Procedure

Chapter 1 Five weeks earlier: Tuesday, October 12, 7:00 a.m. The sight of those tiny human remains spread out before us on the dissecting tray staggered me despite my knowing what to expect. The pink unspoiled lungs, a maroon heart, the small ocher-colored liver, and a spleen the size of a beetall gleaming under the overhead lightlooked new enough to hold the promise of a lifetime's use. But the brain, no bigger than my fist, was covered by a thick mesh of crimson streaks. These fanned out over its surface and obscured the tightly coiled ridges and grooves underneath to the point that I couldn't see their normal beige, gray, and yellow-white coloration. And the kidneys were so speckled with angry red blotches that a layperson would have thought someone had spattered them with paint. From the silence of the other physicians and residents in the room, I'd deduced that everyone was struggling as much as I was to remain clinically detached. Not even the voice of the presenting pathologist, normally our guide to at least make scientific sense out of a death, could ever begin to explain why this child had died. Instead the words simply floated over me, like a Muzak of medical terminology, and consigned themselves to the back of my mind. ". . . the inflamed meninges, the characteristic pattern of hemorrhagic petechiae on the surface of the kidneys, and the rapidity of the catastrophic process . . ." When I examined the brain, holding it in the palm of my hand I could barely feel its weight through the latex gloves that I'd pulled on in order to inspect the specimens. ". . . the mother noticed symptoms attributable to an upper respiratory infection the day before. The baby was irritable, off his food, crying, and had a mild temperature. She gave him an appropriate dose of acetaminophen, attempted to keep him hydrated with juice . . ." His name had been Robert Delany, and it was a week ago that his life had ended at eighteen months of age in our emergency department. ". . . she telephoned the after-hours number of her health maintenance organization, as it was late in the evening, but the HMO's triage nurse told her that the child probably only had a cold and could safely wait until morning to be seen. Yet the boy continued to cry, his fever remained elevated at a hundred and three despite the acetaminophen, and after a few hours the mother once more contacted her clinic. Again she was told that the baby most likely had the flu and that she should bring him over only in the morning. When the mother suggested taking the baby to Emergency that night, she was told she could if she wished, but since the illness seemed minor, payment wouldn't be preauthorized at any more than the rate of an office visit. . . ." The balance of the cost, potentially a thousand dollars if a zealous resident did a battery of tests, they had told her, would not necessarily be covered. As a result she delayed several more hours, until the child had started to seize. The images of what had happened then, after he arrived in ER, haunted me still. We'd been like giants gathered around his tiny form while his limbs jerked with the repetitive rhythm of a grand mal convulsion. He'd had no respirations, his pressure had been unobtainable, and his heart rate was slowing into single digits. "Bag him!" "His jaw's clamped shut." "Anybody got a line?" His eyes had kept flicking to one side, keeping time with the grotesque dance gripping the rest of him. His skin color, already blue from lack of oxygen, had quickly darClement, Peter is the author of 'Procedure', published 2001 under ISBN 9780345482822 and ISBN 0345482824.