The Possible World

by Liese O'Halloran Schwarz

  This happens with embarrassing regularity. Providence is a small enough city that I am forever being hailed in the grocery store or while pumping gas, strangers striding toward me with great familiarity: Hey, Doc. Is it some kind of agnosia that I am not able to recognize them when they are fully clothed and free of the hospital stretcher?

  “Hi,” I say, striving for an all-purpose tone, wanting it to be appropriate to the circumstances of our previous encounter. Did I pronounce your father dead, lance your suppurating groin abscess, splint your fracture, coddle you through a night of drunken excess?

  His smile broadens. Failure: he can tell I don’t know who he is.

  “I’ll give you three guesses.” He nods with raised eyebrows at the chair across from me, then sits down at my return nod.

  “Well, I’ll need three hints.” Glad we aren’t going to play the usual game of me trying not to look blank while the mystery person chats away and I frantically mine the monologue for clues.

  “I’ll give you one.” He peels back the plastic tab on his coffee cup and takes a sip. “You liked my shoes.”

  Shoes. It’s a blank. Shoes. A hint of aftershave comes across the table, and then it swims up to me—the Found Down who smelled too good to have been lying on the sidewalk. It’s none other than Coma Cop.

  “Last I saw you, you were hightailing it down Trauma Alley butt naked.”

  “Not my finest hour,” he concedes.

  “So what was that all about?”

  “It was an undercover operation.” He sips. “We’ve had a lot of complaints from patients who reported thefts after an ER visit. They said they were picked up with a full wallet, and when their belongings were returned the wallets were empty.”

  “Drunks are always saying that.” I had two hundred dollars in here. Our response was always some variation on sure you did.

  “And you blew them off.”

  “They sleep on the sidewalk in South Providence,” I say. “They’re going to get robbed.”

  “Blaming the victim, uh-uh-uh,” he says with mock reproof.

  “Just pointing out the cold, hard facts.”

  “Well, we’ve always blown off those kinds of complaints too. Until our shift commander’s kid was brought in after partying a little too hard. When he was released from the hospital in the morning, the cash was missing from his wallet. The possibilities were other students at the party, hospital personnel, or EMS. When we checked the run sheets for similar complaints on record, we found a common denominator. Always the same squad, and one name was on every single run sheet.”

  Some whaddyacallit designer drug, squawks my memory.

  “Not Big Bill.”

  “Bingo. We waited until his squad stopped for coffee, and I went and lay on the sidewalk nearby while my partners called 911.”

  “Anyone could have picked you up.”

  “We knew their routine: always the same Dunkin’s, around the same time. I lost the coin toss and had to play the patient. Two hundred dollars in my wallet for bait. Big Bill stole it from me in the van.”

  “So you had him right away,” I said. “Why did you have to pretend to be comatose in the trauma room?”

  “We had to keep up the game until Bill actually left the hospital with the money. Otherwise he could always claim that he was intending to turn it over to the nurse.”

  I absorb that. “Well, you did a great job. I mean, we did a blood gas and you didn’t move a muscle.”

  “You did more than that,” he says, and I recall with an internal yikes the rectal examination.

  “That was Alice, not me.”

  “Good to know.”

  There’s a short silence, but it’s not entirely awkward.

  “So you’re the head doc over there?” he says. “You don’t look old enough for that.”

  “No, just a senior resident. The head worker bee on shift. There’s an attending for backup.”

  “The shit you must see.”

  “The shit you must see,” I say, and we share a grin.

  “I’m Dave,” he says, putting out a hand.

  “Lucy.” I notice his warm, dry palm, wonder if the pinprick of his arterial puncture is still there on the inside of his wrist. I remember him naked on the stretcher, the sterile paper ringing his penis, Alice’s hand poised with the catheter.

  “Stop thinking about that,” he orders.

  “How do you know what I’m thinking about?”

  “Am I wrong?” I say nothing. “Okay then. New subject.”

  “Okay. Um. Judging from the accent, you’re not from here.”

  “Aha. That’s where you’re wrong,” he says, stretching out wrawng, smiling at my surprise.

