Silent Treatment

by Michael Palmer

  “Well, Miss”—he checked her name tag—“Jilson, I appreciate your bending the rules for me.”

  “Anytime. Your wife is very beautiful, Dr. Corbett.”

  “Yes … yes, thank you.” Harry hurried away from the woman and down the hall to room 928.

  “… so they’re just mean to me. Mean and nasty. They don’t like me because they think this goddamn floor is clean as a whistle and I keep pointing out the bugs that are crawling everywhere. God, I hate bugs. I hate them. Stuck-up, snobbish, know-it-alls …”

  Several doors from the room, Harry could hear Maura Hughes’s steady stream of babble. He had treated every form of alcohol withdrawal during his residency at Bellevue and over his years of private practice in one of the more indigent areas of the city. DTs—delirium tremens—while at times amusing, was potentially lethal: heart rate up, respiration up, core temperature up, nervous-system irritability marked, fluid loss through perspiration and hyperventilation intense, fluid intake minimal to none. He had seen studies showing a mortality rate from DTs as high as 25 percent. And Maura Hughes was three days post craniotomy as well. She was a medical time bomb, the last roommate he would have chosen for Evie.

  Harry glanced down the hall at the janitor, placidly working his buffer from wall to wall. He had on a Walkman and was bobbing his head in time to the music, totally oblivious to the life-and-death dramas being played out all around him. Harry wondered what it must be like to have a shiny floor be the extent of one’s professional responsibility.

  Evie had the bed next to the windows and farthest from the door. The curtain separating the two beds was pulled. Harry glanced at Maura Hughes as he passed. She was restrained to the bed with a cloth Posy harness. Her wrists were secured to the bedrails by broad leather straps. She wasn’t old. He could tell that much about her, but little more. Below her turban bandage, dense, violet bruises enveloped both of her eyes and ran down to the corners of her mouth. Her oxygen prongs had dislodged from her nose and were ventilating her left ear. Her cracked, arid lips were drawn back in a strange, twisted rictus. Harry’s first impression was that she was snarling at him. Then he realized that she was smiling.

  “Hi,” he said. “I’m Evie’s husband, Harry.”

  “Double, double, toil and trouble, fire burn and cauldron bubble,” she replied.

  Harry managed a smile of his own and stepped beyond the curtain. Evie accepted his kiss on her forehead without reaction.

  “She knows Shakespeare,” he whispered.

  “Actually, she knows a lot of things. It’s just that the insects and snakes and spiders keep getting in the way.”

  “The creepy crawlies. It would be sort of humorous if the insects and such weren’t so damn real to her. She should be through this in another day or so.”

  “Ouch! Get off my sheet, you filthy bug! Hey, will someone please come over and help me!”

  “Go say something,” Evie urged, “Try and calm her down.”

  Harry walked back around the curtain.

  “You’re too late, Gene,” Maura said to him. “It bit me and it’s gone.”

  “Sorry.” Harry realized now that she was even younger than he had originally thought—possibly in her mid-thirties. “My name’s Harry. Not Gene.”

  “Well, you look like Gene Hackman.”

  “Thanks. I like Gene Hackman.”

  “So do I. I thought you were an actor.”

  “I’m not. Why would you think that?”

  “Your pin.”

  For a moment, Harry had no idea what the woman meant. Then he remembered the pin his niece—Phil’s oldest daughter, Jennifer—had given him. It was a tiny depiction of comic and tragic faces—a prize she had won for drama at school. A year or so ago he had helped her place it on the lapel of this particular sports coat, and there it had remained. He rarely even thought about it being there. Maura Hughes had identified it from eight feet away.

  “I’m impressed that you saw this,” he said.

  “I notice things.”

  Suddenly she began squirming and fighting her restraints.

  “Dammit, Gene,” she snapped, “do you have any Southern Comfort on you or not? You promised and—Shit, Gene, watch out! Right there on the wall by your head. What is that? A scorpion? A shrimp?”

  In spite of himself, Harry glanced at the wall.

  “Try and get some rest,” he said.

  He returned to his wife, who was lying almost flat in bed, staring up at the ceiling.

