by Neil Mcmahon
The boy mumbled something. He was slight, olive-skinned, perhaps sixteen, with eyes like a scared fawn’s. Monks felt his professional insulation slipping.
The next gurney was trundling in now, flanked by three blue-uniformed SFPD cops. This boy was older, also strapped down, but struggling and panting. A field dressing covered his left leg from hip to knee. The bandage was blood-crusted, but with no sign of an open major vessel.
Monks called, “Five milligrams morphine, IV,” to a waiting nurse, dien pointed the gurney to the next cubicle.
“We’re gonna take care of you. Can you breathe, does it hurt?” Vernon was yelling now, leaning close to the first boy. No words came from the mouth: only a raspy unintelligible sound of forced air.
Vernon said, “Airway first.”
“Blood loss?”
“No exit wounds and no pumping bleeders. His heart’s probably not hit. We’ve got to trust the MAST suit and IVs.”
“Keep moving and keep talking.”
Vernon thrust his fingers into the open mouth, probing the upper throat. Sweat glistened on his forehead above his goggles.
“Airway’s clear. Let’s move him.”
The paramedics lifted the backboard onto the trauma room’s stainless steel table. Vernon’s fingers traveled over the bloodcaked rib cage, searching for entrance wounds. They paused at a small hole above the right nipple. His hand went flat and moved around the chest, fingers of the other hand tapping its back.
“Right side’s hyperresonant. Percussion dullness of the heart has shifted left.”
“Check his larynx.”
Vernon’s fingers moved over it. When he looked up again, the respect in his eyes was evident.
“Displaced left,” he said. “I’d say we’ve got a tension pneumo.”
Monks had been reasonably sure of that from the paramedics’ description. He had seen a number of them, some from nine-millimeter rounds. Air escaped from a punctured lung and got trapped in the chest cavity, the wound sealed off by the pleural membrane. Pressure held that lung collapsed and useless, while the other functioned with difficulty.
“Proceed.”
Jackie said, “Anesthetic?” She was hanging right in there, Monks noted approvingly, hip to hip with Vernon.
Vernon hesitated, then said, “No time.”
Monks nodded once more, and Jackie took the chest tube from its sterile wrapping: eighteen inches of plastic one-half inch in diameter, to be pushed through an incision in the rib cage deep into the lung.
A commotion was rising outside, shouting voices coming closer. A blue uniform moved by fast. Monks stepped to the door. A small crowd had formed near the Nurses’ Station, the police facing off several young Hispanic men wearing baggy pants and baseball caps turned backward. Limbs flailed in hot gestures, and words flew in staccato street Spanish. He got a brief unsettling flash of being back in Saigon, surrounded by small intense people whose language and intentions he could not understand, except that they might at any second erupt into violence.
A clerk was talking rapidly on the phone, probably to security. Monks glanced back into the trauma room. Vernon was washing the boy’s chest with sterile prep solution. It would not be long now, and without anesthesia this was going to get loud. Monks strode to the nearest cop, a burly man with a deeply lined face and organ-grinder mustache. The cop’s name tag read SALVATORE. He nodded curtly to Monks, his angry gaze staying on one of the young men.
“Says he’s the kid’s brother,” Salvatore said.
“There’s a conference room off the main lobby,” Monks said. “Have them wait there, and tell them somebody will come talk to them in a few minutes.”
The brother’s glare shifted to Monks, and he postured, one shoulder thrust forward and other fist clenched. His hair was bristly on top and slicked back on the sides, falling to his shoulders. He was not much over five feet tall.
“He dies, man, you going with him, motherfucker!”
Monks leaned close to his face.
“Your brother can’t breathe and his belly’s full of blood. You want to come help?”
He watched the eyes turn uncertain and saw through to the truth of it: this was a kid, too, and scared.
But a kid who had likely been pan of the incident, who might have pulled a trigger himself, who could threaten death with chilling ease. Monks’s own anger and fear bristled as he wheeled and stalked back.
