Rupture Page 3

  After a full day in the OR, Eli usually lingered in the lounge, signing operative notes or reading the day-old news, a mindless routine that facilitated his transition from surgeon to civilian. But after the Gaston debacle, he changed from scrubs to street clothes and left the hospital as quickly as he could.

  Mist blurred the windshield, wipers missing a swath, but smearing an accumulation of bugs. He had not washed his ’96 Ford Bronco since heading west from Nashville. Along Interstate 40, insects night bombed like hail from the flatlands of cotton and soybeans. The odometer was stuck at just over 116,000 miles, but Eli knew the vehicle had traveled well over two hundred thousand.

  He took an unusual route through the grounds of the medical center and found himself driving past Anatomy Hall. Moonlight reflected off the crest of a gargoyle that stared from the corner of the roof with a wide ceramic grin. Eli slowed at a stop sign in front of the century-old structure. A row of ground-level windows, barely visible beneath scrubby boxwoods, outlined the foundation of the two-story building. The embalming lab was tucked away in the basement, where Gaston had spent his life preparing the dead for the next group of medical students.

  Eli turned off the wipers as condensation fogged the glass. An anatomist, Professor Elizer Branch had wanted nothing more than for his son to be fascinated with how muscles inserted into bone and how the liver hung from a canopy of ligaments to form the roof of the abdomen. Summers and after school, little Eli spent his time at the anatomy lab, where his father ignited sparks of curiosity that he had hoped would propel the boy into the career of medicine.

  As Eli looked toward the dimly lit building, he pictured himself at ten, sitting high on a stool next to Gaston, watching him pump a new body full of embalming fluid to replace stagnant blood. The medical students called their mascot “little E.” He remembered, with a surprising pang of fondness, being lowered into an open abdomen, his ankles held by two laughing first years as he picked a spilled gallstone from the cadaver’s retroperitoneum.

  Gaston was not so bemused by the students’ antics. He would sneer from behind his grey curls that dangled across his face and fell on bony shoulders. To Eli, the man seemed ancient even then, over twenty years ago.

  Along with his oddities, Gaston appeared deeply committed to Eli’s well-being even though he resented the presence of a young boy among the bodies of those who had made the ultimate donation to medical science. Over the years, Eli questioned whether this commitment was a form of psychological blackmail, an attempt to prevent the unwitting witness from divulging the secret that haunted them both. Now it was Gaston whose body lay in waiting, his soul called beyond.

  Eli pulled the Bronco forward so he could see the back of the building, where the slope of the ground revealed a single window pane, illuminated. He imagined the bare bulb hanging in a stone-encased room, pipes along the ceiling hissing and bucking with the pressure of steam, a cold dwelling furnished with only a low cot in one corner, a cupboard holding canned food in another.Gaston must have left the light on in a rush to reach the hospital. Eli tried to imagine the intense pain that must have pierced Gaston’s body as he lurched the quarter mile across campus to the emergency room.

  Eli drove down Union Avenue wiping condensation off the inside glass with the back of his hand. He passed the Mesquite Chop House, which was formerly Sleep-Out Louie’s. Through the window, he caught the glimpse of a couple sitting off by themselves at the bar. The girl sat sideways on the boy’s lap. A tassel of blonde hair stuck out the back of her baseball cap, her arms draped around his shoulders and her head nestled in the crook of his neck.

  A car pulled up beside him, the latest rave blaring out of open windows. Eli thought of the money he had saved in high school to buy two ear-splitting speakers that he mounted behind the seat of his short bed Chevy pickup. Today, Eli couldn’t name one song in the top ten. What ever happened to Molly Hatchet and southern rock?

  He passed St. Jude’s Children’s Hospital and a linear array of lights outlining the triangular face of the Pyramid Arena, first home of the NBA Grizzlies. An avid baseball fan who always pulled for the Pirates, Eli had never been to an NBA game. In his recruitment package, however, Eli had requested season tickets to the Memphis Redbirds, triple A affiliate of the St. Louis Cardinals. To sweeten the deal, he received not only two seats in Autozone Park, but also prime seats behind the basket in the Grizzlies’ new home, the FedEx Forum.

