JUICING OUT

A novella by Edison McDaniels

The sound was piercing, high pitched, and shrill, but quick and elusive the way a chirp is at once there and not. Irritating too, the midlife equivalent of that old elementary school trick of dragging one’s fingernails across a chalkboard. That chirp was a curiously instantaneous sound, lasting, I came to think of it as defining, an instant. And that instant came again (chirp), and again (chirp), and again (chirp). I timed it later — not because I wanted to but because I had no choice — and found it to be exactly thirty seconds. Oh sure, sometimes it seemed shorter, like maybe only fifteen or even ten seconds had elapsed since the last chirp, but then I would watch the second hand of my timex jerk forward and when the counting was done the interval would be those same goddamn thirty seconds. No sir, that lousy smoke detector was never off by so much as a tick.

I guess maybe it was my sanity that was off.

But that all came later. Just then, at o’dark thirty on that lousy morning, all I knew was that that little birdie of a smoke detector was driving me nutso. I had been up for the better part of two days and I should have been sleeping. My body needed it and I certainly wanted it. A half hour before I hadn’t even bothered to undress. My butt hit that mattress and I fell back like some sort of boneless waif. I was probably asleep before my head even hit the pillow. But some sounds are designed to be heard no matter what, even through a dead sleep — especially through a dead sleep as it turned out — and that smoke detecting little birdie chirp was chief among them. Once it started up, no power on earth seemed capable of canceling it.

If I’d have had a shotgun I’d have blown that goddamn birdie off the ceiling and out of my life. But I didn’t and so began the trouble.

Six hours before, I had just finished my third crani and seventh operation in thirty-six hours. I crack heads for a living, as in brain surgery, not bouncing. It was already going on eight in the evening and I was looking forward to mashed potatoes and a chicken-fried steak at the Hungry Peddler followed by some quality time with my pillow. My week of call had less than twelve hours left. Better yet, I had a week of vacation to follow, though I hadn’t planned much aside from driving over to Minneapolis to see my daughter and her family. I had left that idea open though, maybe I would show up and maybe I wouldn’t, so they weren’t expecting me at any particular time.

My third crani had been a teenager named Junious Flagg. He should have been in school but was out joy-riding with his buddies instead. He arrived smelling of whiskey and I later heard the cops found two empty bottles of Night Train on the floorboards. I guessed he’d had his head out the window, maybe in his cheap whiskey stupor he’d actually been trying to climb out I imagined, when his buddy spun out on the shoulder of the road and Junious took a stop sign to the face. He’d come in seizing, his lips and fingers hypoxic blue and arms and legs flailing like some version of the horizontal funky chicken. One side of his face was hard to look at, a red pulpy mess. But the far bigger problem for him was the clot I saw pressing his brain inward on the CT. We went to surgery on the spot, without bothering to pass go or collect $200. Two hours later, after removing a fair portion of his skull and sucking out the clot along with several good sized pieces of wood, I gave his brain only a fair chance of ever allowing him to wake up. His face was at least covered with skin again, though if he lived he wasn’t going to be impressed with his new look. I was getting him tucked into the ICU when another call came.

‘Another call’ turned out to be a major trauma alert to the ER. One of those all hands events, choreographed chaos. The patient hit the door, another young man, and was whisked straight to the trauma bay. He wore international orange and was awake and talking, though what he was saying was anybody’s guess. His speech was thick and mostly unintelligible, like he had marbles in his mouth. That wasn’t the most of it though. Wrapped around his head was a thick and bloody bandage of a sort I hadn’t seen in all my twenty years of practicing neurosurgery. It looked for all the world like an adult diaper.

It was. I confirmed this a short time later in the OR. Just then though, I was trying to figure what had happened and what needed doing to save his life. The rapid beep-beep-beep of the heart monitor filled the room. Somebody hollered “100/60" and I saw a nurse pull a pair of shears from her smock and start cutting his clothes off. It was done fast and was followed quickly by an intern sticking a finger where the sun doesn’t shine. “Good tone, no blood,” she said to nobody in particular, then went to work sliding a catheter up the shaft of his manhood.

The patient didn’t particularly appear to like this, but then again he probably didn’t like much of what happened over the next several minutes. A lab tech stuck a needle in his arm and blood dribbled from it onto the floor. An IV was started. His arms and legs flailed and at one point he kicked one of the orderlies holding him down. I stepped in and shined a light in his eyes, which were both reactive, and he squenched them closed in the next instant. He opened them again, seemed to gaze at me with a sort of distant, languid look.

“You got what you need, Sam?” somebody asked me.

“What’d you say happened here?”

“Don’t know for sure. He was out in the woods, deer hunting by the looks of him, and was found on the wrong side of a ridge by his buddies.”

“A deer stand diver?” Every year we saw a dozen or more folks who’d fallen out of a deer stand, maybe because it had rotted in the off season, or they had fallen asleep with boredom, or, and this was the grand winner in terms of numbers, because they had mixed guns and alcohol. One year I had a guy who had dropped his shotgun over the side in his beer stupor. It blew the top of his head to smithereens when he peered over the edge just in time to see it striking the ground.

“Not so far as we know.”

“The diaper?” I asked.

“His buddies carried him out. Drove him to the local ER I hear. I guess they used what they had.”

I thought about asking if they were hunting in diapers, but I let it go. “His head?”

“Nobody knows,” he looked at me, asked again, “You got what you need?”

“Yeah, sure. He’s combative and we need a look under that diaper.”

“We’ll get him over to CT as soon as he’s tubed.”

He was tubed, paralyzed, and in the scanner inside of five minutes. I stood with the other docs looking at the monitor as the machine scanned through that diaper. His head was a small ball in the middle of the wad. As the pictures revealed themselves, there was a collective “holy shit,” followed by several loud whistles. To a person they turned to me.

“Anybody think he looks like a deer?” I asked.

Somebody chuckled. The trauma surgeon, Joe Gap was his name, said, “Somebody must’ve thought he did.”

The scan showed several large bullet fragments in the back of his head. His skull had been fractured by the impact and pieces of bone and lead were laced throughout his occipital lobes. Something large and metallic was stuck near the bony prominence at the back of his head. There was no way it hadn’t lacerated the transverse sinus, the big mofo as far as veins in the head go. I looked through the leaded glass at the man laying in the CT scanner, at that stupid looking wrap on his head. Did he look paler than he had in the ER? I had a pretty good idea there must have been a shitload of blood spilled in those woods. Jesus Mother Mary, I thought, and was suddenly glad I hadn’t opted to unwrap that diaper before scanning him. I was shocked they’d gotten him this far alive. This guy owed his life — or the last hour of it anyway — to whichever of those hunters had a problem holding his bowels so severe he’d opted to wear an adult diaper into the woods. I couldn’t believe he hadn’t bled to death out in those woods. I couldn’t believe he’d arrived here talking. Most of all though, I couldn’t see how he was gonna leave here in anything but a body bag. “Shit,” I said, “tell the OR we’re coming. And tell the blood bank I need a half dozen units of O neg. And tell ‘em be quick about it.” I turned to Joe. “Can you give me a hand?”

He nodded, “but just remember, I ain’t no brain surgeon.”

While they moved my patient down the hall and up the elevator two floors to surgery, I made my way back to the ER. I always try to at least meet the next of kin before operating, especially when the next time I talk with them might be with a priest beside me.

His significant other was in the waiting room I was told, but I found her outside smoking a cigarette. It was cold outside, but you couldn’t smoke in the hospital and there was probably nothing she needed more in that instant than a cigarette. That’s a truism I’ve discovered over the years. I watched her through the glass for a moment. She stood beside a pole (in the spring or summer I thought she’d have been leaning against that pole, but not in the dead of winter; that pole would have burned her bare skin). She held a cell phone in the same hand as the cigarette, but she wasn’t using it just then. I saw she wasn’t wearing a sweater and had her shoulders hunched against the cold. She seemed alone in her misery.

