Lie Still Read online

  A N O V E L O F S U S P E N S E

  For Kendra

  MY ROCK, MY OXYGEN

  Contents

  1

  All she said was, “Doctor, he’s turning blue.” She spoke…

  1

  2

  That was almost seven years ago.

  22

  THE BOOK OF MIMI

  27

  3

  My having crawled into Glory, Arizona, where I met Henry…

  29

  4

  Here on the plains my work hours come to

  me…

  48

  5

  Since Henry, since escaping Arizona with my hide and little…

  67

  6

  From here in Nebraska, way beyond being too late, it’s…

  89

  7

  Walter Bryant’s warning about his bleak future as a surgeon…

  108

  8

  There are rules, maxims, and Lessons for Life to be…

  127

  9

  On my first Friday night, years ago, in the Quiet…

  147

  10

  Hundreds of weekends ago Adrienne sent me to one of…

  169

  11

  Timing—usually bad timing—is, logically, the lifeblood of emergency…

  192

  THE CASE OF HENRY ROJELIO

  205

  12

  Henry Rojelio, my asthmatic unfortunate from Glory, on the morning…

  207

  13

  Here in Hooker, besides watching

  thunderstorms while I’m on call…

  223

  14

  Hoacham, Nebraska, Scenic Hub of

  Agriculture for the Republican Valley,…

  237

  15

  Four weeks ago I did an odd thing: a nine…

  255

  16

  Three weeks ago in Othello I met Fred Sommers.

  Fred…

  268

  17

  After a few years of ER work here on the…

  278

  18

  Dad had a spill a couple of weeks ago.

  Since…

  292

  19

  Annie Parrott dubbed last Wednesday in the Othello Clinic “Minor…

  298

  20

  From the time I could walk, I got to tag…

  316

  21

  Figuring I’d try to clear my head with a workout…

  328

  22

  I did not go back to sleep in the lecture,…

  340

  23

  The only possible conclusion was easily reached, but, like a...

  351

  24

  My descent to Phoenix was semiconscious; staring; blinking at the…

  368

  25

  Hooker, two censuses ago, was a town of 10,300

  souls.

  377

  ENDNOTE

  405

  ACKNOWLEDGMENTS

  ABOUT THE AUTHOR

  PRAISE

  COVER

  COPYRIGHT

  ABOUT THE PUBLISHER

  1

  H E N RY RO J E L I O , DAY O N E

  All she said was, “Doctor, he’s turning blue.” She spoke the words softly, quickly into my ear. I turned to look, expecting a grin. All I got, though, was backside, hurrying away to the exam bay, like a game of tag.

  I’ve relived it a million times. It wasn’t a game, it was a play. A stage whisper blurted by a vanishing actress. She knew her audience. She told me the patient was cyanotic—

  cyan-colored, like ice—but the delivery had its own message: I may be new here, but I’m not panicked. I’ve done this before; I’ll do it again. On TV she would have stood up straight and tall in the center of the ER and ceremonially announced just short of a shout, “Doctor! The patient is acro-cyanotic. Come stat! ” Writers love the word stat. Clinicians only use it when they’re pissed off. Stat is Latin for “hurry the fuck up.”

  Anyway, that’s how it started. Henry, Day One.

  She got exactly the response she wanted. On cue, I thought, Bullshit. I probably snorted. Robin Benoit was a nurse. I knew well the common doctorly chauvinisms about nurses as diagnosticians.

  In all the retelling, the reliving of the opening—for the 2

  D AVID FARRIS

  other doctors, the family, my closest friends, my parents, the police, the lawyers, and over and over for myself—I have always admitted that I hesitated, though only for a few seconds.

  Don’t misunderstand me. I would never let a patient lie there starving for oxygen for even a millisecond, no matter whose ego is on the line. But I did not believe thirteen-year-old Henry Rojelio really could have been blue. Not ten minutes earlier he and I had been talking about baseball and his crooked penis. He was not that physically sick.

