The Sandman

by Robert Ward

  Also by Robert Ward

  SHEDDING SKIN

  CATTLE ANNIE AND LITTLE BRITCHES

  THE

  SANDMAN

  THE

  SANDMAN

  Robert Ward

  a division of F+W Media, Inc.

  This book is dedicated to Ellie, Marty, David, Jay, and many of the doctors who helped me with the research. Because of bad nerves in the medical profession, none of them wanted to be named, but their help in the writing of The Sandman was crucial. I might add that most of them, once over the hump, described various possible methods of murder, lunacy, and other gore with a supreme joy. For that, I am most grateful of all.

  Contents

  Cover

  Also by Robert Ward

  Title Page

  Dedication

  1

  2

  3

  4

  5

  6

  7

  8

  9

  10

  11

  12

  13

  14

  15

  16

  17

  18

  19

  20

  21

  22

  23

  24

  25

  26

  27

  28

  29

  Epílogue

  The Cactus Garden

  Also Available

  Copyright

  Oh, Mister Sandman,

  Send me a dream …

  Chordettes

  1

  Though he saw the light in front of him clearly blinking red, Peter Cross’s foot did not hit the brake but the accelerator. A swarm of panic, like a shot of Methedrine, zapped through him and he could hear the squeal of brakes, the screams of a cabbie’s voice.

  “You fucking bum, wake up!”

  Christ, Cross thought, not only do I nearly get my ass killed, but I have to put up with the cheapest sort of irony. For Cross had not been able to “wake up” for three nights. Not been able to, because he had not been asleep for three nights. More like thirty, fifty, a hundred, but he had stopped counting. Cross’s rule: If he suspected that any time during the night he had dozed off at all, then that counted as a night’s sleep. After all, studies made at the Blake Institute showed that incurable insomniacs, even the worst of them, always snatched some few hours of sleep, though they might not be aware of it. The problem was, Cross was aware of it; he couldn’t swallow that soothing analgesic balm designed to “help the patient.” For he suffered from an illness beyond the help of analysis—the Space, burning into his organs, opening him up like a great gutted fruit … He could feel it happening, his kidneys vanishing, his liver, his intestines, his heart. He had been to a shrink once, and the man had tried to pry into him, to open the lid off the top of his handsome head and dig deep into the muck beneath his scalp … prying and peeping, such a good-natured creep with all the insight of a Roto-Rooter man. The Space was eating away inside of him … churning through his flesh … but he had to calm himself, for he was headed for work … he had to calm down.

  “Hey, pal, you better shit or git offa the pot.”

  Cross turned and saw a pig-faced man with arms as pink and flabby as a baby’s. The man’s teeth gnawed at the air, and Peter suddenly felt nauseous and cold and very, very strange.

  “You’re driving on the street, pal,” the man said, spittle flying from his mouth. “You better wake up … you unnerstan? You cut me off again, I’m gonna have ta do some damage.”

  Cross said nothing, turned away, and stared at the macadam.

  The Bagel Nosh, the New York Furriers, P.J. Clarke’s, they flew by him like images from a dream. I cannot wake in the morning, I cannot sleep at night. He thought of Poe, the stories he had started to read, and they seemed like imitations of his own internal state. The same images over and over, the cheap wallpaper of his parents’ house on 21st Street in Baltimore; the pink roses peeling off of the wall, the hoarse bog of his mother’s breathing, terrible pitching and heaving in the old creaked-spring bed, the medicinal odor (menthol) of the vaporizer, the beads of sweat on her forehead; the endless bottles of pills that did nothing to stop the cancer within her but worked only as a holding action against the encroaching pain, which ate away at her liver, her kidneys; she sitting in front of him with those moist deadpan eyes, sipping seltzer water, smiling and trying to tell him about Poe …

  He snapped to at 58th Street, felt his flesh returning to him. It was like that with the Space—boring away at you and then suddenly gone, or there but not as noticeable. He had to slow it down, breathe normally, light a cigarette. Only two more blocks to the hospital. And a very tough day ahead of him.

