Lie Still (49 page)

“Sita,” I said, “what’s goin’ on?”

“This one?” she replied, with a head tilt in the direction of the crying patient. “OD. They give her Narcan, she puke.”

Teresita shrugged and began mopping.

370

DAVID FARRIS

“Mother
fuckers!
” the patient screamed. A female voice.

The ER was lively after all. I need not have worried. “Ruined a good high, eh?” I said as I went around the puddle.

Through the door, I could see the woman was shivering in a grimy jogging suit, huddled against the wall just inside the door. She was staring at me, her face practically imploding in a pained contortion. I was frozen for a second, virtually in mid-step. I stared back. Her face seemed to soften a bit as she mentally wrote me off, then she closed her eyes. I tried for a second to imagine narcotic withdrawal. She spat on the floor, wiped her mouth with the black and brown sleeve of her otherwise red sweatshirt, then spat again.

Around a corner from Sita was the central station, entirely vacant. In a little room behind the Com Desk—the radio and computer links to the city—are all the drugs and supplies. I ducked in and found in the alphabetized drug cabinet two 10-milligram Inderal pills, popped them and drank from my hand under the sink spigot. I checked my watch—5:15. The Inderal would kick in in about twenty minutes.

In a drawer under the med cabinet I grabbed a syringe and needle and an amp of sterile water and slipped them into my pocket.

When I emerged I found another old friend, Alva Leon, the charge nurse on nights, staring at the grease-pencil control board. Nothing was written in for the cursing woman’s room.

“What’s in Ten?” I asked.

“Dr. Malcolm! Hey, I thought you disappear off the earth.” She gave me a big hug. “In Ten? Just got her. Nice little lady had too much of the heroin. Medics gave her Narcan, then hit every bump in the road getting her here. Kind of like roller coaster. They probably take the corners extra quick, too. She makes a mess.” I said nothing. Alva finally looked at me. “Why? You step in it?”

“Almost.” Alva went back to staring at the control board.

“Actually, I was wondering if you needed orders on her or anything. Didn’t seem like anyone had gotten to her yet.”

“Cooney is on his sweet little way. He doing a plastic sur-LIE STILL

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gery repair of forearm in Center Stage. Take forever with those little teeny-tiny sutures no one can see.”

“The guy’s an artist.”

“Yes, he think so. Patient is dirtball.”

I gave her a hard look. “Careful. You never know who may hear you.”

“Well, he is. The laceration go right through the boobs on his tattoo of naked lady and Cooney decided it would be fun to give
her
anatomic repair.”

“At five in the morning.”

“At five in the morning,” she echoed. “What kind of orders you have in mind?”

“Well, I don’t know,” I said, “the usual kind of withdrawal stuff. Some IV fluids, if you can find a vein. Librium. Something for nausea.”

“But I didn’t think you could write orders here anymore.”

“Oh, I can write them,” I said, “the question is whether the nurses who work for the hospital will honor them.” She nodded a small laugh. “Actually, it occurred to me that right now what would do her more good than anything would be a cup of water to rinse her mouth out.”

“You’re a nice man,” she said.

“Now, don’t start spreading that around, Alva. Everybody’s going to want a drink of water.”

“I’ll get her some water. But Cooney will kill me if I give her Librium.”

I scanned the control board. One old man with a headache waiting on Cooney and one older man waiting on Redway Cab for a ride out of there. Probably sobering up and un-happy about it.

On the Com Desk was a wooden box holding the paper records, arranged with paper clips and awaiting transit to Medical Records, of every patient seen in the ER that shift.

Usually it makes good reading.

Underneath two toddler brothers with diarrhea was a guy with a scorpion sting to his scrotum, then a woman who had started to kill herself by running her car’s motor in the closed garage, but panicked when the nausea set in. A cou-372

DAVID FARRIS

ple of lacerations, an old lady with a broken hip, a thirty-two-year-old cocaine shooter with an apparent heart attack.

And two more headaches.

Alva returned and looked at me suspiciously.

“When does the helicopter go for donuts?” I said.

She grinned. “Whenever they want. You want them to get your breakfast?”

