Prelude to a Scream

by Jim Nisbet

  “The rich guys end-run the system,” said Iris.

  “Yeah, like that. But in the third world, it’s really crazy. There’re no controls, and it’s capitalistic beyond our wildest franchises. As if we had no idea what ‘capitalistic’ means, here in the States.”

  “Meaning what?”

  “Meaning we’re moral about it,” said Iris acidly, “and the underdeveloped ignoramuses aren’t.”

  Corrigan rolled his eyes. “Meaning there are third-world clinics where poor people can sell an organ for more money than they’re likely to earn otherwise in their entire lives. And who are we to say they shouldn’t? But there are the shadier operations, too, into whose clutches these same peasants can fall, thinking it’s a legitimate organ-for-cash deal, never to be seen alive again. When a body does turn up, it’s a shell. Everything’s been harvested and, needless to say, the donor didn’t get paid. Another variation is the guy who takes a cab to a clinic for a hangnail and wakes up in a ditch with a nephrectomy. That’s the difference between legitimacy and illegitimacy in the third world. The next step is an organization that buys and sells any organ you want. An organ broker. With overnight delivery. You place a purchase order for an out-of-stock organ and they guarantee to have the item for you by a certain date. The only questions asked or answered are when and how much. Forget whose it was and how it was ‘donated.’ It’s half down, half on delivery; end of procurement phase.

  “There are clinics from Cairo to Zurich to Bombay to Rio where you can get any organ installed, no questions asked. You can get them removed, too. You can get them turned upside down, exchanged, steam-cleaned. You can get your heroin-saturated blood drained and replaced with the blood of new-born babes. You can get bone-marrow that’s been taken from children, sold by their parents. Liver transplants, eyeballs, hearts.…”

  Corrigan removed a pale white handkerchief from the pocket on the front of his brown jacket and mopped his face with it.

  “I tell you Stanley,” he said, blowing his nose, “I tell you Stanley…” he examined the kerchief for a moment, then refolded it and stuffed it back into the jacket pocket, “that kidney of yours is nothing.”

  “Oh, say, thanks, Corrigan,” said Iris. “Try to cheer the guy up, why don’t you?”

  Corrigan raised an eyebrow. “Who, me?”

  “No,” said Iris disgustedly. “Decidedly not you.”

  “That’s okay, Iris,” said Stanley. “This is interesting.”

  “I’ll tell you something else, son,” Corrigan said darkly, pointing a finger at Stanley. “The supply of replaceable human organs will never meet the demand for them. It’s a great racket to be in.”

  Iris read a small wristwatch strapped to the inside of her left wrist. “Personally, I think it’s time for your next dose of morphine, Mr. Ahearn.”

  “Nurse, I —.”

  “Don’t worry sweetie,” she said. “In here, it’s only nine dollars for fifteen milligrams. You can afford it.” She patted his leg and stood up from the bed. “I’ll be right back. Shall I get a nice overdose for Inspector Corrigan while I’m at it?” She pulled open the door and left without waiting for an answer.

  Corrigan sighed. “Sassy little thing, our Iris. I went to Mercy High with her mother. Two peas in a pod.”

  Stanley was watching the door as it squeezed to nothing the vertical shaft of light from the hallway. “You’ve worked with her before?”

  Corrigan walked to the window and looked down at the parking lot. “Eight times,” he said to the glass.

  Stanley looked at his back. “Eight?”

  Corrigan didn’t respond.

  “I’m the ninth?”

  Silence.

  “Inspector?”

  Corrigan filled his trouser pockets with his hands and shrugged. “We figure Iris might pick up something from the victims that might otherwise elude us. She’s been the nurse on every case.”

  “Were they all kidneys?”

  Corrigan nodded.

  “They all survived?”

  He shrugged.

  “You’ve solved none of them?”

  Corrigan ducked his chin and scrubbed one cheek on the shoulder of his jacket. It sounded like someone cleaning upholstery with a wire brush.

  The door admitted Sims. This time he had two clipboards with him, and a disturbed look on his face.

