Murder at the House of Rooster Happiness (5 page)

As Professor Dalrymple said: “You must always treat a patient’s family as an extension of your patient.”

“But…” the director said.

“But?”

He sighed. “I’m only thinking of the Royal Inspectors. They will be here next Monday, you recall?”

She certainly did recall. Indeed, hardly a waking moment in the past month had gone by that Ladarat hadn’t paused to recall that impending event. And if she did forget, there were the frequent reminders from Khun Tippawan, the Director of Excellence.

“And it won’t do to have this man in his bare feet in our waiting room.” He paused, and then, perhaps sensing her im-pending objection, he asked a question that she hadn’t thought of. “Would you see a man like this outside the ICU of the University of Chicago?”

“No, Khun,” she agreed. “You would not.”

“It’s not that it is bad that he is here necessarily. But it is not the sort of scientific and academic image we want to present to the inspectors, is it?”

Ladarat agreed that was probably true. But she also thought that if one of the inspectors were in the ICU, they would want their visiting family members treated with respect and courtesy, no matter what those family members looked like. And whether those family members wore shoes.

But there would be time later to consider the ethical rights of a barefoot visitor. For now, there was work to be done.

As Khun Suphit led her through the glossy steel double doors that swung open automatically, it was as if she’d stepped back in time to her days at the University of Chicago five years ago. Indeed, what she saw was an ICU to make the director proud. The Sriphat Hospital ICU was new and modern, with glassed-in cubicles arrayed around a central nursing station. The place was busy with mechanical conversation. There was the rhythmic whoosh of breathing machines, layered over the background babble of beeps and buzzes and chimes coming from various monitors that were all trying to have their say. It could easily have been the ICU in Chicago where she learned about ethics. Or any other ICU in a major city.

She knew that people in the United States and elsewhere had a tendency to look down on medical care in countries like Thailand. She certainly heard dismissive questions from people in Chicago. Do you have antibiotics? they asked. Or chemotherapy? Or surgery? A brisk walk through this unit would convince them quickly enough that we have all of those things. But, she liked to think, we haven’t forgotten about the caring part of medicine the way the West has.

Now they were standing in front of cubicle 8, where the American named Andrew Fuller was lying on a hospital bed. In his throat he had a breathing tube that was connected to a ventilator, which was breathing for him. His head was bandaged, and his eyes were taped shut to prevent them from drying out, but she could see fresh bruises across his right cheek and jaw. There was bruising around both eyes, too. Raccoon eyes, she remembered from nursing school, were a sign of fractures of the bones that surround the eyes. The heart monitor over the bed was blipping along, but that was the only sign of life.

“He looks… peaceful,” she said hesitantly.

Khun Suphit winced.

“Do you really think so?”

Ladarat nodded.

“Ahh, yes. Of course you are right, Khun. I suppose he does.”

Ladarat nodded again. That was part of the problem. The American appeared to be resting. It was a comforting appearance of peacefulness, but a misleading appearance, too. He looked like he could wake up any second. And once those bruises healed… well… it would be hard for his parents or his wife to believe that anything was wrong. And that would make it much more difficult for them to make a difficult decision. Oh dear.

She had to ask the obvious question. How could the director be sure that the man didn’t have any brain function? How was it possible to know that, after such a short period of time? But she couldn’t ask in that way.

No. She didn’t want to question Khun Suphit’s medical expertise. It was, she knew, a delicate situation that she’d faced many times as a nurse. Fortunately, it was a problem for which she had developed… strategies.

“When I tell the family that his brain is no longer working,” she said slowly, “they will have questions.”

Khun Suphit nodded unhappily. He knew that they would. That was why she was here.

“What shall we tell them?” she asked. “How do we talk to them in a way that will help them to understand his condition?”

“You can tell them three things,” the director said. And he didn’t hesitate. “First, that his pupils don’t respond to light. Second, that the vestibular canals in his ears don’t respond to hot or cold water the way that they should. That means that the part of the brain that controls balance and coordination isn’t functioning. Finally, you can say that we’ve done EEGs two times since he’s been here, and we’ve seen no response. So you see, his brain—it is not sending any of the signals that even a sleeping brain makes.”

“Eehhh. That is bad.”

And it was. Those are the tests that she’d learned about in Chicago. But she also knew that there were other tests, like a brain scan, that Western countries sometimes did. She hoped the family wouldn’t ask about those tests, because they didn’t do them here. Still, she knew that they might ask.

“And if they ask about a PET scan, what should I say?”

He nodded. “Oh, no doubt they will ask. Or they will have a U.S. doctor call me to ask. We can tell them that although that test is used sometimes in the U.S., it is not used in Europe or most other countries.”

“And why is that?” Although she knew perfectly well why not, it would help to give Khun Suphit a chance to practice his explanation.

“Because, you see, it doesn’t add useful information. It is no better than the tests doctors can do at the bedside. Ask any expert, they will tell you the same thing.”

She knew, then, why the director was so eager to have her translate. This would be a conversation that would be full of conflict. There would be angry words and tears. And, probably, accusations of poor care. Accusations that real “experts” would do things differently. In short, the kind of conversation that would cause all of those involved to lose face.

Ladarat and the director stood there watching as Andrew Fuller’s chest rose and fell, knowing that movement didn’t mean anything. And knowing, too, that this was not going to be easy to explain to Andrew Fuller’s family on the other end of that long hallway.

THE
YIM SOO
SMILE OF THE FEMALE SEX

A
nd indeed it was not.

