When The Bough Breaks

Nothing had changed since I'd left. I had to turn sideways to get through the narrow aisle carved into the floor - to - ceiling stacks of charts. No computer here, no high - tech attempt at organizing the tens of thousands of dog - eared manila files into a coherent system. Hospitals are conservative institutions, and Western Pediatric was the most stodgy of hospitals, welcoming progress the way a dog welcomes the mange.

At the end of the aisle was an unadorned gray wall. Just in front of it sat a sleepy - looking Filipino girl, reading a glamor magazine.

"May I help you?"

"Yes. I'm Dr. Delaware. I need to get hold of a chart of a patient of mine."

"You could have your secretary call us, Doctor, and we'd send it to you."

Sure. In two weeks.

"I appreciate that, but I need to look at it right now and my secretary's not here yet."

"What's the patient's name?"

"Adams. Brian Adams." The room was divided alphabetically. I picked a name that would take her to the far end of the A - K section.

"If you'll just fill out this form, I'll get it right for you."

I filled out the form, falsifying with ease. She didn't bother to look at it and dropped it into a metal file box When she was gone, hidden between the stacks, I went to the L - Z side of the room, searched among the Us and found what I was looking for. I slipped it into my briefcase and returned.

She came back minutes later.

"I've got three Brian Adamses, here, Doctor. Which one is it?"

I scanned the three and picked one at random.

"This is it."

"If you sign this" - she held out a second form - "I can let you have it on twenty - four - hour loan."

"There'll be no need for that. I'll just examine it here."

I made a show of looking scholarly, leafed through the medical history of Brian Adams, age eleven, admitted for a routine tonsillectomy five years previously, clucked my tongue, shook my head, jotted down some meaningless notes, and gave it back to her.

"Thanks. You've been most helpful."

She didn't answer, having already returned to the world of cosmetic camouflage and clothing designed for the sado - intellectual set.

I found an empty conference room down the hall next to the morgue, locked the door from the inside and sat down to examine the final chronicles of Gary Nemeth.

The boy had spent the last twenty - two hours of his life in the Intensive Care Unit at Western Pediatric, not a second of it in a conscious state. From a medical point of view it was open and shut: hopeless. The admitting intern had kept his notes factual and objective, labeling it Auto versus Pedestrian, in the quaint lexicon of medicine that makes tragedy sound like a sporting event.

He'd been brought in by ambulance, battered, crushed, skull shredded, all but his most rudimentary bodily functions gone. Yet thousands of dollars had been spent delaying the inevitable, and enough pages had been filled to create a medical chart the size of a textbook. I leafed through them: nursing notes, with their compulsive accounting of intake and output, the child reduced to cubic centimeters of fluid and plumbing: I.C.U graphs, progress notes - that was a cruel joke - consultations from neuro surgeons neurologists, nephrologists, radiologists, cardiologists; blood tests, X rays, scans, shunts, sutures, intravenous feedings, parenteral nutritional supplements, respiratory therapy, and, finally, the autopsy.

Stapled to the back inside cover was the sheriff's report, another example of jargonistic reductionism. In this equally precious dialect, Carey Nemeth was V, for Victim.

V had been hit from behind while walking down Malibu Canyon Road just before midnight. He'd been barefoot, wearing pajamas - yellow, the report was careful to note. There were no skid marks, leading the reporting deputy to conclude that he'd been hit at full force. From the distance the body traveled, the estimated speed of the vehicle was between forty and fifty miles per hour.

The rest was paperwork, a cardboard snack for some downtown computer.

It was a depressing document. Nothing in it surprised me. Not even the fact that Gary Nemeth's private pediatrician of record, the physician who'd actually signed the death report, was Lionel Willard Towle, M.D.

I left the chart stuck under a stack of X - ray plates and walked toward the elevator. Two eleven - year - olds had escaped from the ward and were waging a wheelchair drag race. They whooped by, IV. tubing looping like lariats, and I had to swerve to avoid them.

I reached for the elevator button and heard my name called.

"H'lo, Alex!"

It was the medical director, chatting with a pair of interns. He dismissed them and walked my way.

"Hello, Henry."

He'd put on a few pounds since I'd last seen him, jowls fighting the confines of his shirt collar. His complexion was unhealthily florid. Three cigars stuck out of his breast pocket.

"What a coincidence," he said, giving me a soft hand. "I was just about to call you."

"Really? What about?"

"Let's talk in the office."

He closed the door and scurried behind his desk.