by Gary Kinder
“I was at the hospital every day when he went through the ‘Goddamn’ period,” recalled Kelly. “I’d walk in there and I’d sit down and he’d just jump right up out of bed with his eyes wide open just … just gigantic, and he’d turn over and he’d ‘Goddamn, Goddamn, Goddamn!’ just like that. And, you know, I’d sit there and I’d say, ‘Cort, it’s okay.’ He’d just sit there, ‘Goddamn, Goddamn!’”
One afternoon Claire was visiting Cortney in his new room, and Cortney was sitting in his wheelchair staring out the window. Outside, it was a warm summer day, and Claire sat quietly watching Cortney looking out at the lawns and the houses below. For a long while neither of them had said anything.
“Whatcha thinking about?” Claire finally asked.
Cortney continued staring out the window. Then he said slowly, “Have you ever thought somebody was after you?”
“He was still really out of it,” Claire remembered later. But she wasn’t sure how she should answer him.
“You don’t have to worry about anything, Cortney,” she said. “Everything’s okay.”
“Well, have you ever thought about it? Like someone wanted to kill you?”
Claire’s father had told her not to talk to Cortney about the murders unless Cortney himself specifically asked. He had said that they should talk to Cortney about happy things, about flying and skiing and family pastimes, and not mention the murders or the hospital or the time he had spent in Intensive Care or why his mother had never been to visit him. In the two weeks since Cortney had begun talking, he had never asked about any of these things. Now his conversation was suddenly leading that way, and even though Cortney seemed to remember nothing from one moment to the next, Claire was afraid she would say something wrong.
“Oh,” she said, “do you think somebody does? I haven’t really thought about it.”
“Did you ever think somebody would want to do that?”
“Cortney, everybody loves you and everything’s just fine. You’re doing great, don’t you think?”
Cortney didn’t answer. He still had not turned away from the window to look at Claire. Minutes again passed by in silence. Then Claire said, “Do you want to talk about it anymore?”
“No,” said Cortney.
* * *
The first three weeks that Cortney had been hyperalimented, he had gained weight, and by the middle of June he was up to 114 pounds. But then his weight began to drop sharply. Within one week 9 of the pounds that Cortney had gained were lost again, and Dr. Johnson didn’t know why. He decided to withhold the feedings for two days, in that time hoping to persuade Cortney to begin swallowing enough food to avoid the feedings altogether. But the hope was short-lived. On June 21, Dr. Johnson made the following notation on Cortney’s chart:
Plans were to try to have patient take more by mouth and evaluate his capacity for oral intake. So far today he has not succeeded in eating more than part of an ice-cream cone. Intake has been inadequate for even fluid maintenance. If this continues will be forced to use gastrostomy or IV alimentation again starting tomorrow. Fever level rising—father reports patient changing area of pain complaints. I can’t get response from patient to determine where most tender.
Impression: Clinical state slowly worsening.
That same afternoon Cortney called his father on the phone and told him he would like to go for a ride in the car. Dr. Rees and Dr. Johnson authorized the trip, and Byron was at the hospital with the car at four thirty. Cortney was brought down in his wheelchair, and after a few minutes of delicate maneuvering he was in the front seat next to his father, his seat belt fastened and his IVs hanging from the coat hook.
Byron drove slowly around town for an hour, talking to Cortney about the city and pointing out landmarks such as the high school from Cortney’s past. When they returned to the hospital, Dr. Wallace was on duty in the emergency room and watched them drive up to the ER doors.
“One of the sad things,” Wallace remembered later, “Cortney was very confused, very confused. He could walk and move around a little, but he had a lot of pain, and his favorite word was Goddamn, Goddamn, Goddamn, Goddamn. He said it over and over just like that, repeatedly, twenty-four hours a day. And of course it was from confusion. I remember By coming one time—this was after Cortney was long off the critical list—and putting him in his car and taking him for a ride. They rode around for an hour or two and then By brought him back. Let’s see, what is it he called Cortney? He had a pet name for him. Duke? Anyway, Cortney was so irrational, very hostile. He was always taking a poke at the nurses. So By was helping him out of the car and into his wheelchair, and he said, ‘Well, Duke, I’ll see ya tomorrow!’ And Cortney went pow! smacked By right in the mouth, you know, made his lips bleed. By said, ‘In spite of the fact you hit me, I’ll be back tomorrow.’ And Cortney was sitting there, ‘Goddamn, Goddamn, Goddamn, Goddamn… .’It was a real… Even at that stage of the game, I was wondering whether or not we had done the right thing.”
