The Fifth Vial

by Michael Palmer

  The agony in his chest was nearly disabling, and blood was cascading from his nose into his mouth and down the back of his throat. His tumbling, ill-focused thoughts searched desperately for something he could do, some weapon he could use, or some convincing story that would fit the circumstances and at least slow down the onslaught. That was the instant his hand hit against a spray can of paint. The top of the can had apparently been knocked off.

  “Connie, get the fuck out here and turn the lights on!” the bull hollered, bending down, grabbing Ben’s jacket, and pulling him up like a puppet.

  Praying at once that there was paint in the can and that the nozzle opening was pointing in the right direction, Ben was still being hauled upright when he swung the can to within six inches of his assailant’s eyes and fired. The results were all that he could have hoped for. Instantly, thick, dark paint filled both of the man’s sockets. Shouting obscenities, he reeled backward, pawing at his eyes. Ben had already reached the door when the behemoth slammed onto the steps of the RV.

  “Jesus, Vincent!” a woman’s voice cried out, but Ben, hauling his bag along, was already in the alley, hobbling painfully toward Laurel Way.

  Ten

  No human thing is of serious importance.

  —PLATO, The Republic, Book X

  The first thing Joe Anson became aware of was the steady swoosh of the respirator, gently forcing air into his disease-ravaged lungs. The second was the white-noise thrum of the jet engine. They were airborne and on their way east, more than four thousand miles from Cameroon, to a surgical team awaiting him in Amritsar, India. His years-long, worsening struggle to breathe was very nearly over.

  Anson knew the endotracheal tube was in place down his throat, but it didn’t bother him much. It had to be medication, he reasoned—some sort of narcotic with a little sedative and just a pinch or two of memory eraser thrown in. Psychopharmacology was becoming more and more like the military’s smart bombs—able to pinpoint targets in the brain with ever-increasing accuracy. Whatever the nature of the drugs, the combination he was being given was working. He was experiencing none of the choking, strangulating sensation so many intubated patients complained about.

  What he was experiencing at that moment were overriding feelings of relief, wrapped around a profound sadness—relief that the ordeal of his pulmonary fibrosis was almost over, and sadness that it required the death of a man for him to reach this point.

  It was then that he realized that Elizabeth St. Pierre was sitting quietly beside the stretcher, her hand wrapped around his. He turned his head slightly to see her, and nodded that he was aware of the situation. Her expression was more peaceful than he had ever seen it, almost beatific.

  “Hello, Joseph,” she said softly in French. Then she continued in English, the language in which he was more comfortable. “I have tapered the sedation down just for a little while so you could wake up and know everything is all right. In fact, everything is going perfectly. We’re more than halfway there. Well before we arrive, everything will be in place. The pulmonary transplant surgeons who are being brought in to perform this operation are the best in the world. Do you understand?”

  Anson nodded and then made the motion of writing.

  “Oh, yes, of course,” St. Pierre said. “How foolish of me. I have some paper right here.”

  She handed him a clipboard and a pen.

  Have you learned any more about the man who is soon to save my life? Anson wrote.

  “No more than we already know. The man is—was—thirty-nine. A week or so ago, he suffered the rupture of an aneurysm in his brain. Bleeding was massive, and there wasn’t anything that could be done to save him. He has been pronounced brain-dead by the physicians at the Central Hospital in Amritsar, and has been maintained on life support pending the donation of his heart, lungs, eyes, liver, kidneys, pancreas, and bone. Many will live because of this gallant man, including you.”

  Does he have a family?

  “I know he has a wife. It is she who has given permission, indeed, who has requested that these transplants go ahead.”

  Children?

  “I don’t know. I will find out.”

  Good. I wish to do something for the family.

  “All in due time, Joseph. If they will accept our gratitude in any tangible way, I will be certain they are well compensated.”

  I will wish to meet my savior’s widow.

