Flashback

by Michael Palmer

The security guards will know exactly how to handle things if you show up there. And now, little brother, how about either you leave or I remind you of how much hurt you ended up with every time we fought behind the barn. I probably would enjoy that almost as much as I've enjoyed firing you… You take care, now. Y'hear?

  " Numbly, Zack wandered from his brother's office and through the busy corridors of the hospital. The polished linoleum, the tile, the nurses bustling from one patient to the next in their starched whites, the framed prints in every room-how clean it all appeared on the surface, how perfect. The set of a movie. Zack smiled grimly at the thought.

  Davis Regional had become a gleaming, movie-set hospital-Hollywood veneer with no soul. It was a nightmare. And now, a nightmare he could do no more than walk away from. He drifted into the intensive care unit.

  Suzanne, wearing surgical scrubs beneath her lab coat, was in Toby's cubicle, moving about the heavily bandaged child in a way that could only mean trouble. At the foot of the bed, Owen Walsh, the pediatrician, watched, his perpetually cheerful expression darkened by concern. "Hi," she said, glancing over only momentarily. "Glad you could make it."

  She studied the monitor, and then emptied the contents of a syringe into Toby's IV line. "Problems? " Zack asked. Having just been fired from the staff, he found himself strangely reluctant to approach the bedside.

  "These last sixteen hours have been like a crash refresher course for me in pediatric pharmacology, " she said without looking up. "Every time his temp goes up, his rhythm goes crazy. What we're doing here amounts to nothing more than a holding action. I sure wish we knew what was going on."

  I do know, he wanted to say. Instead, he forced himself to the head of the bed, where he made a quick check of Toby's pupils, eye grounds, and reflexes. While there was still no definite evidence of irreversible damage, there was certainly no sign of improvement. "We've got the promise of a bed for him in Boston, " Owen Walsh said. "But they can't transfer him until late this afternoon or this evening."

  Take him away from this place, away from Jack Pearl, and you take him away from his only chance. Again, Zack's thought went unspoken.

  "Anything I can do in the meantime? " he asked. "You can review the steroids he's getting." Suzanne checked the temperature reading from the rectal probe. "Back down to one-oh-two. And look, Zack-his rhythm's stable again. Damn, what's going on?"

  "If you're able to leave, " he said, "I'd like to talk to you for a minute."

  Suzanne checked the monitor and Toby's chest, and then glanced over at Walsh. "Just don't go too far, " the pediatrician said. "We'll be right outside in the waiting room, Owen, " she replied. "Besides, you're doing fine here."

  Walsh smiled. "She saves this child's life at least five times in one night, and she says I'm doing fine."

  "Nonsense. I'll be back in a little bit. Hang in there."

  As soon as the door to the ICU waiting room clicked shut, Suzanne threw her arms about Zack's chest and buried her head against his shoulder. "I knew you'd come back, " she said. "I'm so damn proud of you of both of us. Listen, as soon as we get Toby off to Boston, let's go to my place for dinner. Helene's going to take Jen for the night, and I have a batch of shrimp in the fridge and-"

  "Suzanne-"

  "No, listen, it's my guilt for acting the way I did in the E. R. last night, and only shrimp sauteed in garlic butter will-" He held her by the shoulders and moved her away. "Suzanne, Frank just fired me."

  "He what?"

  "Effective immediately."

  "He can't do that."

  "Can and did. He even was kind enough to present me with a set of the corporate laws to prove he can."

  He held up the book for her to see. Only then did he realize how totally drained she looked. Her face was pale and drawn, her eyes reddened with strain and fatigue. "This is crazy, " she said. "What reason did he give?"

  "Actually, according to page seven here, he doesn't need a reason. But just to be fair, he provided a couple, being drunk while on call technically, I was, you see-being a disruptive influence. Hell, I can't even remember everything he said. Listen, you look really wasted. Why don't you find an empty bed and crash for an hour or two? I'll watch Toby. Frank won't even know I'm in the hospital. And even if he finds out, he won't do anything about it. Owen's too panicked about being left alone to allow that. We'll talk later, after we get the child to Boston."

