issue 22: January -February 2001 

| author  bio

Frank Huyler is an emergency physician in Albuquerque, New Mexico.   His poetry has appeared in The Atlantic Monthly, The Georgia Review, and Poetry, among others.

THE UNKNOWN ASSAILANT


ONE WAS MIDDLE-AGED, BALDING, the other young, overweight, and both men screamed as they rolled in on the gurneys. We had no warning on the radio at all. The paramedics were urgent, moving quickly and breathing hard. Multiple gun-shot wounds, they said, with unstable vital signs. They didn't have time to call it in; it was too close, they were too busy.
          I took the young one. He lay soaked in sweat, with a blue-red hole in his neck. "I can't move my feet," he yelled, over and over "I can't move my feet."
         The volume of his shouts was like a physical force in the small space. We hung blood immediately-deep red, the icy drops tumbling into him as he grew quiet, and his face settled into the mottled blue mask I'd seen so often in that room.
         On the X ray clipped to the board, the bullet appeared magnified, white against the grays of his chest, just under his heart. As we ran to the operating room, the gurney humming like a shopping cart down the hall to the elevator, I heard the nurse on the phone behind me. "They're coming up right now," she said. "Get the room ready."
         In the elevator the slow minute of quiet, he looked up at me, and I felt his hand on mine. "Please," he said, like a small child beginning to cry, "I don't want to die. Don't let me die."
         "You're not going to die," I replied, thinking he might very well. "We'll take care of you.”
         The bullet had clipped his aorta, torn through one lung, through the diaphragm, and into his belly. He lay on his side, his chest split open, while the surgeons struggled and cursed. With both hands I held his heating heart out of the way so the surgeons could see. His chest was like a misshapen bowl, dark and rich, filling again and again.
         "Jesus Christ, this guy is making us work," Rosa, the surgery resident, said, scooping out handfuls of clotting blood which slid off the surgical drapes onto the floor. Sweat beaded up on her nose above the mask, then fell, drop by drop, into the wound.
         There was so much blood they couldn't see what they were doing, putting in dozens of misplaced stitches until some began to stick, and the bleeding slowed to an ooze. He was cold by then, despite the anesthesiologist's best efforts and the heat turned all the way up in the room, his blood full of acid and losing its ability to clot.
         "OK," Dr. Blake, the attending surgeon, said, "We've got to stop and just hope he doesn't break loose."
         It was a long night in the ICU, transfusing him with unit after unit of blood and plasma. Toward morning he was no  longer recognizable, swollen from the fluid, bruised, but miraculously alive. When I came to see him, before sunrise, I found a police officer sitting in a chair reading a magazine. The policeman yawned when he saw me, put down his magazine, and came out to talk.
         "He's a bad one," he said, gesturing to the monstrously dis­torted figure. "We think he killed at least two convenience store clerks last year.
         "Really?"
         The cop nodded. "Killed them both, after he'd got the money." He made a shooting motion with thumb and forefinger. "Right through the head. We've been after him for a year."
         I vaguely remembered the crime ­- front-page news, CON­VENIENCE STORE CLERKS SHOT DEAD BY UNKNOWN ASSAILANT and I looked at my patient as if for the first time. He didn't move at all, letting the machines do their work.
         'I learned the full story from the other wounded man. He was not my patient, but that morning I went to see him anyway. Ray Solano, lying down the hall, had been extraordinarily lucky.