Cortney had become nearly impossible to manage. He had pulled out every line but the gastrostomy tube and would hit the nurses if they tried to reinsert them. Rees got an IV started in him one afternoon, only to have Cortney jerk it out an hour later. The nurses who took care of him were exhausted, some of them even hesitant to be in his room alone. When Dr. Johnson asked them how Cortney was doing, the frequent reply now was, “Not so good, Doctor, I don’t think he’s going to make it.”
Rees wanted to take Cortney to surgery, put him under anesthesia, then slip a line in behind his neck and down into his jugular where he wouldn’t pull it out. With the new line, at least they could feed him intravenously and supply him with blood, which he needed badly. Rees scheduled the OR for the morning of June 26. During the operation Johnson planned to take another inside look at Corte-ney’s esophagus: it had been seven weeks since the first endoscopy, nine since the murders, and an update on the lesions caused by the Drano might tell him why Cortney was refusing to eat. While these procedures were to be taking place and Cortney was sedated, the lab technicians were to be ready for blood cultures, and the X-ray department was to get films of Cortney’s lower bowel immediately following surgery. But on June 26 the operations were canceled. Two days later Cortney was gone from St. Benedict’s.
The final entry on Cortney’s hospital chart was made by Dr. Johnson:
Plans on 26th were canceled. IV could not be kept in yesterday. Patient’s fever continues and will continue unless some aggressive moves are made. Possibly even needs all medications discontinued, but I suspect bacterial source somewhere in abdominal cavity.
For several reasons the doctors had decided to transfer Cortney to Intensive Care at the other Ogden hospital, McKay-Dee. Staff fatigue among the nurses at St. Benedict’s was becoming apparent; McKay-Dee had new and extensive physical therapy facilities, which Cortney would need if he was ever to become functional again; a surgical resident was on call twenty-four hours a day to assist Dr. Rees should an emergency operation on Cortney become necessary; and since Byron Naisbitt’s office was in the adjoining medical building, having Cortney at McKay-Dee would be more convenient for his frequent visits. But the real reason for transferring Cortney, Dr. Rees explained later.
“The problem was he didn’t have any lines. He had ‘em all out. And was so aggressive that you couldn’t approach him. He was screaming and swearing and abusive and all that sort of thing. I mean, somebody just tried to murder him, and who knows what was going on in his head. Maybe he thought we were just continuing the torturing events that he’d been through. So he pulled everything out. I’ve forgotten how many times I tried just to put an IV in his arm, or anywhere. But if I put the lines in where he could get at them, he’d have them out in five seconds. We’d restrain him, we’d give him big jolts of drugs to calm him down, but he was manic. And the problem that was really wearing on me was how to get blood into him. He got to the point where he was so combative I couldn’t even get an IV into him to do that. Yet
he was anemic. I tried for five days to give him some blood, and he kicked me in the face and bit me and a few other things. Wouldn’t let anybody get near him. One time I was trying to put in an IV and there were two nurses trying to hold him still, and I was trying to sweet-talk him and his dad was too, and he hauled off and kicked me right in the ribs. Knocked me against the wall. It was maddening. So the only alternative I had was to put him to sleep and sneak an IV in from the back, burrow it under the skin and down into the jugular. I went to talk to the anesthesiologist about this, and he wouldn’t even talk to me about it. He says, ‘He has to have blood before we’ll put him to sleep.’ I was caught in this very awkward position of trying to get a line into him to get his blood back up, and the only way to do it was to put him to sleep, and Anesthesia wouldn’t put him to sleep because they felt his blood was too low. But I knew there was an anesthetist at McKay that would do it for me. In my discharge summary I said we transferred him for rehab purposes, which in essence would have been true, but the real reason I transferred him was I couldn’t get cooperation from the head of Anesthesia at St. Benedict’s. The day we transferred him, I’m sure his father doesn’t mind me saying this, he was psychotic.”
