The Book of X

by Sarah Rose Etter

  “Ten coins,” he says.

  I count them out slowly in my palm, then crawl from the back seat.

  The black doors slide open softly. The office is electric white trimmed with dull gray, the colors meant to soften pain. A set of eyes peer over the counter. This time, the eyes are brown, kind.

  “You must be Cassie,” the eyes say.

  “Yes, hello, that’s me.”

  “Well, hi there!” she says, standing up to slide a stack of paperwork on a clipboard to me.

  I stare down at the body chart again. I circle the torso twice. This time, I write the number 10 next to the field marked PAIN LEVEL.

  “Poor thing,” she tuts when I bring the chart back.

  I can feel her eyes on my knot. The pain keeps screaming in the background, it reduces everything around me.

  “He’ll be right with you.”

  There are no magazines. Instead, a large television on mute displays a newscaster silently moving her mouth. The red banner beneath her face spells out ANOTHER BOMB DROPPED, 150 DEAD in white text, scrolling over and over again, infinite.

  Occasionally, the screen cuts to a plume of smoke swallowing land. They do not show the bodies, which must be buried just beneath the cloud.

  “Cassie,” she calls. “We’re ready for you.”

  I follow her down the bright hallway, white as perfect teeth, pristine. Here, there are no plastic organs, just the glow.

  She passes me a gray gown.

  “Why don’t you put this on and the doctor will be right in to see you.”

  The gown is soft and warm, but my pain eclipses that. I climb onto the table and curl into a ball.

  There is a knock at the door.

  “Come in,” I call.

  Doctor Kuznit appears: Large, olive skinned, dark hair, green eyes.

  “Hello,” he says, extending a hand.

  I slide a hand out to slowly shake his.

  “Yes, hello,” I say.

  “You don’t look like you’re doing well today.”

  “The pain is bad.”

  “Well, let’s get you examined. I’ll be gentle. Lie straight on the table for me.”

  I unwind my body and flatten myself on the table.

  “Would you mind pulling up your gown?” he asks.

  He rubs his hands together to warm them. I pull the gown up below my breasts like always.

  “Is it OK if I touch you?” he asks.

  I nod. I am ready to be touched by now. I know they will always touch me.

  His hands move gently over me. He works his way from the bottom of the knot to the top, stopping to ask: “Does it hurt here? How about here?”

  I nod if it hurts there, I shake my head if it doesn’t.

  “All right now, let’s have you sit up so we can talk. Now, it says here your pain is at a 10. Tell me about that.”

  “It started a few months ago and it keeps getting worse. Sometimes it’s so bad I black out.”

  “Black out?”

  “Yeah, like at the store, I don’t know — the pain gets sharp and I collapse.”

  “I see.”

  He stares deeply at me for a moment.

  “That’s what we call breakthrough pain,” he says. “These are flare-ups of intense pain that are hard for the brain to handle. Your body gets overwhelmed and can shut down.”

  I nod.

  “I’m going to need to run a scan on you, but I think you are a candidate for emergency surgery.”

  “What, more injections? Is this the sugar water again?”

  “No, a surgery. I’m going to remove your knot. It’s gotten too tight, and I believe it is choking your vital organs.”

  “How?”

  “Well, first I’m going to make small incisions in the knot to remove the organs.”

  I imagine him sliding my organs from my body.

  “And then I’ll remove the knot itself and rebuild your torso with your organs and animal tissue where needed for regrowth.”

  “What kind of animals?”

  “Most often we use skin from a pig or a donor, someone who is dying and donates their flesh.”

  The lights twinkle above my head. There’s not enough air. The facts suck up all of the oxygen.

  “I’ve done smaller versions of this surgery a number of times,” he explains. “Largely for women with uneven torsos. These cases aren’t exactly the same, but I will do everything in my power to get you back to normal.”

  MY BRAIN SHUTS DOWN AND THE REST IS like a movie I watch:

  The nurses move my body into the scanning machine, drive a needle into my veins to contrast my body and light my insides up like a city, glowing, what a light.

