"Cleat it."
He threw a turn around the nearest cleat and tied it off so that the heavy bike was immobilized at the side of the hatch. "What the hell—"
"Spinning class!"
Jim headed forward along the narrow deck beside the cabin, then onto the cabin roof and face-to-face with Will Spark. In the shadowy half-light Will wore a stiff, twisted expression. His eyes seemed to glow, lit from within, unfocused and confused. And when he tried to speak, the words sprayed like water from a broken faucet.
Gently but firmly Jim removed Will's hands from the winch, made sure the halyard wouldn't slip, then gripped his shoulders. Will cried out, flinching with pain.
"Sorry. Sorry. Okay, let's just go back—"
"You're not putting me below."
"I just want to help you lie down, Will."
"You're not locking me up. No one's locking me up." His body stiffened and he brought up his fists.
"Will."
"No one's sending me below?'
"No. Not below. I just need your help in the cockpit." "What's wrong?"
"We got a problem with the . ." He tried to think of a boat problem—the auto-helm was slipping lately as the gears wore. "The auto-helm. You gotta help me with the auto-helm.
"
Will said, "You new kids, you're so dependent on high-tech."
"That's right, Will. I need your help. Come on back and give me a hand. . ."
They began inching their way back between the cabin
roof and the safety lines. Suddenly, Will grabbed Jim's arm
with a clawlike hand. "Jim, what's wrong with me?" "You're okay."
"No, I'm losing it. I'm losing my mind."
"You'll be better in the morning."
"Jim?"
"What?"
"Promise me something."
"What?"
"This is really important. If I die—"
"You're not going to die. Jesus, you better not. I'd be fucked."
"If I die, you have to promise me that you will deliver my body to Buenos Aires."
"You're not going to die. Come on back to the cockpit before we fall overboard."
"Promise!"
"Okay, I promise."
"The doctor. You have to take me to the doctor." "What doctor?"
"The one who's going to remove this thing from my head."
Suddenly, Will wasn't sounding so crazy anymore. "What's the doctor's name?"
"Her name is Angela Heinman Ruiz. Dr. Angela Hein-man Ruiz. Her address is in my book. Promise."
"I promise. Now, let's go. Let's just swing past here—careful of the winch—and down into the cockpit."
"Hey, where the hell did that come from? What are you bringing the spinning bike up for in the middle of the night? Are you crazy?"
Jim looked at him. The brightening eastern sky revealed a face that was returning to the planet. He said, "I just got this impulse, Will. I was feeling stiff. I thought I'd spin it out."
"Yeah, well, next time, wake me and I'll give you a hand. You belted the hell out of the boat. Look at these gouges. Next time you call me, okay?"
"You bet, Will."
"Do you remember the doctor's name?"
"Dr. Angela Heinman Ruiz."
"She's part English, part German. Married a porteno-- that's a Buenos Airesian—lovely woman. Used to be a real looker—prefers Rio—has a practice there, too. Plastic surgeon. Her husband was a shrink. They had a hell of a business going."
Just to determine to what extent Will was once again making it up as he went along, Jim asked, "Why does she prefer Rio?"
"Buenos Aires is like a second-rate European city—very white, Italian-Spanish, no blacks, no Indians. Too many intellectuals who're afraid they're in the wrong hemisphere."
Jim found himself in touch with Dr. Ruiz sooner than he had expected. It started with an e-mail message to Will, which was encrypted like the messages from his cavemen. He wondered when Will had e-mailed the woman. Apparently, the sick old man drifted around the boat, as silent as a ghost, while Jim was up on deck or sleeping. He carried the laptop into Will's cabin and left him alone for a moment while Will entered the decode command.
Dear One,
It sounds like you're in en awful fix and of course help. But I most emphatically do not recommend an "operation" at see unless you have no other option for treatment—meaning, can you get to a hospital? Neither a lancing," to use another of your quaintly old-fashioned terms, performed by your young man nor, God help us. one you perform on yourself could fall
remotely within the definition of a medical procedure. That said, I've reviewed everything you wrote me.