NIGHTMARE
The morning after Cortney arrived at McKay-Dee Hospital he was taken to surgery, where the anesthetist put him to sleep and Dr. Rees cut into his right jugular to insert a catheter. While Cortney was still sedated, Rees and Johnson ran an endoscope down his esophagus to look at the old lesions. Seven weeks earlier, when Johnson had first seen the inside of Cortney’s esophagus, he had been surprised that the lye ingestion had not caused more damage. Now that the scars had had time to deepen, Johnson expected the esophageal lining to appear more corroded than before.
“I figured, well, he’s having a hard time swallowing his saliva. He’s got pain, probably from strictures in the esophagus, and severe inflammation. And it’s going to look worse than it did the first time because I know that’s the way it is. I’d read about it and I’d seen it once. And I just knew it was going to be worse. But I didn’t think it was going to be that bad.”
Cortney’s esophagus, from where it attached to the back of his throat all the way down to the lower burn ulcer, was blood red and swollen. Johnson couldn’t see beyond that because scar tissue from the caustic burns had formed a casdike stricture so tight the endoscope would not pass. Cortney had been refusing to eat because everything he swallowed was backing up at the stricture. If something wasn’t done soon, his esophagus could close off completely.
The doctors had only two options. One was to cut out the stricture and transplant a section of intestine to bridge the gap. But this was major surgery, and Rees was certain that given Cortney’s metabolic state, if they put him on the operating table now he would die.
The other alternative was a relatively simple procedure called dilatation, where a mercury-filled tube tapered to a point at one end is fed down the patient’s throat and worked gendy back and forth to open the stricture. But there is a danger too in attempting to dilate the esophagus: the scar tissue forming the stricture is thin and brittle, and there is always the possibility that the tube will break through. A single pinhole in Cortney’s esophagus would allow air to leak into his chest, collapse his lungs, and a massive infection would follow as saliva leaked in with the air. And the leak couldn’t be stopped. No surgical procedure would plug it up, and the esophagus couldn’t be cut out because Cortney would never survive such an operation.
Despite the danger of perforation, if Cortney was ever going to swallow again, the doctors had to try to dilate him now. Waiting any longer would only allow the stricture to tighten and make future attempts to dilate him even more dangerous.
With Johnson assisting and Cortney lying on his side still sedated, Rees selected one of the thin rubber tubes, called bougies, and carefully fed the tapered end down Cortney’s throat. As the tip of the bougie approached the stricture, Rees could feel it beginning to bind up. He pressed the bougie gently into the small opening, trying to stretch it wider, but Johnson could see he was having trouble.
“What’s it like?” asked Johnson.
“It’s tight,” said Rees. “It’s really tight.”
Rees pulled the bougie out slowly, got a smaller size, and again inserted the tip of it into Cortney’s mouth. When the tip reached the stricture, Rees tried working it back and forth. But this time it seemed even tighter than before. Again, he carefully withdrew the bougie and reached for a third, even smaller. After it too became bound in the scar tissue, Rees decided to quit. They couldn’t afford to have the stricture tighten any more, but as tight as it already was, Rees couldn’t take any further chances of punching a hole through the esophagus.
Cortney was wheeled out of surgery and taken to the recovery room for observation as he came out of the anesthesia. During the procedures he had undergone, his vital signs had remained stable and his low blood count had not proved critical. Already he was receiving fresh blood through the new catheter in his jugular vein. With Cortney in Recovery, Johnson and Rees went to see other patients in the hospital.
Johnson was on a stairwell between floors a short while later when he heard the hospital operator paging Dr. Rees. Taking note of the page, but thinking little of it, Johnson proceeded to the next floor where he was to examine a patient. During the examination he heard the operator paging Rees again. This time Rees was told to report to Recovery immediately. Upon hearing the second page, Johnson left his patient, went out to the nurses’ desk, and called down to Recovery to see if anything was wrong.