I stepped forward and the doors slid apart. I said “excuse me” and she turned around. She was maybe thirty pounds overweight, the couch potato zone I thought, still a few pounds shy of true obesity with its diabetes, heart disease, and back problems. She had an unflattering ruddy complexion though; not the picture of health. She had the look: she’d been crying and there were rings around her eyes of a sort almost exclusively reserved for those who don’t know if a funeral or a hug is in their future. A wad of kleenex was balled in her off hand. She looked decidedly blue collar in a slightly frayed white maid’s uniform. A name tag pinned over her left breast, above her heart I guessed, said Howard Johnson’s on the top line and Josie in large letters below it. I held my hand out, I like to touch folks (I read somewhere how it makes the interaction more heartfelt for them), and she stuck the kleenex in her pocket after a moment of hesitation and took my hand in hers.

“Is he…” Her voice had a smoker’s phlegmy rattle.

“No,” I said quickly, maybe too quickly I thought afterwards, on the way up to the operating room. “But it doesn’t look good.”

“He gonna make it. Has to, that’s all. Has to.”

Saying it doesn’t make it so I thought but didn’t say. “Why don’t we go inside.”

She took a last drag on the cigarette and stubbed it out under her shoe on the icy sidewalk.

When we were seated in the privacy room, I said, “My name’s Sam. I’m a neurosurgeon.” I paused. Nobody is ever happy to see a neurosurgeon and the realization can come as quite a shock. “He’s hurt real bad.”

“Neurasurgeon. That a brain surgeon, right?” Her eyes loomed large before me, but they never actually looked at me. Like she was afraid to make eye contact. Or maybe she was just overwhelmed. Maybe she was used to taking her cues and getting her words from others. Mostly men I thought. I thought too how those eyes had a hard edge to them. One of them had a tinge of blue beneath it, like an old bruise.

“Yes ma’am. Just now I’ll be taking him into surgery, the back of his head…” I indicated my own head with my hand, “…it’s busted up pretty bad.”

“What you think, Dr. Sam? Does most people what have a busted up head make it? Or does they go to ground?”

I had never heard that term before and there must have been a quizzical look on my face.

“That how my grammie used tuh say it. You think he’ll go to ground, Dr. Sam?”

“Actually, it’s Dr. Vogel, Sam’s my first name. May I call you Josie?” I didn’t wait for an answer, there wasn’t time. “And I don’t know if he’s going to ground.” But there’s a damn good chance of it, I might have added but didn’t.

“He cain’t go to ground. Bobby, he drinks some but he ain’t no bad guy you know. He hardly ever do me when I don’t want it. I know he love me.” She almost looked at me then, and I thought Who gave you that shiner Josie? Did Bobby — your ain’t no bad guy man — do that?

“I ain’t never had no one to love me before. I know something about bad guys and he ain’t one.”

I thought she probably did know something about bad guys. Looking at her, I thought maybe she could write a book about bad guys. I said, “I’ll do my best.” But don’t expect too much, cause that’s a big ol’ bullet somebody put in Bobby’s head, bad guy or no.

She bucked up then, and nodded at me. She looked in that moment like she had seen life at its worst and this wasn’t it. She looked like she had faith in me.

A few minutes later, I was standing in the operating room looking down on Bobby. I knew there was gonna be a bloodletting like nobody’s business as soon as I unwrapped that diaper. Normally, I’d have called my partner to assist me on something like this, but there wasn’t time. Joe was right in that he wasn’t a brain surgeon, but he was a damn good trauma surgeon and wouldn’t faint when things turned to stool.

They turned to stool in a hurry.

I put on a pair of gloves. We had just moved him off the gurney and onto the OR table, his skin felt cold and clammy, when the assault began. “Pressure’s dropping,” one of the anesthesiology folks said. I glanced over his direction and saw six people, each doing their damnedest to keep this guy breathing. “We don’t have any blood yet?” I asked. We turned the guy up on his side and propped him there with a pillow. I positioned an orderly at the man’s back. “You don’t move,” I said. “Pretend you’re a seatbelt.”

“No blood yet,” one of the gas passers on the anesthesia side of the table answered, “even O neg takes some time.”

I turned to Joe, who turned to the circulating nurse, a young beauty named Alyssa. “Get on the goddamn phone and tell them send whatever they got. Tell them he ain’t picky.” By he he meant Bobby of course.

I looked down at the diaper and saw a new flush of red seeping out from somewhere near what had to be the back of his head. The rapid beep-beep-beep of the monitor suddenly hiccoughed, Bobby’s heart had dropped a beat or two under the strain, then became steady again. “How long?” I asked Alyssa, who was standing on the other side of the room and must have read my lips. No way she could have heard me in that confusion.

“Maybe ten minutes.”

Joe mouthed a reply back. “He’ll be dead in five.”

It was Shock 101, first year med school stuff. Bobby was losing blood, the so-called effective circulating volume. I thought he had arrived to the ER having already lost a good bit of the red stuff, maybe a quart. It couldn’t have been much more than that. He had been confused, maybe a little pale. But he had been awake and his heart rate, although fast, hadn’t been skipping beats. He’d been in Class I shock when he hit the door, which by definition in a guy his size worked out to a quart of blood, about 15% of his effective circulating volume if I had my figures right.

He was damn sure beyond that now. The tracing on the monitor showed Bobby’s heart was doing periodic back flips, meaning it was having trouble keeping up with demand. The folks at the top of the table were trying hard, breaking a sweat and dancing like there was no tomorrow. They were giving him salt water in the absence of blood — which meant they were giving him volume but no life saving red blood cells, a trick that would buy a few minutes tops. Pretty soon Bobby would start bleeding water and before too long he wouldn’t even bleed that.

I had seen that once before, bleeding water. A little baby I worked on as a resident in training. That poor kid had been shot as well — his father had blasted away the top of his head with a shotgun — and we couldn’t begin to stop the bloodletting in that case. “Looking pretty thin down here,” I hollered when the stuff coming out his wounds was no more than pink salt water. That baby’s heart stopped, started, stopped and started a dozen times before it finally gave up the ghost and we pronounced him. I could have read a newspaper through the watery stuff coming out his veins by then.

Bobby’s heart wouldn’t last that long. He had probably lost a quart and a half of blood, maybe even two full quarts, by then. Half a gallon of milk. He might survive losing a third quart — though he’d probably have a stroke and speak gibberish for the rest of his miserable life — but he damn sure wouldn’t live to shoot another deer if he lost a fourth, which would bring him up to the magic and lethal number of forty percent blood loss. Everybody goes to ground at that number.

He looked pale. Like instead of a bullet to the brain he’d taken a vampire to the neck. His blood pressure was ninety over thirty one moment and sixty over fuck the next. If he had been awake and not anesthetized, he’d have passed out. He would have fainted and never awakened. Yes sir, he looked like a forty percenter to me.

Bobby, he drinks some but he ain’t no bad guy you know. He hardly ever do me when I don’t want it. I thought Bobby’s days of doing her were just about over.

I stole a glance at the scrub tech. She was frantically trying to get the instruments laid out and ready. I glanced at the table, saw a scalpel and a mess of hemostats, scissors, clamps, and sponges. I thought it probably wouldn’t be enough. I thought it had to be enough. Jesus Mother Mary. You wait any longer, I told myself, you’ll be operating on a cadaver.

“I can’t wait,” I said. “Help me with this, Joe.”

Together we unwrapped the diaper and the crown of his head came into view. He was mostly bald, middle-aged or better I thought. I hadn’t asked his age in the confusion, not that it mattered much now. His age would be on his tombstone after all. No confusion about that.

