Flashback (1988)

by Palmer, Michael

  “No way,” Pearl said.

  Suzanne joined the two other physicians at the bedside. For more than an hour she had been battling one flurry of irregular cardiac rhythms after another in the boy. Now, for the moment at least, the situation seemed to have stabilized, but the dusky shadows enveloping her eyes were mute testimony to the tension of the struggle.

  “So, where do we stand?” she asked, sipping tepid coffee.

  Throughout the crisis she had made no overt reference to Zack’s theories regarding Mainwaring and Pearl, although several times her expression had warned—or begged—him against any confrontation with the anesthesiologist.

  “Well,” Zack said, “we’re right where we were before the arrhythmias started. Cerebral edema. Nothing more. Could be caused by the fever; could be the cause of it; could be both.”

  “Well, for what it’s worth, his arrhythmias seem to be under control.”

  “It’s worth plenty. Nice going.”

  “Thanks. So, have you two decided? Are you going to put the boy back to sleep?”

  The two men exchanged glances. Then Pearl looked away.

  “Well, Jack,” Zack said, “go ahead and tell her. Tell her what we—tell her what you have decided. Look down at that child there, think about what I’ve told you, what I’ve shown you, and tell her.”

  “Zack, please,” Suzanne said. She turned to the anesthesiologist.

  “Sorry,” he mumbled.

  “Jack?” she asked.

  “I refuse to do it,” Pearl said simply. “The evidence that this child’s anesthesia had anything to do with his present condition is flimsy enough by itself. Used as justification for a highly questionable maneuver, such as Iverson here is proposing, is absurd. I positively refuse to do it.”

  “Do what?”

  Frank Iverson appeared near the foot of the bed. He glanced from one physician to the next and then, with some discomfort, at the thrashing boy.

  “Do what, Jack?” he asked again.

  “Frank,” Pearl said, “earlier in the week I filed an official report and complaint about a visit I had from your brother, here. At that time, he accused me of any number of things, including improperly anesthetizing this child.”

  “Why, that’s ridiculous,” Zack said. “I never—”

  “Zack, will you please let him finish.… Thank you. Go ahead, Jack.”

  “Well, now the boy’s got cerebral edema that’s brain swelling—from God knows what. Maybe some form of encephalitis or something. Your brother has this theory that if this is some nervous system reaction to the anesthesia he received, my putting him under again with the same drugs might reverse the effect.”

  “And?” Frank said.

  “And I won’t do it.”

  “Why?”

  “Why?! Well, because it … it won’t work, Frank. That’s why.”

  “Zack, has this been done before?”

  “In analogous circumstances, yes. I brought in an article describing the theory behind it.”

  “Then, Jack,” Frank said calmly, “what harm would it do to put this boy to sleep again as Zack is suggesting? You put critically injured and ill patients under all the time, don’t you?”

  “Well yes, but—”

  “Suzanne, do you think this child would be able to handle being put to sleep?”

  “I … well, his cardiac problems seem to have quieted down, and he is already on a ventilator, so actually, I don’t see why not.”

  “But—”

  “No buts, Jack. I’m sorry I didn’t get over here sooner to discuss all this, but I was tied up trying to reach some people in Akron. Now listen. We’re in the business of helping people. That’s why we’re here. If there’s a chance that what Zack is suggesting will help this kid, I think you should try it. My brothers a pain in the neck sometimes, but he’s hardly foolhardy. If he says he has evidence, then by God, he’s got evidence.”

  Witnessing the bizarre exchange from his spot by the head of Toby’s bed, Zack sensed an intense nonverbal interplay occurring between his brother and the anesthesiologist. He could also tell from Pearl’s expression that the strange little man was no longer going to object to administering the drugs.

  “What were the anesthetics again?” Suzanne asked.

  “Pentothal and isoflurane,” Pearl said.

  “Ah, yes.”

  “Are you going to do it?” Zack asked.

  “How long do you think we’ll have to keep him under?”

  “Eight minutes. That’s how long they did it in the article.”

  Pearl glanced once again at Frank.

