Beat the Reaper

  So I shove my fingers through the membrane that runs between the fibula and the tibia, and grab hold of the bone. It’s about three times the thickness of a pencil, but it isn’t cylindrical. It has sharp edges.

  And now I need to break it. Ideally without wrecking my ankle or knee. The very thought makes me turn my head away and vomit down the left side of my chest. Not much comes out, but hey—it’s warm. And no way do I let go of my fibula.

  How the fuck am I supposed to break it, though? It’s essentially made of stone. Any hit strong enough to break it might also shatter it. I think of kicking it into the sharp edge of the lowest shelf, but that’s more likely to hurt the tibia, which forms most of the shin.

  Then it comes to me. I scoot forward and put my shin up against the edge of the shelf as gently as possible, as close to the ankle as possible. I work my grip higher toward my knee. Then I yank the bone forward, snapping the lower part off just above the ankle and wrenching the upper part free of the tangle of ligaments that hold the knee together.

  O Pain.

  O Pain.

  You know when you’re entirely greasy with sweat even though you’re in a deep-freeze that you may have taken things too far.

  Or when you’re holding a knife you’ve just made out of your own shinbone.

  Eventually the door unlocks, then opens, and someone says, “Come on out.”

  I don’t move. I’m backed up against the rear shelf, trying to keep my streaming eyes open to acclimate them as quickly as possible to the light, which right now is a roaring wall of pure white. I’m holding the knife hidden behind its cousins in my right forearm.

  A man with a gun appears in silhouette and says “I said, Come...Jesus Christ!” Then he says, “He’s back there. But he’s covered in blood, Mr. Locano.”

  A crowd of other men with guns appears behind him to look in. “Oh, fuck,” one of them says.

  Then Skinflick speaks. I recognize his voice, though it’s rougher than it used to be. Both deeper and with a strange new whistle to it.

  “Get him out of there,” Skinflick says.

  No one does anything.

  “It’s just hepatitis,” I say. “You probably won’t catch it from touching me.”

  Everyone backs away from the doorway.

  “Fuck all of you,” Skinflick says.

  He steps into sight. I can’t see him too well because he’s silhouetted and my eyes are still freaking out. But he doesn’t look good. In fact he looks like someone gave an Adam Locano kit to a four-year-old, when it’s recommended for ages nine and up. His entire head is potluck.

  I should talk. I’m naked, except for the blood. My own and the extra bag I needlessly smeared all over myself to draw attention away from my right leg, and the tourniquet there that I made out of my hospital gown. There’s blood all over the room.

  I can’t tell if it bothers Skinflick. He comes in waving his knife, held backhand. The blade is serpentine, with a pattern on the side, so it’s probably Indonesian.

  Skinflick’s not bad. He keeps the knife going constantly, in a kind of electron cloud of defense. Idealist School all the way. But the moment he sees my knife—proud product of my own flesh and blood—he stops and flinches away in fear and surprise, exposing his entire right side to me.

  “Jesus, Skinflick,” I say.

  I stab him just below the right side of his ribcage, angling upwards through the natural hole in his diaphragm, so that the jagged end of my fibula punctures his aorta before coming to rest inside his beating heart.

  Beating till that moment, I mean.

  24

  The next thing I remember is waking up. The thing I remember after that is thinking that For a guy who complains all the time about never getting any sleep, I sure wake up a lot.

  I’m in a hospital bed. Prof. Marmoset is sitting in the La-Z-Boy by the head, reading and marking up what looks like a journal article.

  I’m struck, as always, by how young he looks. Prof. Marmoset has a kind of agelessness that comes from being smarter and better informed than, say, I will ever be, and having really thick hair. But he can’t be that much older than I am.

  “Professor Marmoset!” I say.

  “Ishmael! You’re awake,” he says. “Good. I need to get out of here.”

  I sit up. I feel dizzy but stay up on one arm anyway. “How long have I been out?” I say.

  “Not as long as you think. A few hours. I caught a flight right after we talked. You should lie down.”

