“Gainers! You gotta get back to the camp!”
Gainers began to walk back through the cars stopped at the light on President and Baltimore to the median, where Larry stood hunched over with his hands on his thighs to help him catch his breath. The light turned green just as Gainers reached the left-hand lane; the car at the front of the line beeped at him.
“Hey, man! Just tryin’ to get to safety here!” he shouted at the driver, who flashed a middle finger at him before accelerating away. He stepped up to the curb and put his hand to Larry’s shoulder. “What’s happenin’, man?”
“The camp. They’re clearin’ it. They ain’t bluffin’.”
Gainers dumped the change from his styrofoam cup into the inner pocket of his jacket and began to run up the median. Larry, audibly wheezing, followed close behind.
“Gotta stop smoking,” he gasped.
“I’ll sell you some patches,” replied Gainers.
“No thanks. I think my heart’ll explode if I smoke with one of them on.”
“That’d be a way to make sure you quit.”
They jaywalked across President just before the ramp to I-83, rushing over to the Fallsway sidewalk. Both Larry and Gainers were quickly out of breath and slowed their pace to a walk as they made their way to the camp under the highway. He heard a clink as they passed the Holiday Inn.
“Gainers, you’re losing change!” exclaimed Larry.
Gainers looked down. A dime shone on the sidewalk in between glittering pieces of a Stolichnaya bottle someone had dropped the night before.
“Shit! You’re right.”
Gainers reached into his jacket pocket, running his fingers along the inside. He felt another coin bounce off his knee, then found the hole at the bottom of the pocket. He gathered the rest of the change in his fist and shoved it into his jeans.
“Gonna have to find someone to fix it,” he said.
Larry held up a handful of coins. “Here you go. These are the others. We can go back across the street later– they’re cleaning up real fast.”
“It ain’t right, it ain’t right,” said Gainers.
“I know, man. I’m writin’ a poem in my head right now.”
As they reached Healthcare for the Homeless a few blocks up, they could see the garbage trucks backing into the camp. A handful of protesters were standing on the sidewalk just under I-83, waving signs that Gainers could not read while shouting some kind of slogan that he couldn’t make out over the din of the trash compactors on the trucks. The protest did not seem to deter the city workers, who were meticulously gathering unclaimed belongings in trash bags before tossing them in trucks.
“You gotta be kidding me.”
Gainers clutched his head in his hands. “I been safe there for weeks now, gettin’ a good night’s rest without anyone messin’ with my stuff…”
They crossed the street again just before they reached the strip club, working their way over to where Larry’s tent sat. The plastic shelf that he kept outside was gone and someone was disassembling the tent.
“Whoa, whoa, whoa! That’s my stuff! Don’t you dare!” yelled Larry, nearly throwing himself over the jersey wall between the sidewalk and the parking lot where camp had been set up.
The sanitation worker dropped the tent pole he was holding and backed away. Larry still nearly bowled him over as he ran over to look inside his tent, where the blankets that he and Gainers used were still inside.
“Hey, where’s the shelf that was here?” asked Gainers as he came around the jersey wall.
The worked pointed over at the garbage truck parked along Centre.
“Oh no, oh no, no, no, no,” mumbled Gainers. The compactor had already started to work, crushing its load full of abandoned mattresses and dilapidated furniture.
“This is a fuckin’ travesty!” screamed Larry. “Fuck you all!”
He began to walk towards a group of sanitation workers who were clearing out another corner, but a police officer stepped in his path.
“Calm down, son. Gather your possessions and leave.”
“Get outta my face, pig!” Larry turned and stormed towards Gainers. “Help me out, man, we gotta take the tent down and get outta here.”
“B-b-but my medicine! It was on your shelf!”
“It’s gone now, Gainers.”
“I forgot to take it this morning, too. Shit!”
Gainers looked at his feet, then up at the camp. There was a small bulldozer working its way across an area of the camp that had long since been abandoned after it had picked through, now serving as the communal trash dump.
“You know there’s a bus takin’ people to a motel,” said Larry. “We get three days free, apparently. I’m thinkin’ I might get on.”
“Three days don’t mean shit,” said Gainers. “Plus, y’know… I still don’t want no one runnin’ my name through no database.”
“Those boys you stabbed didn’t know your name, Gainers.”
“Don’t matter. I dropped my pill bottle at the scene.”
“You need to get your dose adjusted, man. That’s just your paranoia runnin’ at the mouth. Or try this Abilify shit. My doctor put me on it–”
“I heard about yo’ Abilify. You even made me try it once, remember?”
“Shit, man. I don’t remember a lot of things. Blame the Valium.”
Gainers shook his head and laughed. A school bus full of their fellow residents shifted gears as it accelerated towards the ramp onto I-83, disappearing into the distance as Gainers watched.
“Missed your chance.”
“There’s more leavin’ sometime.”
“Where they goin’?”
Larry shrugged his shoulders. “Somewhere warmer than here, I hear. Maybe Florida. I hear they do that sometimes, try to drop people off in a different state…”
“I gotta get down to H-C-H and see about a refill.”
“Alright, I’ll catch up with sometime. And I’m sorry I forgot to grab your pills before these motherfuckers threw ‘em away.”
“S’okay. I’ll figure it out.”
Hannah looked down at her notepad once more before approaching the attending surgeon. She had already discussed the case with her resident, but she still walked more slowly than usual as she approached the nurses’ station.
She took one more glance around the room before addressing Dr. Duncan, a tall and stocky woman who was currently shoveling Chinese food rapidly into her mouth with a plastic fork. Eight trauma bays were arranged in a semicircle around the nurses’ station, each divided by a thick curtain and fully stocked along the wall with oxygen and the usual bevy of medical supplies, plus kits for various invasive procedures that would otherwise be back in a storage closet. Here at Shock Trauma, there was not always time to go to a closet for such supplies.
Dr. Duncan caught Hannah’s eye and spoke right away. “You have a question?”
“Um, yes,” said Hannah with a vigorous nod. “Yes, uh, there’s a patient in 2 that I wanted to tell you about…”
“Well, then, tell me about him. Where’s your resident?” Dr. Duncan flipped her grayish-white hair back and narrowing her eyes slightly, creating new wrinkles in her face as she did.
