Robin’s notes carefully. There was nothing derogatory, nothing to suggest why she would later attack my care of Henry.

I found a page of lab tests, none of which had come back to me during Henry’s code or even before the transfer—I checked the times. We had drawn one blood gas analysis during the code and one just prior to sending him out the door. The potassium during the code was 7.9. Decidedly abnormal. Into the range that can make hearts—patients’

and doctors’—go pitter-pat, but might not. High enough to have possibly, unprovably, jimmied Henry’s heart. But not diagnostic. It could have been the result of his shock state during the code. Cause and effect were not clear.

Two pages later I found a screening urinalysis. The row for protein was marked “3+,” unequivocally a positive finding, highly suggestive but likewise not diagnostic of anything. That much muscle damage could have come from the jerking response to the electric shocks.

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DAVID FARRIS

I flipped the pages, wondering where I could get the relevant ones photocopied before my Glory meeting. I thought of just absconding with the whole section of transfer notes.

Nobody looks at them, anyway.

I had them all in one hand, ready to snap open the binder, but stopped as a nurse hurried past. I looked at the front page, pretending to be studying it. When I saw what it was I almost laughed out loud. It was a copy of the “Face Sheet”

from Henry’s ER visit. The Face Sheet is a printout from the hospital database of the patient’s identifying data—name, address, birth date, social security number, religious prefer-ence, next of kin—and most important to the hospital, how the care is going to be paid for—responsible party, health insurance, etc. These come out of the printer in stacks of five, the lower four pages being pressure sensitive to pick up the printing from above. Because I had, at the time of seeing Henry, already pulled the top copy, on which I was required to enter the discharge diagnosis and my signature prior to letting Henry go, the Glory ER nurse had photocopied the next-lower page.

The copy showed clear evidence of its source having lain under other documents as folks wrote, their scratches and scrawls amplified by the wizardry of modern photocopying technology. I looked more closely. I recognized the handwriting. Squarely in the middle of the section for “Discharge Diagnoses,” in Robin’s looping style, was a cryptic set of notes, the code to which I readily recognized. There were the phone number for the Maricopa Pediatric ICU, Henry’s full name, his date of birth, “asthma,” “epi,” and “CPR” with two exclamation points. Under those it said “Superstition Hwy,” “60,” “32 mi,” “Tonto—Green,” “R,” and “two L

forks.”

My consciousness imploded.

It was Henry’s “event.” And directions to Mimi’s canyon hideaway.

I closed Henry’s chart. I stared. I quietly rose and left the Unit.

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H E N RY RO J E L I O , DAY S I X ( C O N T I N U E D )
The only possible conclusion was easily reached, but, like a beginning medical student anxious to ascribe a fever to the exotic African parasite he has just read about, I kept trying to come up with an unobvious explanation.

The implications of the one standing in front of me were horrifying. Robin had called Mimi Lyle. Sometime between Henry’s arrival at the Glory ER and his departure for Maricopa. And Robin was going to the cabin in the canyon.

I was reeling.

Only now, years and miles away, does it make sense that I might have called Detectives Borden and May. At the time it never crossed my mind. Maybe my subcon-scious looked at how I had nothing to lose and did some cost-benefit analysis. If so, it was instantaneous, because once I was completely certain of the connection, I stopped processing at a rational level. I put on my jacket, walked to my car like a man late for a funeral, and drove to Miriam Lyle’s condominium. It was, I suppose, an act of cold fury.

*

*

*

352

DAVID FARRIS

I pounded on her door and waited only a very impolite interval before pounding again. Behind the door she sounded only annoyed. “Who is it?”

I was hoping she would be scared. “Robin Benoit.” There was silence. “That give you a chill, does it?”

“Malcolm?” I said nothing. She opened the door. I had not laid eyes on her in ten months. Her face seemed different. “What are you doing here?” she said. “Especially at this hour.”

“I’ve been up to the Maricopa Pediatric Intensive Care Unit.” She just stared. “I’ve been checking on our mutual friend, Henry Rojelio. Did you even know that was his name? Of course you did. Robin gave you the name when she called you from the ER. At least that’s what her note shows.” She said nothing. “Did Robin tell you she left a nice paper trail in the chart, with her directions to your canyon hideaway?”