  Not the hack I pahked my cah in Hahvahd Yahd you hear from tourists buying crimson T-shirts in Cambridge, not the basic subtraction of terminal Rs that you hear from actors in movies set in Boston, but the more subtle and complex distortion of vowels and consonants specific to the Biggest Little.

  “You can just turn it on and off like that?” I ask.

  “Now I can. A couple of beers and all that practice is out the window, though, right back to normal.” Nahmull. His phone buzzes and he glances down at it. “Shit. I have to go, so I’ll just ask. Wanna go out sometime?”

  It’s been so much less strange than I ever thought it might be, to flirt and be flirted with, but the question takes me aback. “I’m sorry, I’m—”

  “Seeing someone,” he says. “Of course you are.”

  “Well . . . it’s complicated.”

  “Well, if it ever gets uncomplicated enough for a pizza”—he stands, slips a card from his pocket, and offers it to me—“I’m buying.”

  * * *

  ALL THAT’S VISIBLE of my next patient from the door of Trauma 2 are the soles of his sneakers, the treadless deck shoes that are as much a part of the prison uniform as his orange jumpsuit. He’s flat on his back on the stretcher, all four limbs pinned. The jumpsuit is code, and so is the extraneous shackling. In Rhode Island, an orange jumpsuit means life sentence. Four cuffs instead of two is correctional officer code for we extra-hate this guy.

  The prison treats minor injuries and ailments on-site, but more serious afflictions come to us. I’m sure the inmates are very different people when at the prison, but they’re usually nice as pie to me, almost absurdly soft-spoken and courteous. The hospital’s like a vacation to them, the COs have told me; they’ll do anything to get here. I’ve seen plenty of foreign objects in inmates, swallowed or inserted in hopes of the ER field trip. One of the radiologists has collected X rays from those cases into a teaching file: multiple D batteries nestled against the greater curvature of the stomach, a ballpoint nudged under the skin of the forearm, an open safety pin in the small intestine. To medical students, they’re shocking and even humorous examples of human behavior, but I can’t help but see the message of desperation in them: How terrible must prison be, to make a person swallow an open safety pin?

  As I come into the room, nodding hello to one of the COs at the foot of the stretcher, I hear a noise that sends me into high alert: a gurgle. It’s the sound of liquid bubbling in an airway, and it signifies death for someone who’s lying on his back.

  “He needs to sit up,” I tell the COs. “Unshackle his arms so we can pull up the stretcher.”

  He’s been beaten to a pulp, I can see that at a glance, and he’s struggling to breathe through his shattered face. I turn on the wall suction above the head of the bed and unloop the hose.

  “Now,” I say to the COs, who seem to be moving in slow motion, standing and fumbling keys.

  I slip the tonsil tip of the suction between his lips and angle it around carefully in the oral cavity to find the pooling, choking fluid. Success: a rush of blood and saliva thuds into the canister on the wall, accompanied by a huge inward gasp of breath from the ruined face.

  The COs release one wrist at a time, each gripping a forearm hard while I raise the stretcher. When the stretcher back has
been ratcheted up to forty degrees, they immediately begin to refasten the cuffs.

  “Can we leave the right wrist free?” I ask. “That hand looks bad.”

  They’re not pleased but they comply.

  “Don’t try anything,” one of the COs warns the still-gasping patient as they back away just to the foot of the stretcher.

  I tuck the suction tip behind the stretcher pad. Gravity’s taking care of his airway now, secretions drooling out of his mouth instead of back down into his windpipe. Breath sounds clear, good pulses at both ankles, and normal blood pressure. That’s A-B-C taken care of, so I can move to the head-to-toe assessment.

  “I’m Dr. Cole,” I tell the patient, holding up my gloved hand in front of his face. “I’m going to put my fingers in your mouth. Don’t. Bite. Me.” His eyes are barely visible, two coffee-colored irises and bright red sclera peeking out of puffy ecchymosis. He hears me, though, and nods the tiny bit that the cervical collar permits. I tug at his two front teeth gently and stop immediately at the grating shift of his upper jaw. It’s an alarming mobility in a bone that should be anchored to the skull.

