Public Anatomy Read online

  Through those three years, however, only a handful of other medical students had stayed the fight. Faculty attendance and supervision at the clinic were scarce and infrequent. Most of the burden fell to the few dedicated students and Cate took on more than her share. While her classmates were kicking ass on specialty rotations so they could get the best residency spots, Cate signed on for two months of indigent clinic rotation, time she feared would be highly suspect as “unfocused” to most top-notch residency review committees.

  She peered through the dirt-speckled window. As a female, she felt frightened being alone while a mostly male group waited outside. But she knew that these were the people most in need of care and that she was the only one to provide it. She felt strangely comforted by the sight of Mary pushing her cart past the line, mumbling the select words that comprised her favored vocabulary.

  Mary Macklin had become an unsolicited assistant in the clinic early on after proclaiming that she had been a “full-blown” nurse in a previous life. Every day, she pushed herself past those waiting, as if she had risen above them, even though she was just as needy as they, if not more so.

  The clinic space occupied one large square room that led into a small break room, added on during the renovation, its pantry serving as a medical supply closet. Curtains hanging from the ceiling on sliding metal tracks provided the only privacy for a patient during an exam. A metal desk at the entrance marked the reception “triage.” Since the heat wave began, all who came—after receiving a number specifying the order in which they would be seen—got to wait in the luxury of air-conditioning.

  So far, the Poplar Avenue Free Clinic had been lucky and missed the rolling blackouts initiated across the city. Although the clinic lacked sophisticated equipment, surplus and slightly-out-of-date medical supplies had been donated from hospitals throughout Memphis. This outward act of benevolence definitely furthered the best interest of these hospitals if it succeeded in keeping just one more uninsured patient from adding to their already crowded emergency rooms. Cate’s clinic had IV fluids, antibiotics, and samples of antihypertensive medicines from generous pharmaceutical companies. Even the fire department had pitched in, donating an early model defibrillator. Cate thanked God she had not had to use it—yet.

  There were even a few pills of Viagra to hand out. Cate had sequestered this box in the back cabinet, consciously choosing not to take on erectile dysfunction as the clinic’s main medical mission. She shuddered to think of the consequences of resurrected sexual function in this group.

  Cate entered the break room to assess the dwindling supply of bottled water. She turned on the light and immediately noticed that a wicker basket had been placed on the table. A large plastic daisy projected over the handle with “Congratulations” stamped in the fluorescent yellow circle.

  Cate smiled at the basket’s wrapped goodies—two bags of Doritos, a Pay Day candy bar, a Butterfinger, and a giant frosted oatmeal cookie wrapped in cellophane. All the things you like to eat, she whispered, and laughed at her brother’s choice of health food. She had given her brother a key when he volunteered to do minor carpentry inside the clinic, which he completed late one night after work. Cate knew the basket was his way of acknowledging the stress she was under lately. He didn’t quite understand that she had been granted only an interview for a potential residency position in OB/GYN, not the position itself, even though the interview was for one of the premier programs in the country. She assumed he had dropped the basket off before dawn, coming through the back entrance so he could avoid “those people,” as he called them. At least her brother was around and still cared. They had each other, the only family left.

  Cate found a granola bar hidden at the bottom of the basket and she ate it quickly. She would hand out the rest of the food to the patients.

  Her peaceful one-minute breakfast was interrupted by the cymbal-like crash of a grocery cart knocking against the front door. “Get your nasty ass hands away from me.” Then, Cate heard an abrupt shift to the singsong voice of an angel, “Dr. Canavan, I’m here, open up.”

  Cate rushed from the break room to open the door. Mary’s off her meds again, she thought. This is going to be a wild day.

  As Mary banged her way into the clinic, she delivered her final greeting to those waiting, something about the ills of what she called Afro-Americana rap music.

  Her faded orange sundress stopped above her knees, revealing a fetching pair of brown lace-up boots. Cate noticed her legs had not been shaved in months.

  “They out there drinking that Colt 45 malt liquor is what they doing. Colt 45 malt liquor.”

