Do No Harm

A Mexican woman quietly worked a mop across the lobby floor, bringing the tile to a polished shine. Behind her, a chemotherapy-bald boy ran out of the hospital gift shop, stuffing a stolen Snickers in his pocket. The hefty register lady thundered after him, all but shaking her fist.

Good for you, kid, David thought. Run, Forrest, run.

He trudged down to his car, passing a few security guards on the way, and headed lethargically for home. He was glad to see the news vans had finally cleared out. On to the next tragedy, the next big story. Just past San Vicente, David pulled into a corner Shell station, swiped his credit card through the slot, and started to fill up his tank.

While the gas pumped, he sat in the car, his mind playing through the cases of the day, picking at them from all angles to see if he'd made any mistakes. His mind kept returning to Diane, and from there, to Elisabeth.

There is no way to predict an embolus. A perfectly healthy thirty-five-year-old, not even into middle age, no family history of disease, no hypertension, no diabetes, no vascular disease. One day she throws a clot, it lodges in her basilar artery, and for seventeen crucial minutes the brain is denied blood. Seventeen crucial minutes are enough to suck a loving, intelligent woman dry of thought and emotion, to leave her a living husk. Sometimes it takes less time than that.

David had been the chief attending the night Elisabeth had been wheeled in-sick call on his birthday-so, knowing his medical judgment would be impaired, he'd let Don Lambert take lead. Of the first few hours in the ER, he remembered only scurrying bodies and the thick numbness of his tongue. Awhile later, his wife had lain in a limp recline upstairs in the MICU, the sheets humped over her inert body.

The pattern of her gown had been repetitious and infantile, pale blue snowflakes on a white background. David recalled certain images vividly-the drops of urine inching dumbly along her Foley catheter like items on an assembly line; the hum of the ventilator pushing air down the endotracheal tube and through the snarl of plastic into her throat; her thin gown wrinkling slightly as her chest rose and fell, rose and fell.

They'd EEG'd her promptly at David's request, his legs trembling beneath his scrubs. It had shown no activity at all, no wave forms. A still sea.

She'd been tracheotomied and G-tubed, the monitor showing sound vitals. Her body was stable. A perfect life-support system for a dead brain.

Elisabeth had signed a living will. David had maintained his composure, perhaps due to the fact that he was a physician practiced in high-intensity, emotional decision-making, but more likely because he'd seen too many times the other roads that lay ahead. They'd given him some time alone with her body before removing her from life support.

He'd sat in a typical bedside post-leaning forward in the padded chair, chin resting on the union of his fists. He remembered being struck anew by how different the MICU was from the sunken B Level of the ER, in which nurses and doctors scurried among the wounded like industrious ants. The unit exuded a calm, almost peaceful air. Here it was easy to forget that one moved among the sick and dying. The scents were better contained, the nurses more personable, the floors and walls better scrubbed.

Elisabeth's skin had been pale and smooth, like porcelain. Her arm had protruded from the papery cuff of her gown, her skin gray against the white sheets. Her simple wedding band provided the only stroke of color against her flesh.

David had flattened his hand across her forehead and studied her eyes, but he'd seen nothing in them but the faintest flicker of his own reflection. It had taken him only a few moments to determine that Elisabeth's presence did not reside in her body any more than it did in the hospital room.

He had not been moved to tears. He had not been sure what he'd been expecting, but it hadn't been the cold nothingness in his wife's eyes.

The neurologist had been waiting outside the door. He'd rested a hand on David's shoulder. "Are you ready?" he'd asked.

"I'm not going to stay," David had said.

The nurses and doctors on the floor had seemed surprised by how briskly he'd left.

As David had driven home, the first edge of morning had leaked over the horizon, imbuing the air with a dreamlike quality. He'd pulled into the garage, removed his shoes, and stood motionless in the foyer for a full minute.

It hadn't been until he'd walked down the long hallway and sat on their large empty bed that he'd broken down. His hands had started shaking first, then his arms, and then he'd wept softly and erratically, his wife's pillow pressed between his hands.