         'He was wide awake, off the ventilator and he looked up with a start when I came into the room. He'd been hit once in the chest, but somehow the bullet had followed a rib around and out the back without hitting any vital structures. He would be leaving the ICU shortly.
         "Mr. Solano," I said. "I'm sorry to bother you so early. How are you feeling?"
         "Alive," he replied, shaking his head, extending his hand. We shook, even though I'd done nothing for him.
         "What happened?" The man looked at me, and I realized that he was going to cry.
         "I knew he was going to do something as soon as he came into the store. He asked me for a job, and I told him I wasn't hiring." Mr. Solano looked up at the ceiling and took a deep breath. "Then he asked where my safe was, and I saw that he had a gun in his hand. I told him it was in the back, and then he just shot me. Right away, without asking anything else. I knew that he was going to shoot me again." He looked away, crying in earnest now, and I stopped asking questions, apologized, left his room.
        The nurse filled me in. "He knew he was going to get shot again," she said, whispering. "That guy"-she gestured down the hall- "dragged him to the back, where the safe was, and told him to open it, and he went for the gun."
        I imagined that struggle: middle-aged Ray Solano, already wounded, wrestling a much younger man, somehow turning the gun on his attacker and pulling the trigger, then staggering to the telephone. "There was blood all over the place," the cop had said, "like someone dragged it down the hall with a mop.”
        That night I saw my patient on TV. It was the lead story on the local news. A clip of the crime scene with ambulances, and then the smoky, black-and-white surveillance tapes of the pre­vious murders: an overweight, unrecognizable figure standing in front of a cash register his hand outstretched as if pointing at the men, then, very deliberately, two faint flashes, puffs of smoke, into their faces. They dropped like stones, the whole scene strange, distorted by the small wide-angle lens of the camera, like looking into a jar of water
         Over the next few days my patient began to wake up and was taken off the ventilator. I went to see him each morning, and he began to turn his head toward me, open his eyes. He started to look human again as the fluid eased out of him, his thick black hair flowing to the curve of his brown shoulders. He began to speak, to ask the nurse for ice, and within two days it was as if a light had come on, he was alert, back in the world.
         "Thank you, sir" he said, intelligent, as I stood above him. "Thank you for saving my life."
         "I didn't save your life," I replied. "The surgeons saved your life."
         "That was you in the elevator wasn't it?"
         "Yes."
         "I remember you.
         Then later, quietly: "Do you think I'll be able to walk again?"
         "I don't know. It's too early to tell."
         He was unfailingly polite. He thanked me whenever I came into the room, speaking in a curiously childlike voice. I found myself drawn there, doing things for him: adjusting his pillows, bringing him a glass of water There was an aura about him that fascinated me, a presence that the nurses also commented on. He seemed guiltless, unburdened by the act; his relief on learn­ing that his victim was alive and would leave the hospital was real. It meant one less murder charge to face. The evidence of the others was not overwhelming, and he knew it. As did the police.
        "That bastard might get off," one said, shaking his head. "It's a fucked-up world."
        "Hello, Dr Huyler," he said every morning, smiling at me, dark-eyed, his hair unkempt and thick against the pillows. There was knowledge there, and I was glad, even as weak as he was, that he meant me no harm, that I was not Mr. Solano, alone in the store and unready.
        Each day I helped him get better.