  The old woman, Lorraine Bell. Admitted yesterday, he had checked her stats, tried to get out of the room before her smell got to him. They had cleaned her, of course, but there was no hiding her smell. The rotting flesh. A gomer for sure. That was Harry Gardner’s word, just another old piece of meat shipped from the nursing home, Windy Hills. Such a nice, pleasant name, and all the walls painted pastel to rest the old eyes, keep the old pulse level. But there was no slowing any of it down. Always going straight ahead, through the cutting edges of the morning. Always going straight ahead.

  Except for her mouth, the way the lips curled up, as though she were in command of something—as though she were about to make a joke. There was a residue of beauty in her mouth. It had shocked him (and he recalled seeing the mouth last night, as he was pacing his apartment, walking slowly like a caged lion).

  He turned into the 72nd Street entrance, went down the ramp, and felt as though he were riding along the surface of a tongue. A darting tongue which would flip him into the space marked in red, “Peter Cross Anesthesiologist.” He stopped the Mercedes with a jerk, stepped out on the asphalt, saw the white shadow of a nurse walking toward the far elevator. Inside his chest he could hear something taking place. Stop that. You must stop. He crushed out the cigarette, adjusted his glasses, stooped down and looked at his thin, scholarly face in the window mirror. He noticed the slight blue bags under his tense slit-eyes. Like a serpent, he thought. Patient’s name Lorraine Bell. Moldy, wrapped in gauze. With a joke about the mouth.

  He walked from the elevator to the scheduling room. Check and see if the patient survived the night. She had. They were tough, very tough. Tougher than Harry Gardner supposed.

  “Hey, Cross, you got the gomer this morning?”

  Harry Gardner stood in front of him holding his nose. Peter stared at his huge, hairy forearms, the short, powerful torso and the stubs of legs. Harry looked like Popeye, or an ape.

  “Her name is Lorraine Bell, Harry,” Peter said.

  He could feel the beehive churning in him. Whirling ghostholes through his body.

  “The old bag is going to soil herself, Peter. Look out when she lets the big load rip.”

  “Christ, Harry,” Peter said. He started to turn away, but Harry grabbed his arm. Peter felt as though there were a branding iron on his flesh.

  Then Harry cracked up and let Cross loose.

  “Don’t do that again,” Peter said.

  “What’s this?” Harry said, taking a step back toward Peter. “You getting tough?”

  Peter stared at him, through him, and heard the sound of stones being rolled.

  “Good morning, Harry,” he said.

  “Space Cadet,” Harry said. “You are the original Space Cadet.”

  Peter heard his voice. It sounded small and far away. He turned, went into the changing room, walked down the rows of lockers, which suddenly looked as menacing as the buildings on Third Avenue. He removed his pants, neatly folded them over a hanger. Took off his shirt and stared down at
his well-muscled torso. He kept himself slender, in shape, and yet he did not see that. He saw sagging flesh, the muscles being ground down by the years. He changed into greens, got his keys, slammed his locker shut, went into the hall, and stopped by A Room. Opening it, he stared at the shelves of briefcases, the other armamentaria of his colleagues. Here they kept their drugs, all of them—Rizzoli, Lampur the little Indian, Hernandez the Puerto Rican, Chung the Chinese, and Harry Gardner. He stared at their names taped on the bags. None of them was as good as he. Most were like Gardner, who only got into anesthesiology because he couldn’t cut it at med school. Easy hours, good mobility, get stoned and laid on the weekends. He picked up his bag. Get ready for Miss Lorraine Bell.

  She was eighty-one, blood pressure 160 over 60, with a joke around the mouth. Do your job, do it well … she is in pain and needs you. The doctors will find out where the bowel is obstructed. Though Peter thought he already knew. Her bowel would be obstructed from adhesions. Adhesions caused by other needless operations. He walked into the Ready Room, opened his armamentarium, and stared down at his drugs—plenty of neostigmine, succinylcholine, curare. He looked down at the long needle and thought of his mother, the injection heading into her arm…. Then he packed it all up and headed into the OR.

  He was the first one in the room, and he busied himself checking over the anesthesia machine, making certain that the tanks of oxygen and nitrous oxide were set to the correct proportions. The oxygen content was all right—between 18 and 24 pounds per inch, but the nitrous oxide was a little low, so he raised it to 575 pounds per square inch. Then he turned as the two scrub nurses wheeled in Lorraine Bell.

