Flashback

by Michael Palmer

  Beaulieu and his researchers had been thoroughly preparing themselves for battle. Still, despite their diligence, it looked to Zack as if the evidence they had accumulated of Ultramed's avaricious business practices was circumstantial and vague. Zack felt certain that although the assorted documents might raise some eyebrows among the hospital trustees, they were lacking the one, essential ingredient that might turn that concern into votes, a flesh-and blood example-even one-of the dangers of such practices-what Rock Hudson had been to AIDS, or the Challenger explosion to the dangers of space exploration. Without such a rallying point, such an emotional linchpin, Zack knew that Beaulieu's efforts were ultimately as doomed as the man himself. In addition to the evidence against Ultramed, the envelope contained a diary. During the early morning hours, Zack had done no more than scan the small, spiral-bound notebook. Now, after clearing a space on the table for his breakfast, he opened it randomly. Not surprisingly, the writing, almost all of it in fountain pen, was meticulous and precise. December 11th, Several patients cancelled today, including Clarisse L'Frenniere. Spoke on phone to her. She was reluctant to say anything. Had to beg her.

  Finally admitted that her son Ricky had heard at school that I had seen one of the girls in his class for a lump on her neck, and had undressed her and made her lie on my examining table, and then that I had walked around and around the table, touching her. No such patient exists in my records or memory. Made several calls to parents of any young girls I had treated. They admitted to having heard rumors, but denied any of them dealt with their daughters. They were all quite distant and embarrassed. I feel I may have done myself more harm than good by contacting them. Called Ricky and begged him to give me the girl's name.

  He could or would not. Finally, Clarisse took the phone from him, told me not to call again, and hung up. I will not stop trying. Zack glanced at several other pages, some of which outlined more of Guy's efforts to dive beneath the murky sea of rumors. Others described clashes with members of the medical staff, the local newspaper, and even certain patients. Taken as a whole, it was a chronicle of the agonizing disintegration of a man's life. Allegations of malpractice, none of them substantiated or backed up with a suit… Ietters of complaint to the newspapers and the hospital, most of them anonymous… rumors of sexual misconduct… rumors of inappropriate behavior… patient defections … Blow after blow, humiliation after humiliation, yet Guy Beaulieu had refused to knuckle under. On one page he seemed heroic, on the next, pathologically obstinate. As Zack scanned the notes, the fine line separating the two conditions grew even less distinct. The chances that a man is in the right increase geometrically by the vigor with which others are trying to prove him wrong The maxim was one of Zack's favorites, and he had cited it any number of times over the years. But never had he felt it in his gut the way he did at this moment. Still, there was more than gut instinct to consider. There was the incriminating letter from Maureen Banas, along with other damning evidence Frank claimed to have. There was also Guy's explosive and irrational behavior in the emergency ward on the morning of his death.

  And finally, there was the lack of any really good explanation as to why the man might have been singled out for destruction in the first place Certainly, his widow's belief that Ultramed was trying to rid itself of a potential troublemaker was possible, but the response seemed absurdly out of proportion to the threat Guy posed-like shooting a fly with an elephant gun. Zack retrieved Cheap dog from where he was lurking beneath the window of a neighbor's unspayed collie, and chained him on a long run in the yard. Then he showered, dressed, and headed for the hospital, wondering what he would do if he had to confront Marie Fontaine and her mother with hard evidence that Guy had been, in fact, irrational, unstable, and paranoid. Even with a negative autopsy, the man could have been in the early stages of Alzheimer's or struggling with nonanatomical mental illness. As he was pulling into the small Doctors Only lot at the hospital Zack flashed on another saying-this one from a poster he had tacked to the wall of his med school apartment. Just because you re paranoid, doesn't mean they're not out to get you. The emergency ward was in a louder-than-usual morning hum, with several private physicians doing minor procedures, and the E. R. physician of the day, Wilton Marshfield, huffing from one of four "active" rooms to the next, clearly upset that things were not proceeding at a more gentle pace. Zack stopped by the lounge for one final cup of coffee, and was in the process of failing to confound two candy stripers with a thumb palm, when he was paged for an outside call. "Zack, it's Brookings here, Phil Brookings."

