The Resurrectionist

by Matthew Guinn

  “The last year was the hardest,” Jacob begins. “I had a lot of debt, just piling up, and the moonlighting was the only way out of it. I was getting stretched too thin. I was getting tired.”

  Reithoffer studies the gauge of the cuff. Jacob can hear the starch in her white coat crackle when she moves. She nods for Jacob to continue.

  Jacob takes a deep breath, closes his eyes, and remembers.

  That third year of his residency, something had slipped, some cog in the turning wheels of his ambition had sprung loose. He’d been working like a dog at the little county hospital out in Newberry in between shifts at Memorial, trying to stay ahead of his rent and the enormous student loans. Some weeks that meant two to three days with no sleep, the seven-to-seven shift in Newberry sandwiched between his schedule at the university and his ancient Honda overheating on I-26 as he floored the pedal to make it from one ER to another. It had started out as hard as he could imagine. Then it had gotten harder.

  It was especially bad in Newberry that fall. He lost three patients in November—two of them goners that he could have let go easily enough, but the third a woman of thirty-two whose breast cancer had metastasized at a rate beyond any even the oncologist could comprehend. Jacob had diagnosed the tumor and consulted with the oncologist throughout her treatment. Everyone knew it wasn’t his fault and couldn’t have been. But still there were her eyes, sinking into her skull in the last two weeks she was alive, which would never accuse him. And that, somehow, was the worst of it, the last indictment of his incompetence as her physician.

  Her chemotherapy had been aggressive and it had taken its course on her body. A week before Thanksgiving he had stuck his head in a door on rounds and apologized to the woman in the bed.

  “Wrong room,” he said. “Sorry.”

  “No, right room, Doctor Thacker,” she said as he looked down to recheck the name on his chart. “Wrong life, I guess.”

  Jacob froze. He felt that he could never again look up from the clipboard, so great was his shame, his disgust with himself.

  “It’s all right,” she said softly from the bed. “It’s okay.”

  When he looked up, she was smiling. Her weary face wore an open expression, already past this latest indignity. Not as though she were anticipating some long-shot good news from this visit, but simply that she was glad to see him. Her expression was simply, impossibly human.

  He understood then that she knew this Friday afternoon to be her last, and tomorrow’s Saturday afternoon to be her last. He sat down on her bed and they did not talk about the cancer or her regimen but simply talked. Yet her approaching death was in every unspoken word, fusing the conversation and charging it with meaning, with a new significance of the mundane. Later it would strike him that it was something like grace in the room, but then he could see it only as death, a thing she had somehow transcended while it crippled her healer.

  After that it was as though his horizon had shifted, then dimmed. The bright goal was still there but now with less luster. The woman died on Thanksgiving Day. Jacob was at the hospital, midway through his twelve-hour shift, when he heard. He had eaten a Thanksgiving meal of cold turkey and store-bought dressing without tasting any of it.

  Later that evening, a farmer had come in with his hand mangled to hamburger from attempting a thresher repair after too much holiday cheer. The man’s wife was hysterical to the point of shock, so once Jacob got the farmer stabilized he went to the supply closet to get her a Xanax. And there in the supply room, his hand paused with the bottle of sedatives in it, as if by its own will. He knew the dose was .5 milligrams. He had shaken out two pills and swallowed one of them dry.

  Reithoffer shifts on the desk and turns the valve of the blood-pressure cuff. The bulb hisses as the air drains from the cuff, and Jacob feels the pressure loosen against his arm.

  “So where was the error, Jacob?”

  He attempts a joke. “Not sending a nurse to the supply room.”

  But Reithoffer does not smile, only fixes her flinty eyes on Jacob as she pulls the stethoscope from her ears.

  “The error was a confusion of compassion,” Jacob says, sighing. They have been over this same ground for months.

  “Exactly. Patients die, Jacob. They die when they should not, when we are unprepared and when their medical records indicate any other feasible outcome. College athletes in the prime of health suffer massive infarctions. Twenty-year-old mothers die of postpartum stroke after routine deliveries. And young women get cancer.”

