Lie Still, page 21
By the time Dad, who was driving, got stopped and ran back to the would-be Amelia Earhart, she had regained consciousness and was bawling appropriately.
The local medics brought her to me for a good going-over.
The nurse and I peeled her off her dad long enough to de-termine, despite Dad’s inability to do much more than stammer, that she had apparently been launched with enough velocity to have cleared the gravelly part of the roadway and made it straight to the grass. Our evidence, besides the grass stains, was her complete lack of any injury worse than a good goose egg on the side of her head. Still, one is compelled to get a CAT scan.
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While my little Sally Ride was in the scanner her mom arrived in my ER. Not fully hysterical, but significantly louder than Dad had been. That’s when things got interesting.
Seems they don’t like each other. Stood along opposite walls and worked entirely on blame issues. Lawyers’ names came up. Neither was wearing a wedding ring.
The little girl checked out completely and I sent her on her way. Mom had a pretty good grip on her. I learned by observation a Useful Maxim of Marriage: The worst time to launch your two-year-old daughter out the backseat of a moving vehicle is when you’re in the middle of a custody fight. There’s bad timing.
T H E B O O K O F M I M I , C H A P T E R N I N E
Now, mercifully, I can end The Book of Mimi.
After meeting Steven White, I went straight back to Maricopa for a unique kind of rounds: In the ER office I photocopied Mimi’s thank-you note. In the library I scrawled out three pages of recitations and explanations addressed to Marshall Bullock. At the ICU nurse’s station I made photocopies of the whole package—a set for Joe Kellogg and one for me. In the OR Business Office I sealed theirs into interdepartmental mail envelopes and dropped them in the “Campus Mail.”
I checked with my intern. All was quiet. I went home.
I spent the evening staring out the window of my town house. I pictured the faces of nameless professors at my upcoming meeting with the GME Committee. A Give-’em-hell call from Dr. Hebert would have been nice, but unlikely. Re-calling his advice to come out firing, I sat down to plan strategy.
In outline form I wrote lists of everything “Mimi” I could remember: her phone numbers, the personal artifacts one would find in her condo living room, her kitchen, her bathroom, her bedroom, certain nonobvious aspects of her anatomy. From my Surgeon’s Case Log and personal date-194
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book I found a few clues to prod my shoddy memory. I was able to construct a passable list of our ventures to restaurants, each of which I knew to have been paid for with a Platinum Visa in the name “M M Lyle, MD, PC.” I found the receipt for my silver belt buckle still tucked under the cotton in the gift box. I added it to my file.
I went out and made ten more copies of Dr. White’s note. I made up a list of the committee’s probable questions, tried to think of all the angles they might take, then think through the implications of every possible answer and select tactics that would build my case. I tried to prepare my arguments, to anticipate Mimi’s unspoken counterarguments, to plan for anything they might throw at me. Both barrels.
When the day came I thought I was prepared. I was not, of course, calm. If there exists a medical resident—in actuality still a schoolboy despite years of full biologic adulthood—
who could be calm in such a setting, he—not I—should be drug-tested.
Dr. Montoya was politely professional, almost friendly, pointing me to my chair and introducing each inquisitor individually, smiling.
“You know why we’re all here,” she said.
One of the Unknowns, Dr. Aaron Kerlin, a graying man with half-glasses perched at nose tip, interjected, “We have charges of cocaine—”
Dr. Montoya cut him off. “Aaron, please. Dr. Ishmail, you’ve read Dr. Lyle’s letter. We would like to hear your version of these events.”
“Thank you, Dr. Montoya.” I looked about the group and took a deep breath. From my folder I took my yellow pad and flipped several pages to my final outline. It said at the top, “Slow down!”