She blinked. “I don’t know what you’re talking about.”

“I believe you do. And I believe the police detectives in Mesa will want to talk to you. Would you like their number?

Will Borden and Ken May. Will seems a nice kind of chap but Ken is a bit brutish. Probably has Parkinson’s, though.”

A silence.

“Did you know Henry is hanging in limbo? Have you been able to follow his case?”

She stared.

“I know how you did it. Or how you had Robin do it. A TB syringe with a dose of succinylcholine, a bubble, and a bit of epi. The perfect weapon.”

She stepped aside and motioned for me to enter. She had on a terry-cloth robe and her hair was falling on her shoulders. She was not the lioness I remembered, stunning and powerful, deep red mane streaming, but grim-faced, harried, stiff, tired, more prey than hunter. I had the knowledge. I would have said I had the power, the control of the situation, but my instincts were on edge, saying otherwise. She said,

“Sit down.”

I sat but probably failed to hide my agitation.

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“Coffee?” she said.

“No thanks.”

“What is it you think I did?”

“I know what you did. Or what Robin did for you.” I stared at her hard but she made no response. “The only thing I cannot figure out is why. What’s the connection? Between you and her.”

“Robin who?”

“Oh, cut it out. Robin Benoit. Actually, an ER nurse from California posing as Robin Benoit. It would seem the
real
Robin is an Englishman. The fake Robin was in a rented house out in Mesa I suspect you paid rent for. Had a wad of cash stuffed in a secret hiding place. Cozied up to me out in Glory. Picked out a ne’er-do-well asthmatic and shot him with succinylcholine instead of epinephrine to generate a disaster under my nose. Ringing any bells? On my watch.

Blame me. Write a report that I can’t handle an asthmatic much less an arrest. Get me fired, run out of town. Things turned to shit, though, didn’t they? Probably way more than you planned.”

She was impassive, even more rigid than before.

“Did you look up his potassium level? I mean the one from Glory? They were probably pretty normal by the time he got to Maricopa. But in Glory they were pretty high. It’s funny, though, isn’t it? We didn’t get the lab results at the time. Sent the blood off but never saw the numbers, either. It happens, though. That’s why we treat the patient, not the lab values.

“You didn’t count on his funky little muscles, did you, Mimi? Got more that you wanted. All that potassium made his heart go a-titter. And all you’d wanted was a little apnea.”

“You really should leave now.”

I went on. “Your ‘Robin’ then laid out all kinds of bullshit, in writing mind you, about what a fuckup I seem to be.

And we both know my position in the medical world is a bit precarious, also thanks to you.”

Only silence.

“She left the epinephrine syringe—beautifully labeled 354

DAVID FARRIS

and all—lying there for me to take. Not to worry about a chemical analysis. The sux was separated from real honest-to-God adrenaline by a simple air bubble. In a tiny syringe that’s all it takes. I tried it. Surface tension, you know.

‘Physics is everywhere,’ my old professor used to say. But damn if Robin didn’t leave the bubble in the hub of the needle. Saw it myself.”

She leaned toward me and said, “You have no idea what you are talking about.”

“Maybe you’d care to correct me.”

She closed her eyes for a second, then took a deep breath.

“Let me get some clothes on.” She went into her bedroom.

“Hey,” I called, “got Robin’s dead body back there? I almost left that part out. The police are looking for the body, you know. They don’t seem all that convinced the one they found in the canal is her. They asked me if she was bruised or bleeding the last time I saw her. And whether she was in any kind of trouble. You know, they ask an awful lot of questions.”

“No,” she answered, “no Robin. I know no Robin. But I will explain what you think you know.” Her voice had a different timbre.

“I’m dying for an explanation. Really, I am.”

There was an odd silence. I turned and looked back. She was standing in her bedroom door in jeans and a sweater, with light glaring from a bank of bulbs behind her. She had passed from frightened and haunted, through only a silhou-etted change in physical attitude, to undeniably predatory.

She said, “Stay very still.” She was pointing directly at my face a moderately large black semiautomatic pistol, I guessed a nine millimeter. With less than ten feet separating us, I doubted she would miss. I did not move.

“You know I know very well how to use this. And here I am defending myself against a deranged former resident.