of study and God only knew how many other C-spines in how many other settings. Whatever it was, something made him stop, turn, and study the X rays in more detail. The fractures of vertebrae C-1 and C-2 were far from the most obvious he had ever seen, but they were certainly present-and unquestionably unstable. If the spinal cord had not already been damaged, a sudden twist, or turn, or bump could be disastrous.
Either way, he certainly should have been called in on the case. He checked the name and birthdate, Stacy Mills, age 14 Next, he cut through the nurses' station, looking for Wilton Marshfield. The portly physician was hunched over a counter, hurriedly writing a set of discharge instructions. Next to the instruction sheet was a soft cervical collar.
'Hi, ' Zack said, moving close enough to verify that the instructions were, in fact, for Stacy Mills. He looked past the man to bed 3, where a dark, pretty girl in riding jodhpurs and a lavender T-shirt was waiting with her parents. She was sitting on the edge of the litter with her feet dangling down, and she was rubbing gently at the base of her skull.
'Oh, hi, Iverson, ' Marshfield said. He glanced up only long enough to nod, and then returned to his writing. 'This is one bitch of a morning, I'll tell you… Saw you at Beaulieu's funeral yesterday Terrible business. Terrible.'
'Wilton, could I talk to you for a moment? ' Zack asked softly Marshfield shook his head. 'Can't stop right now, ' he said, pulling a prescription pad from his clinic coat. 'I've got to get rid of this kid, and then I still have two more patients to see. I'm getting too old for this pace, Iverson. Too damn old. Tell your brother he'd better hurry up and get this place straightened out so I can get back to my trout stream and my grandchildren.'
'It's about that girl you're getting ready to send home, ' Zack said.
'Stacy Mills.'
Marshfield squinted over at the girl, and then picked up the cervical collar and the instruction sheet, and began writing a prescription for a muscle relaxant. 'Fell off her horse and strained her neck muscles, ' he said as he wrote. 'Look, Iverson, ' he added curtly, 'I'm sorry I snapped at you the other night. But please, just don't make any trouble for me today. I'm too far behind to-'
'Listen, Marshfield, ' Zack whispered. 'I just looked at her films over there. She has a fracture. Two of them, I think. C-one and C-two.'
The older man froze. In slow motion, his pen wobbled in his fingertips and then fell, clattering onto the counter. 'Are you sure? ' he rasped.
Zack nodded. 'Jesus…'
'Come, let me show you.'
Moments later, Zack led a mute, badly shaken Wilton Marshfield across to Stacy Mills and her parents 'Hello, Stacy, Mr. and Mrs. Mills, ' he said. 'My name is Iverson. Zachary Iverson. I'm a neurosurgeon.'
He glanced back at Marshfield, who looked as if he were listening blindfolded to the final counts from a firing squad. Inwardly, Zack smiled. If the man was waiting for gunfire, he was in for a pleasant surprise. Hey, Wilton, relax, he was thinking. As far as I'm concerned, this business of ours has never been a contest or a game. It's life.
It's the real bananae And it's hard enough to do right even without the bullshit and the oneupsmanshipw You did the best you could, and that's all we got-any of us. There's no way I would hang you out to dzy. 'Dr.
Marshfield, here, has just made an excellent pickup on Stacy's X rays,' he said. 'He spotted a shadow he didn't like, and wanted me to check it before he would consider sending her home. I'm afraid his suspicions were correct. Stacy, there is a small fracture-a broken bone right up here.'
'I knew it, ' Stacy said. 'See Mother, I told you it was killing me.'
'Is it dangerous? ' the girl's mother asked. 'It would have been, ' Zack said, slipping the soft collar into place, 'if it had gone undetected.
It could have been a blooming disaster. But everything is under control now. You're going to be just fine.'
Mrs, Mills reached over and squeezed a stunned Wilton Marshfield's hand.
Her husband patted him on the shoulder. 'Now, Stacy, ' Zack went on,
'first of all, I don't want you moving your head around, okay?'
'Okay.'
'Good. Then there are some things I must explain to you and to your parents about what we do for cervical fractures.'
'Dr Iverson, please, ' the girl's mother said. 'Before you start, I d like to get Stacy's aunt-my sister-over here. Would that be okay?'
'Certainly, but I don't see-'
'She helps me understand medical things. I'm sure you know her. She's the head nurse here. Maureen. Maureen Banas.'
CHAPTER TEN
Although operating room 2 at Ultramed-Davis was newer than some of the dozens Zack had worked in, the ambience was no different. The sounds, the lighting, the tile, the filtered air-tinged with the unique mix of antiseptic and talc and freshly laundered gowns-provided sensations as familiar to him, as reassuring, as the mountains. The stabilization of Stacy Mills's neck was proceeding flawlessly. Standing by the head of the table, Zack paused, savoring the sensations — the wonder of what he was able to do, and the bond he was feeling with the rest of the O. R. team. The sound system-Frank's brainchild, now installed in nearly all Ultramed's hospitals-was playing George Winston's magical treatment of 'The Holly and the Ivy.'
'All set? ' he asked the scrub nurse. The woman nodded. 'All right, then, ' he said evenly. 'Stacy, this is the part I told you about. We're going to twist those four screws into place on your head. I've put lots of novocaine in each spot, so they won't hurt, but it will feel funny, and you might hear the grinding noise. Everything is going Just fine. I know it's scary for you, but there's really nothing to be frightened about.'
'I'm not frightened, ' the girl said. 'At least, not too much.'
'Good. And you remember what you have to do?'
'Don't move, ' she answered. 'Exactly…'
Zack checked the position of the cervical halo one last time, and worked the four screws farther into place through the small incisions he had made in the girl's scalp. 'Unless I tell you to, don't move.'
From a spot several feet behind the O. R. team, Wilton Marshfield watched, his every breath a sigh of relief. Even though Zack Iverson had publicly gone out of his way to share credit for the pickup with him and had privately assured him that this sort of cervical fracture was the toughest of all to diagnose, he sensed that he would never be truly comfortable in the emergency ward again. He had come out of retirement and into the E. R. as a favor to Frank Iverson, and because he was bored. Now, he knew, it was time to stop. And thanks to Iverson's brother, after forty years of busting his hump, of doing his best to survive first the knowledge explosion, then medicare and the paperwork crunch, then the malpractice crisis, and now the goddamn corporate-policy crap, he could at least go out as something of a winner. 'God love ya, kid, ' he said softly, as Zack tightened the apparatus in place. 'God love ya.'
'Okay, Stacy, ' Zack was saying, 'that's one. Now, wiggle your toes the way I showed you. Good. Now your fingers. Good, good. We're almost there.'
He stepped back for a moment and shifted his focus from the metal frame to the fine features and peaceful face of the girl/woman. Biology, organic chemistry, anatomy and physiology, boards and more boards, endless nights and weekends on duty or on call, countless meals of cafeteria food or nondescript leftovers in cardboard containers, countiess hours in the O. R. and on the wards, scattered days, and weeks, and even months of consuming self-doubt-at moments like this one, the choices he had made in his life and the price he had paid made so much sense. And when it was over, when the girl who loved to ride horses walked away from the hospital and from the split second that could have paralyzed her forever, he would take that moment and bankroll it in his mind as vindication for all the years and all the anguish, and as a hedge against those outcomes yet-to-be which would not bring smiles and handshakes and pats on the back-outcomes that, as long as they were unavoidable, were no
