Prelude to a Scream

by Jim Nisbet

  Stanley thought better than to take issue with this. “That’s a good way of putting it, Jaime,” he confirmed, his voice slurred with menace. “Get us a straw and some kind of knife or a scalpel. Right now. Chop chop!” He forestalled Jaime with a raised pistol. “Hold it. Green Eyes!”

  The eyes flashed above the seam of the surgical mask.

  So she knew her name…

  “Pitch this guy something with an edge to it.”

  She hesitated.

  “Do it, honey,” beseeched Jaime, watching the pistol.

  She selected an instrument from a table behind her.

  “Not over the goddamn site!” barked Djell, raising a hand to forestall her throw.

  Sibyl stepped behind the operating table and pitched a long-bladed scalpel to Jaime, still in its sterile package.

  She pushed the throw from the shoulder, like a feathery shot-put.

  It was the most girlish thing Stanley had ever seen her do.

  As if divining his thought, as if she’d revealed something to him she hadn’t wanted him to see, her eyes flashed him a look of pure hatred.

  Stanley smiled woozily, like a drunk holding up a stop sign. At last he’d scored, he thought, a miserable little point.

  A relationship was developing.

  “Unwrap it. Leave it on the gurney.”

  Jaime did these things.

  Not turning around Djell made an impatient movement. “Can we get on with this? We were making good time, there, for a while.”

  “Straw,” said Stanley, ignoring him.

  “The doctor needs me,” said Jaime.

  Stanley shook his head and lowered the gun barrel a point or two. “A stall like that could cost you, Jaime.”

  “Oh a straw. A straw, he says. Right here. I got one right here. Christ, I can’t believe I forgot I had one right…” Jaime raised an edge of his surgical cap and plucked three inches of a soda straw from behind his ear. He smiled.

  The straw had a red and white spiral on it, like a barber pole.

  Jaime placed the straw next to the scalpel.

  Stanley wagged the gun at the gurney.

  “Now beat it. Back to work.”

  Jaime side-stepped across the room, not taking his eyes off Stanley, passing sideways around the foot of the operating table. Once there, he picked up a syringe and began to fiddle with it.

  “I see goose bumps,” said Stanley suddenly. “Is she cold?”

  Djell abruptly raised his head and looked around. “Who?”

  Jaime’s eyes panicked. He set the syringe down and wrung his hands wordlessly.

  “Is she?” Stanley insisted. “Speak up!”

  Djell and Sibyl exchanged a furtive glance.

  “She’s cold,” snarled Stanley.

  “Another sheet,” Djell ordered.

  Jaime opened his mouth, closed it, looked from Djell to Stanley to Green Eyes to the anesthetized Iris, then back at Stanley. “What do you —.”

  “Cover her!” Stanley screamed.

  Without taking his eyes off Stanley, Jaime unfolded a clean sheet from a stack on a side table and covered Iris’ legs with it.

  “Okay…”

  Stanley nodded warily.

  “Okay,” Djell repeated raggedly. “The distal ureter.”

  “Here,” said Sibyl, her gloved fingers in Iris’ guts.

  “Ah,” Jaime smirked. Drawn in by the surgical routine he resumed his station among his equipment, on the far side of the operating table.

  Stanley positioned himself between the gurney and the double doors, with the notion that if any renal clowns rushed him he’d be projected through the doors instead of pinned against the wall. Somebody among this crowd almost certainly had a gun stashed somewhere. But given the various offices of the players, it seemed most likely that such an appliance would have belonged to either Vince or Sturgeon, both of which characters lay dead on the floor, their blood descending in various rivulets along the tiles until it commingled with Iris’ in a drain beneath the operating table. There was getting to be enough blood on the scene to produce an audible gurgle.

  The taste in his mouth reminded Stanley of an aluminum gum wrapper, but it was the taste of blood. He knew that the more he could taste the blood the more the drugs in him were wearing off, and the more his pain and fatigue were increasing. He had launched himself on an irreversible path. Though likely to be construed as self-defense, he had killed a man. He’d lost an eye in the deal. He was in the process of stealing a kidney from the only woman who had cared about him in years. She’d even slept with him.

