When the Bough Breaks (27 page)

I wore my white coat and hospital badge and carried my briefcase as the automatic doors allowed me through and the sixtyish, red-nosed guard nodded as I passed:

“Morning, Doctor.”

I rode the elevator to the basement along with a despondent black couple in their thirties and their son, a withered, gray-skinned nine-year-old in a wheelchair. At the mezzanine we were joined by a lab tech, a fat girl carrying a basket of syringes, needles, rubber tubing and glass cylinders full of the ruby syrup of life. The parents of the boy in the wheelchair looked longingly at the blood; the child turned his head to the wall.

The ride ended with a bump. We were disgorged into a dingy yellow corridor. The other passengers turned right, toward the lab. I went the other way, came to a door marked “Medical Records,” opened it and went in.

Nothing had changed since I’d left. I had to turn sideways to get through the narrow aisle carved into the floor-to-ceiling stacks of charts. No computer here, no high tech attempt at organizing the tens of thousands of dog-eared manila files into a coherent system. Hospitals are conservative institutions, and Western Pediatric was the most stodgy of hospitals, welcoming progress the way a dog welcomes the mange.

At the end of the aisle was a unadorned gray wall. Just in front of it sat a sleepy-looking Filipino girl, reading a glamor magazine.

“May I help you?”

“Yes. I’m Dr. Delaware. I need to get hold of a chart of a patient of mine.”

“You could have your secretary call us, Doctor, and we’d send it to you.”

Sure. In two weeks.

“I appreciate that, but I need to look at it right now and my secretary’s not here yet.”

“What’s the patient’s name?”

“Adams. Brian Adams.” The room was divided alphabetically. I picked a name that would take her to the far end of the A-K section.

“If you’ll just fill out this form, I’ll get it right for you.”

I filled out the form, falsifying with ease. She didn’t bother to look at it and dropped it into a metal filebox. When she was gone, hidden between the stacks, I went to the L-Z side of the room, searched among the N’s and found what I was looking for. I slipped it into my briefcase and returned.

She came back minutes later.

“I’ve got three Brian Adamses, here, Doctor. Which one is it?”

I scanned the three and picked one at random.

“This is it.”

“If you sign this”—she held out a second form—“I can let you have it on twenty-four-hour loan.”

“There’ll be no need for that. I’ll just examine it here.”

I made a show of looking scholarly, leafed through the medical history of Brian Adams, age eleven, admitted for a routine tonsillectomy five years previously, clucked my tongue, shook my head, jotted down some meaningless notes, and gave it back to her.

“Thanks. You’ve been most helpful.”

She didn’t answer, having already returned to the world of cosmetic camouflage and clothing designed for the sado-intellectual set.

I found an empty conference room down the hall next to the morgue, locked the door from the inside and sat down to examine the final chronicles of Cary Nemeth.

The boy had spent the last twenty-two hours of his life in the Intensive Care Unit at Western Pediatric, not a second of it in a conscious state. From a medical point of view it was open and shut: hopeless. The admitting intern had kept his notes factual and objective, labeling it Auto versus Pedestrian, in the quaint lexicon of medicine that makes tragedy sound like a sporting event.

He’d been brought in by ambulance, battered, crushed, skull shredded, all but his most rudimentary bodily functions gone. Yet thousands of dollars had been spent delaying the inevitable, and enough pages had been filled to create a medical chart the size of a textbook. I leafed through them: nursing notes, with their compulsive accounting of intake and output, the child reduced to cubic centimeters of fluid and plumbing; ICU graphs, progress notes—that was a cruel joke—consultations from neurosurgeons, neurologists, nephrologists, radiologists, cardiologists; blood tests, X-rays, scans, shunts, sutures, intravenous feedings, parenteral nutritional supplements, respiratory therapy, and, finally, the autopsy.

Stapled to the back inside cover was the sheriff’s report, another example of jargonistic reductionism. In this equally precious dialect, Cary Nemeth was V, for Victim.

V had been hit from behind while walking down Malibu Canyon Road just before midnight. He’d been barefoot, wearing pajamas—yellow, the report was careful to note. There were no skid marks, leading the reporting deputy to conclude that he’d been hit at full force. From the distance the body traveled, the estimated speed of the vehicle was between forty and fifty miles per hour.