  “It’s okay, Mary. Let them be for a minute.” Cate noticed that her cart was full. “What have you got there?”

  “Umbrellas. Bunches of them.”

  “I see that.”

  Umbrellas of all sizes and colors filled the grocery cart. All were used and had bare metal spokes sticking out. Mary removed one, opened it, and twirled it over her head like Mary Poppins.

  “Where did you get all these?”

  Mary smiled and curtsied. “From the garbage. There’s lots of garbage out now, you know?”

  Cate nodded. “Yes, I know.”

  “Figured we could sell them to folks, keep the sun off their backs.”

  Cate tried not to laugh. “We won’t sell the umbrellas, but I bet the patients will be most appreciative.” She pointed at Mary’s cart. “Pull it over here and we’ll get started.”

  When Cate turned back, Mary was using the umbrella like a cane to prop herself up. She looked very serious and asked, “You see that prego out there?”

  “Excuse me?”

  Mary dropped the umbrella and held both hands way out in front of her belly. “Big old fat prego. Probably been drinking Colt 45 malt liquor.”

  Through the front window, Cate saw Mary’s “prego.” Halfway down the line, a teenage girl stood with both hands on her distended abdomen. She was much too thin to be carrying a child. A sleeveless cotton blouse stretched over her gravid abdomen. She wore no bra. Definitely not maternity clothes, Cate thought. Probably no prenatal care either.

  One of the male patients circled the teen, gawking.

  “Those whore daddies out there did it to her, Dr. C. Guarantee.”

  Cate tried to ignore Mary. “The pregnant girl needs to be the first patient in,” Cate said. “I’ll finish setting up, but I need you to go out and get her.”

  The cart-pushing, blaspheming clinic nurse continued to stare out the window.

  “Mary,” Cate said, loud enough to get her attention, “I need you to do that for me.”

  Mary started for the door, pushing her cart in front of her.

  Cate grabbed the cart’s handle. “I’ll keep it here.”

  Reluctantly, Mary released the cart and walked outside.

  Relieved that there would be a few moments before the patient came inside, Cate needed time to think. A pregnant teenager no less. From the looks of her, she was well into her third trimester, possibly term. And likely suffering from dehydration, or worse, heatstroke. Even though Cate was just months away from starting her OB residency, this was a far cry from the controlled environment of the prenatal clinic or the delivery room.

  I’ll need to start an IV and give her fluids, Cate thought. Hopefully she’s not having contractions. Or in active labor.

  Her mental planning did not last long before she heard shouts from outside.

  “Let go of her, you pimp whore dog.”

  Cate ran to the front window. Mary had carried one of the umbrellas with her and was swinging at two men, who now cowered away from her.

  “Can’t you see she’s impregnated with child?”

  Cate knew she had to defuse the situation quickly. She had seen Mary on the wrong end of a fistfight before and it wasn’t pretty. She opened the clinic door. “We’re ready for the first appointment,” she said. She pointed to the young girl. “You’re right on time, sweetheart. Please come in.”
/>   Mary gave her a gentle slap on the bottom and the girl approached the clinic door.

  “Hey, why does she get to go in first?”

  “Yeah. My appointment was sooner than hers.”

  Cate held up both hands in surrender. “Everyone will have a turn, I promise.”

  There was some mumbling and cursing, but all returned to their places in line. Cate was young and only a student, but in this clinic she assumed an authoritative position and the patients responded. She knew they thought of her as their doctor.

  Inside, Mary tried to lead the patient to a stretcher, but the girl collapsed in a chair by the door instead. Cate knelt beside her and pinched the girl’s wrist to feel her pulse. She looked even younger close up. Sixteen. Maybe. Her pulse was rapid, her breathing shallow, eyes wild with fear.

  “What’s happening to me?”

  Cate placed her hand on the girl’s knee. Her skin was warm and dry. “You’re dehydrated. I need to start an IV.” As she said this, Cate glanced at the girl’s arms. Needle tracks pocked the inside bend on both sides.