“I, uh, Sarah’s around here somewhere, she just said she was going to go to the bathroom…”
“Dr. Janvier shouldn’t throw students on their first call to the wolves like that.”
Hannah’s eyes turned to her shoes, then came back up. “I…”
“Sorry. Tell me what’s going on.”
“The patient is a 47-year-old man with a past medical history of hypertension here because he fell off a ladder.”
Dr. Duncan nodded and took another bite of food.
“He fell onto his right side and has pain along his side, but denies any neuro deficits…”
“He denies any neuro deficits? Did you ask him if he had neuro deficits? If you ask a patient if he has neuro deficits, he’s probably going to say ‘no’ because he has no idea what the hell you’re saying, just like me.”
“I’m sorry,” Hannah mumbled, pulling the paper that she’d used to take notes on the history.
“You don’t need to apologize to me. Just keep telling me what happened.”
“Well, the patient denied any numbness or tingling in his hand or arm, and he was cervically cleared, so we were just planning to scan his head and neck and x-ray his arm-”
WEE-OH WEE-OH WEE-OH
Hannah’s words were cut off by the harsh two-tone signal indicating that an EMT was radioing in to Shock Trauma. Dr. Duncan reached back and grabbed the phone with one hand, displacing her plastic fork with the sudden motion. She caught the fork with her other hand before it hit the floor.
“Dr. Duncan, Shock Trauma.”
“Yeah, this is Unit 57, we’ve got a gunshot to the chest, patient has a pulse but not breathing and unconscious. We field intubated and are coming your way, ETA eight minutes.”
Dr. Duncan blinked. “I copy, Unit 57. See you in eight.”
She hung up the phone. The click of the receiver echoed briefly through the trauma bays before the frantic movements of the doctors, nurses, and techs in pink scrubs engulfed the area.
Hannah edged up next to the nurses’ station to watch. With everyone dressed in the same color scrubs– the pink color chosen, she’d been told, for its calming effect on terrified trauma patients– the nurses, residents, techs, and students were distinguishable only by how confidently they moved from one place to the other. Dr. Duncan was calmly standing in the middle of the crowd, giving specific instructions to each person who walked by. All but two of the trauma bays were already occupied with patients– most of them, like the one Hannah had been presenting, were simply waiting on a CT scan and some prescriptions to go home with.
Hannah felt a tap on her shoulder. “What’d she say?”
Hannah turned back to see Sarah, her senior resident. She pushed her short brown hair out of her tired-looking eyes.
“She…” Hannah started, looked back to make sure Dr. Duncan was out of earshot, and then faced Sarah again. “She said that you shouldn’t have left me alone to present to her.”
Sarah rolled her eyes. “What a bitch. Does she agree with our plan or not?”
“Well, she kinda got interrupted by the phone–”
“What’s going on?”
“Gunshot wound coming in. Intubated in the field.”
“Oh shit. Well, this is your first big one, right? Find a place to stand that’s not in the way and watch carefully. Pay attention and next time I’ll let you get in there to do the FAST or something.”
“Okay!” said Hannah with a vigorous nod. A group of people had gathered at a trauma bay adjacent to the one where the staff were preparing to receive their new patient; they were already standing still and watching so Hannah decided to join them. In addition to the students and residents from University of Maryland, there were residents from other surgery programs and even some military personnel that rotated through the Shock Trauma center at various intervals. Dr. Duncan called each person in the trauma bay by name, double-checking each person’s role.
“They’re at the front door!” someone shouted.
Dr. Duncan, standing just outside the bay, turned to face the doors on the other side of the nurses’ station. Everyone inside the trauma bay had put a blue gown on over their scrubs and some were still getting surgical masks with clear plastic shields on. Sarah was against one wall, holding an ultrasound probe connected to a portable machine to quickly look for internal bleeding. Tom the resident had what looked like a chest tube kit in his hands; his fingers kept running over the corner flap as he prepared to open it. An anesthesiologist was holding some airway equipment and several other nurses and physicians stood at the ready on either side with intravenous line equipment or a blood pressure cuff.
The doors to the room opened with a click. Hannah felt her chest tighten just a little as she saw several EMTs pull a stretcher in with only the patient’s legs visible. One paramedic was pushing down rapidly on his chest, while another kept squeezing a big purple balloon attached to the tube down his throat. Blood was streaked down the patient’s jeans and as he got closer she could see that his shirt was not just spattered but soaked through.
As they handed off the stretcher to a nurse standing near the edge of the trauma bay and turned it so that he went in headfirst, Hannah caught a glimpse of his face. He had African-American features but very light-skinned, so a fine pattern of blood spots stood out on his cheeks. The endotracheal tube dangled out of his mouth, hastily affixed to his face by white tape. His eyes were closed but his head bobbed as the chest compressions continued.
“When was the last pulse check?” asked Dr. Duncan.
One of the EMTs looked at his watch. “95 seconds ago.”
The swarm of pink scrubs surrounded the stretcher as the patient was moved to the Shock Trauma bed.
“When did you lose the pulse?”
“About five minutes ago.”
A pair of hands picked up the chest compressions right where they had left off.
“So you’ve given one epi and one shock?”
“Yes, at 100 joules.”
A stethoscope shot out from the head of the bed as the anesthesiologist tried to find a place inside the chest where air was being exchanged. After a few seconds of stillness, he quickly detached the purple balloon that another hand was squeezing to pump air into the patient’s lungs and attached the endotracheal tube into another tube snaking into the back of the bay.
“Pulse check!” called Dr. Duncan.
The chest compressions stopped. Everyone looked to a nurse who had the patient’s right wrist in her hand. Her eyes were closed and her face scrunched in concentration, as if she we were trying to will blood to flow through the limp artery that her index and middle fingers were pushing against.
“Okay, let’s shock at 150 joules.”
Scissors appeared from someone’s pocket and began cutting off the young man’s clothes, exposing a red-and-black hole just to the left of his sternum. A piece of broken rib was flailing with each chest compression. Sarah was intently studying the screen of her ultrasound machine, but Hannah couldn’t see where her hand was.
A voice called from somewhere. “Charged!”