  “If that is possible, I shall make it happen. Now please, my friend, you must rest.”

  Wait.

  “Yes?”

  Has Sarah been notified?

  “Not yet.”

  Contact her before I go into the operating room. Tell her I love her.

  “I will do my best to locate them and tell her.”

  I am afraid of dying before my work is done.

  “That is nonsense. You were facing death. In fact, as you remember, your breathing stopped altogether. But now you will live and be healthy. We have a perfect match, Joseph—a twelve-point match. That is one in a million. No, no, given your unusual protein pattern and blood type, one in ten million. You will not die.”

  I will not die, he wrote.

  “Now rest, Joseph. Rest and dream of a life where the air is sweet and fragrant and rich with oxygen as only jungle air can be, and you can get as much of it into your body as you want.”

  Elizabeth took away the clipboard and kissed him tenderly on the forehead. Then Anson saw her take up his intravenous line and inject something into the rubber port. In just seconds, he felt a wave of warmth and serenity sweep over him.

  Anson opened his eyes and saw the gleaming giant saucer lights of the operating room shining overhead. The scent of disinfectant was in the air. The temperature in the room was rather cool, and involuntarily, he shuddered.

  “Dr. Anson,” a reassuring male voice, Indian, speaking fluent, accented English, said, “I am Dr. Sanjay Khanduri. You are doing very well, and so are we. Your new lung is here and we are ready to put it in place. We will transplant only one lung. The other will go to a person also in desperate need. In a very short time, the volume of your new lung will expand in such a way that you will be able to function as if you had two. I assure you, Dr. Anson, that I am very, very good at performing this procedure. In fact, if I were going to have this operation done, I would be sad because it wouldn’t be me doing it.” Khanduri’s laugh was high-pitched and merry. “Okay, then, Dr. Anson,” he went on, “just close your eyes and in your mind count with me backward from ten. When you awake you will be a new man. Ready? Ten…nine…”

  Eleven

  Some of you have the power of command, and in the composition of these God has mingled gold,…others he has made of silver, to be auxiliaries…. others again who are to be husbandmen and craftsmen he has composed of brass and iron.

  —PLATO, The Republic, Book III

  “Where are we going?”

  “You said the Inter-Continental. This is the quick way.”

  “I don’t want the quick way. I want to go back on the highway.”

  “You are a very beautiful woman.”

  “Take me back to the highway this minute!”

  “Very beautiful.”

  The cab accelerates. The area around us deteriorates. What streetlights there are have been smashed. Most of the houses are shuttered. Almost nobody is on the street.

  I am more frightened every second. I try to see the cabbie’s license, but it is too dark. Something terrible is going on. Something terrible. Is there anything I can use as a weapon? Anything at all I can do?

  “Goddamn it! Take me back to the highway.”

  “The customers at the House of Love will adore you. You will be very happy there…. Very happy there…. Very happy there….”

  I am more terrified than I have ever been. I have heard of women being kidnapped and then addicted to narcotics and used in whorehouses. I have heard of women vanishing, never to be heard from again. The scene around me continues to blur, the
n comes back into focus. It is so real one moment, so surreal the next. I need to get out. No matter how fast we are going, I need to get out of this cab. I can run. If I can just get out without hurting my legs, I can run faster than this bastard…faster than anyone. I will not be anyone’s crack whore. Not ever. I would kill myself first. My passport. I need my passport and my wallet. I take them out of my purse and jam them into my jacket pocket.

  “Money. I’ll give you money to let me out right here. Three thousand reais. I have three thousand reais. Just let me go!”

  I reach for the door handle and prepare myself to hit the pavement at forty miles an hour. But before I can move, the cab screeches to a halt, throwing me hard against the back of the passenger seat. What is happening? Again, the scene blurs. The movement around me is indistinct. Suddenly the door is ripped open. A large man reaches in and grabs me. I fight, but he is very strong. A black nylon stocking covers his face. I try tearing at the mask, but a second man is on me. His face is also covered. His breath smells terribly of fish and garlic. Before I can react, a syringe appears in his hand. The heavier man tightens his grip on me. No! Please no! Don’t!