  I lie down. Pull the blanket aside. My right leg is heavily bandaged. I still have patches of dried blood all over me. “What happened?” I say.

  “You’re better at surgery than I remembered,” Prof. Marmoset says. “That bit with the girl who turned out not to have osteosarcoma was impressive. We discussed a case like that once, I think. But the autofibulectomy was very impressive. You may have to write that up for the New England Journal. For the Federal Witness Edition, at least.”

  “What happened with those guys?”

  “The mob guys?”

  I nod.

  “David Locano’s son, you stabbed in the heart. The rest of them you shot with David Locano’s son’s gun. Except for one of them, whose head you slammed in the fridge door a bunch of times. He’s not going to make it either.”

  “Jesus. I don’t remember any of that.”

  “You’ll be wanting to stick to that story.”

  “Why? Am I under arrest?”

  “Not yet. Keep your fingers crossed.” He gathers up his papers. “It’s great to see you’re all right. I really wish I could stay longer.”

  I force myself to ask. “Are they going to throw me out?”

  “Of Manhattan Catholic? Definitely.”

  “Of medicine.”

  Prof. Marmoset looks right at me, for what I realize might be the first time in my life. His eyes are a lighter shade of brown than I’d thought.

  “That depends,” he says. “Do you feel your work as a physician is done?”

  I think about it.

  “Not even close,” I have to say. “I wish it was.”

  “So we’ll figure something out,” he says. “In the meantime, you may need to get a grant to go do research for a while. Somewhere far away. I recommend UC Davis. Call me about it.” He stands.

  “Wait,” I say. “What about Squillante?”

  “Still dead.”

  “Who killed him?”

  “Your med students.”

  “What?” I say. “Why?”

  “He went into ventricular fibrillation. They tried to stop it by giving him potassium. They thought they were doing him a favor.”

  “That’s my fault. I gave them way too much responsibility.”

  “That’s what they’re off claiming now.”

  “I was asleep when it happened.”

  He looks at his watch. “They weren’t. And they knew better than to try to handle a code on their own. Anyway, it’s not our problem: they’ll either get thrown out or they won’t.”

  “How did you find out it was them?”

  Prof. Marmoset looks uncomfortable. “It...seemed kind of obvious. Anything else?”

  “Just one more thing,” I tell him. “I had a patient with multiple abscesses. I got an anonymous call claiming he was bitten by a bat—”

  “The man from your needlestick.”

  “Right. How’s he doing?”

  Prof. Marmoset shrugs. “His insurance company wouldn’t pay for him to stay another day, so he got transferred to a state facility.”

  “But what was wrong with him?”

  “Who knows? You can try calling them if you want. Odds are we’ll never hear anything else about it. Your own blood work is clear. It’s just one more thing that’s not our problem.”

  He pats me on the noninjured knee. “It’s like the alcoholics say. Any time you can tell the difference between something you can do something about and something you can’t, you should thank God. Particularly if it tur
ns out to be something you can’t.”

  I shift, and the pain in my leg ignites, then fades weirdly. My head and my stomach are both light from painkillers. “Thank you for coming,” I say.

  “I wouldn’t miss it. Call me.”

  “I will.”

  He leaves. I doze.

  It’s cool: he’s got shit to do.

  I don’t.

  WARNING

  All parts of this book except this paragraph, the acknowledgments, and the dedication are fiction. Even the epigraph is fiction. Believing otherwise, particularly regarding medical information, would be a very bad idea.

  ACKNOWLEDGMENTS

  TEACHERS Stanley and Doris Tanz, Marvin Terban, Gilbert and Barbara Millstein, Martin Martel, Wendi Dragonfire, Arnold Weinstein, Michael Wilkes

  MOVERS Susan Dominus, Markus Hoffmann, Reagan Arthur, Michael Pietsch

  SOURCES DESERVING SPECIAL MENTION FOR INFORMATION NOT FOUND ELSEWHERECause of Death: A Leading Forensic Expert Sets the Record Straight, by Cyril H. Wecht, Mark Curriden, and Benjamin Wecht; Guy Shochat; Office of the Chief Medical Examiner, City of New York; New York Aquarium; WITSEC: Inside the Federal Witness Protection Program, by Pete Earley and Gerald Shur

