Stella herself had handled only two injuries this afternoon, one an epileptic, autistic boy who'd bitten his tongue during a seizure, and a teenaged girl who'd managed to lose a condom in her uterus. Despite the boy's writhing and the girl's panicking, she'd sent them both off in under an hour.
All of the carts had been stocked, the instrument pans sterilized and dried; all the soiled sheets were bagged for either the laundry or the incinerator; all the duty rosters had been made out and approved. Like a college town diner awaiting the end of a homecoming game, the ER was only taking a breather in anticipation of the non-stop chaos that was sure to begin with the first shadow of dusk.
In the lazy, air-conditioned silence, Stella's mind reached out to previously unnoticed minutiae to keep itself busy. She wrinkled her nose at the fetid, rotten-foot odor that hung in the air. Someone had been eating Fritos. The powerful antiseptics used in the hospital subdued even the reek of charred flesh, but mutated the smell of any fatty fried snack into a palpable cloud reminiscent of gangrene. A Muzak rendition of Nirvana's "Come As You Are" spewed from the speaker above her head. Every so often, the nasal squawk of the intercom summoned someone she'd never heard of to somewhere she'd never had cause to go, but nothing was going on in the ER.
Stella Orozco's features were what men called "exotic," and women called "striking," when they wanted to say "weird" and "intimidating."
From her father she'd inherited the bronze skin and ebony hair common to Mexican mestizos, but her face was a gift from her Indian mother, with angular brow and cheekbones, deepset black eyes, an aquiline nose and an almost too-wide, generously lipped mouth that scarcely moved even when it spoke, which wasn't often. Her shortness, her fragile slimness could do nothing to contradict that face, those eyes that were forever saying, Leave me alone with my secrets, or I might just tell you one.
At twenty-nine, Stella had been an LPN for only three years, having taken community college courses for four years to get certified. Her age and temperament led her coworkers to think Stella had drifted into nursing the same way other young women of poor prospects might end up in retail or clerical work, and she offered them nothing that made them think otherwise. But Stella's path to her present life had been a struggle up out of depths none of the other staff could imagine, and she wanted no one's pity.
Her parents were migrants from lower Mexico who began crossing the border to work the fields of Central California in 1970. They scrambled over fences and through sewers to get into the U.S. every harvest season; toiled for twelve to fourteen hours a day for a few dollars every week, inhaling pesticides like DDT, malathion, parathion and experimental compounds the USDA would never hear of; lived in shanties with no electricity or running water for five months out of the year, and snuck back over the border like thieves, their only crime a season of backbreaking labor for pennies.
Stella's mother was already three months' pregnant with her that first season, and they stayed in California long enough for her to be born a U.S. citizen. They still migrated back to Mexico for the next couple of years before legitimately applying for citizenship themselves and settling in the dusty farm town of Modesto. By the time she was eight, Stella's father was doing landscaping and construction work and owned a truck, and her mother stayed home and devoted herself to spoiling her only daughter rotten. Stella's mother was so generous and radiant with love for her that Stella never noticed how sick she was. She died just before Stella turned twelve; her father started drinking in earnest and abandoned her less than a year later, most likely returning to Mexico.
Cycled through a route of wildly variant foster homes, Stella forgot that parents were for loving, and learned to view them as models to be observed, obeyed and evaded. She quickly picked up which responses earned her her privacy, her meals, and minimal emotional support, and learned to spot which ones simply couldn't be reasoned with, and how to keep them from hurting her. From them, she had learned that an education and a calling were what separated the former from the latter types, and she threw herself into getting both.
She worked long and hard, and got further than statistics predicted for one so poor, and so late in learning English, but not nearly so far as she'd dreamed. For all that her quick, cautious mind ran circles round most others who'd never had to work as hard, the language would always be a strange tool on her tongue, with appendages she could not grasp, and textures that eluded her palate. Fortunately, Stella recognized this early on, with the characteristic talent for accepting hard, ugly reality that comes naturally for those who have never been able to afford self-pity. Taking stock of her marketable natural talents, Stella discovered that she enjoyed caring for people, was excited by science, and (perhaps a scar of her years in the fields, an untouchable whom even transients never willingly saw) needed invisibility. She decided to become a nurse.