The motion all stopped again as the blue-gloved hands all over the young man’s body all shot up. Hannah could now appreciate that dirty, blood-stained pads were stuck to the front and side of his chest, just above the gunshot wound. The cords attached to these pads were now plugged into the crash cart to his left inside the trauma bay, ready to carry a shock to try to restart his heart.
“All clear?” It must have been one of the nurses.
“Clear!” came the unanimous shout from the team.
The patient’s body gave a slight tremor before the blue nitrile gloves got back to work again. More chest compressions, more images on the ultrasound, more clothes coming off. Dr. Duncan moved from one side of the trauma bay to the other, her eyes darting from the wound to Sarah’s monitor showing the ultrasound images and back. Hannah could now see that Sarah’s hand had come to rest just to the right of the wound, pointing her probe towards the patient’s still heart. While it did not appear to be moving on its own, the whole image kept moving as the patient’s chest was forcefully squashed every second.
“C’mon,” said Dr. Duncan.
“Should I put in a chest tube?” asked Tom.
Dr. Duncan snorted. “If you’d like the practice, I suppose.”
Tom tore open the chest tube as if he had just been given a Christmas present. He had already begun to frantically rinse the back part of the patient’s ribs with iodine solution in preparation for this opportunity. Hannah could not help but smile at his eagerness, although the thought was immediately chilled by wondering how much that kit cost. By the time Tom got the chest tube in, the patient would likely already be dead.
“All this money,” Hannah said out loud to no one in particular. She couldn’t help but marvel at the frantic action, each pair of blue gloves doing exactly what it needed to do to resuscitate this patient or prepare for when his heartbeat came back. The forces that had directed the bullet into his thorax were untouchable or unknowable, but here in the Shock Trauma Center there was power.
Dr. Duncan’s hand reached out and swatted Tom’s away. “Wait.”
Her eyes were fixed on the ultrasound monitor. There was a new rhythm besides the squashing of chest compressions. In between pushes, the heart was beating on its own.
“He’s got a heartbeat.” Hannah saw a smile cross Dr. Duncan’s face for the first time, then averted her eyes when the trauma surgeon looked in her direction.
“ Let’s go to the OR!” Dr. Duncan pointed one thin, long finger in Hannah’s direction.
Hannah looked either way, then behind her. The wooden doors to the operating room stood closed. She rushed over the door and hit the metal button that triggered the automatic opening sequence; the team pushed the bed over with the anesthesia machine in tow just as the doors clicked all the way open.
“You wanna scrub in?” asked Sarah, tugging on Hannah’s scrubs as she came by.
Hannah looked down at Sarah’s fingers, which had left a streak of blood on her shirt.
Gainers walked towards the door of the Mount Vernon pharmacy clutching his pill bottle. Before he opened the door, he poured half of his pills into a small plastic baggie and zipped it tightly, then tucked the baggie into the back pocket of his jeans and put the bottle next to the change in his jacket.
A harsh wind immediately met him as he walked out, blowing north up Fallsway in the direction of the now-vacant camp. The last news crew, parked along the west side of the street, was packing up their equipment into a white van. All of the city’s trucks and workers were long gone, having made remarkably short work of tearing the camp down.
“Whatcha got, brother?” came a voice.
Gainers nodded hello to a guy he’d seen around the camp a few times, a tall and skinny white man whose windburned face was protected only a thick blonde beard. “Nothin’ much, just my Haldol.”
“Aw, man, you know that shit shuts down your ability to receive messages from God. They tried it on me and the angels stopped all their communications.”
“Yeah, man, I’m good with that.”
He’d waited since the morning to see a doctor, who had managed to squeeze him in at the very end of the afternoon session to dash off a prescription for Haldol. Apparently, Gainers was not the only one who had lost things in the camp clearing– others in line in front of him at the pharmacy were refilling their insulin needles and trying to get new canes. A few had walked out cursing after finding that their insurance would not fill new supplies of pain medications that had just been filled days ago. The doctor, whose thick Eastern European accent Gainers had a hard time deciphering, kept shaking his head throughout their brief interview.
His dry lips stung with another gust of wind. The inside of his mouth felt even drier. The clinic had already closed, so there was no chance he could go back inside and get water to swallow his pills. He was hungry, too– he’d thought many times about leaving the clinic to get something to eat, but he feared losing his chance at an appointment and a prescription if he’d disappeared when he was called. There was still some change in his cup from his morning panhandling session, but not quite enough for dinner.
He decided to walk downtown to ask around for whatever was necessary to get himself a bottle of water and a sandwich. There was a group from some church in the suburbs that often brought food and water on Friday nights down in the Harbor, though they had been scarcer in the cold and Gainers was still terrified of approaching them after being yelled at for approaching a woman who wasn’t in the group and asking her for food.
The dark gray sky of the afternoon was quickly giving way to the blue-black evening horizon over the harbor. Several of his knuckles felt a twinge of pain as the wind blew through a large hole in his grayish-black gloves, prompting him to put his hand inside of his coat. The same gust hit his eyes, which he closed as he winced. He wondered if there would be anyone out and about worth asking for anything since it was already this cold at this time of day.
He passed through the cars backed up into the crosswalk at President Street and saw his first potential benefactor, a young man who was waiting behind him to cross when the walk signal appeared. His jacket appeared to be some sort of designer brand although Gainers could not make out the logo. When light changed and the cars in the crosswalk did not move, he looked somewhat confused but took several steps out into the street after hesitating and looking both ways.
“Good evening, sir,” said Gainers as the man approached his side of the sidewalk. “My name is Gainers, and I was wonderin’ if you could help me g-g-get something to eat tonight.”
As soon as Gainers began to talk, he saw the look of nervousness change on the man’s face to surprise, then fear, then suspicion. It was a sequence of countenances that Gainers was familiar with, it had several variations but most followed the same basic pattern if it was someone unfamiliar with downtown. Most of those more familiar with the city simply walked faster when he opened his mouth or shook their heads before he could even introduce himself. Once someone responded in conversation, though, he gave himself a 50-50 chance of getting something.