  Don’t shut me out, he wanted to insist. After nine years, on this of all nights, why can’t you share some of what’s going on inside you?

  “There are no empty beds on the whole floor,” he said instead. “No place to move either of you. If the nurses can’t medicate her anymore, perhaps they can give you something.”

  “I don’t want anything,” she said, without turning her gaze from the ceiling. “I want my brain functioning at maximum capacity right up until the last possible moment.”

  “I understand. You’re going to do fine.” It was then Harry saw the IV—a bag of 5 percent dextrose in water, hanging from a ceiling hook nestled in the dividing curtain, delivering tiny droplets through flow-control tubing. “When did that go in?”

  “A few hours ago.”

  “I didn’t even notice it. I wonder why they put it in tonight and not in the OR tomorrow. Do you know who ordered it?”

  “The anesthesiologist, I think the IV nurse said.”

  “Hmm.”

  “What difference does it make?”

  “None, I guess.”

  A prolonged, uncomfortable silence followed.

  “Look, Harry,” she said suddenly, “I think I need to be alone.”

  The words hit him like a slap. He stared at her, uncertain how to respond.

  “Could you please tell me what’s going on?” he said finally.

  “Nothing’s going on. I … I just have a lot on my mind.” She took a deep breath. Her tension seemed to ease a bit. “Look, they said I could eat until midnight. I’ll tell you what. I’m dying for an extra-thick chocolate malt from Alphano’s. Pick me up one, then we’ll talk. Okay?”

  Alphano’s Ice Cream Emporium was two blocks beyond their co-op—a fifteen-minute drive from the hospital if the traffic was reasonable. But Harry felt grateful to have something—anything—to contribute.

  “Done,” he said, rising. “I’ll be back within the hour. And we don’t have to talk. I’ll be happy just to hang with you for a while.”

  He bent to kiss her but again there was no response. He settled for another peck on her forehead.

  “Gene, Gene, lean and mean. Keep him loose and keep him clean,” Maura Hughes sang as he passed.

  Out in the hall, the buffer man had stopped his work and was kneeling down, Walkman still in place, scowling at the motor of his machine when Harry walked by. Harry felt strangely pleased to see that the man’s life wasn’t so uncomplicated after all.

  Farther down the hall, the nurse, Sue Jilson, smiled up at him as he approached.

  “Leaving so soon?”

  “My wife asked for a milk shake that’s only made at a place on West Ninetieth. I can be back by nine-thirty, if that’s okay.”

  “No problem.”

  “Would you like one?”

  “Thanks, but no thanks. I made a deal with my jeans to keep fitting in them. How’s the moaner?”

  “Agitated and a bit disoriented. She could probably use some more medication if it’s ordered.”

  “I’ll check. There’s nothing any of us like better than sedating Maura.”

  “Thanks. See you in an hour.”

  Harry drove to the West Side through a misty rain and fairly heavy traffic. The line in Alphano’s was longer than usual, the service slow enough to be irritating. He ordered an extra-thick chocolate malt. Then, wondering if Maura Hughes might be lured out of orbit, he ordered a second one. If she couldn’t handle it, he would make the sacrifice.

  I
t was nine-thirty by the time he left the ice-cream parlor, and close to ten when he reentered the hospital. After visitors’ hours, only the main entrance was open. Harry crossed the deserted lobby and flashed his plastic ID at the security guard, whose desk blocked the main corridor to the hospital.

  “I’ve got to have you sign in, Doc,” the man said. “After nine.”

  Harry scribbled his name and destination. The guard glanced at it.

  “Alexander Nine,” he said. “You going up there for the Code Ninety-nine?”

  At that instant, the overhead page began urgently summoning Dr. Richard Cohen to Alexander 928.

  Harry hurried toward the elevators. Something had happened to Maura Hughes, he was thinking. She hadn’t looked that great when he left, but she certainly hadn’t seemed in imminent danger. Then suddenly he remembered that Richard Cohen was a member of the same neurosurgical group as Ben Dunleavy, Evie’s neurosurgeon. Cohen was undoubtedly covering for the night. Gripped by an intense foreboding, Harry kept jabbing at the elevator call button until one of the doors slid open. The ride up to Alexander 9 took an eternity.