  The needle is jammed down into the muscle at the base of my neck. I scream, but hear no sound. Heroin. It must be heroin. This can’t be happening to me. The cab peels away, spraying dirt and stones. I feel weak and disconnected from the two men. My mind is spinning, trying desperately to sort things out. But that effort confuses me even more. It is still too soon for any drug to take effect. Don’t let this happen. Keep fighting. Kick and punch and try to bite. Don’t give in. Don’t let this happen.

  They have my arms now and are dragging me facedown through the dirt of an alley. I can smell the garbage. I twist and kick violently, and suddenly my right arm is free. The smaller man’s groin is inches away. I punch him there with all the strength I have. He cries out and falls. Now I am on my feet, gasping for breath, terrified and angry. Goddamn animals!

  Get away! Get away from them before the drug kicks in. The larger man comes at me. I punch him in the face. He stumbles backward. Run! Run! Down the alley is the only way to go.

  There are buildings all around—one story, two, some even three. The details are vague and indistinct, yet I clearly see a light wink on in one of the windows. Everything is blurry now. I feel detached…distant…surreal. The drug must be kicking in.

  “I have a pistol. Stop right now or I will shoot!”

  My legs are fueled by terror. I would rather die than live as they plan. Ignore the gun. Just run! Run, damn it!

  My body responds. I’m running…running as hard as I can.

  Oh, God, the alley’s blocked. A pile of trash and garbage and barrels and cardboard boxes…and a fence. There’s a fence! I can make it. I can make it over the trash and the fence. I’ve got to.

  From behind me I hear a shot. No pain. I wasn’t hit. I can make it. Leg up onto the top of the fence. Almost there. Another shot. Burning pain in my back on the right. Oh, God! I’ve been shot. No! This can’t be happening….

  “Dr. Santoro, I think she is waking up.”

  Another shot. More pain. No! I don’t want to die…. “She is waking up!”

  The woman’s words, spoken in Portuguese, forced themselves into Natalie’s consciousness, dispelling the terrible images from the alley.

  This has to be real…. I must be alive.

  “Miss, wake up. Wake up and meet us. Just nod your head if you hear me. Good, good. Don’t try and open your eyes yet. We have them covered.”

  Natalie could understand enough of the woman’s Portuguese to interpret it. Still, she felt unable to speak.

  “Dr. Santoro, she hears us.”

  “Well, well. Our dove begins to spread her wings.” A man’s voice—deep and calming. “Perhaps soon the great mystery will be over. Turn off the lights and we shall uncover her eyes. Miss, can you hear me? Please squeeze my hand if you can hear me.”

  “I…am…American,” Natalie heard her strained, hoarse voice say in somewhat awkward Portuguese. “I…do not…speak…Portuguese…very well.”

  She felt extremely vague and hungover, but one at a time, her senses were checking in. There was a pounding in her temples and behind her eyes that was extremely unpleasant, but bearable. The smell of isopropyl alcohol and disinfectant was distinctively hospital. The institutional texture of the sheets supported that conclusion. Then she became aware of the oxygen prongs in her nose. The message from her senses blended with the all-too-clear memories of being assaulted, nearly escaping, and then being shot in the back.

  “Actually, it sounds as if your Portuguese is quite good,” the man said in accented English, “but I will try and accommodate you. I am Dr. Xavier Santoro. You are a patient in the Santa Teresa Hospital in Rio de Janeiro. You have been a patient here for a number of days. The lights have now been turned off. I will take the pads from your eyes, but I will have to replace them soon. Your corneas were quite scratched, the right more than the left. They have responded nicely to treatment, but they are not all better. After I remove the pads, please open your eyes intermittently to allow them some time to adjust. If you have any significant discomfort, we will immediately replace the patches.”

