Pretty Ugly: A Novel

by Kirker Butler

  Tossing the overnight bag (substandard swag from the even more substandard Little Miss Kentuckiana Sweetheart Pageant—Jeffersonville, Indiana) onto the kitchen table, Miranda shook her head in disgust. “Second Runner-up,” she muttered, still not over it. “Never trust a judge from Indiana.”

  Pulling Bailey’s socks and underwear from the dryer, Miranda shoved them unfolded into the bag, then stopped. Even with something important to occupy her mind, she couldn’t stop thinking about that ludicrous photography ad.

  “Are your children sexy enough?” she practically spat. “How dare they?”

  Storming to the freezer, Miranda reached past the tube of frozen tapeworm eggs (a gift from a pageant mom whose own daughter had experienced an unfortunate weight gain), and pulled out a three-pound block of ice that encased the family’s last usable credit card. A financial adviser had suggested she and Ray freeze their cards to help reduce impulse spending and rein in their mounting debt.

  “When you want to use your card, just set the ice on the counter and let it thaw,” the man advised from behind his four-thousand-dollar oak desk. “It should take about ninety minutes. If after that time you still want to make your purchase, then go ahead. If not, it probably wasn’t that important.”

  Miranda put the chunk of ice in the microwave and set it on High for three minutes. Brixton kicked. “Ooh, sweetie, did you think Mommy was making your lunch?” She chuckled, patted her bump, and checked the clock by the fridge. “Eighteen more minutes.”

  Fishing her phone from her purse, Miranda called the number at the bottom of the ad and sighed, disappointed in herself and humanity. As the phone rang, she fiddled with the magnetic poetry on her fridge, picking through limitless combinations until she’d written: i hate stupid people

  “Glamour Time Photography Studio. How can I help you?”

  “Yes, my name is Miranda Miller and I saw your ad in the pageant newsletter? I’d like to schedule a sitting for my daughter.”

  Bailey may have been getting fat, but there was still a chance she could be sexy.

  chapter three

  Ray Miller peeled off his white New Balance cross trainers and relished the cool air on his damp socks. The pedometer clipped to the waistband of his scrubs read eight point six miles. He was too tired to process that number, but he knew it was nowhere near a record. It was Ray’s fifth consecutive twelve-hour shift, and he couldn’t remember most of his day. But that was okay. He was just happy to have something to do.

  As he added up his total mileage for the week, a familiar voice screeched from the intercom: “Nurse Miller, please report to the ER. Nurse Miller to the ER.”

  “Fuck.” He sighed heavily and considered slipping out the back door by the used-needle incinerator where he used to smoke, back when he smoked, back when he did nice things for himself. Instead, he slid his swollen feet back into his warm, moist shoes and stood up. Resetting his pedometer, he laced his fingers behind his head and slowly twisted his back, exhaling when he felt the deeply satisfying pop of his spine.

  The tiny nurses’ lounge reeked of stale sterility, like it had been cleaned with sour towels and hand sanitizer. When the doctors’ lounge received a multimillion-dollar remodel two years earlier, the nurses inherited a museum of outdated sofas and easy chairs. Most were threadbare and musty, but Ray slept better on them than he did his own bed.

  A blister pack of sample pills left by a pharmaceutical rep sat on a stack of old magazines by the twenty-seven-inch TV that hadn’t worked since the world went digital. Ray quickly popped two of the orange caplets without reading the label and swallowed them dry. New sample packets arrived daily like junk mail, and Ray tried every one he found. It had become a game he played to pass the time: take a pill, wait an hour, then try to figure out what he’d taken based on the side effects. Everyone needs a hobby, he told himself. After a decade as a respected medical professional, he could now identify most medications on sight, so taking something new was always exciting.

  A standard tox screen would have shown his blood to be a cocktail of muscle relaxers, painkillers, amphetamines, benzodiazepines, depressants, antidepressants, antibiotics, anti-anxieties, steroids, blood clotters, blood thinners, finasteride, Valium, Zoloft, lithium, Percocet, Depakote, Soma, Adderall, Xanax, Vicodin, Focalin, Lortab, Paxil, Coumadin, Estrace, OxyContin, Effexor, Ambien, Ativan, Flexoril, tramadol, Provigil, Nuvigil, Proscar, prednisone, Klonopin, Lexapro, Lipitor, Lunesta, Valtrex, Ritalin, Dexedrine, Prozac, Wellbutrin, Tylenol with codeine, codeine without Tylenol … The list went on and on, and so did his boredom.

