Lie Still (5 page)

chromosome went on alert whenever she was near. Call it a schoolboy crush.

My distinctly mixed fortunes with
la Profesora
began in the spring of my second year of general surgical residency.

I drew a rotation on Neurosurgery while she was the Attending assigned to the teaching service—my immediate boss. Though no one would expect a general surgeon, even one, say, stranded in the Nebraska Outback, to operate on brains and spinal cords, we were expected to have at least a rudimentary understanding of the field.

I’d been warned of her operating room deficits, sort of.

Among medical underlings the right kind of story about our superiors easily becomes mythic, retold often enough that senior residents will correct details in their juniors’ versions of the story just as they would an incorrect medication order.

Oral history is a healthy tradition in teaching hospitals.

The neo-campfire for us Maricopans was The Longhorn, a Tex-Mex restaurant a block from the hospital. A maze of LIE STILL

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sprawling cinder-block rooms growing like mushrooms from a decrepit old adobe house, it had been the residents’

bad habit for as long as anyone could remember, loved and hated in equal parts: The meals were cheap, yet big enough to fuel the average mortal for days. The secret of their success was grease.

The center of the action was a certain large, oval table—

forever ennobled among the brethren as “The Oval Table: Where Everyone’s More Equal Than an Intern.” There, I got my first Tales of Mimi, over chips, salsa, and
cerveza
.

Maybe when the crunch came I was carrying along the opinions and judgments of my residency peers instead of forming my own based on firsthand observation. Not very doctorlike.

But the stories were scary.

A talkative resident two years my senior had told me she was once scrubbed in with Mimi for six hours to do a one-level laminectomy, an extraordinarily long time for a routine operation on a herniated spinal disc. Reason: They couldn’t find the offending piece of disc. “No wonder,” I was told.

“She was two levels off.”

“But couldn’t that happen to anyone?” I asked.

“One level, maybe. Two? Rarely. Anyway, you’re supposed to get films.”

“Films. Looking for . . . ?” A pause. I was obviously not in on this.

“X-ray comes in and shoots a cross-table lateral, after the surgeon has marked the level she’s at with something that will show up on the film, like a twenty-two-gauge spinal needle. It’s standard. Then anybody who can count backwards from five can see that the needle is at L Two-Three, not L Four-Five, and you move down.”

“She never got films,” I said.

“Refused to. The nurse asked twice if she should call X-ray. Dreamy Mimi was humming to herself and didn’t answer the first time. So the nurse repeated it. She had the needle up on the field, ready to go. Like I said, it’s considered standard.

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DAVID FARRIS

“Meems didn’t like it,” she went on. “She said, ‘Listen, honey’—kinda singsongy, like it was supposed to be a joke—‘at the Mayo Clinic only wimps need radiologists looking over their shoulders. Do you know what they charge to review an intra-op film, two days after we’ve finished the surgery?’

“The nurses here have a lot of guts,” my resident went on,

“I guess they have to. This nurse is about older than God and
big
. She says to Mimi, ‘I’ve heard Dr. Hebert ask what the three most overrated things in America are.’ ”

Dr. Hebert was the Chair of General Surgery at Maricopa, my ultimate boss.

She went on: “There’s a real painful silence because everyone there—probably Mimi included—has heard Dickie Hebert’s pat line about the Mayo Clinic. She finishes,

‘Home cooking, home fucking, and the Mayo Clinic.’

There’s a longer silence, except from the anesthesiologist, who’s doing a very bad job of trying not to laugh—he must have heard that line twenty times. My guess is he’s just enjoying seeing someone throw it in Mimi’s face. She’s so full of herself and that Mayo Clinic shit.”

“And . . .” I prompted.

She leaned slightly toward me. “I’ve heard Mimi Lyle has a pretty good vindictive streak. They say she does target practice at a shooting range every few months. Like a cop. I wish I knew this nurse’s name. She might die a mysterious death someday. Say a thirty-eight to the thalamus or scalpel to the medulla oblongata. Mimi hasn’t said a thing, so the nurse says, ‘I don’t know about the home fuckin’

part. I never really thought of it as being that highly rated to begin with.’

“Mimi is, I guess, not up for this repartee. She can only drop names. ‘Ian McWhorten is one of the finest neurosurgeons on the planet, and he could operate circles around anybody in Phoenix,’ and blahbedy blahbedy.”

“Who’s Ian McWhorten?” I asked.