He stepped into the trauma room in time to see Vernon making a scalpel incision low on the right armpit. With a quick glance at Monks, Vernon set aside the scalpel, chose a Kelly clamp, and eased it into the slit, twisting downward. Monks gripped his wrist, stopping him. An artery and nerve ran beneath each rib, vulnerable to the clamp’s sharp jaws.
“On top of the rib. The artery.”
Vernon closed his eyes in despair.
“Shake it off,” Monks said fiercely, fingers digging into Vernon’s wrist. “Come on, he’s dying.” Vernon inhaled, readjusted the clamp, then stopped again. His face was almost white. Monks counted, one, two, and just as he was about to shove in and take over, Vernon found his nerve and thrust the clamp through the pleura.
The hiss of escaping air was drowned by the boy’s cry, a feeble shriek like the rending of rusted metal. His limbs thrashed against the webbing while Jackie held him down,—but he was breathing again. Vernon, still ashen-faced but now firm, probed the incision with his finger, then slowly introduced the tube into the heaving chest cavity in an obscene parody of sword-swallowing-It would be sewed into place and taped airtight, then attached to a water-seal mechanism to suck out the excess air and allow the lung to expand fully.
Monks glanced up and saw Charlie Kolb, a wiry man with the grim look trauma surgeons developed, standing at the door.
“The OR’s here,” Monks said to Vernon. “Blood pressure’s holding and he’s breathing. Get that tube hooked up and we’ll call him stable for now.”
Kolb was a compendium of nervous gestures, pulling at his ears and lips, running his hand over his thin hair as Monks briefed him. There remained the matter of at least three liters of lost blood, much of it probably sloshing around inside the belly. But the real danger would come with the MAST suit’s deflation; whatever damaged blood vessels it was compressing would open again rapidly.
“We’ll go into his belly now if you want,” Monks said. “Your call.”
“Let’s get him upstairs. We’ll try to clamp him off.”
Monks watched with a mixture of letdown and relief as the process of transfer began; the ER’s responsibility was ending, the OR’s beginning. Surgery was better equipped to handle it, but both of them understood that this was a bad situation for surprises.
The burly cop, Salvatore, was standing outside the next cubicle. One of his partners had moved to the ER entrance and stood with radio in hand, watching the parking lot.
“We think you just got cruised,” Salvatore said. “A car came around, bunch of kids; took off when they saw the units. Maybe the other gang, coming by to clean up.”
Automatic weaponfire in the ER, Monks thought. Their little hospital was growing up.
“Any idea who or what?”
Salvatore shrugged. “Turf war. The others were Asians. The way they do it now, they leave their wounded and take off; they know we’ll bring them to the hospital. Then both sides say it was a drive-by.” He nodded at the second boy, King strapped to his backboard. “We know these guys, they’re homeboys. The other kid’s an Esposito, with the mouthy brother. This one’s Vasquez, Rafael. Rafael ain’t talking, he’s a tough guy. Got to protect his good buddies that left him bleeding cm the sidewalk.”
This boy looked older, muscular but slack and silent now from the morphine, or perhaps because the reality of the situation was starting to break through to him.
“Right, tough guy?” Salvatore said. “How old are you? I want to know, is it gonna be juvie hall or Q?”
The lips moved, a reflexive mutter Monks understood witho
ut hearing: chinga tu madre.
Salvatore grimaced. “Truth is, he’ll be out in a few months. Big reputation and a scar to brag on.”
“Give me a minute with him,” Monks said, and stepped to the bedside. “The pain coming back?” Rafael Vasquez said nothing, but Monks saw the answer in the glazed defiance of his eyes.
“How’s he doin’, man?” Rafael’s head gestured in the direction of the next room.
“He’s not doing too well, Rafael,” Monks said quietly. “Tell me something. I’m a doctor, not a cop. I won’t rat you off. I just want to understand. What happened that was worth this?”
The eyes went veiled, the head rolling away: all the answer Monks was going to get.