  "No, Zack. I'm fine. Really." she said. "But Zack, we can't let him do this,"

  "You don't understand. This isn't a hospital the way we were trained to know one. It's a merchandise mart that hires doctors and nurses and technicians. And Frank is the president to that company-at least here in Sterling he is. He hires, and he can fire. Except with someone like Guy Beaulieu. In Guy's case, Frank didn't want the hassle Beaulieu was threatening him with, so be just took the route of destroying the man by rumor and innuendo. He admitted being responsible for all of that." 66 TO you?"

  "He had already fired me. What did he have to be afraid of? He was actually boasting when he told me."

  Suzanne sank onto the sofa. "Oh, Zack, " was all she could manage.

  "Listen, Suze, this is my problem, and I'll work it out."

  "No, " she said suddenly' whatt' "No, it,s not your problem-at least not yours alone. It's all of ours. The medical staff, I mean. We're going to fight this."

  "Suzanne, I don't want anyone else getting hurt because-"

  "No,)isten to me. For years now, at least as long as I've been here, the doctors in this hospital have been acting like… like ostriches.

  This isn't the first time there's been a problem between Frank or Don Norman and staff doctors, Zack. It isn't the first time one of us has clashed with the system here and then suddenly found himself out. Don't you remember what Wil Marshfield said that first night? And I've been as much of an ostrich as anyone-so grateful for getting out of the trouble I was in that I've turned my back on any number of company decisions that might not have been in the best interests of our patients. I didn't feel committed enough to any one issue to make waves. But dammit, I feel committed now."

  "Suzanne, I don't want you-"

  "Please. You had the guts to come back and face the music. And now, dammit, I'm going to see to it that the medical staff gets behind you.

  It's time we stood up for this community-time that we stood up for our own… She rose and took his hands. "Zack, hang in here. Please. Do it for all of us. If I can just get us to present a unified front, I'm sure the medical staff can stand up to the coq@oration. And if we can't get Ultramed to listen, then… then we'll just take our case to the community."

  "You think you could pull that off? " he asked. "I'm tougher than I look." He touched her cheek. "That's not saying much, you know."

  "Well, you just watch. Can you stand the heat? "

  "Suzanne, I don't want to leave here. I don't want to leave you."

  "Okay, then. It's decided. As soon as I finish with my office appointments, I'm going to start twisting some arms."

  "It's not going to be easy."

  She kissed him lightly. "It's not going to be as hard as you think.

  Listen, I ought to get back in there. What are you going to do right now?"

  "I think I'm going to try and get in to see my father.

  He refused to see me earlier, but I think it's worth one more try.

  I was planning on putting in an appearance at that board meeting later today, but Frank has promised to have the hospital security people ready for me if I do."

  "Damn him. Zack, I think your brother and I are about due for a little meeting of the minds."

  "You would do that?"

  "Would and will. I have too many friends around here, and make too much money for this place for him not to listen to me. You must be strong..

  .. God, Zachary, it feels so good to realize that all of a sudden I'm not afraid anymore."

  "You were afraid of the corporation?"

  "No, " she said, kissing him
once again. "Of you."

  Brief operative note (full note dictated),… Four-inch gash over T-10, 11, and 12 debrided… hemostasis attained… wound explored…

