Rupture Page 16

  The nurse estimated her age as between fifteen and seventeen years. She was a tall girl with magnificent features. On her right hip, just below the curve of her back, was a beautifully crafted, pink butterfly tattoo.

  The absence of bodily injuries made the resident uncomfortable about continuing with the physical examination of the teenaged girl. He decided to stop, and they rolled the girl on her side and stuffed a body bag beneath her. Although it was not medically necessary, the nurse held traction on her neck to prevent further twisting and grinding of the vertebra. It just seemed like the right thing to do. They zipped the bag closed and parked her body in an isolated room to await transport to the morgue.

  CHAPTER THIRTY

  SURGICAL INTENSIVE CARE UNIT

  GATES MEMORIAL HOSPITAL

  7:01 P.M.

  No sooner had Eli reached the Surgical ICU than his beeper went off again. This time, it was the ER. He quickly located neurosurgeon Thomas Champ, the physician who had mercifully paged him away from the Tynes family. The CT of Scott’s head had been completed and showed exactly what they all feared.

  Diffuse axonal injury with severe swelling.

  An ominous sign.

  Dr. Champ had paged Eli to tell him that an intracranial monitoring device was needed to relieve pressure on the boy’s brain. The procedure was already underway as Eli arrived. Scott’s scalp was shaved and painted yellow with Betadine, and Champ was screwing the bolt into his head.

  “It doesn’t look good,” the neurosurgeon called from beneath his mask amid a medley of electronic beeps, buzzes, and hums. “All we can do is keep his intracranial pressure low and hope for the best.”

  “Thanks for coming so quickly,” Eli said. He thought of the days and weeks ahead for Scott Tynes. A few patients in his condition would live, the majority wouldn’t. Those who did make it required prolonged rehabilitation and would exist in a vegetative state, dependent on a feeding tube for life. And in less than twenty-four hours, Eli would no longer be a member of Gates Memorial medical staff. He would not even have hospital privileges that would allow him to take care of his patient.

  Eli took this opportunity to make a request.

  “Dr. Champ, I’m off to the ER again. Would you mind updating his family?”

  The neurosurgeon looked up from his procedure. “What do they know?”

  “I told them about his intra-abdominal injuries and that we’re concerned about his head.”

  “Concerned puts it mildly.” Champ calibrated a monitor that showed life-threatening intracranial hypertension. “Sure, I’ll talk with them. They should get prepared for a final visit.”

  The remaining portion of Eli’s call proved one of the busiest trauma nights of the summer. Not the usual knife-and-gun-club stuff. More in the dark and twisted category of domestic violence.

  At midnight, an ambulance brought a woman shot in the abdomen with a nail gun. She had poured out her husband’s last bottle of beer. Eli and Susan rushed her immediately to the OR.

  Two hours later, they were asked to see a man with a wooden dowel crammed up his rectum. A carpenter had discovered the man in bed with his wife and decided to use some of his woodwork to take care of the problem. The patient survived, albeit with a colostomy.

  The woman shot by the nail gun didn’t fare as well. The nail pierced and lodged in her aorta. She arrived in stable condition, the nail plugging the hole like a thumb in a dike. During the fluid resuscitation in the ER, the woman’s blood pressure shot up, the nail dislodged, and she promptly coded. In the elevator on the way to the operating room, she exsanguinated through the aortic hole and never regained a pulse.

  At the end of his night on call, Eli walked through the empty surgery lounge, an orange-yellow burst of sun showing through the only window. There would be no more consults, no stat pages to the ER. He would finish morning rounds and try to salvage the day ahead.

  In the intensive care unit, he found that Scott’s vital signs had stabilized. His intracranial pressure remained elevated, but the diuretic medication had drawn fluid off and the numbers were slowly coming down. But the question of brain death remained.

