In these halls the human calculus is ceaselessly differentiated with all the rote, overlearned ease of a child doing her lower times tables. Too many bodies even to be blasé over. An n-space, imploded theater-in-the-round. Charity cases line the passages, capitalism’s crash-test dummies and quantity grist. They drift, tubed down, stranded, pharmaceutically beached, cobbled up in assorted VA-surplus rolling furniture, talking to themselves, beyond all help but the perfunctory patch job. Emergency gone quotidian. In residents’ parlance, SHPOS. Subhuman pieces of shit.
Kraft makes rounds. The first pubescent post-op on the list isn’t in his room. Probably off in the can getting high. Perhaps he should join the boy. But today’s narcotics of choice are way out of his parlance. Two other must-sees from the same room are perched precariously on the windowsill, where they busily force flaming stuffed animals out through the barred windows to certain death six stories below.
The view from that window reveals an all-points, single-story hacienda sprawl as intricate and comprehensive as mold overwhelming a slice of damp bread. Kraft spots, in the switchback of streets that curl like machine parings, other hospitals, his previous rotations in the Byzantine farming-out that landed him here. The journeyman system has its pedagogic advantages. It lets him sample a mix of varying protocols and staffs. Each neighborhood (a euphemism in this unincorporable metastasis of urban planning) has its exemplary disasters of the flesh. Each round is tailored to its geographical destiny: coronary with the haves; pede with the have-nots. Would that the have-nots had had a few fewer.
Every mini-mall, each net of streets beats its own unique socioeconomic pathologic path. For acquiring a rounded, hands-on account of general surgery, there’s no substitute for touring the trenches. Short services are his entrée into semi-autonomous regions just one burb over, those closed camps he could never have hoped to visit otherwise and survive. Join the army, see the world. Old idea of the study abroad, the foreign exchange program, the school field trip. Only this time, the museum is real.
Carver General—Angel City Charity—shows him things that remain obscene rumor everywhere else. Obsolete, vanquished, nineteenth-century ailments. Consumption. Botulism. Infections that the texts consign to nostalgia. Paint poisonings. Bizarre, abdomen-filling parasites. He has cured a boy of deafness by surgically removing a raw chick-pea jammed up his ear. Six months of public work put him in touch with disruptions of body and spirit not even hinted at in the random distribution he has left on the city map outside this window.
If it yielded no other therapeutic insights, the rotation system would still have provided him with this indispensable view from above, a key to the patterns of disease traveling through the city, the wake it traces through the addresses it devastates. Each new hospital adds to his hands-on conviction: something is afoot just off the freeway. Something undreamed of by the stay-at-homes.
But these private educational benefits are not the real reason he is here. Pedagogical payoff is ultimately the cover for an elaborate cost-sharing scheme. Conscript labor is the only sustainable way to staff a freebie hospital on this scale, an institution otherwise manned exclusively by alcoholics, incompetents, and saints. Comes down to power broking, horse trading. Folks up in the Hills will send their boys down only if they can secure in exchange two pros from Hollywood Pres plus a minor-league internal leech to be named later.
The knots of this kickback scam are mere ripples in a network of mutual blackmail that dwarfs even the city itself. The convoluted auction of goods and services depends on a trillion simultaneous back-scratches all coming off at once. Angel’s palaces have been built largely on free riders, illegal taps into Central Power, unmet overdrafts, slumlording, vapor profits, safety paper documents erased with dollops of acid, and timely bankruptcies declared on imaginary underwritings. But for now, and for the next few moments, the whole poker-deck superstructure stands successfully shackled together on gum, safety pins, and signed agreements.
Kraft rustles up the children he must examine, hook by crook. Rounds squared away, it behooves him now only to complete clinic without passing into unconsciousness or its many equivalents. The best way to further this end is to avoid peeking at the afternoon OR schedule until too late for either hysterics or hypotheticals. Clinic is a three-hour, walk-through Decameron carved up into fifteen-minute segments during which he must play talk-show host to the afflicted, humoring illness’s endless invention.