The knife surely penetrated the pleural cavity, causing the pneumothorax that collapsed the lung. As you are no longer experiencing shortness of breath, apparently your collapsed lung has self-corrected as I hoped it might. But, yes. your wound is almost certainly infected. Yes, draining the abscess now, rather than later, is paramount. I'm particularly concerned that the abscess might break and travel down the path of the knife into your lung. So. despite my many reservations, I am prepared to assist from this great distance.
Love.
Angela
YOUNG MAN, READ THIS VERY CAREFULLY.
Your goal is to incise and drain an abscess. Once you have enlarged the opening of the wound, you will use your gloved finger to break up the loculation—little pockets of pus—into a unicameral single cavity pocket of pus. which you will push out through the larger hole you are making....
His stomach churning, Jim read it three times. Will, propped up on pillows, watched with a faint smile.
"My good gal loves me,
Everybody knows.
'Cause she paid a hundred cash dollars. Just to buy my suit of clothes."
"I presume I'm the young man," said Jim.
"Are you up to it?"
"I've taken a whole mess of first-aid courses. CPR and all that."
"That's why I hired you. Next best thing to sailing with a doctor."
"Not quite. I've never cut anybody open."
"No problem," said Will. "I'm open already. Little Margaret really had a way with a shiv."
"What do we do about the pain?"
"I swallow morphine. You shoot the area around it with Marcane."
"You have Marcane?"
"Of course I have Marcane. This is a blue-water boat. I can't call an ambulance three thousand miles from the middle of nowhere."
Jim was still trying to get his mind around a picture of his cutting Will's flesh. "Yeah, well, just in case it's not enough, maybe I better strap you down somehow so you can't start thrashing around in the middle of it."
"Not necessary. We'll localize me until I'm numb as a piece of wood. I won't feel a thing.
Hell, I'd do it myself, except my chin would get in the way." He winked, but even though they were discussing cutting him open as casually as they might plan a change of sails or a repair of the auto-helm, he looked as scared as Jim did.
Angela had advised them to do it outside, not in the cabin.
The light is better outdoors. Salt-swept decks ere rather more sterile than an interior space inhabited by two males. And as the procedure will turn messy—not to mention the odor of an anaerobic infection—it's much simpler to hose down the cockpit afterward.
wouldn't you think?
"Thoughtful of her," Will grunted.
"She sounds like a funny woman. 'Inhabited by two males' makes us sound like orangutans." The fact was, Will was as strict as hell about cleanliness; the cabin was immaculate.
"Any suggestions about how to control the bleeding?'
Jim was rereading anxiously. Her instructions were as specific and matter-of-fact as the Sailing Directions, and made the unlikely seem slightly more possible. "She says that controlling the bleeding is going to be a bitch. I'm supposed to pack it with Iodoform gauze. Do we have enough?'
"Tons."
"I should press on anything that bleeds and hol
d it for a
while. Do we have a retractor? I might need it to hold the incision open while I poke around inside."
"Yes."
"She says I should use my fingers."
"I presume she means while wearing a glove:'
"Oh, cool! She says, 'Your eyes are in your fingers.' And look at this."
Will peered at the printout and read aloud, " 'In medical school my professors said, "
Watch one, do one, teach one." You will have to skip the first and it's unlikely you'll be called upon for the third.' That should put you at ease."
"Listen, can't we get her on the radio? We could rig up a headset so she could guide me."
"There's no privacy on the radio. Anyone can listen in. They'll know we're here. They'll know everything."
"Who's going to find us in the middle of nowhere?"
"How about that Russian you almost ran into? There're ships everywhere. Or some goddamned do-gooder will come sailing up to lend a hand and we'll end up 'rescued' on the six o'clock news and Andy Nickels will find us. No radio."
"It's your life."
Will gestured toward the open sky gleaming through the hatch. "Shall we?"
"I gotta sharpen my pocket knife."
"Very funny."