  “Mr. Ahearn.”

  “Why, Dr. Sims, at last you seem upset.”

  “What’s the matter?” said Iris, following him into the room.

  “Maybe they socialized medicine,” said Stanley.

  Corrigan turned away from the window.

  Sims took a deep breath. “I’ve just been handed this report from Pathology.”

  “Yes?”

  Sims looked as if he were about to faint.

  “So?” said Stanley, annoyed. “Is something wrong? I mean, is something else wrong?”

  Even as he said it, everybody in the room realized that, yes, something else was wrong.

  Sims opened his mouth and moved his lips. No sound. His face turned red. He shook his head and moved his lips again. No syllables emerged.

  Summoning what remained of his resolve, Stanley said weakly, “Out with it!”

  “Mr. Ahearn,” Sims blurted. “How long have you had amyloidosis?”

  Silence filled the room.

  Finally Stanley asked, “How long have I what?”

  “I’ll tell you,” said Sims, adjusting his glasses. He appeared to study one of his clipboards. Before long he realized it was the wrong one. He quickly covered it with the second clipboard and began the study over again.

  “Don’t be so nervous,” said Stanley. “I might get the idea you made a mistake I can sue you for.”

  “One to two years.”

  “One to two years? For what?”

  “You’ve had amyloidosis — or the condition that precipitates it — for one to two years.”

  “What did you call it?”

  “Amyloidosis.”

  “It sounds like Gaelic square dancing.”

  Corrigan and Iris nodded.

  Sims nodded morosely. “I wish it were, Mr. Ahearn.”

  Everybody waited.

  “Just relax, Doctor Sims,” said Corrigan soothingly. “Take your time. Take a deep breath. Maybe even walk around the block. Ahearn’s not going anywhere. Just let him twist in the wind.”

  “Right,” said Sims, snapping out of his humanistic reverie. “It’s a chronic, underlying disease of the kidneys.”

  “Kidney,” Stanley corrected.

  Sims continued quietly, “It could be collateral with or systematic of tuberculosis — which we automatically ruled out when we let you in here — which leaves,” he cleared his throat, “rheumatoid arthritis or multiple myeloma.”

  Stanley stared at Sims long enough to make Sims even more uncomfortable. Finally, Sims held up the two clipboards, and said, “On the bright side, you’re HIV negative.”

  He didn’t even smile.

  “Oh, you idiot,” said Iris.

  Sims appeared very innocent.

  “Why don’t you just rub his face in it?” Iris continued.

  “I just want him to feel better,” said Sims lamely. “I thought…”

  “Don’t try to think,” Iris shouted, “before you can crawl!”

  Sims was truly puzzled by this remark. “Do you mean… emotionally? Crawl emotionally…?”

  Iris stamped her foot in exasperation. “Oh!” she finally said, and, turning on the very heel she’d stamped, left the room.

  The three men looked every way but at each other for a moment, in total silence.

  Finally, Stanley made a suggestion. “Help me get this straight.”

  Corrigan advanced from the window, watching Sims.

  “You mean to tell me, Sims, that my kidneys are… my kidney is… sick?”

  “Kidney,” Sims timidly held up a forefinger, “Yes. Singular, is… no good.” He shook his head. “Bad kidne
y. No good…”

  “Is this a puppy or a kidney, goddamn it? How no good?”

  “Very no good.”

  “You mean, like, completely no good?”

  “Potentially fatal.”

  A bolus of mucus seemed to be caught in Stanley’s throat. His right ear was ringing. The room seemed to be tilting at an odd angle.

  From beyond the door came the egg-timer ping of an arriving elevator.

  “Sims. You can fix this?”

  “I didn’t say that.”

  “Can someone else fix this?”

  “Maybe.”

  “Wait a minute,” said Corrigan. “Could this mean the other kidney, the missing one, was diseased too?”

  “Almost certainly,” Sims confirmed.

  “Correct me if I’m wrong,” Corrigan said thoughtfully. “This means that these people who stole Ahearn’s kidney have stolen something they can’t use?”

  Sims nodded. “That’s exactly what it means.”