  The tape, holding pads over Natalie’s eyes, was gently pulled away. She kept her lids closed for a minute as she tested her hands and feet, then her arms and legs. Her joints were piteously stiff, but they all seemed to be working. No paralysis. Her hand brushed across a urinary catheter, which suggested she had been in Santa Teresa’s for some time. Cautiously, she opened her eyes. The room was dimly lit from fluorescent light flowing in from the corridor outside her door. The glare was unpleasant, but objects quickly came into focus. An IV was draining into her left forearm. There was an ornate crucifix over the doorway. There were no windows on the three walls she could see.

  Dr. Xavier Santoro, wearing scrubs and a surgical coat, gazed down at her benignly. His face was scholarly, long and narrow with a prominent nose and wire-rimmed glasses, and from where she lay, he seemed quite tall.

  “I…I was shot,” she said. “Am I all right?”

  “Here, let me help you up in bed a bit.”

  Santoro pulled her up toward the head of the bed, then raised it forty-five degrees.

  “I’m a medical student…a senior medical student in Boston…. My name is Natalie Reyes…. A taxi driver took me from the airport to an alley and…am I all right?”

  Santoro inhaled deeply and exhaled slowly.

  “You were found in an alley with only your panties on, Miss Reyes. No bra. As you said, you had been shot twice—twice in the back on the right. We estimate you were there, lying unconscious beneath a pile of trash in the alley, for two days. You lost a good deal of blood. This is midwinter here in Brazil. The temperature at night has been less than ten degrees Celsius—not freezing, but cold enough.”

  “What day was I brought in here?”

  Santoro consulted her bedside chart.

  “The eighteenth.”

  “I flew in on the fifteenth…and was attacked on the way from the airport, so it was three days…. What day is it now?”

  “It is the twenty-seventh, a Wednesday. You have been in a coma since your arrival—probably from the prolonged exposure, shock, and infection. We had no idea who you were.”

  “Nobody called the police…looking for me?”

  “Not as far as we know. The police have been here, though. They will want to come back and get a statement from you.”

  “I feel short of breath.”

  Santoro took her hand.

  “That is understandable,” he said, “but I promise you that symptom will improve with time.”

  “With time?”

  Santoro hesitated.

  “You were quite ill when you were brought in,” he said finally, “badly dehydrated and in shock. Your right lung had collapsed completely from the gunshots and the bleeding into your chest. There was life-threatening infection…. I’m sorry to
have to tell you this, but with the bullet wounds and infection we could not reinflate the lung and your vital signs were slipping. The decision was made that to save your life, the lung had to be removed.”

  “Removed?”

  Natalie felt a sudden wave of nausea sweep over her. She began to hyperventilate. Bile swept up into her throat. My lung.

  “We had no choice,” Santoro was saying.

  “No, this can’t be.”

  “But on the positive side, you have made a remarkable recovery to date.”

  “I was an athlete,” she managed to say. “A…a runner.”

  Please…please let this be a dream.

  Images of herself dragging ahead using a walker swirled through her brain. My lung! She would be a pulmonary cripple forever, never to run again, always short of breath. She tried chastising herself for not responding to the fact that these people had saved her life, but all she could focus on was that life as she had known it was over.

  “An athlete,” Santoro said. “Well, that explains your response to the surgery. I am sure this is a terrible shock to you, but take it from a chest surgeon, Miss Reyes, having this operation does not mean you will no longer be able to run. With time your left lung will compensate and your breathing capacity will increase to the point where it could come close to equaling what you could do with both lungs.”

  “Oh, God. I can’t believe this.”

  “Perhaps you would like us to contact someone back home?”

  “Oh, yes, yes. I have family who must be frantic with worry. Dr. Santoro, I’m sorry for not sounding more appreciative to you and everyone for saving my life. I just can’t believe what’s happened.”