Lie Still (37 page)

After deep breaths all around I said, “How’s the rest of your service? That baby with the obliterated bronchioles?”

“Little Celia,” Monty said. “Same. Spikes a fever at least once a day. We send cultures. Nothing grows.”

“Her creatinine is going up,” Michelle added.

Mary Ellen gave me a look. “Dying kidneys, you know.”

“Dialysis?” I said.

“Not if I can help it,” Mary Ellen said.

The doors whirred open again and a tall, middle-aged man wearing a tan suit came in. I took him for a drug company rep. He stopped at the control desk, casting about to see who might be able to direct him. His glance settled on Michelle, who was closest to him and the most formally dressed. Michelle silently looked to Mary Ellen for help.

The man’s eyes naturally followed hers.

“I’m Ted Priestley,” he said. “I’m a close family friend of the Mendozas. They asked to come up and look in on their son Henry.”

Monty introduced herself, then said, “I’m the senior resident here. I’m more or less in charge of Henry’s care on an hour-to-hour basis.”

“I understand. I met with the Mendozas last night and discussed the situation at some length. I promised them I would come by and see the boy.” He nodded to her, then me. “I’m sorry to interrupt your rounds, or whatever.”

Mary Ellen pointed him to Henry’s cubicle. When he was safely gone I said, “That would be their lawyer.”

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“Just who we need,” Monty said.

“Well, he’s not a fanged ogre,” I said. “What do you think? Cute guy?”

“Him? Gawd no. But the priest. Did you see him? He was in this morning. Oh my Lord. What a waste. Did you see the eyes?”

I looked blank, so she turned to her intern. “Am I right?”

“Oh yes. Yes,” she bubbled.

I rolled my eyes and sighed.

Mary Ellen said, “Malcolm, you have no taste in men.”

I looked at her. “No, I don’t. And don’t ever tell anybody otherwise.”

Monty’s pager went off. While she took the call, I thought again about Robin’s sneak attack. Perhaps she was just the killer type. I idly asked Michelle, “So, how would you know if a syringe of epinephrine had epinephrine in it?” I expected vacancy.

Michelle said, “The epinephrine signature.”

I looked at her. “The what?”

“You know. Like in dog lab. In med school? Didn’t you guys do dog lab? In physiology?”

“Yeah. We did,” I said.

“And did you inject epinephrine? And neostigmine and isoproterenol and all the other drugs that affect the controls? And graph out the changes? The sympathetic and parasympathetic, the agonists, antagonists, alpha, beta, dopaminergic . . .”

I said, “Uh-huh. We did that. Most of what I remember from that, though, was one of our classmates bawling and practically screaming when we made the hearts fibrillate and the dogs died.”

Michelle said, “We had two crying at my medical school.

But don’t you remember the epinephrine signature?”

“Refresh me.”

Michelle said, “Beta first? You know, just as the first few drug molecules hit it’s still in a low concentration. At low concentration the beta effects dominate. Beta opens up the vessels—vasodilation. You get a real quick little drop in LIE STILL

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pulse and blood pressure. But then the alpha effects, when the full dose hits, do the opposite. Rising pulse and blood pressure. You don’t remember that?”

“It’s coming back to me,” I said. Mary Ellen rejoined us.

I said to her, “Michelle has been refreshing me on epinephrine.” To Michelle I said, “Only epinephrine does that bipha-sic thing.”

“Right.” She smiled at me and batted her fake eyelashes.

“Only epinephrine has alpha and beta effects like that.”

I said to Mary Ellen, “From the mouths of babes.” I thought to myself,
Now all I need is a dog lab.

17

After a few years of ER work here on the plains, I thought I
had seen enough to pronounce the Quiet Little ERs Where
Nothing Ever Happens different from their citified brothers
only in the pace of events. I knew that broken femurs showered just as much marrow into the pulmonary arteries in St.

Petersburg and Ogallala as they did in San Diego, that
headaches were just as aggravating for all concerned in
Hoacham as in Phoenix, and that bleeding was messy everywhere.

It took me years of experience to notice that one type of
case was different—the patient “found down.” These are
people found by someone else, unconscious, unable to give
a history. I have learned that local knowledge makes those

“found down” not only more interesting—knowing who they
are and why they got into their current messes—but they get
more accurate and efficient diagnosis and treatment.

