Free Lie Still by David Farris Page A

these terms. But if you could . . .”
    “No, of course you don’t. You wouldn’t. You let us worry about these technical things.”
    “But I’ll need to know . . .”
    “Well, we’ll see. We’ll need to get the angio today. This morning actually. It’s a dye study—X-rays of the head.
    With these things it’s best to let the brain recover somewhat. Cool off a couple of days. Stabilize. But there’s also 56
    DAVID FARRIS
    the risk of re-bleeds. We can’t wait too long. We generally go in at about day two or three to clip the aneurysm. It can be very touchy surgery but our success rate is pretty good.”
    It was obvious to me Ms. Roberts had not processed much of that. I was used to imperious professors but Abbie had not done the time. Mimi’s peremptory attitude would turn Abbie’s emotional shock into a turtlelike disappearance.
    I said, “The angiogram is a dye study. They inject an io-dine contrast—people call it a dye—into the arteries so the X-rays can show what they look like, and frequently it will show if there’s leaking—bleeding—too.”
    Ms. Roberts nodded, but Mimi shot me a withering You’re-wasting-my-time-again look.
    The thought flashed through my mind, Fuck it. Maybe I don’t want to be a surgeon. I gave Abbie another tissue.
    She asked Mimi, “But what do you think his chances are?
    I mean . . .”
    “He should make it.”
    “But will he be . . . He wouldn’t want to be . . .” She was sobbing too hard to finish. Mimi motioned to me we would leave.
    Ms. Roberts said, “But he’s never even been sick.”
    Mimi said, “We’ll talk more later.”
    At the nurse’s station she rattled off some orders for me to write: Admit to ICU. Neuro protocol vital signs. Nothing by mouth. Consent for cerebral angiography. Consent for a pressure-monitoring bolt in the skull. Stop the hyperventila-tion. She seemed agitated but said only, “I’ll be in my office,” and left.
    I found the forms for the consents and wrote for the new ventilator settings. I caught up with Mr. Coles and his wife as the ER nurse was pushing the stretcher out the automatic doors. The nurse was saying, “This is her specialty . . . ,” but stopped when I came in.
    I offered Ms. Roberts an apologetic smile. “Maybe I can fill in a few of the blank spots,” I said. She mustered a small smile in return.
    As I helped the nurse negotiate the gurney over the yel-LIE STILL
    57
    lowed carpet, up the ramp between buildings, and into the elevator, I explained to Ms. Roberts the procedure involved for an angiogram and what we expected to find. I said Dr.
    Lyle also wanted her consent for us to put into Keith’s head what we call a bolt—a device that screws into a small hole in the skull, through which we thread a thin catheter to measure the intracranial pressure, or ICP. “Because the brain is within a closed space,” I said, “any swelling—
    edema—of injured brain would raise the pressure inside the skull. If the pressure gets too high it can interfere with or even stop the blood flow to the brain.” I looked over my shoulder to see her face. She was staring. I wasn’t certain she had heard me.
    “And then what do you do?” she asked.
    “Then?”
    “If the pressure gets too high and there’s no blood flow.”
    “The plan, what we try to do, is know how the pressure is going. We can lower it, usually, with certain drugs or hyperventilation, for brief periods. Hyperventilation lowers the carbon dioxide in the blood, and the blood vessels in the brain constrict down. That lowers the pressure in the head.
    Blood can actually flow in better. Protects the perfusion pressure.”
    “Perfusion pressure. Blood pressure to the brain?”
    “Pretty much. Yeah.”
    “So the blood pressure can’t be too low?”
    “That’s part of it. The blood pressure has to be a certain amount greater than the pressure inside the skull or the blood flow will be too low. Or stop.”
    “So you’re looking at the pressure