The skin at the back of his head was torn and bruised. I saw that much. Then Joe pulled the diaper off the hole in Bobby’s skull and the damn burst wide. A sea of dark blue, almost black, blood. For an instant, it poured out like somebody had diverted Niagara freakin’ Falls into that broken head. Acting with twenty years of experience behind me and without really thinking, I stuffed a wad of cotton into that opening. It might make things worse, might even kill him on the spot if there was a clot inside half as big as the wad of cotton outside. That clot would press the brainstem and then, in the words of Josie’s grammie, he’d go to ground quick. But I didn’t think that would happen. Blood finds it’s own level, and, like water, is always looking for a way out, any way out. I hadn’t seen a clot on the scan (which at twenty minutes old was, admittedly, now ancient history) but the man had looked too good right up until a minute before. So I pressed that wad of cotton against the hole in his skull, against his brain, and bought us a few more precious minutes. “Get that blood, goddammit.” I hadn’t even had time to wash my hands or put on a gown.

“Getting frequent PVC’s over here.” Back flips again. The beeps filled the room, going up and down like a radio signal you couldn’t quite tune in. Bobby’s heart was losing the race. “We need blood for christ’s sake.”

The door opened just then and a pimply faced kid came in carrying a picnic cooler. If he had a clue he was carrying the man’s life in his hands, he didn’t show it. “Hey who do I give this to?”

The blood was hanging within one minute. One of the anesthesia folks (I couldn’t keep straight who was doing what and didn’t try) was squeezing the blood bag between his hands. When the first was finished, he squeezed in a second. He was on his third bag before I pulled away the cotton.

A large piece of lead floated out of Bobby head, followed by dark chunks of what could only be pieces of Bobby’s brain.

The torrent started up again. It flowed steady rather than pulsed with his heart. I knew from that, and from the amount of blood, that it was that mofo vein bleeding. And probably more than a small tear if the amount of blood was telling. I thought there had to be a hole the size of Montana in that thing. “Jesus Mother Mary” I said, then “Stitch!”

The scrub tech slapped a needle holder into my palm, a curved needle and silk stitch clamped into the end of it. I might have closed my eyes — I’ve been told I do that sometimes in surgery when I’m trying to visualize something — though if so I don’t remember doing it. I took that needle and aimed it into the pool of blood. “Suck here Joe, right here,” I said, and when I thought I could see something, something gray and not black red, I plunged the pointy end of the needle through whatever the visible tissue was and looped it out again. I cinched it down and tied it quick, then repeated the maneuver again after adjusting slightly for lighting, sweating, my own bounding heartbeat, and the regret I wasn’t wearing my own diaper. We’re losing.

An image of Josie came to me then. Josie in her Howard Johnson’s maid’s outfit, her weight in the upper limits of the couch potato zone, her unhealthy ruddy complexion. She sucked a cigarette and smelled of pinesol from the toilets she cleaned. The blue beneath her eye had coalesced somehow and now she had a decidedly black eye. Bobby, he drinks some but he ain’t no bad guy you know. He hardly ever do me when I don’t want it. I know he love me.

I fished out another piece of lead. Either the blood was slowing or whatever was left in his veins was thinning, I couldn’t say which at that moment. But I thought maybe I could see better, that Joe was doing a pretty damn good job moving that sucker here and there, sucking away the blood and oozing brain so I could work. Looking at that broken mess, looking through that thinning blood, I suddenly saw what needed doing, how there was not but one thing to do.

I saw that if I oversewed that mofo vein, it would probably kill him within a few minutes. That’d be like plugging a hose at its business end while water still flowed in from the faucet. In a few seconds that hose would rupture at its weakest point. Bobby’s weakest point was somewhere deep inside his skull, somewhere I hadn’t a prayer of getting to, and when it burst — game freaking over.

But I had no other choice. He was like a pig on a stick otherwise. I could watch him bleed out right now, or I could oversew that mofo vein and wait a few minutes for his head to explode.

He hardly ever do me when I don’t want it. I know he love me.

I thought, So that’s true love then This is for you, Josie. It’s all I got left to save your ain’t no bad guy. And I began to oversew that mother-fucker. When I was nearly done, I looked up to see Bobby’s color was better and, more important, his heart sounded a steady beep throughout the room. More important still, the puddle of blood at my feet had stopped growing and the flow out of his head had thickened and trickled. A few final throws and it stopped altogether.

“Damn fine job, Sam,” Joe said. “You can cut on me anytime.”

I didn’t look at Joe. He wasn’t a neurosurgeon after all and maybe it hadn’t occurred to him how I had just plugged the hose. I got busy watching Bobby’s brain pulsate in time to the beeps and wondering how long it would be before that weak spot blew open in the middle of his brain. I had an idea Joe would change his tone then, that he’d be a little less sanguine about me cutting on him someday.

But that brain stayed put. It pulsed up and down, mostly imperceptibly like it was supposed to, and after awhile I stepped back and took a few deep breaths. “Jesus Mother Mary with Christ in a hand basket,” I said, suddenly very tired, like I had run the goddamn Boston Marathon. Joe actually shook my hand and in the moment I thought how some wise man, probably an ancient surgeon, had intoned better to be lucky than good. “Somebody get me a gown and let’s get this finished up. And Alyssa, you maybe wanna bring me a coke?”

I didn’t know which I wanted more, the sugar or the caffeine.

I talked to Josie again, still without a priest, and told her Bobby might never wake up but that he hadn’t gone to ground, for now, I thought but didn’t add. What she took away from that brief conversation was anybody’s guess, probably something like he was gonna be okay and nothing else. People, even overweight Howard Johnson’s maids (I thought especially overweight Howard Johnson’s maids) hear what they want.

It was after eleven when I came out of the hospital, my third coke of the evening already half empty in my hand. I was dead tired. The sort of tired that actually hurts. I got in behind the wheel of my Nissan and just sitting was a chore. I thought I could sleep right there. I had only four miles to drive home, but in those first moments behind that wheel, I didn’t think I could do it. I sipped my coke and turned the key and the engine chugged to life, followed a moment later by my iPod. Beethoven’s Ode to Joy[Beethoven’s Ninth Symphony in D minor] filled the car. A sort of post-game pick-me-up if you like. I put my head back, nodding in time to the classic rhythm, and my eyes closed. I guess I did sleep for a bit right there. No more than a few minutes though. I woke when the music looped back to the beginning.

With Ode still playing, I pulled out of the parking ramp, still tired in that painful way, thinking only about making it into my bed. I drank my coke and cruised along the boulevard and maybe I watched the lights pass by. The night was a dark one, a no moon sort of night I guess, and I can’t say I remember too much about that drive except that it seemed a long one. Every time I stopped at a light I would doze a little, once I only woke when the guy behind me starting blaring his horn. He pulled around me and when I looked up he was flashing me the bird. Probably thought I was drunk. Or maybe he was.

A block from my apartment there was a stop sign and I had to make a right turn. I stopped at that sign, but my mind was fogged or maybe I was actually sleep driving. Either way, I never saw the car that hit me. He clipped me along the driver’s side when I pulled out and I rolled off the asphalt into a shallow ditch alongside the road. I cursed, but at least I was awake by then and I got out and stepped back up on the road. It was cold out there and I could see my breath in the air. The other car was sitting cockeyed with one tire off in the dirt. The engine was still running. The driver opened the door, I saw the dome light come on, and a man in a cowboy hat looked back at me with a lit cigarette dangling off his lips. A sticker on the bumper announced: We don’t use 911 — We use Smith & Wesson, and I remember thinking I hope that’s not true. I saw his breathe hitch in and out and that cowboy hat rise up and I thought here it comes. Then, for the second time that night, I got the bird. He slammed the door and gunned his engine, the tires squealed, and the one off the road kicked up a spray of dirt and ice that covered most of my hood. The wheels caught a moment later and he took off. I was too tired to rant and never thought to get his plate number. I just nodded and cursed again under my breath. I looked at my car. The driver’s side front tire was flat where the fender had been bent into the rubber. I knew I wasn’t driving any further that night.