I recounted my weeks as a faux-neurosurgeon. When I got to the faculty inquiry over the Keith Coles case, I said, “Initially I sided with her—we were, well, on the same side. We talked a lot about the case. Tragic as it was, though, it LIE STILL
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seemed to us to be just another bad outcome in brain surgery. It seems to happen all the time. You all know, I presume, the investigation cleared Dr. Lyle in the case. That might have been the end of it but for something Dr. Lyle said to me after the inquiry was finished.” I looked around at the faces. “She told me the reason those types of operations go so badly for her is she gets lost inside the head.”
Some committee members were staring at me. “Her words: ‘Lost inside the head.’ At first . . . well, at first it scared me. I mean, lost in someone’s brain. But I more or less shrugged it off. Everyone has self-doubts. Especially after a patient dies.”
I then described Susan McKenzie’s case, working my way to, “I heard Dr. Lyle say to herself ‘Here we go again.’
I got scared again. I remembered what she had told me. I asked around among the OR people. They told me about a similar operation she had botched a few years ago. I tried to get her to seek some help with the adenoma—asked her directly—but she wouldn’t hear of it.”
“Yes,” one muttered.
“I tried to rationalize away my fears. I couldn’t come up with much else I could do. The operation went ahead but it didn’t go particularly well. We spent a lot of time spinning wheels. I realized in that OR that she was again lost.” I looked around again. “I sat and watched and realized that was exactly what was going on. ‘Having trouble constructing things in her mind in three dimensions’—again, her terms. It also explained the Coles case.
“I gave this a lot of thought. Believe me. But I had to do something. I felt I had to bring forth Dr. Lyle’s troubles with three-dimensional thinking. It occurred to me that someone with this kind of relative deficiency probably shouldn’t be cutting into people’s brains, at least not too deep. I set up an appointment with Marshall Bullock, the Chair of all U of A Neurosurgery, in Tucson. I told him all of this, exactly what she’d said and what I’d seen. I felt she needed some kind of surgical help, or backup, or a restriction of privileges, or something.”
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“What did he say?” a stout woman asked.
“He told me he would, you know, take it under advise-ment. I did think it made something of an impression, though nothing seems to have changed. He seemed interested in maintaining her reputation.”
Two of them nodded. I went on, “I didn’t really feel I had done enough, but it was all I could do.”
“And since then? Have you heard anything more?”
“The next thing I heard was Dr. Goodbout knocking on my door in clinic for a urine specimen.” Two of them began leafing through the folders they each had in front of them. I saw one pull out a hospital lab printout, no doubt the report on my drug test. I kept my poker face.
Dr. Kerlin was finally allowed to speak: “There are written allegations from a respected faculty member that you proposed a date with her, saying you had some ‘pharmaceutical grade cocaine’ to share with her.”
I nodded.
“And this comes on the heels, within three weeks, anyway, of a reported discrepancy in the drug count in the OR
lockbox. Two 10-cc vials of 10 percent cocaine have been reported missing.”
That was staggering. I mouthed to myself, “Oh fuck.” I had not heard about that little heist, the perfect coincidence of bad timing. Without mentally calculating it out I knew each vial would have been worth thousands of dollars on the street.
“What say you, Dr. Ishmail?” he said, feigning a smile.
“Complete falsehood.” I said, trying to find a tone of voice neither too vehement nor quavering.
“Is that it?” he asked.
“Dr. Kerlin, I didn’t steal the OR’s cocaine and I never offered drugs to Dr. Lyle. If there’s some other evidence, something more than an accusation . . .” I held up my hands.
Dr. Kerlin frowned at Dr. Montoya. She sighed a bit.
“By the way,” I said, “Dr. Hebert said he was going to send a letter to the committee.”
“Yes, we each have a copy,” Dr. Montoya said.
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“Good. I appreciate Dr. Hebert’s support. Anyway, it’s easy for me to imagine being on Dr. Lyle’s hit list. I reported my concerns to Dr. Bullock. I presume she knows about that.”
Another of the ensemble spoke, a nerdy-looking man with a sparse mustache and a squinting face. “But you and Dr.
