Resistant

by Michael Palmer

  Even though Cap was on IV fluids and pressors to raise his blood pressure, it remained a disconcerting 85/55. Residual shock from blood loss into his thigh was a possibility, although there was no sign of continued bleeding. Internal hemorrhaging from a ruptured bowel or lacerated spleen remained lurking on Lou’s list of possibilities like an alligator in the marsh. Cap would need to be worked up carefully before being taken to the OR for repair of his shattered femur.

  In addition to his low pressure, Cap’s other vital signs were also shaky. His body temp was still ninety-four degrees Fahrenheit. Hopefully the hypothermia was due to exposure and not early shutdown of his kidneys or liver, or anything going on in the regulatory centers of his brain. Given his vitals, including a pulse rate hovering at 110, and a respiratory rate of twenty-four breaths a minute, Lou knew they had a long way to go before he’d take a relieved breath himself.

  He was just about to ask for an ETA, when the jagged cityscape of Atlanta appeared in the distance.

  “Almost there, pal,” he said, mustering just enough enthusiasm to get a thumbs-up sign from Cap.

  “What are they injecting into me?” Cap asked, his voice not much louder than the flap of a butterfly wing.

  “Morphine,” Lou replied, electing to ignore the fact that the question had been asked and answered before.

  “Ah, the good stuff. I thought so.”

  “You worried?”

  “You worked on my leg back there, doc. You tell me.”

  “Your blood pressure is still a little low, but you’re not getting that much morphine. I can ask to have you get a little more.”

  “Don’t worry, it won’t send me down the slippery slope.”

  Lou knew he and Cap were in complete agreement when it came to prescribed painkillers and other mood-altering drugs. Just because a person had been addicted to drugs or alcohol did not mean they were barred from receiving medically controlled pharmaceuticals, so long as the doctor who wrote the script, or ordered the meds in a hospital, was fully aware of their history.

  During a pickup touch football game five years into his recovery, Lou did a number on the cartilage and a ligament in his right knee that required extensive arthroscopy. He still clearly recalled the first days following his surgery: The instructions for the Percocet says one or two every four to six hours. Is this one pain I’m having, or a two?… It’s been three and a half hours. What if I take two now and wait an extra hour for the next dose?…

  Obsession.

  His dormant addiction was making him crazy. The pain of having the narcotics around quickly became worse than the pain in his knee. After a day and a half, he talked things over with Cap, then poured the pills in the toilet, and broke out the Tylenol and Motrin.

  Cap had been there for him throughout that struggle. Now, with their roles reversed, he would be there for the man for as long as he was needed. At the moment, though, Lou was worried a lot more about Cap’s sagging blood pressure then he was about reigniting Cap’s addiction.

  The chopper circled twice before making a feather-soft touchdown on the helipad atop a glass-and-steel sixteen-story building. The empty landing area, built in the shape of a cross, looked vast enough to accommodate four med flight helicopters. Within seconds of wheels down, a three-person team in aqua Arbor General scrubs began the unloading process. Lou exchanged hugs and handshakes with the crew from the North Georgia Air Rescue and caught up with Cap and the Arbor staff just as the doors to the express elevator opened. Cap and his splint made it inside by an inch.

  “There’s an ER team waiting for him,” the nurse said to Lou on their way down. “Everyone is ready.”

  Cap was slipping in and out of consciousness again. Surgery could not happen soon enough. Two minutes later they were headed down a long corridor, walking briskly under a phalanx of fluorescent lights. It had only been a few days since he was last in a hospital, but it felt much longer, and just the smell of the place filled him with relief. At times during the hours just past, Lou had serious doubts, but now he felt certain Cap Duncan was going to survive this ordeal.

  As if in warning against overconfidence, Cap’s respirations became shallower and slower.

  Come on, everyone … Come on!

