The Sandman

by Robert Ward

  He watched Dios and his assistant, Black, kneading Lorraine Bell’s intestines, looking for fluid or gas trapped in the loops of the distended bowel. He watched as they shook their heads.

  “It’s not there,” Dios said.

  “I don’t see any adhesions,” Black said.

  “This is so frustrating,” Dios said. “If we can’t find it, we’ll have to open her up again.”

  “I know,” said Black wearily, as if he had already given up hope.

  Cross watched as she lay there; then he checked her heart, her blood pressure, her breathing. All okay, but then there was a sickening stench and the scrub nurse held her fingers over her nose.

  “God,” she said, “she’s done it. She smells like dead fish.”

  The room reeked of Lorraine Bell’s shit, and the circulating nurse, Mrs. Martin, looked as though she were going to pass out.

  Now they were working on her abdominal wall, Dr. Black using the rakes and Kocher clamps to keep the wall open. Cross watched, still stunned, his left hand preparing to inject her with a slight taste more of anesthetic, this time curare if she became too light and began feeling the pain. (And also to allow her to stay at that great place he had put her. Yes, he was growing excited again, reaching for the syringe labeled Curare.) He watched as they freed the small bowel from the anterior abdominal wall, dividing the adhesions which they found with dissecting scissors.

  “Maybe these are it,” said Dios. “Two adhesions. God, the last guy butchered her with the stitching …”

  “Yeah,” said Black, “but it didn’t stop her from butchering us. Christ, that odor.”

  Cross watched as they began to cut through the adhesions. He knew that these two adhesions wouldn’t be the last of Lorraine Bell’s problems. Sure, they got rid of them, but from the looks of her, some young resident had been practicing carving turkey on her. How many more adhesions did she have inside the loops of bowel that Dios and Black didn’t bother to plunge into because of the smell? It was clear from the speed at which they worked that they were doing their best to get out as fast as possible. Not that they were bad doctors—Dios was a bit of a hacker, but he was by no means the worst—it was just that everyone felt the same way. One had only so much time, stamina, and strength to waste on a gomer. Everyone knew she would be better off dead. So, given that premise, anything one did was sort of a bonus for her. Cross watched as the two surgeons started the Noble Plication, and he suddenly felt tears come to his eyes. God, don’t let them notice. What was happening to him? Was he having some kind of crackup? He didn’t understand it. But the moment he had seen her, something had clicked, and so now, as her body began to jerk a little from them tugging on her mesentery, he felt a cold chill come down his back.

  He reached for the curare, with its pale green label, only he didn’t pick it up. His hand reached for the neostigmine, and he had almost injected the drug into the IV when he noticed … My God, the wrong drug … or was it wrong … Lord, don’t let them see. Slowly, he put back the neostigmine, picked up the curare, and shot it into the IV. Six millimeters of it. Almost immediately Lorraine Bell began to relax. The doctors resumed stitching up the mesentery. The patient bucked, and now he felt a strange calmness descending over him. All the shakes and fears were gone.

  He felt himself pulling away from everything, and he found his hand reaching for the neostigmine, the syringe with 2.5 milligrams in it, reaching behind the curtain where no one could see him (but then they couldn’t see him anyway, for somehow they were no longer in the room, it was just he and Lorraine Bell, oh, yes, and he felt good … all of a piece, not split or unsure of himself anymore) and he stuck the 2-millimeter syringe into the IV, shooting the drug into it, then replaced it with the empty curare syringe, so if anybody looked, they would see nothing unusual, nothing unusual at all … and he heard his mother, Lila Lee, saying to him, “If I could just sleep through it … If I could only sleep through the pain … Petey … I could bear it if I could just sleep through the pain.”

  He checked her blood pressure. Christ, it was happening already. Her pulse rate had dropped off from 100 to 90 and was rapidly descending. Her blood pressure had dropped from 100 to 80 and was going down fast. Peter watched and felt the faintest sense of fear, a chill, but the chill seemed to be changed into something else, a rush of excitement, a spreading of happiness which poured through his veins.