  “Her name was Varina Payton.”

  “Let it go, Jacob. Our concern is with the survivors. The living.”

  Jacob thinks to tell her again about the woman’s eyes, the depths of suffering and endurance in them, but knows it is no use. He suspects Reithoffer has witnessed too much of it to really see it anymore.

  “You cannot be a doctor without achieving the proper distance from your patients. Every physician must face the terminal cases and move on. Some are beyond our reach. Move on.”

  Jacob nods. Reithoffer pulls the cuff off his arm and hangs it on the wall. When she turns back to him, the flinty eyes seem to have softened a degree.

  “Jacob,” she says, “how did you lose your mother?”

  He looks up more quickly than he had intended. “Not breast cancer. Emphysema. Dad too, three years earlier. They both worked in the mills all their life.”

  Reithoffer nods, bends over her desk to make a notation in Jacob’s chart.

  “Last week I had to reply to a memo on conserving printer paper, Kirstin. Office supplies. I should be handling charts, seeing patients. Some days I look up from that computer, that desk, and I don’t even know who I am anymore.”

  “Blood pressure is one-thirty over ninety-two. Not too good. You need to be getting more exercise.”

  “I haven’t gotten down to the gym much lately.”

  “Make it a priority. We are all busy.” Reithoffer closes the chart and puts it into a filing cabinet behind her desk.

  “How is everything otherwise? We’re at the midpoint now, right? Will I get a good report?”

  Reithoffer locks the filing cabinet and drops the key in her pocket, checking her watch as she does it. She steps around the desk to where Jacob sits and rests a hand on his shoulder; Jacob can just make out the neatly manicured fingernails in his peripheral vision.

  “These things take time, and the task force feels it can never be too careful. Get some exercise. Get some rest. You look tired.” The hand grips his shoulder. “Recovery is one day at a time. And today I have a long line of patients to see.”

  Then the hand is gone and Jacob can hear the office door opening. Before it shuts, Reithoffer speaks again.

  “You left a urine specimen with the technician?”

  Jacob drops his head. “Not yet, ma’am,” he says.

  TWO HOURS LATER he is back in the office, finishing a set of interview questions for Miss Nasir’s profile in the next issue of the alumni magazine. Interviewing the new med students is usually awkward for him, but he feels a bit of genuine anticipation this time. He prints the document and sits back while the printer whirs.

  Something is happening downstairs. The old building’s central stairwells and open banisters cannot hide much from one story to the next. The racket of the construction has been building steadily for nearly a week, but now its timbre has changed; there is still noise, but not machinery, no hammering or sawing. Only voices charged with a current of intensity beyond the daily banter.

  Below him, three black men emerge onto the front lawn clad in the khaki uniforms of the physical plant, their legs slathered with clay. One of them slings his hard hat back toward the building and stomps off toward the crosswalk at Gervais Street, and the others look after him for a moment before lighting cigarettes. They gesture expansively as they talk and drag deeply on their smokes. He recognizes one—Lorenzo Shanks—as a familiar face from the gym on Beltline Avenue, Jacob’s occasional spotter on the bench press. He
has never seen Lorenzo’s face so intense, almost frightened.

  A few minutes later, Jacob is down on the main floor, brushing aside the plastic sheet that has guarded the presidential offices from the dust of the foundation work in the cellar. His loafers sound emptily on the wooden stairs as he descends to the droplights that gleam against the red walls hewn from the dirt of the cellar. The foreman, Bowman, stands near one corner of the basement, shaking his head over the raw clay and smoking a cigarette of his own—an express violation of code inside a state building.

  “You should know there’s no smoking in here,” Jacob says as he approaches, but the man seems not to hear as he kicks at the dirt and a small collection of ivory fragments upon it. Bones.

  “What I’ve got to work with,” he says. “Jesus Christ. If you-all had let me bring in my men, we’d be half done by now.” Smoke billows from his nostrils as he grunts. “White crew wouldn’t have spooked at no pile of cat bones.”