  Room 928 was halfway down the far arm of the “L.” The nurse’s station and near corridor were deserted. Harry set down the bag from Alphano’s and sprinted down the hallway, his heart pounding in his throat. It took only a moment after he rounded the corner to have his worst fears confirmed. There were half a dozen nurses and med students standing outside room 928, craning to catch a glimpse of the action. Maura Hughes, still restrained in her bed, had been pulled to the far side of the corridor. Standing beside her, stroking her hand, was a young, uniformed policeman.

  Harry raced past them all and into the room.

  The scene was one he had witnessed or participated in hundreds of times over the years. The monitors, the lines, the crash cart, the defibrillator, the nurses, physicians, and technicians moving grimly from equipment to bedside and back like a platoon of army ants. Only this time, at the center of the controlled chaos, intubated through her nose and being ventilated by a rubber bag, was his wife. The cardiac monitor showed a regular rhythm. Every ten seconds or so, though, her arms extended to the maximum and rotated inward, turning her palms away from her body in an eerily unnatural position. Decerebrate posturing. A horrible prognostic sign. Almost certainly, her aneurysm had blown. He moved to the bedside. The nurse, Sue Jilson, was the first to realize he was there.

  “When did this happen?” he asked.

  The neurosurgical resident who was running the resuscitation looked up.

  “This is Dr. Corbett, her husband,” the nurse explained.

  “Oh, sorry,” the resident said. “Her aneurysm appears to have ruptured. Dr. Cohen is covering for Dr. Dunleavy. I just got word that he’s on the way up.”

  “What happened?” Harry asked. “I left her just a little over an hour ago and she was fine.”

  Sue Jilson shook her head.

  “About half an hour after you left I went in to medicate Maura. I heard a moan from behind the curtain. When I looked, your wife had vomited and was barely conscious. The initial blood pressure reading I got was three hundred over one-fifty. One pupil was already larger than the other.”

  Harry stared down at Evie, his mind unwilling to connect what he was seeing with what he knew of cerebral hemorrhaging. He reached down and gently lifted her eyelids. Both of her pupils were so wide that almost no iris color could be seen. He felt numb, dreamlike. It was already over.

  Dr. Richard Cohen rushed into the room. He already knew the patient’s history, he breathlessly told the resident. The resident gave him a capsule summary of the past thirty-eight minutes.

  “You’ve done everything right,” Cohen said as he examined the inside of Evie’s eyes with an ophthalmoscope.

  He quickly checked her reflexes and response to pain. Then he used the end of his reflex hammer to firmly stroke an arc along the soles of her feet from heel to great toe. The Babinski reflex—the great toe pulling up instead of curling down—was a grave, grave sign that her cerebral cortex, the thinking part of her brain, was no longer influencing the movements of her body. Harry watched, stunned.

  “We’ll get a CT scan,” Cohen said grimly, “but in all honesty, I don’t think we can get her to the OR. The brain swelling is enormous. Both of her optic discs are showing severe papilledema.”

  Papilledema—the optic nerve engorgement caused by marked, usually irreversible pressure within the skull. The finding made the evolving scene even more surreal.

  “She … she doesn’t want any heroic measures,” Harry heard himself saying.

  “Arterial line’s in,” another resident called out. “Her systolic is still two-ninety.”

  “That’s very strange,” Cohen said. “We’ve given her a huge amount of antihypertensives already, but her pressure hasn’t budged.”

  “But wouldn’t you expect her pressure to be up like this with a large hemorrhage?” Harry asked.

  “Temporarily, maybe. Most CNS bleeds do have a period of marked rise. But they almost always respond to conventional treatment, and the residents have already gone well beyond that.”

  “Oh, God,” Harry whispered, still feeling detached and unreal.

  “We’ll keep trying to get her pressure down,” the neurosurgeon said. “And we’ll get a CT to document what we already know. Meanwhile, Harry, difficult as it is under these circumstances, there’s something you should be thinking about.”

  “I understand,” Harry murmured.