  "Oh, yes, Phil. If you're calling about that youngster, Nelms, I had to postpone his appointment because of Guy Beaulieu's funeral. I'll be seeing him tomorrow afternoon."

  Zack glanced over at the candy stripers, one of whom was completing the more-than-passable thumb palm of a penny on her first try. "I know," the psychiatrist said. "The boy's mother called me. She was, how can I say, a little concerned that you told her to meet you on the side of some mountain. I promised her I would check with you to see if… ah… if there was anything further I could do."

  "Actually, " Zack said, smiling at Brookings's discomfiture, "It's near the base of the mountain. Not on the side."

  "Oh… I see… Well, I'll just give Mrs. Nelms a call and reassure her that you're not the, how should I say, the eccentric she thinks you might be."

  This time, Zack laughed out loud. "Phil, forgive me for being glib. The truth is, I probably am the eccentric she thinks I might be. But this time, at least, I'm just doing 1, what I can to avoid the difficulty you had. It's a little tricky doing a detailed neurological exam on a moving target."

  "I understand, " Brookings said, although his tone suggested some lingering doubts. "I'll speak with the boy's mother and make sure they show up. And just in case, perhaps you should wear your sneakers.

  The kid is fast."

  "Thanks, Phil. I'll be in touch."

  Zack hung up as the candy stripers, still practicing, were preparing to leave the lounge. "Here you go, ladies, " he said. "One more. This one's called a finger roll. In it, this perfectly normal American quarter will be magically transported across the tops of my fingers and back without the aid of a crane, bulldozer, or my other hand."

  Between the second and the third roll, the quarter slipped between his fingers and plunked into his coffee. "Now, I suggest that you two stay away from this trick until you're old enough to work with hot coffee," he warned. He stood proudly by the cup and waited to retrieve his coin until the bewildered pair had left the room. "Me, eccentric, " he muttered as he headed through the emergency ward. "That's ridiculous.

  Absolutely ridiculous."

  A set of X rays, five views of a teenager's cervical spine, were wedged up on a four-paneled viewbox in the corridor. Hours later, when the tension and excitement had died down and there was time to reflect, Zack would be unable to explain what it was about those films that had caught his eye. But in that one microsecond as he passed by, something did. It might have been the widening of a shadow, or perhaps the slightly unusual curve in the lateral view. Or it might have been nothing more or less than the instinctive processing of the films against thirteen years of study and God only knew how many other C-spines in how many other settings. Whatever it was, something made him stop, turn, and study the X rays in more detail. The fractures of vertebrae C-1 and C-2 were far from the most obvious he had ever seen, but they were certainly present-and unquestionably unstable. If the spinal cord had not already been damaged, a sudden twist, or turn, or bump could be disastrous.

  Either way, he certainly should have been called in on the case. He checked the name and birthdate, Stacy Mills, age 14 Next, he cut through the nurses' station, looking for Wilton Marshfield. The portly physician was hunched over a counter, hurriedly writing a set of discharge instructions. Next to the instruction sheet was a soft cervical collar.

  "Hi, " Zack said, moving close enough to verify that the instructions were, in fact, for Stacy Mills. He
looked past the man to bed 3, where a dark, pretty girl in riding jodhpurs and a lavender T-shirt was waiting with her parents. She was sitting on the edge of the litter with her feet dangling down, and she was rubbing gently at the base of her skull.

  "Oh, hi, Iverson, " Marshfield said. He glanced up only long enough to nod, and then returned to his writing. "This is one bitch of a morning, I'll tell you… Saw you at Beaulieu's funeral yesterday Terrible business. Terrible."

  "Wilton, could I talk to you for a moment? " Zack asked softly Marshfield shook his head. "Can't stop right now, " he said, pulling a prescription pad from his clinic coat. "I've got to get rid of this kid, and then I still have two more patients to see. I'm getting too old for this pace, Iverson. Too damn old. Tell your brother he'd better hurry up and get this place straightened out so I can get back to my trout stream and my grandchildren."