  Suddenly, Dios spoke up sharply: “Hey, Peter, there isn’t much bleeding.”

  Peter turned and looked at the monitors (turned coolly, as if he had been preparing for this all his life).

  “My God,” he said, hearing his voice register a wonderfully accurate degree of shock and dismay. “Her blood pressure is down to sixty and her heart rate is down to fifty-five … and dropping … I don’t know what the hell is going on! Stop the operation until I can get her stable.”

  Oh, he had done it. Just the right amount of “professional” concern.

  Black’s voice was urgent: “Her heart … ventricular heartbeats … now it seems … Christ, she’s going into ventricular tachycardia … Shit … It’s happening too quick … What the hell is it … she’s going into V-fib …”

  Dios nodded and yelled. (Though Cross couldn’t hear him, he felt as if he had turned to gold. Never had there been anything like this. He had been waiting for this moment.) “All right, I’m starting external cardiac massage … Get the crash cart … We’ve got to get the pads on her.”

  Dios began to pump up and down on the heart, harder and harder, and Peter, feeling as though he were watching himself perform, began to give Lorraine 1.2 milligrams of atropine, which ordinarily would increase the heart rate, but he knew now that he had been successful. He had waited too long. The atropine would get to her too late … Oh, yes, as would the sodium bicarbonate, 50 milliequivalents worth he pumped into her, and finally the one milligram of epinephrine used to stimulate the pulse rate.

  “It’s not working,” Peter said. “Nothing’s working at all.”

  “It’s no fucking good,” said Dios.

  “My God,” said Debby. She turned her long, beautiful back to Peter and held her hair with her hands, like someone gripping the edge of a building. Peter watched her and felt another jolt go through him. He wanted to go over to her, put his arm around her, hold her face and tell her it was all right. Everything was going to be just fine.

  He stood there, hands limp at his sides, the glare of the hot lights reflecting off his glasses. He watched, deeply moved, as they wheeled the corpse into the hall.

  He walked through his living room, hearing the sound of his stockinged feet as they glided over the fake Oriental rug. In his hand was a Scotch and soda, and the sounds of the ice cubes clicking sounded like the roll of dice on a back alley in Baltimore.

  She was done. She was history, and he waited to feel ashamed, waited for the Space to start eating away inside of him, the rawness of the organs as the Space ate through him like an acid. He sat down heavily in his white chair, stared at the blank TV screen, and remembered the first time he had felt that way, sitting in his peeling wallpapered room on 21st street in Baltimore.

  He had been staring across the alley at Rosalie Fangikis, the Greek girl, and she had started to take off her clothes. He watched her take off her sweater, toss her black hair back, walk to the window, and he felt himself getting excited—Christ how he wanted her. But then it came over him, the way his father had laughed at his skinny arms, the absurdity of his small chest, and birdlike legs. And he felt suddenly a wave of paralyzing self-loathing. It was nuts to even think of it. Not only was he not going to have Rosalie, but the fact was he was never going to have anybody. He was a mama’s boy, Lila Lee’s boy, the artsy crazy lady of the block. He began to shiver and to hold himself, wrapping his arms around his waist and moaning. It was then, at that moment, that the Space was born.

  He felt hollow. He felt his heart, veins, kidneys, lungs disintegrating, like people disintegrating on Captain Video ser
ials. He squirmed on the cold, wide bed, and tried talking to himself—it’s just a crazy feeling … it’s all in your head … your heart is still in your body, you can hear it beating … your lungs are still there, you’re still breathing. But the logic of his words didn’t ease him. He felt empty, drained out, a non-person. He was never going to be alive, never going to be a man. He was a pussy. He couldn’t even climb the fucking ropes in gym for Chrissakes. And when he turned and saw her body across the dark alley, he felt as though he were an empty goblet or a manikin. Push him over on the floor and he would shatter into a million fragments.