  “Hello, Peter.”

  Peter smiled at Debby Hunter, a tall, beautiful blonde, new to Eastern Medical. She smiled back at him, and he felt shy and looked away from her. He stared down but became aware of her legs, long and slender, and he thought of her standing there naked, no one else in the room … and the thought made the Space inside of him howl again, shift, hurting him.

  He looked down at Lorraine Bell. Her face was lined with wrinkles—so many of them that he couldn’t believe it. But there was the mouth—it seemed to be smiling—and it seemed to be young. He hooked the hoses up to the ceiling, green for oxygen, blue for nitrous oxide. He watched as Dr. Dios, the Filipino surgeon, came in. The doctor was a smooth, urbane-looking man, but Peter wondered what went on behind the mask. Now Dios began to kid around with Debby Hunter, ignoring the other nurse, Robin Hanlon, entirely. That was the way it always was. The good-looking, the beautiful, they got all the attention. The Lorraine Bells of the world got operations they didn’t need. He looked down on her and was hit by such a surplus of emotions that he felt as though he would gag. He breathed in deeply again and checked the pop-off valve on the anesthesia machine.

  “Peter, how have you been?” Debby Hunter smiled at him, and Cross felt his face flush. No goddamn good with girls. Never had been.

  “I’m fine. Fine.”

  “That’s good. Been reading much?”

  “Why?”

  “You looked tired. Besides, I see you reading at lunch hour. You usually have one of those ghoulish books of yours.”

  “Escape from the white tile womb,” Peter said.

  Debby laughed and helped Dios and the other nurse get Lorraine Bell onto the operating table. Peter went back to his work, his pulse beating faster.

  “Cross? Dr. Cross?”

  “Yes?”

  “How we coming?”

  “Fine, just checking the vaporizer.”

  Cross poured a 150-cc. bottle of enflurane into the vaporizer, then turned and opened his armamentarium and began laying out his drugs—the 10-cc. syringe of sodium pentothal with 250 milligrams of the drug which would first induce Lorraine Bell to sleep, the 5-cc. syringe filled with 100 milligrams of succinylcholine which would relax her muscles, the 5-cc. syringe of curare used to maintain relaxation, and another syringe which he found himself reaching for as if he were in a dream, a 5-cc. syringe in which he placed 2.5 milligrams of neostigmine. He was barely aware of what he was doing. He began to shudder a bit … and laid out the atropine, 1.2 milligrams in a 3-cc. syringe. His tongue was dry, and he felt a cold chill come up his back. Across the room Debby Hunter talked with Dios, but he felt as though he were looking at her through a fog.

  “Cross, Dr. Cross?”

  “Yes. I’m coming.”

  He laid out the endotracheal tube, tested the rubber cuff on it by inflating and deflating the balloon. He then inserted the stylet into the end of the tube which would remain outside of Lorraine Bell’s mouth. He lubricated it, softly rubbing the steel, rubbing it round and round, feeling, as he did it, clean and fast as though he were breaking out of a trance. He then checked out the laryngoscope to see if the light worked. He laid out oral and nasal airways and several tongue depressors to help the patient breathe. He wanted her to breathe for him. He wanted to feel her breath on his wrist. He checked her blood pressure chart again: 100 over 60. Still very very bad. Then he nodded to the nurse and let her know he was ready. He put on the blood pressure cuff, hooked on the leads for the cardiac monitor, made sure the IV was running properly. Lorraine Bell was now receiving her 5 percent dextrose and normal saline.

  Quietly, fluidly, in a voice which sounded strange to him—it was that calm and peaceful—he said to Dios, “When she’s asleep, I’ll put in a central venous pressure line.” Dios nodded and Peter took her blood pressure again. It registered as it had on the chart, 100 over 60, and her heart rate was 100, but irregularly irregular, which meant she was suffering from atrial fibrillation. In short, her heart was very weak, and he must be careful. Not too much anesthesia.