“Her mentor at Mayo’s. Supposedly a great neurosurgeon, so he probably could operate circles around anybody LIE STILL

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in Phoenix, but he apparently didn’t let Dr. Lyle in on any of his secrets.” She paused. “Like I said, she was two vertebrae off. Spent two hours inside that guy’s L-spine before she’d get a film.”

“And when she did?”

“Spent a long time looking at the CT and then the film, then the CT, then the film. Finally she extended the incision, did the lam, pulled out a chunk of disc the size of a goddamn almond, closed up, and went home.”

“Never said a word,” I guessed.

“Said, ‘These things happen,’ to me. Never said a word to the nurses.”

“Anything happen after that?”

“Are you on drugs? What would happen? The nurses
maybe
write up an incident report, which goes into a confi-dential file and rots. I imagine Joe Kellogg, the Chief of Neurosurgery, heard about it all, eventually, though it’s not like an official report. I was the only other doctor scrubbed and I’m not writing it up. I suppose the anesthesiologist or nurses dropped a few hints around the OR for Kellogg. But face it, the only thing Dr. Kellogg is going to do is tell her to get a film. It’s not like she’s the first neurosurgeon to open at the wrong level.”

“What about when she opens the wrong side of the skull?” I asked. This wasn’t the first story I’d heard about Dr. Lyle.

“I wasn’t there for that one,” she said. “In fact I don’t know anyone who was. I heard the story, though: car-wreck-coma, CT shows a big clot on the brain, rush to the OR at midnight, turn a really neat flap, but it’s on the
wrong side
.

Close up, turn the head, do it again. This time find a big ugly clot, suck it out, close up, go home. Patient dies. Probably would have died anyway. Most do.”

“I heard he ended up in long-term care.”

“Well, same thing.”

“And nothing came of that.”

“Sheesh. You don’t get it. She’s hot shit around here. She was the first female neurosurgeon west of St. Louis and not 34

DAVID FARRIS

in California, and Joe Kellogg landed her here. She was considered a hot little go-getter and something of a plum for a shithole like this. She’s smart—she knows the science. And she gets grant money. She does a little research and goes to all the meetings and flounces around like a princess among the good-old-boy brain surgeons. They like her. They publish her papers. She gets more grant money.”

“But she can’t operate.”

“Say what you will, Doctor”—she opened her hands up like a crocus—“I’d call that operating.”

“Does she get films now during lams?”

“I try not to be around when she’s in surgery.”

As a “PGY-2” (Post-Graduate Year-2) resident, my standing on the clinical totem pole was just on top of the interns (“PGY-1’s”), who were only on top of the medical students (baggage). In this continuous initiation process one is regularly moved from place to place and service to service, and therefore continuously ignorant. Ignorance is vulnerability, and rather than worrying over her operative skills I was more interested in the stories of her occasional meanness and caprice. She was said to have thrown an intern out of the operating room for not knowing some fact of neuroanatomy that she thought was supposed to be basic knowledge. About all I remembered of neuroanatomy, beyond the names of the big lobes, was that studying it was like trying to memorize a huge computer circuit board you couldn’t see and none of it seemed like basic knowledge.

She was known to have stationed interns with her post-op patients for forty-eight straight hours in the ICUs, calling in at odd hours, supposedly a little tipsy after late-night trysts, more to see that the hapless trainees were there and awake than how the patient was doing. The patients often as not did poorly, but that wasn’t unusual in neurosurgery. The problem, I was told, was that she would have mucked around in their brains for eight or ten or twelve hours, pressing retractors on their memories or motor abilities or coordination until they disappeared into oblivion as the underlying brain slowly turned to yogurt. Another surgeon LIE STILL

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might have taken a fourth that long, and the parts of the patient’s brain that were in the way would have seen less physical abuse and more blood flow and had a better chance of hanging around.

The Book of Mimi
has its genesis, appropriately, in an intensive care unit.

Just as I did to start every rotation, I showed up on the designated patient unit—this time it was the Surgical ICU—at 6:30 A.M. on the appointed Monday to see the patients with the interns in preparation for rounds with the professor. That day, though, I was alone. Maricopa Medical Branch is the junior varsity of the UA Centers for Health; the smaller specialty services like neurosurgery often don’t get both an intern and a resident. Though a resident is usually better off sans intern in terms of efficiency, it meant I was alone in the gunsights. On top of that, my particular

“Month with Meems,” through a quirk in the academic calendar, was to be six weeks. Six weeks at the foot of the mis-tress, seeing patients only in her clinic, rounding just with her, reading up on literature germane to her research projects, sharing the meals on the fly, and, in my case at least, getting highly personal.