  “Okay,” he said unenthusiastically. “Give me a couple of minutes to get my equipment together.”

  “Good. I’ll try and get this place set up.” Zack leveled his gaze at the man. “Jack, whatever the kid got for that hernia of his, that’s what he should get now. Understand?”

  “He got Pentothal and isoflurane,” Pearl responded with exaggerated firmness. “Now, are we going to do this or not?”

  “Suzanne?”

  “No objections,” she said.

  “Okay, then. Let’s go for it,” Zack said.

  The eerie scene was one that nobody in the ICU that night would ever forget. Throughout the unit, all unnecessary lights were extinguished and every noncritica] piece of equipment that produced a noise or vibration was shut off. Nurses sat silently and grimly beside their patients or by the nurses’ station.

  In cubicle 7, the only lights were flashes of Zack’s and Jack Pearls small penlights and the shimmering monitor readouts of Toby Nelms’s cardiac pattern and blood pressure.

  Toby himself, anesthetized first with Pentothal, and now with the gas, isoflurane, lay motionless and peaceful, his eyes patched and taped shut, his ears plugged with oil-soaked cotton and covered with bandages. His feet were encased in lamb’s wool. Two thin cotton blankets covered him on top, and the water-filled cooling blanket lay underneath him.

  Zack had checked both the new, unopened vial of Pentothal and the label on the isoflurane tank before okaying their administration. Now, watch in hand, he sat to one side of the darkened cubicle, waiting. Jack Pearl’s willingness to administer the two anesthetics had dispelled some of his suspicions regarding an experimental drug, but doubt remained.

  And even if this treatment was the right one, even if the anesthetics were correct, even if Jack Pearl was as pure and honorable a physician as Galen, Zack knew they might have waited too long. Cerebral edema was, all too often, a one-way street.

  Five minutes, six … the time seemed endless.… Blood pressure, ninety and holding; pulse 120 … Seven minutes.

  Zack watched the last thirty seconds tick off, glancing over briefly at Suzanne, whose attention was riveted on the monitor screen.

  “Okay, Jack,” he said. “That’s it. Eight minutes.”

  He threw back the draperies to the room and motioned the nurse back in.

  Her first move was to reinsert the rectal probe attached to the cooling blanket console.

  “It’s 103,” she said.

  Slowly, Toby began to stir, as concentrated oxygen washed the isoflurane from his lungs and bloodstream. Zack bent over him and checked his pupils. They were, if anything, more sluggishly reactive than before. Otherwise, a top-to-bottom neurologic exam showed no change.

  “Anything?” Suzanne asked.

  “Nothing.”

  Zack left the cubicle and circled the counter to where she was stationed.

  “Satisfied?” she whispered.

  “Not really, but I guess there’s nothing more I can do.”

  Across from them, Jack Pearl had removed Toby’s eye patches and was conducting his own exam.

  “I really appreciated your restraint in dealing with Jack.”

  “It wasn’t easy.”

  “I could tell.”

  “You still don’t believe me about all this, do you?”

  She shook her head.

  “As I said in your office,
” she whispered, glancing first at the monitor and then at Pearl, “one other case, and I’ll at least listen.”

  “I’m going to find it.”

  “You know, you are without a doubt the most headstrong man I’ve ever met.”

  “I’m the most headstrong man I’ve ever met,” he said. “It’s my finest attribute.”

  She looked at him coolly.

  “Well, Zachary, that may be. But unfortunately, it’s also your most frightening one.”

  She brushed past him and joined Pearl at the bedside.

  Zack stood alone at the nurses’ station, fighting the hollow-ness in his chest, trying to cling to the notion that for the moment, at least, he had done all he could for Toby Nelms—he had done his best.

  “Dr. Iverson,” the ward clerk called to him from her desk. “The call on line two is for you. It’s Mr. Iverson.”

  “Zack,” Frank said breathlessly, “I’m down in the E.R. We’ve got trouble. Maybe big trouble.”

  “What?”

  “Auto accident. Two cars. Both drivers injured.” “Bad?”