“I, uh, well…” The man attempted to look away from Gainers– another common response. His eyes wandered back to Gainers, who attempted to lean back with his palms open and low, the most nonthreatening stance that he could muster.
“Here, here’s a dollar,” said the man, looking both ways before reaching in his pocket just like he had before he’d crossed the street. He fumbled the bill to Gainers, who gave his biggest smile possible.
“God bless you, sir,’ he said, slipping the dollar into his coat’s inner pocket before he could finish the sentence. “You know where you’re goin’? You look a little lost.”
The man, still clearly under the impression that Gainers might still rob him or give him a communicable disease, nodded while trying to fomr the word “no” on his lips.
“Where you tryin’ to get at?”
“Uh, the, uh, police station.”
“You need somethin’ at the police station?” Gainers’ smile disappeared as he began to look the man over, wondering if his nervousness was from some recent trauma. “You okay?”
“No, just the block next to the police station,” explained the man.
“Ohhhh,” remarked Gainers. “You mean The Block?”
“Is that what they call it?”
Gainers laughed and shook his head. “Lord have mercy, you lookin’ for The Block. It’s just down this street here one more block and then make a right. Few more blocks down. Can’t miss it.”
He pointed southward and then gestured to the west.
“Thanks, man.” He rushed off in the direction that Gainers had pointed him towards, quickly disappearing into the ever-darkening night.
Gainers preferred not to panhandle on The Block, but his hunger and thirst were beginning to make him feel even edgier than he would have normally been without a dose of his medication. Unless there was some kind of event down at the Inner Harbor, it was unlikely there’d be many people outside tonight worth approaching. He let his fresh-faced benefactor disappear from sight before following behind.
As Gainers rounded the corner and walked another block, the orange, red, and pink lights of The Block became more distinct. Even on this cold night, women in stilettos and stockings paced on the sidewalks or stood outside of various establishments to invite passersby inside. With his jacket zipped up and his hat on, Gainers did not look much different from any of the potential customers on the street and heard plenty of invitations shouted or cooed to him, some followed by a discomforted “Oh.” The voices were disorienting and maddening to him, as a handful sounded like the ones that came from inside his head. He decided that he would ignore them all.
There was a group of young men standing in the middle of the corner, awestruck at the spectacle of light. Gainers overheard them muttering to one another about which bar they should enter in hushed tones, as if they had entered a church and were deliberating about which pew to sit in.
“Hey fellas, how y’all doin’ tonight?”
A few of the boys responded with alarmed looks and shifted back. Gainers had approached them quietly and announced his presence after he had gotten as close to them as they were to each other. None of them responded to Gainers’ question, trying to looking away as if he were not in their presence.
“Awful cold out here, and I just need somethin’ to eat if you can spare a dollar.”
Three of the boys looked to the fourth, who turned his eyes to Gainers and shook his head. “Sorry, man.”
Gainers nodded. “Alright, no problem.” He turned and continued up the street, immediately setting his sights ahead on another group ahead. They all appeared to be dressed in leather with metal studs sticking out from various places reflecting the lights on the street. As he got closer, he could see that there were both men and women in the group, though it was difficult to tell from either the haircuts, clothes, or makeup that any of them wore. Gainers rarely had a refusal from a mixed-sex group, so he began to walk faster towards them.
“Hey, how y’all-”
“HEY!” The shout from behind startled Gainers. He looked back to see two police officers approach in full uniform. Gainers froze in place.
“Uh, uh, hello, officers…”
“You need to step off, son. You’re harassing people.” The cop who spoke was short and square-faced, jabbing a finger towards Gainers. His partner was taller and skinnier; he kept his arms crossed throughout the conversation.
“I-I-I didn’t mean to harass nobody, I’m jus’ tryin’ to get a little somethin’ to eat–”
“Look, I understand that but those young men over there complained and we’re gonna have to ask you to leave.”
Gainers peered over the cop’s shoulder to the group of boys he’d just left; they were still deep in conversation with one another but turning every now and then to look at Gainers and the policemen. He looked back to the leather-clad circle, one of whom already had a dollar in her hand but was trying to put it back in her pocket.
“Let me just finish with my friends here…”
“Move on!” bellowed the shorter officer. His arms shot out, pushing Gainers back. He felt his feet slide on a patch of ice, he reached out and found himself holding onto the other cop’s still-folded arms. The officer gripped his wrist and pulled him upward, but did not release him.
“What’s this?” asked his partner, who bent to his knees on the ground. Gainers turned his head to look as best as he could and watched as the officer rose to his full height (which was still shorter than Gainers) with the medications in their plastic baggie.
“They’s my medications.”
Gainers looked around again. The folks in leather were crossing the street. One of the boys had a cell phone out.
“You got a bottle? You got a prescription? Anything?”
“Yeah, right here.” Gainers reached back into his pocket. His fingers found only the hole.
“You got anything?”
A single quarter from earlier remained. Somewhere between the pharmacy and here, it must have slipped out. He lifted up his shirt, feeling all around in his pants pockets just in case the bottle had managed to get caught somewhere. Nothing.
“Naw, man, I like to keep ‘em in the baggie like that.”
“Doesn’t seem very smart to me. This could be anything.”
“Fuck, man, let me be!” Gainers trying to wrest his arm away from the taller officer, who responded by grabbing his other wrist.
“I need you to listen to me and not use language like that, you little shit,” said the officer. “Now get off before we bring you in for disorderly conduct.”
The taller officer loosened his grip, but not before giving Gainers another push. He slid backwards on the ice and pitched himself forward, landing on both palms on the ground. He scrambled on his hands and knees to the curb, then pulled himself up using a car door handle. He stared at the two cops for a few seconds, each one glaring at him with eyes that seemed to get more vicious the longer that he looked. He grit his teeth as he moved his gaze to the baggie of pills disappearing into the officer’s coat.
You little shit.
He heard the officer speak again, but the man’s fat lips did not move.
You little shit.
Gainers pushed away from the car and hurried towards the darker part of the street.
You little shit.
Jessi took a crying baby Olivia into her arms as she sat on her couch and raised the infant above her head. Tanisha began to dig around in her diaper bag, but was distracted by the news report coming from the television– something about corruption at the city jail. Jessi wasn’t quite sure what was happening, as her attention was fully devoted to the baby.
