Critical Judgment (1996) (5 page)

“Hang in there, Mr. Ives,” she said.

“Dr. Dolan, a woman just brought in her six-year-old girl with a nosebleed. It’s a gusher. I put them in three rather than the pedi room because the table and the light are better.”

“Perfect.”

“What do you want to do about him?”

Abby glanced at the three other patients she had yet to finish. Samuel Ives’s face was going to require several dozen carefully placed sutures. A good hour’s work.

“Call Dr. Bartholomew and ask him to see Mr. Ives,” she said. “Is the ENT tray in with the child?”

“On the counter.”

The girl’s nosebleed, like most such episodes, wasn’t as bad as it looked. The few that
were
as bad as they looked were absolute nightmares, as often as not ending up in intensive care, or the operating room, or both. But though the bleeding point in this child was higher than Abby would have liked, it was reachable. She was in the process of cauterizing it with a touch of silver nitrate when a shouting match began in room one.

“You know, you shouldn’t be marching into town looking like you do,” Martin Bartholomew was saying. “You scare the kids half to death.”

“You probably scare quite a few of them, yourself,” Ives countered.

“People like you feel society owes them,” the surgeon ranted on. “Feed me, clothe me, educate my children, take care of me when I’m sick.”

“I don’t have any children to educate.”

“And you don’t have any insurance, either. Do you think I’m going to get paid for sewing up these cuts of yours? Twenty years of school and training, my family’s home waiting dinner, and I’m here suturing this … this person who hasn’t taken a bath in months.”

“Years,” Ives said. “Listen, why don’t you just stop and go home? That’s what I’m going to do.”

“Hey, lie still! Dammit, lie still before I stick myself!”

“I’m getting out of here.”

Abby apologized to the girl and her mother, set the silver nitrate stick aside, and hurried to the door.

“Bud, would you please get them to stop this right away? Call security if you have to.”

She turned back to the child.

“These stitches need to come out in a week,” Bartholomew bellowed. “Come to the ER to have it done. I’m finished with you.”

Abby heard him storm out of the room. He had been with Ives for only twenty minutes, yet he was done. She
turned as he reached the doorway of room three. His puffed face was crimson, his eyes froglike.

“I’ll be home or on my beeper,” he said icily. “Thank you for the referral.”

He stalked off without waiting for a reply. Abby was reasonably sure, however, that
he
wouldn’t be called on the carpet in George Oleander’s office for his brusqueness to a colleague.

She put the finishing touches on a Vaseline pack in the six-year-old’s nose, went over the nosebleed instruction sheet with the mother, and discharged them to the waiting room for a precautionary half hour. Then she went into room one. Samuel Ives was off the litter, his back to her. He was gathering his things.

“Mr. Ives?” she said softly.

He turned, and instantly Abby felt her temper reach boiling point.

The sutures, probably 3-0 thickness rather than the much finer 6-0 or even 7-0 used for faces, were carelessly placed and tied in such a way that Ives’s skin was bunched. Why hadn’t the nurses let her know what was going on?

She took a deep, calming breath. Not only had Martin Bartholomew done a sophomoric job of suturing, but it appeared that no one had bothered undressing Ives to examine him for signs of less apparent injury.

Until we know someone, the
way
they say things is as important as what they have to say.… Practice being a little gentler on the staff.…

The world according to George Oleander. Abby forced herself to focus on the many kind, compassionate, intelligent, and professional things she had seen the nursing staff do over the weeks she had worked with them. It was really Bartholomew’s fault. He had set the tone in room one. He had invited the staff to bring in their distaste for people like Samuel Ives. She closed the door behind her.

“Mr. Ives, could you please lie back down?” she said. “I want to examine you a little bit more, and then I want to suture your face over again.”

For the second time Ives allowed his gaze to meet hers.

“No X rays,” he said.

She peeked out at the treatment bays. Another patient was being brought in. She closed the door again, got Lew Alvarez’s number from her clinic book, and called him. If he was free, could he possibly come in an hour early? She was already behind and was facing a complex suturing job. By their eight o’clock changeover, the place could be bedlam.

“Fifteen minutes,” Alvarez said, no questions asked.