  Nor did my hesitation make one whit of difference. The record will support that. Five seconds was not long enough to have mattered. But the issue has never laid down and died.

  Professional machismo looks lousy in the hindsight of self-recrimination.

  I was on the phone. I ended the call, abruptly, then sat there with a vacuum-tube stare long enough to show that I wasn’t impressed and certainly wasn’t panicked either. This from the rules I’d learned early on: Never run. For punctua-tion I took a last gulp from my can of Squirt and made a point of finding my stethoscope. “Where’s my fucking stethoscope?” I remember saying out loud. I was annoyed.

  Whether the patient’s cyanosis is real or imaginary, it’s a pain in the ass for all concerned. I patted all my pockets, then found it looped over my shoulders. All this may have added five seconds to the downtime. That could not have been critical. I sauntered after Robin. I didn’t—I wouldn’t—

  believe her. Five seconds.

  Though new to me, Henry had been a regular in the Glory ER. His chart—which I had dutifully read over—was into its fourth volume. At his worst he was only a moderately bad asthmatic. When I listened to his chest on admission he was not all that tight, and he was getting overaggressive treatment as it was. True “blue” was not possible.

  I pushed open the door, smiling, stupidly optimistic that a doctorly presence would right the misdiagnosis and end the scurrilous rumors. It had worked before.

  He was, however, lying oddly flat and straight, uncon-LIE STILL

  3

  scious and limp, and by-God blue all right. And starting to turn a mottled gray, which is worse than blue, because it’s what comes next.

  I thought to turn around, not to run away, but to find the Resident-Who-Knew-What-to-Do. For almost all of my time tending patients, there had been somebody at least one year further along in training standing behind me, sheltering both the patient and me. Certainly I’d signed on in little Glory to be The Doctor, but I had hoped to avoid conflagra-tion at least until the locals had come to trust me. I knew I was a good doctor despite anything they might have heard.

  They’d told me it was a quiet little ER in a quiet little town, and no one would bother me. Turns out, though, sickness is pervasive.

  I was, I confess, paralyzed. Though not as long as they tried to imply. A second can seem so long. Panic, however ephemeral, looks bad. All my brain parts were going off at once, chattering and bickering. “Hurry, think, hurry, think, hurry, think.” Robin, bless her heart, spoke, coaching me. “Is he breathing?”

  I put the back of my hand an inch under the boy’s nose, hoping for a tiny current or hint of warmth. Nothing was moving. Of course he wasn’t breathing; that’s why he was so goddamn blue. He was, though, a known malingerer. It said so in his chart. Maybe he was holding his breath. I’d heard mothers swear their children would hold their breath long enough to turn blue, but I’d never seen it. I didn’t really believe it possible, but at that moment I was willing to believe in the Tooth Fairy if she could help. I dug a knuckle into his sternum, hard, and twisted it. It’s one of the accepted bits of medical sadism we use to weed out fakers and wake up drunks. Henry, however, lay still.

  He was dying or maybe already dead. He needed me to breathe for him. I looked for the bag. Every ER room in the world is supposed to have a breathing bag and mask in plain sight, ready to go, no glass to break in case of emergency.

  It’s usually hanging on the wall by the oxygen outlet. In Henry’s room there was only a stripe of yellowed adhesive 4

  D AVID FARRIS

  tape, loose at one end, no bag. The breathing bag had not been replaced from the last disaster, which, in this backwater, may have been years earlier.

  I imagine there are times in every profession when you feel as though you are the last fledgling hawk or hawklet high up the rock wall in a canyon and it’s time to see if your upper extremities are functional or merely decorative. You sit on your ledge and look down and all around for as long as you can. Then you jump.

  Just as I’d done on vinyl dummies, only faintly fearful I’d ever have to do it on flesh and mucus, I tilted his head back, pinched his nostrils, sealed my mouth over his, and blew in.

  I think his chest rose like it was supposed to, but it wasn’t as if I knew what a good chest rise looked like. This was my first time. I muttered an inanity, “Holy shit,” then the obvious: “Get the crash cart.”