  “Good,” Stanley said, through clenched teeth. “The bastards.”

  Sims adjusted his glasses. “It’s not a good idea to open up someone to remove their diseased kidney and replace it with another diseased kidney, no matter how sick they are. Yes. A terrible waste of the patient’s energy, not to mention the surgeon’s. A waste of money too. Useless. It would be very like replacing a worn out fuel pump on a car with another worn out fuel pump. To take another example—”

  “Okay, okay,” grumbled Corrigan.

  Stanley managed a grim smile. “That’s a tough break for the bad guys.”

  “That’s your point of view,” Sims said primly. “What if the thieves didn’t care whether it was diseased or not? Let’s go one step further and ask, what if the people who are receiving the stolen kidney don’t care whether they install diseased kidneys or not? All anybody’s interested in is the money.”

  Corrigan shook his head. “Bad for business. My money says they’re stuck with it.”

  “They couldn’t spot the condition when they opened me up?”

  “Not amyloidosis,” said Sims. “You’d need a biopsy to detect it.”

  “You know,” said Corrigan, “there’s another interesting angle.”

  “What’s that?” said Stanley.

  “They let you live. They try to let their victims live. If they’ve lost a single patient I’ve yet to hear about it. Although,” he added darkly, “that doesn’t mean it hasn’t happened. There are ways to disappear a body. But think of it.”

  “I can hardly think of anything else.”

  “To evade murder charges, they’re taking a tremendous risk. What if the donor saw something, or remembered something?” He looked at Stanley.

  Stanley looked at him.

  “That’s true.” said Sims. “Patients often remember unlikely details from their surgical procedures.”

  “Is that so.” said Stanley mildly.

  “Yes,” said Sims earnestly. “While theoretically unconscious, while machines are controlling their cardio-pulmonary functions entirely, patients are able to recall details that are surprisingly accurate. They remember that the anesthesiologist was a black man, or that the walls in the O.R. were green, or that the surgeon requested Mozart, or that a nurse was wearing pink sneakers. One patient filed a lawsuit because she overheard the entire surgical team discussing how fat she was while they were operating on her.”

  “You’re kidding,” said Stanley, as ingenuously as seemed credible.

  “I never kid.”

  Stanley could believe that. “Did she win?”

  “Are you kidding?”

  “As much as possible.”

  “Hey,” said Sims, “you’re talking aggravated distress in the extreme. Beyond the pale. Not only could she hear what they were saying about her, she could feel the pain of the knife, too. But the partial anesthesia rendered her unable to move or speak.”

  “Jesus,” said Stanley.

  “Ouch,” winced Corrigan. “What kind of surgery was it?”

  “Full knee-joint replacement.”

  “My God.”

  “She won the case,” said Stanley.

  Sims nodded. “It never saw the inside of a courtroom.” He shrugged. “The point is, under such circumstances inexplicably random, isolated details somehow filter in through the anesthetized senses.”

  “Little details like mind-searing pain,” said Corrigan.

  “But I would think,” Stanley said, “in a case where they were stealing a part of the patient’s body, if the patient were a victim, if he had obviously returned to consciousness, if he could see and hear the perpetrators, why then…”

  “They’d have to ice him,” concluded Corrigan, watching Stanley.

  “Yes,” Stanley agreed thoughtfully. “They’d have to ice him.”

  “They probably wished they’d iced the fat lady,” said Sims.

  The hallway door opened to admit Iris, who pushed a cart before her. “Okay you professional jerks,” she said. “It’s time to work on the patient’s health. Everybody out.”

  Sims stood aside. Iris wheeled the cart up next to the side of the bed. “We’ll keep feeding him. Iris,” Sims said, “but the oxygen and the catheter can go. Did Nuñez put on the ascorbic acid?”

  Nurse Considine scanned a pink clipboard on top of the cart. “Yes, doctor.”

  “Pedameth?”

  “Yes.”

  He held out his hand. Iris handed him the pink schedule.