She'd worked odd jobs to pay her way through college while interning as a candy-striper in the hospital, then moved in as a nurse. Now, she felt secure and safely detached, and wanted nothing more from life. She'd reflected deeply and meaningfully, and seen that she would do all right if things stayed this way forever, with or without a man or a winning lottery ticket or a best friend.
The only thing wrong now was that she had liver cancer, and about six months to live.
She hadn't told anyone at the hospital about this, either.
"Heads up, Stella." The voice made her jump and scald her thumb on the tea. She turned, biting her lip to avoid embarrassing herself further by voicing her pain.
Nurse Fisher, a red-headed anvil in pink surgical scrubs, crept up behind her, a mug of coffee in one hand and a cinnamon roll on a saucer in the other. For such a large, loud woman, Nurse Fisher glided through the ER like a hologram. The nurses and orderlies squeaked furiously on the heavily waxed tile floors, while the heavier oxfords of the doctors and the boots of the police and EMTs sounded like the Budweiser Clydesdales in a gymnasium. But damnable Nurse Fisher was always slipping up on her, surprising her, throwing her off guard.
"Brought you this," Fisher parked the cinnamon roll in front of her. Stella eyed it dubiously.
"Thank you. How much do I owe you?" Stella started to reach for her wallet. Ruth's hand intercepted hers, her red, rough skin hot on Stella's wrist.
"Don't sweat it, sweetie. You'll get me back, sometime. Oh, I almost forgot. Life Flight chopper went out to near Big Pine just a minute ago. Coming back in about thirty. You might want to get Trauma One warmed up."
"How many? What happened?"
"You know, same old story: boy meets train, boy loses train, limbs and a whole lot of blood. I'm gonna go get Doc Balsam and Quon."
Stella hurried to Trauma One and busied herself with unpacking the surgical tools and laying out bedding. She hesitated a moment, then went into the trauma storage closet and pulled out a vinyl bodybag, folded it and laid it neatly on the counter. Then she went back to her tea and waited, fingers drumming on the desk. A Muzak rendition of "Folsom Prison Blues." She waited for Terry and Rosalinde to wind up their game and wondered what kind of pervert picked the songs for hospital music tapes.
When it came just minutes after sunset, they were waiting on the rooftop. Stella, Terry, Ruth and Dr. Balsam stood on the lip of the heliport deck, tracking the noisy speck on the horizon, looking like pallbearers in search of a coffin. The Life Flight helicopter grew larger by the second and in less than a minute, it hovered overhead, wheeling round to come down on the deck even as the two EMTs inside threw open the loading door and climbed down. Something about their movements sent a signal that all four emergency personnel read clearly; there was no reason to hurry. Stella wished she'd been bold enough to bring the bag up on the deck with her. Lately, it had become much harder to look the dead in the eyes.
The EMTs trundled their gurney off the chopper and kicked the legs out, then steered it towards them, heads bowed under the ferocious wash of the propeller-blades. Stella caught only a glimpse of the shape between them. She made out
an ice chest resting on the foot of the gurney, and a flash of blood-flecked fleshtones at the other end. Whatever they were bringing back was in pieces, but it was also alive.
"John Doe, condition's stable!" the first paramedic shouted. "Bleeding's stopped, pressure's a hundred over sixty, no sign of shock-trauma, he's doped up real good, and we got most of him in the box. You're gonna love this one!"
The emergency team flanked the gurney as it barged through the doors into the corridor. Dr. Balsam, the short, owlish senior attending physician, stepped up onto the crossbars of the gurney like running-boards and rode as they pushed, rechecking the victim's vitals. The doors closed, enfolding them in a quiet they split wide open with their footfalls. Stella looked down at the patient and just kept looking, because there was nothing else to do.
The patient was a Caucasian male, mid-forties, with receding gingerbread hair and whitening eyebrows, dressed in a black tracksuit with a white sunburst logo on the breast. His eyes were closed, his mouth hanging slightly ajar beneath an oxygen mask, as if he'd simply nodded off. Stella knew he wouldn't be nearly as composed when he woke up.