A few months ago in Ogallala the medics brought in, at
midnight, an unconscious middle-aged woman, smelling
heavily of regurgitated alcohol, some of her partly digested
dinner clinging to her hair. Where I went to medical school
and did my aborted residency, the history from the paramedics usually would have been very short. Something like,

“Middle-aged female, found down, no blood visible, no
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signs of violence, no incontinence.” The unsaid part was,

“No one has any clue who she is.”

But in my Quiet Little ER the medic told me her name and
age, what antiseizure medications she was supposed to be
taking, and why she doesn’t take the pink ones—she hates
pink. The RN told me the woman always said she was allergic to “tranquilizers” but in fact thought highly of Valium.

We sent a toxicology screen, got her stomach cleaned out,
got her rehydrated, got her head scanned, and got her
cleaned up. Diagnosis: Acute (and chronic) intoxication
with alcohol and Valium. Not (acutely) life threatening.

The nurse phoned the woman’s son, saying “Mom’s here
again.” He said he’d be there, leaving the time unspecified,
implying Mom would be sleeping it off in one of our bays.

That seemed to be the routine. I realized any objection
would be counterproductive—the woman’s “rest” would be
the highest and best use of the space that night.

I learned another maxim: If you’re going to be “found
down,” you’re better off doing it where folks know your
name.

H E N RY RO J E L I O , DAY F I V E ( C O N T I N U E D )
When I said to myself I needed a dog lab, I was being facetious. Then, suddenly, it seemed like a good idea. Maybe, in fact, just what I needed.

Any medical center doing research has animal labs.

They’re used for everything from studies of subcellular metabolism to developing new surgical techniques. My problem was not going to be finding an animal lab, but finding one on very short notice with an appropriate animal prep and a supervisor who might be willing to let me play.

I didn’t have time to work up from the bottom. Rather I needed to cash in my few remaining chips at the top. From my talk with Monty and Michelle, I went up to Dr. Hebert’s office.

His secretary said he had just “gone down to a trauma.”

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That meant he was leading the cast assembled in the ER to receive an acutely injured patient directly from the EMS

crew.

I shuffled into the back of the ER and blended into the hind end of the crowd. The paramedic in charge was just rattling off the patient’s story: a fifty-six-year-old man who crashed his delivery van into a power pole at fifty-plus miles per hour. He was properly belted, so he was alive, but his bald pate and fleshy face were peppered with small, angular lacerations from the sharp edges of busted glass. He was screaming.

Dr. Hebert was sitting quietly in the corner of the room, reading something handwritten. The Chief Resident was conducting the team through the paces of handling the patient.

I waited quietly beside Dr. Hebert. He looked up at me as he flipped a page. “Ishmail! Goddamn. They ain’t kilt you yet?”

“No, sir. But it seems they’re trying.”

I explained, in vague terms, that I needed his help. “I think I can clear up a goodly chunk of this mess in a good old-fashioned dog lab. Run a sample, check the vitals. I knew the Surgery Department would likely have studies going on in different—”

“Shit, son, we got studies! We oughta be so smart we hurt.” He looked at the wall clock. He shouted at the resident, “Avery, the clock is
tickin’
. I ain’t heard just yet what you plannin’ on doin’ with this old boy.”

Avery said, “Yes, sir. I was thinking about sending him to the CT scanner.”

Dr. Hebert said, “Not very original, but I guess that’s what I’d likely do, too.” To me he said, “What’a you up to?”

“It’s kind of a long story.”

The patient shrieked. Dr. Hebert said to me, “You think this old boy is hurt?”

“Not bad.” He was starting to grin at me. I went on,

“Hebert’s Law Number Two: You gotta be healthy to be loud.”

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“Goddamn, you was payin’ attention.”

“And Hebert’s Law Number One: Never fuck with the pancreas.”

“That’s right, but now I can’t take credit for thinkin’ that one up, but it’s a good one to frikkin’ remember. You get yo’self back on the team here and I’ll let you in on a couple other dandies.”

“Yes, sir, I’d like that.”