I was only a block from home. I called a tow truck and they said they’d pick it up in the morning unless I absolutely needed it that night. Absolutely needing it would cost an extra $125 so I decided the morning would be fine. I was still on call for a few more hours, but I didn’t plan on going back to the hospital unless it was a matter of life and death. Then I would take a cab.

I walked the block through the cold to my apartment and it occurred to me I could have stayed over at the hospital. That idea had never appealed to me though. I didn’t have a call bed — I had argued that case with the administration for months and gotten nowhere — but I could have slept in an empty patient room. When I pictured that, I pictured some old geezer in his final days coughing out his insides all over that room. I pictured him pissing himself and laying in his own stool. I had an idea that after they wrapped him in sheets and put his ass in a morgue cart, somebody would clean that room, but how well could you really clean a room like that? And it wasn’t only one old geezer, it was every old geezer who had ever occupied that damn room. I felt like they had each left a part of themselves behind, and it wasn’t the best part either.

I could also have slept on the couch in the break room in my office across the street from the hospital. I had tried that a couple of times, but each time the cleaning lady, an oldie but a goodie named Bertha, had chased me out at six am. “Dr. Sam” — I had told her a hundred times it was just Sam, or Dr. Vogel if she preferred, but either she didn’t care or was beyond caring with old timer’s disease — “I has to clean dis here room now. People eat dey food an’ don’t do no picking up cause dey know I’ll be along. Don’t want none a dem cocker roaches.”

No, we don’t want none of dem cocker roaches, I thought as I approached my building, a four story affair. There were a total of eight condos in the building, each condo being two stories. I had one of the four upstory units. Each of those had a downstory unit below it. Walking up the stairs I remembered how tired I was. My legs felt as if weighted with lead shot as I entered my condo and climbed another flight to my bedroom. I was still thinking about sleep and I paused only long enough to piss, not hardly paying attention to the gurgling of the pipes when I flushed. My biggest gripe about the place: the plumbing sucked. Every time my downstory neighbor flushed, it was like sending a telegram my way: Hey neighbor, there goes my shit! Of course, his shit flowed away from me but I still heard it clear enough. I could only imagine the message he got when I flushed.

I took my piss and, maybe thinking the hell with it, I flushed. After that I didn’t even undress. I still had my cellphone on my belt and my keys in my pocket when I hit the bed.

I don’t remember my head hitting the pillow.

Maybe a half hour later, that damn birdie chirp started up. I tossed and turned a few times, tried to ignore it, thought maybe it was a glitch in whatever dream I was having. But I was too tired for dreaming. And that wasn’t a sound designed to be ignored. Like the devil himself had put it together. I would close my eyes, take a few breaths, and there it would come again to jerk me awake. Awful, simply awful. I had to do something about it.

When I finally realized it was one of the damn smoke detectors, this was after maybe a dozen chirps, I said “Perfect. Just freakin’ perfect.” I threw a pillow at the bedroom door.

I waited a few more minutes to see if either it would stop or I could sleep. When neither seemed imminent, I got up. I was so damn tired I had to consciously work at keeping my eyes open. They felt like someone had sanded them. I opened the bedroom door and now I realized it wasn’t just a chirp, but a chirp and two quick words, “new ba’ry.” Either the voice was mechanical or Stephen Hawking had a second job dubbing for GE. “Why don’t you just shut up,” I said. It didn’t, of course.

If it had been the smoke detector on the lower level, I could have reached it no problem standing on the foot rest. But the ceiling on the top level was vaulted and to reach the smoke detector was gonna take a ladder. I thought maybe I could reach it with the short step ladder I had in the mechanical room on the first level. If not, I’d have to go all the way to the garage. I didn’t want to do that. Truth is, I didn’t know if I could do that. Not how I was feeling then.

My eyes wouldn’t focus. I had a headache and my bowels were acting up, like maybe I had peppered my food too heavy. I had an idea I was gonna have to flush that toilet again before morning. And I couldn’t walk in a straight line. I found that out going down the stairs to the main level. Going down those stairs…interesting. I kept bouncing from one wall to the other like I was drunk. Guess that’s how I felt, like I had been out with my med school dorm buddies all night. A hell of a hangover.

I would have crawled to that freakin’ mechanical room if it would have shut up that goddamn chirping.

Carrying that ladder back up the stairs was a pain in the ass. It wasn’t all that heavy, but I’ve already said I was like a drunk man and a drunk man’s no business on the stairs with a six foot ladder at two in the morning. I gouged the wall a couple of times, cursing at how I was gonna either have to pay for that or spend time painting it myself. I wondered if anybody had ever sued GE for mental duress caused by one of their chirping birds.

Except for my shoes, I was still fully dressed when I set that ladder up at the top of the stairs. The chirping was especially loud right under the thing, loud enough to actually hurt the ears and not just be irritating. Chirp! New ba’ry! I thought what the hell does that mean? I wondered if the other detectors would go off when I started messing with this one. I had a vague recollection of that happening years before when I had changed a battery elsewhere. I thought I might just walk out and get a hotel room if that little concert ensued, then remembered my car. Hell, I thought, I’ll take a taxi back to the office and sleep on the couch in the break room after all. And the hell with dem cocker roaches. I made a mental note to petition the administration again for a call room. Cheap sonsofbitches.

I was thinking about all of these things and none of these things as I stood on the top of that ladder. My mind was working over time one moment and shorting out the next.

Chirp! New ba’ry!

The ladder wasn’t quite tall enough. My fingers could touch the birdie, I could even get a tease of a grip on the thing, but I couldn’t develop any force to twist it. I had opened the toolbox beside the ladder and grabbed a screwdriver just in case I needed to pry the thing open. I’d put it in my back pocket, where it was now. What I hadn’t grabbed was the hammer. I said a curse under my breath as I thought about that. One swipe with the hammer and that birdie would have been history and I could have gone to back to bed.

Chirp! New ba’ry!

What was I going to do when I got the birdie down, anyway? I sure as shit didn’t have a new battery. That’s when it hit me what the chirp was trying to say: new battery. Duh. That’s the thing about sleep deprivation. It dulls the body and the mind. I reached for that screwdriver in my back pocket and was actually listening for that damn chirp to come around again, I wanted to test my theory about what the thing was in fact saying, when I lost my balance.

I tumbled and the last thing I remember hearing before my world went black was Chirp! followed by two words, fuck you!

Swear to god.

The first thing I saw when I opened my eyes was the bright orb of light at the top of the stairs. Intensely bright. I wondered if maybe it might be an angel, but that wasn’t right. I never believed in angels. I blinked, put my arm up, and tried to palm the thing. I succeeded in hiding it, which meant at least it wasn’t shining in my eyes for the moment. Another few seconds passed and I understood it was the sun shining through the window. Daylight.

Daylight?

I rubbed my eyes and turned away from the light. I was thirsty, or at least I thought I might be thirsty. In those first few moments, I wasn’t sure about anything.

Where the hell am I? Daylight?

The floor was hard. Carpeted, but hard nonetheless. My back ached. I turned my head to the right and saw three Chinese warriors staring down at me from their perch on the fireplace mantle in the next room. They were dressed in armor, one kneeling, all three ready for battle. On the other side of the fireplace was the replica of a helmet as might have been worn by a Trojan warrior. I knew these things. I knew them because this was…my home.