“Now, ain’t you something?” She gave Olivia a kiss, prompting a smile.
“Don’t that just warm your heart? When she smile real big like that?” Tanisha looked up with a pacifier in her hand, then threw it back in the diaper bag as she saw that it was no longer needed.
Olivia’s smile was rather heartwarming, pulling both cheeks up into bunches above her generous jowls. Drool gathered on her lower lip as she stared at her grandmother with bright, round eyes. Jessi gave her another kiss and then hugged her close.
“Dario want to get married, Ma.”
Jessi’s eyes turned from the baby’s smile for a brief moment, but she quickly looked back to her kisses. “Oh, really?”
“Says his fahver been givin’ him a hard time on account of us livin’ in sin.”
“Well, you is livin’ in sin.”
“I’m just makin’ an observation.”
“Don’t tell me you ain’t never done the same.”
Jessi put Olivia into her lap and began to bounce the infant up and down, elicited a few squeaks of joy. “I ain’t sayin’ that I ain’t never done the same. There’s lots of things I’ve done that I ain’t proud of and I hope you never repeat.”
Tanisha continued to scowl at her mother.
“What I meant to say is that I’m happy for you and I’m glad that Oli’s father is gonna be married to her mother.” Jessi extended an arm to Tanisha and embraced her. Olivia’s thick hands each found a breast and grabbed as eagerly as she could, drawing guffaws of laughter from her mother and grandmother.
“Sorry, honey, ain’t no milk comin’ out of this one,” said Jessi as she shook her head. “So you gonna get all dressed up in a pretty dress for your mama and papa’s wedding?”
Olivia kicked her legs eagerly and grunted.
“You heard from Uncle G recently?”
“I haven’t.” Jessi’s voice lowered.
“You think he’s still alive?”
“I think they’d tell us if he died. Knowin’ Gainers and the way this city operates, I’d probably have to go haul his dead ass offa whatever corner he happened to expire on.”
“Speak of the devil!”
Tanisha raised a finger towards the tiny television that Jessi had brought up from the basement. The grainy picture showed the unmistakable image of Gainers, standing as he often did with his hands on his hips, his belly protruding out from his oversize coat. He was shaking his head as a bulldozer was pushing through a large heap of trash.
“What’s goin’ on?” asked Jessi.
“I dunno. They’s clearing out some homeless camp or somethin’,” said Tanisha.
“What a shame.”
“At least we know he’s safe.”
“Was safe. I guess he was livin’ down there. Guess things didn’t work out with that crab shack.”
“You think he’ll come back here?” Tanisha took Olivia back into her arms and began to bounce her.
“I dunno. Things didn’t end so well between us.”
“You still got his knife?”
Jessi gave Tanisha a side-eyed glance. “Are you jokin’? I sold that piece o– that thing as soon as he wasn’t lookin’. And I did it at a pawnshop out in the county just to make sure.”
Olivia silently regurgitated, spewing forth the remnants of her most recent bottle onto Tanisha’s shirt.
“Aw, no, not again….”
Jessi rose and grabbed a rag from the diaper bag. “So, y’all gonna stay in that same apartment after you get hitched?”
“Naw, we lookin’ to maybe buy out in the county. Prices ain’t bad right now from what Dario say.”
“Movin’ on up, huh?”
Tanisha laughed. “Somethin’ like that. It’d be nice to get the kids in a better school system, get a little yard.”
“Gonna be a longer commute to the Rotunda, though. And farther from me.”
“I know, Ma. We just thinkin’ about it. I know you’s always complainin’ about how all the good folk movin’ out of the neighborhood. But you might be able to sell this house and join us if you wanted.”
“I ain’t leavin’,” said Jessi, taking Olivia back into her arms as Tanisha continued to try to wipe the spitup stain from her dark blue sweater. It continued to leave a yellowish-ivory stain streaked across her left arm.
“Just suggestin’, that’s all.”
“No harm in suggestin’, I guess.” Olivia laid her head on Jessi’s shoulder and took her meaty thumb into her mouth. “I don’t mean to be short wit’ you. I jus– there’s still some people worth fightin’ for here. You know my mother and father worked hard to buy this place. They may have gotten ripped off by the men who was usin’ them to scare away the white folks outta this neighborhood, but it was theirs. And there’s others who can’t leave. I don’t even know if I can leave unless my SSI come through, even then– am I gonna give up this place, fallin’ apart as it is, for some rinky-dink Section 8 apartment out in the county? I don’t think so.”
“Guess so.” Tanisha shrugged.
“If we’re just tossin’ around suggestions, maybe you could move back here. You might qualify for one of them Habitat for Humanity houses.”
Tanisha shook her head. “Where we live is ghetto enough, Ma. Dario ain’t lookin’ to raise his daughter in any place rougher than where we at now.”
“Don’t be actin’ like the rats in Pen Lucy ain’t no smaller than in Sandtown or the sh- the trash don’t stink.”
“Ain’t sayin’ that, Ma.”
Jessi looked down at Olivia’s long, full lashes. They were fluttering as she nestled as close to her grandmother as she could get, just before she closed her eyes completely and her thick pink lips stretched open in a yawn.
“She only gettin’ more beautiful.”
Tanisha nodded, stroking a soft, full cheek with one of her red lacquered nails. “You see what I mean.”
“Maybe one day she grows up and fixes all the problems we got here.”
Tanisha laughed. “Maybe.”
Gainers’ hand trembled as he clutched his second prescription of the day in line at the pharmacy. He heard a grinding sound and looked over his shoulder to see the store employees dragging the metal security grate across the front doors. The sound continued in his head even though they stopped halfway across. He had managed to get in the door at the pharmacy at 9:55, after a three-hour wait in the Emergency Room at Mercy hospital and another hour wandering on foot across downtown to find a pharmacy that was still open. He lost count of how many bars that would still be open until 2AM.
The person in line ahead of him finished and he passed the prescription to the woman behind the counter.
“Have you filled a prescription here before?” She quickly began to type the information into her computer.
“I’m sure I have, but can’t remember for sure.”
“Okay, it looks like it’s been a few years. Do you have insurance?”