  Eli pulled Scott’s covers down to expose his chest. One of the main predictors of brain stem activity was response to pain. As a medical student, Eli cringed when the pain reflex was demonstrated. As he reached down and grabbed the boy’s nipple, Eli felt impending remorse. But he had to know. He pinched the nipple hard and twisted in a clockwise direction. From the depth of his coma, Scott reflexively pulled both arms inward to the pain and Eli released the plug of skin.

  “I’m sorry, buddy,” Eli said as he replaced the warm covers around Scott’s neck. “I had to do it.”

  The lobby of Gates Memorial Hospital served as the waiting room for family and friends of those in surgery. A coffee stand provided hot beverages and Danish pastries. The morning newspaper was used as a distraction to the invasive events occurring on the third floor.

  At seven o’clock, Eli walked through the lobby. Every available chair was occupied, arranged in semicircular units of family and friends. Behind the information desk, a couch served as a makeshift bed for a couple that couldn’t have been over eighteen. A group of four adults huddled in one corner of the room, their eyes red from lack of sleep.

  Eli’s own sleep amounted to less than an hour. He eyed an empty couch against a wall. H ow easy it would be to just crash here. He was almost to the exit when he slowed his pace for a young woman in front of him. She wore a bandana on her head and her mouth was covered with a surgical mask tied at the base of her hairless skull. It was easy for Eli to substitute a similar image of his mother, sick from the chemotherapy in her last weeks of life.

  The woman held onto the IV pole and pushed it with difficulty, its wheels getting hung up on the carpeted floor. When she turned toward the hospital chapel, Eli quickly walked around her. As a pair of nearby doors opened automatically for him, he looked back at the woman and saw her struggling to enter the place of worship. She held the door with one arm and yanked on the IV pole with the other. With calm persistence, she tried to lift the pole, heavy with two full bags of fluid and a pain pump attached. Eli stopped, reached around her to hold the door, and hoisted her pole over the threshold. Metal blinds covering the glass of the door shifted and announced their entrance.

  Eli had not noticed the chapel before, an unadvertised room with a single door off the rear of the lobby. Inside, four short pews on each side of a center aisle faced a wooden cross that rose from the floor. The small sanctuary was half-full with fewer than ten people.

  “Please come in, we’ve yet to start.”

  Eli looked up. A priest in a purple robe that appeared too small for his bulky frame extended both arms to his impromptu congregation.

  The woman cleared the doorway and sat at the closest end of a pew. Eli, still holding the IV pole, placed it beside her.

  “Thank you,” she said, her voice weak and muffled behind the mask.

  Eli had the feeling that someone was looking at him. He turned and saw Regina Tynes in the back pew across the aisle. Her hair was pulled back and secured with a barrette. She looked like a worried mother who had not slept the night, but her face seemed to ease when she saw Dr. Eli Branch enter the chapel. She nodded with a slight but graceful smile. She appreciates that her son’s surgeon would seek a place of spiritual refuge, Eli thought.

  “Welcome all,” the priest called again.

  As the door shut, Eli felt smothered. At once, he was back in church again, thirty years ago, with his parents and Henry. Everything was there, the pews, the candles, and a priest waiting to reprimand and embarrass them all.

  Despite the eyes of Regina Tynes and the congregation upon him, Eli scrambled out the door, a set of shifting metal blinds declaring his escape.

  CHAPTER THIRTY-ONE

  NORTH RESEARCH BUILDING

  FRIDAY MORNING

  7:24 A.M.

  The yellow tape had been removed from arou
nd his laboratory, and the police and reporters were gone. Early morning was usually a time to be productive with research grants and manuscripts to prepare before the constant interruptions of the beeper. Eli just wanted to get to his office, sit at his desk in silence, and try to make sense of the last few days.

  As he approached the lab, he saw that his mail had been dropped in a pile outside the door. Usually, the administrative assistant for the labs sorted the letters from the journals in designated racks inside his office. He scooped up the mail with one hand and inserted his key in the door.

  But only halfway.

  He tried it again but the grooves ground against the new mechanism.

  Then he knew. He was being shut out.

  What will be next? My house?

  He tried one last time, twisting hard, and his key broke off in the lock.