  “It’s here,” Robin said.

  I gave Henry another breath. I did indeed know what to do.

  Henry’s chest rose, I
was sure, but only a little, then fell.

  A gurgling sound came from his lips. I stuck my thumb into his mouth, under the tongue. I wrapped my other four fingers over the chin, closing a circle around the jaw, and pulled up. I held it there with my other hand and tried a third breath. It moved a bit more air.

  The next step seems odd. It’s peaceful. You check for a pulse. You lay two fingers on the throat, just to the side of the trachea, and try to dig them gently under the muscles and feel the carotid artery. Even with only a very weak pulse, say a blood pressure of 40, they say you can feel it there. It’s peaceful because you stand perfectly still. You can’t have anybody jerking the patient’s clothes off, sticking in IVs, or doing CPR. In fact, you really want it quiet. You get a glazed-over stare. Your eyes aren’t focusing on anything. All your focus is in your fingertips.

  Until you’ve done it, you think it’s an easy call. That’s what they blithely teach in CPR: “Check for pulse.” Either there’s a pulse or there isn’t. But in a real live or maybe dead person, when there isn’t, you keep thinking it’s your fault.

  LIE STILL

  5

  You’re missing it. “It’s weak but it’s there.” “Try a little farther over that way; no, back the other way.” “Surely there’s a pulse.” “There ought to be a pulse there.”

  Robin was rummaging in the crash cart. She was hurrying to uncoil a length of green plastic oxygen tubing. She jerked on it violently to straighten a tangle, then slammed the cart drawer shut. I said, “Could you be quiet for just a second?”

  Immediately she was as still as the other two of us, staring at me. Her I’m-not-panicked bit was gone: She looked terrified.

  As much as I wanted there to be a pulse in that boy’s neck, I couldn’t find it.

  I had already waited too long in Fantasyland. That’s always how it is. Time slips by as you try to find a way around admitting that the heart really isn’t beating and by God you need to do chest compressions, and by God, now that you think of it, you should have been doing them for some time now. You don’t want to admit, on the hospital overhead speakers, The Reaper is winning. But you have no choice: I called a code.

  “Launch” is probably the better verb. It’s a rocket with a very short fuse. You strike the match and make sure you can get the hell out of the way because a million things are about to happen, and the process, unless you and someone from Hospital Security physically block the door, will run its course. “Get help” is all I said. That’s all it takes. I closed my eyes for half a second and when I opened them Robin was gone. I heard her shout just outside the door, then someone running, then another voice shouting.

  I felt Henry’s breastbone and walked my fingers down to its end. I backtracked an inch and squared the heel of my left hand in the center of his chest. I put my right hand on top of my left, locked the fingers together, then rose up on the balls of my feet, directly over him. The gurney was too high for me to lock my elbows, but I could still bear my weight into his chest, feeling for what I guessed was just enough “give”

  to squeeze the heart between the spine and the ribcage and pump blood downstream.

  6

  D AVID FARRIS

  I wondered what a small-town code team would look like.

  I don’t often pray but I remember thinking of God, and for a couple of milliseconds I might have asked for mercy for Henry, and just as much for me.

  Even alone and scared I was thankful to be doing something physical. Just like everyone else doing CPR for the first time, I didn’t know if I was doing it right. I imagined his heart being squeezed under my palms, then passively refilling. Once as a med student I watched an intern do chest compressions on a pulmonary cripple who had a line in the artery in his wrist. We could see on the monitor the blood pressure waves she was generating, and she adjusted her stroke to the best wave. In him at least, the best flow came with a sharp and frighteningly deep squeeze. His ribs cracked. The intern winced. The resident said, “It’s better than staying dead.” He did that also.

  I bore down on Henry’s chest, trying to do the same kind of stroke. I counted to fifteen, because that’s what I’d learned in CPR class. I gave him two more breaths, then started over. The eternity of pumping and breathing alone probably measured less than ninety seconds by the clock.