  At the beginning of his final year in medical school, he was invited to a Fourth of July celebration in Harbor Town at the home of one of his radiology professors. From the second-story balcony, as fireworks lit the sky over Tom Lee Park, Eli was intrigued by the homes that lined the eastern bank of the Mississippi River. In contrast to the frenzied pace of medical school, the massive river had a calming effect on Eli and he considered it a refuge.

  After crossing Auction Bridge to Mud Island, Eli turned onto Island Drive and drove toward his new Harbor Town home. He passed the gazebo and followed an inland channel that snaked its way past villas and condos of orange brick, alternating with wooden homes of light yellow or Caribbean blue. Fountains shot tentacles of water that glistened in the sunlight during the day and kept the stagnant muddy water moving at night. Willows hung over the channel with drooping limbs that accentuated the serene landscape.

  His bungalow was a small rental unit, but Eli had plans. After knocking down his medical school debt, he would buy a plantation-like home that faced the river. He pulled into his driveway, cut the lights so as not to wake the neighbors, and coasted into the garage. He turned off the engine, let his head fall back, and yawned. The pulsating screech of his beeper shattered the moment. His body jerked as if the beeper hadn’t gone off a thousand times before. He glanced at the number.

  Now what? From his cell phone he thumbed in the number to the OR.

  A tired voice answered. “Front desk.”

  “Dr. Branch,” Eli said in a tone meant to discourage further paging.

  “Anyone page Branch,” the voice yelled, as if calling an order back to the fry cook.

  Too tired to shake his head, Eli imagined the scene, a couple of nurses at the desk flipping through mail-order catalogs, orderlies cleaning Room One after the bloodletting, a spotless floor being readied for the next victim: some youngster shot in a crosstown brawl or a dozing factory worker from West Memphis, Arkansas, slamming into a concrete abutment.

  Eli heard the phone bounce across the counter and another voice answering, “This guy has no family.”

  It was Korinsky, calling about Gaston’s autopsy. Eli was surprised the surgeon was still there. Why did he care about the autopsy? Then Eli remembered. Just before Korinsky left the OR, he stressed the need to obtain autopsy consent from the family. “This device killed him and I want to know the hell why.” Eli could have saved Korinsky the trouble of searching for family that Gaston didn’t have.

  “But I talked to the medical examiner,” Korinsky barked into the phone. “They’ll have to do an autopsy since he died on the table. It’s set for seven tomorrow morning, if you care.”

  Hell yeah, I care. But Eli suppressed the urge to jab Korinsky for his behavior in the OR. “Thanks for the call.”

  “Sure.”

  Eli knew that Korinsky wouldn’t show for the autopsy. His presence would, in effect, acknowledge defeat. Something to which the chief of vascular surgery was surely unaccustomed.

  Eli did wish that Korinsky knew about Gaston. That he wasn’t just another case off the street that nobody cared about. That Eli had spent hours looking over the man’s back at cadavers. But he hid what he knew would be seen as touchy-feely crap and ended the conversation with “I’m sorry we couldn’t save him.”

  Before he hit the end call button, Eli heard Korinsky again.

  “Hey, Branch.”

  “Yeah?”

  “One more thing. Hope it goes well this morning with Fisher.”

  CHAPTER FOUR

  HARBOR TOWN

&n
bsp; MEMPHIS

  2:46 A.M.

  The night mist turned to rain just as Eli opened the rear gate and sprinted across his deck, barely large enough for an outdoor grill and two small chairs. He headed straight for the refrigerator, grabbed a beer, and flipped on the television from a leather chair that no longer reclined. He had saved money by furnishing the unit himself, which meant loading his worn-out furniture and appliances into a U-Haul the same day he finished surgical residency at Vanderbilt before leaving Nashville.

  At least some things you can count on, he thought, watching a female meteorologist on the Weather Channel predicting highs near one hundred for the next three days and a humidity level about the same.Good ole Memphis summers.

  He changed to ESPN and caught the last minute of a beer commercial, a cold bottle snatched from a bucket of ice.Sports Center came on and highlighted the top ten plays of the day. He sipped from the can and watched a two-run, upper-deck homer, then a bone-slapping collision in the outfield with the left fielder snow-coning the ball.