  The scene as the electronic doors to the ER swung open was as familiar to Lou as his bedroom, only now he was on the fringes of the action looking in. He managed a thank-you to the team for their professionalism and kindness, just as nurses converged on the stretcher, and with quiet efficiency began the hookup to monitoring equipment, oxygen, and IV poles. Cap woke up moaning as four of them, using the sheet beneath him, transferred him to a bed with a stretcher lashed to the end of it to accommodate his splint.

  Good stuff.

  A stout, hard-looking ER nurse asked Lou to wait off to one side while the team went to work. It seemed as if everyone knew he was an ER doc, but how good an ER doc was anyone’s guess, and this wasn’t the time to find out. Clearly, Floyd Weems’s clothes did nothing to enhance their confidence in him.

  He thought through how the team at Eisenhower would handle things if he were in charge. He’d order labs including a six-unit crossmatch, recheck Cap’s vitals and, ready to intubate him if his respiratory rate fell, administer enough pain medication to perform a decent exam before positioning him for x-rays. Arbor General was a top-notch academic hospital, and everyone here was speaking the same language as at Eisenhower—the language of competence and caring.

  On a scale of ten, activity in the massive ER seemed to be perking along at about a four. Lou had heard enough to know that the place was abuzz over the ingenious in-field reduction of Cap’s compound fracture, and the fact that the patient himself had assisted in the procedure. Soon the hospital grapevine, assuming it was as efficient as the supersonic one at Eisenhower, would have carried the news to the remotest corners of the place.

  Lou waited until the initial commotion had settled down, and moved over to the doc in charge, a handsome, broad-shouldered man with a Hollywood jaw and coppery skin, who looked as if his teenage years were not that far behind him. They moved out to the hallway, exchanged introductions, and agreed to use first names. Cap’s life was, for the moment, in the hands of Dr. Hal Garvey and his staff.

  If Lou’s unusual attire registered, Hal Garvey didn’t show it. There wasn’t much any ER doc or nurse hadn’t seen in one form or another.

  “You look like you could use some medical attention, yourself,” Garvey said, pointing to the gouge running down the side of Lou’s bruised and dirty face.

  “I’m okay,” he said. “For the moment, all I’m worried about is my friend. His real name is Hank. Cap is something from his career as a prizefighter. Not many people call him anything other than that.”

  “Cap it is. I’ll tell the staff. I’m the chief resident down here. This is my fifth year counting a year of research. I don’t know if you’ve heard much about AGH, but this is a good place—the best in the South, we think. We’re going to take excellent care of your friend.”

  “That’s terrific to hear. I sensed good things as soon as we got here. Cap’s very special to a lot of people in D.C., including me. I’d do anything for him.”

  “From what I’ve heard, you were quite the miracle worker out in the woods.”

  “Believe it or not, Cap did a lot of the work. He actually was the one who reduced the fracture by pulling on a rope and pushing against a tree with his good leg. I just splinted the pieces in place.”

  “Impressive. Your friend sounds tough.”

  “No one who knows him thinks otherwise. Hal, I don’t want to sound pushy, but I want him to have the best orthopedist in the hospital. Can you help me out there?”

  Garvey checked his smartphone.

  “Ortho is possibly the strongest department in this hospital. They have a rotation for handling referrals from us, but if a patient requests a specific surgeon, I can call and see if they’re available. Dr. Lichter would be scheduled to take this case. He’s
more than competent. Trust me, Cap will be well cared for on every level—especially when word gets around that he reduced his own compound fracture. A little like that guy who cut off his own arm to free himself in that canyon in Utah. Listen, let me finish going over him, and I’ll put a call into Dr. Lichter. Why don’t you wait in the doctor’s lounge down that hall on the left. There’s a restroom with a shower in it where you can get cleaned up. And also some scrubs. I’ll come and get you when we’ve got a plan in place.”

  They shook hands and headed in opposite directions, Garvey back into Cap’s room and Lou to the doctor’s lounge.

  Before he reached the corridor, Lou heard a soft, somewhat distorted voice say, “I wouldn’t let Lichter do the surgery.”

  CHAPTER 16

  Great change is brought about not by desire, but by perseverance. Where once there lay an empty parcel of land, you see now a city, built brick by brick by the steady hands representative of determined wills.