Will's medical kit contained scalpels, numerous replacement blades in sterile packaging, and a surgical prep kit. Jim laid them out in Will's stainless-steel baking pan, along with absorbent twelve-by-twelve cotton sponges, the self-retaining retractor—which looked like a bent kitchen spatula with a handgrip—and several disposable preloaded Marcane syringes.
This was step by step, he told himself, like planning the crossing by reading Ocean Passages. That is, until he read Angela's warning: having never done this before, he would not know what to feel for.
"I'm going to wash. You better start popping morphine."
"I already have."
"Do some more. My hands are shaking?'
"That's exactly why I'm not popping any more. One of us needs a clear head."
"I'll wash my hands?'
"Didn't she say to wear sterile gloves?"
"I'm still going to wash my hands first. Come on, Captain. Let's do it?'
A SHARK WAS pacing the boat like a malevolent shadow. Will saw it when they came up on deck and all the banter fell out of his voice. "Oh, that is a lousy omen."
It was swimming twenty feet behind the stern, dorsal and tail slicing the wake. Will watched it gloomily as its head churned the surface and it appeared to rise from the water for a closer look at the cockpit.
For a moment, Jim couldn't take his eyes off the animal. But with a pan full of surgical tools in one hand and Will's shrunken arm in the other, a shark was the least of his worries.
"It's just a shark."
"It's a blood omen."
"Okay. I'm going to lay you right across the back here so I kneel on the bench."
"Jim, listen to me."
"Hey, if you don't want to do it, that's fine with me. Don't let me talk you into this."
"It's not that."
"Yeah, well, the only reason I'm willing to try this is because I'm the only one who can.
But it was your idea, and if you want to change your mind, feel free."
"If I die . ."
"You're not going to die," said Jim_ What the hell else could he say to the man?
"Listen!" Will turned harshly toward him and for a moment he was the old Will, strong and healthy, singing along with Fountains of Wayne as he pumped away on the spinning bike like a young jock. "If I die . . . take my body to Buenos Aires. Bring it to Angela."
"Will, you're not going to die. But if you did, we're at least three weeks from Argentina and you would be a very smelly corpse."
Jim heard his voice slide into high personal-trainer mode, taking charge of the client's body by taking charge of his mind so the client didn't lose focus by dwelling on pain and defeat.
"Lie down. If you want to do this, let's do it?'
"Put my body in the freezer."
"The freezer isn't big enough."
"Then put my head in the freezer."
"Will, are you asking me to cut off your head?"
"Put it in the freezer and take it to Angela!"
"I don't think I could do that."
"Use the serrated Global bread knife. Did you know that the Japanese laminate leaves of steel for the Global in the same way they made samurai swords?"
It was not possible for Jim to put his own hand on the knife in a mental picture of someone cutting off Will's head. "No way, Will."
"If you want what's floating around in my head you bloody well will do it."
Will showed Jim how to use the prep sponge. Then he stretched out on his back across the deck behind the cockpit, glanced fearfully at the shark, and closed his eyes.
Jim slapped the sealed container the way Will had demonstrated, causing Betadine and alcohol to combine, and tore it open. There was no way on God's earth or the whole damned ocean that he would cut Will's head off if he died.
But as he scrubbed the skin around the raw, red gash in Will's left breast with the brown disinfectant mix he found it just as impossible to imagine picking up the scalpel to slit his living flesh.
Sticking him with the Marcane syringe was hard enough. Will jumped at the first prick, then bit his lips and braced himself as Jim pierced the tender skin again and again, squeezing the local painkiller from the hypodermic in the same way he recalled the dentist's spreading it around his gums. It took effect immediately, and when Jim shot him again, with a second syringe just to be on the safe side, Will didn't even notice.
Still, he emptied the syringe, stalling while he tried to get ready to do what had to be done next. It was the first close look at the wound that Will had allowed him, and it dispelled his last doubts about the intentions of Margaret in the white dress. When the blade slid between Will's second and third ribs only dumb luck had prevented it from ripping through his heart or severing the big arteries rising out of it.