  It’s never as good as the commercials. He swallowed the tepid brew from his outdated refrigerator that barely kept milk from spoiling.

  At nine A.M. he would meet with his chairman, Karl Fisher, head of the Department of Surgery. To support Eli’s goal of becoming a surgeon-scientist, Dr. Fisher would pour money into his laboratory as start-up funds while Eli applied for external grant money from the National

  Institutes of Health. Until then, patients would be diverted from Dr. Fisher’s practice to Eli’s clinic to provide a source of early income. Eli had barely started in this position and already he felt in debt, a tremendous pressure to see patients and operate successfully without complications while simultaneously conducting state-of-the-art molecular research.

  The layered structure of the medical school imposed many bosses to whom Eli would have to answer, from the president of the university to the Medical School dean and on down. But Dr. Fisher had recruited Eli, steering him away from the lure of high-income private practice offers and into the trench of academia, one that ran deeply in the Branch family, having been dug over the career of his father.

  Elizer Branch had been the medical school’s professor of anatomy for twenty-seven years before his death. That event, two years ago, had left Eli unmoored from the rock of his life. Although his father never complained about it, Eli knew the man felt isolated in the old anatomy building, an obscure anatomist on the fringe of the medical profession. And since Eli’s return to Memphis, no one had even mentioned his father. How soon the dead are forgotten.

  Although his father held none of the power or prestige of the physicians in the medical school, Eli had still distanced himself from the man, almost to the point of rebellion, to ensure that not a hint of favoritism or leniency was perceived by his fellow medical students. Toward the end, when his father lay ill and Eli was too busy to visit, he realized that his self-imposed distance had been costly to them both.

  In a few hours, after having witnessed the death of an old friend, Eli would watch the man being filleted open, his organs cut away one by one. Then he would attend the first official meeting with Chairman Fisher since his arrival at Gates Memorial. Possibly the most important meeting of his career.

  Eli turned off the television and walked into the kitchen where the day’s mail lay on the counter. The events of the evening still swirled in his head and he could not make sense of them. He knew that he wouldn’t be able to sleep.

  The mail consisted of two bills and a missing person card. He glanced at the age-progressed face of a ten-year-old girl next to another female he assumed was her mother. After twelve years in emergency rooms and indigent clinics, Eli always felt obligated to look.

  The first bill was a friendly note from his consolidated loan agency that reminded him, monthly, that he could no longer defer his medical school debt and must start payments now. With his new address, he had hoped for a month’s reprieve, but they had wasted no time in tracking him down. He slid the bill behind the coffeemaker, out of sight.

  Eli held the other envelope in front of him with both hands. He would pay this one before the Harbor Town management or his loan officer ever saw a dime. Along with the statement was a brief note.

  Dear Dr. Branch:

  This letter is addressed to you as legal caregiver of Henry L. Branch. As indicated in an earlier correspondence, you will notice an increase in the monthly dues. We trust you will understand that this allows us to give the best care to your loved one. Please note that this increase is in response to recent renovations of Green Hills State Home required by the State of Tennessee.

  Renovations? What, you decided to mop urine off the floor? Maybe got some soap for the bathrooms?

  Eli removed a check from the drawer, filled in the figure of $3,157, and slipped it into the enclosed envelope. He took the check out again to confirm that he had written the correct amount, signed it, and put it back in the envelope.

  The digital clock on the microwave showed almost three A.M. “This is crazy,” he said aloud as he inverted the beer can in the sink and climbed the stairs to a loft bedroom.

  As unrehearsed as breathing, he slid a pressed blue button-down shirt to the middle of the closet rack, then a pair of dark green slacks beside it. A pair of socks on the banister, underwear and tee shirt thrown on the bathroom counter. He selected his favorite tie, dark blue with a crisscrossing array of bright red diamonds. Eli reconsidered the meeting with Dr. Fisher as a time to look respectful, conservative, and needy. He replaced the flashy tie with a brown one, diagonal thin tan stripes, barely visible. He clicked the switch of his alarm, set to hard-driving classic rock at his standard 5:14 A.M., and lay on the bed. He imagined his meeting with Fisher, step by step.