“Uh… yes! Yes I do.” He nodded quickly, then reached into his pocket for his wallet. The insurance card was still there, at least. He handed it over.
She kept typing. “Um… it looks like you just filled this today.”
Gainers nodded again. “Yes, ma’am, that’s correct.”
“So… your insurance won’t pay for it.”
“I mean, they paid for a one-month supply today. We can’t fill it again unless you want to pay for it again.”
“Shit! Well, how much is it?”
“Well, let’s see… 5mg twice a day, so that’s $30.”
Gainers reached into his pants pocket again, digging out the change he had. It came to $1.47.
“Sorry, sir.” She placed the script down on the counter and began to bring down the metal grate over the pharmacy counter, but Gainers reached out his hand to grab it.
“Please! It was stolen! I need this medication tonight.”
“Do you have a police report?”
Gainers laughed. “Police report? The po-lice was the ones who stole it!”
“I’m sorry, sir, but we can’t…”
“Can I just get it on store credit?”
The grate came down, nearly smashing his fingers before he pulled them away.
“Gimme ten minutes, I’ll go get the money,” he said.
This time, she simply walked away.
“Fuck this shit,” he said, crumpling the prescription in his hand.
He felt a surge of anger his chest, bringing with it a jumble of noises. They were all indistinct, which was usually a sign that he needed to go somewhere and calm down. That was what his old therapist had said, anyway.
He swung out at a display of sunglasses as he stormed out of the store, knocking the merchandise to the ground as he marched.
“Call the police!” someone shouted.
The automatic doors to the pharmacy opened in front of Gainers. He turned around to shout an obscenity that was racing through his mind over and over, but hesitated. He kicked the security grate again, then ran across the parking lot towards Fayette Street.
The bare, leafless trees still provided some shadows to disappear into. He moved as quickly as he could behind several houses, running out of wind just as he reached Hollins Market. The market itself was closed, but a few of the little restaurants and stores around the square still had their lights on. No one was outside.
He paced up the street, his coins still in his hand. He recounted; it was now $1.37 after having lost a dime somewhere where he was running. What could he buy with this much?
He looked up at the neon sign illuminating his count. The yellow light spelled out “PACKAGE GOODS.”
A new voice announced itself through the clutter in his mind. It was lower and darker than Jessi’s, vaguely reminiscent of his father’s harsh bass.
He stepped inside. A skinny Korean man with a salt-and-pepper mustache looked up from his cell phone.
“What can I get for you?”
Gainers dumped his change into the dirty plexiglass lazy susan. “Vodka.”
You little shit.
This time, he thought it might be Jessi saying it. Her voice was earthy, but often took on a higher and nasally tone whenever she was scolding him. There was no way he could go back tonight. Maybe tomorrow.
The clerk returned four cents to him along with a miniature plastic vodka bottle in a black plastic bag. Gainers thanked him and walked out of the store, back into the yellow light.
The deeper voice came back. Kill yourself.
He twisted the cap off.
He felt better as he drank. The familiar burning in his throat soon gave way to a similar feeling in his head, like he was purging whatever bacteria were building up there and clearing them away. He had had a few sips of beer with friends ever since he had gotten his liver treatment, but the taste of hard liquor for the first time in over two years was a different feeling altogether. He felt Jessi’s nattering voice fade into the background as he walked from the reach of one streetlight to another, briefly disappearing into the darkness.
He held the plastic miniature upside-down against his lips again, trying to let gravity drain anything he hadn’t caught the last time he tried this. He was fairly certain that there was no way of getting Haldol tonight, although he supposed that he could try waiting in the ER again for someone to x-ray his back and tell him that he had a broken bone. It usually got him a few Tramadol or Percocet, but now that he’d tasted vodka again, he didn’t feel like waiting for something that didn’t have quite the same effect.
“Shut up! I ain’t gonna!”
Monday morning he would go back to the clinic and get his medication. The alcohol would just be to get through the weekend. He hated scraping together change, standing in line, getting drunk, and waking up huddled up against concrete. This would only be for a day or two. He might even be able to buy some more Haldol from someone if he could figure out where people from the camp relocated to.
“I promised that doctor, not this weekend.”
He tipped the bottle straight up and held his mouth open again.
Solomon picked up his phone and scrolled through his texts. A passive-aggressive inquisition from Rita about whether or not he was still in the OR. A less passive but still quite aggressive inquiry from the statistician about when he would get a report back to her. A picture from Hannah showing the wound she had stitched up on Shock Trauma.
He pulled off his dirty scrubs and tossed them in the hamper. The Men’s locker room was quiet except for the noise of the scrub tech who had finished the case with him, although he’d had the good fortune to have his shift start at 7pm and Solomon had been scrubbed in since noon. It was now almost midnight and Solomon was trying to recall if he had anything to eat at his condo.
“G’night,” said the scrub tech as he passed.
“Night,” said Solomon, picking up his phone again. He considered calling Rita– she was probably still up, after all– but he mostly felt like going to sleep.
He put on the dress pants and shirt that he had walked into work today wearing, slinging his suit coat and tie over his shoulder. His heavy coat was in his office where he had taken it off this morning, meaning that he would have to walk all the way over there before he made it home. He reached into the pocket of his suit coat, only to find the empty wrapper of the granola bar he had eaten before he went into the OR since he had not had time to get lunch before the surgery started.
A few other hospital personnel moved through the hallways in scrubs. Most were still working and moved with more urgency than Solomon. When he reached the 24-hour sandwich shop on the first floor, they tapped their feet and looked at their signout sheets over and over until they got their orders, at which point they rushed away back to the other floors. Solomon reached into his coat pocket to check for his wallet before he got into line.
He turned his head. Clad in pink scrubs with a few streaks of blood on her left shoulder, Hannah hurried towards him with greater speed than anyone else in the atrium. She wore her usual look of nervous excitement.
“Did you get my text?” she asked.
“Of course I did. Was that his back?”
“Yup! They let me do the exit wound.”
Solomon chuckled. “How’s the front of him look?”
“Not as pretty, but looks like he’ll live.”
“Good to hear it. You need to be a little gentler. The wound edges will heal better if you evert them a little.”