  Jacob squats at his feet. He prods at the bones until he arranges them into the metacarpus and phalanges of a small hand, human. He cradles the bones in his palm and rises with them in his hand like porcelain, until he is toe-to-toe with Bowman.

  “Turns out your crew is smarter than you thought,” Jacob says, breathing evenly. “This is a second-shaft metacarpus and a first-row phalange. Which to you means the pointer finger of a small child, maybe five years old.”

  Bowman backs up a step. “Shit,” he says.

  “No shit. How many have you found?”

  “They’re all over the place. One of the boys looked in that vat yonder and just about ran out of here screaming. Rest followed him.”

  Jacob looks where Bowman has nodded and sees an ancient cask of wooden slats bound in iron bands at the edge of the electric light. It is half buried in the dry earth of the cellar, like something that has washed up on a beach, then been partly reclaimed by tides. He’s heard stories of old times, of the school contained in this single antebellum building, anatomy lab and all. He thinks he knows what might be in the cask. The old familiar smell in here underneath all the other odors, beneath the scents of raw earth and dry rot, is formaldehyde.

  “We need to seal this area off. You and your men can take the day until I notify you.”

  “Losing a day’s going to cost us, you know. It’ll fuck everything up.”

  “I’m aware of that. Leave it to me.”

  “I stand to lose a lot here, getting set back.”

  “I said I’m aware of that. I’ll speak to the dean personally.”

  Bowman drops his cigarette and snuffs it with a boot heel. Almost as an afterthought, he spits on the ground before turning toward the stairway.

  And then Bowman too is gone and Jacob is left with the clay and the musty darkness and the scattered bones. Like shards of ivory littering the earthen floor, so many of them.

  THE FIRST CHANCE Jacob gets to meet with the dean is no chance at all—McMichaels has breezed into the auditorium of the Chapel Clinic at three minutes to one o’clock, when the white-coat ceremony is set to begin. He presses Jacob’s hand as he passes the dais of faculty and administrators and steps to the podium. He does not need to call for order; after the immediate burst of applause that greeted him, the assembly has quieted to a funereal hush. After flashing them all a big-toothed smile, his face assumes a somber expression, and he begins.

  “Ladies and gentlemen, we have convened today for a sacred rite: the ceremony that symbolizes your first step on the journey that will culminate—for many of you, but not all—in the realization of a dream dear not only to your hearts but to our faculty’s as well, and beyond that, to the hearts of our state and our nation. Those of you who prevail in the next four years will emerge as physicians, as healers. It is a great responsibility—indeed, a universal one. For there is no man so lofty that he does not welcome the presence of the physician in his hour of need.

  “To those of you who seek fortune, I counsel another path, because ours is a sacred profession, ladies and gentlemen, and I do not use the word lightly. History has enshrined physicians in the roster of humanity’s greatest achievements: Hippocrates, Galen, Lister, Pasteur, and Salk. The very names echo with the gravity of their contributions to the human family. It is our responsibility, however meager our means may seem compared to these men, to uphold that tradition and carry it forward.”

  McMichaels pauses for a moment, letting his words sink in to the bright minds seated in front of him.

  “We may note with some pride that our own institution has played a role in that great tradition. The state-of-the-art clinic in which we have gathered is named for but one of many illustrious forebears at the Medical College of South Carolina—George Chapel, who performed the first open-heart surgery in the South, a bold operation carried out with characteristic precision in spite of rudimentary equipment and daunting odds. Seated behind me—and still very much among the living,” he adds with a smile—“is Kirstin Reithoffer, author of the internal medicine textbook you will soon be using as the manual for your first year—a text used in every medical school in the nation as a benchmark of medical scholarship. More distant to us through the mists of time, but no less important, is the figure of Frederick Johnston, the founder of our institution. Our present administration building, once the school’s sole facility, bears his name in tribute. For it was Doctor Johnston, casting the long shadow of his influence, who assembled in this city a faculty of intrepid physicians committed to advancing the medical arts. We can thank those pioneering men for our presence here today.”