The ceiling above me looked impossibly far away. The walls towered. The door to my bedroom was wide open and I had a clear view into the room. The bed, my bed, seemed tall from that odd angle on the floor.

I turned my head left, this sent a twinge of pain down my back, and saw…what?…a ladder? A ladder over on its side. Why the hell’s there a ladder on the floor? What the fuck?

My pager went off at that moment. Two high pitched beeps. I thought about that a moment. Not an initial page but a follow-up page. I had failed to answer the initial page and now the unit was beeping a reminder every few minutes. I wondered how long that had been going on.

Chirp! New ba’ry!

That got my attention. The same way a neon light grabs your vision. Blamo! Too fucking loud.

Enough. I made an effort to sit up but my muscles didn’t answer the call, not the ones in my waist anyway. Or my legs. I turned over then, or rather I tried to turn over. A searing pain erupted in my back and for just a moment, I had an idea someone had poured boiling oil over me. Talk about your wake up calls. Blamo! Don’t do that buddy! I didn’t breathe for a long moment after that. I was afraid to.

“Oh god,” I said aloud. I dared to look at my lower half. One leg was crumpled under the other, bending where it shouldn’t. But that wasn’t the worst of it, no sir. The worst of it was how it didn’t hurt. A break like that should have been saying Blamo! Blamo! Blamo! Blamo!

I’d been a doc twenty years by then. So no surprise how the physician in me came to the fore. White male, fifty-two years of age, no significant past medical history. Recent fall from ladder — had I, in fact, fallen? Must have, I guessed, looking around at the evidence.

“Jesus Mother Mary.”

I began again, this time aloud: “white male, fifty-two years of age, a physician. Nonsmoker. No significant past medical history. No meds, allergic to penicillin. Recent fall from ladder, maybe” — I looked up, then looked at the toppled ladder — “ten feet or so. Loss of consciousness, duration” — I looked around again — “hours. Hard to say how long exactly. Airway seems ok, breathing fine, a little fast.” Slow it down. I ran my hand through my hair and it came back bloody. “All right, relax. It isn’t much blood. You’d be dead by now if you were gonna bleed out.”

There was that loud Chirp! New ba’ry! again and I had a thought out of nowhere. Something from a book I read once, The House of God. It was the fat man talking, the cynical asshole: At a cardiac arrest, the first procedure is to take your own pulse…

So that’s what I did. I slid my hand up along my neck, felt the carotid. Bounding. I counted the beats for what I thought was twenty seconds then tripled the number. Ninety-six beats per minute. Fast, but not overly so. Still well within the life zone. I reached down to my crotch with the other hand, felt the crease of my groin, thought nerve, artery, vein. Or was it supposed to be nerve, vein, artery? From outside to inside, what was the order of the structures as they passed under the inguinal ligament — the layman’s groin crease. I supposed it didn’t matter too much, I ought to be able to feel the pulse either way — it wasn’t like I was gonna stick a needle in it or anything — but still it bothered me I couldn’t cull the memory. I had taken the pulse at the groin at least a thousand times and I couldn’t remember the anatomy. Come on, get it together. You’re a surgeon for god’s sake. A brain surgeon.

I felt along my groin crease, found my pulse. Still bounding. This time I got ninety-two. Or eighty-six. I couldn’t concentrate, not completely. I knew my blood pressure had to be at least 80 systolic if I could feel it at the groin. A stupid thought, I decided, realizing it was probably much higher since I was not just laying there, but actually thinking.

At least the squash is being perfused.

I tried to feel the carpet around my head. It didn’t seem damp. “Ok, so I hit my head and took a little nap.” I held up both hands, made fists, bent the elbows. “No hemiparesis. No epidural. Of course, I knew that. A mild head injury. A concussion for sure. A tolerable injury.”

I chuckled at that. A tolerable injury. Tolerable. One of my favorite words.

I tried to turn over again and once more the back came alive and that boiling oil pain seared through me. Jesus Mother Mary! I wiggled my toes but I could see they weren’t moving. I concentrated, thought “wiggle your goddamn toes,” and still nothing happened. The floor under me felt hard against my ass, or at least I thought it did. I ran my hands over my belly and down to my crotch again. I felt my junk. I tried to convince myself I could feel my hands down there, that I could feel my fingers pulling my dick, but I couldn’t be sure. Might be a trick of the mind.

But when I tried to move, well, that was no trick of the mind. I couldn’t move below the waist. Paralyzed.

Something’s broken inside. “T12, maybe L1,” I said and turned my head again. I was lying against the stair rail. “Damn. Must have hit the rail on the way down.”

Paralyzed. How many times had I said that word over the years? Like the twenty year-old who fell off a third floor balcony trying to impress his friends as he balanced on the railing after his sixth or seventh beer. Paralyzed. Or the never ending string of folks who dove head first into shallow water. Paralyzed. Or the bar fights and auto accidents. Paralyzed.

Paralyzed.

Paralyzed!

Paralyzed!!!

“Help me! Help! Anybody? Help!”

For the next few minutes — it could have been longer because time had begun to stretch out in bizarre ways by then — I took to hollering and listening and hollering again, nearly losing my mind in the effort. This went on until my throat wore out, until my lungs lost their air and could no longer generate enough umph to get the words above a whisper.

That was when I started crying. The crying lasted longer than the hollering had by a fair amount.

When I was cried out, I laid still for awhile. Nothing much in the way of thoughts passed through my mind, except how I was thirsty. And once that idea occurred to me, it became all consuming, a torture like no other. I blinked my eyes and watched the sun rise in the sky outside the window. It wasn’t yet shining on me directly, but it would. And when it did, I had an idea the thirst I felt now would be nothing by comparison.

And the whole time that little birdie kept chirping.

My cell phone. Why hadn’t the idea occurred to me sooner? I always carried my cell phone with me. Everywhere. Everywhere except to bed, of course. But I hadn’t undressed. I didn’t actually remember I hadn’t undressed, but the proof was right there for me to see. I was still in my clothes.

I felt for the phone at my waist and found nothing but the empty clip. I had to quell a sense of despair then, a sense so strong it got me to crying again. I closed my eyes, but only for a moment. I was afraid if I closed them too long, they might never open again.

If I had been dressed for bed, I would have put the cell phone on the night stand. Had I done that? I remembered sitting on the edge of the bed, but that was all. Damn, I’ll never be able to get to it. Then I felt the clip again. I was pretty sure I would have removed both the phone and the clip together, so I guessed the cell phone had to be down on the floor with me.

My pager pinged off again and I turned to find it against the wall at arm’s length. The idea they might come looking for me since I didn’t answer the page occurred to me. I had to chuckle at that. Half the folks in the system didn’t answer their pages routinely. I retrieved the pager and found I had missed six pages. I saw two little words in the lower corner of the digital screen as well: low bat. Shit, I thought, it’s a goddamn conspiracy.

Chirp! New ba’ry!

The smoke detector was right above me. Goddammit. Stupid. Just stupid.

“All right,” I said, “work the problem. You’re three inches deep in somebody’s brain and they start to bleed. What do you do? You work the problem — logically, from one side to the other. Work it.”

Three inches deep inside somebody’s head? I thought of Bobby then, of that shit load of blood, of that mofo vein. You think he’ll go to ground, Dr. Sam?

