Lie Still (36 page)

They were all empty. I returned to the drawer nearest the phone. Piece by piece I went through perhaps twenty scraps and notes and found nothing.

I went back to the bedroom. There was no wastebasket, but in the drawer in Robin’s nightstand I found a page of hospital chart paper. The top was stamped with a patient imprint whose name I did not recognize. I examined it at an angle to the light, looking for impressions, but there were none.

I poured a dash more wine and sat. I wondered where help might be had.

I came up blank.

I closed all the drawers and doors, killed the lights, and tripped on out. I put the key back in its wide-open hiding place.

Driving home to the heart of Phoenix, I realized I still had no explanation for Robin’s blind-side assault on my handling of Henry Rojelio. Henry’s dying in the ICU was an ever-ready reminder that maybe after all I truly had fucked up the case. I have learned very well that each of us is blindest to his own defects. Still, every time I ran through the decision-making tree for Henry’s care, it came out the same way.

I took to bed two distractions: a Hemingway book I was limping through and another glass of wine.

16

Three weeks ago in Othello I met Fred Sommers. Fred came
to the clinic under protest. A neighbor virtually dragged him
in. The neighbor recognized shortness of breath, involuntary
weight loss, and coughing up blood as fearful things.

Fred looked bad, but his chest X-ray pretty much told the
story: A lemon-sized mass of something bad was growing
just to the right of his heart. It had choked off most airflow
to the bottom half of the right lung. When lung lobules don’t
get air certain bad bacteria run rampant. These isolated
parts of the lung were socked in with pneumonia. The combined inflammatory effects of infection and cancer had stimulated his chest to fill with fluid.

When I gave Fred the news he merely nodded. He was
willing to acknowledge that it hurt, but mostly he wanted to
get back to his farm. His kids were at the neighbor’s and he
didn’t like the imposition. His wife had left him five years
earlier. His kids needed him.

I convinced him, with help and promises from his neighbor, to stay with us for a little while. He did allow that the
oxygen I had running to his nose seemed to make his breathing easier.

Once we had all the culture specimens in the lab, I got an
IV going, ordered the right antibiotics, and called Annie
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Parrott to get her input. I figured Fred needed some high-end oncology help in Lincoln or Denver. She concurred and
said she knew just the person to call. While she made
arrangements I put on gloves, washed and anesthetized the
back side of Fred’s chest, stuck him with some big needles,
and drained off a liter and a half of blood-flecked fluid that
looked like moldy maple syrup. He took a deeper breath and
thanked me.

Fred went that night by ambulance to Lincoln. I heard no
more until Annie called me last night. She said the patholo-gist called the biopsy so “anaplastic”—a descriptor for malignant cells that connotes a raw, primitive origin, usually
fast-growing and highly refractive to treatment—that he was
unable to classify the cancer. Treatment would have to be by

“best guess.”

Thoughts of a cure were zero. The oncology team hoped
only to shrink the tumor enough to clear out the pneumonia
and get Fred home to see his kids. They hit it with industrial-strength radiation. And nothing happened. The tumor kept
growing.

Fred got sicker by the day and died nine days after I had
seen him. He was fifty-one.

The Hooker bank has a little fund going for the kids. I
wrote a check for about what I made the day I had seen
Fred, acutely aware of my insignificance.

H E N RY RO J E L I O , DAY F I V E

Henry, Day Five, had a painful beginning. Anxiety and anger had churned my dream loop into a froth I hadn’t seen since early internship, so at seven o’clock I thought to try prolonging the night’s half-sleep by lying in bed with the sheets over my head. It seemed a well-reasoned choice, but I knew I could never pull it off. I’m wired to get up.

I found my bathrobe and banged around the town house, putting away belongings and scrubbing the bathroom with a fury, trying to tell myself as a mantra that the truth would 270

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prevail, never mind its no-show at the end of my residency and truancy now.

At 8:02, as I was brushing my teeth, minty white foam dripping from my mouth, the phone rang. I spit and rinsed and ran to grab the handset as the answering machine was kicking in. It was Sally Marquam.