  Eli stopped his truck at the gate of the medical center’s parking garage. He waved a white plastic card across the invisible beam, eased off the brake, and pulled forward. But the gate remained closed.

  Another swipe.

  Nothing.

  A Land Rover pulled up to the opposite gate to enter the garage.

  Eli rubbed the card, back and forth against the black surface as if he were sanding furniture. The silver LR3 idled with the gate open. Eli looked at the driver.

  Dr. Karl Fisher.

  Well, this is awkward. Surely he’ll give me his card and let me out.

  But Fisher just revved his engine, pulled forward, and disappeared into the concrete maze. Eli waited a few minutes until the next employee arrived, who was nice enough to let him out of the garage.

  The morning was gray and overcast, and a bank of fog pushed low against the river like a cloud. Eli drove slowly along Riverside Drive, his mind as thick and muddled as the water itself. He stopped for the light at Jefferson Street. Not a car in sight.If only it could stay like this, deserted and lonely, like the morning after nuclear devastation or maybe, Armageddon.

  Just before the final operative case of the long night, Eli had a chance to lie down for an hour. But his mind buzzed as though on a double-shot caffeine high. He sweated into the sheets one minute, shook with feverish chills the next. He never had difficulty with sleep before. In medical school and residency, he could fall asleep instantly, a blessing for postcall nights, a curse for lectures and conferences.

  I could just keep driving, he thought. He could take Interstate 55 down to Batesville and on to Oxford, maybe cut over to the Natchez Trace, or get lost in some small town along the river where they don’t watch the news, and don’t give a damn. Take a labor job, hire out and drive a tractor sunup to sundown in rich delta land, and ride out of the field in the back of a truck across acres and acres of cotton, sharing a cigarette with men too tired to talk, but counting dollars and change for a quart at the package store ahead. He could feel the openness of the land and the desolation, the gratifying ache in his muscles and —

  Eli woke abruptly to a horn blaring as a car passed to his right and shifted to the lane in front of him. He looked up at the light where he’d come to a stop.

  Green. Back to yellow.

  Eli pressed the accelerator with an overcompensated stomp and gripped the steering wheel with both hands. Forty-five seconds of precious sleep. He caught a fleeting whiff of smoke from the shared cigarette in his dream.

  Eli was halfway across the Hernando DeSoto Bridge before he felt his grip on the steering wheel slacken. He had been driving in a dream-like state, staring straight ahead, fantasizing about what he could do to Fisher and Korinsky. He pictured the slews and bottoms in North Mississippi, miles and miles from nowhere. Eli had hunted there during duck season while at Ole Miss. He had felt the stark isolation of the frozen channels and lakes. How long would it take? Months? Years? before the bodies of the two men were found.

  The tranquility of first light on a flooded cotton field overcame his homicidal thoughts. At Ole Miss, four o’clock on Saturday mornings in the winter, he would leave the fraternity house with hunting buddies Charles Jackson and Frank Ames. They would take Highway 278 over to Sardis Lake where Frank’s uncle leased a duck blind in a flooded corner of land they called Buzzard Slew. It would be pitch-dark as they drove out to the lease, tires of the four-wheel drive cutting ruts in frozen mud, stars overhead, crisp air in the mid-twenty-degree range.

  How easy we could do that then. Keg parties the night before. A few times they didn’t even go to bed.

  Dressed in full camouflage and toting their guns in cases, they would ease down the stairs of the Phi Delt house so as not to awaken their brothers. They would pass by the den, littered with cups of spilt beer and couch cushions thrown on the floor for those who couldn’t quite make it up the stairs. They would crack the front door, line up as a trio, and bring their duck calls into position. They would take one final moment to relish the complete silence and anticipate the shattering soon to come. With their calls poised, Eli would mouth “one, two, three” —

  “QUUUAAACK.”

  “QUACK, QUACK, Quack, Quack, Quack.”

  “QUUUAAACK.”

  “QUACK, QUACK, Quack, Quack, Quack.”