I thought then of Megan, my daughter, how I was supposed to visit her this week. Would she come looking for me when I didn’t show? I thought she might, especially if she didn’t hear anything from me. But that wouldn’t be for a few days at minimum since I had left the exact date open. But she’d call sooner rather than later I guessed, and maybe when I didn’t answer she’d drive the hundred-fifty miles to look for me. Or more likely she’d call the state troopers and ask them to check on me. And how would that go? I thought they’d probably knock on the door, maybe even check the garage. And when they found my car was gone, they’d stop. They’d assume I’d gone off on my own, that maybe I hadn’t wanted to tell Megan about my tryst…

Work the problem. At first I thought the problem might be immediate survival, but from a strictly medical standpoint, if my injuries had been that life-threatening, I guessed I would have been dead by then. So the problem to be worked was really how to get help. The condo next door was empty, I knew that much. They hadn’t even built out the walls yet. The folks in the downstory condo had left on vacation a week or so before, or at least I thought they had. I tried to recall their names, Cardoza, Cabrera, something like that. Something ethnic sounding. I’d only seen them a few times in passing. A husband and wife I guessed, never saw any kids. I couldn’t recall where they had gone on their vacation, not that it mattered much. Except that if I could recall details like when they had left and where they had gone, I might be able to remember when they were coming back. And I wanted to recall that. I had an idea recalling a detail like that might be important. Because unless and until they came back, shouting for help was gonna be a little like pissing in the wind with my mouth open: it might seem like I was accomplishing something, but in the end I was gonna be the worse for it.

I didn’t own a landline. But thinking about that made me think about my cell phone again. I eyeballed the night stand beside the bed. I tried again to rise to a sitting position, but there was that boiling oil again, only lukewarm because I was quick to settle back. Sitting, I decided, was no good. I tried scooting along the carpet, but every time I moved the slightest, bits of electricity blistered their way through my groin and sometimes my legs.

Oh you bitch. Don’t fucking give up on me, not if you ever wanna walk again — not if you ever wanna live again. Not if you don’t wanna go to ground.

That chirping was driving me nutso. I had an idea I could lose my mind from that alone.

I gummed my tongue and tasted the dust in the air. I thought, I’m going to die if I don’t find a way to get help. So it was a problem of survival after all.

I had gone no more than six inches toward the night stand, every inch a fought over hell, when I saw it. The sun had climbed high now, nearly as high as it could, and the heat coming through that goddamn picture window over the stairs was near unbearable. “I’m a done tom turkey,” I said, then later, “turn me, I’m done.” It was just after this last that a glint of sunlight reflected off something on the carpet. I squinted my eyes — they were hardly what they had been even a few hours before I thought, wondering if maybe I was dying by parts. That was when I saw the cell phone. I reached for it, my fingers came up just short. An inch, maybe two, three at the outside; I couldn’t tell distance anymore. I was teetering on the edge mentally at that point, between being there and not I guess. I tried rolling, felt the wave building within me, and vomited.

I awoke to the smell of dried puke. Shit too. I guessed I had soiled myself both top and bottom. I thought for a moment at least my thirst had passed, but just thinking about it proved me wrong.

I laid on the floor taking the room in around me. The Chinese soldiers were still there, the one kneeling and the others standing. All mocking me with their eyes. Even the small statuette of William Shakespeare, this was on the bookcase beside the closet door, was looking at me. “Get off your ass!” Shakespeare seemed to say.

I swallowed then, just barely. I had an idea that before long swallowing would be a thing of the past. Before long, I would be a thing of the past.

You think you’ll go to ground, Dr. Sam? It was Josie’s voice, and for a moment I thought she was right there with me. “No fucking way,” I said.

I turned my head and saw the cell phone again. I steeled myself against the pain and turned over — until that moment I had been on my back — and reached again for the phone. It was just there, pressing the tips of my fingers. It moved gently out of the way as I tried to grab it. I took another breath, I guess it made my chest bigger and increased my reach by maybe half an inch, but that was enough. “Oh thank you God thank you God thank you God.”

Like I said earlier, I was teetering, wasn’t all there. That phone didn’t feel right the instant I picked it up. I had allowed myself to think otherwise for a moment, but when I brought it up before my eyes I couldn’t ignore the simple truth. The battery was missing.

The battery and the phone had parted when I fell.

I lost it then. It was rote really, nothing I thought about. If I had, I wouldn’t have done it. “You bitch,” I said and chucked the phone at the Chinese soldiers with their mocking slanted eyes. I missed the soldiers and hit the brick facade of the fireplace instead.

The phone broke apart in a hundred pieces.

I guess I dozed after that. It was dark when I woke again. An angel stood before me, a bright ring of golden light encompassing her. Her arms were up in the manner of a supplicant, and I thought the smile on her face the most beautiful I had ever seen. She was looking at me as if nothing and nobody else had ever existed, as if all the world entire had been made for me alone. A second angel, as beautiful a creature as ever there was, stroked a harp. I had never, in my entire life to that moment, heard a harp played. I thought the music soothing as well as beautiful, but I was certain it was a violin I was hearing and not a harp. Ashokan Farewell to be exact. One of my favorites. Maybe my most favorite.

It was all so easy. I relaxed and a great peace began to overtake me, of a sort I had never known. I closed my eyes and laid my head back and in the next instant I opened them again.

The room was dark and the floor was vibrating. The angels, if they had ever been there, were gone. The music now was heavy metal. Or at least I thought it might be heavy metal, not something I ever listened to.

But the Cardozas/Cabreras did.

On the instant I knew the downstory neighbors were back. Salvation was at hand.

I rapped the floor with my hands. The dull thuds were not nearly loud enough though, would never be heard over the noise from downstairs. Not to mention I was on the second floor of my condo. There was an entire floor between us. But desperation is a very convincing mother, so I waited for the music to stop. It dragged on interminably. I tried knocking on the floor against the beat of the music.

I had a bad moment then. What if it was just an automated system coming on, an alarm perhaps? I was suddenly sure that’s what it was. Many people set their stereos to sound off like that. Damn. My hopes faded and I stopped knocking, just listened. I ignored the music, tried to hear the people that might be present under the music. I didn’t hear a damn thing.

God I was so thirsty.

I starting coughing and couldn’t stop. Pneumonia, sure. I had been lying on that floor for hours — days? — and pneumonia was only a matter of time in such a case. The old man’s friend. It would be a slow death, but I’d probably be out of my head with fever and lack of air long before it was over. I wouldn’t know shit about it. I’m going to ground, entering the dead zone.

The music finally went off in the downstory. I started my little knocking again, rapping against the wall. But I was weak. I might as well have been knocking with cotton against that wall.

Awhile later, it could have been an hour I guess, I heard a mechanical sound, followed by a familiar gurgling noise. Hey neighbor, there goes my shit!

So somebody was home in the downstory. A person might automate music, but the sound of a toilet flushing? I thought not.

Tears welled in my eyes.

Work the problem.

Outside, it was black dark and no moon to ease the night. I thought it must be late, but with the traffic sounds outside I doubted it was after ten or eleven yet. The time really didn’t matter though, except in so far as the downstory folks would be going to bed soon. Maybe had already. I needed them awake.

You need to get their attention, whatever it takes. Work the problem.

I tried to think, tried to look at options. Tried not to think about the thirst, which in truth was driving me mad at that moment. I slid my hand up to my carotid artery again. I counted the beats between chirps, multiplied times two and got a pulse rate of 104. Strong, a little fast. The ground is coming up, I thought, thinking I was gonna die not thirty feet from a sink, a toilet, and a shower. I thought how they’d find my body a few days after the flies, after it had started to juice through the ceiling to the living room below.

I thought about slitting my throat then, how I could take a blade and slide it across the crook of my neck from one side to the other. Up close under the angle of my jaw. The blood would pour out, pulsate really, and it would all be over in two minutes, maybe three. I’d lose consciousness, maybe see those angels again. The condo would look like an axe murder had taken place. The builder would probably have to cut out the sheet rock and floor boards under the carpet. The blood would soak through everything because blood finds its own level.