  When he thought that, it was as if his mind had cleared and he was himself again—he felt brilliant, logical, scientific—the room had become all hard-edged chrome, steel, and tile, and the ecstasy and strangeness that had encircled him a moment ago were now gone. He felt “normal,” though he didn’t know exactly what that meant. But he did know that he kept right on feeling normal until the moment he put the 150 milligrams of sodium pentothal into the IV line. Then, out of the corner of his eye, he once again saw her mouth and he began to feel the fog sweeping over him.

  Quickly he picked up the mask, put it over her face, and continued to hand-ventilate her with the bag. He watched as she went deeper, then he injected 60 milligrams of succinylcholine, and he watched as her muscles began their fasciculations, the fluttering of the eyelids, the rippling of the muscles in the arms and the knees, and finally the feet, jerking a little, then relaxing. He knew she was peaceful now, that all her pain was gone and that she was in the place beyond even dreams.

  He inserted the laryngoscope into her mouth, exposed the larynx, and placed the endotracheal tube down through the vocal chords into the trachea. He then removed the steel stylet from the other end and hooked up the connector to the machine. Carefully pressing the bag, he inflated the endotracheal cuff, checked for leaks, and, once satisfied there were none, he turned on the nitrous oxide and enfluorane mixture, still checking her blood pressure and keeping an eye on the cardiac monitor (he couldn’t be too careful there).

  He kept ventilating with the hand bag and secured the endotracheal tube with a loop of tape which went around her lips. When he touched them, something seemed to break inside of him, literally shatter, as though there were some delicate crystal goblet instead of organs inside his own body. But when it shattered, instead of pain, he seemed to be filled with a terrifically warm liquid, all at once clear and good, and he felt himself swimming in a kind of compassion.

  Now he put in the oral airway, using a tongue depressor, and placed in an esophageal stethoscope which allowed him to listen to the patient’s heartbeat and breathing. He checked the heart rate and noticed that during the induction it had gone up from 100 to 126, but now it was returning to normal. The blood pressure had dropped slightly, to 90, but he checked the intravenous line, inserted it, and took the pressure.
He found it acceptable—”acceptable”—another word like “professional.” Suddenly that word, too, made him feel wretched, and he began to breathe deeply. God, don’t let anyone notice.

  He put the manometer on the line—it read 9 centimeters of water pressure and was fluctuating well. She was ready now, and the circulating nurse prepped the patient’s stomach with iodine soap. Debby handed the surgeon the sterile drapes and towels, and Dios draped Lorraine Bell. He did it quickly, professionally, and Cross felt as he always did when the patient was draped—cut off, removed from the operation. He had heard other anesthesiologists complain about it, especially Harry: “We get them all ready, we control it, and then they take over with their big egos and they get all the credit.” With Harry it was all a game of power. Harry was sorry he hadn’t been able to “cut it” in surgery. Dios now turned to Cross and nodded.

  “May I begin?”

  “Certainly,” Cross said, and he liked the sound of his voice when he said it. Crisp, in control.

  Dios wasted no time. He accepted the scalpel from Debby and made the first incision on the belly. His assistant, Dr. Black, clamped the skin off, and the operation was underway. It would take a while to find the obstruction in Lorraine’s bowel. Since she couldn’t tell them where she hurt, the obstruction could be practically anywhere. Dios had made the incision where another incision had already been made. Cross thought of the old adage he’d learned in medical school: “See an abdominal scar; think of obstruction due to adhesions.” Surgery from the world of the blind. The patients knew nothing, the surgeon little more.

  Cross was certain that Dios hadn’t bothered to tell Lorraine Bell’s children, if she had any, or if they had bothered to ask him. Probably they had not. Probably they had sent her off to a nursing home years ago, going out every week at first, then every couple of weeks, and finally once a month. By the second year they would call on her birthday and talk to a nurse, who would tell them she was doing quite well and “had taken her medication. Wouldn’t it be a shame to wake her?” And, of course, they would agree … it would be too bad … ridiculous to wake a now senile woman out of a good dreamy sleep. And so she would waste away until one day when everything had fallen in—her cheeks, her nose, her eyes, one vast sag of wrinkles—everything gone except the mouth, as if it were fighting the battle all by itself, the battle to remain young and beautiful. Such a futile battle it was, too. Cross knew that. He was only thirty-five, but already in himself he could see the signs of decay. He stared over at Debby Hunter. God, she was beautiful.