  This is not a small guy. He’s muscular and tall, yet his assailants were able to hold him down and punch his face hard and repeatedly. There are contusions over his ribs and at least one fracture there; luckily no abdominal tenderness, so no damage to liver and spleen; the long bones are intact, but the unshackled hand is extremely damaged and swollen, like a glove full of Jell-O with fragments of bones rolling free inside.

  As I examine him, the sequence of events comes to life: here he was pinned down while someone battered his face with a fist or a blunt object; here they kicked him as he curled up to protect himself; here they stomped on his wrist and hand. Someone armed with something sharp tried to stab him, but he brought his forearm up and the blade glanced off the ulnar surface, ripping through the skin and down into the muscle. The weapon must have come into play near the end of the attack; a second stab would likely have reached something vital, and he’d be dead.

  “You’ve got significant facial fractures,” I tell the patient. “You’ll need surgery to fix them.” Jackpot, murmurs one of the COs behind me. As if the man had beaten himself up as a ruse to get here. “Your hand’s badly broken; it’ll also need surgical repair. I can give you some pain meds. Are you allergic to anything?”

  “No,” he says. A single syllable, a deep voice.

  “Okay. We’ll get some X rays and a CT of your face and abdomen and see where we are. If your neck bones look okay the collar can come off.”

  “How long’s he gonna be here?” asks one of the COs.

  “Not sure,” I say. “The specialists need to see him. He’s definitely going to be admitted for surgery, and it could be a couple of weeks post-op before he can go home.” The last word lingers mockingly in the air. Prison is hardly home.

  I put consults in to three services: Trauma, Face, and Hand. Ear, Nose, and Throat is covering Face today, and Plastics is on Hand; they’ll do his surgeries, but by protocol Trauma will have to accept him to their service for the first twenty-four hours. After that, there’ll be a little hot-potato skirmish between the ENT and Plastics service chiefs.

  “I’m writing for Ancef and tetanus,” I tell Stacey, his nurse, who’s appeared in the doorway. Where has she been? I go over to her and add sotto voce: “Listen, this guy almost choked to death. They had him in four points with an unstable airway.”

  “Sorry,” she says, but her tone says she’s not at all sorry. The orange jumpsuit can have that effect.

  After X rays have ruled out cervical spine injury and his collar has been removed, after Trauma and Neurosurg have consulted and Plastics has splinted his left hand and ENT has booked him into the OR, there’s still the long slice on his right forearm to be repaired. It’s nearly dawn, and all the consulting surgeons have vanished to upper floors in the hospital to make their morning rounds. I don’t feel like fighting with them about whose responsibility it is to repair the lac. Trauma will argue that everything below the elbow is considered Hand, but Hand will argue that a simple laceration, however deep, doesn’t need subspecialty repair. They’ll both be sort of right and sort of wrong. It’s easier just to do it myself.

  I sweep through Triage, make sure everyone in the urgent area is stable, then with a mental fingers-crossed against an influx of new patients, gather all the materials I’ll need from the Clean Utility Room. As I load up a deep plastic bin with bottles of sterile saline, a big syringe for irrigation, four-by-four gauze pads, and antibiotic ointment, the charge nurse, Brenda, pushes open the door.

  “You gonna sew up Trauma Two?” she asks.

  “Yup.” I add two rolls of gauze and an adhesive dressing to the bin. “Listen, I don’t know what’s going on with Stacey. She left him alone in Trauma with a compromised airway. You might want to check in with her about that.”

  “She was helping in Trauma One,” Brenda says, in that same sorry-not-sorry tone. “The guards were with him.” Her eyes fall onto the bottle of local anesthetic I’m taking from the drawer. “You could do him without any lido. He deserves the pain.” She sees that I’m not following. “You know who that is, right?”

  “No.” I drop sterile packets—needle driver, toothed forceps, mosquito clamp—into the bucket.

  “That’s the guy. The Birthday Party Killer. The one who murdered those kids.” She watches comprehension sweep across my face. “See what you can do.”

  She lets the door fall closed.