  Mary noticed them too. “Colt 45 malt liquor and then some.”

  “My name is Cate. What’s yours?”

  “You’re not going to turn me in, are you?”

  “No,” Cate said and then waited for her to answer.

  “My name’s Deanna.”

  “I won’t turn you in, but you have to help us, Deanna. When’s the last time you shot up.”

  She looked down at her right arm where a fresh track lay red and infected. “I don’t know.”

  “Deanna, it’s important. This could hurt your baby.”

  The girl pushed Cate’s hand off her knee and stiffened up. “Baby? What baby?”

  Cate took Deanna’s hand and placed it on the most protuberant part of her abdomen. “Your baby.”

  The girl stood up abruptly, knocking Cate back. “Y’all go to hell, I ain’t got no baby.”

  Mary stepped forward, but Cate stopped her before she opened her mouth.

  From the sudden movement, Deanna was now light-headed and looked as if she might faint. She swayed back and forth like a tree in the wind.

  “Sit your ass down,” Mary said. She helped the girl by pushing on her shoulders. “That Colt 45 malt liquor done turned your baby into a snappin’ turtle.”

  Deanna heard none of this. Her eyes had rolled back, fluttering.

  “Mary, run to the break room and get me a cold washrag.”

  Mary shook her head and mumbled. “Turtle won’t let go till lightning strikes.” She made a song of it. “Turtle won’t let—”

  “Mary, please!”

  Mary waddled toward the break room and Cate grabbed an eighteen-gauge needle and a bag of saline. Not only was Deanna’s life in danger, but so was her baby’s. Dehydration would induce premature contractions and ultimately labor. The last thing Cate needed was a premature drug baby showing its head at the free clinic.

  With a closer look at Deanna’s abdomen, Cate estimated seven months. Eight at the most. The baby could possibly survive, even now, with the help of a neonatal ICU, and if it were not too deformed from all the drugs.

  Cate wrapped a tourniquet around Deanna’s arm and swabbed it with an alcohol wipe. The needle tracks were a daunting sign. Her veins had likely been all used up. She slapped the back of Deanna’s hand and a tiny but distended vein appeared. It was much too small for an eighteen-gauge needle so she chose a smaller twenty-two-gauge instead. All she needed was a bag of fluid hanging to keep her conscious on the way to the hospital.

  Mary returned with a heavily soaked towel and slung it around Deanna’s head like a turban.

  Cate got a flash of blood on the first pass and threaded the IV. She connected the bag and watched the fluid flow in. Deanna’s pulse was still rapid and weak. The way the girl sat, both legs flung apart, allowed Cate a quick and easy exam of her perineum. She raised the tattered hem of Deanna’s dress just enough to see thin bloody fluid smeared between her legs. From outside the clinic, Cate heard whooping and hollering and someone clapped behind her. Three male patients stood at the window, watching.

  Mary went on the attack. “Get y’alls nasty asses away from there.”

  Cate grabbed the basket her brother had left, went outside, and distributed the remaining food. While the patients were distracted by the snacks, Cate flipped open her cell phone and dialed the emergency room at Gates Memorial.

  The ER clerk answered her call, a cacophony of beeps and chatter in the background.

  “This is Cate Canavan. I need to transfer in a patient. She’s a—”

  “Hold, please.”

  Waiting for the chief resident on call to come to the phone, Cate reentered the clinic. Mary was holding the big frosted cookie to Deanna’s lips, trying to get the unconscious girl to eat.

  “Gates ER. Dr. Morris speaking.”

  “Hi, I’m a fourth-year student working at the free clinic.”

  The resident groaned. “This can’t be good.”

  “Young girl, pregnant. Needle tracks all over. No prenatal care. She’s really dehydrated. And blood-per-vagina.”

  Cate heard an audible sigh on the other end of the phone. “What a night. First, we had an open cardiac massage roll through the door, the doctor straddling the boy’s chest with balloons in his heart. Now, you call, with only thirty minutes left on my shift.”

