Bloodletting and Miraculous Cures

by Vincent Lam

  The police left. A nurse entered.

  “Fiona, can you draw blood for hepatitis B and C, and HIV 1 and 2.”

  Fiona was calm. She told Eli she was going to take some blood. I stood with my cut hand on his forearm, in case he bucked. He flinched as the needle plunged under his skin. Dry. She rolled the skin under her white latex fingers. Blood bears the curse of human malice. This life fluid may conceal destruction, the way words and thoughts can kill unseen. Within blood the idea of death can flow. The blood from Eli’s forehead had stopped, and now we sought to pull it from his arm.

  “He doesn’t have much left here,” said Fiona, probing the network of old punctures and thickened scars for a suitable vessel. Eli tried to pull his arm away. I dug in my nails and he stopped moving, Fiona readjusted. Then the gush. The vacuum in the tube pulled up his blood squirting thin, safe, within the sealed glass walls. Fiona left the room with the blood in the tubes, like little glass torpedoes.

  On my wrist were two jagged abrasions adjacent to my metal watchband, leaking red. The skin was peeled back, but not deep. Was it teeth? The cuff of my lab coat was ripped sideways. Did his teeth tear the coat? Was it teeth through the coat cutting my wrist? Or was it teeth pulling my watch, with the rungs of the watchband scraping my skin off? I removed the watch, turned it over. The watch was perfect, unmarked. The human bite is the dirtiest, the most foul, and destined for infection. Worse than dogs or cats, because the human mouth is full of filth.

  I sat down on the edge of the stretcher where Eli was handcuffed. He was tired from his efforts and lay quietly, eyes open, breathing hard. The staples in his forehead were haphazard and excessive in number. The wound did not bleed anymore.

  “Eli. Why did you do that?” Until now, I had been mostly interested in creating clean paperwork, deriving a mild pleasure from inconveniencing the police. This no longer felt like quite enough, and I knew that I would feel cheated if I left it at that.

  “Yo man, they fucked with me.”

  “Did I fuck with you?” I said softly. Now, I told myself, let it go if Eli makes a nice apology. The right apology. I made a deal—Fitz, you’ll be nice now for the right apology, if he says something close to begging.

  Eli shrugged.

  “Is that what you say after you bite someone?” I asked in a very sweet way, knowing now that there would be no apology.

  “Go to fucking hell.”

  “Open your mouth.”

  He half-opened his mouth, and I didn’t see any blood. None from him, none from me. With a tongue depressor I lifted his lips, the way you lift the lips to see a horse’s teeth. Gums intact. Saliva, though. Saliva, clear and innocent, but sometimes it carries infections and curses like the words it lubricates. I was angry at Eli for taking a bite, I was angry at officer 6982 for letting go, or slipping, or losing whatever balance lies between a head held and released. I darted the stick further into his mouth, gagged him hard—against the tongue only so as to leave no marks—and let him retch, grunting against the tongue depressor for a while, until I started to feel better.

  “You’re going with the police now.” I turned away.

  “Hey, I’m seeing shit. Dancing elephants and shit.”

  “Never heard you say it.”

  I plucked the suture off the tray and dropped it into the sharps disposal box. I placed the forceps and needle driver in the silver k-basin. Officers 6982 and 1483 stood outside the room, wrote on their pads. Eli watched them. No one’s eyes were on the quiet room. I placed the scissors on the stretcher within reach of Eli’s cuffed right hand. The evil of blood is like a malevolent thought. Once it touches, the very suspicion of its presence causes it to grow, to distort motive and action, and to propagate its own dark, spreading reach. Then I wrapped the light blue covers over the rest of the tray and picked it up, left the room. Eli’s right hand lay on his side away from the window, and could not be seen from where the officers sat.

  Outside the room, eight charts on the rack. Last time I checked we were three hours behind. I pressed gauze onto my cut.

  “Sorry I lost my grip there,” said officer 6982.

  The child in the next room was still crying, the sound of a child who knows he’s being ignored. The fact of being ignored made the waiting painful.