  SUPPORT IN NEW YORK The Bazell family, Benjamin Dattner, Joanna Fried, the Fried family, Eric Grode, Marc Leonardo, Linda Lewis, C-Lo and the Gang, Marcia Lux, Elizabeth O’Neill, Joseph Rhinewine, Scott Small, David Sugar, Susan Turner, Jason White, Jesse Zanger, Sam Zanger

  SUPPORT IN SAN FRANCISCO Joseph Caston, Robert Daroff, Ellen Haller, Cassis Henry, Tamar Hurwitz, Marc Jacobs, Yunnie Lee, Peri Soyugenc, Kim Stopak, my co-residents at UCSF

  SUPPORT ELSEWHERE Michael Bennett, Edward Goljan, the Gordon family, Mary Victoria Robbins, Lawrence Stern

  CANINE SUPPORT Lottie

  SUPPORT ALL OVER THE PLACE, SINCE BIRTH my sister Rebecca Bazell

  ABOUT THE AUTHOR

  JOSH BAZELL has a BA in English literature and writing from Brown University and an MD from Columbia University. He is currently a resident at the University of California, San Francisco, and is working on his second novel.

  * And you can compare this to your lower leg, where the same setup is vestigial. The two bones of the lower leg, the tibia and fibula, are locked in place. The outer one, the fibula, doesn’t even support weight. In fact you can take most of it out—to use as a graft or whatever—and as long as you don’t fuck up the ankle or the knee, it won’t affect the patient’s ability to walk. (back to text)

  * Doctors always know how old you are. We use it to tell whether you’re lying to us. There are various formulas for it—compare the creases of the neck to the veins on the backs of the hands and so on—but they’re not really necessary. If you met thirty people a day and asked them how old they were, you’d get good at it too. (back to text)

  * The tattoo on my left shoulder—winged staff, two snakes—turns out to actually be the symbol of Hermes, and therefore of commerce. The symbol of Asclepius, and therefore of medicine, is a nonwinged staff with one snake. Who knew? (back to text)

  * Scrub suits are reversible, with pockets on both sides, in case you need to run anesthesia or whatever but are too tired to put your pants on correctly. (back to text)

  * “Stat” is short, though not very, for statim. “Calling a code” is what you do when you want to pretend you don’t know someone’s already dead. (back to text)

  † In fact, the medical word for pubic hair, “escutcheon,” means “shield,” although in free-range humans only women’s pubic hair is shield-shaped. Men’s is naturally diamond-shaped, pointing up toward the navel as well as down toward the groin. Which is why women who shave their pubic hair into a diamond shape subconsciously skeeze you out. (back to text)

  * This is an actual job, though it’s not interesting enough to go into. (back to text)

  * Think more money can’t buy you worse healthcare? Forget the endless studies showing that the U.S. spends twice as much per capita as any other country, with results outside the top thirty-six. Take a look at Michael Jackson. (back to text)

  * This was Konrad Preysing, aka “The One Good German.” Preysing made thirteen separate presentations of Holocaust evidence to Pope Pius XII, who in 1941 announced that Nazi policies did not conflict with Catholic teachings. When Pius gets sanctified, I hope they cite that as his miracle. (back to text)

  * Auschwitz had a death camp—Birkenau—but it also had Monowitz, which was a slave labor camp. That made odds of survival at Auschwitz 1 in 500, which is why you’ve even heard of Auschwitz. Odds of survival in the death camps were 1 in 75,000. (back to text)

  * My parents had long since gotten divorced. My mother had become a real estate agent, and my father, who was Italian—but not, I should say, Sicilian—had moved to Riverside, Florida. Last I heard he ran an upscale franchise restaurant I won’t name. They both have different names now, and I am not in contact with either of them. (back to text)