He supposed it was a lesson of history, ethnic groups in a melting pot where the melting was too slow for their liking. In the Mission, the older Mexican and black gangs had kept things relatively stable, but now they were under fierce pressure from immigrant Central Americans, Vietnamese, Taiwanese pushing out from Chinatown, and their own young. Throw in a few eye-watering spices—crack, crank, ice—and readily available weapons from Uzis to bazookas, and what you had was increasingly close to open warfare. In Monk’s boyhood on Chicago’s south side, tough guys fought with fists, really hard cases carried switchblades or chains, and a few zip guns were rumored. There was also an archaic concept known as “fighting fair.”
“I’ll get you something for the pain,” Monks said. He stepped out of the room, wanting a drink himself.
The ER was settling down, a sort of post-coital lull in the wake of crisis. Outside the lobby entrance, the dark figure of the patrolling officer moved through the night’s thickening fog. The Esposito boy’s gurney was rolling out of the ER, pushed by two attendants with a nurse alongside, on its way to surgery like a ship sailing off on a long journey: six inches of tube protruding from the chest, oxygen mask over the face, water-seal apparatus and IV bags hanging on the rails, and a cardiac monitor between the feet. The trauma room’s inside was littered with bloody debris, wrappings, used instruments, and trays. Vernon and Jackie, spattered with blood and body fluids, goggles pushed up on foreheads, stood like the survivors of a bombing raid.
“The kid next door’s had five milligrams of morphine IV,” he told Jackie. “Get him five more, please. Clean him up and see if X-ray can locate that slug.” To Vernon he said, “His brother’s waiting in the conference room. Scared, very hostile. That’s part of the job, too.”
They both looked tense and exhausted: puzzled, as if not quite grasping that after all that had happened, their work might end wrong, that the giddiness of saving a life might still be shattered by the helplessness of losing it.
Monks said, “You might want to know it was nineteen minutes from entry to surgery. There was nothing—zero—more we could have done. You two were right there.”
“I lost it,” Vernon said. His head bowed to stare down into his large hands, as if they had dropped the winning touchdown pass.
Sharp annoyance hit Monks at the thought that Vernon was more concerned with his performance than with the patient.
“If I had any complaints, Doctor,” Monks said, “believe me, you’d hear them.”
He left, already regretting his tone. But Vernon’s mind would be off it soon enough, explaining to a young man pumped full of enraged machismo that in order for his little brother to live out the next hour, everything was going to have to go just right.
Monks stripped off gloves and gown and washed with automatic precision. His own scrubs were soaked with sweat and God knew what else, but his shift was almost over. He reported to the Nurses’ Station.
“If there’s nothing urgent, I’m going to start on my charts,” he told Leah.
“There’s someone here to see you.”
“Mrs. Horvitz, last time I looked, there was a whole roomful of people here to see me. I’d like to think that’s because of my charming personality, but I suspect otherwise. Dr. Dickhaut will be available in a few minutes.”
“I think it might be the lady who called earlier.”
Leah’s usual concerned look was gone, replaced by something softer. Perhaps a trifle arch. Appraising.
Monks walked to the glass door of the waiting room. A woman stood just on the other side. She was wearing jeans, boots, and a leather jacket over a sweater. Chin-length chestnut hair. Slim but not willowy, shoulders suggesting strength. Wide mouth, high strong cheekbones, hazel eyes that sloed toward the exotic.
Alison Chapley said, “When are you going to get off the firing line, Rasp?”
The nickname was short for Rasputin. He had picked it up in the navy. Only a few people called him by it anymore. He realized that he was braced in the doorway, as if his body had stopped itself on its way toward her and was holding on to safety.
He said, “I keep trying.”
“Are those boys going to be all right?”
“One of them.”
“If you’re too busy, I’ll leave.”
Headlights arced into the parking lot. Monks watched, remembering that a carload of possibly armed young men had been sighted earlier. But the vehicle was a newish minivan, not a likely ride for a street gang.
He said, “Too busy for what?”
“It’s complicated.” She glanced around at the other faces in the waiting room, and Monks had the sudden sense that they were pressing close, listening covertly. “Could I buy you a drink?”