Even at a dink hospital like Providence of Glory, I guess you have to have certain
huevos
to make VP. I’m sure she hated doing it—I would have—but apparently between supper and breakfast she had reported to her Executive Committee, counted the votes—all three—and hardened her stones to call me to tell me the bad news, doing it as if she did it every day. My working privileges at Glory were suspended indefinitely. There would be a full investigation of the ER incident involving Henry Rojelio. Fourteen days hence they would all have a meeting. I was invited, for the second half only.

Sally Marquam was all desiccated professionalism. I suppose any warmth would have been shocking and no doubt wasted on a doctor quickly spinning out of her orbital plane.

As I was about to hang up, she added, “And don’t talk to any reporters.”

I said, “You must be joking.”

“I wish I was. We’ve gotten calls from a reporter from the Phoenix paper. He seems to know some of the details already.

Press coverage will not be good.” She told me the CEO, already having conniptions over yesterday’s announcement of Medicare’s latest nonpayment foolishness, had reacted to the prospect of adverse press like the world was ending. The President of the Medical Staff had been more philosophical, saying something about their patients’ generally ignoring newspapers. I figured they were both wrong.

She added, “I must also tell you we will not tolerate you harassing any of our staff.”

“I was looking for some explanation for your staff’s lying about me.”

“Whatever you may think, please keep away from Miss Benoit. It will be better for both of you.”

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I thought,
Yeah. Where were you when that advice might
have helped?

My personal inventory was in free fall: I knew I wasn’t just losing a job. A formal termination of privileges at the Glory Hospital would have to be reported to the Arizona Medical Board, which, in my case, could readily metastasize to a loss of my license. If that happened my appeals to residency directors, regardless what state they were in, would be instantly vaporized.

Through an interesting quirk of karmic timing, the day’s mail contained a notice that my student loan repayments were to begin in two months. The grace period they allow after one’s termination of student status was expiring, and would I please call them at my earliest convenience to discuss repayment plans?

I tried a five-mile run. I churned along the canals that parse out the Salt ex-River into its bluegrass support role, but my legs were pegs and my shoulder seared from stray reminders of its earlier ball of fire. It was more an exercise in frustration than exercise. I think the gods don’t grant an endorphin high to one who would shake the firmament of his superiors.

I gulped water back at my town house. I popped a can of Squirt and took it to the shower. I stood bent under the hot spray and breathed the steam and was still. I became aware of my heart slowly hammering under my ribcage.

I thought I should adopt a scientist’s approach—analyze and verify whatever evidence I had. My only link with Henry’s mysterious event lay in my refrigerator, the epi syringe. It seemed I could begin by getting the contents of the syringe verified. Though I knew it to be grasping at straws, I was indeed drowning and drowning men will do that.

Once dried off, though still not dressed, I noticed that the cut on my hand from my display of disgust during Henry’s code had started oozing again. I improvised a fresh bandage as I called Maricopa and asked the operator to connect me to the chemistry lab. I asked the lab woman, “Who would 272

DAVID FARRIS

know about ordering a complex chemical analysis of the contents of a syringe?”

She transferred me to a supervisor. He confirmed my fears: Complex analytics get run once a week. It would have to be sent out. To a State of Arizona lab. Three-hundred fifty bucks minimum, considerably more if they have to analyze

“unknowns.” For billing she would need either the patient’s Maricopa Hospital account number or a research account number. And the State Health Division keeps copies of anything and everything medical. I didn’t ask if they would accept a postdated check and my jar of pocket change; the thought of having my name on yet another eyebrow-raising piece of paper on another clipboard anywhere within the Health Division was ample deterrence.

Gravity drew me to the ’Copa. I had no particular purpose. I didn’t look at a clock. The hour of the day, the day of the week,
schedule,
to me, was nonexistent.

But Mary Ellen Montgomery, my only local confidant, was somewhere there, locked in hand-to-hand combat with all the usual foes—death, disease, bumbling interns, indifferent professors, and the odd passive-aggressive nurse. She did not and could not, if she were going to respect me, know every detail of my demise, but she still gave off warmth and good ideas.