  Vigilance has waned in Trauma 2. The original adrenaline-taut pair of COs is gone and the single CO that replaced them is seated on a chair outside the room, chat-flirting with a tech; he nods to me as I go by.

  The four-point restraints have become two-point ankle shackles; the fractured hand is splinted and the other arm, the one I’ll be suturing, is free. His eyes, glinting slits in the swollen face, watch me put the bucket on a bedside stand and roll a stool up to the stretcher. I run water into the bucket and squirt in some amber disinfectant. With wadded four-by-fours, I scrub and rinse the skin, then adjust the surgical light over the field and punch it on. Under its heat I irrigate the wound, jetting sterile saline through the big syringe until the tissue is clean and soft and waterlogged, all clot and dirt and foreign matter removed.

  “This is going to sting a little.” I pull up lidocaine into a five-cc syringe, attach a twenty-five-gauge needle, and slide it into the tough white layer of dermis.

  “They told you,” growls the patient, his voice nasal from the blocked nostrils but no gurgle in it now. He’s breathing without difficulty because I saved him from choking to death a few hours before.

  “Told me what.” No expression, redirecting the needle under the skin, injecting, injecting. I have not looked him in the eyes since I reentered the room, and I don’t look up now.

  “I know they told you.”

  I’ve doctored countless murderers before him and sutured miles of swastika-tattooed skin, all with professional detachment. This shouldn’t be any different. I drape the arm, peel the instruments and sutures out of their packaging so they drop onto the sterile field, then pull on sterile gloves and study the injury to plan my repair. Muscle is difficult to sew, like wet tissue paper: too much tension and the suture cord pulls right through. Maybe a horizontal mattress will spread out the tension. I clamp a 4-0 chromic gut suture in the jaws of my needle driver.

  “You should be numb now, but tell me if you feel anything,” I say, and slide the curved needle into the muscle.

  Suturing is considered a menial task, one usually consigned to junior residents, but it can be deeply satisfying. You begin with a bloody mess and end with a neat row of black stitches, working by instinct to get there, matching uneven layers by the slant and placement of the needle, restoring the anatomy as closely as possible to its unviolated condition. Like turning back time.

  “You know, I did kill them,” he says, conversational.

  Startled in
midstitch, I look up at him, then glance toward the doorway.

  “He can’t hear me,” he says. A snatch of conversation and laughter drifts in. He smiles; a small star-shaped tattoo beside his eye crimps and flares against the bruised, shiny-swollen tissue there. “And you’re my doctor. You can’t tell him anything I say.”

  I use the toothed forceps to approximate the next section of torn muscle and pierce first one side, then the other with my needle, pulling the suture through smoothly, watching the flesh draw together. Perfect.

  “The kids were easy.” Another good stitch, just the right angle. “I did the big one before the other two even knew what happened.” Another knot snugged down the length of cord, five throws to keep it from loosening, clip the ends. “They barely made a sound. The women put up a fight, though.”

  My head is buzzing and light, my vision a tunnel around the tableau of gloved hands, needle and suture, half-closed muscle. I could leave, just lay my instruments down and stand up. Leave the room, leave the wound open. But it’s already been open for hours; it needs to be closed or infection will set in. I begin the subcutaneous layer.

  “They won’t convict me,” he says. “It was the perfect crime. And you’ll never guess,” he continues, in a just-wait-it-gets-better voice, like we’re laughing together over an anecdote, “where I hid the clothes I was wearing.” He stage whispers, “Septic tank. So even if they find them, they’re covered with other people’s DNA.”

  I shouldn’t answer of course, but it’s impossible not to; his smugness is too disgusting.

  “You left evidence behind in the house,” I say. A cell, a hair, a fiber. A witness.

  “Nope.” The syllable is plump with satisfaction. “And doesn’t matter even if I did. I installed new carpet in that house a month ago. I was all over that house for that job.”

  Maybe he doesn’t know about the boy. Had Ben been hidden?

  “I don’t want to hear any more,” I say.

  The laughter grates out of him. “You can’t fool me,” he says. “You’re the kind of person who wants to know everything.”