Mr. Fuller nodded. “Anything would be helpful, I guess.”
She and Sisithorn put the stack of papers between them and took turns pulling sheets from the file. First one, then the other, they walked the Americans through what had happened to Andrew in the past three days.
“This,” Ladarat said carefully, “is the admission note from Sunday.” The three Americans were watching her intently, and Mr. Fuller’s hand began to write. She hoped she didn’t say anything that was wrong. She hoped even more that Sisithorn would be careful.
“This describes some of his injuries. His pelvis was broken in three places, it says. And his right femur. The CT scan says he has a hematoma—a collection of blood—in the capsule around his liver. That sometimes happens with trauma.” She scanned the rest of the report.
“There are other small things,” she concluded, “but those seem to be the main problems.”
“But what about his brain?” Mr. Fuller asked.
Ladarat looked to Sisithorn, who was holding the neurologist’s report. She looked at Ladarat nervously and Ladarat nodded. She could trust Sisithorn not to say anything that was insensitive.
“This is the neurologist’s report from yesterday,” Sisithorn said. “The neurologist is Dr. Ratana. It talks about the CT scan that they did, and his own exam. It is a summary, you understand?” The three Americans nodded.
“Dr. Ratana describes… what happened to Mr. Fuller, from the reports available.” She looked up cautiously at the ladies and especially at the elder Mr. Fuller. She seemed to decide that a review of those details would be too painful.
“He describes those events,” she repeated lamely. “And then he describes Mr. Fuller’s neurological status when he arrived here.”
“Keep in mind,” Ladarat interjected, “that these findings are a day old. They don’t include… changes”—she almost said “improvements”—“that might have happened since then.”
The Americans nodded. No doubt they’d heard some version of that before. That was yesterday, but tomorrow is another day, as they are fond of saying in the United States.
Of course, tomorrow is not really another day. Usually tomorrow is just another version of yesterday, with slightly different weather and new lottery numbers. But if you’re an American, she knew, then sunrise was a promise that anything could happen.
Sisithorn looked at her, then at the Americans. Then she began to read again, picking through the information as one might pick through som tam—green papaya salad—looking for the crunchiest bits of fruit while avoiding the fiery chilies.
She described the CT scan results: Skull fractured along the parietal bones, at the top of the head. Also a fracture of the orbit, around the right eye. The jaw was broken and needed to be wired in place.
And the brain. This is what the Americans would want to know about. Always so worried about brain function. Although, if you asked her, it seemed that many Americans didn’t use their brains for much of anything that was important. Still, it would be important to these three people sitting in front of her. Sisithorn seemed to know that, so her description was particularly careful.
“With respect to the brain,” she began slowly after reading the entire next paragraph to herself, “there is little visible trauma. There is some clotted blood in the anterior sulcus of the parietal lobe, consistent with a subdural hematoma. That means the blood is inside the lining that protects the brain,” she explained. “But it says that there is no other sign of injury.”
“So his brain is basically normal.” This was from the elder Mr. Fuller, and Ladarat was concerned to hear that it wasn’t a question. He didn’t ask whether his son’s brain was normal, but instead seemed to be telling them that it must be.
Sisithorn looked to Ladarat for help.
“Dr. Jainukul can explain this better than we can,” she said. “But the CT scan results only provide a picture of what the brain looks like. It can’t tell how the brain is functioning.” She searched back in her mind for an example that she’d heard in Chicago.
“When you see a car that’s run out of gas,” she said, “it looks like a normal car, yes?” The Americans nodded. “But it will not run. Yet it looks like it should. CT scans of the brain can be much the same. They may make the brain look normal—as if it should run—but it does not.”
The elder Mr. Fuller, at least, was nodding. Proving once again that to explain medical things to patients and families, you must choose your terms carefully. A metaphor that works for a man will not work for his wife, and vice versa. That insight didn’t rise to the philosophical heights for which the wise Professor Dalrymple was so well-known. And perhaps if Ladarat were wiser herself, she’d be able create a saying that would merit inclusion in the professor’s little book. But it was true nonetheless. And now, if Mr. Fuller understood, then he could help to explain things to the ladies.