  He was an awful color. I stopped once and again laid my fingers on his throat. Some patients bounce right back. If my desire counted, his carotid would have been booming. I tried to invoke all my years of study and training and a fiercely wrought want and strength of will. As if it might help.

  The exam room door jumped open, shattering our silent supplication. It hit the wall behind it and shook with a deep bass vibrato. Patty Kucera, RN, one of the ER regulars and a sizeable woman of around six feet and 280 pounds, was first of the motley cavalry of backwater medicine to charge in. On her heels were two other women, a tall man in hospital scrubs, and Robin.

  I had run codes as an intern, but when you’re the intern giving orders to an experienced code team, it’s like being a little kid telling Mom what goes next in the cookie dough.

  She’ll do what you say as long as you say the right thing. If LIE STILL

  7

  you say the wrong thing, Mom will do the right thing and smile at you. You’ll learn. I knew the approved protocols for a standard code, but sometimes that’s not enough.

  The best spot at a code is the one standing over the patient’s heart, bobbing up and down. The job is at once the most mindless and the most critical. You can look around, talk to people, smile sometimes. It is like sex: You can do it with empathy and passion or you can do it with your head in the next county—if your mechanics are adequate the immediate outcome likely will be identical. It is not, however, the place for the person who’s supposed to be making decisions, so I tagged Patty to take over the chest compressions.

  It’s a sea change to go from the physical simplicity of one-rescuer CPR to the role of the Guy-in-Charge-of-the-Code. I stood there for a second knowing I was forgetting something. I mouthed to myself, “ABC. Airway, breathing, circulation.” I asked, “Where’s Respiratory?”

  “Right here, Doc.” It was the lone male in the crew, a respiratory therapist—RT—named Roger. He had somehow materialized a breathing bag and mask and was jamming the mask onto the boy’s face, squeezing in oxygen. He gave me a little sideways grin. He was straining to hold the mask tight to Henry’s face with one hand. The mask was too big and half the oxygen was being expelled over the eye sockets with a farting noise. Even so, the chest was definitely moving.

  Vickie Rhoades, the evening shift charge nurse out on the wards, slit Henry’s sleeves and pant legs with long gliding scissors strokes. In seconds he was naked but for stained briefs. She threw flimsy wires around his neck and connected pasties to his chest for the EKG. She tucked the free parts of the wires under his shoulders so they wouldn’t flop around and get pulled off, which they always do anyway.

  Vickie wrapped a wide floppy yellow rubber tube around the boy’s left biceps area and slip-knotted it. She snapped her finger on the big vein over the elbow, wiped it furiously with alcohol, and slid in an IV. She finessed the catheter off the needle and up the vein, pressed hard on the vein with the 8

  D AVID FARRIS

  other thumb to plug it off, snap-released the tourniquet, connected the line, and opened the roller valve, all without spilling a drop of blood. The whole thing took maybe thirty seconds.

  “Got an IV,” she said. “D-Five. Runs like a racehorse.

  TKO for now. Atropine and epi going in. An amp of D-Fifty, Doc?”

  I was blank. There was no reason to give sugar. I mumbled, “No. Hypoglycemia this isn’t.”

  “It’s protocol,” she said.

  “Well, okay, I guess it won’t hurt. We’ll try everything.”

  “Narcan?” Vickie asked.

  Again a blank. Narcotic reversal? “He a user?” I asked.

  “No. Protocol.”

  I said, “Sure. Wouldn’t want to buck protocol.” She smiled and nodded.

  Patty was breaking a sweat over Henry’s chest. “You need a break?” I asked her.

  “Naw, I’m fine.”

  Two more women had come in, but there was nothing immediate for them to do. They stood waiting for a job, adding their worry. One said, “Oh my God, it’s Henry.”

  Half the hospital’s evening personnel were in the room.

  “Who’s tending shop?” I asked.

  “Beulah,” Patty answered with a grunt.

  “Who’s she?”

  “Ward secretary. She’ll call us if somebody needs something important.” In a thirty-bed hospital even the secretary will know who’s in trouble.