Hannah’s face fell, but then she giggled. “Fuck you, too. Late surgery tonight?”
Solomon lost his place in line as a young resident whose white coat had clearly not been washed in over a year moved past him. He turned his head to utter a harsh word, but then moved back to Hannah. “Yup. Initial transplant. Went well.”
“You seem to be having fun on surgery.”
“They’re still making me pick up everyone’s sandwich order.” Hannah waved a list in her hand.
“Who’s your attending? I’ll talk to him.”
“It’s a her. Dr. D– don’t.”
“Dr. Don’t? Is that what they’re calling her?”
“I mean don’t do it. Don’t talk to her. You don’t have to protect me from the scut or whatever. I can handle it.”
“I’m not trying to protect you, I just want you to spend as much time as you can in the
OR, seeing patients, writing notes. Learning how to be a goddamned doctor, not doing scut work like fetching sandwiches.”
“It’s quiet right now anyway, so I think I’ll be okay.”
“You’ll see how I run things on my service next week. I don’t send med students to buy lunch. If there’s scut work, it’s finding bandages and shit like that. Shit that matters to patients.”
“I know you don’t do that. And don’t treat me any different than any other third year when I’m on service with you next week, okay?”
Solomon nodded. “I’ll punish you extra hard just like every other student who wants to go into Surgery. Unless you’ve made up your mind about Family Medicine.”
Hannah shook her head and sighed. “Don’t remind me.”
“I won’t take it personally.”
“Do you take anything personally?”
Solomon chuckled. “I used to think not, but I’ve since changed my mind.”
“Did, uh, Rita have something to do with that?”
“Don’t you have an order to place right now?” he shot back.
Hannah laughed and got into line. “If you insist.”
“No, but seriously. I think you’d make a good family doctor. Raise the average intelligence and surgical skill set of the population.”
Hannah rolled her eyes. “I won’t tell Rita you said that.”
“She’s heard it before.”
“She must like you.”
“She likes challenges.”
They reached the counter. Hannah read off the orders that she’d written down from the residents and other students and Solomon got his usual meatball sub.
“So you’re really okay with it?” she asked.
“With what? Not choosing Surgery as your specialty? Why would I want you to make a decision just to please me?”
“Because you’ve been such an important mentor to me. Because you’ve made me learn to love surgery despite how poisonous surgeons are.”
“I forced you to work hard. If that counts as mentoring, I should be getting awards left and right in this school.”
“Do I detect a hint of humility hidden behind that bluster?”
“My god, does Rita coach you on these things?”
Hannah counted out the crinkled bills she’d been handed to buy everyone’s lunch, then started recounting when they didn’t add up to the total. Solomon handed her a twenty.
“Tell them Dr. Bode expects everyone to pull their own weight.”
“No thanks. I’d like to do something other than scut for the rest of the rotation, and you throwing your weight around will only get me punished.”
Hannah took her bag of sandwiches in hand and began heading back towards Shock Trauma.
“Hannah, you should–”
She stopped and turned back, still moving slowly away.
“You might increase the general level of compassion and emotional skill set of the General Surgery population. Just a thought.”
Hannah gave a brief snort of laughter. “Got it. You’re gonna have to pull your own weight, though. I’m not gonna be an excuse for you to bring down the average.”
Solomon laughed. “I just spent nearly 12 hours in surgery replacing a liver for some poor soul who cooked his with Hepatitis C he got from shooting drugs. I’m doing my part.”
The pink scrubs disappeared behind a corner. Solomon took his sandwich and walked the other way towards the stairs.
Gainers was walking in the opposite direction of traffic on Pratt, crossing up towards the University of Maryland Emergency Room. There was no one out left on the street and the cars that stopped at the lights wouldn’t even roll down their windows when he approached. The red-and-white lights of the hospital gleamed just a block away as he hurried up Greene Street.
A man in a long black wool coat approached. Gainers slowed his pace slightly.
“Hey, can I get a dollar for a…”
The man, who was black, tall, and well-built, kept walking without even looking Gainers in the eye.
“Oh, come on, man!”
He kept walking. Here was the only person he’d seen out on the sidewalk for the past 10 minutes. He had to keep trying, futile as it might end up.
get him get him get him
“Please, sir, I just need a little something.” Gainers ran and touched his elbow.
“Get away!” he shouted in response, swinging back and catching Gainers’ jaw with the back of his hand. Gainers hit the cold sidewalk with his palms and knees, feeling his skin tear on his hands as he skidded backwards. His face did not hurt too badly, but it still smarted. The man stood over him now, casting a shadow over Gainers from the nearest streetlight.
“Jesus fucking Christ, it’s you.”
It’s you! His words reverberated in Gainers’ ears like they were alone in a canyon. Always you, he said to himself or out loud.
“What- what the fuck is you talkin’ about?”
“I tried to help you, Gainers. You’re beyond help.”
Gainers hung his head. He was right. The voices quickly confirmed this, again urging him to kill himself. He reached into his pocket for the knife.
“God knows how much money has been spent on rehabs and programs and then the medicine. If you take the retail cost that Verilife is pushing now, you probably cost $750,000 on that little exercise alone. Gratis. And here you are panhandling for some change to buy another bottle of vodka. Don’t think I can’t smell it on you.”
“B-b-but I tried…”
“Fuck your trying.”
“Fuck you,” Gainers repeated what he heard, immediately feeling a twinge of guilt as the words escaped from his mouth.
“Are you not able to control yourself? Why am I wasting my fucking time here?” The dark figure threw his hands up and began to walk away. Gainers began to rise to his feet.
“Do you remember me?”
Gainers shook his head. The face was still just a silhouette in the darkness of the streetlamp. He thought he saw a demon crawling along the man’s shoulders, circling around his neck like it was a pet. Gainers quickly reasoned to himself that it must be a hallucination, as the demons were clearly stuck to him, tugging on his arm to pull the knife out of his jacket. He held it firm, trying to imagine the faces of Jessi and Tanisha and the kids instead of the darkness.
“I should go home. But I never told you or your sister, and I suppose I should mention it before you get hit by a car or die of hypothermia clutching a goddamned bottle.”
“No!” Gainers said out loud.