Sisithorn turned back to her, relieved, and Ladarat turned to the next page. This was the neurologist’s examination. She read quickly, and summarized.
“Here Dr. Ratana tells about Mr. Fuller’s brain function. Remember, though, that these results are from yesterday. So, he says that Mr. Fuller was not awake. He had no response to touch. That is, he did not move when touched.” In practice, she knew, Dr. Ratana would have used painful stimuli, like a pin. But she didn’t think the Fullers would want to hear that some foreign doctor was poking their loved one with pins.
“He goes on to describe other tests. These are the tests that your doctors in America will want to see.” She summarized the tests that Dr. Jainukul had described in her office the previous morning, omitting the interpretation, which was beyond her. As the director said, those tests included movement of the pupils of the eyes, and response to cold water introduced into the ear canals. Also reflexes. Normally that would be enough, Ladarat knew. But perhaps because Dr. Ratana sensed that doctors in America would be looking over his shoulder, he had arranged an electroencephalogram on that first day as well. She wasn’t sure how to explain the results, but it seemed as though there was some brain activity, so that’s what she said.
And of course, the elder Mr. Fuller grasped tightly to that little bit of information. Almost immediately, she wished she hadn’t said anything about the EEG.
“So there is some brain function,” he said, slapping both hands on his thighs. “So… he’s not out of gas, is he?” He smiled. “Okay, now that’s something to go on.”
Sisithorn looked at her in confusion, but Ladarat had grown used to this strange and obdurate optimism during her year in the United States. Any good news became the focus of families’ attention. You could say that a patient’s kidneys were not working, and that he wasn’t waking up, and that his liver was failing. But if his blood sugar was normal, that was viewed as a good sign.
It was a little like those fortune-tellers in Isaan who would read your future in tea leaves. If they wanted to find good news—or if they sensed that their client was willing to pay more for good news—they would be sure to find it somewhere. If a farmer came to town on a Saturday, he might be poor and childless, and his wife may have left him. But he could depend on a fortune-teller to say, with perfect sincerity, that perhaps his tiny house would get a new roof in the spring.
Once again, Ladarat found herself thinking about kling wai korn, pho sorn wai. To do whatever needs to be done. Anything to get past a crisis.
Not for the first time, she wondered if that rule of thumb was invented to help Thais deal with foreigners. It certainly seemed to be necessary particularly often when dealing with farang in general, and Chinese in particular. They were so demanding, and so hopeful. Often there was no choice but to tell a little white lie that would spare them discomfort and spare the hospital embarrassment. So that is what she did.
“Ah, so there is some brain function. You are right. My reference to the car that runs out of gas was not a good one. I apologize. How much function, you should discuss with Dr. Jainukul.”
Mr.
Fuller had other questions, and Kate did as well. But the older Mrs. Fuller was strangely silent. Perhaps that was just her personality. Ladarat had known women of her generation in the United States who seemed content to let others do the talking. They were paying attention, and listening carefully, but didn’t feel the need to be in the middle of things. Those women were often very patient. Those women, she thought, were also very Thai.
She and Sisithorn answered Kate’s and the elder Mr. Fuller’s questions as best they could, about what tests had been done (many) and what the lab results had shown (surprisingly normal).
They talked, too, about what had been done so far. The ventilator, for instance, and antibiotics to prevent infections. Dr. Jainukul had also used drugs to reduce the swelling in Mr. Fuller’s brain. Ladarat described many of these treatments in excessive detail, for no other reason than to make sure the Americans knew how much they were doing, and how hard everyone was working to save Mr. Fuller.