SPEAKING IN TONGUES

RUTH WAS A SMALL BRITISH WOMAN WITH CLOSE-CROPPED blond hair and a tiny white triangular scar that lifted the corner of her upper lip just enough to make her look secretly amused. She was the new attending neurosurgeon, already in her early forties, though you wouldn't know it to look at her with her smooth fair skin, her quick exact movements.
         Usually she was calm and polite, but you could never tell what would set her off. Her face would grow still, she would step up close, white-lipped, and empty her flat gray eyes into yours. It didn't matter if her tone was mild, or even if her anger was reasonable; you felt as if a door to a room you did not want to enter had opened, and then closed again.
         She was technically skilled, there was no question. She was quick and accurate, and could pop a pressure monitor into the  brain in her sleep, her small hands deft on the instruments. But by the end of the year the wards were full of rumors, and she was gone.
        Once, in the middle of the night, I brought her a CAT scan to read. She was alone with the scrub nurse in the OR, the anesthetist invisible behind the drapes. Music was playing chants, a vaguely Cajun rhythm, and I saw, looking in the hol­low where her neck rose out of the gown, that she was wearing a black, tie-dyed T-shirt under her scrubs.
        A man lay on the table, his head wrapped in sterile plastic. Through a little round hole in the center of his skull, I could see the dura, the thin connective tissue that covers the brain. The dura was a vague blue, bulging, under pressure, and hair shorn from the man's scalp, lay in brown clumps on the floor by Ruth's feet.
        "Thank you, Dr Huyler" she said, as I came into the room and clipped the scan onto the luminous board. She craned her neck, reading it. "Good. The ventricles are open."
        I turned to go, but she stopped me. "Dr. Huyler" she said. "Come here. I want to show you something." I stepped up behind her careful not to violate the sterile field, and looked over her shoulder at the wound.
         "Have you ever seen the movie Alien?" She was smiling a little.
        "I have."
        "Are you familiar with the scene where the alien bursts from the man's chest? On the spaceship?"
        "Sure.”
        "Watch." And she touched the tip of the scalpel to the dura, as delicate as a brushstroke.
        At first nothing happened. Then, slowly, a little blue-red worm of drying blood began twisting from the slit like tooth­paste, and suddenly the clot spurted out of the man's head like a plum, dripped down past his ear to the drapes.
        "That," Ruth said, "is how you take out a subdural hematoma."

WHEN I WAS A BOY my family lived in Brazil, and during those months, as Ruth revealed herself to us, it kept coming back to me - festival night, down by the lake. Ash Wednesday and Africa combined, macumba, or santería, or voodoo, call it what you will. The poor gathered there by the hundreds after dark. It was luck they were after, good fortune for the coming year. They stood in the shallows at the water’s edge with tiny boats they had made. On the boats were candles, photographs of dead loved ones and saints, offerings: bananas, small pieces of meat, feathers. They said prayers, then pushed the boats into the darkness. If the boats continued out in the water it meant the offerings were accepted. If they returned to shore it meant an indifferent future.
         And so nothing was left to chance. The boats were wired, with small electric motors and batteries -expensive in the slums - and they continued, for hundreds of yards, until it was a lake of candles, a small constellation of human need.
         A thousand miles to the east, the scene repeated itself on a massive scale, as enormous crowds gathered at the beaches of Rio and Bahia, and the boats went into the open sea. But the people here were too poor to travel, and so they made do with what they had: a small lake, with garbage on the shore, on the
         outskirts of the inland city. That night, in the dark, it seemed sufficient, beautiful, and the lake vast, without visible edges, full of candles entering the distance until they burned out.
        A few yards offshore, hip-deep in the lake in a long line, stood the frogmen of the military police. They stood quietly, their black scuba tanks and wetsuits glittering in the lights off the beach, careful to let the boats pass untouched between them.

ONE NIGHT IN THE ER, as the faint siren of the ambulance grew nearer, I sat with Angela at the doctors' station. She was a surgery resident who had just rotated off the neurosurgery ser­vice, and we talked about Ruth. It wasn't my case, I didn't have to go into the trauma room this time, and I felt calm, even con­tent, as I watched. Ruth stood just outside the trauma room, and she was angry again - I could see it in her stiffness as she waited for the ambulance. Someone had called her too soon, before the patient had arrived.
         The ER was full, as always, and a man was yelling nearby, his voice heavy and incoherent, that they were hurting him. "It wouldn't hurt if you didn't fight us," a nurse said, breathing hard, as they struggled to hold the man down on the gurney, buckling the leather straps to his wrists and ankles. He was wild, drunk, full of half-formed words, watched by the patients who sat waiting around us.
         "I don't know how you work down here," Angela said. The man heaved and bucked on the gurney, and nurses converged, a knot of dark blue scrubs bending over him, until he was quiet. I shrugged my shoulders, and we turned back to Ruth.
        Of all of us, Angela knew Ruth the best. By coincidence they had come from the same hospital in Miami, Ruth as a new attending, Angela to complete the last year of her surgery resi­dency. But there was no loyalty between them. "She got really friendly in Miami a couple of years ago," she said, nodding to where Ruth stood down the hall, "when she found out I was from Panama. She said they have some powerful magic down there. It was weird. She invited me over for dinner once and then we went out drinking. Now she acts like she doesn't know who I am."
         "She is good, though," she added. "She knows what she's doing." And she was. I remembered, that night before the har­vest, the liver transplant, how the pressure monitor had seemed to flow into the young woman's head through Ruth's hands, deep into the ventricle of the brain. And as the numbers climbed on the screen - 40, 50, 6O - Ruth had shaken her head.
         "She'll die," she'd said. "Her intercranial pressure is far too high this early." And then she'd gone off to find the family.

