Murder at the House of Rooster Happiness

by David Casarett

  Ladarat nodded, beginning to see why the director wanted her to convey this information. In the United States, she knew, this man would be brain-dead. His life support would be stopped. That would be very sad for the man’s family, of course. But at least they would be able to close that door behind them.

  But here in Thailand there was no such door for them to close. There were no such hard-and-fast rules about what to do. So it would be difficult indeed to explain the man’s situation to his wife. And if his situation were not explained correctly—and perhaps even if it were—she might insist on keeping him “alive” and supported artificially, for weeks or even months.

  Their hospital could not afford that. Their ICU was always full, she knew, and there was always a waiting list. As long as the American was there, there would be patients who would not get the ICU care they needed.

  Of course she would help. There was no question of that. Wasn’t this why she’d been sent to receive ethics training at the University of Chicago? Wasn’t this why she had braved a year of extreme cold, and rude people, and bland, salty food? Food, in fact, that was so tasteless that eating a meal was no more satisfying than reading a menu. She suffered all of that for a year so she could bring the principle of ethics back to the best hospital in northern Thailand.

  So she would have to help. No question. But this was the director’s responsibility as well.

  “Then we should meet with her together,” she suggested. “I will need to ask you for the medical details and prognosis, and of course, the importance of your position and status will make the conversation easier.”

  A little flattery, Ladarat had always found, worked wonders with doctors. With everyone, actually. But with doctors more than most.

  Yet the director did not seem to be overly enthusiastic about this plan. He looked down at his hands. Then up at the tiny mail slot window set high into the wall behind her.

  “You are the expert in injuries of this type,” she explained gently. “Everyone knows this. It would seem strange, would it not, if you were absent for such an important discussion?”

  This direct appeal to his vanity was her last hope. The director considered for a moment. At last, Khun Suphit seemed to agree that his absence would be strange indeed. He nodded.

  “But you will do the talking?”

  What could she say? She nodded. “I will do the talking.”

  The director stood up, at least partly relieved. This meeting had not gone quite as well as he’d hoped, but it had gone better than he’d feared.

  And that, Ladarat had always thought, was the way things usually worked out. One’s hopes are never fully realized. Or almost never. But on the other hand, one’s fears are not usually justified. If she were wise enough to write a book like Professor Dalrymple’s, that would be the sort of advice she would offer.

  “Then we should go now,” the director announced.

  “Now?” Ladarat’s stomach gave a modest lurch of protest as she realized that there would be no khao neo dam in her immediate future. Nor would she be able to begin her work as a detective. Nor would she be able to prepare for the upcoming inspection.

  “Right now,” the director said. “You see, she has been transferred out of the ICU and is in a private ward. And the man’s parents are here. They flew here last night from Alb… Alb…”

  “Albuquerque?”

  “Yes, that’s it. Al-bu-quer-que. And they want to know what is happening.”

  “I’m certain that they do.”

  And she was certain, too, that the man’s parents wanted their son to get the best possible care. No doubt they were deeply suspicious that anyone could get the best possible care in Thailand, of all places. If he’d had the good fortune to be in a Bangkok hospital, which everyone knew rivaled the best in the United States. Instead, they were here in Chiang Mai. Little more than a point of departure for tourists and trekkers venturing into the wild forests of the Golden Triangle. At least that was what they thought.

  So she would need to reassure them that Sriphat Hospital was the equal of any hospital in Bangkok. Or Albuquerque. Or even Chicago, for that matter. But that, she knew, wasn’t going to be easy.

  As Ladarat rose to follow Khun Suphit out of her little office, her gaze rested for a moment on Professor Dalrymple’s wise book. She thought of another wise passage from that very wise book: “One must never tell a patient that there is no hope. There is always hope. It’s just a matter of helping our patients hope for what is reasonable.”

  That was good advice indeed. But what could this poor man’s family hope for? And certainly there was no simple aphorism that could offer comfort to his wife. Still, perhaps Ladarat could offer something.

  THE ETHICAL RIGHTS OF A BAREFOOT VISITOR

  Khun Suphit led the way, swinging his thick arms around a broad middle section as he strode down the low-ceilinged hallway. It was not difficult to remain a few deferential steps behind him as they walked to the north elevators. The director moved very quickly for a man of such… roundness.

  She caught up with him at the elevator, just as the doors slid open. It seemed to have been waiting for him. Odd how some people inspire the world to give them what they need. Somboon had been like that. Relentlessly upbeat, he always expected the best, and usually received it. Up until the very end, he’d been irrepressibly cheerful. And even hopeful.

  But she, Ladarat, was not one of those people. Doors seemed to open for her grudgingly, as if they had better things to do with their time. And people, too, did not step out of their way to help her as they did for Somboon. They didn’t hinder her, exactly. It was more that she wasn’t… noticeable. Ah well.

  She and the director discussed their strategy as the elevator took them from the basement up to the ICU on the sixth floor. They would see the man first, they agreed, and review his case. Then they would go to see the wife.

  “Together, yes?” she clarified.