Rees had arrived only moments before and already was examining Cortney. The nurse had reported to him that shordy after the two doctors had sent Cortney to the recovery room, his blood pressure had dropped and his pulse suddenly had increased. He had turned cold and clammy. At that point the nurse had had Dr. Rees paged.
Rees went to the phone to talk briefly with Johnson.
“He’s still in recovery and he doesn’t look good,” he said. “He’s trying to get shocky.”
“Oh, God,” said Johnson, knowing what was coming next.
Then Rees said, “I think we perforated him.”
Cortney was rushed to X-ray, and from the moment he saw the first picture, Rees knew that the esophagus was lost. On the film a small, light-gray mass was forming in the left chest adjacent to the stricture. It was air already beginning to leak through the perforation.
How rapidly the air pocket in Cortney’s chest expanded over the next twelve to twenty-four hours would indicate the size of the perforation. For now, there was little to do but monitor the leak and be prepared to go into Cortney’s chest with tubes should the air increase and an infection start to form.
While the doctors watched the progression of Cortney’s esophageal leak on X ray, Cortney was in Intensive Care, lying in a fetal position on an ice blanket, shivering and delirious from a fever that remained between 102 and 103 degrees. He couldn’t stand to be touched. If the nurses tried to move him or roll him over, he would slap weakly at their hands or grab for the bed rail so he couldn’t be turned. He could communicate when he wanted to, but most of the time he was withdrawn.
“He was like a pitiful animal suffering,” said one of the nurses. “When he was alone in the room, he would cry out these terrible, hurt-animal sounds. And yet you could go in and say, ‘What’s the matter, Cortney?’ and chances are you’d get no response at all from him. No response at all.”
Cortney weighed 106 pounds. Despite frequent injections of Valium, Demerol, and morphine he was restless, sweaty, his breathing quick and shallow. He knew his name was Cortney, but he told a nurse he was only fifteen. When the nurse asked him where he was, Cortney had no idea.
A few hours after the first set of X rays was taken, a second set showed a continuing leakage of air into Cortney’s chest. Air still had not penetrated the lung vicinity, but a thickish fluid was beginning to form immediately adjacent to the lung. Then hours late
r the third set of X rays came back, and the situation in Cortney’s chest had changed dramatically.
The small pocket of fluid that had shown up on the second film had rapidly expanded, invading the lung cavity and filling the region at the base of Cortney’s lung. Ahead of it, pressing upward, was an even larger mass of air.
The pockets of fluid and air continued to grow until, thirty-six hours later, Cortney’s left chest on film was totally opaque, a solid block of gray. The perforation had not sealed off, and the resulting air and fluid in Cortney’s chest had pressed into the pleural cavity, finally collapsing his lung.
Rees took Cortney back to surgery and inserted two tubes through his rib cage, one in his lower chest for draining off the fluid, and one in his upper chest for drawing out the air. The tubes were attached to a pressure pump, but the air and fluid could not be sucked out as fast as they were building in Cortney’s chest. The following day Cortney’s lung, like a deflated balloon on the end of a stick, shriveled even further back toward the bronchus, and the space created filled with the incoming fluid.
With his lung collapsed, Cortney went into respiratory distress and couldn’t breathe without an oxygen mask. As the air was drawn out of his chest, his lung partially reinflated, but the dense fluid there now was keeping the lung collapsed. And though the lower tube drained quarts of the fluid, the tissues inflamed by the infection continued to manufacture even more. The serum itself was almost like pudding, so thick it began to clog the chest tube. In three days the tube sealed off completely and Rees made plans to remove it, and insert a new tube on the morning of July 4. The night before Rees could replace the old tube Cortney himself reached up and pulled it out of his chest.
Since the first night at St. Benedict’s, nearly two and a half months earlier, the visits to see his brother had never been easy for Brett. Now they became even more difficult.