  Jagged five centimeter by three centimeter piece of rusty metal removed without difficulty… dura appears intact… No collection of blood noted… Wound irrigated copiously, and then closed with drain in place … Patient sent to recovery room in stable condition, still unable to move either lower extremity… Tetanus and antibiotic prophylaxis initiated… Preoperative impression, foreign body, low midback, postoperative impression, same, plus paraplegia-etiology uncertain, possibly secondary to spinal cord disruption or circulatory embarrassment… Seated to one side of the nurses' station, Zack read and reread the account of his father's surgery, and confirmed through John Burris's terse progress note and two much more detailed nurse's notes, that there had been little change in the Judge's condition since his surgery. Dura intact… No collection of blood… Zack chewed on the nub of his pen as he stared out the window at the Presidential Range. Something was off. The Judge's symptoms seemed out of proportion to the extent of his injury-way out of proportion. The pieces of this clinical puzzle simply weren't locking together. Sheering forces snapping fibers in the cord, arterial spasm with enough interruption of blood supply to cause nerve damage-there were a number of logical explanations for the Judge's paraplegia, but none of them sat just right. At one end of the Formica counter, a small plastic tray was piled high with pens and pencils, as well as a stethoscope and several other pieces of medical equipment. Zack slipped an opbthalmoseope, reflex hammer, and straight pin into his pocket and headed for his father's room. It wasn't that he was questioning Burris's findings and opinion, he rationalized, it was just that… that a physician was taught never to completely trust anyone's findings or conclusions other than his own, Now, if he could only get the Judge to allow him close enough to do an exam… Cinnie Iverson was seated on a low, hard-backed chair id the hallway outside of her husband's room. She was, as always, dressed immaculately-this day in a plain blue dress, with a white cardigan draped over her shoulders. Lipstick and an ample amount of rouge failed to completely obscure her pallor. Her ever-present lace handleerchief was balled in one fist. "Hello, Mom, " Zack said as he approached, She stood, and allowed him to kiss her on the cheek. Her expression was cool, but not angry, which was to say, as disapproving as Zack had ever known it to be. "How's he doing? " he asked. "The nurse is giving him a bed bath."

  "Any change?"

  Cinnie Iverson bit at her lower lip and shook her head. "Mom, I… I'm sorry this has happened. You can't know how terrible I feel."

  "I'm sure you do, " she said quietly. "We all do. She hesitated, then went on. "Zachary, I'm quite sure that in time I'll see things more charitably, but right now, with the Judge lying in there like that, you'll have to forgive me if-"

  "I understand," he said. "All I want you to know is the same thing I came up here to tell him, and that is that I was only trying to do what I thought was right."

  "I believe that. I don't think he'll speak with you, though, " she added. "He's very upset-at everybody. And he's very depressed."

  "He doesn't have to speak, Mom. He just has to listen. Who sent the flowers?"

  He motioned toward an enormous vase of lilies, orchids, and birds of paradise that he estimated must have cost one hundred fifty dollars — probably even more. "It just arrived from Frank, " she said. "Whether you know it or not, you owe your brother quite a thank-you. He was very helpful in keeping us all under control last night. Very helpful."

  "I'll… I'll thank him just as soon as I can, Mom."

  "I just don't know what we would have done without him."

  She dabbed her handleerchief at the corner of one eye. "I understand,"

  Zack said, fighting off a wave of rage. "I only wish Lisette were around. At least then I'd know he was getting a decent meal once in a while."

  "He told you about Lisette?"

  "He told me she and the girls are in Virginia visiting an old friend of hers, if that's what you mean."

  "Sure, Mom, " Zack said through nearly clenched teeth. "That's what I meant."

  At that moment, the private duty nurse, an expansive woman with pendulous upper arms and thick ankles, wheeled her cart from the room.

  "He's all set, dear, " she said. "Sorry to take so long, but that husband of yours is a big man…" She eyed Zack warily. "Still no visitors, Doctor, " she said. "I'm sorry."

  "Mom, I need to go in to talk to the Judge."

  Cinnie took a moment to size up the exchange. "It's okay, Mrs. Caulkins,

  " she said. "I'll take care of things here. You go do whatever it is you have to." She waited until the woman had gone. "Zachary, I'll ask your father if your visit would be okay, but I don't expect him to say yes."

  "Mom, it's important-very important that I speak with him."

  She hesitated. "Mom, please "You won't say anything to upset him? "

  "Promise."

  "Well, then, I suppose you should be allowed to go in there and say your piece."

  "Mom, thank you."

  "Arid Zachary? " She continued to work her handleerchief over and over in her hands. "I know you didn't mean things to turn out this way."

  "That's right, Mom," he said, knowing that she would miss the understatement-the sad irony id his voice. "I certainly didn't."

  Muted sunlight, filtering through the nearly closed blinds, provided the only illumination in the room. The Judge, wearing a blue hospital Johnny, Jay on his back, staring at the ceiling. An intravenous line was draining into one arm. "Hello! Judge, " Zack said. Clayton Iverson glanced over at him, and then looked away. "Are you in much pain?"