  "It's about that girl you're getting ready to send home, " Zack said.

  "Stacy Mills."

  Marshfield squinted over at the girl, and then picked up the cervical collar and the instruction sheet, and began writing a prescription for a muscle relaxant. "Fell off her horse and strained her neck muscles, " he said as he wrote. "Look, Iverson, " he added curtly, "I'm sorry I snapped at you the other night. But please, just don't make any trouble for me today. I'm too far behind to-"

  "Listen, Marshfield, " Zack whispered. "I just looked at her films over there. She has a fracture. Two of them, I think. C-one and C-two."

  The older man froze. In slow motion, his pen wobbled in his fingertips and then fell, clattering onto the counter. "Are you sure? " he rasped.

  Zack nodded. "Jesus…"

  "Come, let me show you."

  Moments later, Zack led a mute, badly shaken Wilton Marshfield across to Stacy Mills and her parents "Hello, Stacy, Mr. and Mrs. Mills, " he said. "My name is Iverson. Zachary Iverson. I'm a neurosurgeon."

  He glanced back at Marshfield, who looked as if he were listening blindfolded to the final counts from a firing squad. Inwardly, Zack smiled. If the man was waiting for gunfire, he was in for a pleasant surprise. Hey, Wilton, relax, he was thinking. As far as I'm concerned, this business of ours has never been a contest or a game. It's life.

  It's the real bananae And it's hard enough to do right even without the bullshit and the oneupsmanshipw You did the best you could, and that's all we got-any of us. There's no way I would hang you out to dzy. "Dr.

  Marshfield, here, has just made an excellent pickup on Stacy's X rays," he said. "He spotted a shadow he didn't like, and wanted me to check it before he would consider sending her home. I'm afraid his suspicions were correct. Stacy, there is a small fracture-a broken bone right up here."

  "I knew it, " Stacy said. "See Mother, I told you it was killing me."

  "Is it dangerous? " the girl's mother asked. "It would have been, " Zack said, slipping the soft collar into place, "if it had gone undetected.

  It could have been a blooming disaster. But everything is under control now. You're going to be just fine."

  Mrs, Mills reached over and squeezed a stunned Wilton Marshfield's hand.

  Her husband patted him on the shoulder. "Now, Stacy, " Zack went on,

  "first of all, I don't want you moving your head around, okay?"

  "Okay."

  "Good. Then there are some things I must explain to you and to your parents about what we do for cervical fractures."

  "Dr Iverson, please, " the girl's mother said. "Before you start, I d like to get Stacy's aunt-my sister-over here. Would that be okay?"

  "Certainly, but I don't see-"

  "She helps me understand medical things. I'm sure you know her. She's the head nurse here. Maureen. Maureen Banas."

  CHAPTER TEN

  Although operating room 2 at Ultramed-Davis was newer than some of the dozens Zack had worked in, the ambience was no different. The sounds, the lighting, the tile, the filtered air-tinged with the unique mix of antiseptic and talc and freshly laundered gowns-provided sensations as familiar to him, as reassuring, as the mountains. The stabilization of Stacy Mills's neck was proceeding flawlessly. Standing by the head of the table, Zack paused, savoring the sensations — the wonder of what he was able to do, and the bond he was feeling with the rest of the O. R. team. The sound system-Frank's brainchild, now installed in nearly all Ultramed's hospitals-was playing George Winston's magical treatment of "The Holly and the Ivy."

  "All set? " he asked the scrub nurse. The woman nodded. "All right, then, " he said evenly. "Stacy, this is the part I told you about. We're going to twist those four screws into place on your head. I've put lots of novocaine in each spot, so they won't hurt, but it will feel funny, and you might hear the grinding noise. Everything is going Just fine. I know it's scary for you, but there's really nothing to be frightened about."

  "I'm not frightened, " the girl said. "At least, not too much."

  "Good. And you remember what you have to do?"

  "Don't move, " she answered. "Exactly…"

  Zack checked the position of the cervical halo one last time, and worked the four screws farther into place through the small incisions he had made in the girl's scalp. "Unless I tell you to, don't move."