The patient's right leg was severed less than four inches below the crotch, and not neatly, either. Clearly, the wheel of a freight train had crushed the leg. The same had happened to the left hand, an inch or so above the wrist. A tourniquet had been applied at the hip joint and elbow; below, gory streamers of skin, muscles and crushed veins and arteries hung from the stump.
By all rights, the patient should've bled to death within five minutes of the accident. It'd been over forty minutes since the Life Flight chopper had taken off. Even if some extraordinarily gifted Boy Scout master with a Nobel Prize in First Aid had tied off the man's injuries in time to stop the bleeding, he would've sunk into a coma. By the steady pulse Stella heard on the stethoscope, this man appeared to be sleeping comfortably. His blood pressure argued that he hadn't lost any blood, either.
Stella palpated the flesh of the leg to prove the effectiveness of the tourniquet, and withdrew her hand with a hiss of disgust.
The insides of the leg looked like a cross-section of a lamprey from the depths of Lake Erie. A riotous garden of bulbous black and pink tumors blossomed from the muscle, the veins, even the flattened stub of bone. Like toadstools sprouting from the circuit boards of a computer, they stood out as a violation of the orderly functionality of the anatomy, a transgression every bit as awful as the injury itself.
Stella sucked in air as she saw the same monstrous growths blooming inside herself.
"Stella? Stella? Are you with us, dear?" Ruth Fisher chiseled her out of her fugue. They were getting on the elevator now. Terry hit the button, and they descended, cramped uncomfortably over the dismembered man.
Dr. Balsam was asking the EMT questions in a quavery voice. "How long ago did this happen?"
"We took the call fifty minutes ago, anonymous tip from a payphone. The caller said it'd just happened, he found him lying on the southbound track of the Southern Pacific line. We radioed the depots here, in Mojave and in Lone Pine, to get a lead on the train."
"Just the short of it, please," Dr. Balsam said. "When did it happen?"
"That's the thing," the paramedic shot back. "There was no train this afternoon. That track's barely used anymore. The last bunch of them to come through went at three forty-five this morning. They're looking it over now."
"Did you tourniquet him?"
"Yeah. But he wasn't bleeding when we got there. He was clotted."
"Did you give him blood?"
"Hell no."
Balsam pinched the soft belly of the man's left biceps. Blood seeped back into the capillaries as soon as his finger released the skin. "This man has lost maybe a pint of blood—from losing an arm and a leg to a train. Was there much blood at the scene?"
"Yeah, everywhere." The EMT hesitated, then his brow furrowed. "You know, if this guy was chopped up, you know, somewhere else, and dumped there…"
"That's something for the police to decide. I presume one was on the scene?"
"Yeah. Detective Foley. He'll probably be waiting downstairs."
"Have any of you looked inside him?" Stella heard herself asking. She bit her lip. She'd followed their words with her eyes turned to the wall, but she couldn't stop her mind from racing ahead of the conversation, ahead of the afterimage of those cancers in the man on the gurney.
"What? Oh, you mean those…the tumors. We figured that was why he must've been lying on train tracks at four in the morning."
"Sweet Jesus," Balsam whispered through his droopy mustache as he pressed down on the wrist and the polyps lolled out like a cluster of makeshift tongues. "Have you gone over him with a Geiger counter?"
The elevator doors yawned open and Terry hauled the gurney out. It rocketed across the corridor, but suddenly nobody was in a hurry to follow.
As expected, the ER began to fill up after dusk, and Stella was pressed to stretch the night shift. The nameless patient waited in a cul-desac outside Trauma One. They'd verified that his condition was stable, and assessed the condition of the recovered limb. Only the leg was in the ice chest, far too badly mangled for reattachment. The police were unable to discover either his identity or the time of his injury, let alone the final disposition of the severed hand. Detective Foley took a short statement from Stella and the other personnel who'd treated him, shrugged, and left. Without a relative to worry or an insurance company to pay for him, the John Doe was forgotten.