Abby next called Bud Perlow at the nurses’ station. She would be in room one and did not need any help except for him to hold down the fort until Dr. Alvarez arrived. Oh, and one more thing. She would appreciate it if he told absolutely no one what she was doing.

Samuel Ives closed his eyes as she widened the narrow, shaved track Bartholomew had made in his beard. Then she cut away the sutures, numbed the edges of the lacerations once again, set a pair of magnifying glasses low on the bridge of her nose, and began a meticulous closure.

The repair took forty-five minutes. During that time not a word was exchanged between them. When the last knot had been tied and cut, Abby stepped back from the table, working the stiffness from her neck. She called it being “zoned.” For forty-five minutes her brain had been free of all extraneous thoughts. She had probably not moved any muscle except in her hands and forearms through the entire procedure.
Zoned
. It was a joy to have been there.

She unbuttoned Ives’s work shirt, which was heavy with drying blood. A more careful exam showed his chest and belly were free of discernible injury.

“Did they give you a tetanus shot?” she asked.

“They did.”

“These stitches can come out in five days. Just come in and find me. No need to check in at the desk. I’m going to have the nurse give you a shot of antibiotic and five days’ worth of pills. I’m also going to see if we can find you a shirt to wear home.”

“I’ve been having a little trouble with my leg,” Ives said. “Pick out some pills that will help that, too.”

Abby gloved once again, and with Ives’s help, lowered his fetid, bloodied jeans. The infection, covering five or six inches of his right shin, was long-standing and deep—undoubtedly deep enough to include the bone. Almost certainly chronic osteomyelitis, one of the most difficult, recalcitrant of all infections. She grimaced, not so much from the sight of the thick, raw inflammatory tissue, as from her knowledge of how difficult it was going to be to treat. Then she realized that he was watching her.

“How’d you do this?” she managed.

“A fall. I hit a rock.”

“When?”

“Two, three years ago.”

“And you can get around okay?”

“It hurts some.”

She sighed.

“Mr. Ives—”

“Just Ives. That’s what people I like call me. Ives.”

“Ives, this is a pretty deep and serious infection. I don’t know for sure if it’s gotten into the bone, and I have no idea what germ is causing it. But if we don’t treat it properly, sooner or later you’re going to get very sick from it. You could even lose your leg.”

“It really doesn’t bother me that much. How about just giving me some medicine now and—”

“It’s not that simple!” she snapped. She took another calming breath. Fatigue from the long, difficult day was catching up with her. She knew, especially after the debade
with Bartholomew, there wasn’t a chance in the world that Ives would ever willingly be an inpatient. “Ives, listen. Let me at least take a small biopsy to send off for culture and some slides. Then I’ll give you some intravenous antibiotics. Tomorrow I’ll talk to the infectious-disease person and one of the bone specialists. Okay?”

“I don’t—”

“Ives, please.”

“Okay, okay.”

“Thank you.”

She opened the door and, for the first time in an hour, reconnected with the rest of the ER. Lew Alvarez was writing prescriptions for the last of the patients. She stood some distance away and watched him converse with the woman in fluent, animated Spanish. His English, she had noticed, was accent free. She wondered which was his native language. He was forty or so, and handsomer than any man needed to be. His eyes were dark and lively, and his thick brows and mustache were offset by rich copper skin. Of all the physicians in the ER, he was the one she found the most interesting.

George Oleander’s description of him as excessively opinionated and not a team player did not easily fit the man she was watching—the man who had responded to her call for assistance without a single quibble.

He noticed her just as he was sending his patient away.

“Ta
da
!” he sang, motioning to the now-empty ER.

He moved toward her with a natural, easy grace. Regardless of what he had said about her to George Oleander, she could not imagine this man being intimidated by anyone.

“Thanks for coming in,” she said.

“No problem. I understand you’ve had a day of it. Diagnosing Cushing’s syndrome in the middle of a code. Hail to the chief.”

“It hasn’t been confirmed.”

“It will be. And now, in comes Sam Ives.”

“It’s just Ives, he says. He doesn’t like being called anything else.”

“He was a college professor at one time. Or at least so I’ve been told.”