  Now he sipped his Scotch, and looked around the room. The Space had never left him—never. He had tried to fight it, had finally, tearfully (and full of shame) told Lila Lee about his trouble, not actually mentioning the Space—he was too ashamed of that, too fearful of it to actually call it by name, at least to her—for even then he was aware that somehow she was partially responsible for it. She had taken him to Dr. Salem. He recalled the man’s old office on Greenmount Avenue, the musty smell of old furniture and the dead glare of faded yellow lampshades. He had gone into the doctor’s office and sat in front of the bald man, and after an hour of twitching and stalling, he could resist no longer, and he had broken down and told him about the Space—how he felt like nothing, how he would be on his way to school, and he would see a woman and he would feel it happening, the organs vanishing, smoking like dry ice. Eventually, after Peter had spilled himself to Salem, the doctor had asked him to wait in an adjoining room, and called in Lila Lee. Peter had sat by the door, staring down at a copy of Jack and Jill magazine. He sat quietly for a few minutes, and when the receptionist went to lunch, he crept close to the door and listened while the old man said things he didn’t fully understand, “self-image,” “hallucinations,” “due to a terrible feeling of guilt and worthlessness,” and hearing them made him even worse, for they seemed to be a death sentence, an actual confirmation of his most terrible fears. He was all these things. A “sicky,” a “weirdo,” a “nerd.”

  Then he heard his mother saying, “My son is not like that. He’s just a little upset, that’s all. How dare you label my son like that.” And he had felt such tenderness toward her. She had taken up for him. She was his companion. The only one he could count on; and yet, yet wasn’t it she who had made him that way? God, it was too terrible. He loved her, and yet when they left the office, and she tried to take his hand, he had violently pulled it away and then felt guilt for that, and inside him the Space began growing again, more violently now, like a jungle vine twisting around all his organs, smothering them, and it whispered a secret message to him, that it was never going to let him go—never—that he would pay for betraying it to that doctor, that he would always pay for the rest of his life. He was nothing, nobody, dead, no, worse than dead, he would be condemned to keep on living, while feeling hollow, scooped out, less than zero.

  Now he got up and walked to the bedroom. Something strange was happening—something so new and delicious that he could barely understand it. He sat down on the bed, and with his right hand he touched his left bicep. It felt strong, full of muscle, and then he poked himself in the stomach. It too was all right—flat, muscular. God, he felt exhilarated, almost ecstatic. Those old memories of the Space, the persistent feeling of worthlessness which had never left him, never even after all these years, even after success as a doctor (For what was a doctor but a mama’s boy grown up?)—suddenly the memories were simply that—memories. It was as though they were somebody else’s life story, some poor, pathetic bastard who was lost and alone.

  The Space had called to him and challenged him. He had met the challenge head on. He had killed—don’t try and hide it—he had killed. He had taken the leap that every man, woman and child wondered about and secretly desired. (After all, what child hadn’t thought about killing his punishing father, what poor working slob hadn’t fantasized about doing away with a manipulating boss?)

  He had killed and he felt good about it. He was alive, a man, and sitting there he felt powerful, aware of his own magnetic presence in the room. For the first time in his life he liked himself. He lay back, stared up at the ceiling, and he couldn’t believe it—peace.

  He was warm, very warm, and drowsy. And then, for the first night in years, Peter Cross fell into a deep, perfect sleep.

  2

  Dr. Robert Beauregard, chief of Anesthesiology, sat at the head of the long oak conference table and stared down at Dr. Dios and Dr. Black, Dios’s assistant on the Lorraine Bell case. The long table, big enough for twenty, was where the department held its weekly morbidity and mortality meetings. During these inquisitions, any questionable deaths were discussed and accounted for.