The first hint of trouble came in the hallway outside the room of Andrew Fuller’s wife. His soon-to-be widow. Kate, she was called.

As Ladarat and Khun Suphit approached the door, a new nurse, just out of nursing school at Chiang Mai University, one of the best nursing schools in the country, came hurrying out of the American’s room, smiling furiously.

To a
farang
—a foreigner—she might look happy. But one glance revealed her smile to be what Thais call
yim soo
, or “I’m smiling because I don’t know what else to do.”

If it seems like Thais smile too much, it’s not because we have so much to smile about, but because we use a smile for so many occasions. It was a little like what the undergraduates said at the University of Chicago: Drinking is only for after 5
P.M.
, but it’s always after 5
P.M.
somewhere.

In Thailand we smile because even if there is nothing to smile about, there may be something worth smiling about someday. Or there used to be. She was sure that those college students were addicted to their drinking and she often wondered whether perhaps Thais suffered from a similar addiction to smiling.

The young nurse rushed between them, slowing only for a hurried
wai
. Normally she was ambitious and almost obsequious, particularly to a powerful doctor like Khun Suphit. Her hurry was bad sign. A very bad sign.

Khun Suphit paused. Then he sighed. Then—of course—he smiled. Then he led the way into the room.

It was one of the best rooms in the hospital. Khun Suphit had made sure of that. Normally used for government officials and very important
farang
, it had wide windows that afforded a panoramic view of the deep green mountains to the west. It also boasted a wide expanse of marble floor and a large sitting area with comfortable teak and rattan furniture.

Ladarat was in general not in favor of special, private rooms that gave some patients better treatment than others. The proponents of such luxurious accommodations said that those patients do not receive better care, only more comfort, as if that made injustice more acceptable. In her view, it did not.

And wasn’t the distinction between care and comfort a false one? Don’t people who are more comfortable heal faster? So aren’t we giving some people better care than we’re giving others? That is unfair.

Yet she could not fault the hospital for giving special treatment to the Americans. They had been through so much, compassion dictated that they should offer additional comfort. One could only hope that the Americans would appreciate this gesture, but she suspected that they would not.

Americans—and indeed all tourists—never seemed to appreciate the hospitality for which Thailand was justly famous. No matter how hard a hotel clerk or a waitress might try to anticipate a guest’s needs, the guest seemed to take those efforts as their due. Just what was expected. And they never smiled.

Khun Suphit’s broad back paused in the doorway, obscuring for a moment the scene that awaited them. Then he stepped backward and to his right, revealing a solid middle-aged American man who was standing with his hand on his hips, blocking their entrance. He had sandy hair and high cheekbones like a woodcarving, and probably would have been very handsome once. Behind him was the woman Kate, sitting in a wheelchair next to her bed, with a hopeful smile and bright green eyes. Despite the bandages that encircled her head and partially hid her blond hair, you could tell that she was beautiful. This Andrew Fuller had been—for a short time at least—a very lucky man.

Then Ladarat’s attention was jostled by a flicker of movement off to her right, and she glanced beyond the man who was blocking their way. Thin and pale, with red hair and a tentative smile, a woman rose from her place on the sofa to greet them with a deep
wai
, in the correct order, first to the director and then to her. Khun Suphit was nonplussed for a second—a first for him, no doubt. But he returned the American’s
wai
, then turned to the man, and finally to the girl on the bed. The girl smiled uncomfortably, and the man simply nodded.

Well.

The three Americans looked expectantly at the director, and it wasn’t until he took another step backward and to the side, looking directly at Ladarat, that she remembered that she was to do the talking. That recollection didn’t feel very good.

“This,” she announced an uncertain voice, “is Dr. Suphit Jainukul. He is the director of the ICU. He is responsible for the oversight of Mr. Fuller’s care.”

“Are you a doctor?” This from the man.

The director turned to her, with a tentative smile, pretending that he didn’t speak English. Oh, so very clever. She smiled, too, contemplating revenge.

“Yes, Dr. Jainukul is a doctor. He is a pulmonary physician. And my name is Ladarat Patalung; I am a nurse.” Mentioning that she was the ethicist for the hospital would only confuse things.

“You speak English very well,” the woman said, peering around her husband’s shoulder.

“Thank you. I had the good fortune to spend a year at the University of Chicago studying. And this is why,” she continued, “Dr. Jainukul asked me to join you for this conversation as a translator. That,” she said somewhat unnecessarily, “is my role.”

If the director followed this, he gave no sign. Instead he had assumed a pleasant yet vacant expression of superficial interest. This was his defense mechanism, she knew. Whatever happened, and whatever the Americans said, he would smile his distracted smile, trying very hard to think of the gardening he would do this weekend.

No wonder Thailand has never been in a serious war. We are allergic to conflict, whereas Americans seemed hardwired to seek it out. The man, for instance, was staring at them with a strange intensity. And—what was truly odd—he still hadn’t moved aside to let them pass. It would be awkward indeed to get into the room unless he gave way. But the women were nodding and smiling hopefully, waiting for some good news.

Then the man surprised them all. “I’m going out for a smoke. You all just talk about… whatever you need to talk about.”

And before Ladarat could explain that he needed to be here—that they needed him to be here—he slipped between her and the director with a grace that was surprising for a man of his size.

There was an uneasy moment as the four of them who remained looked at one another. Then his wife broke the silence with an awkward shrug and a smile. She sheepishly held up a pack of Marlboro Lights, whose red was anemic and washed out. Knockoffs from China or Cambodia probably. “He left these here. I think… I think maybe he’s just not ready to talk.”