“What’s wrong with here?”
Her fingers touched his arm. “Please.”
The minivan’s occupants were getting out, a woman helping a heavy man who moved with a hand pressed to his flank, lifting his right foot mincingly. Appendix, sciatica, maybe kidney stones: nothing Vernon couldn’t handle by himself.
Monks said, “I’m due off at ten. I could meet you.”
“Zack’s?”
Monks nodded.
“Thanks for the gift,” he said. “It’s classy.”
“I found it in an antique store. I thought of you right off.”
“Why a razor?”
She smiled. “I don’t know, exactly. It just seemed right. Maybe something about an edge.”
Monks watched her walk away, hips swinging, bootheels clicking on the pavement. He turned back inside to find Leah’s gaze still on him, as if she could see into his memory.
Chapter 2
Alison was sitting at the near end of the bar when Monks walked in. He was not surprised to see a man standing next to her, leaning against the rail, talking. The man’s hand rested familiarly on her shoulder.
Monks stepped to her other side. She turned to him quickly, shrugging off the hand as if it were a suddenly discovered annoyance. The man glanced at Monks, a sour look that stopped just short of belligerence, and drank from his beer bottle.
The place had the feel of a saloon, with a pool table, a country juke box, and a bandstand that offered bluegrass on Friday and Saturday nights. The clientele was mostly male, fit young men wearing tight jeans and work shins. In gay San Francisco, Zack’s was straight and determined to show it.
“I’m buying,” she said. “Is it still vodka?”
“It is. But not now.” Monks had debated the issue on the drive here. He wanted a drink fiercely, but a single drink had never done him any good, and there remained the residual business of the ER charts to finish and patients who were still in some way his.
She pushed a key ring toward him. Monks recognized a large Ford key, to the Bronco, and a worn older one: the key to his house.
“I thought you might want these back,” she said.
He left them untouched on the bar. “I might.”
She laughed. “I’m out of practice sparring.”
“Best I can recall, you never had much competition.”
“Not in a place like this.” Her voice was loud enough for the man behind her to hear.
Monks gripped her wrist tightly. Her smile faded.
He said, “Whatever this is, let’s get to
it.”
Her gaze shifted away. She stood. Monks released her, waiting to see if she would walk out.
“I could use a cigarette,” she said. She called to the bartender, “Warren, another one, please. I’ll be right back.” He was washing glasses and did not look up.
Monks followed her out onto Clement Street, moderately busy with late-night traffic. Alison paused to search in her purse. Monks noted that she was still smoking Marlboro Lights, and still wearing a single ring, an elliptical black opal, on her right hand. Bachelor’s degree from Radcliffe, psychology doctorate from Stanford, post-doc work at UCSF. The kind of facial bone structure that spoke of generations of blue blood, and plenty of money. Chapley, she had once told him, was from DeChaplais, Huguenots who had come to this country fleeing persecution in the early eighteenth century, and had kept track of every ancestor before and since.
It was a package she could have parlayed into anything she wanted. What she had chosen was to specialize in the treatment of dangerously violent men.
“I quit smoking for two years,” she murmured, cigarette in mouth.
Monks was not one to criticize a self-destructive vice. He took her lighter and watched her hair spill forward, brushing her neck as she leaned into the flame.
He said, “I’m flattered that you remembered me, Alison. I’m waiting to find out why.”
She exhaled, a thin stream of smoke that blended with the fog.
“Still in the investigation business?”
“Strictly armchair,” Monks said warily. “Same as always.”
“Someone’s been coming around to people I know, asking questions about me. He’s posing as a state licensing inspector. Says he’s checking me out for a job, and I haven’t applied for any.”
“What kind of questions?”
“Partying. That sort of thing.”
“Did your friends get his name?”
“Stryker. And I didn’t say they were my friends.”
Monks said, “People you bought drugs from?”
She nodded curtly. “One. Who’s seriously annoyed at me right now. He thinks I shot my mouth off and dial Stryker’s an undercover cop.”
