Unless you’ve glimpsed surgery from the inside, you can’t know how some things are just too much fun, too grab-ass exciting, to give up
The Day the Fat Man Almost Fell, The Day We Almost Lost Him, Danny is sitting on his stool beside the circular cubicle in which Mrs. Kincone washes the OR instruments, waiting for his next blue light, peeking down her V-neck top when she bends to get a new tray of dirties.
Mrs. Kincone is gap toothed, short, and plump. She harrows Danny with lust and fear. Her greens fit her so snugly (they seem shrink wrapped around all the female hospital workers) that Danny wonders if giving him a permanent hard-on is part of his Treatment Plan. When she squats to open the autoclave, he sometimes cannot suppress a soft groan. While her fingers paddle in the stainless steel pans bobbing with bloody bits, she sings, about the girls and young women lined up on stretchers outside Room 7, her little song of variable tune: “D&C, C&D, Lucky for you, Ooh! Aah! for me”—with an oysterish wink at Danny and sawing motions below her waist on the “Ooh!” and the “Aah!” Danny winces and grins.
The student covering Rooms 1 to 10 prowls slowly past. Danny gives him a friendly nod, but the kid flatlines him back. Lifer, Danny imagines him thinking, for which he has no real comeback. They’re about the same age, but Danny feels years older. True, as Senior Man, he covers eleven rooms to the kid’s ten. And the kid is slow to respond to a dirty room’s blue light (he’s been reprimanded twice already), whereas Danny knows enough about the lengths of many surgeries to be standing outside the door just before the light goes on. The Whipple procedure under way in Room 3 right now, for instance, means he won’t be needed there all shift; cleanup will fall to the afternoon man, who will also likely catch some shit from the exhausted team emerging. The kid wouldn’t know such a thing. But then why would he need to? It’s as remote to him as any of the other medical realities Danny has had to learn. Stent. Lipids. Plasmapheresis.
“Looking for somewhere to fuck the dog,” Danny says cautiously. Wisecracks are Mrs. Kincone’s department, and her deeply lewd mind can spasm at routine ribaldry. But she is tracking with narrowed eyes the kid’s receding ass. “No dogs here,” she mutters. “Nope,” says Danny, though he’s far from sure.
It is right into the sour silence after this exchange that the new thing flies.
“You! Come quick! Quick!” Danny turns at the shouts and sees a scrub nurse a little way down the curving corridor, her mask pushed down, frantically beckoning him. He is so excited to be summoned into drama, hospital drama, that he doesn’t care—doesn’t even notice—that a nurse he’s worked with for three years hasn’t yet learned his name. The nurse turns and sprints away, while Danny, who gets winded easily, walks after her as rapidly as he can. It is the Moment, the Call, that ever since his first days as an ALPer he has always dreamt might await him in the hospital.
Three years ago, when he had just left school and taken an on-call job in Housekeeping, Danny was an eighteen-year-old with spongy eyes and a reflex of ducking his head when spoken to or looked at directly, as if he could dodge expected blows with these head bobs of nimble deference. He suffered from a host of medical problems, some of them serious and invisible. The ones he worried about most, though, were the minor, middle-aged kind that came to the surface to attract curiosity and distaste: eczema that attacked his scalp (treated with a combination of a special shampoo formulated by a St. Bar–Laz dermatologist and a steroidal cream under a moisturizing barrier); rectal polyps (day surgery and ointments); and poor muscle tone (a physio/nutrition/vitamin regimen, featuring a booklet that grouped foods under Orange, Blue, Red, etc., and had pages of self-adhesive coloured dots he could put beside the appropriate choices on his copy of the cafeteria’s weekly menu). His major illnesses require him to take several medications, in pill and liquid form. Once a week, he receives an injection, an experimental part of his Treatment Program, which he qualifies for as a Research Associate and which significantly expands his ALP benefits.