THE FROGMEN WERE THERE for a reason; there had been drown­ings in the past. Earlier, as I stood in the crowd with my father and mother watching the boats, I had noticed the women, dressed in white, their black arms dipped in flour. A dozen or so, and even at first they had seemed odd, a strange look in their eyes as they stood near the water. Slowly, one by one, they began to rock, back and forth, murmuring at first, letting it build up in them. Then it would start, the speaking in tongues, the jerking of their bodies as the crowd gathered around them, the convulsing on the ground, and finally, the rush for the lake. They would flip and heave into the shallows, driven out from the beach, soaked dresses clinging to their backs, to their breasts and legs, trying for deeper water. And then the frogmen would converge. It was the moment they had been waiting for grabbing the women in their arms, picking them up, and drag­ging them back to the beach. Then the line of divers would re­form, and the women would lie back, spent, in the blankets of the crowd until it came on again. It was the force of order of military rule, against the spirit world: soldiers, with women in their arms, carrying them to the safety of dry ground.

"RUTH KEEPS A COMPLETE fetal skeleton in a jar in her bed­room," Angela said. "She took it out and showed it to me. I couldn't believe it. She told me it reminds her of why she's a surgeon." Angela looked uneasily away, but after a bit she con­tinued, as if talking to herself alone. "Do you know what she did every chance she got when we were in Miami?" I said nothing.
         "She'd go to raves. She talks like someone in Masterpiece Theatre, and she was a regular rave-queen. She'd go when she was on call. She'd carry her beeper and whenever there was a bad head she'd come in smelling of incense. Everyone knew it.
         "When we went out that time she got pretty drunk. We were sitting there in this bar and this middle-aged woman walked by. Ruth was staring at her, I mean, just staring. And then she turns to me. 'Angela,' she says, 'there's something I want to tell you.' 'What,' I say. And then she looks at me, and she whispers, so quiet I can barely hear her 'I'll fuck anything.' That was what she said. 'I'll fuck anything.' I'm telling you, I went home pretty quick."

THE WOMAN CALLED 911, and told the paramedics, very clearly, that she wished to be transported to University Hospital, where her lover was a doctor
         She was big and black, with silver studs running up the arc of her left ear and she was crying. Her face was a mass of bruises, a split lip, one eye swollen shut, with scratches on her neck.
         "Ruth did this to me," the woman said clearly, to anyone who would listen. "Ruth. Ruth did this. This is what she does to me.
         But despite all the talk Ruth was the same. She continued, distant and controlled, just as she had been, nodding politely to me in the hall when we passed, a small woman, with small quick steps. They drove her hard, beyond herself. All of us were used to call, to being up thirty-six hours or longer but as a junior attending Ruth was on call every night, at home with her beeper. On a bad string, if events aligned, she could go for the better part of a week with only scraps of sleep, so tired she could barely stand, until the heads lay shaved beneath her fingers, and she had to do it again.
         And then there was that curious phrase, that I heard only once, under her breath, when things were going badly one night: "Esmeralda's going to die tonight."