  “Dunno about one of them—apparently they’re still trying to cut him out of his pickup. Marshfield’s in with the other one right now.”

  “Let me just wash my face and I’ll be right down.”

  “Make it quick, Zack. The guy Marshfield’s working on is the Judge.”

  27

  The emergency ward was bedlam. Nearly every bed was full, as was the waiting room. Nurses, some of whom Zack recognized as having been called down from the floors, were hurrying between patients, the med locker, and the supply room. EKG and portable X-ray technicians were standing by their equipment in the hallway. Several blue-clad rescue team members were assisting the nurses while several more sat perched on countertops filling out forms.

  Two of the rooms seemed to be the foci of most of the activity.

  “The Judge is over there, in eight,” Frank said as he and Zack crossed the lobby.

  “What in the hell was he doing driving around at this hour without Mom, anyhow?”

  “I don’t know, Zack. You can ask him. He’s all bandaged and splinted up, but he’s perfectly with it. He must be. He’s already told me that if we couldn’t get a hold of his-son-the-neurosurgeon, he wanted to be transferred to another hospital.”

  “Frank, it’s okay not to be snide right now, all right? Who’s with him?”

  “Not sure. Marshfield was, but I see him over there in trauma. The other guy from the accident has just been brought in.

  “Well, do you want to call Mom now, or wait until we know what’s going on?”

  “The later the better as far as I’m concerned.”

  “Okay. Well, maybe you can call Lisette and have her go over and get her.”

  “Lisette’s … gone.”

  Zack checked his watch.

  “Well, when will she be back?”

  “No,” Frank said. “She’s gone, as in: gone. It’s a temporary thing. Listen, you go ahead in with the Judge. I’ll take care of Mom.… And Zack?”

  “Yes?”

  “Too bad things aren’t working out for that kid.”

  Without waiting for a response, Frank turned and crossed the emergency ward to where two uniformed troopers were speaking with a reporter from the White Mountains Gazette.

  “Yeah, Frank,” Zack muttered, flashing briefly on the bizarre, sub rosa interplay between his brother and Jack Pearl. “Too bad.”

  He was heading toward room 8 when the curtain drew back and the nurse, Doreen Lavalley, emerged.

  “Oh, Dr. Iverson, I’m glad you were able to get down here so quickly,” she said. “They called me down because I used to do E.R. work, but it’s been a few years and—”

  “I’m sure you’re doing great. What’s the story?”

  “Well, I’ve been in there since just after they brought your father in. The rescue people found him sitting propped against a tree about fifty feet from the crash. They suspect he was thrown out of the car and then walked or crawled over there. He almost certainly has a fractured wrist. The rescue people also report there’s a huge gash in his lower back, but nobody’s had the chance yet to move him off the board to check it. Dr. Marshfield had to go in with the fellow from the other car. From a distance, at least, that guy doesn’t look good at all.”

  Zack moved to a spot just outside the doorway to room 8. Through it, he could see his father, strapped to a transfer board, with his head and neck secured in excellent first aid fashion. One arm was wrapped and splinted, the other fitted just above the wrist with an IV line. A monitor was in place and chronicling a perfectly normal rate and rhythm.

  “Did Dr. Marshfield have the chance to get any films?”

  Doreen Lavalley consulted a scrap of paper.

  “He got a portable shoot-through of his neck and a view approximately over where that gash is. I had the lab draw a blood count and chemistries.”

  “Blood bank, too?”

  “Yes. I asked them to type him and crossmatch him for four units.”

  “Nice going, Doreen. I’m glad to see you’re still working here.”

  “Just one more week,” she said, somewhat sadly. “I’ve taken a job with the Visiting Nurse Association.”

  “Well, that’s going to be Davis’s loss.”

  “Thank you. I’ll miss this place. At least the way it used to be, I will. I’ll see if I can get those films.”

  If Clayton Iverson was relieved to see his son, he showed little evidence of it. Zack was not surprised. It had always been that way, and regardless of the circumstances, it would be that way this night.

  “H’lo, Judge.”