  —LANCASTER R. HILL, 100 Neighbors, SAWYER RIVER BOOKS, 1939, P. 6

  Lou turned to locate the source of the voice and needed a moment to realize the speaker was below his eye level, a frail, tousled, bespectacled man, nearly lost behind the complex console of his motorized wheelchair. It didn’t take a diagnostic wizard to see that he had severe spastic cerebral palsy.

  “I’m sorry,” Lou said. “What did you say?”

  “Don’t be sorry,” the man replied, enunciating as deliberately as he was able. “Lots of people ask me to repeat myself. Others should, but don’t. The truth is, most people can’t be bothered. Sorting out what I’m saying is simply too much work for them. Long sentences can be tiring for me, too. Sometimes leave out words that aren’t important. Sometimes use screen and joystick.”

  His speech was articulated with effort, and some words were distorted by involuntary grimacing and grunting. But in general, his physical limitations were more prominent than those affecting talking. The man was probably around forty, and his disability was impressive—spastic quadriplegia, one of the most disabling manifestations of CP. His facial muscles and limbs were in nearly constant motion, and his lips were often distorted. Straps on his wrists helped keep his limbs in proper alignment.

  Lou had the impression he had never walked, and at the very least, had help dressing and undressing himself each day. But despite his condition, he was able to manipulate a very complex wheelchair console, and to make his speech legible by shortening his sentences if his listener was willing to make the effort to concentrate. Perhaps his most appealing feature, though by no means his only one, were his dark brown eyes—wide and intelligent, even behind the thick lenses of his tortoiseshell glasses.

  Lou’s experiences with CP were largely limited to a girl in his high school and to patients in the ER. But over the last decade, he felt connected to those people on a very special level—one that unfortunately not all physicians shared. Based solely on outward appearances—poor motor control and thick, difficult speech—too many doctors assumed that CP was a global neurologic disorder affecting not only movement and speech, but intellect as well. In truth, with exceptions, a CP person’s intelligence was fully engaged.

  Lou was sensitive to any form of generalization or stereotyping—especially medical stereotyping. As a doctor who had past troubles with drugs and alcohol, he had encountered too many colleagues who judged his condition to be a moral deficiency, or who lumped him in with others afflicted with his disease.

  The wiry man in the wheelchair appeared simply to be hanging around the ER, and nobody working there seemed to care. It was Lou’s nature to listen to people—especially those with information that might be useful to him. He pulled over a chair so they could be at the same level.

  “You said Dr. Lichter is not the right doctor for Cap?”

  “That’s what I said,” the man replied.

  “How’d you hear our conversation anyway? You were at least fifteen feet away from us and we weren’t speaking that loudly.”

  The man pointed to a tiny microphone affixed to his wheelchair and then to the small plastic hearing aid in his right ear.

  “As if CP wasn’t enough, also a little hard of hearing. Don’t want pick up other’s conversations, but it’s that or miss a lot. Name’s Miller. Humphrey Miller.”

  “Nice to meet you, Humphrey Miller. Do you work here?”

  “I do. Pharmacy tech ten years. Pharmacists fill rolling cart and attach to front of chair. I transport to floors. Just brought white coat laundry. Spares at my apartment. Often here after my shift when there’s action.”

  “I certainly guess you could call this action.”

  “Hospital buzzing ’bout you and friend even before you landed.”

  “I’m Lou Welcome, an ER doc from Washington, D.C.” They shook hands, albeit with some difficulty. “Humphrey’s not a very common name.”

  “Neither is Welcome.”

  “I have a feeling someone in my lineage—maybe someone with a sense of humor—changed it from something else somewhere along the line. My father doesn’t seem to want to tell me who, or else maybe he doesn’t know.”

  “As might guess, mom huge Bogart fan. Naming me Humphrey in addition to my CP was double-whammy.”

  Even with his shorthand speech, it took Humphrey most of a minute to get some sentences out.