Lyle have not spoken about this, had any confrontation, say, about your having . . . ‘turned her in,’ for lack of a better term?”
“No. It certainly became clear to me, though, when Dr.
Goodbout came around for a specimen.”
“Yes, yes, I suppose so,” he said.
“But, if I may add something,” I said, looking at Dr. Montoya. She nodded. “I realized that other neurosurgeons have seen what I’ve been talking about. When Dr. Lyle is struggling to find her way, she usually calls Ed Adams to assist her. He helped on the Coles case. I wanted to get his thoughts on this, but he’s been out of the country.
“Dr. Lyle did share with me, though, that one time, some years ago, when Dr. Adams was also unavailable, she had called in Dr. Steven White. Dr. White is—has been—practicing primarily in Scottsdale. He came in late one Friday to help with another aneurysm and, according to Dr. Lyle, had little difficulty getting it clipped.
“I met with Dr. White, a few days ago, at his home. He shared his opinion that Mimi is in the wrong specialty. He gave me this note.” I pulled the card, still in its envelope, from my folder. “He referred to it as ‘confessional.’ In it she describes her own inabilities.” I passed my stack of copies to Dr. Montoya, then waited.
Several nodded as they read. The nerdy man said, “Have you shown this to anyone else?”
“I got it a week ago. I sent copies to Dr. Bullock and Dr.
Kellogg.”
The stout woman said, “You, a resident, seem to want to sit in judgment of your professor.”
“No.”
“You want her to be, what? Error-free? ”
“No. That’s not it. I thought the thing about mistakes in 198
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medicine was, whether they’re bad judgment or lack of information or lack of experience or whatever, that you’re supposed to learn from them. Not hurt somebody the same way twice.”
They were staring at me.
A wiry-haired woman said, “And how did the patient do?
The young woman with the adenoma?”
“Okay. She woke up a little slow, I guess, but she was grossly intact when I saw her.”
“So, do you think you were wrong to have worried?”
“Not at all. I’d be just as worried about the next one.”
“Did you speak with Dr. Lyle about your concerns?”
“Like I said, I asked her about getting help. When the case was booked. She made it very clear she didn’t want to hear suggestions from me. I just went off service a few days after that, started my vascular rotation, and next thing I know, this.”
“And you contend that her letter is . . . what? A complete fabrication? Pure lies? For some sort of retribution?”
“Apparently so. Yes. I think she is—obviously—trying to disgrace me. Make it seem that what I told Dr. Bullock was a stupid attempt at revenge for having been spurned.”
Dr. Kerlin spoke: “Okay, perhaps so. But let us go through her allegations.” He looked at Dr. Montoya. “I think we need to do that.” She nodded. To me: “Did you do the things in her letter?”
I looked blankly at my notepad. This was expected. “I may have made mistakes, sir. Certainly. In my residency. In my life.” I looked up. “Fortunately I can say with a clear conscience—and I was once an altar boy—that not one of them is in that letter.” Two of them smiled.
“Okay. You never asked Dr. Lyle for a date?”
I hesitated. “No. Certainly not as she describes it.”
Dr. Kelin sat forward. “What do you mean by that?”
“Just that. I did not ask Dr. Lyle for a date.”
Dr. Kerlin looked at Dr. Montoya. He said to me with obvious frustration, “Did you seek dates? Seek sex? Other than asking for a date?”
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My ground was shaking. I looked at my notes. They held no solace. “I’m not trying to be cute with the wording. Dr.
Lyle and I had a relationship.” I felt my face burn. “It never involved any of the kinds of things she says in her letter.”
A pause. Dr. Kerlin: “You—you and Dr. Lyle—you had ‘a relationship.’ But you did not ask her for a date.”
“Yes, sir. That’s a fair statement.”
“Will you care to elaborate for us? Help us understand . . . ?”
“Sir, with all due respect, the particulars of our relationship are not really germane.”
“Are we to understand that you two are, or were, lovers?