  Zack leaned against the bed rail, assessing his father—the slight pallor about his lips, the deepened creases at the corner of his eyes. The man was in some pain, and probably still bordering on shock. Reflexively, Zack reached across and increased the intravenous flow.

  “Zachary …” The Judge spoke through teeth nearly clenched by the bandages pulled tightly across his forehead and beneath his chin to stabilize his neck. “Do you think you could get rid of this damn stufi?”

  “As soon as I’ve seen the film of your neck, Judge. Apparently you weren’t all that coherent when the police arrived. You could have hurt your neck and not know it. You in much discomfort?”

  “Mostly my back—right through here.…” He motioned with his unsplinted hand at a spot just above his navel. “Does your mother know I’m here?”

  “Frank went to take care of diat.”

  “Have him tell her to wait at home, and that I’ll call her later.”

  “Judge, just relax and let us take care of things. Okay? Now, what happened?”

  “I don’t know. I was on my way over to … ah … to talk with Frank and Lisette about some investments they’re thinking of making. And just as I was passing by Cedar Street, boom. The next thing I really remember was the inside of the ambulance.”

  … to talk with Frank and Lisette? … Lisette’s gone Judge. Who’s lying? Frank to you or you to me?

  “Did you hit your head?”

  “Not that I know.”

  “Zack?” Suzanne stood by the doorway, the X rays in her hand. “I came down to see if I could be of any help. The nurse said she’d be next door if you need her.”

  “How’s the boy?”

  “Not awake at all, but still reasonably stable. Owen Walsh is trying to arrange a transfer, but I don’t think he’s been able to find a bed yet.”

  “Well, I’m glad you could get down. Have you seen the films?”

  It was only then that he noticed the tension in her face. Something was wrong in the X rays.

  “Flip ’em right up there,” he said, motioning her to the two view boxes on the wall beside the Judge’s litter.

  She illuminated the lateral shoot-through of the Judges neck. Zack counted to be certain that all seven cervical vertebrae were displayed, and then checked the alignment and spacing of each.


  “Normal,” he said. “Perfect. Looks like we’re in luck, Judge. We’ll get a complete set of films, just to be certain, but I suspect they’ll be fine. I don’t see any reason not to remove this harness they’ve rigged up.”

  He reached for the restraint.

  “Zack, you may want to wait on that,” Suzanne said, snapping the second film into place. “There was a load of scrap metal in the pickup. The police wonder if maybe he fell on something.”

  “What is that thing?” the Judge asked.

  Still constrained by the harness, he was forcing his eyes far to the left in order to see the X ray.

  “It’s a chunk of metal, Dad,” Zack said, studying the piece, which was stubby, wedge-shaped, and pointed on all three corners. The longest, sharpest point of the three was directly between two vertebrae, the twelfth dorsal and first lumbar. “A pretty big chunk, too. I’ll need a lateral view to know how deep it is. Are you having any numbness or tingling in your legs at all?”

  “I … I don’t think so.”

  “Well, just the same, I think I’ll leave you strapped in for now.”

  “If you have to. Am I going to be all right?”

  “Of course you are. But I’ll feel happier when we know exactly where that metal is and we’ve gotten someone to take it out.”

  “You’re not going to do it?”

  “Judge, first things first, okay? Suzanne, can you send in the portable unit for a lateral view? Meanwhile, I’ll go over the rest of him.”

  Suction, I need suction!” … “Doctor, do you want another line?” … “His pupils dilating” … “Christ, I asked for suction.…”

  The snatches of exchange between Wilton Marshfield and a nurse came from the trauma room.

  “… He’s vomiting again. Doctor, I think he’s seizing” … “Get me ten of Valium for an IV push” … “Did you know that Dr. Iverson is in with his lather?”

  “Sounds like trouble,” the Judge said. “Are you going in there?”

  “If they need me, they’ll come and get me,” Zack said. “I’m not leaving you alone. Suze, while you’re out there can you please check on what’s going on? If that’s the other driver from the accident, find out who he is.”

  Zack was completing a rapid exam when the curtain flew back and Frank entered.