With the stories I had collected around the Medical Center of Mimi the Witch, no one had told me she was charming. Nor would our introduction suggest it.

That first morning I asked the ICU charge nurse, a woman who had sheltered me a few times during the storms of internship, if Dr. Lyle had any patients there. She smiled wryly and nodded. “Mrs. Gottshok. Bed five.” I turned but she went on. “You and Mimi, huh?

“Yes.”

“This’ll be good.”

I shot her a look. I assumed she meant I was going to be another case of medical-training mincemeat. She was smiling. I said, “You’ll be sure I get a decent burial, won’t you?”

“Whatever you need, Doctor.”

I gave her back a look of surrender.

I found the patient’s chart. She was a seventy-one-year-36

DAVID FARRIS

old woman with a leaky mitral valve, prone to congestive heart failure. The Friday prior, Dr. Lyle had taken an irritat-ing rub off a major nerve to her left arm by fusing two of the woman’s cervical vertebrae. They put the woman in the Unit supposedly for overnight monitoring only, but she became short of breath post-op. The resident on the cardiology team put a catheter in her pulmonary artery to diagnose what he already knew, namely that water was backed up in her lungs.

He gave her diuretics and her heart failure resolved. She was still in the ICU because, in poking the huge needle under her collar bone to get the catheter in, he had also punctured her lung, giving her a small pneumothorax—a collapsed lung.

The morning chest film had already been done, so I compared it to the ones from the days before; the lung was again up and working.

Mrs. Gottshok was sitting up flicking through the televi-sion channels with the old-fashioned hardwired remote control unique to hospitals. I introduced myself and asked how she was feeling.

“Bored,” she said, nearly shouting. “I want to go home.

You people are all boring.”

I smiled. “You’re an astute observer,” I said. “How’s your breathing this morning?”

“I’m here, aren’t I? My breathing is just peachy. Now are you going to let me out of here?”

“I sure hope so. Your chest X-ray looks like you’re headed in that direction. But better let me have a listen, first.”

I had the bell of my stethoscope on the woman’s back when Dr. Lyle came into the room. I nodded a hello. Dr. Lyle asked Mrs. Gottshok something like, “How are you this morning?” With my ears full of stethoscope, trying to sort out normal wind tunnel sounds from a few stray whistles and a whooshing heart murmur, all I heard was mumbo jumbo. Mrs. Gottshok began a long answer at high-decibel volumes, nearly deafening me. I held up my hand to cut her off, and again asked her to just take a nice deep breath. It never occurred to me that I was cutting off Dr. Lyle’s interview of the patient, only that I could not complete my phys-LIE STILL

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ical exam if they were going to talk. Auscultation of the patient’s chest is relatively sacrosanct, even when done by a trainee.

After we left the bedside, Dr. Lyle asked me what I thought. “Her lung’s back up. She’s surgically stable. We should get her out of the Unit today, maybe even home tomorrow.” Mimi nodded, her arms folded. I said, “I’ll write for it. When do you want to see her in clinic?”

“Seven to ten days. Resident clinic.”

“Sure.”

“Your name Malcolm?” She was reading my nametag.

“Yes, it is. Malcolm Ishmail.”

“Dr. Ishmail, please don’t ever again cut me off as I’m talking to a patient.”

I tensed. “I’m—oh, uh—sorry, Dr. Lyle.” Twenty minutes into the rotation and I was already a bumbling nincompoop.

“I guess it was just, you know, a reflex. I was concentrating on her breath sounds. You know, trying to—”

“You can do that on your time. Not when I’m making rounds.”

“Yes. I’m sorry.” I knew the paramilitary drill: Short answers invite the least reprisal.

I spent the next few days being brief and to the point, and trying to do what a good medical resident is supposed to do: Know at any given instant precisely what the professor is thinking despite the absence of discernible clues. I saw all the patients in clinic and in the hospital ahead of her and then presented the history and physical findings with my own speculative assessment and treatment plan. She would nod or frown, prod, ask leading guess-what-I’m-thinking kinds of questions, and correct or sometimes completely ignore, probably out of sympathy, my diagnoses and plans.