“So you say this man is ‘not bad hurt.’ Right, Doctor?”

“Yes.”

“Good, I’ll put you’ name on the chart, too. ‘Consulting—

Dr. Malcolm I-S-H-M-A-I-L.’ ”

“That would really upset somebody.”

“That’s
exactly
why I’m goin’ to do it.”

He scribbled a chart entry, scrawled his signature at the bottom, and told Avery to “hurry the fuck up, son.” He called up to his secretary and asked her to phone the animal lab in Tucson to find a time I could run a quick test. To me: “How much time you going to need?”

“Ten minutes.”

He frowned at me. Into the phone: “Marie, get Alphonse to find a half hour for a unique piece of research. Dr. Ishmail needs to run some potion through a dog. He’ll be up to get Alphonse’s number from you.” To me: “Alphonse Emmerick is so smart he ought to frikkin’ glow in the dark. And he ain’t bad with his hands, even with the tremor. Unfortunately he has trouble makin’ up his frikkin’ mind. Stand and hem and fuckin’ haw long enough to have finished both the operations he was tryin’ to decide between.”

I nodded.

“Knows his science, though. If you got too much time on your hands, get him to tell you about what pulmonary immune mediators do in endotoxin shock.
Chingalamadre,
that will make your eyeballs
spin
.” Dr. Hebert pronounced the Mexican curse with no hint of Hispanic inflections.

“I can imagine.”

Dr. Hebert’s secretary gave me Dr. Emmerick’s phone number and directions to his lab in Tucson. She said he had 282

DAVID FARRIS

been adamant that I be there by seven-fifteen in the morning; he was not going to disrupt the day’s schedule for any

“dilettante science.”

I headed home. Unlocking the door to my town house, I sensed the walkway darkening behind me. I had company.

Strongly backlit in the portico was a man with a police badge in his hand. I squinted at the shiny metal, then at his face. He identified himself as Will Borden, a detective from the Mesa Police Department.

“Are you Dr. Malcolm Ishmail?”

I frowned and squinted again. “Yes. Yes, I am.”

“May I come in?” He looked to be in his early thirties.

Easy smile, perfect teeth, very little belly, and a crewneck Italian sweater over expensive slacks. Not, to my mind, a typical detective. I looked past him to a second man watching us from ten paces back.

“My partner,” Detective Borden said. “We’re like nuns. We always travel in pairs.” The second man was looking at the sky, hands in his pockets. “Does he want to come in?” I said.

“No.”

I nodded and let Borden in.

I looked again at the second man, but he seemed to be studying the way the low light angle set off the cheap construction of the town houses. I closed the door. “Sit down,”

I said, motioning to the couch under the front window. “I just need to go pee.”

“This will only take a minute,” he said.

I looked at him. “Still, I gotta pee.”

“Okay, but leave the door open. If you don’t mind.”

I frowned but did as he asked. I called from the bathroom,

“What is this about?”

“Just needed to talk with you. Thought maybe you could help us.”

I went to the kitchen and put the coffeepot in the microwave. “What with? Did I do something?” I half-laughed.

“Well, Dr. Ishmail, we’re doing some checking around.

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We’re trying to find someone who may or may not be missing. Robin Benoit. A nurse. We were told you knew her.”

“She worked in the ER where I worked.”

“Uh-huh.” A pause.

I said, “Is she missing?”

“The Glory Hospital people phoned us. Her boss is worried about her. Apparently she left work last night feeling sick.”

“Coffee?”

“Yeah, sure. Thanks.”

“Would your other half like some?”

“I doubt it. He’s stretching his legs.”

I envisioned him watching the back windows for any impolite egress. I got two mugs. I stared over at him.

“Is that a police matter? I mean, nurses go home sick all the time.”

“Well, that’s what we’re wondering.” He sipped his coffee and looked up. “When was the last time you saw her?”

I thought through the sequence. Minutes seemed like days. “Yesterday.”

“Uh-huh.” He smiled at me. I waited. He said, “When yesterday?”

“In the afternoon. Five-ish. Why are you asking me?”

“You two worked together. May have been friends. Someone at the hospital thought maybe you had been to her house. We just thought you might have some idea where she went.”