  Then the nurses slide a giant needle into the center of my knot, a painkiller, it spreads through me, a perfect springtime, flowers blooming inside of me to block the pain, sweet relief, the drugs a sun shining all through me, my body suddenly a song.

  ON THE WAY HOME, I FEEL LIKE AIR, NO pain. I feel the light of heaven rushing through me. I buy a single slice of cake, pure white icing, and take it home with me, the sensation of a parade. I crawl into bed, drug smiling, giant fork, and slide the cake into my mouth, sugar teeth, a laugh escaping my lips.

  “SOPHIA,” I SINGSONG INTO THE PHONE. “I’m having my knot removed!”

  “Wait, what? You sound strange. What are you talking about?”

  “I found a doctor, and he can get rid of it!”

  “Are you... are you sure that’s what you want?”

  “Of course it is! Why would I want to stay like this?”

  “Sometimes, we just get used to things...” she trails off. “I thought maybe you had gotten used to it.”

  MY MOTHER ARRIVES TO BE MY CAREtaker.

  “What’s all this?” she asks, lifting up the papers and pamphlets from the doctor’s office.

  I must: Fast, eat only ice, strip my fingernails and toenails bare so they can monitor the amount of oxygen in my body.

  “Are you sure you want to do this?” she asks.

  I don’t answer. We both know there is no other choice.

  I WAKE UP BEFORE THE SUN RISES. IN THE dark of my bedroom, I prepare for surgery like a strange bride.

  I soap myself carefully in the shower. I wash my hair deeply, down into the scalp. I shave my body with the sharp razor.

  I towel my body off and dry my hair. I put on my simplest clothes: black cloth pants, black t-shirt, black sweater. I wear no makeup, no jewelry, stripped down to just a body. Each nerve in my system knows it faces a knife.

  “Are you ready?” my mother asks, bleary eyed.

  “Yeah, I guess,” I say.

  We climb into a cab. The driver is quiet in the early hour. I can smell the morning on his breath from the back seat.

  “Are you nervous?” my mother asks. “I’m nervous.”

  “I just keep wondering where will I go when they put me under,” I say. “Where does the person in me go?”

  “Don’t think like that. It’s going to be fine. They do it all the time.”

  She reaches over and holds my hand. The sun starts to crest over the horizon. My body presses deeper into the seat with each mile we pass, my fear growing the closer we get.

  ◆In the 1500s, the first German physician successfully synthesized ether

  ◆In 1846, a doctor created “The Ether Dome,” where patients were first successfully put under ether anesthesia

  ◆General anesthesia may cause amnesia

  ◆A fully anesthetized brain is not unlike the deeply unconscious, low-brain activity seen in coma patients

  THE NURSES ARE A QUIET CHORUS IN SEA-foam green scrubs. Once I change into my gown, they guide me to a large hospital bed with metal railings down the side. I climb up.

  My mother clutches my hand, tears in her eyes.

  “This is going to be fine,” she says, like we’re in a bad movie. “Everything is going to be fine.”

  Then the doctor enters. He looks different this time, in
in black scrubs and a face mask.

  “How are we feeling this morning?” he asks. “I don’t know about you, but I’m feeling good!”

  He cracks his knuckles, which will soon be inside of me, a brutal intimacy.

  “A little nervous,” my mother says.

  “Well, you put those nerves aside,” he says. “We’re going to take good care of Cassie today.”

  He winks at me over the face mask and it takes on a menacing air since I cannot see his smile. Then things begin to move very quickly.

  “All right, you’re going to feel a small pinch in your arm and then you’re going to drift away.”

  I nod, then there is a pinch and I do drift away. Soon, there is nothing, just a blank space where my mind was, the needle a guillotine, my body almost a corpse.

  VISION

  I am nude in the Butcher Field. It is a rite of passage. The air is cool, a shiver across the belly, back, bare bottom, breasts. The landscape is vibrant, stark: gray-lavender pre-storm sky, lush green moss beneath my feet.