Eventually, though, the Americans ran out of questions. It was clear that all of Andrew Fuller’s troubles were fixable, except for his brain. That would be the problem they could do nothing about. They would simply need to wait and see, and that was something that Americans were not good at.
As Ladarat and Sisithorn stood to leave, the elder Fullers stood, too. Whether that was a mark of respect was difficult to tell, but Ladarat wanted to believe that it was. And why not?
Sisithorn promised to come back later that afternoon. She spoke to all of them but looked in particular at Kate, who smiled shyly and nodded. That unfortunate girl could definitely be helped by talking with someone her own age. And someone who was not related to her husband.
But where was her family? Surely her parents would have come to provide support? She was not as seriously ill as her husband, but still… Ladarat made a note to herself to have Sisithorn find out.
As they rode the elevator back down to Ladarat’s office, she asked Sisithorn what she thought. They were alone in the elevator, and Sisithorn took her time to think.
“Mr. Fuller seems angry,” she said finally. “But I don’t think he’s angry at us.” She shook her head, perplexed. “He is acting as though he’s angry at us, but I think he’s just angry at what has happened.”
Ladarat nodded. “Anger for Americans is like the way that we smile. Just as our smiles can mean many things, their anger can mean many things.”
The doors open and they stepped out into the basement hallway.
“But the older Mrs. Fuller,” Sisithorn continued thoughtfully, “she is not angry. She wants everyone to get along. She wants harmony.”
Ladarat smiled. “Yes, I thought many times during that meeting that she is as Thai as we are.” She thought for a moment as they stepped off the elevator. “But the young woman—she is scared. And, I think, she is lonely. Why doesn’t she have her family here?”
They both thought about that for a moment. To be alone in a strange land, with a husband who is likely going to die, with no one for comfort besides his parents? That would be very frightening.
Sisithorn nodded her agreement. “I had the same thought,” she admitted. “She is the one who needs our help the most. But she won’t ask me to talk with her, will she?”
Ladarat shook her head. “No… I think she will not want to be… a burden.”
“A burden? But she is our guest.”
Ladarat thought about how to explain this concept of “burden.” A minute later, they’d reached her office, and she was still thinking. She shrugged.
“Americans are very… independent. Remember how the older Mr. Fuller was reading his son’s medical records? In Thai? Yet he didn’t ask someone to explain. He was going to do it himself. Or try to. Well, that is how Americans are.”
“Then,” Sisithorn said with decision, “I will go back to visit her on my own. I will go in, and I will sit in front of her, and I will listen.”
More than a minute after Sisithorn had left her, Ladarat found that she was still standing outside her door. She was staring absently at the sign that proclaimed her to be a nurse ethicist, her key dangling, forgotten, from her hand.
Nurse ethicist. That sign meant that she had skills of ethics and decision making, did it not? And shouldn’t she use those skills where they were needed? In supporting the Fuller family certainly. And in the case of the farmer in the ICU waiting room.
Well, why shouldn’t she use those skills to protect men like the unfortunate Zhang Wei from being harmed? Was that not ethical work? And wasn’t that work as significant as reviewing policies?
That simple insight was what had caused her to pause outside her door. And that was the question that had led her to search her mental index of Professor Dalrymple’s wise advice. And that was why she was still standing outside her door, looking perhaps like one of those crew-cutted, heavily perspiring, white-shirted missionaries who tried to find converts.
Khun Tippawan would say, she supposed, that such work was unrelated to the tasks of Sriphat Hospital. That was true, perhaps. But… wasn’t one of these deaths declared in their emergency room? So wasn’t this the hospital’s problem? And wasn’t it, therefore, a problem for Sriphat Hospital’s nurse ethicist?
Ladarat was strangely elated to find that she could answer her own question without hesitation. Of course this was her responsibility. And she was hardly shirking her duties as a nurse ethicist by investigating a murder—a possible murder—in which their very own hospital might have been complicit.