  There was no response. "Judge, it won't hurt to talk to me. Believe me, it won't… Okay, okay, suit yourself."

  It might have been a mistake to have come. Zack could see that now.

  Merely going against the man's wishes was enough to warrant the silent treatment, let alone going against his wishes and achieving such disastrous results. He reminded himself that the Judge could be as petulant and inflexible as Frank. Zack turned to go, but then he stopped. There were things he had to get out-if not for his father, then for himself. "Okay, Judge, you don't have to say a word. I won't stay long. I just wanted to tell you that I feel very badly for the way things have turned out. I was only doing what I spent so many years training to do-using my judgment, and trying to do my best."

  He pulled a chair over as he spoke, and sat down by his father's hand.

  The Judge continued to stare at the ceiling. "Judgment, Dad… that's what you have to rely on, too, now that I think about it. Maybe in time, that will help you understand the dilemma I was in… "Judge, you're my father. I love you for that-for the things you've done for me, for the kind of person you've helped me become. I would never want to see you hurt. Never. I honestly believe that I would give up my life, if necessary, to protect you. But that's my life… "Anyhow, I guess what I really want you to know is that although I'm sorry as hell for the way everything turned out, given the information I had to work with last night, if the same situation arose again, I would make the same choices.

  That's the sort of person my parents raised me to be, and the sort of surgeon I was trained to be. I came up here to ask for understanding, not absolution."

  He paused, hoping for some sort of reply. There was none. In that moment, he decided to say nothing of what had transpired with Frank.

  Soon, the Judge would learn it all anyhow, but this was not the time to attack the man's myth of his quarterback son. "Well, then, " he said. "I guess that's that." He rose. "Oh, except for one other thing. I'm going to that meeting today to present Guy's case to the board. I don't expect to sway many votes, but I think Guy was right. I think we need to take a hard look at what we're willing to give up in exchange for a few shiny pieces of equipment and some black ink on the bottom line. So if you could just talk to me enough to tell me where that folder of his i
s, I'll-"

  "It's gone, " Clayton Iverson said flatly, still not looking at his son.

  "What!"

  "I said the folder is gone. I… I gave it to the Ultramed people to examine. They have it. Now please, go."

  Zack sighed. "You certainly underwent one heck of a change of heart there, Dad, " he said. "I asked you to leave."

  "I'm going. I'm going."

  As he turned, Zack's hand brushed against the instruments in his pocket.

  He hesitated, took several steps toward the door, and then turned back.

  "Judge, I know you want me out of here, " he said, "but… but I'd like to examine a couple of things on you if I could before I go."

  Tentatively, he returned to the bedside, waiting for the man's outburst.

  There was none. He lifted the sheet off his father's legs. "Thank you, Dad, " he whispered, gauging the muscle tone of one calf with his fingertips. "Thank you for trusting me this much. This will only take a minute."

  In fact, Zack's examination, carried out mostly with his touch and reflex hammer, took just over five minutes. Clayton Iverson watched him work in stony silence, although there was a spark of curiosity in his eyes. By the time Zack had finished, by the time he had dropped down on a corner of the bed, shaken and mentally drained, the loose-fitting pieces of the clinical puzzle had been pulled apart and rearranged in the strangest of patterns. "Mom, can you come in here, please?" he called out, after he had regained some composure. "There's something I want both of you to hear together."

  Cinnie Iverson entered, took the chair next to the Judge, and held his hand. Zack paced from one side of the room to the other, choosing each word carefully, suddenly frightened that the tendon and muscle activity he had detected were not true neurologic indicators at all, but rather the phantoms of his own hopes. "Judge, Mom, " he began, "have either of you ever heard of a conversion reaction?"

  Cinnie Iverson shook her head. Clayton did not move. "An older term for it was conversion hysteria, but I never liked that phrase, because hysteria implies craziness, and a conversion reaction is much more an intense, involuntary focusing of emotional energy than it is a sign of anything crazy."