ALP defines so much of his life now that he is amazed to think that only a couple of years ago he had never heard of it. “There’s a new program we’re rolling out,” said Dr. Rufus Cushing, a man high up in Admin to whom Danny had been referred by his long-time GP, a fuddly old shoulder squeezer who these days had little to do with Danny’s care (which from the start had taken him far out of his depth) beyond coordinating his visits to various specialists. Under the Assisted Living Program—”Not a disability pension, not a Goodwill kind of job at all,” Dr. Cushing corrected Danny sharply, but a holistic treatment model, cutting-edge innovation; if he didn’t find it to his taste, there was a long waiting list of applicants (Danny was too cowed by this rebuke to recall that he hadn’t applied for anything). He would be entitled to a number of benefits, which would multiply as the program expanded. With each benefit he listed, Dr. Cushing poked a finger from his fist. Discounts on food in the hospital cafeteria. Meds. Physio. Employee discounts (“Full-time employment in the complex is part of the program, did I say?”), plus the ALP discount would mean that most necessaries could be purchased with little or no cash. Eventually, it was hoped, deductions could be made straight from Payroll, “because, let’s face it, none of us likes getting paid with one hand and giving it back with the other.” (Danny liked Dr. Cushing, he liked most people, and facing him across this desk in this office made him feel as if his head was filling with gas and lifting off from his body; he was only unnerved by the suddenness of the man’s grins, fault lines of mirth that split his face without warning and then closed up just as abruptly, at jokes Danny hadn’t got or maybe hadn’t heard.) First crack at joining study teams as a Research Associate, some extra benefits in that, one such opportunity coming up soon, if he wasn’t mistaken. Subsidized housing. (Here Dr. Cushing lowered his voice and leaned across the table; Danny leaned in, too, over the rich litter of files.) “Not really needed as part of the program, but when a couple of us got talking about the wages we pay you and the cost of an average flat these days, well, we damn well insisted on it. Correction. We slid it in…”
When he got his room in a renovated house near St. Bar–Laz, Dr. Rufus Cushing himself gave him the key and took his deposit. Another housekeeper and a guy from Maintenance were already living there, and more support workers were moving in to other old houses nearby, which the hospital was buying as fast as funds allowed and turning into multi-unit dwellings. “Shit,” said the Maintenance man one night, when they were sharing a pot of chili in the communal kitchen and joking about the cute ward clerks two doors down. “Looks like we made it to college after all.” There were rumours of future underground tunnels that would connect Housing to the hospital, everything would be underground, you wouldn’t see anything from the surface, but for now there was the bitch of a walk in February down Concession Street—but Danny didn’t mind, it was what, ten minutes, and with so much construction going on there were always plywood hoardings to break the wind, big earthmoving machines and pallets of bricks and cinder blocks, and sometimes cozy wood and plastic sheeting tunnels, dim inside and flappy like the wind picking at an old hut—hell, it was halfway an indoor walk already.
At the door to Room 6, the nurse is standing, waving a mask like a frantic hanky. Hurry, hurry, put it on, put it on—she doesn’t need to say the words. Over her shoulder is a monstrous sight. A gigantic naked man, he would go at least 400 pounds, is on his side at the very edge of the operating table. Behind him, on the other side, the surgeon and two scrub nurses are gripping him desperately, their gloved fingers sunk in his clammy-looking flesh. At the head of the table, the anaesthetist is trying to keep one hand on the tube down the giant’s throat while leaning forward to push with the other between his great, pouring breasts.
He is falling off. Already too much of him is over the edge for them to push him flat without losing him. And none of the three behind can let go for the few seconds it would take to rush around to the other side. And push what—a 400-pound dead weight?
“Let’s go! Let’s go!” shouts the surgeon, catching sight of Danny.
“He’s not sterile!” calls the nurse.
“Fuck that! We’re losing him!”
“They were trying to turn him over on his front, but he got away from them,” the nurse says in a rush while motioning Danny in.
“C’mon, c’mon, c’mon,” bawls the surgeon.
Surgeons, with their gowns and soft upraised hands, get kowtowed to like priests, but like priests they must traffic in squalid secrets. Their job is a calling and a curse. Danny has seen amazing things through the little rectangular window high in OR doors. Legs painted orange from ankle to hip and hoisted into the air in stirrups, the painter’s head thrown back in a silent guffaw at whatever his smirking henchman just said. A hand on a platter—waiting? left over? They come to speak of the body in parts, like butchers, though a few resist this brutal drift. In the staff lounge, a burly General says, yawning, “I’ve got that breast in 19.” “Pardon? ” says a prim young Plastic, with a warning glance Danny’s way. “I’m—taking—off—that—tit.” They have huge homes, a cottage on a lake or a condo in the Caribbean, and drive whatever cars they like, but they do work a sewer gang would refuse.
Danny walked into one room where the stench was like a bouncer’s chest, something so huge and unyielding that it hardly seemed to be a smell. The last nurse staggered from the room with her hand over her mouth, flapping her other hand behind her. Danny pressed on. Two puddles of vomit lay near the table. Surely that couldn’t be the smell. Around the table were scattered blackish chunks, like cooling lava left behind by a little volcano. Chunks of shit, Danny learned later, that the surgeon had pried with his fingers from the bowels of a man constipated to this point of petrifaction. Even after he’d bagged the muck and sprayed every surface multiple times, taking shallow, gagging breaths all the while, the smell remained the same. As if it had no definite source, so could find no exit. “Disimpaction” was the word Danny learned that day, another nasty thing surgeons did. Like dictating over your name—the Chief Surgeon did this—a posted memo that nurses wearing smock-style greens “must always wear underpants, due to the risk of perineal fallout.” Shit, again, was what was meant. Shit specks falling from a nurse’s crack, which could float around the chilled air and drop inside a patient’s opened body, where they would explode like bombs. Shit: a surgeon had to keep his gaze fixed on it.