  “Need some stitches, doc?” said the male officer, smiling. I felt the anger rising inside me—a heat that filled my chest. I exhaled. I felt the relief of justification about the scissors. I wrote in the chart that after being bitten, I had closed the patient’s laceration with staples, and that the wound edges were well apposed.

  “Bad stuff happens,” I said, looking up. “You guys see it all the time. I’ve got to get a bandage. Then I need to speak to one of you.”

  At the nursing station, the father of the child in the next stall asked how long for the tests to come back. They paged me in the resuscitation room to reassess two patients, and announced overhead that there was a call for me on line six from a pharmacist. I gestured to Fiona, stepped into the drug dispensing room, and sat among the racks and drawers.

  “How’s your wrist?” asked Fiona.

  “It’s nothing. A scrape.” I tried to sound convincing. “We have to send mine, too.” I rolled up my sleeve. The Potential HIV Exposure kits were in paper bags on the left. Lots of pills. Yellow and black ones. Red and white ones. They made everyone so sick that no one ever finished taking the full course of precautionary anti-retrovirals. My sleeve was up, and Fiona’s white latexed fingers directed the cool sharp rush of the needle. Seeing my own blood flow freely and thick, the texture of boiled milk, lulled me for a moment. I sat still. She pulled out the syringe with a quick withdrawal that was like the same pain in reverse. This blood wouldn’t show anything. This was innocence blood, to show I was clean today in case I seroconverted later. My disability policy would pay for occupational HIV, but not if I got it a month previously from a hooker.

  “Make sure it’s labelled properly, Fiona. It’s insurance blood.”

  “You okay?” she asked. “You better start the pills.”

  “No. No. Low risk, just a scratch. Maybe my watch, maybe not even his teeth.”

  “The pills make you sick, don’t they? But he’s got tracks all over.”

  “Sick like anything. I feel sick enough.” I remembered his puncture-scarred arms, his smell of life in decay. “Maybe I should take the prophylaxis. Yeah, sign one out to me. Tell resusc I’m going to be a minute. Ask that woman officer to come in.” I took one of the paper bags, shoved it in a pocket.

  In the dispensing room there was a soft light that glowed from under the edges of the cupboards. This was to make it easier to count pills. I liked this room. You could see everything you needed to see. There was a knock.

  The woman officer said, “Hi doc. Problem?”

  “No problem. You know what? I don’t think he’s so crazy. He can go with you tonight.”

  “But what about…” she said, unsure how to phrase her concern.

  “What, about coercion and police brutality, all that stuff? About that stuff?”

  “Yeah, that.”

  “I wrote here in the chart that his account of the events changed from time to time and was inconsistent.” I showed it the officer. “I’m sure a judge would find you more credible than your prisoner. If he has the chance to tell a judge.”

  “I’m sorry about the mess.”

  “The bite,” I said. I smiled. “Like you said, gotta watch yourself. We both work with occupational hazards.”

  “All the time.”

  “About his head, I guess he fell on the car door, huh? That’s what I’ll write down, that he fell on the door of the cruiser while he was getting in. Clumsy.”

  “That’s exactly what we wrote. Exactly what happened.”

  “You know what else? You may not have noticed this yet, but he’s got multiple bruises on his limbs and torso. He was flailing around at some point. Hurt himself.”

  “No, I hadn’t noticed.”<
br />
  “Well, here’s what I saw. He’s moving all four limbs well. No broken bones or anything, no cuts except for the one on the head where we fixed him. But there’s a lot of bruising that you may not have noticed yet. Multiple bruises consistent with accidental injury. That’s what I’m writing in the chart. What was that ‘yummy yummy’ nonsense anyhow?”

  “I really couldn’t say, doctor.”

  “Eli needs to learn respect for the police. I’m going to discharge him to your custody.”

  “I see what you mean.”

  “Just my job. ’Night, officer.”

  They took him out. Eli swore and stumbled. Maybe it would happen just down the street, in this precinct anyhow. He might bolt outside the hospital, or there were a lot of quiet corners where he might try to escape, and they would have to take him into custody again, teach some respect. I went into the quiet room. It stank. The scissors were gone, and what can you say about that? So many things happen at once. A doctor could lose track of one small, sharp object, and an agitated patient could easily grab a little pair of scissors.