  Ray had stopped keeping track of how many hours he worked. He just showed up, punched his card, and did the job: six days a week at the hospital and five nights working hospice. At thirty-four, he felt at least ten years older, and with small gangs of gray hairs starting to bully the remaining brown ones, it wouldn’t be long until he looked it. Miranda said his gray hair looked “dignified,” but she said it in the way one might tell a bald man that his toupee looks “natural.” To be honest, Ray didn’t care.

  “Better to turn gray than turn loose,” one of his hospice patients said right before she died.

  The walking kept Ray fit, and the pills kept him balanced enough to deal with the few hours he spent at home with his family.

  People often praised Ray for his hospice work, casually throwing around words like “noble” and “hero,” but those people were full of shit. Nothing about Ray’s life bore even a passing resemblance to nobility or heroism. He worked hospice because it paid. After nearly a decade, Miranda had spent roughly $89,687 on Bailey’s pageants, winning a grand total of $49,406 in cash, prizes, and “scholarships” (a label designed to make parents believe the pageants were contributing something to their child’s future besides emotional instability). Ray had done the math. If Miranda never spent another dollar on pageants, and Bailey won every competion she entered for the next twenty-six years, they would ultimately break even. Ray would be sixty years old and would have walked 109,287 miles, four and a half trips around the circumference of the Earth.

  Splashing water on his face, Ray looked at himself in the shatterproof mirror over the federally mandated handicapped sink and tried to remember the last time he shaved. Two days ago? Three? What day was it?

  “Nurse Miller. Please report to the ER.”

  “Jesus, I’m coming,” he said, and dried his face with one of the surgical masks someone had stacked in place of paper towels, which because of recent budget cuts were locked up tighter than the pharmacy. Again, the voice shrieked from the intercom, “Nurse Miller, report to the ER. STAT!”

  “Fuck off, Nancy!” Ray shouted back, then clipped his pedometer to his pants and shambled out the door.

  Walking quickly past the patients’ rooms, Ray kept his head down. Owensboro was a relatively small town, and if he wasn’t careful he might see someone he knew, and Ray didn’t really like anyone he knew. Somewhere, he imagined, there were people he might enjoy spending time with, people with similar interests, but he didn’t know where they lived or how to meet them. He reluctantly went online, dipping a toe into the social mares’ nest that is Facebook, but after a few months, Ray’s handful of Facebook friends were just the real-life friends he was hoping to replace. Ray had always held that the Internet was at best just an expensive porn delivery system and at worst the most loathsome thing ever created by mankind. So he gave up, abandoning his Facebook page like an office he never fully moved into, at a job he never really wanted.

  As Ray reached the ER, he felt the unmistakable signs of an impending erection. “Shit.” He sighed. The pills. Must be a new ED medication, he thought. I probably shouldn’t have taken two. Everyone needs a hobby.

  Working a code with a drug-induced erection was the worst, not that he hadn’t done it before, but Ray had been on his feet for twelve hours. He really wasn’t in the mood. Ducking into the men’s room, he darted past a waiting room refugee vomiting blood into a urinal and lock
ed himself in a vacant stall where he tucked his penis into the waistband of his scrubs. He tightened the drawstring to hold it firmly in place, then stepped back out into the chaos that was the ER.

  Victims of a drunken boat race laid on gurneys as orderlies led equally drunken family members to the waiting area. Ray sighed without emotion and absorbed the too-familiar sights and sounds of avoidable tragedy.

  Once upon a time Ray enjoyed nursing, even though everyone he met assumed he was gay, which didn’t bother him nearly as much as the people who thought he became a nurse because he wasn’t smart enough to be a doctor, as if all nurses were just failed med students. It was particularly bothersome because in his case it happened to be true. Ray never wanted to be a doctor, but since the Civil War every firstborn male in his family had been one.

  “In fact,” his father, Dr. Benjamin Miller, once told him, “Dr. Sam Mudd, the physician who set John Wilkes Booth’s broken leg after he shot President Lincoln, was your great-great-great uncle.” Ray wasn’t sure if it was pride or shame he heard in his father’s voice, but it didn’t matter. “My son is not going to waste his time playing music. You’re going to be a doctor.”