Danny knows just what to do. How he knew, he will always wonder at. The falling man is leaning at a more dangerous angle than ever, his huge, blank head with taped eyes and mouth stretched around the tube facing the floor, thirty fingers slipping back in slow, dreamlike channels through his flesh. Danny scoots in underneath, turns around, and gets his back under the centre of the toppling mass. Soft weight sags onto him, like an immense flesh tent collapsing. The others let go, or can’t hold on anymore, he hears their curses as if they are far away, as if they have left the room and are watching this through a window or on television. But it is all right. I’ve got it. I’ve got him. His knees buckle, but he throws his arms out like a weightlifter, letting more of the great flesh flow down through them to the floor where it wants to go. He is wheezing and turning, he knows, blue in the face from one of his invisible problems, but he can do it. I’ve got it. Though it might be the work of twenty seconds for the three to come around to his side, or no, just two of them, a man and a woman, and push the great man back while the third steadies him to make sure he doesn’t topple off the other side, Danny will always remember it as a long and complicated rescue operation, something he was doing or preparing for, for a long time, and would keep doing for a long time after, a task that moved, or its shadows did, backward and forward in time, reclaiming what it needed from his life.
It is done. The man is back on his back, staring through his taped eyelids at the white ceiling lights, a nurse draping a cloth over the area where a bud of penis, shocked and shrivelled, must crouch. Blinking sweat from his eyes, his nerves adrenalized and singing, Danny waits for instructions. They still have to turn him, after all. Get him on his belly. Are we operating on his ass?
“Get him out of here,” mutters the surgeon, stalking away.
Hey, Atlas,” says a nurse he passes later on his way to afternoon break. She is gowned and masked, just a slit of eyes and forehead below her bonnet. It’s exciting not to know who she is. She might’ve been one of the ones in the room, watching him save the day, or she might’ve just heard about it, the story might already be making the rounds. “Hey, Atlas,” she says, with a teasing lilt and a quick wink that freezes in Danny’s sight—one eye closed, one eye open, nothing like Mrs. Kincone’s heavy-lidded stares, innocent and fun and full of dirty mischief all at once—and though he doesn’t know what “Atlas” means, if it means this wink, he’s ready to pawn his birth name for it.
Twenty years later, he’s still riding that wink. It comes back to him at odd moments almost every day, like the flutter of a magic carpet he’s perched on. I’m Atlas. Danny is the instrument washer now. Mrs. Kincone’s veins and knees couldn’t take any more standing, and about that time her husband had his first coronary, so the two of them had to enter a Research Associate Plan in a hub in another city.
So much is changing, so fast, at St. Bar–Laz, that Mrs. Kincone’s departure is hardly noticed. Doctors and nurses, hospital staff from administrators and technicians down to pot washers in Dietary, planners in hard hats, construction workers—personnel of all kinds come and go, swapping places like the interchangeable soldiers of a vast army on the move. A squad will move in one day on a specific campaign, set up camp in some corner of the enterprise, draw for a time huge stores of interest and energy and other supplies, then strike camp just as suddenly, departing after days or months without goodbyes, sometimes leaving behind a shining completed project, the visible sign of transformation, and sometimes leaving a site looking as it had before, with no clue as to what purpose might have been achieved or thwarted or invisibly commenced. It’s as if standing still has been identified as the one true disease, and the entire hospital, down to its last bit of material and human energy, dedicated to its cure. Change itself makes the air electric, it moves into every sense, a tingling white noise hum that is a shining of charged particles of anticipation and a sweet, stinging nectar on the tongue and a faint whiff of singed matter that revs you up and makes you blink in delayed recognition.