What the hell was the second rib called? His many training courses had included some basic anatomy. Very basic. The second sternal rib. Sternals were true ribs, as opposed_ to the lower false ribs and the floating ribs.
He was fleeing the moment.
He forced his eyes back to Will's collarbone. Will's clavicle. But bones were remote, safely invisible. Dr. Angela had referred to tissue. But this was about flesh. Cutting into flesh, exposing rotten flesh, lancing—incising—pus-poisoned flesh. Flesh was real—there was nothing remote or detached about flesh. Unless you forced yourself to remember that flesh was made of muscle—the improvement of which, training, firming, and sculpting, put meat on the fitness instructor's table.
Jim picked up the scalpel, poised it over the red gash, and tried to concentrate on cutting the skin on either end of the red gash by remembering the names of the muscles he had studied in anatomy. Margaret's knife had plunged into Will's pec. Pectoralis major. The depth the knife had pierced indicated that it had gone through the pectoralis minor as well,
depositing bacteria on every single layer that it penetrated. Angela had written that the way the blade initially resisted being pulled out suggested that it had been pinched or caught by a rib.
"I'm really starting to float out on the morphine," Will whispered. "I don't feel a thing."
"How about this?" It was now or never. Jim held the scalpel like a pencil. The angle was wrong. He shifted it in his hand and guided it with his index finger.
"Jesus!" Will gasped.
Jim jumped back. Blood was oozing from a half-inch slit that lengthened the knife wound. Blood as bright red as the sky was blue and the clouds white.
"Do it!" said Will. "It didn't hurt. I can't feel it. It just surprised me." He took a deep breath, let it out, and relaxed his entire body. "Go," he whispered. "I just remembered something I heard somewhere: the incision heals from the sides, not from the ends. It doesn't matter how long you make it."
"Yeah, well, it used to be true. Come on, Jim, do it!"
Jim cut into the flesh. Blood welled, red blood, sharp red in the sea's light. He mopped with the cotton sponges, which instantly soaked wet red. He cut again, lengthening the incision and working deeper. About a half inch in, he started to feel detached, far from the rhythmically rolling boat, the clean wind, and the blood; but closer too, close to the blade and the job he was trying to do. He cut tissue and mopped, trying to see what was going on inside, under the sheath of the man.
Something dark and grayish appeared, swollen, bulging, like a miniature shark swimming in the ocean of Will's flesh. Jim couldn't see it clearly through the welling blood and he wondered whether he had exposed an artery. Would his next stroke send Will's lifeblood geysering into his face? But no, there was no pulse to it, no sense of rushing life. It was dark and repellent, and he sensed as much as guessed that this was the infection that had been dogging Will for weeks.
Jim probed it tentatively.
There was pressure under its surface. He wondered if it was within the muscle cover.
What the hell was the muscle sheath called? The fascia layer. He mopped a wet, red blot, then pushed his finger in and poked.
Gray pus oozed. An overwhelming stench filled his nostrils. He turned his face to the trade wind, which whipped it away. Then he forced himself to shove his finger in again. .
Irrigate the incision, Angela had written. If there was any pure water left in a polluted world, their boat was sailing on it, thousands of miles from poisoning shores. Jim dipped the bucket they used to swab the decks, scooped it back by its rope, and sluiced the contents into the gaping incision.
Will shouted, "That's cold:'
Jim sluiced the wound again and again. The salt slowed the bleeding. He took a long hard look at his handiwork. There was stuff still in there. He probed and squeezed repeatedly around the incision. He paused to wash it with seawater and did it again.
Something gleamed. Jim leaned closer, focused the halogen penlight, and saw to his astonishment a small piece of metal winking from the depths of the wound. He ran below, found a forceps in the medical locker, wiped it with Beta-dine, sluiced blood from the wound, and probed for the metal. He felt it scrape on the forceps, gripped it, and withdrew it. The tip of Margaret's fish knife must have broken off. It was half an inch long and heavy enough to clink when he dropped it in the pan. God only knew what bugs had been on it.
Buried At Sea Page 22