  “Yes… of course, Khun. Together.”

  A moment later, the elevator doors opened onto a different world. Where Ladarat’s basement office was dark, with just a small window close to the ceiling, the hallway that led to the ICU was broad and light-filled, as was the waiting room at the far end. Tall windows offered spectacular views of the mountains that began just a few kilometers to the west, and Ladarat knew that if you looked up and to the left, from some of the waiting-room seats you could see the Doi Suthep temple perched on the mountainside. That must be such a comfort to many visitors, in this Buddhist country.

  There were hardly any visitors today, though. It was still early, and many friends and family members needed to travel from the countryside. Chiang Mai was really just a small city in the midst of rich farmland and—to the north and west—endless forests. Visitors might take an overnight bus, arriving midmorning, if they could come at all. They’d pay their respects, and then return home in time to work the next day.

  Many patients came from small villages, where people earned money only if they worked. The fields wouldn’t tend themselves, and if people didn’t work, they didn’t eat. So the waiting rooms were often empty, except if a patient came from very close to Chiang Mai, or was in the city itself.

  This morning there was only one man in the waiting room, in the far corner, with his back to the wall that separated the waiting room from the ICU. Despite the fact that there was a wide field of empty chairs in front of him, the man was squatting on the floor, his arms cantilevered out over his knees. He was rocking back and forth very slowly, in time to some rhythm in his head.

  The man’s posture reminded her of the people from the hill tribes where she’d grown up, near Mae Jo. Coming into town for the day to buy or sell or trade, they’d avoid chairs and benches, preferring to squat as this man was doing. As if there was safety and security in being as close to the ground as possible.

  Ladarat looked more closely at the man but was careful not to stare, which would be rude and inhospitable. He was a guest, after all. Moreove
r, he could be here only because of a serious tragedy, so he deserved her compassion.

  She followed Khun Suphit across the waiting room, turning to admire the view. As she did, she glanced over just long enough to see that, in fact, the man did have the long face of one of the Karen hill tribe people. Their light skin was distinctive, too. He was probably from a small village along the border of Thailand and Myanmar, perhaps even on the other side of the border. Most of the hill tribes didn’t care about borders—they’d lived here long before anybody thought to divide the Golden Triangle into the territories of Myanmar, Laos, and Thailand.

  The man noticed Ladarat looking at him, so she stopped, of course, and greeted him formally as one should greet a guest. Startled by her attention, he got to his feet, revealing very thin arms and legs, with prominent veins and corded muscles. He appeared to be in his forties or fifties but was probably much younger. His body and face had been weathered and molded by a difficult life of hard outdoor labor and just enough food—mostly fruit and fish and sticky rice—to survive.

  He stooped, keeping his head at a respectful level below hers. And that was difficult for the poor man, since she herself was only one and a half meters tall. Then he returned her greeting with a mumble that was barely audible and offered a deep wai. Joining his hands, palms together, in front of his chest, he brought his nose down to touch his fingertips, bending almost double at the waist. It was as deep a wai as Ladarat would offer the dean of the school of nursing, or a high government official.

  Yet despite that demonstration of profound respect, the man did not linger. Instead, after a pause that was just long enough to avoid an appearance of disrespect, he scooped up an old gray burlap bag that had been behind him, slung it crosswise over his shoulder, and scurried toward the hallway. It was only as he padded away that Ladarat noticed that he wasn’t wearing shoes.

  But she didn’t have time to think about that, because Khun Suphit was waiting for her at the large double doors to the ICU. He’d been watching her interaction with the Karen man, and now he was nodding.

  “Yes, it’s strange,” he said. “The man arrived here last night. I don’t know who he’s here to see. He just sits and waits. And he’ll run away if you try to talk to him. Last night the charge nurse told him he couldn’t stay there all night, so he left, but I don’t know where he went. Then first thing this morning he was back.”

  “If he’s from a village, it’s likely he doesn’t have a place to stay here, or anything to eat,” she said. And that is no way to treat a guest, she thought.

  He nodded. “I’ll make sure the volunteers know to send him to Wat Sai Moon.” Many staff prayed at that temple and gave their donations there to make merit. In return, the monks would visit patients and would take in visitors who needed a place to stay.

  The man might not want to accept their hospitality. Indeed, he had seemed almost painfully shy and was almost certainly overwhelmed by the big city. It was, in all likelihood, the first time he’d been to Chiang Mai, and almost certainly the first time he’d been in a hospital. So it was all the more important that they make him welcome.

  As Professor Dalrymple said: “You must always treat a patient’s family as an extension of your patient.”

  “But…” the director said.

  “But?”

  He sighed. “I’m only thinking of the Royal Inspectors. They will be here next Monday, you recall?”

  She certainly did recall. Indeed, hardly a waking moment in the past month had gone by that Ladarat hadn’t paused to recall that impending event. And if she did forget, there were the frequent reminders from Khun Tippawan, the Director of Excellence.

  “And it won’t do to have this man in his bare feet in our waiting room.” He paused, and then, perhaps sensing her im-pending objection, he asked a question that she hadn’t thought of. “Would you see a man like this outside the ICU of the University of Chicago?”

