Michael Palmer - Flashback

Slowly, the dim light in the room faded, and Annie felt a merciful, peaceful darkness settle in. The night was heavy-overcast and humid, with not quite enough breeze for comfort. It was nearing eleven when Zack eased the Judge's Chrysler into the largely empty parking lot outside the Ultramed-Davis emergency ward. The Judge, hands folded stoically in his lap, sat next to him. His mother, grim and silent, rode in the backseat, working over the handleerchief she had balled in her fists. Annie Doucette was in trouble. Zack would have much preferred to evaluate the woman's situation before involving his parents, but a well-meaning nurse, unable to reach Annie's son in Connecticut, had noted that they were listed in her record as "employer, " and had called them. A fractured hip and new coronary were the only snatches a shaken Cinnie Iverson could remember to repeat to Zack from that conversation.

"Zachary, dear, " she said now, as he helped her from the car, "do you think they'll operate on her tonight?"

"I don't know, Mom. It's doubtful, though. Especially if the nurse I spoke to is right about her having had a new heart attack."

"Her doctor-what is his name?"

"Norman, Mom. Don Norman."

"Dr. Norman. Did you speak to him?"

"He was in working on Annie. I didn't see any sense in bothering him."

"And did Frank say he'd be right in?"

"Yes, Mom. He's waiting for Lisette to get back from her sister's, and then he'll be in."

Cinnie gave her handleerchief one last squeeze and then stuffed it in her purse. "Well, " she said, "I just hope Annie's okay."

"Okay?"

Clayton Iverson laughed disdainfully. "Jesus, Cynthia, what world do you live in? The woman's almost eighty years old and she just fell out of bed, broke her hip, and had a heart attack. How in the hell could you possibly think she'd be okay?"

"Sorry, " Cinnie said. "There's no need to cuss, " she added in a whisper directed more to herself than to her husband. They entered the hospital through the emergency ward and took the elevator to the second floor. Annie had been moved back to the intensive care unit. I "Why don't you two wait in there, " Zack said, motioning them into the small waiting room just outside the unit. "I'll be back as soon as I find out what's going on."

Anger and tension had knotted the muscles at the base of his neck and were gnawing at the pit of his stomach. To be sure, over the years of his training he had had patients fall out of bed, even when strict precautions had been taken. The risk was always there, especially with so many hospitalized patients being old and infirm.

But this situation was different. Since he was a consultant on her case, Annie Doucette was, technically, his patient, but even more than that, she was his friend. In some ways she had been as much a parent to him as had Cinnie and the Judge. And even beyond that, he knew, was the special, proprietary feeling experienced by every physician toward a patient whose life he or she had saved. He was on edge, his physician's detachment and objectivity hanging by the thinnest of threads. From the moment Cinnie had called him with the news, he had been reminding himself that, while it was reasonable for him to be upset, there was seldom, if ever, justification for a physician to lose objectivity-even when confronting oversight or negligence. In the microcosm of the hospital, explosions by physicians helped no one. As he was heading into the unit, Sam Christian, one of three staff orthopedic surgeons, emerged. He was a tall, gaunt man, in his mid-fifties, who walked with a slight limp. Twenty-two years before, Zack and his mangled left knee had been one of his first cases. "Evening, Zack, " he said, He glanced into the small waiting room. "Judge, Cinnie."

"Hello, Sam." The Judge came out to shake his hand. "What's the story?"

Christian shrugged. "She needs a new hip, " he said matter-of-factty.

"But until her cardiac situation gets straightened out, that's out of the question. Tomorrow, if she's still-I mean, if she's settled down, I'll put some pins across the joint to stabilize it until we can do something definitive."

"Do you know what happened? " Zack asked. "Were the side rails up on her bed?"

Christian's expression darkened. "You'd best talk to Don Norman about all that. But yes, apparently the railings were up. She went off the end."

"Oh, dear God, " Cinnie gasped. "Thanks, Sam," Zack said. He turned to his parents. "I'll be out in a little bit."

As he entered the unit he heard the Judge say, "So, Sam, level with me, now. Who screwed up here?"

Zack had seen Annie briefly during morning rounds. At that time, she was awake and responsive, but somewhat depressed and more lethargic than she had been. He suggested that she try spending more time out of bed, and had actually offered to walk down the hall with her. She refused, citing a headache and lack of sleep. The change in her over just fourteen hours, even allowing for her accident, was terrifying. She was disoriented and combative, her speech was thick and slurred. Her gray hair was matted against her scalp with perspiration and bits of feces.

From the doorway, Zack watched as Don Norman struggled to examine Annie's chest. The portly internist had stripped off his suitcoat and rolled up his shirt-sleeves, but he was still wearing his tie, vest, and gold watch fob. Beads of sweat dotted his fleshy forehead and upper lip.

A young nurse stood off to one side, her face drawn and pale. "Need an extra pair of hands? " Zack asked as Norman stepped back from the bed.

The man looked down at Annie and then shook his head. "No, thank you, Doctor, " he said. "I'm just about done."

"She okay?"

"If you mean is she going to die, the answer is no… at least not tonight. Since we got a line in and gave her some fluid, her pressure has come up. But she's extended her old coronary. There's not much question about that. And I guess you know that she's fractured her hip."

She's extended her coronary. She's fractured her hip. Norman's emotionless statement-his tacit implication that Annie was responsible for her own misfortune-instantly rekindled the dislike Zack had developed toward the man during their interview many months before.

Still, there could be no arguing the truth in his grim assessment of her situation and prognosis. Pneumonia, stroke, embolism, heart failure, while orthopedists could work near-miracles with hips in the operating room, physicians and nurses knew all too well that immobilization of any sort was the deadliest enemy of advancing age. Zack moved to within two feet of the bed. "Is she making any sense?"

"Nope. Strictly word salad."

"Stroke? "

"I don't think so."

"Is there any evidence she hit her head?"

Norman shifted uncomfortably. cci. I haven't really checked," he said.

"As you can see, she's not the easiest thing in the world to examine right now."

"Mind if I try?"

"Try anything you want, " Norman responded somewhat testily. Then he glanced over at the nurse. Zack caught the look and warned himself against doing anything that would embarrass the man. He took Annie's hand. Instantly, she dug her nails into his palm. "Hey, Annie D, leggo!

It's me. It's Zack. I need that hand for my coin tricks."

She looked up at him, blinking as if struggling to peer through a haze.

Then, slowly, she loosened her grip. "Do you recognize me?" Zack said, already speeding through a neurologic exam. Annie did not respond.

"Well, you should." He checked her scalp for any telltale lumps, and her neck for any points of tenderness. "You used to wipe my runny nose and drag me back to the bathroom to wash behind my ears. Remember that?"

Although it remained uncertain whether or not Annie recognized him, there could be no doubt that his words had calmed her down. She lay reasonably still as he checked her eardrums and retinae. "Well?" Norman asked. His arms were folded tightly across his chest. Zack smoothed Annie's matted hair off her forehead. "There are — no focal neurologic signs. Let's go out to the nurses' station and talk, ekay?"