Michael Palmer - Flashback

He put the car in gear, turned around with more difficulty than usual, and sped down the winding drive. Frank would have an explanation, he thought. He would have an acceptable explanation for everything, and together they would find a reasonable way out. But if there was no explanation… if Frank had nothing to offer evcept greed… The Judge sped through the turn onto the Androscoggin access road. A station wagon speeding south swerved sharply, narrowly avoiding a collision. Clayton Iverson did not notice… Of all the ungrateful, inconsiderate things Frank had ever done, he was thinking, this was absolutely the worst…

Perhaps it was time he put his foot down… Prison or no prison, disgrace or no disgrace, perhaps it was time… His eyes open, but unseeing, Toby Nelms lay twitching on the cooling blanket, jerking one restrained hand from time to time in what might have been an attempt to get at the breathing tube Jack Pearl had inserted into his trachea. His core temperature, despite the blanket, intravenous cortisone, and several doses of rectally-administered lylenol, was still 103.

Absolutely not, " Pearl was saying. "There's absolutely no way I am going to put a critically ill child under anesthesia for some off-the all theory."

"Jack, let me go over this again, " Zack pleaded, making no attempt to mask his exasperation. "What I'm proposing is not off the wall. Just because it isn't a widely used technique doesn't mean that it's wrong.

Hell, the problem hasn't been studied enough to be certain one way or the other. But there is the LSD article. Why do you think I drove all the way home to get it from my files for you?"

"No way, " Pearl said. Suzanne joined the two other physicians at the bedside. For more than an hour she had been battling one flurry of irregular cardiac rhythms after another in the boy. Now, for the moment at least, the situation seemed to have stabilized, but the dusky shadows enveloping her eyes were mute testimony to the tension of the struggle.

"So, where do we stand? " she asked, sipping tepid coffee. Throughout the crisis she had made no overt reference to Zack's theories regarding Mainwaring and Pearl, although several times her expression had warned-or begged-him against any confrontation with the anesthesiologist. "Well, " Zack said, "we're right where we were before the arrhythmias started. Cerebral edema. Nothing more. Could be caused by the fever, could be the cause of it, could be both."

"Well, for what it's worth, his arrhythmias seem to be under control."

"It's worth plenty. Nice going."

"Thanks. So, have you two decided? Are you going to put the boy back to sleep?"

The two men exchanged glances. Then Pearl looked away. "Well, Jack,"

Zack said, "go ahead and tell her. Tell her what wetell her what you have decided. Look down at that child there, think about what I've told you, what I've shown you, and tell her."

"Zack, please, " Suzanne said. She turned to the anesthesiologist.

"Sorry," he mumbled. "Jack? " she asked. "I refuse to do it, " Pearl said simply. "The evidence that this child's anesthesia had anything to do with his present condition is flimsy enough by itself. Used as justification for a highly questionable maneuver, such as Iverson here is proposing, is absurd. I positively refuse to do it."

"Do what?"

Frank Iverson appeared near the foot of the bed. He glanced from one physician to the next and then, with some discomfort, at the thrashing boy. "Do what, Jack? " he asked again. "Frank, " Pearl said, "earlier in the week I filed an official report and complaint about a visit I had from your brother, here. At that time, he accused me of any number of things, including improperly anesthe izing this child."

"Why, that's ridiculous, " Zack said. "I never-"

"Zack, will you please let him finish… Thank you. Go ahead, Jack."

"Well, now the boy's got cerebral edema-that's brain swelling from God knows what. Maybe some form of encephalitis or something. Your brother has this theory that if this is some nervous system reaction to the anesthesia he received, my putting him under again with the same drugs might reverse the effect."

"And? " Frank said. "And I won't do it." why?"

"Why! Well, because it… it won't work, Frank. That's why."

"Zack, has this been done before?"

"In analogous circumstances, yes. I brought in an article describing the theory behind it."

"Then, Jack, " Frank said calmly, "what harm would it do to put this boy to sleep again as Zack is suggesting? You put critically injured and ill patients under all the time, don't you? "

"Well yes, but-"

"Suzanne, do you think this child would be able to handle being put to sleep?"

"I… well, his cardiac problems seem to have quieted down, and he is already on a ventilator, so actually, I don't see why not."

"But-"

"No buts, Jack. I'm sorry I didn't get over here sooner to discuss all this, but I was tied up trying to reach some people in Akron. Now listen. We're in the business of helping people. That's why we're here.

If there's a chance that what Zack is suggesting will help this kid, I think you should try it. My brother's a pain in the neck sometimes, but he's hardly foolhardy. If he says he has evidence, then by God, He's got evidence."

Witnessing the bizarre exchange from his spot by the head of Toby's bed, Zack sensed an intense nonverbal interplay occurring between his brother and the anesthesiologist. he could also tell from Pearl's expression that the strange little man was no longer going to object to administering the drugs. "What were the anesthe ics again? " Suzanne asked. "Peiitothal and isoflurane, " Pearl said. gil", yes. "Are you going to do it? " Zack asked. "How long do you think we'll have to keep him under?"

"Eight minutes. That's how long they did it in the article." Pearl glanced once again at Frank. "Okay, " he said unenthusiastically. "Give me a couple of minutes to get my equipment together."

"Good. I'll try and get this place set up." Zack leveled his gaze at the man. "Jack, whatever the kid got for that hernia of his, that's what he should get now. Understand?"

"He got Pentothal and isoflurane, " Pearl responded with exaggerated firmness. "Now, are we going to do this or not?"

"Suzanne?"

"No objections, " she said. "Okay, then. Let's go for it, " Zack said.

The eerie scene was one that nobody in the ICU that night would ever forget. Throughout the unit, all unnecessary lights were extinguished and every noncritical piece of equipment that produced a noise or vibration was shut off. Nurses sat silently and grimly beside their patients or by the nurses' station. In cubicle 7, the only lights were flashes of Zack's and Jack Pearl's small penlights and the shimmering monitor readouts of Toby Nelms's cardiac pattern and blood pressure.

Toby himself, anesthe ized first with Pentothal, and now with the gas, isoflurane, lay motionless and peaceful, his eyes patched and taped shut, his ears plugged with oil-soaked cotton and covered with bandages.

His feet were encased in lamb's wool. Two thin cotton blankets covered him on top, and the water-filled cooling blanket lay underneath him.

Zack had checked both the new, unopened vial of Pentothal and the label on the isoflurane tank before okaying their administration. Now, watch in hand, he sat to one side of the darkened cubicle, waiting. Jack Pearl's willingness to administer the two anesthe ics had dispelled some of his suspicions regarding an experimental drug, but doubt remained.

And even if this treatment was the right one, even if the anesthe ics were correct, even if Jack Pearl was as pure and honorable a physician as Galen, Zack knew they might have waited too long. Cerebral edema was, all too often, a one-way street. Five minutes, six… the time seemed endless… Blood pressure, ninety and holding, pulse 120… Seven minutes. Zack watched the last thirty seconds tick off, glancing over briefly at Suzanne, whose attention was riveted on the monitor screen.