  From a spot several feet behind the O. R. team, Wilton Marshfield watched, his every breath a sigh of relief. Even though Zack Iverson had publicly gone out of his way to share credit for the pickup with him and had privately assured him that this sort of cervical fracture was the toughest of all to diagnose, he sensed that he would never be truly comfortable in the emergency ward again. He had come out of retirement and into the E. R. as a favor to Frank Iverson, and because he was bored. Now, he knew, it was time to stop. And thanks to Iverson's brother, after forty years of busting his hump, of doing his best to survive first the knowledge explosion, then medicare and the paperwork crunch, then the malpractice crisis, and now the goddamn corporate-policy crap, he could at least go out as something of a winner. "God love ya, kid, " he said softly, as Zack tightened the apparatus in place. "God love ya."

  "Okay, Stacy, " Zack was saying, "that's one. Now, wiggle your toes the way I showed you. Good. Now your fingers. Good, good. We're almost there."

  He stepped back for a moment and shifted his focus from the metal frame to the fine features and peaceful face of the girl/woman. Biology, organic chemistry, anatomy and physiology, boards and more boards, endless nights and weekends on duty or on call, countless meals of cafeteria food or nondescript leftovers in cardboard containers, countiess hours in the O. R. and on the wards, scattered days, and weeks, and even months of consuming self-doubt-at moments like this one, the choices he had made in his life and the price he had paid made so much sense. And when it was over, when the girl who loved to ride horses walked away from the hospital and from the split second that could have paralyzed her forever, he would take that moment and bankroll it in his mind as vindication for all the years and all the anguish, and as a hedge against those outcomes yet-to-be which would not bring smiles and handshakes and pats on the back-outcomes that, as long as they were unavoidable, were no less a part of medicine than this one. "That's it, Stacy, " he cooed as he tightened down the last of the screws. "That's it. You're doing perfect. We're all doing perfect."

  With the elective surgery schedule now an hour behind, O. R. 2 was emptied out as soon as the last screw was in place and the proper position of the halo was verified. Zack accompanied Stacy Mills to the east-wing room where, for a few days, she would be observed for signs of spinal cord swelling or compression. "Well, you just take it easy, Stacy, " he said. "I'm going to go talk to your folks, and then I'll send them up. I'll be back to see you at the end of the day. Wearing this device won't be the most fun you've ever had, but like I said, it won't be forever."

  "Dr. Zack, " the girl called out as he was leaving, "in the operating room I said that I wasn't scared. Well, now that it's all over, I can tell you that I really was. I just didn't want to sound like a baby."

  Zack returned
to the bedside and smiled down at her. "In that case, " he said, "I've got something to tell you-something I've never told any patient before." He bent over her bed and whispered, "I'm always a little frightened and a little nervous when I operate."

  "You are? Really?"

  "The truth. I think it helps my concentration never to forget that it's always possible that something could go wrong. There, I said it, and..

  hey, Dr. Mills, I feel better already!"

  "You're very silly, do you know that?"

  "I hope so, " he said. As he was leaving the girl's room, Zack spotted Maureen Banas approaching down the corridor. She was in her late forties or early fifties, he guessed, with short, graying hair that looked as if it had been cut by an amateur. Although she carried herself with authority, the tension etched into her face and the lack of attention to ten or fifteen excess pounds hinted at a life that had, perhaps, not been an easy one. "Congratulations, Dr. Iverson, and thanks, " she said with an almost clinical lack of emotion. "Stacy is a very special child to a lot of people. We all owe you a great deal for what you did."

  In that case, he wanted to say, tell me about the nail you helped hammer into Guy Beaulieu's coffin. "Listen, " he replied instead, "just-seeing her moving those arms and legs and piggies of hers is enough to get me through six months of the usual neurosurgical nightmares. Besides, it's Wilton Marshfield you should be thanking. I was just the technician."

  "Nonsense. I know he missed those fractures. Sticking up for him was a very kind thing for you to do, especially with the altercation you two had last week. Wilton's really a sweet old guy most of the time. But he misses too much."