I guessed I would eventually find my way into the Cardozas/Cabreras’ ceiling. It might take a few days I thought, maybe even a little longer seeing as how I was on the second floor of my condo and I’d have to ooze through two floors. But it would happen I was sure of that. The Cardozas/Cabreras would wake up one morning and — blamo! — there I’d be to greet them. A big ol’ smelly stain on the ceiling. Well, not quite me, but enough of me to know I was close by. Those folks whose name I couldn’t even remember would be cleaning me out of their heads and off their ceiling for days to come. No doubt about that.

I had seen it on one of those documentary shows. Something about a body farm in Virginia or North Carolina or Kentucky. One of those Southern states anyway. A place where nerds wearing pocket protectors and horn rim glasses looked into how bodies rotted, or more properly, decomposed. We had called it something else in med school. ‘Juicing out.’

An awful term that. Juicing out.

Finding my body after I juiced out didn’t offer much solace. But what if somebody could find it before I juiced out? Or, more properly, could I juice out without dying? Impossible.

I lolled it over in my surgeon’s mind though. I decided it was unlikely, even very unlikely. But then I thought about Bobby, how that diaper had wrapped his head. Once removed, he had bled like the proverbial stuck pig. Maybe half of his effective circulating volume — my surgeon’s mind was still working and thank god for that — had wound up across my shoes and the operating room floor. That sonofabitch had juiced out in front of me, no question. And he hadn’t gone to ground.

Could I juice out and live to tell about it? I had to say probably not. But was it impossible? No, I thought, it’s possible. Just ask Bobby.

I wouldn’t slit my throat, of course. For starters, I didn’t have a knife, a problem I would have to deal with in due time. But not just then.

I worked the situation from my trauma surgeon’s viewpoint. I needed an artery of some size, one easily accessible, one I could control. Because my brain wasn’t what it had been a day ago, I spoke the potentials slowly. And because it seemed there was less noise in the room than in my head, I spoke the list out loud. I had an idea the inside of my head was getting sort of crowded. “Think on everything twice,” I said.

I closed my eyes and began the mantra. “The carotid artery ascends in the neck just medial and deep to the sternocleidomastoid muscle, where it bifurcates into two branches: the external and internal carotid arteries. The external feeds the face, the internal supplies the brain…”

Out of the question — the squash needs to be perfused.

“The brachial artery in the upper arm…”

Another nonstarter from the git. Too deep and inconvenient.

“The radial artery on the thumb side of the wrist…”

Superficial and convenient, but no. I need both hands for this rodeo.

“The femoral artery runs under the inguinal ligament on the medial side of the groin. Between the femoral nerve and vein,” I said, then added, “at least I think it does. Nerve-artery-vein, from outside to inside. Yeah, the artery is in the middle.”

Bingo. That’s the one. Convenient, not too deep, and controllable — at least in theory. It’ll bleed fast but I can shut it down quick too.

I needed a tourniquet, which I might or might not be able to hold in my weakened state — which would be all the weaker after the bloodletting.

Work the problem, dammit.

First, the tourniquet. I had my belt of course. It was more than long enough since it encircled my entire waist. I tugged on it a couple of times, sort of testing it. One problem solved.

The femoral artery was at least an inch, maybe two, below the skin on the crotch side of my thigh. I thought it might be doable, painful as hell, but doable. Then I remembered I couldn’t feel my legs — the idea I was paralyzed had blissfully, incredibly, escaped my thinking for what must have been hours. I knew then I really was going crazy, that I couldn’t depend on my mind anymore. I needed something to anchor it, something to keep me from floating into oblivion.

That’s when I started timing that chirp. It came every thirty seconds, not a tick late as I’ve said. Every time I thought my mind was wandering, whenever I felt myself slipping into the near dead zone, I timed that chirp. First I used my timex, but later I didn’t trust even that and I used my own heartbeat or sometimes I compared it to my breathing.

And there was something else too. At first I wasn’t sure, but I couldn’t deny it as the hours passed. That damn birdie was running down, going to ground in its own right. Yes sir, that near blood-curdling, piercing loudness that had grabbed me out of my sleep was fading. The chirp was still there, but it had lost something over the many hours. It’s personality had changed too. It didn’t seem to be mocking me anymore. Now it just seemed more to be marking time. My time.

I guess maybe I got it in my head that when that chirping stopped, I would too.

I put that thought out of my head — the same way I do when I need to take a piss in surgery. I put it in a corner of my mind where I would think no more on it, where it became, for all intents and purposes, untouchable. Done.

So I was paralyzed. No feeling below my navel. Slicing into my thigh and severing the artery wouldn’t hurt any more than cutting into my mother’s Easter ham.

But was it nerve artery vein, or nerve vein artery?

It wasn’t just an academic question. For this thing to work, the planning had to be meticulous. Cutting both, or even the wrong one, might be — almost certainly would be — fatal. Too much bloodletting and they’d find me sure enough, but the flies would find me first. They’d time the moment of my death by looking at the stages of the maggots. I had seen that on the body farm show as well. And too little bleeding? I’d still die, it would just take a little longer and with no chance of being found first. I thought I’d probably pass out from the loss of blood in either event, so I wouldn’t have a second chance at this.

But how much bleeding is enough?

I listened for the chirp and timed the interval against my heartbeat. After that I did a few quick calculations. I guessed I had about five liters of blood, minus whatever I had lost when I first fell, which I thought probably wasn’t much. I calculated that if I lost two litters, a half gallon of milk, that would put me into grade 3 shock — extreme blood loss — and certainly gain me entry to the near dead zone. Any more loss, a cup, even a tablespoon, would probably be enough that my kidneys and liver would begin to fail — I might die tomorrow or next week even if I survived initially. Anything less and I would just fade into oblivion. I was sure I would pass out eventually, but it would be a slow and uncomfortable death in any event.

So 2,000 cc. Almost, but not quite, half my blood. I would sweat, probably unbearably so. My breathing would increase, my blood pressure would fall (like a pressurized hydraulic system that has suddenly sprung one helluva leak) and my heart rate would climb into the stratosphere in compensation. I might even have a heart attack. I laughed at that idea, thinking how I had invented a new sort of cardiac stress test.

Of course, there were at least two other obstacles I had to overcome before I could take the plunge. But their solution turned out to be one and the same.

First, I didn’t have a knife. And, as the saying goes, no ticky, no washee. Without a knife, or something closely resembling one, everything I had just worked out was going to be for not.

Second, I was in the wrong place. I’ve already said I was on the second floor of my condo, at the top of the stairs. That meant that my blood, or whatever else I spilled out of my person, had to make its way through two floors. I had an idea I could improve my chances of being discovered while still this side of the grave if I could somehow get down to the first floor of my condo. There, my floor would be the downstory condo’s ceiling. I didn’t know how long it would take to juice through to the other side, but I doubted it would take longer than a few hours. With luck, I would bleed through before the neighbors left for work in the am.

There was, as far as I could see, only one way down to the next level.

I hadn’t moved in hours. I was laying on my back again, my feet still dangling over the highest step and into space. I pushed off with my hands and moved an inch or two toward those stairs. The pain in my back flared but I repeated the action every few minutes, stopping each time to listen for the chirp and gum whatever saliva was in my mouth. I took my pulse at my wrist. Fifty-five times two, one hundred and ten. My breathing quickened, then slowed as I rested.

I had to push my legs along with my hands. The smell was terrible. I had shat myself. The smell had lingered all night, sort of a light and airy eau de shit cologne, and I had been able to avoid thinking about it. But it was way past that now. Now it was a stink, pure and unadulterated. Every time I took a breath, that shit stink reminded how fucked I was. It made my eyes water too, or maybe that was just me crying. Hell, I spent half that goddamn night crying. Anyway, after awhile, something between thirty minutes and two hours I figured, I heard the plumbing gurgle again. It was still very dark in the window, hours before morning, so I guessed somebody in the downstory had got up to piss. Maybe they had both got up. I had a bad moment then. Maybe they were night owls. Maybe they had both roused to their alarm clock and were headed out to some dark-of-the-night engagement.