  No matter. The illness consuming his remaining kidney would have come to haunt him much sooner than the absence of half his sight, not to mention the loss of a girlfriend. He could still watch television. He could still lift a drink with one hand and zap a commercial with the other. If he could just get that new kidney, he could live out his days in peace, high atop Hop Toy’s apartment building on Brooklyn Place, with its view of the Bay Bridge and the TransAmerica Pyramid and Treasure Island and the yachts of the rich and a thousand other great and small reminders of the entrepreneurial spirit of mankind.

  And Stanley, too, might retain in his sunset years his own reminder of the entrepreneurial spirit, safely tucked away below his twelfth rib, expressing nutrients out of whiskey or whatever a kidney’s job was.

  And Iris, being crazy enough, healed enough, disembittered enough, might be that warm someone to tongue his scar for him.

  Maybe he would bring himself to do the same for her.

  Maybe not.

  Holding the eight ball of cocaine against the bed of the gurney with the barrel of his pistol, he cut the plastic with the scalpel. The granules spilled over the stainless steel like a miniature talus of granite chips cloaking the shoulder of a Sierra cirque. Ah. On the big screen over the bar of his mind let’s scroll Stanley’s special memory of The Sierra Nevada, as seen from the window of the San Francisco-to-Reno bus known as the Gambler’s Special. He often wondered why he hadn’t moved to Reno. Was it because of his subconscious awareness of the beauty of all those Sierra cirques he’d be living within sight of? Cirques whose beauty would ever be too great for him to readily contemplate?

  Or was it because there was no wholesale grocer in Reno willing to give him a job and a truck and let him live and drink and pass out on the roof of an apartment building for free?

  Hah. Ask a hard one.

  Loser, Corrigan had said — shouted. Oh yeah? Well, losers sat around losing. Losers went to a shitty job every day and came home to a braying wife and scrapping children. Losers made one smart move, and then walked around for the rest of their lives letting people call them hero. Losers let renal bandits harvest all over them.…

  Losers never fought back.

  It was true that Stanley had lost or pissed away everything he’d ever been interested in. Mary, for example, the girl with the gray eyes — why not bring her up again? Any loser would. Then there were the six years he’d spent wandering around Canada instead of allowing himself to be drafted. Years spent bucking hay, driving tractor, nutting calves, picking apples, wrangling. By the time those years were over he was as lean and brown and hard as a hickory ax-handle, and what little idealism he’d started them with had dried up. The Carter Amnesty had let him off that hook, allowing him to return to the States as a citizen. Too, there were the more recent years of his life he’d spent as a drunk. Throw in a couple of years as a stoned hippie, for high school, for elementary school, for the time he’d passed letting his mother nurse him a little too long before she disappeared — it added up to a life.

  Sadly, this shambles was not something he wanted to give up on. Not yet.

  And if he had to lose, he was going to take a few others with him. Already had done so, it would seem.

  He glanced up at the tableau that faced him across the operating room. Three alive, plus Iris. Two dead. He winced. Correction: Giles made three.

  The word’s not in on Ted, ye
t.

  Or Tommy Quinn.

  The clip in the .45 held seven cartridges. The chambered round made eight. Three, presumably, had been expended. One in the hall, two in the operating theater — he hardly even cared. Somewhere in the room was Stanley’s extra clip. Somewhere in the room, come to think of it, were Stanley’s clothes.

  Of course, if he found it there was the problem of getting the second clip into the handle of the pistol, which actually succeeded the problem of getting the expended clip out of it, both of which preceded that of jacking a fresh shell into the firing chamber, all to be accomplished before his adversaries could rush him and plunge scalpels deep into his functioning anatomy, about which they doubtless knew plenty, and then drag him over to the operating table and extract a hundred thousand dollars worth of revenge out of his peritoneal cavity.

  Well, they all knew the kidney was no good. Maybe the liver was shot, too. What about the lungs? Spleen?

  And, oh yes…

  His heart.

  He clutched the sheet around him.

  Stanley would like to have a look inside that one himself.