  So Ray struggled through premed at Western Kentucky University and graduated near the bottom of his class from an inexpensive, low-tier North Carolina med school. Thanks to his father, Ray landed an internship at a war-zone public hospital near downtown Detroit. Within six months, his substandard education and slow recall were at least partially responsible for the deaths of seven patients. Ray didn’t sleep much after that. Overwhelmed with guilt, he’d spent his nights studying, cramming, literally forcing too much information into a too-small space.

  “It was like a guy in a bad sitcom closing a door on an overfull closet,” he’d explained to Miranda. “And later someone opens the door, and everything comes spilling out all over the floor. That was med school for me. Everything was in my brain, but it was just all over the place.”

  The resulting wave of malpractice lawsuits eventually forced the ninety-eight-year-old hospital to permanently shut its doors. Ray knew it would have been impossible to defend his intelligence, so at his medical board hearing he tried defending his dead patients instead.

  “They were all very old and had been treated repeatedly by other doctors, hospitals, and clinics. One of them had been shot twice in the past three years. In my professional medical opinion, they had—at best—a combined twenty years among them. And I believe that most, if not all, of those years would not have been quality. So, if I may answer your question with one of my own: Is life itself more important than quality of life?”

  The board didn’t think much of Ray’s professional, medical opinion, or of his “decidedly European” attitude toward patients’ quality of life.

  “Your primary responsibility was to save lives, and you failed that responsibility,” said an elderly physician who looked like a melting wax sculpture of Ronald Reagan. “Therefore, this board believes that the most appropriate punishment is to ban you from practicing medicine in the United States.”

  Ray felt like he’d been granted a divorce from an arranged marriage. He’d wanted out from the beginning, but looking back, he couldn’t say he hadn’t learned something. Reluctant to squander what little knowledge he had retained, Ray moved back to Owensboro and enrolled in a nursing program at the community college. Having a nurse for a son would have killed Dr. Ben Miller if he hadn’t dropped dead of an aneurysm at a tobacco auction two years earlier. And while Ray was a total failure as a doctor, he soon discovered that he was a very competent nurse.

  “I really like it,” he e-mailed an old med school buddy, “less pressure, less responsibility, I don’t have to cure anyone. I just have to help. I can do that. Plus, there’s a lot less stuff I have to know. It’s doctor lite.”

  Ray moved to Owensboro when he was ten. His father had been lured to the area to head up Bluegrass Memorial Hospital’s new Spinal Action Team, a title that exuded more positivity than Dr. Miller ever had about anything in his life. While very proud of being “the Barbeque Capital of the World,” the people of Owensboro always worried that the rest of Kentucky thought of their beloved town as just a smaller, shittier Louisville. Both sat on the Ohio River, but Owensboro was downstream, which created the distinct feeling of being constantly pissed on by the larger city. Louisville was fast becoming a major force in the health-care industry, and Owensboro was not going to stand idly by while its smug, more successful cousin cornered the market on health care and tobacco. A call to action was declared by the Department of Economic Development, charging the city’s four hospitals with the goal of making Owensboro synonymous with back pain. Money soon started flowing like piss down a river.

  THE BACKBONE OF AMERICA bumper stickers started appearing on ambulances and Cadillacs. Hospitals raced to see which could expand faster, one even convinced the city to declare eminent domain on an adjoining neighborhood that overlapped with its planned multimillion-dollar spinal rehab facility. Lawsuits followed, but “progress” won the war, and four blocks of residents could only stand by and watch as the homes they’d lived in their entire lives were bulldozed to make room for someone else’s dream. Six months into the crusade, Baptist Hospitals of Louisville bought Bluegrass Memorial and established the Bluegrass Baptist Spinal Center, “a revolutionary spinal treatment facility that will work hand in hand with our world-class spinal center in Louisville to provide quality care to patients throughout the Commonwealth of Kentucky.” The battle was over. Owensboro got its spine center, and those four blocks of razed homes gave the town something else to brag about: the largest parking lot in the state.

  Ray liked Owensboro well enough. It was a nice place to raise a family: safe, good schools. It had the feel of a city—there were four colleges, three Starbucks, and five McDonald’s—but it was really just a town. You could be anonymous if you wanted, or you could be popular if you tried. Like everything else in life, it was kind of like high school.