I listened for a long time after that, but the only thing I heard was the dying chirps of the birdie on the ceiling. Time was running out for that birdie, which meant time was running out for me too. I took a deep breath and my hand brushed against a small object the size of a cigarette lighter. It had been underneath me. I pulled it out. It was the cell phone battery.

I started to cry, but only started. I bucked up in the next moment, thinking how Josie had bucked up when I told her Bobby was all but a goner.

Then I reached the tipping point and over I went down those stairs.

I didn’t pass out, but I wished I had. That boiling oil pain came over my lower half again, only this time it didn’t dissipate quick like it had before. It lingered like it was boring in for the long haul and I wondered if I had really screwed the pooch. I had worked on many paralyzed patients over my twenty years, and I knew that being paralyzed was far from the worst thing, medically speaking. I had had a handful of patients who were not only paralyzed, but suffered with constant pain in their legs as well. In the worst cases, those patients wanted first to amputate their lower halves, then ultimately to kill themselves to put an end to their misery.

I had thought then I could appreciate what their suffering had been about. I was wrong. My lower half felt as if I had been dipped in boiling oil. My innards positively sizzled with the pain. When it finally died away, I have no idea how long that took but it was still black dark outside and I could still hear the birdie chirping faintly upstairs, I thought I had died and gone to heaven.

The stairs came out to one side of my living room on the lower level. A carpeted floor. I was all but done with living then, nothing left. My body wasn’t done though. It was talking to me. There wasn’t a part of it that didn’t ache, even the lower half. And my mouth was bleeding. I had knocked out my two front teeth tumbling down those stairs.

I spit the teeth out and staunched the bleeding with my sleeve. As I was doing this I wondered how I was going to make the cut without a knife. I damn sure wasn’t gonna be able to gnaw through my thigh. I turned my head to spit again and I saw the screwdriver beside me. It had been in my back pocket before I fell off the ladder. I picked it up. It was a slot head screwdriver. The slot head itself was thin, not quite sharp but I thought it might work as a puncture device and, if I punctured the right spot, I thought that might be enough.

I was pretty damn tired by then, thought I had best get it over with. But was the anatomy nerve-artery-vein or nerve-vein-artery?

I had spent a few years in the navy as a young man. Nothing too remarkable about that. It came to me then: NAVY, never-again-volunteer-yourself and NAV, nerve-artery-vein. Had to be.

I tied the belt around my left thigh, as close up on the groin as I could. My left thigh because I’m right handed. I listened for the faint chirp and counted my heartbeats until the next chirp. Sixty-two times two. One-hundred-and-twenty-four. Strong, even bounding. My breath was steady, not too deep nor too shallow. I was very conscious of my breathing. I didn’t want to hyperventilate.

I took up the screwdriver and felt for the pulse in my thigh. I listened for another barely audible chirp, and pressed the slot-head against my inner thigh. I pressed the skin hard, there was no pain whatsoever and that fact made me mad as hell, and when the next chirp came — the last chirp I remember hearing — I craned my neck and lifted the screwdriver maybe a foot off my skin. “You best get to it. Don’t be a wuss,” I said.

I plunged the screwdriver down. Hard.

The skin resisted a moment, and then broke. I drove the shaft of the screwdriver home, one inch, two inches. Suddenly the blood geysered about three feet across the room, it came in great pulsations, and I thought Wow. Oh wow

I took my pulse again, I had to guess at it since the birdie had either finally shut up or I was having a brain seize. I thought maybe one-forty, but it could have been twice that I guess. Jesus Mother Mary.

The condo was dead quiet aside from my breathing. The blood poured out and I held the screwdriver with one hand and grabbed for the belt with the other. I felt myself getting whoozy, like the world was turning all around me. Somebody honked a car horn. Tires screeched on the roadway outside. In the downstory, a toilet flushed and the water gurgled through the pipes again. I’m killing myself, I thought, and redoubled my efforts to stay awake.

The blood pumped the air, then poured like a red river out onto the carpet when I dropped the screwdriver and shielded the blood stream. It wouldn’t do to have it anywhere but beneath me, where it could pool and work its way through the floor to the ceiling on the other side. Blood finds its own level.

I let it bleed for maybe ten seconds, then pulled the belt tight. The puddle of blood continued to grow, albeit at a slowed rate. I pulled tighter, it should have hurt like hell but there was nothing, and held the belt with one hand and took my pulse with the other. One-fifty or one-sixty, I couldn’t tell. I was sweating though, felt like the humidity in the room had suddenly rocketed toward infinity, and my breathing had changed, had both deepened and accelerated. I tried slowing it, but I was no longer in control. The oxygen had gone out of the air and my body was on autopilot trying to find it again.

My hand slackened on the belt and the blood poured out anew. Five seconds, ten seconds, fifteen seconds. I lost count, felt the world turing around me, turning over me, me turning over the world. I lifted my head — my legs erupted with that boiling oil as I did so — and I saw my life blood spilling across the carpet under me. Enough. Oh shit. Enough.

I tried to cinch down the belt but my fingers had become clumsy. It took everything I had to pull it tight. On maybe the third try I succeeded in locking the buckle.

The pressure in the center of my chest was unbearable. I was soaked with sweat and my breathing had become an engine within. I sucked in huge gouts of air, barely expelling one before I took in another. The other side of the room looked impossibly far away, then blurred to nothing and everything in the next instant. My head fell back and thudded against the carpet. My ears rang, and rang, and rang…

With my last act, I felt the pulse at my neck. I estimated ten seconds, in which time I counted forty beats. I multiplied by six. I passed out thinking two-hundred-forty beats, the dead zone…

They found me later that day, when the Cardozas came home from work. I guess it took longer for me to juice through than I thought it would. Alex later told me they didn’t notice anything on the ceiling when they left for work. In the afternoon, when they got home, it was the smell they noticed first. Alex, his wife’s name was Felicia, told me it was a sickly odor, like a not quite spoiled ham. The sort of odor that permeated. He said they’d never have eaten such a ham.

It was Felicia that saw the ceiling, saw me, first. I was smeared across their hallway ceiling I guess, and had oozed a bit down the sheetrock between the kitchen and living room. They supposed something — or somebody — had died up there and called the police. The cops too thought I was dead and called the coroner. It was the coroner who realized I wasn’t yet worm food. Perhaps it was the absence of maggots when he started to examine me. I doubt it got that far, but that’s how I’ve always thought of it. I don’t really know ‘cause I spent three weeks in a coma and four months in rehab. I have ten screws and two rods in my back, a pin in one leg, and was on dialysis for weeks, though my beans eventually recovered. I still have some liver damage, though nothing I can’t live with. I had a heart attack too, just a small one, but thank god no stroke. My mind is my own.

But I’m paralyzed of course. From the waist down. Wheelchair city.

I’m retired now. Bobby was my last patient as an operating neurosurgeon. We shared a room in rehab for a few days, but there was no chemistry and I guess he asked for a transfer. Or maybe I did. My memory for that part is fuzzy. I can tell you he wasn’t a bad guy though.

As for me? Well, I guess I’m still breathing. Did I juice out? Naw, not really. I’d be dead if that was the case. I came close though, that’s all.

Jesus Mother Mary close.

About The Author

Edison McDaniels is a practicing surgeon & wordsmith, who writes short stories, novellas, and novels when he’s not incising skin. Read more about him at www.surgeonwriter.com and look for his fine & intense works of fiction at the Amazon Kindle store.

His latest novel, Not One Among Them Whole, is available for the Kindle and as a trade paperback from Northampton House Press.

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