  Now with its seventeen empty chairs, the room seemed a melodramatic prop in a trial held in the Soviet Union for Crimes Against the People. At least Dios felt that way. He looked up, tried to meet Beauregard’s gaze head-on, but it was impossible. Beauregard’s power, his bearlike presence, was hidden beneath a shock of graying hair. His blue eyes were often penetrating, as though they were judging a man, even on the best of days, but during these meetings they looked cold, full of ice … Beauregard’s obsession with unnecessary deaths was a legend in the hospital. Indeed, when they felt very good, some of the surgeons might make a passing joke about it. But not today, not sitting in the hot seat staring up at him. Beauregard had the lowest of burning points. He drove himself and his staff as hard as he could, and Dios had known from the very moment of Lorraine Bell’s death that he was now on the shit list. Beauregard had said it over and over, “No unexplained OR deaths. They are unacceptable.” Dios shuddered a bit, thinking of what a scandal could do to his career. He had come from a poor family in the Philippines, worked hard to get through med school, and was just starting to enjoy the fruits of his labor.

  Dios’s furious musings were interrupted by Cross’s entrance. Peter swept through the door at precisely ten o’clock, a red scarf wrapped around his neck, his black raincoat unbuckled and swooping behind him like a cape. He looked, Dios thought, like some character out of the nineteenth century, very, very strange.

  “Gentlemen,” said Dr. Robert Beauregard in a voice that sounded as if it had come out of the grave, “let us begin. First, let me express to you my feelings on this matter. Lorraine Bell died during a bowel obstruction probe last night. You three men were the attending physicians. A human life was offered to you, put under your care, and you allowed that life to simply fizzle out. I can see from your looks that you’re already angry at me for my tone of voice here. Well, I assure you that it’s quite intentional. I don’t accept the death of elderly patients at Eastern. As you know, I believe, and want you to believe, that older patients’ lives are, if anything, more precious simply because their condition is more precarious. Every possible precaution must be taken to see that they do not have a shock reaction. Every possible gentleness and consideration must be standard operating procedure. I’m not talking about ‘doing your job,’ I’m talking about using extra caution, extra consideration. Now, knowing that, I want some explanation, gentlemen. I want some solid, concrete explanation. What the hell happened last night?”

  Beauregard turned and looked at Dios, and Dios felt himself burning with anger, felt his own heartbeat pumping up, as if he had just spent an hour jogging. Sweat formed on his forehead and he was afraid to wipe it off because he was afraid to acknowledge its presence. Sweat might be interpreted as guilt.

  He had to say something. So he cleared his throat and began: “I needn’t explain to you that the nature of the bowel operation was made more difficult because the patient was unable to tell us what pains she was experiencing. We opened her up and we checked the small intestine. I think that Dr. Black will agree with me that we took every possible precaution with Lorraine Bell’s intestines. We handled her gently, as gently as possible. When we found the adhesion, we detached it. Again, we were extremely cautious. And when we sewed her up we were again
very careful. I would say that we were extremely careful, wouldn’t you, Dr. Black?”

  Black nodded and looked straight at Beauregard. Dios welcomed Black’s support, felt his breath come back in his lungs, and was able to swallow again.

  On the other side of the table, Peter Cross remained motionless. He sat with his scarf still dangling insouciantly from his neck. His raincoat opened with a slash. His pince-nez glasses reflected the old brass lamp on the table. He heard Dios as though Dios were at the end of a long hallway, shouting to him through a broken bullhorn. He felt a wind sweep at his ankles and wondered why Debby Hunter wasn’t there.

  “What about the mesentery?” Beauregard said. “When you were sewing up Lorraine Bell …”

  Dios, his confidence swelling, interrupted: “The woman had an irregularly irregular heartbeat to begin with, Doctor. We had a tough job with the mesentery. I’m sure you can appreciate that the tissue was already in an advanced state of degeneration. There was nothing much to work with. But we didn’t put her under any abnormal strain.”

  Beauregard’s eyes grew large and his right hand twisted into a fist. “According to whom?” he boomed.

  “I don’t follow you,” Dios said, feeling the fear creep back in again.

  “You said, Doctor, that you didn’t put her under any ‘abnormal’ strain. And I want to know what your definition is. What is ‘abnormal strain’ in a case such as this? Are you telling me that according to the textbook, patient X received the legitimate amount of pressure?”