  “She’s really sick, near unresponsive.”

  “How you getting her here?”

  “She needs an ambulance. Can you send one?”

  “I’ll call one, but the paramedics had a busy night. They’re back out on other calls. Might be a while.”

  Cate looked at Deanna. Her condition had worsened, each breath rapid and shallow. Even her black skin looked pale. If she had the baby here, it would likely not survive and the mother’s life would be in jeopardy as well.

  The chief resident added, “And someone will have to cover the cost, you know.”

  That did it.

  “Forget the ambulance. I’ll get her there myself.”

  “We’ll be ready for her, but I need the name of a transferring physician. Preferably an OB/GYN.”

  Cate knew this problem would eventually surface. The clinic had attending physician backup only half the time. The only name she could think of was Liza French. Dr. French had allowed Cate to list her in the clinic’s brochure although the gynecologist had never set foot in the clinic.

  “Dr. French is the admitting physician.”

  Cate hoped the ER shift had not yet been informed of the operative death. She wanted to forget the dreadful operation and was glad to be distracted by this sick patient.

  A few moments hesitation. “We were told Dr. French’s privileges have been suspended.”

  “Only her operative privileges,” Cate lied. “She can still admit to the hospital.”

  “Whatever, just get the girl here.”

  Mary helped Cate move the girl into the clinic’s only wheelchair. They rolled her to Cate’s car, a ’99 Ford Explorer that her mother had bought her in college. They laid Deanna in the backseat and Mary jumped in beside her. Reluctantly, Cate allowed Mary to ride along. The trip to the hospital would take less than ten minutes. It would take longer than that to get Mary out of the vehicle.

  Before speeding off toward Gates Memorial, Cate noticed that more patients had gathered outside the clinic. One of her classmates would arrive at eight o’clock, in less than an hour. Cate called out to the patients, promising them she would return.

  CHAPTER FOURTEEN

  Gates Memorial Hospital is a 554-bed, level one trauma center located in the heart of downtown Memphis. Gates provides tertiary care to a largely indigent population and brings the most complex procedures and operations to the city’s most ill. Memphis’s Knife and Gun Club contributes a steady annual supply of penetrating trauma cases to the hospital. These patients train residents and medical students across multiple disciplines of surgery and medicine at the
University of the Mid-South Medical Center each year.

  Although Gates Memorial is recognized for its trauma and critical care, the hospital boasts the most active OB department in the region, with over a thousand live births annually. Based on this volume, the medical school made financial commitments to support select innovative programs, the most noteworthy being Liza French’s Program of Robotic Surgery.

  Another program selected by the board of trustees was a research initiative called the Program of Molecular Oncology. The first recruit to this multimillion-dollar program had been Dr. Eli Branch, a young surgeon who’d just finished a near decade of surgical training and cancer research at Vanderbilt University.

  That was six months ago.

  Since then, Dr. Branch had become entangled with a corrupt biotech company, discovered that his own father had been involved in the illicit transactions, lost his research program after his lab assistant was murdered, and—most horrifying to a surgeon—had his left hand maimed in a knife fight.

  Through all this, his life was endangered, yet he was heralded a hero by those in the medical center because he had exposed the biotech company. The national media caught the story and suddenly Eli Branch became prime time.

  Everyone has fifteen minutes of fame, they say.

  Then it’s gone.

  Way gone.

  The media’s exposure of the biotech company and its ties to Gates Memorial was a little too much for the hospital’s administration. The discovery that his late father was coconspirator in the illegal operation had tarnished the once prominent name of Branch in the medical center. The day after the news broke, Eli had his Gates Memorial Hospital privileges revoked.

  This was the reason for the casual, just-a-visitor attire that Eli wore to “visit” the patient he’d brought to Gates Memorial just thirty-six hours earlier—his hand around the boy’s heart. Yet he knew hospital security would likely keep him from entering the hospital. Eli assumed that a memo, probably with the same photo used by the medical center newsletter that announced his recruitment, had been circulated to security and those with a need to know.