Stella sneaked away from her other patients whenever she could to check on him. Once when she adjusted the glucose IV mounted to the railing of his bed, the patient seemed to come awake and whispered something. She recoiled from the bubbling plea that escaped his lips, then saw his eyes were open, and focused on her.
She marveled at the way they seemed to shift in color from green to a steely gray, and the way his complexion flushed and paled, as if roiling clouds of blood and melanin churned beneath his skin. Most of all, she wondered at the expression on his face. Over the course of her life, Stella had ample opportunity to study the faces of suffering: of horror at an unexpected catastrophe coming home to rip apart lives; of despair at the capricious appetite of disease; of drugged oblivion; of lifelong fear. Here, in this man who had lost his limbs to a machine, whose remaining limbs were riddled with cancer, there was only awe, and some glimpse of a wonder that made Stella lean closer to hear.
"The…moon ladder…" he murmured. "Moon-ladder…"
"What can you remember about what happened?" Stella whispered.
His eyes rolled, tracking something so wonderful it had taken him away from the hospital, from his broken, dying body. "So…beautiful…the Radiant Dawn…I want…to go home now."
"And you will, Stephen, you will. Pardon me, Nurse." A leather-gloved hand politely separated her from the bed, and a man in a heavy woolen overcoat rolled it down the corridor, towards the exit. Stella looked up, her head swimming.
After a moment, she focused on Dr. Balsam, looking more owlish and bemused than ever. Stu Balsam was on his twentieth hour at the ER. He was the only physician Stella'd ever heard of who had to be chased out of the hospital, and she'd never seen him back down from a fight. Now he looked whipped, ready to accede to anything that would empty a bed.
The man beside him was Balsam's opposite in every way: tall, aquiline, not crushed by age so much as sharpened by it, with a regal mantle of white hair and gray eyes that speedily took stock of Stella, then flicked back to Balsam. The doctor withered under his scrutiny like a waxwork under a hydrogen laser, and Stella sensed that whatever was going on had already been settled.
"This is Dr. Keogh, of the Radiant Dawn Hospice Village," Dr. Balsam said, trying badly to look as if he'd heard of it before.
"They're taking him away," Stella managed.
"Stephen is very, very ill," Dr. Keogh said. "If his condition is stabilized, we would like to return him to the hospice to make his remaining time as pleasant as possible."
>
Clearly, Dr. Balsam wasn't even going to ask any questions. "What was he doing out on the train tracks?" Stella asked.
"Stella, please, don't bother the man," Dr. Balsam said, but Dr. Keogh made an expansive gesture and drew a breath, as if gathering his wits to deliver tragic personal news.
"Stephen has terminal cancer in almost every major organ in his body, including his brain. His brain tumor triggers seizures, in which he may sleepwalk. Somehow, he walked out of the Hospice Village last night, and must've stumbled on the train tracks. His treatment included the implant of a time-release sedative drip, as well as a coagulant. These two factors probably saved his life, for I'm told his wounds had closed, and he'd lost very little blood. Remarkable, that." Keogh started down the corridor after the bed, then stopped. "One more thing. I'd like to have any blood or tissue samples you might have taken from Stephen. Also, a copy of your report, Doctor. And yours, ma'am."
"Yes, of course, Dr. Keogh." Balsam turned away, flagged down Terry, barked, "Get down to the lab and bring up all the samples from the John Doe."
"The blood…and the reports?" Stella whispered in his ear. "That's ridiculous, Doctor. The tumors stopped the bleeding!"
"Yes, everything," he grumbled, looking eager to wash his hands of the whole mess.
"Right away, boss," Terry said, and sped away.
"Stella, I think you'd better get back to work. There are still patients we can help here." Balsam rubbed his hands together in an exaggerated that's-that gesture and turned away. Stella started to leave, but she felt Keogh's eyes on her, and froze. Turning to meet his gaze, Stella wanted to cover herself up, because those eyes made her feel not only visible, but naked, vivisected, laid bare down to her bones, down to her liver. His gunmetal eyes seemed to melt for a moment, and Stella gasped, because he could see it, she could see in his eyes that he knew she was terminal.
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