  Evie was a young, completely healthy woman, whose only organic problem was her aneurysm. At the moment, she was the sort of prize coveted by every organ transplant specialist—a source of life or sight for any number of people.

  “Let’s get the scan and then I’ll let you know,” Harry said. “Meanwhile, go ahead and begin tissue typing.”

  CHAPTER 7

  After half an hour, the battle to control Evie’s astronomical blood pressure was finally won. But everyone involved in the case knew that the war had already been lost. Harry stood helplessly by the door as the respiratory technician adjusted the controls on the ventilator that was now Evie’s only link to life. There were IVs in both her arms and tubes into her stomach, bladder, and lungs. Every minute or two, in response to nothing in particular, her entire body would tighten and extend into a decerebrate posture. This nightmarish scene was one he had witnessed many times in his professional life and in Nam. But emotionally he had never become very adept at dealing with it.

  There was inevitably a part of him unwilling to accept the simple truth that it was over.

  Wait. Give me another five minutes. Just be patient. This woman’s going to get right up and walk out of here.… You’ll see.…

  “No, thank you,” he replied to a nurse who offered him coffee. “I … I’ve got to call Evie’s folks.”

  He glanced at the corridor behind him. Maura Hughes seemed calmer. Her brother, a carrottop with a face too youthful for the uniform he wore, continued stroking her hand as he watched the unfolding horror in room 928. It was quarter of eleven. The CT scanner would be free in five minutes. Blood samples had been sent off to the lab for tissue typing. On the way back from the CT scan, assuming nothing had come up that would send her to the operating room, Evie would get the first of what would probably be a series of electroencephalograms. Two flat or near flat EEGs twelve hours apart were considered to be the electrophysiologic equivalent of death. Harry reached up unaware and brushed aside a tear that had worked its way to the top of one cheek.

  “Corbett, what in the hell is going on here?”

  Still half-dazed, Harry turned toward the voice. Caspar Sidonis stood several feet away, hands on hips, his expression pinched and angry.

  “I don’t know what you’re talking about,” Harry managed. “But right now I’m a little busy. You see, my—”

  “I’m talking about Evie, dammit!” Sidonis snapped. “Oh, never mind.”

  He pushed past Harry and into the
room. Richard Cohen, the neurosurgeon, was again checking Evie’s eyes. Sue Jilson was on the other side of the bed adjusting the IV.

  “Dick, what happened here?” Sidonis asked.

  “Oh, hi, Caspar. This woman a patient of yours?”

  “No. She’s … she’s a close friend.”

  “Well, her husband is right over th—”

  “I don’t want to hear from him, Dick. I want to hear from you. Tell me what happened.”

  It was a demand, not a request. Cohen, taken aback by the physician’s aggressiveness, quickly regained his composure.

  “You know she was pre-op for repair of a berry?”

  “Yes, yes. Or course I know.”

  “Well, a little while ago, Sue Jilson, here, came in and found her unresponsive, with one blown pupil and a systolic pressure of over three hundred. We’ve thrown the whole pharmacy at her and we’ve still had a bitch of a time getting her pressure down to one-thirty, where it is now. Meanwhile, her other pupil’s blown. She has bilateral papilledema indicative of massive intracranial pressure, and she’s posturing.”

  “Jesus.” Sidonis looked shaken.

  From the doorway, Harry watched, stunned, as the cardiac surgeon reached down and took one of Evie’s hands gently in his. Then, with his other hand, he caressed her cheek. Richard Cohen looked on nonplussed. Sue Jilson was wide-eyed.

  “Dick, does she have any chance at all?” Sidonis asked.

  To any physician, let alone one of Sidonis’s pedigree, the answer to the question was inescapable. The neurosurgeon looked at him queerly.

  “I … um … I don’t think so, Caspar,” he said. “We’re waiting to take her down for a CT and an EEG.”

  “Was he in here with her?” Sidonis gestured toward the doorway.

  “Pardon?”

  It was only now that Harry shook off his own reluctant fascination with what was transpiring and moved into the room. As far as he knew, Sidonis and Evie might have met in passing at some staff party or other. But certainly she had never spoken of the man.

  “Caspar, do you know my wife?”