“You don’t want to know?”
“I… I… wasn’t talkin’ to you. What is you tryin’ to say?”
“Do you remember when you tried to get me to sell drugs?”
“Twenty-five years ago. At the corner of Woodbrook and Fulton. You were pushing drugs out there, poisoning our community. And you tried to get me to join in. Called me all sorts of names and waved your knife around. I remember it like yesterday.”
Gainers could not remember this incident at all, but he nodded along like he did.
“Well, while you spent five years at Jessup for what you did with that knife, I spent four years in med school.”
“And here you’ve just continued to piss your life away.”
“God, Rita is gonna be furious with me.”
He walked away again, passing to the other side of the streetlamp so that only the backside of his head was visible.
“Gimme your wallet,” demanded Gainers. He needed a drink so badly. It was the only thing that would keep him from pulling out the knife now.
The man spun around, finally revealing his face in the light. It was very clearly Dr. Solomon Bode, with the demon now gone in the harsh white light of the streetlamp. It could be hiding behind his back if it were still there, or perhaps snuggled up inside his coat. Perhaps it had snuck back to Gainers and was making his right hand, sweaty against the plastic handle of the knife, tremble.
“What they hell are you going to do?” asked Dr. Bode. “Are you going to threaten me?”
“I-I’ll kill myself.”
“You’ve already been doing that for years. Make it faster and save us all some money and time.”
“H-help me,” said Gainers quietly.
“Already did.” Dr. Bode swung around yet again.
“I wasn’t talking to you.”
Gainers’ hand stopped trembling as he pulled it free from his jacket.
Hannah looked down at her watch. 1:30AM. Still another five and a half hours until signout, when a fresh team of residents and students would arrive to handle new trauma cases coming in. Her team would round on all the patients they’d admitted since 7AM yesterday and then she would finally get home and get to sleep a little.
“Nothing’s come in for a few minutes, Hannah. Why don’t you go upstairs and check on the gunshot wound?” asked Sarah, who was scribbling notes into a stack of charts like the other two residents sitting at the nurses’ station.
“The young man with the gunshot wound, you mean?” asked Hannah.
Sarah looked up from her chart, staring at Hannah while she breathed in deeply with her nostrils. “Why don’t you go upstairs and check on the young man with the gunshot wound? Perhaps you could inquire into what sort of legitimate business he was up to when the misfortune he currently suffers fell upon him?”
Hannah, feeling chastened by Sarah’s iciness, bit her lip. “I will.”
It seemed like a simple thing to refer to patients as people and not as diseases. Hannah acknowledged to herself as she headed towards the wooden double doors that it was very late, that everyone was tired, that Sarah was an otherwise caring doctor, and that she could have been nicer in making her point to Sarah. Still, it irked her that such shorthand was common. The attendings on her Internal Medicine rotation had inconsistently corrected such slips of the tongue when they came out on rounds, which was where Hannah had first begun to notice how pervasive abstractions applied to patients’ bodies and lives were.
Her hand had just touched the metal plate to trigger the automatic door opener when the phone rang. Dr. Duncan, who was asleep in a chair propped against the wall just below the phone, reached up and answered on the second ring.
“We’ve got a stabbing victim, multiple wounds on abdomen and hands who walked into the hospital,” crackled the voice across the intercom.
“What the hell? Where is he?”
“Gudelsky entrance. There’s a lot of blood.”
Dr. Duncan slammed the phone down. “Okay everyone! Gudelsky, now!”
The previously quiet nurses’ station erupted as the team got to their feet. Hannah, already closer to the door than anyone else, began to run down the hall.
She wondered if it would just be faster to take the outside stairwell and go on the sidewalk in the frigid night to the hospital entrance on Greene Street where the patient had walked in, rather than having to double back through the hallways inside. She didn’t want to get separated from the team, though, and she didn’t know how far inside the patient already was.
She sprinted past a man pushing a trashcan on wheels and the doctor with the coat that hadn’t been washed in months. She turned into the main atrium, where she could hear chatter up ahead and a small crowd gathered just beyond the information desk. She could see people pressed against the glass hallways lining the atrium above her for 9 floors.
“Shock Trauma’s here!” someone shouted.
Hannah looked down at her pink scrubs as she started to catch her breath. She held nothing in her hands and the team was just starting to turn the corner in the long hallway behind her. The crowd in front parted just enough for her to advance, so she strode forward.
The patient lay across the white tile, a trail of his dark red blood leading all the back to the revolving door behind him. He was still trying to crawl forward, despite the pleas of the people around him not to. At least one doctor in scrubs and a white coat was trying to listen to his lungs with a stethoscope. As he raised each hand to move forward, Hannah could see streaks of bright red blood which made blurred handprints on the floor.
He looked up.
“Solomon!” she gasped.
He let his face fall to the floor as the rest of the Shock Trauma team arrived.
Union Memorial Hospital
Patient: Solomon Bode
Procedure: Washout and Debridement, R hand fascia
Attending Surgeon: Dr. Mahmood Abdelrahman
Blood loss: 20cc
This is an operative report for an unfortunate 41-year-old surgeon who was attacked on the street and initially suffered stab wounds to his abdomen and defensive lacerations across both of his palms. He subsequently had a wound infection of the right hand which persisted despite broad-spectrum antibiotics. An abscess pocket had begun to form, necessitating debridement of his current wound.
After the patient was consented and a thoracic block performed by anesthesia at the patient’s request, the right hand was prepped and draped in a fashion allowing the patient to observe as he requested. The initial laceration extended from the hypothenar eminence about three-quarters laterally and distally. There was erythema surrounding the original sutures placed when the patient was initially stitched up. A small abscess pocket just medial to the flexor policis brevis muscle was appreciated as soon as these sutures were removed. Unfortunately, given the level of infection within the hand, the sutures originally placed in the lacerated flexor tendons had to be removed.
The area was thoroughly irrigated with bacitracin-containing solution. The wound was then re-sutured with 3-0 Vicryl and the patient was transferred to the perioperative area. There were no complications.
Mehmood Abdelrahman, MD
Chapter 14 will be released in 2016.
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Trousseau Syndrome by Matthew Loftus is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.