  “Mmmm… serum… potassium… I reckon we can dispose of the hemoglobin, hematocrit, urinalysis…”

  Sims made a few notes and, drawing blue lines down the front of his breast pocket, returned the clipboard to Iris. “I’ll be looking in on you in the morning, Mr. Ahearn. Try to get better in the meantime.” He assumed a smile. “After all, a sick man can’t very well get to work and pay his bills.” He stopped short. Iris groaned. Sims’ smile faded. “We could use a few more tests — angiogram, maybe bone marrow just to clear up that business about the myeloma, a scintigram even, but,” he shrugged, “you have no money.” He grimaced. “Should get to the bottom of that amyloidosis, though.” He looked up suddenly. “Had a physical lately? Who’s your G.P.?”

  Stanley stared into a middle distance.

  Sims was shocked. “But it says here you’re forty-seven years old. You’ve got to have a physical…” His voice trailed off.

  After a silence in which everyone pursued his own thoughts—of mortality, of actuarial tables, of flexible sigmoidoscopy—Sims straightened, suddenly crisp. “Good day.” He took the second clipboard and left the room.

  “Guy’s one of the biggest jerks in the hospital,” said Iris before the door had even closed. “But he’s a renal ace.”

  “I’ll be around to see you again,” said Corrigan. “While you concentrate on healing yourself, try to recall what details you can about last weekend. Also, are there any strange new people among your recent acquaintances? Any failed medical students? Anybody who suddenly has more money than they should? Any hookers dressed beyond their meager means?”

  “Corrigan,” snapped Iris firmly. “Out.”

  “Think on them especially,” Corrigan said. “As my mother always said, you can’t entirely trust a girl who spends all her time out of doors. Good night, Iris.” He left.

  “Like my mother still says,” Iris said after the door closed. “He’s all cop. Good for very little else.”

  The door opened again. “And consider this,” Corrigan stuck his head and shoulders into the room and pointed a finger at Stanley. “Sometime this week or next, somewhere in this town, some poor schlub is going to go missing a kidney in exactly the same way as you have. And it’s going to go on like that, week in and week out, until we stop them.”

  The door swung shut.

  Iris busied herself with the cart. Stanley watched her. After a minute had gone by he said, “He told me he went to high school with your mother.”

  “That he did.”
/>   “Were they sweet on each other?”

  “Nobody’s talking. But after my dad died he was very attentive, very helpful. They go to the movies. Sometimes he stays over. It suits them to pretend I don’t know.”

  “When did your dad die?”

  “A long time ago.”

  “Your mother never remarried?”

  “Never.”

  “Brothers and sisters?”

  “Four.”

  “That’s a tough road for your mother.”

  “She became a CPA and put three of us through college.”

  “Hard work.”

  Iris said nothing to this, but busied herself around the wheeled cart.

  The room had long since darkened as evening closed down on the city outside the window, and now only the television and a light from the bathroom door provided illumination. The cartoon on the television had elided into a rehash of various Olympic highlights. Young girls cartwheeled on the balance beam, fireworks exploded, men and women and even claymation beer bottles swam above an underwater camera. The constant motion was enough to churn anybody’s stomach, let alone Stanley’s. He asked Iris to turn it off. She retrieved a remote control from a drawer in the nightstand and squeezed it toward the television. The picture died.

  “Thanks,” said Stanley, his face obscured by darkness. “That’s a beautiful blank picture.”

  “It is,” she agreed cheerfully. “But it’s the morphine that makes you irritable. It’s wearing off. I’ll show you. First, let’s get rid of this.”

  She peeled a bit of adhesive tape off his upper lip and removed the breathing tubes from his nose.

  “Most people would complain about that,” she said.

  She took up a package from the top of the cart and began to unwrap it. The noise of tearing paper wracked Stanley’s nerves. The little snaps and pops made by the latex gloves as she drew them over her delicate hands seemed unnecessarily loud.

  “Do you have to make so much noise?” he said.

  She smiled and held up her gloved hands. “All set.” She retrieved a syringe from the cart and removed its needle’s protective sleeve. “This is the morphine. The first of three injections.”