  * The actual amount that will stroke out any particular person is highly variable, because 30 percent of people have a hole in the wall between the right and left sides of their heart capable of sending a bubble that would otherwise go to their lungs (and from there into the atmosphere) directly into their brain. But most pieces of IV equipment are a lot harder to clear than a syringe, so nobody bothers to do it. (back to text)

  * Electrocardiograms are abbreviated “EKG” because “ECG” sounds too much like “EEG,” which is an electroencephalogram. Or maybe Willem Einthoven, who invented them, called them “electrokardiograms.” (back to text)

  † The Ballad of John and Yoko: “Peter Brown called to say / You can make it O.K. / You can get married in Gibraltar near Spain.” Peter Brown was the longest-serving roadie for the Beatles. (back to text)

  * This basic interaction—Good morning, sir/Sorry, kids. I’ll teach you something later—is the primary activity of the last two years of medical school. The primary activity of the first two years is a PowerPoint presentation by whatever bitter, unpaid PhD was too slow to avoid getting tapped by the dean that morning. (back to text)

  * “CVA” stands for “cerebrovascular accident,” or stroke. A brain artery either getting jammed (usually by a clot, usually from your heart) or outright exploding. Meet the Reaper: it’s the number two cause of death in the United States. (back to text)

  * Michael drops the gun after shooting the cop in The Godfather because the kid drops the gun after shooting the cop in Battle for Algiers. Where it at least makes sense, since during the Algerian Revolution the French had checkpoints every other block. (back to text)

  * Oops, I said it. (back to text)

  * Ishmael was my code name inside WITSEC, though no one except Prof. Marmoset ever actually called me that. WITSEC is the abbreviation the Feds use, helpfully, for the Federal Witness Protection Program. (back to text)

  * Expand the mind, and the body will follow, you might say, but it never seemed to make me fat, and Skinflick was fat already. (back to text)

  * Like a woman’s escutcheon, if you’ve been paying attention. (back to text)

  * For those following along in their Gray’s Anatomy, in medicine the solar plexus has been called the celiac plexus for the last few decades. About as long as it’s been since anyone read Gray’s Anatomy. (back to text)

  * Like you care what this means. (back to text)

  * My favorite Lech Wałesa story is from shortly before I went to Poland. Realizing he was about to lose the presidency, Wałesa announced that his opponent was secretly Jewish. He then denied he was a bigot, saying, “Actually I wish I was Jewish myself. Because then I would have a lot more money.” Funny guy! (back to text)

  * I. G. Farben, the chemical company that ran the labor camp at Auschwitz—it isn’t named after a person, it’s short for “International Dye Company” in German—stayed in business after the war by claiming it needed to pay reparations to its former slaves, of whom it had used 83,000 at any one time. It then went on to portray itself for d
ecades as being unfairly hounded by greedy, vengeful Jews. In 2003 it found itself on the verge of being forced to actually pay out two hundred and fifty thousand dollars (total, not per person), and declared bankruptcy instead. But not until it had spun off Agfa, BASF, Bayer, and Hoechst (now half of pharmaceutical giant Aventis), all of which prosper to this day. (back to text)

  * ”Status post,” abbreviated “s/p,” is a common medical term meaning “after” and implying “but not necessarily caused by.” It’s Latin for “Try suing me now, Fucker.” (back to text)

  * “Lesion” is a nonspecific but extremely useful (because it sounds like a crater of pus) term for any abnormality. (back to text)

  * Medically it’s not all that clear. A woman who mates with her first cousin adds about 2 percent to her chance of having a kid with a birth defect. (For comparison, a woman who conceives at age forty has a 10 percent chance that the fetus will have Down’s Syndrome.) On the other hand, offspring of cousins may benefit from an increased chance of family stability. Either way, the human genome is already far more “conserved,” i.e., inbred, than that of any other known mammal, so we’ve already done a lot more cousin-jumping than, say, the rat. (back to text)

  * I should admit here that my failure to communicate with my parents has been more than just a WITSEC formality. You’re allowed to exchange messages and even talk on the phone with your family through the Virginia clearinghouse, and if you do this often enough the agents will eventually “slip up” and give your family your direct contact information. I just never tried. (back to text)