The rest was paperwork, a cardboard snack for some downtown computer.

It was a depressing document. Nothing in it surprised me. Not even the fact that Cary Nemeth’s private pediatrician of record, the physician who’d actually signed the death report, was Lionel Willard Towle, M.D.

I left the chart stuck under a stack of X-ray plates and walked toward the elevator. Two eleven-year-olds had escaped from the ward and were waging a wheelchair drag race. They whooped by, I.V. tubing looping like lariats, and I had to swerve to avoid them.

I reached for the elevator button and heard my name called.

“H’lo, Alex!”

It was the medical director, chatting with a pair of interns. He dismissed them and walked my way.

“Hello, Henry.”

He’d put on a few pounds since I’d last seen him, jowls fighting the confines of his shirt collar. His complexion was unhealthily florid. Three cigars stuck out of his breast pocket.

“What a coincidence,” he said, giving me a soft hand. “I was just about to call you.”

“Really? What about?”

“Let’s talk in the office.”

He closed the door and scurried behind his desk.

“How’ve you been, son?”

“Just fine.” Dad.

“Good, good.” He took a cigar out of his pocket and made masturbatory motions up and down the cellophane wrapper. “I’m not going to beat around the bush, Alex. You know that’s not my way—always come right out and say what’s on your mind is my philosophy. Let people know where you stand.”

“Please do.”

“Yes. Hmm. I’ll come out and say it.” He leaned forward, either about to retch or preparing to impart some grave confidence. “I’ve—we’ve received a complaint about your professional conduct.”

He sat back, pleasurably expectant, a boy waiting for a firecracker to explode.

“Will Towle?”

His eyebrows shot skyward. There were no fireworks up there, so they came back down again.

“You know?”

“Call it a good guess.”

“Yes, well, you’re correct. He’s up in arms about some hypnotizing you’ve done or some such nonsense.”

“He’s full of shit, Henry.”

His fingers fumbled with the cellophane. I wondered how long it had been since he’d done surgery. “I understand your point; however Will Towle is an important man, not to be taken lightly. He’s demanding an investigation, some kind of—”

“Witch hunt?”

“You’re not making this any easier, young man.”

“I’m not beholden to Towle or anyone else. I’m retired, Henry, or have you forgotten that? Check the last time I received my salary.”

“That’s not the point—”

“The point is, Henry, if Towle has a gripe against me, let him bring it up before the State Board. I’m prepared to swap accusations. I guarantee it will be an educational experience for all concerned.”

He smiled unctuously.

“I like you, Alex. I’m telling you this to warn you.”

“Warn me of what?”

“Will Towle’s family has donated hundreds of thousands of dollars to this hospital. They may very well have paid for the chair you’re sitting on.”

I stood up.

“Thanks for the warning.”

His little eyes hardened. The cigar snapped between his fingers, showering the desk with shreds of tobacco. He looked down at his lost pacifier and for a moment I thought he’d break into tears. He’d be great fun on the analyst’s couch.

“You’re not as independent as you think you are. There’s the matter of your staff privileges.”

“Are you telling me that because Will Towle complained about me I’m in danger of losing my right to practice here?”

“I’m saying: Don’t make waves. Call Will, make amends. He’s not a bad fellow. In fact the two of you should have a lot in common. He’s an expert in-”

“Behavioral Pediatrics. I know. Henry, I’ve heard his tune and we don’t play in the same band.”

“Remember this, Alex—the status of psychologists on the medical staff has always been tenuous.”

An old speech came to mind. Something about the importance of the human factor and how it interfaced with modern medicine. I considered throwing it back in his face. Then I looked at his face and decided nothing could help it.

“Is that it?”

He had nothing to say. His type seldom does, when the conversation gets beyond platitudes, entendres, or threats.

“Good day, Doctor Delaware,” he said.

I left quietly, closing the door behind me.