An aggressively built Latin woman hauls in her seven-year-old girl by both fists. She insists that Kraft excise the child’s kidneys right there in the office. He flips rapidly through a pocket bilingual translating dictionary that he keeps by him at all times, as indispensable a tool these days as the stethoscope, although he suspects it of frequently capricious translations. A few confused imperfect verbs later, it becomes clear that the kid is a front: the real problem is a softball-sized lump—the big, sixteen-inch, kapok variety—in the mother’s pelvic region. Kraft hooks her up with the proper department and, over her departing protests, buzzes in the next guest.
Who is, today, a return from two weeks ago—Turkish kid to whose parents Kraft failed to make clear (no dictionary) that the dressing had to be cleaned. Fourteen days of festering fuses the gauze into a scab-plastered mess more serious than the tumor the cut corrected. Kraft rasps at the leaking, Technicolor wound, picking at the putrid bits while trying to leave flesh, a fresco restorer unable to cut the grime without sponging off half the disintegrating plaster.
Throughout, he exchanges varying flavors of Englishes with the family—verbal bourse signals both opaque and disastrous. Clinic consists of Kraft’s finding fifteen-minute ingenious synonym lists for “Excuse me?” Even when language is no barrier, the visitors often have a hard time explaining just what they’ve gotten themselves into. Exactly why did you leave a rubber band tightly constricted around your little toe for three weeks? Just how did this burned kitchen match come to lodge itself so deeply up your nasal passage?
For grotesqueries, Kraft may be perpetually one-upped by Plummer, with his Tales from the Emergency Zone. There simply is no matching live rats in plastic bags inserted up rectums, or even the relatively more mainstream erotic strangulations that get out of hand. Thomas tells with great relish accounts such as that of the woman who was shipped in covered with blood, her throat transversely knifed open. Starting big-bore IVs to stabilize her, they cut her clothes off to discover male genitalia, which doubtless explained the knife wound. No, there is no topping ER for sheer dramatic thrust.
Still, on two scores, Kiddie Karpentry exerts theatrical superiority. First, it is fabulously small, a technological feat of miniaturization. Simply straightening out the gross anatomy of a two-foot-long infant almost requires loupes. And second, Pediatrics—the next generation, wave of the future, America’s hope for, etc.—provides the quintessential, unexpurgated view of just where Western Civ’s whole project is really headed in its third thousand years.
By clinic’s third hour, the traffic of juvenile misery drifting through his office begins to mirror the freeway’s aimless lane change. It’s as if Kraft’s still on his commute here, a ball of fluid sucked along by capillaries’ secret adhesions. Clinical existence carries no forward motion at all, only small perturbations, place-swaps, disturbances out on the edge of the crumbling empire. He lives in an afternoon when the old meliorist fantasy gives way to bare maintenance, if that. By clinic’s end, Kraft has entered a long, intercalary dark age that lasts until he finds himself swabbing both arms with brown, lathery disinfectant in preparation for surgery.
The factory load is light today, the team relaxed. Somebody’s hooked up the optics monitor to receive cable, and everybody stands around watching an infomagazine about how certain notorious primetime bouffant bitches are really lovely, caring people who like to lend their megafame at low rates to assist the Third World. The current duffer intern—perfect man to send out to fetch the figurative falafel—switches between this and a big-bud
get docudrama about the colossal fireball death of America’s space voyagers. Nothing is real until it’s been fictionalized.
Opening a three-year-old’s chest puts a damper on the party. Something Geppetto-like to manipulating this puppet—paste, papier-mâché, hanging strapped by its face to the anesthesia mask like a fish on a barb. Its purple-coral organelles pump in unconscious coordination, racing all together now for some impossible finish line they can never reach, as if the whole, heaving mechanism needs to get someplace particular by daylight.