The OR where Danny started is now one of eight surgical pods, three of which are up and alternately running (one always is, of course; it astonishes him how they can schedule this, moving the active surgeries around amid the renovations, these sterile life-and-death procedures in the midst of cables and sawdust and dirty boots and banging), connected by temporary plywood walkways to a central hub, a vertical tube filled with large, fast elevators to whisk patients and supplies up and down. When the eight pods are completed, there will be nearly 200 operating rooms, all of them going all the time. (For years, Danny has heard people say surgery will soon be obsolete, new advances will phase out something so primitive as slicing people open, but he knows better. Unless you’ve glimpsed it from inside, you can’t know how some things are just too much fun, too grab-ass exciting, to give up.) In the pod that’s furthest along, they’re wrestling with installing a Movator—they keep having to rip out what they’ve laid and start again—a gully with a floor of black rubber webbing that will run around the perimeter of the pod, then scoot down the arm to the hub and around that, carrying supplies and, Danny imagines, extending what he has been told, porters and housekeepers and perhaps even patients. Keep the hallways clear. He goes over on his breaks to check out the progress, but the workmen get on his nerves. They call the Movator the Gutter, the Trough, never by its proper name, sitting on the edge of it with their boots dangling, cracking farts and jokes, tossing chip bags and smoke butts down into it as though it were their personal garbage trench, though when break is over they hammer and wire and measure with total concentration, their faces intent and professional. The contrast grates on Danny, who would rather not view someone in these shifting colours, but either all the way a Jerk-off or a Good Man.
A better time to visit is after hours, when the workmen have gone home. Then he can walk around the tools and piles of materials and hanging wires and fixtures and imagine the future, seeing it all. He walks for hours sometimes, getting lost in what is unfolding, this gigantic flowering that surrounds him. The tunnels to Housing were completed long ago, so he can ramble, lost in his thoughts, for hours, and still trust his feet to get him to an elevator that will take him down to a corridor leading to his room. Sometimes he thinks he should go outside and walk a long way away, to some vantage where he can take in the whole project, but somehow he never gets around to it; there’s too much to do and see inside, and one day swallows another. Included as part of his TP is a subscription to Medworld Marvels (his favourite in the last issue, a real mind blower, “Self-Med Sam: The Terrifying True Tale of a TP Tinkerer,” with its unforgettable first line: ” ‘Thought you knew better than the doctors,’ said, as soon as it had lips, the head growing in his armpit.”) And he knows he is living inside the most amazing story of all. Of all the ways his ALP package has expanded, the pass that lets him roam about the hospital is the one he appreciates most. No matter how long they keep me alive, I’ll never see it all, he murmurs to himself, his throat husking with emotion. Some of what he sees seems torn from a dream (or all of it does, but some parts he remembers clearly and knows he dreamt, while others float close in elusive snippets, half-recollected fragments snapped from source or context: Did I dream it? Read it? Hear it somewhere?). Like the day he was way out at the end of some corridor, when he found himself at the rim of a vast open space, sunken in its middle like an amphitheatre, not outside but so wide and bare it felt like it, with cracked concrete showing dirt and pallid weeds, the domed glass ceiling high, high overhead, and an older workman sitting on a crate, who told him that down the line this would be the Fish Pond—and instantly at the words Danny saw it, blue ripples, grass, trees bending over from the banks: “Can you imagine what it will mean to the kids? Bring them over from Pedes, whole buses of them, let them catch their dinner, get their pictures taken, then take them back to Dietary for a fry-up. Or do it right here. Fires on the shore. Who knows what they have in mind?” He left the old labourer and paced around to the other side to picture it in privacy.
There are bad days, of course, same as any job, hours of just ache and frenzy, when future visions by themselves can’t sail clear of the murk of numb hard doing. Routines are needed, little numbers. That’s when Danny, bald and wheezing, forty but looking sixty, rasps out “D&C” to a horrified kid (the stool’s the same, but the kid keeps changing, he never learns their names)—What kinda weird fag am I? he thinks mid-grind without missing a beat—and never says where the song came from or that it isn’t his own. Most days, though, fantasy can float him through. Only: is it fantasy if it helps birth the real? One pissed-off shift that turned out great, years ago, they seconded him to Admin, who were short a bunch of dogfuckers, and on the wall of an office he was vacuuming he saw a beautiful rendering, ink and watercolour under glass, of the finished hub and pods. The rest of the structure and the city below trailed away in suggestive smears, cloudlike clusters, but the close-up of the pods showed them as clear ovals, circled by dark bands about two-thirds down, like wires holding transparent eggs above boiling water. That’ll be where the Movators run, he thought excitedly, peering from an inch away, the vacuum hose dropped. And he saw himself crouched in the nub or nipple of Plexi-bubble below the band, like a ball turret gunner below the great belly of his craft, all the throbbing, vast machinery shuddering above him in his clear, busy nest, the misty-transparent city dreaming far below. He gazed a long time, until the picture hung inside his mind, and the wall was merely a pool reflecting it shimmeringly back to him. It hangs in undistracting darkness, bathed by a single brightness stopping precisely at its edges. He stares and stares at it. Losing track of himself, of his surroundings. And though it makes no sense, he knows that by concentrating on it, believing in it, day after day, hour after hour, he is doing his part to make it come about.
This appeared in the June 2012 issue.