Abby was instantly intrigued.

“Where? What’d he teach?”

Alvarez shrugged.

“No idea. A year or so ago he was looking for odd jobs, so I gave him some work on my farm. We never talked much. I don’t think he gets many offers. People around here are scared of him.”

“Has he ever hurt anyone?”

“Hardly. Just being out of the ordinary is all it takes around here, and he is certainly that.”

“One of the nurses said he lives in a cave.”

Alvarez laughed.

“His shack isn’t much. No electricity, no plumbing. But it’s not a cave.”

“He’s got chronic osteomyelitis on his anterior leg. He needs a surgical debridement and intensive antibiotic therapy. Maybe even a graft. Right now all he’ll allow me to do is a biopsy and some IV antibiotics. Want to help?”

“Sure, if there’s a chance something will rub off on me and I can diagnose Cushing’s during a code.”

Abby started to react to his sarcasm. But there was only warmth in his expression. He was teasing her, true, but not maliciously; he really was impressed. They got the biopsy kit and culture tubes ready, and set up an IV of powerful antibiotics. Then they brought them into room one.

Ives was gone. They checked the nearest bathrooms, but Abby knew he had skipped. She had come on too strong and frightened him away. Muttering curses at herself, she returned to the room.

Beneath the litter was the plastic possessions bag.
Abby dumped the contents out on the mattress. All it contained were sanded wood fragments—heads, torsos, and limbs of what might have been beautiful, delicately carved figures—and a well-worn copy of Conrad’s
Lord Jim
.

O
n the way home from Peking Pagoda, Abby ate an egg roll and half a carton of ribs. There was a time when she had smoked in response to stress—up to a pack a day of unfiltered Pall Malls. Soon after she’d given up cigarettes, she had found that, more and more, she was dealing with the people and events that upset her by drinking—only wine, and always top-shelf stuff. Eventually, she had felt obligated to limit her drinking to days when she wasn’t worried about something or angry with someone, a move that effectively kept her on the wagon most of the time. With little time or inclination for regular exercise or meditation, food became and remained her pacifier. And the ten pounds between her clothes fitting well and feeling tight became a battlefield.

Tonight, with Bill Tracy, George Oleander, Martin Bartholomew, Lew Alvarez, and Ives competing for headspace with Josh, she felt fortunate to make it home with any dinner left at all.

The house Josh had rented was a six-room, cedar-shingled ranch on the north side of town. The charm of the place came from its setting at the end of a wooded cul-de-sac at the base of the hills. Over the weeks she
had been living there, Abby had reconnected with her love of the outdoors.

The drive from the hospital to the house was about two miles, but she took a long way around, paralleling the north side of the valley, hoping she might catch up with Ives. By the time she pulled into their driveway, it was almost nine. The smell of cooking told her that Josh had decided not to wait for her to arrive home with their dinner.

“Honey, I’m home,” she called out, knowing that their gravel driveway made the announcement redundant.

His not coming out to the kitchen to meet her probably signaled another evening of tension. She paused by the back door for one more rib.

“In here,” he said.

As she passed through the kitchen, she noticed the bottle of pills on the counter. They were prescribed for Josh by the employees’ clinic at Colstar. Fioricet—headache medication with generic Tylenol, some caffeine, and a moderately strong sedative. At least he had gone to see someone. If he mentioned having a headache, fine. But she had started enough skirmishes by bringing the subject up herself. Not tonight.

He was on the couch in the living room, his favorite spot, eating some vegetable stir fry, watching a baseball game, and doing a crossword puzzle. Taken as an isolated freeze-frame, the scene looked incredibly normal. She bent over and hugged him from behind. Then she took off his glasses and inserted herself between him and the puzzle.

“In case you can’t tell,” she said from breath-mint range, “I’m a little starved for affection.”

He blinked as if he had just noticed she was there. Then he took her face in his hands and, for a moment, seemed to be peering at her through a fog. Even so, his blue-green eyes drew her in as they always had. Finally he responded to her closeness with a kiss, lips nearly
closed, eyes open. It was hardly an invitation to anything more intense, but for the moment she would take it.