Poking inside the cavity, Kraft’s fingers move about the place with pride of ownership: All my beautiful anatomical overlays—who dared fuck this perfection up? Even when he recalls that he did not design these inextricable meshes, Kraft’s hands go on insisting that only those who have looked on the internal works, who patiently isolate the pulsing parts, who even go so far as to reroute or replace them, only this select club of God’s on-site warranty service can begin to see through the cast of fantasy figures inhabiting the upper reaches of human consciousness where everyone else lives out his life.
It’s all true, what the general public dares not suspect: no one can live with full anatomical knowledge. The heat and pressure of apocalyptic repair jobs transacted in wholesale volume every day of existence inevitably autoclave the heart. After a few hours of call, he does begin to see these needy, shivering bodies strapped to the monitors as so many deli cuts. These days, the freeze sets in as early as the instant he arrives in the theater.
The act of cutting never closes. It lingers on afterward, at the movies, alone over a burger. He replays the tapes of the last session, even in the thick of the next. He sees scars everywhere—perfect physiques betrayed by tiny lateral fissures. Shame-braceleted wrists, throats inscribed with suture-pearl necklaces. In bed some weeks before with an auburn beauty manifold enough to have become The One, he placed his petting hand on what had been soft breast once but now harbored implant. His finger felt the welt of the well-closed insertion slit, and he went instantly as impotent as the best lyric poets. No explanations possible; all he could do was ask her to take her perfect silhouette hence.
Three-year-old ribs retract in front of him, supple and suggestive in their cartilage, the cleavages of subcutaneous wrapping revealing, like tea leaves, the fact that the surgeon must eventually grow inured, restore the veil, return in time to those pretenses that allow casual engagement, human exchange. Every attending, however seasoned and congealed, struggles to forget what was thrust on him during the shock of internship: pus is the spirit’s maiden name. Mucus, before anything.
It shocked Kraft, half a dozen years ago, during his first foray into an operating room on the conscious side of the knife, to discover how prosaic cutting’s accoutrements were. You mean we just open them up, right here, in the billowing air? A scalpel was the same thing he kept in his kitchen rack, no value added. The cauterizer, just a soldering iron with no purpose except, well, to burn flesh. The wisps of smoke that the searing stick gives off smell—what else could they smell like?—like a wonderful steak on the backyard grill of a summer’s night. That first time, he had actually salivated before making the induction.
He cycles through his selection of instruments, calling for them by gauges of thickness and weight and curvature, the choice of each a mix of skilled estimate and judgment call. The same basic tools employed since the Babylonians, when the punishment for malpractice was to remove the surgeon’s hands. The devices available to Kraft on the sampler tray have gone unchanged for a hundred years: knives, scissors, needles, thread, forceps, retractors, the all-important hemostat. Nor has their use, despite the explosion of tech, graduated beyond the original Vedic paradox: inducing an injury to address an injury. And managing the damage of the injury induced.
What has changed, and changed only recently, is the scalpel’s leverage. Incursion is nothing now; they invade and stamp about the forbidden grounds, almost at will. The only limits hemming the surgeon in are that abiding trio: shock, self-infection, pain. And of these three, the greatest is pain.
The profession’s dream—free manipulation of the interior—was blocked until recently by the need to convince the body that inflicted destruction is better than the alternative. General anesthesia marked hope’s first great breakthrough. More. Kraft would promote the discovery to Cornerstone of that imagined city civilization has been building from the start. The ability to baffle life’s built-in jettison mechanism divides all history into Before and After: the era of all-annihilating agony and the age of deliverance by constitutional coup. On his best days, Kraft even gets a little glimpse of tenable existence off in the distance.
To crack the cap of negating pain, to rip a hacksaw downward through an expanse of flesh, to mash bone and burrow into marrow without tripping off a single shutdown signal—the chance dismantles the world and resurrects it, redecorates its interior. Life has sat imprisoned by the guard dogs posted to watch the house. Hard to overestimate just how much this advance rewrites the whole human shooting match, reassembles it elsewhere. Philosophy’s frilly solfeggios now have half a fighting shot at dictating the terms of a new truce. Agony need no longer always have the last word. One might do more than abide.