  Faint bells clang in the distance, then a new rhythm: Feet pounding on the earth, dozens of them, the sound of a stampede until new shapes appear on the horizon.

  As they move closer, they come into view: A gang of butchers move toward me in a line, their bodies muscled and broad beneath their uniforms of white rubber aprons, black pants, red rubber boots.

  The sky darkens and swirls as the butchers close in. My hands cover my private parts. They circle around me, review my body.

  “And what do we have here?” one jeers.

  “What a delight,” another hisses.

  The butchers’ faces have bulging noses, strong black beards, aging eyes. Organs are reflected in their pupils — the intestines of lambs, the grassy stomachs of goats, the long-dead hearts of bulls.

  “What shall we do with this one?” another one asks.

  A silence descends on the group. I can smell death on the land now that they are here. They have been in the white rooms where the blood of animals swirls down sterile silver drains.

  “I think we should do the classic,” says one butcher. “Just the inventory.”

  “Yep, that’s right, Don,” another one shouts back. The bells ring again in agreement.

  Two butchers step forward and grasp me by the upper arms.

  They lift me into the air and lay me on the moss. The scent of dirt fills my nose, my mouth, my bare body pressed into the young earth. The butchers gather around me again, kneeling, knives in hands.

  “Don, why don’t you do the honors?”

  I scour their faces, trying to determine which one is Don. My question is answered when the gray-bearded man near my knees pulls his knife from its sheath.

  “My pleasure,” he says.

  The rest of the butchers hold down my arms and legs. A butcher near my head places an arm over my forehead, forcing me into the earth.

  “Please don’t do this,” I say. “I’ll do anything.”

  “Now, just hold still, little lady,” Don says.

  He raises his sharp knife into the air and brings it down to my abdomen, sinking the metal into my skin. Another butcher puts his hand over my mouth to bury my scream.

  I smell something wilder than my blood on his fingers. Cold air enters the mouth of the wound, and I shake violently.

  “Now, just hold her down,” Don says, and their arms get tighter on me, stronger. The pain subsides a bit and I go slack against the earth, each breath a shock.

  “So, let’s get on in here,” Don says. “Time to see what we’re working with.”

  One butcher reaches down and holds the mouth of my wound open. Another butcher slides a hand into the slit. A new sensation begins: I can feel the pressure of his hand, the pain tearing through me, the cold air on my organs.

  “Stop it,” I moan.

  “Well, her intestines are in good shape,” he says, giving a squeeze that makes me scream. “Don, you want to check out her liver?”

  Don slides his hand into me and up, tearing a new pathway through my body. I feel a pinch on my liver and groan.

  “Good liver on this one, good to go there,” he says.

  More hands enter the wound: They explore me like a strange new terrain, their fingers greedy. Each new motion sends another shot of pain through my body. I tremble against the moss, color drained from my skin.

  “Well, that’s enough,” announces one butcher after they’re all bloodied to the wrists.

  “You’ve got some nice organs,” says Don. “You’ll be fine. You pass inspection.”

  The bells ring again, and the butchers begin their parade, this time away from me, my viscera on their boot bottoms as they retreat into the horizon.

  I’m still on the moss, bloodless, waiting for the earth to swallow me.

  MY MOTHER IS THE WOUND-TENDER. SHE has become softer since I’ve moved away, nicer when she’s close to me, when she helps me heal.

  “Time to clean the gashes,” she singsongs.

  My abdomen is a nightmare. It hurts to breathe, to sit up, to swallow, to cough. My mother carries medical supplies, and a small cake. She places the lot of it on my nightstand, then lifts the blanket from my body.

  “First the bad stuff,” she says. “Then the fun! Now undo that robe.”

  I untie the cheap robe, fingers fat and clumsy. My stomach is a collision of scars, train tracked, black stitches holding the gashes closed, gnarled caterpillars crawling across my body.

  The scent of the secretions floats up off of the wound group. My wounds heal at different paces: Some ooze green, some yellow or clear, others just leak blood.

  My mother slathers her fingers in white cream from a long tube.

  “Let’s start from the top!” she says.