  McMichaels pauses again, taking a moment to look at each expectant face before closing. “It is time now for you to step forward and join our tradition.”

  Awed to silence, the first-years begin to file down the aisles as the new associate dean of admissions, Malloy, assuming his position, steps forward to hand McMichaels the first of two hundred lab coats he will dispense this afternoon. The speech, even by McMichaels’s standards, has been a good one. And it is made more so for Jacob by his seeing that there is nothing on the podium before the dean but a creased and grease-stained takeout menu from Pete’s Barbeque. The students begin passing in line, the dean draping a starched coat on each set of shoulders, one by one. Jacob smiles, then his face sobers—not only out of a sense of decorum, but because he is thinking again of the basement. Telling McMichaels about it, he knows, is going to ruin the dean’s banner day.

  Fernyear: 1857

  FREDERICK AUGUSTUS JOHNSTON STRODE down the aisle, savoring the sound of each creaking board beneath his feet. With his mustache waxed, the gold chain of his pocket watch gleaming, and his hands hooked into his vest pockets, he looked the very embodiment of the best the Carolina College of Medicine and Physic could produce. Behind him, the faculty entered the room in double file, all six of them, and took their places against the walls of the room, flanking the incoming class seated in the center.

  The new class was raw material, to be certain. Country boys, most of them, arrayed on the rude benches in various attitudes of untidy poise. Johnston was pleased, however, to note that most of them straightened as he made his slow progress toward the front of the room, their crimson necks flushing a shade deeper to be in the presence of the noted Doctor Johnston, who had studied under the great Benjamin Rush at Pittsburgh—now one of South Carolina’s leading medical men, lately arrived in the capital to found the new school. They had come here expecting him to shape and mold them after his model. And that he would do, God willing. Provided they could endure ten months of rigorous study and training, they too could attain the heights of medical science.

  As Johnston neared the first row, one of the boys leaned over and expelled a long stream of tobacco juice onto the new plank floor, not even bothering to aim for the spittoon placed at the end of each row expressly for that purpose. Johnston flinched. Raw material, he reminded himself, and each of them important to our mission. Indeed, a good deal was riding on this class. The new building, impre
ssive as it was, was threatening to sink the young college in a sea of red ink. The faculty needed every tuition dollar these boys could bring them.

  Johnston took his place in front of the slate chalkboard, leaning back a little on his heels. “Gentlemen,” he began, “you are the third class of the Carolina College of Medicine and Physic. It is my privilege and honor to welcome you here today. You come seeking an honorable trade, and we are prepared to supply you with one. Our mission is to provide this great and sovereign state with as many doctors as we can produce, within reason, and to make open the road for poor boys to learn a lucrative profession. To that end, we can offer you the finest facilities in Columbia for medical instruction. Allow me to elaborate.

  “Our Negro hospital is the first of its kind in the South and the envy of the region. Through it we have access to a range of patients offering you a wealth of clinical experience, ranging from gunshot wounds to childbirths. Administered by Doctor Evans”—Johnston nodded toward his bearded colleague—“the hospital will advance your education most expeditiously.”

  Johnston stepped to the corner of the room, where a microscope and a half-dozen slides rested on a small table set in front of a skeleton suspended from the ceiling. “Our chemical equipment is of the latest manufacture from London,” he said, resting a hand on the fragile-looking piece. “I trust several of you have had the chemistry course in high school?”

  One of the boys nodded.

  “Very well, then. Doctor Winston will guide you through the mysteries of chemistry.” Winston’s spectacles winked in the light as he nodded to the young men.

  “Last and perhaps greatest, taught by the entire faculty collectively, is the ancient art of human anatomy.” Johnston placed a hand on the skeleton’s shoulder. “This fellow, along with our female manikin for obstetrical instruction, will soon become a close associate of yours as we guide you through the intricacies of skeletal and muscular structure.” He noticed that a few of the students were looking out the windows, their interest flagging. He turned the skeleton around so the bullet hole in the back of its skull came into view. “A veteran of the Mexican War, gentlemen,” he said, “and unfortunately for him, a Mexican.”