  Djell rooted around in Iris’ guts, assisted by his beautiful, blood-spattered wife and the neurotic anesthesiologist. “Okay,” he announced, leaning toward Sibyl in order to facilitate her dabbing his brow with a sponge. “Ureter dissected.” He took a deep breath and exhaled loudly. He rotated his head atop his spinal column, 360 degrees one way, 360 degrees the other way. His surgical mask had a dark moustache of perspiration. “Now,” he finally said, “let’s reflect the fat from the lower pole.”

  “Wow he’s reflecting fat,” Jaime blurted, smiling meaninglessly at Stanley, as if unable to contain his joy at the news. His nerves seemed to be getting the better of him.

  The medical team’s concentration renewed, Stanley buried one end of the straw in the cocaine and the other in his right nostril. The absence of his right eye presented no difficulty to this operation. Although it would be nice, a little voice observed acidly, to be able to keep one eye on those bums and another on the blow.

  For a guy who doesn’t exist, thought Stanley, you’re getting mighty chatty, my catbird buddy. Coke getting to you?

  An inner shrug. It’s just that you’re getting so lonely.

  Within minutes two stout snorts of cocaine had alleviated many of the symptoms from which Stanley was suffering. Even the rising pain in his eye socket was tempered, and his nausea subsided. Above all, he was wide awake. The light above the operating table glowed like a flying saucer.

  “Ligating distal stump,” Djell said, and, as Sibyl mopped his brow, Iris moaned.

  Jaime, who had been nostalgically watching Stanley snort cocaine, blinked and straightened up. Now he glanced at his instruments and shot a covert look at Djell.

  “Not now, for God’s sakes,” said Djell, without interrupting his work.

  “Get it together, Jaime,” growled Sibyl, handing Djell a mosquito clamp.

  Jaime twisted valves, rattled tubes, looked at dials.

  “No,” said Sibyl. “That’s the gonadal vein.”

  “Right,” said Djell. “You sure?”

  “Christ,” said Jaime. “How many do you have to see?”

  “Shut up,” Djell snapped. “Monitor the urine or something.”

  “You monitor that gonadal vein, O leader, and don’t worry about me. Christ. Sometimes I don’t think you know proximal from distal. Christ.”

  “It’s true,” muttered Djell, “that at the moment I’m not sure which end is up.”

  Jaime nodded in cautious agreement.

  Stanley pressed a finger against the taped side of his nose and sniffed loudly.

  “You really think he’s going to go through with this?” Sibyl said.

  Djell was busy, but he grunted, “He’s off to a good start.”

  “Who is this woman, anyway?” said Jaime.

  “His girlfriend,” said Sibyl.

  “Really? If that’s the case, this is a pretty extreme example of pre-spousal altruism.”

  “More like pre-spousal abuse,” Djell nodded. “My pet,” he added.

  “She’s dedicated,” said Sibyl.

  “Not like some girls,” said Jaime.

  “Not like this girl,” said Sibyl.

  “What, my dove?” Djell protested innocently. “You wouldn’t cough up the odd organ for the love of your life?”

  “No more than you’d cough up one for yours,” Sibyl said coldly.

  “Why, my sweet, I cough it up for you most regularly.”

  “Ah,” cooed Jaime, “geriatric amour.”

  “Shut up,” said Djell.

  “I know why she gave it up,” Jaime prattled on.

  “Why?” asked Sibyl.

  “He’s good in the sack.”

  “Who, him?” Sibyl laughed. “Don’t make me laugh.”

  Stanley stared at her.

  For the first time, Sibyl’s eyes lacked the gleam of superiority he’d always detected in them before. A shadow had appeared in them. A tincture of uncertainty. They reflected ugliness.

  “Adrenal vein, Sibyl,” said Djell impatiently. “Adrenal. Heads up, please.”

  Sibyl handed Djell a hemostat in whose jaws was clamped a pre-threaded needle.

  After a while Djell announced he was freeing the renal vein.

  A little while after that, Jaime dutifully narrated that Djell had started in on the adrenal gland, dissecting it away from the upper pole of the kidney and its attendant arterial structures, a matter of delicacy and finesse.

  Stanley helped himself to two more lines.

  As he was inhaling his second line a drop of blood appeared on the crystalline pile, fallen from the soaked gauze over his ruined eye. After a moment he caught himself staring, as its red stain spread through the white powder.