  I went to the bathroom, took the small handful of pills that would reduce my probability of seroconverting if I had actually been exposed to HIV and washed them down with handfuls of water. Soon my shift was over, and I signed over to the next physician.

  As I drove away, I saw a speeding police cruiser with sirens on, blazing toward the hospital. There’re a lot of cruisers, like crackling fireflies in the night. The police bring in their prisoners when necessary, and the officers come themselves as patients when they’re hurt. I didn’t look to see the faces of the officers in that car.

  AFTERWARDS

  DOCTOR SRI WATCHED THE AMBULANCE CREW wheel in the big, motionless man. In resuscitation bay 3, the form wrapped in the blanket was lifted upward by a circle of hands, each grasping the orange cloth. The medics and nurses asked and answered each other at the same time. This heavy form in the bright blanket rose off the ambulance gurney, floated for a moment, and then settled on the hospital stretcher. Around the silent man, a choir of beeping monitors and electronic alarms rang out a desperate melody. Lines and cables spilled over each other, into him and onto the floor.

  “What’s the story?” asked Sri.

  Zoltan the paramedic said, “Unwitnessed collapse in a hair salon. He was in back. Found in vee-fib. Shocked three times, tubed, epi times three, atropine times two. En route, total six shocks—no response.”

  “Time down?”

  “Call at fourteen-oh-five…now twenty-five minutes down.”

  “All right.” Sri placed his stethoscope on the man’s chest—no heart sounds. The eyeballs were beginning to dry and stick to the open lids, and the pupils were a fixed size. The hands were a lacy blue web, which spread up the arms to the purple face. Sri felt relaxed, almost placid.

  “Twenty-five minutes down?” said Sri. He felt calm because it was too late to make a difference.

  “Yeah. Traffic.”

  “Fine. Bolus Amio three hundred. Pads, and get ready to shock.” Hands reached for drug boxes, for the paddles. The monitor’s frantic line jumped up and down. Bouncing, bouncing, and wild. Ventricular fibrillation, the heart’s desperate spasm.

  “Amio in,” called out a nurse.

  Sri held the paddles in front of himself.

  “Charging to three-sixty,” said Sri. His thumbs flicked the red button on each paddle. The counter climbed: two-fifty, three hundred, three-sixty. “I’m clear.” He placed the paddles on the chest. “You’re clear.” He looked up and down the stretcher to see that everyone had stepped back. “Everyone’s clear.” Sri leaned down hard over the paddles. His thumbs found the big orange buttons. With a quiet beep of the defibrillator, the man’s body jumped in a moment and softly rustled the sheets in falling back into them. Sri always thought there was a noise in that jumping—like a little bang or a snap. Afterwards, he wondered if he had imagined it, and then he couldn’t be sure.

  “Continue CPR,” said Sri.

  Zoltan, whose shoulders were broader than his planted feet, compressed the chest. With his hands overlapped and a closed-mouth smile, he pumped the chest casually, flexed at the elbows. Most people lock their elbows and lunge from the waist to achieve enough force. Zoltan pumped with a delicate stroking motion that pushed the silent man audibly down, down into the stretcher.

  “Good output,” said Sri. His gloved hand felt for a pulse on the groin of this human shape in the nest of sheets and wires. The blood not clotted yet, but not warm either. At the requisite intervals, Sri ordered injections, shocked the human form, and re-examined. On the monitor, the dancing line became a lazy wave. Sri wrote in the chart.

  It was fourteen-fifty when Sri said, “Hold compression.” The line was flat across the monitor. “Is the family here yet?”

  “No one.”

  “Well, I think we’re done. I’m calling it. Thank you everyone.”

  Four patients later, Nurse Lillian came to Dr. Sri.

  “Mr. Wilhelm’s family is in the family room,” she said.

  “Who?”

  “The vee-fib. His family.”

  They began to walk down the hall. Lillian handed Sri the chart.

  “Wife and son,” said Lillian. Her voice was light and firm, a tone that might signal the arrival of guests who were expected but not especially welcome.