And this letter is, according to you, part of a lovers’ spat?”
“No, sir. I mean, we are not lovers. Whether we were or not is irrelevant. And the letter is her retaliation for participating in the process of trying to ensure good patient care.”
“But you were lovers.”
I hesitated. I took an involuntary sigh. “Yes, sir. Were.”
He looked about as if he were resting his case, victorious.
“For how long?” asked Dr. Wiry Hair.
“Well, of my six-week rotation there, take out the first week or so and most of the last two weeks,” I said.
“But you never asked her for a date?”
“No, ma’am. I acquiesced. I said yes.”
“She initiated it?”
“Yes, ma’am.”
“When did this happen?”
“Middle of the second week of my rotation. We hit it off.
But really, how it began, how it ended, none of that is important. What is important is that she told me why she has so much trouble. I acted on my obligation to patient care.
She is apparently seeking revenge.”
“And no one knew of this? You did not tell Dr. Bullock?”
“It’s really irrelevant. It obscures the real issue.” A pause.
I said, “I think—I guess I’m sure—she feels betrayed.”
Dr. Kerlin: “She initiated this affair.”
“Yes, she did.”
Two were shuffling their folders. One said, “How did you manage to keep this a secret for—what—a month?”
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“She had it pretty well thought through. How to put down cover and hide tracks.”
They were all staring. “Had she done this before?”
“You mean with a resident? I have no idea. You’ll have to ask Dr. Lyle.” They continued to stare. Dr. Montoya nodded.
“And just to be completely explicit: Yours was a . . . sexual relationship?” The questioner was a nearly child-sized man with a thick beard and a bow tie.
“Entirely so.”
“Did you, at any time, make any objections?” The haughty expressions I’m sure were meant to convey profes-sorial disgust, but it was not difficult to imagine a tinge of fascination behind the Victorian veneer.
I hesitated. I had trouble believing any of them really expected a young man to put very obscure academic scruples in front of a very tangible erection. Besides, the professor’s ethical obligation in such a case was much the greater. “No,”
I said, “why would I?” Several of them smiled.
“You would have, Doctor, because it was the right thing to do,” said Dr. Kerlin.
“By some standards that may be true, sir,” I said. “But the ethical problem arises from the power one holds over the other. And I believed from the start she would never abuse that power. She never did. I was no victim here. That was something between consenting adults.”
“You’re not here to lecture us on ethics.”
“No, sir. But my relationship really is not the issue.”
“You’re here to answer allegations of drug abuse,” he went on. “And harassment.”
“Yes, sir.”
“You deny offering drugs to Dr. Lyle, but say she was your lover?”
“Yes, sir.”
“Were there drugs involved in your alleged relationship?”
“That’s not Dr. Lyle’s allegation.”
“No, she alleges that you repeatedly offered her cocaine.”
“I did not offer her cocaine.”
“But were there drugs involved in your relationship?”
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I sat silently. I knew dodging to be a virtual admission, but better than an outright declaration.
“Other drugs? What . . . marijuana? Opiates? Pills?”
I sat quietly, trying to convince myself the obvious logic of the greater issues would prevail.
“Cocaine?”
Still, I sat quietly.
“You will not answer whether or not there was cocaine involved in your relationship.”
Every movement I made, every blink, swallow, glance, weight shift, or roll of a finger hurt. I felt like crying. I said only, “No.”
“Then, were there or were there not drugs used between you two?”
A long pause. “I think,” I said as calmly as I could, “I am entitled to withhold certain answers.”
The nerd said, “Well, I think we have an answer.”
Another pause. “Your urine test was entirely clean,” Dr.
Montoya said. She was apparently the ever-compassionate doctor, giving me a bit more rope that I might not hang myself.
I only nodded, pointlessly clinging to the strategic notion of seeming to know all along that it would be. Another pause.
“How could you satisfy us,” said Dr. Kerlin, “that you have never used drugs?”