I was down in the lobby, which had cleared of patients and was now filled with a group of visitors from some ladies’ volunteer group. The ladies had old money and good breeding written all over their handsome faces—sorority girls grown up. They listened raptly as an
administration lackey gave them a prefabricated spiel about how the hospital was in the forefront of medical and humanitarian progress for children, nodding their heads, trying not to show their anxiety.

The lackey prattled on about children being the resources of the future. All that came to my mind was young bones ground up as grist for someone’s mill.

I turned and walked back to the elevator.

The third floor of the hospital housed the bulk of the administrative offices, which were shaped in an inverted T, paneled in dark wood, and carpeted in something the color and consistency of moss. The medical staff office was situated at the bottom of the stem of the T, in a glass-walled suite with a view of the Hollywood Hills. The elegant blonde behind the desk was someone I hadn’t counted upon seeing, but I straightened my tie and went in.

She looked up, contemplated not recognizing me, then thought better of it and gave me a regal smile. She extended her hand with the imperious manner of someone who’d been at the same job long enough to harbor illusions of irreplaceability.

“Good morning, Alex.”

Her nails were long and thickly coated with mother-of-pearl polish, as if she’d plundered the depths of the ocean for the sake of vanity. I took the hand and handled it with the care it cried out for.

“Cora.”

“How nice to see you again. It’s been a long time.”

“Yes it has.”

“Are you returning to us—I’d heard you resigned.”

“No, I’m not, and yes, I did.”

“Enjoying your freedom?” She favored me with another smile. Her hair looked blonder, coarser, her figure fuller, but still first-rate, packed into a chartreuse knit that would have intimidated someone of less heroic proportions.

“I am. And you?”

“Doing the same old thing,” she sighed.

“And doing it well, I’m sure.”

For a moment I thought the flattery was a mistake. Her face hardened and grew a few new wrinkles.

“We know,” I went on, “who really keeps things together around here.”

“Oh, go on.” She flexed her hand like an abalone-tipped fan.

“It sure ain’t the doctors.” I resisted calling her Ol’ Buddy.

“Ain’t that the truth. Amazing what twenty years of education won’t give you in the way of common sense. I’m just a wage slave but I know which end is up.”

“I’m sure you could never be anyone’s slave, Cora.”

“Well, I don’t know.” Lashes as thick and dark as raven feathers lowered coquettishly.

She was in her early forties and under the merciless fluorescent lighting of the office every year showed. But she was well put together, with good features, one of those women who retain the form of youth but not the texture. Once, centuries ago, she’d seemed girlish, hearty and athletic, as we’d thrashed around the floor of the medical records office. It had been a one-shot deal, followed by mutual boycott. Now she was flirting, her memory cleansed by the passage of time.

“Have they been treating you okay?” I asked.

“As well as can be expected. You know how doctors are.”

I grinned.

“I’m a fixture,” she said. “If they ever move the office, they’ll pick me up with the furniture.”

I looked up and down her body.

“I don’t think anyone could mistake you for furniture.”

She laughed nervously and touched her hair self-consciously.

“Thanks.” Self-scrutiny became too unsettling and she put me in the spotlight.

“What brings you down here?”

“Tying up loose ends—a few unfinished charts, paperwork. I’ve been careless about answering my mail. I thought I received a notice about overdue staff dues.”

“I don’t remember sending you one but it could have been one of the other girls. I was out for a month. Had surgery.”

“I’m sorry to hear that, Cora. Is everything all right?”

“Female troubles.” She smiled. “They say I’m fine.” Her expression said that she thought “they” were abject liars.

“I’m glad.”

We locked gazes. For just a moment she looked twenty, innocent and hopeful. She turned her back to me, as if wanting to preserve that image in my mind.

“Let me check your file.”

She got up and slid open the drawer of a black-lacquered file cabinet, and came up with a blue folder.

“No,” she said, “you’re all paid up. You’ll be getting a notice for next year in a couple of months.”

“Thanks.”

“Don’t mention it.”

She returned the folder.

“How about a cup of coffee?” I asked casually.

She looked at me, then at her watch.

“I’m not due for a break until ten, but what the hell, live it up, huh?”

“Right.”

“Let me go to the little girls’ room and freshen up.” She fluffed her hair, picked up her purse and left the office to go into the lavatory across the hall.