  First, he would go to the pathology suite to follow-up on Gaston’s autopsy. Not good . He’d smell like the morgue when he shook hands with the boss. He dragged himself out of bed to get a pair of blue scrubs from the piled collection he had “borrowed” over the years from a dozen hospitals. He’d carry his real clothes in on a hanger and change after the autopsy.

  The beat of raindrops against the skylight kept pace as his mind raced through Gaston’s operation; his first operation as an attending surgeon at Gates Memorial.

  A stellar debut, he thought. One hundred percent mortality . His next ninety-nine patients would have to sail through their operations for him to achieve an acceptable mortality rate of 1 percent. It didn’t seem fair. Korinsky had called him in after it was too late. Given all the blood loss, Gaston had already crossed the line—a Wigger’s prep, his physiology teacher had called it, when a lab animal was bled to irreversible shock and could not survive.

  That’s it! That’s why Korinsky left the operation early. Some of the mystery surrounding the case was becoming clear.I would have to pronounce the time of death, and the mortality would be charged to my record. So that’s how it works in big-time academia.

  Lightning flashed over the skylight, closely followed by the rumble of thunder. The rising humidity smothered the loft and a sweaty shiver rippled over his skin.

  Gaston’s death was troubling beyond the mere fact that Eli knew him. It was the timing. The blood. Then the needle stick exposure of his intern and the sordid history of Gaston that Eli had never been able to get his mind around but was again forced to confront.

  But it was the device that most bothered him now.

  The failed device.

  Out of bed once more, his heart racing, Eli removed a dusty, oversized folder from behind the dresser. Of the hundreds of radiographs he had seen, he had a formidable aversion to viewing an X-ray from his own family. He slid a single film out of the jacket and turned on the reading light above his bed. Holding the newspaper-sized plastic sheet at the bottom with a cupped hand, he lifted it to the light. A sharp crack of thunder shook the house and the lights blinked off.

  Damn.

  Eli leaned back against the headboard. The cool pillow felt good again
st his neck and he thought of the girl in the baseball cap, of a pleated skirt that framed long brown legs. He wondered about the couples he’d seen inside the Chop House and what it would take to sustain a long-term relationship.

  At the next rumble, he raised the X-ray and the next flash through the skylight was enough to illuminate the metal device centered on the abdominal X-ray, confirming his suspicion in the OR. He closed his eyes and the bright outline of the device remained, as though burnt against his retina. He recalled Gaston’s X-ray from a few hours before and the configuration of the old man’s aortic device. When he looked again at the film in his hand, he realized that the two metallic devices were near identical.

  CHAPTER FIVE

  GATES MEMORIAL HOSPITAL

  PATHOLOGY DEPARTMENT MONDAY MORNING

  6:51 A.M.

  The floor was wet with a thin film of slime, as though moisture oozed from the concrete. Along the ceiling, rusty pipes twisted around a corner and led Eli down a long hall to a set of double glass doors. AUTOPSY was lettered on one, SUITE on the other. He hadn’t been to this part of the hospital since his second year as a medical student. He whispered the popular name for the place: “The dungeon.” It hadn’t changed a bit.

  He glanced at his watch and thought of Korinsky’s call.Maybe I’ll be surprised and he’ll be here too. Maybe he’ll delay his first case to attend the final ceremony of this patient, whom he knew so intensely yet so briefly.

  Not a chance.

  The doors reflected his image like a mirror, blue scrubs under a white coat. Carrying a hanger with his shirt over a pair of pants, he parted the doors and entered the void of the autopsy suite.

  The suite was no more than a square room with cheap wood paneling and rows of filing cabinets. The stringent smell of formalin flooded him with memories of Anatomy Hall. The noxious chemical had seeped from his skin and anointed his clothes during the entire first year. Before him sat an empty desk with a bulky computer and brass nameplate that signified Ms. Conch, the occupant.How, in a six hundred-bed hospital, with patients and families and visiting students, can a place exist so completely and absolutely alone?