So it was with a light heart that she entered her office, exchanged her white coat for her bag, and then exited, closing the door behind her. It was only three o’clock as she passed through the grand hall outside the outpatient clinics. The wide tiled space was often home to musicians and sometimes dancers, who entertained patients and staff alike.
But today there was just a single musician. And she heard his music before she saw him. From the center of the crowded hall, she heard the strange, sad notes of a lueng bouncing like raindrops off the tiles beneath her feet. Ladarat altered her course to pass by the small dais where musicians performed and found an older man—perhaps in his seventies—with his small instrument that looked something like a lute. A traditional part of Lanna culture, it was one of three instruments in the salo-so-sueng ensemble, along with a small fiddle (salo) and a reed pipe (pi so). Through some sort of strange magic, even its fastest rhythms somehow sounded sad.
So intent was she on the notes that floated and danced around her that Ladarat didn’t notice the intrusion of a harsh chirping that couldn’t have been more out of place. It wasn’t until an older woman and her daughter standing nearby glared at her that she recognized the intrusive signal of a mobile phone. Her mobile phone.
She ducked her head and silenced the phone until she could step away. But as soon as she answered, she wished she hadn’t.
“You have not forgotten the meeting of the operating room procedures, have you, Khun? It begins promptly at three o’clock.”
“No, Khun Tippawan. Of course not.”
But… how did she know?
“Ah, that is good, Khun Ladarat. You see, I saw you enjoying today’s entertainment, and I was just a bit jealous.”
“Jealous, Khun?”
“Yes, just a bit, you understand. Because I wish that I had time to enjoy music on my way home in the middle of the afternoon. But of course, I have work to do, so I cannot afford such luxury.”
“Khun, I…” But the Director of Excellence had disconnected. So Ladarat hitched her bag to her shoulder and turned back to the elevator, preparing herself to spend the rest of the afternoon in yet another meeting.
THE CONSIDERABLE BENEFITS OF A MATCHMAKER FOR THE SHY PERSON
The rest of the afternoon had been interminable. “Interminable,” incidentally, was Ladarat’s favorite English word. Odd that there was nothing that meant quite the same thing in Thai, yet the pace of Thai life often called for such a word. Maybe that made sense. Only a people who
hoped that everything would have been done yesterday could create such a wonderful word to sum up the futility of that hope.
The director of the operating room wanted to review their policies regarding sterile technique, and they did so, in paralyzing detail. Still, Ladarat supposed that was one area that no one wanted the inspectors to have trouble with, and yet the operating room staff were sometimes so lazy. No wonder some of the private hospitals hired nurses from Singapore and the Philippines—those ladies were much more conscientious sometimes. Sometimes the live-and-let-live Thai attitude was not what you wanted. Like when you were undergoing open-heart surgery.
Then, back in her little cubby of an office, she’d reviewed a dozen more policies, which made her feel a little more confident that she could actually review them all by next week. So the afternoon had been interminable, but now, at last, she could leave. And she should. Before anything else happened.
She was just rising from her chair and reaching for her bag when the telephone rang. It was Detective Mookjai, asking for an update.
Ladarat was hesitant at first. After all, she had found nothing. And that’s what she explained. No note. No lab results. And no record of any blood sample having been taken. In short, a failure. Except…
“Except?”
“A name. That is to say, I have the woman’s name. On her marriage certificate. She is called Anchan Pibul.” Ladarat paused to let that information register.
“Ah, Khun Ladarat. That is very good. Very good. More progress than I’ve made.”
She smiled at that. She was perhaps doing better at detecting than a real detective?
“And there is a little more,” Ladarat admitted. “Although I don’t know what it means. The marriage certificate…”
“Yes?”
“It was dated more than five years ago.”
There was a protracted silence as the detective considered this revelation.
“Khun Wiriya?”
“Yes, I’m sorry. I was just thinking about what this new information means.” He sighed. “I’m not sure. I suspect it means… something.”
Murder at the House of Rooster Happiness Page 7