I started at the PICU. Henry himself might have something for me. His chart might be full of clues. He might even wake up. I was not optimistic, but should he be one of the lucky few, my own luck would be considerably improved.

Henry was alone in his cubicle. A boom box was softly playing some syrupy piano music. The ventilator made its rhythmic whish-clicks; the IV pumps silently blinked their little green lights. Henry had acquired a long, triple-channel catheter in the garden-hose vein living under his left collar-bone; his milky “food”—“hyperalimentation”—was being pumped through it.

He lay still, except for his chest rising and falling with each whish-click. The nurse had just washed his face and combed his hair. He was pink. Peaceful looking.

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I checked his medication sheet; the list of drugs required to support the patient is a backdoor indicator of the patient’s problems, but the quickest. He had morphine and Valium ordered “as needed,” but he had needed none. His unconsciousness was all his own. He was getting only peptic ulcer prophylaxis and a suppository laxative; hardly teetering on the physiologic brink.

His daily chart notes were equally unenlightening: Hospital Day 4.

Subjective: Naught.

Objective:

Vital signs stable. Off all drips.

Normal cardiac function.

Pulmonary: On minimal ventilator support, breathing room air. Checking blood gases only twice a day. All values within normal limits.

GI: On ulcer prevention protocol.

Renal: Good urine output. Chemical waste levels within normal.

Metabolic: Electrolytes normal. Ramping up IV feeding to achieve full nutrition soon.

Neuro: Remains comatose. CAT scan shows no hemorrhages, no masses. Brain edema consistent with diffuse hypoxic injury.

We—I use the grand collective medical “we” since I was not then actively involved in Henry’s care—were in the wheel-spinning phase, waiting out the brain, “waiting 274

DAVID FARRIS

for the swelling to go down,” waiting for it to declare itself good, bad, or a total indeterminate mess.

As I stood staring, one zombie to another, the Rojelio/Mendoza family traipsed in to see their son and brother. When Daniel saw me his frown tightened and his neck straightened.

It was the bleakest of assemblies. From Daniel on down, each looked more haggard than the one before. Even the baby, barely walking, seemed to have bags under his eyes. I nodded a professional hello, then left them, wordlessly, to their private hour of pain.

I paged Mary Ellen, but instead of calling back, she came into the Unit, towing along her bubbly intern, Michelle Rosenbaum.

“Malcolm. You’re alive,” she said.

“That depends on your definition. I guess I’m at least as alive as our boy in Bed Two.”

“Any change?” she said.

“No, pretty comatose.”

“Sorry I’m not more on top of him, Malcolm. We’ve been buried. He’s one of those we’re taking care of by assumption. You know, ‘We haven’t heard any cries for help so he must be okay.’ ”

“Yeah, of course. You can’t do much for a brain injury, anyway.”

“We’re expecting a patient transfer any minute. He might interest a surgeon such as yourself.”

“Thanks, but I’ve given it up.”

“Oh, Malcolm. Don’t be a wuss.”

“Okay, I’m not a wuss. What are you getting?”

“Gunshot. Four-year-old supposedly shot himself.”

“Where?”

“Casa Grande.”

“No, where in the body?”

“Oh, belly. Flank, actually. Through and through. May be a classic flesh wound. No surgery indicated. At least that’s what the transferring doc thought. We’ll see.”

“Yeah, we’ll see.”

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“And we’ll see how he got a gun.”

“I can tell you that,” I said. “Dad set it down and turned his back—only for a second.”

Henry’s mother hurried back out of the Unit, streaming tears, dragging along behind her the oldest of Henry’s half-brothers. The boy, who looked to be eight or nine, was hitting her back and shoulder as hard as he could with his trailing fist, but her grip on his forearm was nonnegotiable.

“Oh Jesus,” I mumbled.

Mary Ellen said, “Lovely. Fucking lovely.”

Dr. Rosenbaum said, “Geez,” giving it two syllables.