  At full blow, three unified duck calls could pull a formation of mallards from a thousand feet. Still, it took a couple of rounds before the house came fully alive. A chorus would start from the bedrooms upstairs.

  “Shut up, you crazy bastards.”

  “Go to hell. Go straight to hell.”

  The three of them would retreat to an idling truck in the parking lot, laughing at the smack of beer cans thrown against the wall. The brothers of Phi Delta Theta grew to hate those early Saturday mornings of winter. And a legacy was born.

  From the bridge, Eli watched the muddy water pass slowly below him like a huge, even-tempered monster. The river had always had a calming effect on him. In medical school, before the big block of do-or-die biochem and anatomy tests, he would jog down Jefferson Street until he saw the reflection of evening sun off the water. He would sprint across Riverside Drive to a park bench on a grassy hill along the bank. The minutia and detail of oxidative metabolism, the precise point of insertion of every muscle along the pelvic bone, all of it took on a certain insignificance, a much-needed perspective, when he considered the vastness of water that moved every day past this little spot of the world.

  As his truck entered West Memphis, Arkansas, Eli remembered a woman on a Riverside park bench who had sat not thirty feet from him one clear afternoon in the middle of May. She was dressed too warmly in a green overcoat and plastic rain hood. From a sack of bread ends, she methodically pinched off little pieces and delivered them, one by one, to the faithful pigeons that gathered at her feet. Isolated in the immense pleasure of her task, she never looked at Eli. After the last bread crumb was thrown, the birds still pecking and strutting in the patch of grass, she sat a while in a blank stare, as if her only enjoyment in this life had ended. Then, with no fanfare, she pushed the cellophane bag into her coat pocket and drifted away.

  Eli turned onto the tree-lined RBI drive and coveted the simplicity of the woman’s selfless act.

  At the guardhouse, Eli stayed in his Bronco as Tongue pressed a handheld iris scanner against his face. A single wave of light confirmed his identification, and the gate opened before him. To Eli’s surprise, Tongue spoke.

  Pointing to a row of parked cars, he said, “You can park right of the building.” He formed his words as if his tongue were competing with a mouthful of potatoes. “Your spot’s the third one down.”

  Eli thanked him and pulled away.

  My spot?

  Past the fountain he slowed at a line of parked cars, discrete signs identifying each spot. The first was occupied by Harvey Stone’s silver BMW. Next was a racing green Jaguar that belonged to A. Zaboyan, according to the sign. The next parking space was empty, so Eli eased the Bronco in place. To his amazement, the sign read: E. BRANCH, M.D.

  He leaned forward with both arms draped across the steer
ing wheel and stared at his name. He thought of the old saying, when one door closes, another opens. He looked at the immaculately detailed cars to his right, then at the patch of rust that grew on the center of his hood. Eli shook his head and laughed.

  He entered the marbled foyer and was disappointed to find that Lisa was not at the reception desk. He had envisioned her popping up from the desk to greet him, maybe in a classy blue blazer hugging a pink halter top.

  “Good morning.” A thin woman, fiftyish, her thick grey hair pulled up in a bun, stood at the desk holding a clipboard. She wore hoop earrings the diameter of a dinner plate.

  “Any trouble with your parking, Dr. Branch?”

  Eli was surprised that she knew his name, but his expectations were being surpassed now on a frequent basis. He thought of the parking privileges that had been revoked at the medical center.

  “No, no problems at all.”

  “Good,” she said. “Can I show you to your office?”

  As she nodded her head, Eli watched the big rings sway and tug at eroded earlobes.How long before they cut all the way through?

  “Office?”

  “Right this way,” she said and stepped from behind the booth.

  “That’s okay,” Eli said, preferring to find it himself. “Remind me again.”

  She pointed at the elevator. “To the second floor and down the hall, last door on the right.”

  He recalled the second floor layout of the East Wing. Tsarina’s lab was down the hall on the left.

  How convenient.

  “Thank you,” Eli said.