  “No, Khun,” she agreed. “You would not.”

  “It’s not that it is bad that he is here necessarily. But it is not the sort of scientific and academic image we want to present to the inspectors, is it?”

  Ladarat agreed that was probably true. But she also thought that if one of the inspectors were in the ICU, they would want their visiting family members treated with respect and courtesy, no matter what those family members looked like. And whether those family members wore shoes.

  But there would be time later to consider the ethical rights of a barefoot visitor. For now, there was work to be done.

  As Khun Suphit led her through the glossy steel double doors that swung open automatically, it was as if she’d stepped back in time to her days at the University of Chicago five years ago. Indeed, what she saw was an ICU to make the director proud. The Sriphat Hospital ICU was new and modern, with glassed-in cubicles arrayed around a central nursing station. The place was busy with mechanical conversation. There was the rhythmic whoosh of breathing machines, layered over the background babble of beeps and buzzes and chimes coming from various monitors that were all trying to have their say. It could easily have been the ICU in Chicago where she learned about ethics. Or any other ICU in a major city.

  She knew that people in the United States and elsewhere had a tendency to look down on medical care in countries like Thailand. She certainly heard dismissive questions from people in Chicago. Do you have antibiotics? they asked. Or chemotherapy? Or surgery? A brisk walk through this unit would convince them quickly enough that we have all of those things. But, she liked to think, we haven’t forgotten about the caring part of medicine the way the West has.

  Now they were standing in front of cubicle 8, where the American named Andrew Fuller was lying on a hospital bed. In his throat he had a breathing tube that was connected to a ventilator, which was breathing for him. His head was bandaged, and his eyes were taped shut to prevent them from drying out, but she could see fresh bruises across his right cheek and jaw. There was bruising around both eyes, too. Raccoon eyes, she remembered from nursing school, were a sign of fractures of the bones that surround the eyes. The heart monitor over the bed was blipping along, but that was the only sign of life.

  “He looks… peaceful,” she said hesitantly.

  Khun Suphit winced.

  “Do you really think so?”

  Ladarat nodded.

  “Ahh, yes. Of course you are right, Khun. I suppose he does.”

  Ladarat nodded again. That was part of the problem. The American appeared to be resting. It was a comforting appearance of peacefulness, but a misleading appearance, too. He looked like he could wake up any second. And once those bruises healed… well… it would be hard for his parents or his wife to believe that anything was wrong. And that would make it much more difficult for them to make a difficult decision. Oh dear.

  She had to ask the obvious question. How could the director be sure that the man didn’t have any brain function? How was it possible to know that, after such a short period of time? But she couldn’t ask in that way.

  No. She didn’t want to question Khun Suphit’s medical expertise. It was, she knew, a delicate situation that she’d faced many times as a nurse. Fortunately, it was a problem for which she had developed… strategies.

  “When I tell the family that his brain is no longer working,” she said slowly, “they will have questions.”

  Khun Suphit nodded unhappily. He knew that they would. That was why she was here.

  “What shall we tell them?” she asked. “How do we talk to them in a way that will help them to understand his condition?”

  “You can tell them three things,” the director said. And he didn’t hesitate. “First, that his pupils don’t respond to light. Second, that the vestibular canals in his ears don’t respond to hot or cold water the way that they should. That means that the part of the brain that controls balance and coordination isn’t functioning. Finally, you can say that we’ve done EEGs two times since he’s been here, and we’ve seen no response. So
you see, his brain—it is not sending any of the signals that even a sleeping brain makes.”

  “Eehhh. That is bad.”

  And it was. Those are the tests that she’d learned about in Chicago. But she also knew that there were other tests, like a brain scan, that Western countries sometimes did. She hoped the family wouldn’t ask about those tests, because they didn’t do them here. Still, she knew that they might ask.

  “And if they ask about a PET scan, what should I say?”

  He nodded. “Oh, no doubt they will ask. Or they will have a U.S. doctor call me to ask. We can tell them that although that test is used sometimes in the U.S., it is not used in Europe or most other countries.”

  “And why is that?” Although she knew perfectly well why not, it would help to give Khun Suphit a chance to practice his explanation.

  “Because, you see, it doesn’t add useful information. It is no better than the tests doctors can do at the bedside. Ask any expert, they will tell you the same thing.”

  She knew, then, why the director was so eager to have her translate. This would be a conversation that would be full of conflict. There would be angry words and tears. And, probably, accusations of poor care. Accusations that real “experts” would do things differently. In short, the kind of conversation that would cause all of those involved to lose face.

  Ladarat and the director stood there watching as Andrew Fuller’s chest rose and fell, knowing that movement didn’t mean anything. And knowing, too, that this was not going to be easy to explain to Andrew Fuller’s family on the other end of that long hallway.

  THE YIM SOO SMILE OF THE FEMALE SEX

  And indeed it was not.

  The first hint of trouble came in the hallway outside the room of Andrew Fuller’s wife. His soon-to-be widow. Kate, she was called.