I stood and stretched. “Nah. I think I should go get some sleep. But you gotta tell me how a man gets a scorpion sting on his scrotum.”

“He uses kitchen sink for bathing after his job. He keeps a piece of water hose in under the sink, uses that for rinsing.

Last night he plugs hose to faucet and flushes out little scorpion. It stings him on the way to the floor, then he step on it, too. His foot not stung, though.”

“Ouch.”

“Yes, ouch. Very big and painful.”

“I’m sure. Hope Cooney gave him some good drugs.”

“Only the best.”

I said my goodbyes and shuffled out.

The OD woman had lain down on the exam table and folded her arms over her chest. She was staring at the ceiling.

I turned left just short of the exit, ducking down a hallway.

In a men’s room stall I mixed the gram of sux in the sterile water and drew it into the syringe.

In an intensive care unit the light never changes and the doors never lock, just like Las Vegas casinos. I wandered in, trying to look sleepy. I spun the chart rack like a kid kicking the merry-go-round in spite of his vertigo. The slot for Henry’s chart was empty.

I went to his cubicle. He was alone. His chart was on the bedside stand. I went and bent over it, pretending to study the lab result printouts and the vital-sign flow sheets and the nurses’ neuro checks, all the time scanning around to see who was to be watching him. A nurse popped her head in.

She was one of the legion of hospital folk I had seen many LIE STILL

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times in the cafeteria and the elevators but never had reason to speak to. I didn’t know her name. If I had run into her in the shoe department at Goldwater’s, I’d have had the vague sense that I was supposed to know who she was, but didn’t.

I looked up but said nothing. She said, “If you need anything, I’ll try to help. I’m just covering Jeanie while she’s on break.” She nodded at Henry. “He’s been just rock steady, I guess.”

“Yeah, that’s what I see. I’m just making some notes.”

She nodded and left.

I began to repeat my neuro exam. I peeled back the sheet covering Henry and crossed his right leg over his left, then tucked my left arm under the right knee, lifting about two inches. Karate-chopping the patellar ligament will usually elicit a good reflex if one is there to be had.

I walked around to the other side of the bed and I re-crossed Henry’s legs the other way. While knocking on his left patella I scanned the various IVs to see which was his

“maintenance” line—the one sure to go on running all day unchanged. The only choice was his hyper-al—his milky IV

feeding. The bag was still half full—enough to run at least until late afternoon. The bag would not be changed out—no intern on earth would write the day’s full page of hyper-al orders, specifying in detail every nutrient and mineral,
before
determining brain death.

I looked over my shoulder. I knew doing so would appear suspicious, should anyone actually be watching, but I couldn’t help it. I took the syringe from my jacket pocket and pulled the needle cover. I put the full gram of succinylcholine through the latex nipple into Henry’s IV feeding bag and gave the bag a couple of squeezes to mix it in. I spoke quietly: “You can rest now, Henry. Sleep well. If you’re going to some kind of other life, I hope you get to leave behind the scars from this go-round. I hope we all do. I hope all of you is straight and strong and happy on the other side.”

I started to leave. At the door to his cubicle I turned back.

“And Henry, if it works out, come back and let me know.”

I looked at the pictures of his family. I recapped the nee-374

DAVID FARRIS

dle and put the syringe back deep in my pocket. I left, nodding my thanks to the nurse two cubicles away.

When I made it home it struck me as odd that nothing had changed. Logically there was no reason for things to be different, but I did not expect logic to hold.

Mary Ellen was up, drying her hair, already dressed for the hospital.

“You got early rounds, still?” I asked.

“Uh-huh. Where have you been?”

I grunted. “Had to see a man about a horse.” She took that to mean I was getting laid. “You remember a case you told me about two years ago?” I said. “Eight- or ten-year-old girl you got into a fight over. You wanted to take her off the ventilator?”

She stared at me for a few seconds. I said, “Brain-stem infarcts. All locked in . . .”

“Gawd. Nancy Madsen.”

“Yeah. That sounds familiar.”

“Malc, why bring up Nancy at six in the morning?”

“I need some clinical history for an important case,” I said.

“But you’re not working,” she said.

“Don’t get technical. I’ve been thinking about Henry.”

