"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 brother's 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 anesthe ics again? " Suzanne asked. "Peiitothal and isoflurane, " Pearl said. gil", 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 noncritical 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 Pearl's small penlights and the shimmering monitor readouts of Toby Nelms's cardiac pattern and blood pressure.
Toby himself, anesthe ized 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 anesthe ics 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 anesthe ics 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 hollowness 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."
CHAPTER NINETEEN
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 Lav
alley, emerged. "Oh, Dr. Iverson, I'tn 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. Marshfleld 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 stuff?"
"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 that."
"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 Judge's 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 pupil's 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 father?"
"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. "Oo-ee, what a zoo out there, " he said. "Police, reporters, the works. What gives here?"
"He's got a chunk of metal in his back-see? It looks like it shot in there during the crash, but maybe he fell on it or rolled over it. I won't know exactly where it is until I see some more views, but it obviously has to come out."
"Well, Judge, " Frank said, "even if it does, you got the better end of the deal in this one. "Ole Beau in there is a mess."
"Beau Robillard? " Zack and the Judge said the name in unison. "Yeah, didn't you know? Public nuisance number one is right in the next room.
That was his rust-bucket pickup you hit. If he's operating true to form, that scrap metal in the back of it was probably hot. Hey, Zack, remember how Robillard and his buddies used to follow you home after school and kick the daylights out of you?"
"Frank, that was junior high, for goodness sakes."
"He hasn't changed, " the Judge said. "I see him in my court every other week, it seems. He's as nasty as ever. Nastier. I should have put him away the last time I had the chance. Was there anyone in the truck with him?"
"Nope, " Frank answered. "The police say that while they were cutting him out of the cab he kept screaming that you ran the light at the bottom of the Mill Street hill."
"That's ridiculous."
At that moment, Suzanne reappeared at the doorway with the X-ray technician. "Zack, " she said, "Wilton asked if you could help him next door. The guy from the truck has a bad head injury. He's started seizing. His name's Robillard."
"Beau Robillard. We know. He used to beat me up in junior high."
"He's trash, " the Judg
e said. "Petty theft, assault, disturbing the peace. Zachary, I don't want you going in there."
"What?"
"You heard me. Tell Marshfield you're tied up in here and you can't help him."
"Judge, I can't do that. Zack paused, waiting for support for his position from Frank and Suzanne. There was none. "Listen, " he said finally, "I've got to go in and at least honor his request for help.
Besides, you need more X rays and maybe a CT scan, and… and the O. R. team's got to be mobilized. By the time all those studies are completed, I should be done in there, okay?"
"I already told you how I felt, " the Judge said. "Why are you asking if it's okay?"
"Zack, " Frank said, "let me talk to you outside for a minute."
"Okay, in just a second…" Zack felt shaken. "Please go ahead with a lateral of his thoraco-lumbar region and a shot of his wrist, " he said to the X-ray technician. "On second thought, why don't you forget the portable. Take him over and get a really good set of films. Suze, can you go with him?"
"Sure. Owen Walsh'il call me if anything develops in the unit."
"You might want to go over him for pre-op clearance. I don't think they've had time yet to get a full EKG."
"I'll take care of that."
"Also, find out who's on for orthopedics, if you can."
"Zachary, I meant what I said about Robillard, " the Judge said as Suzanne and the technician wheeled him from the room.
"I never meant anything more." Zack could only shake his head. "Hey, listen, " Frank said when the two of them were alone. "Just go in there and see Robillard, and do whatever you have to do. Leave the Judge to me."
"I know he's hurt and angry, Frank, but all the same, I can't believe he would talk like that. I just can't believe it."
"You've been away from here-away from the man-for a long time. Remember, buddy, we're not the only ones he keeps passing judgment on. Years and years of sentencing the same stiffs over and over again has done something to him. Listen, don't worry about him. I can handle things.
Just go on in there and play doctor."
"Did you call Mom? "
"I have one of the state troopers going to get her."
Flashback Page 30