  Is he really dead yet? Sri wondered. Mr. Wilhelm himself was gone, but the Mr. Wilhelm who existed with his family was alive until Sri told them of the death. This hallway to the family room always feels long, thought Sri. Sri knew he was wondering idly, because either this death had happened or was soon about to be finished. It didn’t matter if it was a secret reality in this hallway. The door appeared. What if I don’t go through this door? thought Sri. He would not turn away. He had been in the family room many times.

  Sri opened the door that had no window in it. He and Lillian entered the room.

  “Hi, I’m Dr. Sri. This is Nurse Lillian.”

  Glancing at the chart, Sri saw that he had not yet written that the patient was deceased. What if, just now, he thought, I forgot that Mr. Wilhelm died? Sri shook hands with Mrs. Wilhelm and then her son, Tomas. “Pleased to meet you,” said Sri. Seeing them, now it seemed unfair that he knew and they did not. He wanted to rush the words. “I’m sorry it’s under these circumstances.” But first the key phrases. What did he usually say in this time when everything but the facts would be lost? Each time it feels like I’m rehearsing. “Your husband arrived here about an hour ago.” I should just say it, to make it real and end it. They already know. A wife knows—some believe that at the moment of death she feels it already. “He collapsed in a hair salon. The paramedics came immediately, and did everything they could.” I used the past tense. It gives it away. What would I say if the man were alive? I would start by saying he was alive. Beginning to tell it, Sri felt calm. “They transported him here. We began to resuscitate him immediately. His heart had stopped beating. We did everything we could.” That last phrase felt like soap opera, but these words always came out of Sri’s mouth. To talk like this creates a delay, but there’s a story to tell. Tell them the story. The story needs to come before the ending so that it makes sense looking back. “We couldn’t restart his heart.” So he had maybe tricked himself by revealing the death without saying the actual words. I still have to say it. “I’m sorry, but Mr. Wilhelm passed away peacefully about half an hour ago. He was in no pain or discomfort.” That last part, I always feel I might be lying.

  There.

  The wife’s face held a shattered expectation. Tomas Wilhelm was Dr. Sri’s age, with quiet eyes that had the calmness of grey water. The young Wilhelm gazed beyond the space of the small room. This room. Sri had seen its pictures so many times but he could never think of what they showed. Forgotten landscapes, maybe, hung over the soft, easy-to-clean vinyl furniture.

  “Heart attack,” said Sri. “Most likely.”

  “He didn’t take car
e of himself,” said Tomas, squinting.

  “I see.”

  “He smoked, never exercised, he was a diabetic—didn’t care about his sugar.”

  Sri always felt relief to learn that a deceased person’s end was predicted by his life. It made it a happens-to-someone-else event, a bound-to-happen circumstance. There was less to explain, or understand.

  “Well, I’m sure there’s a lot to remember,” said Sri. Relieved at having told his part of the story, he tried to look at his watch without appearing to do so.

  “He was in a hair salon?” asked Mrs. Wilhelm.

  “Yes, a hair salon,” said Sri. “He fell in the back room. They called the ambulance. The paramedics gave him—”

  “A hair salon? You mean his barber,” said Mrs. Wilhelm.

  “I suppose his barber.”

  “Why was he in the back of his barber’s shop?” asked Tomas.

  “Well, I don’t know,” said Sri. Details. Everyone wants the details. Emphasize the promptness of treatment. “The ambulance crew shocked him immediately, and—”

  “Immediately? The ambulance people were there?” asked Tomas.

  “After they arrived.”

  “I don’t think his barber has a back room,” said Mrs. Wilhelm. She turned to Tomas, “Did he ever call it a hair salon?”

  “It must be the back part of the shop.” How would I know? Sri looked openly at his watch.

  “The haircut place. We’ll get the address for you later,” said Lillian. “The ambulance people write down something that describes the place. For instance, if they bring someone from a coffee shop they might write café. Hair salon, barber. Back room, back of the store.”

  Sri decided to try his medical speech again. “I can assure you that he received all the treatments that had a chance of saving him.”

  “What about his car? Where is it parked?” asked Tomas.

  “They won’t tow it if he’s died,” said Mrs. Wilhelm. “Will they?”

  “Well, you know the parking police,” said Sri, and then wondered if he should have said something different. It was true that they ticketed and towed you even after death.