“What do you want to know about Nancy?”

“She was the one with the brain-stem strokes.”

“Right.”

“Not brain-dead.”

“No. Worse. At best—or worst—we predicted she would have been awake and completely unable to talk, breathe on her own, or move a finger. Unable even to blink. Imprisoned in her own skull. I wanted to take her off the ventilator. Her respiratory failure was so severe her heart would have quit in about two minutes.”

“But they didn’t let you do it.”

“No. And her lungs got better, but her brainstem didn’t.”

“Yeah, I remember. I used to see them all touring around the hospital. Broke your heart.”

She nodded.

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I hesitated. “Do you ever wish you had done anything differently?”

“If there had been anything to do differently, I would have done it.”

“When you told me about the girl, we talked about the tragedy of our insufficiency. Somebody doesn’t quite die and we hand her back to the family to drag around. Make them carry the weight of a medical failure.”

“When someone dies you can cry and grieve and get over it and then get on with life—you know, have an actual life—

or you can a carry around a formerly human albatross and live in an unending disaster.”

I said, “Funny how the best and worst outcomes are indistinguishable at these extremes.”

“It proves the universe is spherical.”

“God may not play dice, but He’s got a warped sense of humor.”

She nodded.

“There was something you used to say in those kinds of cases. A summary statement.”

“‘Her disaster is
over
?”’

“Yeah, that’s it.”

“I say that all the time in the ICU,” she said.

I nodded. “The patient’s disaster is over. We should stop spreading it around.” After a minute I said, “But you didn’t know.”

“Know? Know, like for sure? An absolute?”

“Yeah.”

“Malcolm, you know there are no absolutes. In her case they wanted to wait to see if the brain would miraculously recover, and when it didn’t it was too late. The family was stuck with the result.” She was putting on her jacket and heading for the door. “Swelling goes down. You know how it works.”

“Yeah. But it’s good to review.”

“You’re a doctor. They didn’t put those two little letters at the end of your name just because they wanted you to pass out antibiotics for colds and sore throats. Sometimes you 376

DAVID FARRIS

have to make decisions in the land between what you know and what you can prove. It’s where we live. You do it to help people.”

I nodded and smiled at her. I said, “I know.”

She nodded at me, closed the door, and left.

25

Hooker, two censuses ago, was a town of 10,300 souls. Like many such anachronistic towns, it is slowly wasting. Last census it was at 9,858.

The brochure from the Chamber of Commerce has a glossy picture of Herefords grazing on gently undulating pastures, with a windmill, Nebraska’s favorite cliché, just this side of the horizon. Also a picture of two prepubescent boys gleefully holding up a stringer of undersized bluegills, and a picture of a father and son (presumably) ambling into a sunset, shotguns over shoulders, carrying a dead pheasant.

If your town lacks demonstrable culture, has a monolithic and disappearing economic base, a shrinking population, and nothing on any restaurant menu more exotic than Chicken Kiev, deep-fried straight from the freezer, you have to go with what you got: fishing, hunting, simplicity, and cows. The tag line on the brochure is one I see everywhere here, even on the license plates: “Nebraska. The Good Life.”

Thank God—and Dad—I had a license here.

When I lost my residency I didn’t give up and run. I entered an appeal at Maricopa, citing the obvious issues. I also applied to seven other surgery residencies, in California, Oregon, and Utah. I stayed in the town house with Mary 378

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Ellen, though I had squandered part of our friendship. I picked up work in ERs like Glory while I awaited my fate.

When Mimi Lyle got me flushed out of Arizona, I thought I was merely taking an extended trip home to my folks. I wasn’t running away, only hoping to reconnoiter. I needed work. I found Western Acute. I talked often to Adrienne.

Mom cooked meals. Dad had strokes. I stayed.

At the end of two years my appeals had run aground in Arizona. Each of the residencies—initially seemingly so happy to find me a spot—had sequentially decided I was un-worthy. I could easily imagine the facial expressions when they got the copies of the file from the Arizona board.

By then, luckily, I found I really did like ERs. Through experience and study and asking “dumb” questions, I was sufficiently up to speed to feel adequate. By now, it seems, I am adept.