  The desperate moans of the boat race victims provided a haunting sound track to the brusque demands of the doctors.

  “BP 80 palp! Let’s get two of O neg, and move her to Trauma 3!”

  In their expensive words, Ray could hear the interest accruing on their student loans, and he allowed himself a fleeting moment of gratitude for his failure in Detroit.

  Commencing CPR on a thirty-year-old Asian man who probably wasn’t going to make it, Ray realized he’d tied his scrubs too tight, cutting off circulation to his rapidly growing erection. He also realized that the head of his penis was visible over the top of his scrubs. Unfortunately, another nurse noticed first.

  “Oh, my God, Ray! I can’t believe I just saw that! Why is it purple?”

  “It’s fine, Christie.” Ray deadpanned, embarrassed. “If I try really hard I can make it any color I want.” He tucked his penis back into his pants without missing a single compression.

  Christie was Ray’s only real work friend, and like most of his other friends, he didn’t like her very much. An insufferable do-gooder who spent every weekend volunteering at the county animal shelter, Christie was the kind of person who made you feel terrible about yourself for not doing more to help save the world but was so immensely off-putting about it that you wanted to hasten the end of the world just so she would shut up. The thought of an animal being put down for any reason was too much for Christie’s fragile critter-loving heart to bear, so every weekend she would “rescue” some two-legged dog or cat with AIDS, then spend the next week trying to convince someone at the hospital to adopt it. The fresh claw marks across her face, arms, and neck made this increasingly difficult to pull off.

  “I thought your shift was over.”

  “It was. It is,” Ray answered.

  “So why are you still here?” Christie asked, as if talking to a stupid person.

  “I got paged.”

  “Ah. You working hospice tonight?”

  “Soon as I’m done with him.”


  Ray looked down and noticed that with every compression, the erection now tenting the front of his scrubs was rubbing across his patient’s unconscious face.

  “Jesus,” Ray screamed, and turned around.

  Christie looked at the patient, mistaking Ray’s shame for grief. “Is he dead?”

  Ray turned back around. “Yep.”

  Sighing, he peeled off his latex gloves, loosened the strings on his waistband, and adjusted his throbbing penis.

  Christie gave a good-natured chuckle. “The Angel of Death strikes again. How many is that now?”

  Ray just shrugged. “I don’t know,” he said. But he knew. Since those first seven in Detroit, Ray had kept a running total of how many people he’d been physically touching when they died. This was number three hundred sixty-five. I’ve killed a whole year of people, he thought. Ray stood silently for a moment, reflecting on his newest milestone.

  “He your first Asian?”

  “Hm? No. I don’t know. What’s Filipino?”

  Christie shrugged and looked at the clock on the wall. “Time of death six oh nine P.M.”

  “Shit,” Ray said, “I gotta get to work.”

  “Try not to kill this one, will you?” Christie laughed.

  “It’s hospice,” Ray said, forcing a smile. “Those ones are supposed to die.” But it’s still early, he thought. Maybe I’ll get a leap year before sundown.

  Heading toward the parking lot, Ray passed the nurses’ station and spied two unattended pills in a tiny paper cup waiting to be delivered. A rack on the nearby wall was filled with informational pamphlets left by various pharma reps: “Stop Suffering from Depression,” “How to Cope with Stress,” “Why Be Anxious About Your Anxiety?” They looked trustworthy, like they’d been lifted from the pages of the New England Journal of Medicine or The Lancet. Informative, in that everyone who read them could easily diagnose themselves as having that particular disorder; and comforting, in that they could recommend an effective new medication that could help! None of them suggested exercise, or a change in diet, or turning off the TV. Just drugs. Ray shook his head and threw back the tiny paper cup like a shot of tequila. In an hour he would be feeling … something. It was something to look forward to. Just then his eyes landed on a pamphlet he’d never seen before. Three smiling, ethnically diverse women sat in a gazebo surrounded by wildflowers: “The Breast Self-Exam Guide.” Ray stared at it and tried to imagine the breasts of the women in the picture. They were just models, probably never even had cancer, so thinking about their breasts didn’t seem inappropriate. Ray looked at his watch: six fourteen. He was going to be late. Adjusting his still erect penis, nurse Ray Miller snatched a copy of “The Breast Self-Exam Guide” from the rack and quietly slipped out the back door by the used-needle incinerator.