  It is strange to see her this way, the caretaker, the kind one.

  She rubs the cream over my wounds, one by one, the pressure of her fingers excruciating, making me squirm in the bed. Small moans crest out of my mouth, wave-like. Her knot brushes against my arm as she leans over me. I stay silent.

  “Now,” she says. “How about some cake? It’s like a little party in here!”

  She pulls out the vanilla cake. She plunges a fork into frosting.

  I let her slide the bite between my lips. I’m just a giant mouth, just lips in a bed.

  “WE REALLY SHOULD DO SOMETHING about your face today,” my mother says.

  I have grown into the mattress by now, part bed, part woman, the sheets ingrained in my skin.

  “What’s wrong with my face?” I ask.

  The painkillers make me mean, hot, flashes of fever shot through the body.

  “It could just use, I don’t know, something more,” my mother says.

  She pulls a bag from behind her back.

  “I just brought a few things...” she says.

  I don’t have the energy to fight, so I stay where I am, sink deeper into the bed. She smears the flesh color on my face, then the silver over the eyelids.

  “Yes, just like that,” she murmurs. “Look how nice, we’re getting somewhere now.”

  She traces black liner over my eyelids, blushes my cheeks, then mascara to spider the lashes.

  “There, now,” she says, flashing a small mirror at me. “Look how much better you look!”

  I STARE AT MY STRANGE NEW SELF, EYES dulled by the pills, face painted bright.

  “HOW’S MY GIRL DOING?” COMES MY father’s voice over the phone.

  “I’m holding up,” I murmur, alternating between pain and painkiller bliss.

  “That’s what your mother says.”

  “How are you? I wish you were here.”

  “I know, but I’ve had to stick around here. We had to close up the Meat Quarry.”

  “What?”

  Even under the drugs, the news hurts me.

  “I’m sorry, I know you loved that place. Sure as hell, I did too. But it just wasn’t making us money anymore.”

  I picture it closed up, the red walls fa
ding, the meat scent evaporating. I hang up the phone, pulled back into drugged sleep.

  DAY 1: MY MOTHER TENDS MY WOUNDS

  Day 2: My mother tends my wounds

  Day 3: The wounds are tended by my mother

  Day 4: I am a wound tended to by a mother

  Day 5: A series of my wounds are tended to by my mother

  Day 6: My mother is the tender of my wounds

  Day 7: A wound is tended to by a mother which is mine

  Day 8: In a garden of wounds, my mother is the gardener

  Day 9: A constellation of wounds is named by my mother

  Day 10: My wounds are a tender mother

  Day 11: My mother tends the wounds and I begin to walk again

  Day 12: My mother is the wound-tender and I walk up and down the stairs

  Day 13: I tend the wounds and walk the stairs

  Day 14: I tend the wounds and sleep

  Day 15: I tend my own wounds

  Day 16: I am the wound-tender

  Day 17: The wounds are mouths to which I tend, my small children

  Day 18: Wounds are tended by my hand

  Day 19: Alone, I tend the wounds

  Day 20: I lose track of the days, tending the wounds

  Day 21: I fall into a deep trance at the cut of the light through the blinds, casting patterns onto the walls

  Day 22: I pluck the stitches from the wounds like feathers from a bird, strange wires pulled from my body

  Day 23: I trace the wounds with my fingers, then I touch myself, thinking of the last man from the bar

  Day 24: The doctor’s office is brighter than ever.

  “How are we?” he winks, lifting my dress.

  He traces my wounds with his fingers.

  “Very nice. You must’ve had a talented surgeon,” he smiles. “Now, let’s see you walk.”

  I walk for him and he nods.

  “Now let’s get you back to work,” he says.

  I put my dress back on, no more robes, no more gowns, no more needles in the veins, no more stitches. I walk out into the world knotless.

  I CLIMB INTO THE WHITE PORCELAIN TUB slowly, with care. I wash myself the same: soft motions across the scars with the soap, a low lather across the skin, a gentle raising of the hands to the hair to cleanse the scalp. I move so carefully my mind goes blank.