  “Let’s hear it for parents,” Lou said, immediately drawn to the man.

  “You didn’t fidget,” Humphrey said.

  “Excuse me?”

  “Usually when I talk any length of time, people fidget or stare off into space. You didn’t do either.”

  “That’s because you do require some concentration,” Lou said with a chuckle, “and I never fidget when I’m concentrating.”

  Humphrey’s bass laugh at his own expense was joyous, and fun to watch. He was the school nerd all grown up. His ears were large for his head, but somehow fit his personality, as if anything smaller would be a disservice to his character.

  “So, what’s this about Lichter?” Lou asked.

  “You seem like nice guy. Here’s tip. Don’t let Ed Lichter do operation.”

  “Why not?”

  “Lichter decent enough but not best we have. Loses interest after case is done. Turns things over to residents soon as can.”

  “Go on, but please forgive me in advance if I ask you to repeat.”

  “Sure. If complications, Dr. Len Standish follows up better. Man is wizard. Did my ankles to stabilize them.”

  Lou quickly pushed back and stood up, anxious to return to Garvey.

  “I believe you, Humphrey,” he said, “and I thank you. I owe you lunch.”

  “I heard compound femur fracture. You may be around awhile.”

  “I’ll be around as long as my friend needs me. First, though, I’ve got to go and get him assigned to Dr. Standish.”

  “Won’t be disappointed. I’m here. Let know how make out.”

  “Promise.”

  “Then decide dinner. Maybe later tonight. But forget lunch. That time passed hours ago.”

  Lou felt his throat tighten. He checked the time and pounded his forehead with the heel of his palm. It was five in the afternoon.

  He had missed giving Filstrup’s speech by two hours.

  CHAPTER 17

  Until such time when government entitlements threaten our liberty and the pioneering spirit of our founding fathers, the Neighbors shall hide in plain sight and will be in appearance what their name suggests: neighborly. Each Neighbor shall remain committed to the overriding ideals of blending in with their community and enjoying the fruits of life, while sharing in the glory of God.

  —LANCASTER R. HILL, 100 Neighbors, SAWYER RIVER BOOKS, 1939, PP. 10–11

  Cap was awake and actually watching television when Lou entered his hospital room bearing a large box of chocolates, a paperback thriller, and a couple of glossy magazines. He immediately brightened.

  “Hey, buddy,” Cap said, “long time no see.”
>
  “Yeah, like two hours ago while they were getting ready to discharge you from the recovery room. I hope those drugs are feeling as good as they’re acting.”

  “Man, I get so out of it from them, Stevie Wonder could be singing at the foot of my bed and I wouldn’t remember. How you doing?”

  “Let’s just say if we were allowed to trade in days, I would have done it for the last couple.”

  “Same here, amigo. Don’t know if I ever properly thanked you for what you did for me out in the woods. That was a pretty dumb, clumsy thing for me to do.”

  Lou made a face suggesting that the mea culpa was totally inappropriate.

  Cap’s airy room, on the eighth floor, was a double, but at least for the moment he was without a roommate. His bed was the one by the window.

  “The docs said the surgery was a big success,” Lou said, setting down the stuff he had brought.

  Cap’s face was puffy from all the fluids he’d been given. He gestured at his elevated leg, suspended above his bed by an elaborate contraption of ropes and pulleys, and held in place by a steel external fixation frame.

  “Guess I’m going to have to take a pass on trail running for a little while,” he said.

  “Day at a time, bro. Now, who could have taught me that?”

  Most of the pins, plates, and screws Leonard Standish inserted into Cap’s leg to hold the fragments of bone aligned were now a permanent part of his anatomy. A test for the TSA people at the airports.

  Even though the surgery was a success, the risk of problems post-op remained high. There were those who believed that simply being a hospitalized patient, especially one needing assistance for almost everything, carried a serious risk of complications. In addition, blood clots from immobilization were a constant danger, and the hardware penetrating skin and bone were an invitation to infection. This was going to be a long, long haul. But Lou was determined to be there for the man every step of the way.