  He jerked his head up, his hand training the pistol barrel. Jaime was watching him, and could not suppress a grin. “Surgery is exhausting,” he suggested. “It makes you soooo sleepy…”

  Stanley could barely hear him. Some kind of aortal roar had co-opted his sense of hearing. He shook his head like a wet dog. Drops of blood spiraled onto the metal surface of the gurney.

  “Hurry the fuck up,” he growled.

  “Right, right,” Djell said without looking up. “Hurry the surgery and fuck it up. Surgery costs money. Everybody’s in a rush. And who pays in the end? The patient.”

  “Well,” put in Jaime. “This isn’t exactly brain surgery, here.”

  “Piss off, Lopez.”

  “No,” said Jaime mildly, glancing at a tube. “Diuresis is just about right.”

  “Could use an arteriogram, here,” muttered Djell.

  “Oh, listen to him,” Jaime said, addressing Stanley. “A hundred nephrectomies, nearly all of them illegal, and he wants lab results. Why don’t you run upstairs and get them for us?”

  All of them, thought Stanley, amazed. One hundred…?

  “In a better world,” said Djell, “this wouldn’t be illegal.”

  “No, no,” said Jaime. “They’d give you a medal shaped like a BMW.”

  “Turgor,” said Djell.

  “Looks okay to me,” said Sibyl.

  “Why not ask me?” Jaime whined.

  “Single vein, single artery,” observed Sibyl.

  “Spasm subsided,” said Jaime.

  “We’re getting there,” said Djell. “Ready for perfusion?”

  Jaime made motions toward a sink-like device at the foot of the table. The machine was on casters, with cables and tubes trailing after it.

  Jaime said to Stanley, who was watching him warily, “I gotta do this.”

  “What is it?”

  “It’s a perfusion machine. To keep the kidney viable. Your kidney.”

  Stanley pursed his lips vaguely. He looked like a man getting off a plane in Nome who’s almost remembered he left his stove on in Tallahassee.

  “Vince was in charge of it,” Jaime explained sadly. “Before he.�
��” Jaime cleared his throat. “Now I’ll have to handle it.”

  Stanley nodded his agreement. But he was becoming seriously disoriented, now leaning over the gurney for support, using both hands to keep the pistol trained on the surgical team.

  Jaime rolled the machine around the table, next to Djell.

  “Heparin.”

  “And now…,” Jaime said to Stanley.

  “This shit’s not working,” Stanley snarled.

  “Have some more already,” said Jaime. “You’ve a lot of negativity to overcome.”

  “What’s in this stuff?” Stanley demanded. “I’m passing out.” He drew a bead on the anesthesiologist. “Fix it. Fix it or I kill everybody, starting with…” his voice faltered, “with… you.”

  They just waited, watching him.

  Stanley side-armed the scalpel at Jaime, left-handed, with all the strength he could muster.

  “Ow, shit!” Though it glanced harmlessly off his upper arm before he could react otherwise, Jaime, screamed and spun, ducked and hugged himself as if the tool had gone right through him, before it hit the radio and clattered to the floor.

  Nobody moved. Jaime half crouched behind the operating table, looking around desperately for a place to hide.

  “Don’t make me get violent,” said Stanley. “Reverse this chemical.”

  “Oh, dear,” whined Jaime. “Oh dear oh dear oh dear.”

  “Jaime,” said Djell, raising an eye toward Stanley. He pointed a hip toward the anesthesiologist. “Here.”

  “And bring back the scalpel.”

  Cringing and crouching, Jaime retrieved the scalpel and scuttled around the end of the operating table, muttering to himself. “That was the right pocket. Should it have been the left? I can never remember whether it’s right or left… Oh my god,” he shook his head with great exaggeration, nearly weeping with hysteria. “That was the heroinnnn.…”

  He plunged his hand into Djell’s left trouser pocket, waving the scalpel with the other, an irrational expression on his face. The surgeon winced. Stanley had the impression that Jaime had pinched him viciously. Djell twisted away, but not before Jaime had extracted a second package. It, too, looked like powdered sugar or flour, wrapped in a clear plastic cylinder about the size of a polish hot dog. If it was cocaine, it was close to an ounce of it.