Free Lie Still by David Farris Page B

difference.”
    “Uh-huh.”
    “And drugs can control it.”
    “Usually.”
    “And if they can’t?”
    “The injury to the brain extends.”
    She blinked. “More brain cells die.”
    “Uh-huh.” I was not being medically eloquent but we had resumed communicating.

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    DAVID FARRIS
    “Could the whole brain die?”
    “Not really. I mean it can, in the most extreme cases, usually through herniation, where the lower parts of the brain get squeezed down into the hole at the base of the skull, the foramen magnum, and all the blood flow around there stops.”
    “And then he would be brain dead?”
    “Yeah, that can happen. Or even just . . . dead.” “Expired”
    came to mind but we were beyond the usual euphemistic niceties. “That part of the brain controls the heart to a certain extent. But that’s not what will happen here. That usually only happens in the severe injuries, the really bad head traumas.”
    “So what’s going to happen in Keith’s case?” I offered a sympathetic frown. She went on, “I mean, the most likely things. What could happen.”
    “The cortex, the outer layer”—I was gesturing over the top of my head—“is the most vulnerable, the most sensitive.”
    “But that’s the most important, isn’t it?”
    “Well, the deeper parts control basic life functions. They keep us alive.”
    “But the cortex, the outer . . . the vulnerable part, that’s where we think and feel, right?”
    “Well, right.”
    “So if Keith loses his cortex, what would he want with basic life functions?”
    I nodded. “Well, I guess most people would see it that way.”
    There was a pause. She said, “He would see it that way. If his cortex is dead I want him off the machines.”
    “We think we can avoid that,” I said. It was all I could say, though I was not sure it was true.
    In the ICU she read over the consents and looked up at me, tearful. “Of course I’ll sign them. You’ve been kind to explain, but, really, how would I know?”
    After a silence I looked her in the eye and said, “We’re going to be doing everything that can be done. We’ll give him the best chances. He’s in the best of hands.”
    I meant it. I did not know better.

    LIE STILL
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    *
    *
    *
    Mimi was scribbling furiously on a yellow legal pad when I got to her office. I sat silently on the couch there and went through my note cards on the various patients admitted over the weekend: A pair of three-hundred-pound Hawaiians who had been drunk, sharing a large motorcycle, and turned in front of an even larger truck. A three-year-old admitted with an infection of her ventriculo-peritoneal shunt.
    Mimi said from out of nowhere, “You know, if she wants to assume the care of her husband it’s fucking fine with me. Four years of college, four years of medical school.
    Six years of residency, two years of fellowship. You’d think just once someone would be willing to take my word for something.”
    After a deep breath I ventured, “Well, I went through some of the stuff in detail with Mrs. Coles—Roberts, I mean. She’s really pretty sharp. And scared, of course.”
    “Don’t let her run you around. You’re the doctor.”
    I bit my lip—the proper response of a junior resident.
    Maybe she was showing me what it took to be a surgeon.
    Maybe I wouldn’t make it.
    In those days ICP bolts were done in the OR, not the ICU.
    This meant someone—someone low on the totem pole—
    had to move Mr. Coles’s bed, monitors, IV pumps, ventilator, drainage bags, and body, as a unit, down some halls, around some corners, through some doors, into and out of an elevator, and dock them softly against an OR table. Hallways, corners, and elevators have a surprising ability to reach out and disconnect the critically ill from their life-support devices.
    I was in the ICU when the OR team came for Mr. Coles.
    A tall, quiet OR nurse and an anesthesiologist I thought I recognized, an elfin man with spindly fingers and a naso-whiny Brooklyn