Kraft tries to imagine this procedure, the one underneath his hands, coming off without anesthesia. Something pupates inside this baby. They must smash their way in, violating the miniature traceries of rib cage. A few feeble attempts to explain things to the infant, a pint of whiskey forced through a funnel to deaden the surface tingling. Then the blade, so sharp that even gristle melts at its wedge. Two adults to pin the flailing creature to the table, and a prayer that the child passes out relatively quickly. A shrieking worse than any that ever wafted over the death camps, because it screams, You were my protectors; I trusted you. Square off the incision and fold back the flaps. Take a fine-toothed jeweler’s rasp to the sternum, pull the whole structure carefully apart like a Cornish game hen. By now, the infant brain so floods with torture’s telegraph that it begins convulsing. He has read the stats: without dope, seven times out of ten, shock collapses the organism and pulls life in around it.
Then there is the time-honored alternative. Spread the pain out over a couple years, leaving disease free to multiply through the child where it frequently peaks in equally unbearable anguish, this time for weeks. Kill the kid quickly on the outside chance, or condemn it to certain, creeping death, coaching it through on promises of a future, pain-stripped place. There the prospect has stood, since nerve came conscious, until yesterday. That humankind, living through that scene even once, has carried on planning and projecting is almost as much a miracle as the discovery of the chemicals that might make the whole self-deluded, transparent, paper-hat tea party endurable.
Just beyond the folds of his left ear the Millstone, Kraft’s attending, breathes epically, like wind sculpting a canyon. The steady oscillation calls Kraft back to the living infant on the table underneath them. Adenoidal in the best of times, the Millstone truly starts to snore when the going gets tiny. Yet better that than Father Kino and his Short Man’s Syndrome. (“A short man, perhaps,” Plummer frequently jokes. “But at day’s end the fellow casts a semilong shadow.”)
Together, the team extracts the mass they were after, clamps it off, and hacks it out at its insidious roots. In admiring tones as the gourd is lifted out and laid in a waiting pan, the Millstone marvels, “Hang that up on the top of your Christmas tree.”
Kraft briefly considers trying to get someone to close for him, but elects against putting his limited seniority to the test. After all, as his mother used to tell him when he went fishing with a low trump, one must never send a boy to do a man’s job. He’s carried the ball this far. Might as well finish, although it must be obvious to everyone on the team that he’s about to go narcoleptic.
He sews like the zigzag accessory on a Singer. His sheep shanks run as erratically as a tricky halfback, say Sayers or Sweetness. This girl will grow up with Welli
ngton’s Victory stenciled across her belly—a thin red line dominating her front. However sultry and beautiful, however high her features, there will be this mark, and her every lover to a boy-man will wonder: What happened to you?
Some minutes pass, maybe even half an hour, before he realizes they are done. Quick, now: what day is it? What month, for that matter? He knows only that the time has not yet come when he is working for himself.
Outside in the parking lot, it is sunset or sunrise. Low light, in any case. Kino’s favorite—day’s end. The hour of Short Men the world over.
Could go home a while, but what’s the point? At this hour, the freeway’s still an open sewer. It will stay a running sore from now until the moment when the red trains are returned of necessity from their mothball bower.
Besides, he’d just have to swing around and come back in another few hours. Here, the meals are already made. A motel room at the Knife and Gun, already reserved in Kraft’s name. And when was the last time he could do anything else but slink back to the ward and try to become a better hacker than he has been today, one for whom technique, intuition, and hands-on knowledge might, in some sustainable future, begin to grow almost equal to the body gone wrong, the infinite, anonymous petitions laid at his door?
A girl too small for her twelve years, still pitching from months on the sheet of corrugated tin that took her six hundred miles across the South China Sea, stands in front of history class in the eastern ravages of Angel City and guesses where the lost Roanoke colony has disappeared to. A year and a half of English administered by evangelical Philippines relief camp aides and a battery of weeks stateside qualifies her for the Oral Report, that time-honored ritual of passage. She chooses, for some reason, American history.
Operation Wandering Soul Page 3