WHEN ANGELA FINALLY turned Ruth in, the chairman of surgery came into the clinic with a nurse, and they took Ruth with them to the bathroom. As the chairman waited outside, Ruth did what they asked, went into the stall, urinated into the plastic cup while the nurse stood and watched. Of course she knew then that she was finished, but she went back to the clinic anyway, the nurse said, and kept seeing patients as if nothing had happened.
         'Her urine lit up. Fentanyl. Cocaine. Valium. Marijuana. The drugs of the hospital and the street, and she was gone, the very next day, the headlines - BRAIN SURGEON SHOOTING UP BETWEEN OPERATIONS - suppressed from the city papers. They handled it well - rehabilitation, a special program in another state, paid for by the hospital. No talk. The next plane out.

THREE MONTHS LATER, they rolled the man in, and this time it was mine, this time I couldn't watch from a distance. He was in his fifties, in a suit, ejected from the car intubated already by the paramedics, and his head, the bones of his skull, felt loose, like gravel and warm bread.
         "Call neurosurgery," I said to the nurse, then continued, lis­tening to his chest, feeling his belly, watching the scissors go through the suit cloth as we stripped him.
         And then Ruth walked in through the door like a ghost. She was done with rehab, and they'd let her come back. "What do you have for me, Dr. Huyler?" she asked, looking down at the dying man. I stared at her unable to answer for a few seconds.
         "Um, unstable skull fractures. And he's posturing." As I spoke, the man's arms curled again up to his chest, his wrists twisting outward in the darkest of involuntary reflexes. A bad head. His arms had their own intention, their own power and the nurses struggled to keep the IVs in place.
         "OK," Ruth said. "Paralyze him." So I gave the order the drugs flowed, and he went slack like a dead man.
         Ruth had changed, it was as if life had gone from her. She looked tremulous, frail, her skin wrinkled and dry. She looked her true age, she looked uncovered, with none of the strength I was used to, the well I had seen her call on again and again. She was a husk, and as we waited for the CAT scan I tried to make small talk. "Good to have you back," I said, watching her closely. Even then I knew it was a taunt, a match held up to the birdcage, where the hawk sat on a stick.
         She looked back at me over the man's still figure, her eyes glittering, and inclined her head. It was the last time I saw her. A few days later they caught her again, and fired her for good.
         "She'd been through rehab before," Angela said, "back in Miami, only nobody out here knew about it. Why would it work this time?" I wondered if Angela was afraid now. She showed no sign of it, but she had reason. Ruth's career was over all those years of work, and she had Angela to blame. "I felt bad about telling on her until her girlfriend called me up. She thanked me for turning Ruth in."
         "She thanked you?"
         Angela nodded. "She told me a lot about Ruth. How every morning before work she'd drink a cup of black coffee and do two lines of coke. Every morning. How when she'd had a really bad day she'd go to the farmers' market and buy a live chicken. She'd take it home and light candles and put on music and cut the chicken's throat with a straight razor"
         Esmeralda's going to die tonight.

BUT THE MONTHS PASSED, and Ruth was well and truly gone. No one knew where. Probably she left the city, drifted to the raves of New Orleans or LA, where no one would know who she was. But I'm not certain, and half of me expects to see her again, there in the doorway as I stand by the gurney.
         "What do you have for me, Dr Huyler?" she'll ask, full of prayers and cocaine, smelling like candles. And I'll answer her.
         "Gunshot wound," I'll say. "To the head."

These two stories from The Blood of Strangers: Stories from Emergency Medicine are published in The Barcelona Review with kind permission of the University of California Press, Berkeley. Book ordering available from www.cupress.edu

This story may not be archived or distributed further without the author's express permission. Please see our conditions of use.

Frederick Barthelme - Driver
Helen Simpson - Wurstigkeit
Frank Huyler - two stories
John Aber - Massage
Juan Goytisolo - two stories

George Orwell
Answers to last issue's Gothic/Horror Quiz

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