This version of my novel has been superceded by re-writes three and four. This version is only of historical interest and I admit that history is a bitch. Don't want this history repeated nor retold. Go to the book and read the new version, when it's published.
TheMadMutt. Go to my new blog KarmicKnightMadisonMuttnickMD
This fictional story is a WIP (Work In Progress) although the manuscript is a final draft. This is truly a work of fiction and all characters are imaginary. Any resemblance to persons alive or dead is purely coincidental. The actions and histories portrayed in this narrative are as well fiction. They were written for the reader’s enjoyment. Please enjoy. Please look at the title for the date of the most recent revision of this chapter. Thank you for your consideration.
TheMadMutt. Go to my new blog KarmicKnightMadisonMuttnickMD
This fictional story is a WIP (Work In Progress) although the manuscript is a final draft. This is truly a work of fiction and all characters are imaginary. Any resemblance to persons alive or dead is purely coincidental. The actions and histories portrayed in this narrative are as well fiction. They were written for the reader’s enjoyment. Please enjoy. Please look at the title for the date of the most recent revision of this chapter. Thank you for your consideration.
Prologue
February 17th office hours ended at 5. My office manager Peggy rushed out a minute later, without saying good-bye, slamming the door. At 6 Rose left to make dinner, then the call on the private line came from the Emergency Room. My car’s mechanic Willie Washington had been in a motorcycle accident. He wasn’t wearing a helmet. There’s a reason they call it a brain bucket. He knew cars, but had no concept of neurology, neurosurgery and brain death.
My colleague, Fish, was Willie’s internist. He ranted at me on the phone.
“How bad is it?” I asked. I had my coat on prepared to brave the February New Jersey cold on the way to my home. My destination changed instantly.
“Both legs are broke. Just get here quick, and bring a Neurosurgeon if you can find one.”
“Shit. You must be kidding.” I sprinted from my office to my car without calling Rose who waited for me at home. I drove to the ER like I was racing in the Indie 500.
No Neurosurgeons came to our ER because the administrators had refused to buy them a microscope to operate through. We had the task of keeping head injuries alive long enough to ship them out. Like UPS we wrapped and shipped them, but four victims, all salvageable, died this year before they could be sent out. They, instead, shipped stiff and cold to the morgue. Pressure on the brain kills every time.
My job as Willie’s orthopedic surgeon was to quickly splint Willie’s legs, so he survived to his next stop, a hospital with a neurosurgeon to decompress the pressure on his brain.
When I rushed through the ER doors, I bumped into Dr. Beller.
“Did they call you for this guy?” He pointed over his shoulder at Willie, who was gorked out, tube down his throat, a respirator breathing for him. “I was here and I thought . . . it was an emergency.”
Dr. Smith the chief physician of the ER called these patient “fresh produce,” meaning vegetables waiting for the some one to harvest their organs. Not much more we can do.
“He’s my patient.” I said. “Thanks for the look in.”
“Sure, didn’t want to waste my time. He has no insurance. Bikers rarely do.” Beller turned and walked away to his Ferrari parked in the ER lot next to my Honda.
Fish called to me, “Hey, the left leg is open.” He meant that the broken bone’s edge had cut through the skin. Infection was another way for Willie to die.
Willie bled rapidly from that wound and another on his scalp. His blood pressure dropped. All around the bed, people raced this way and that. It didn’t look coordinated, but it was even when two people gave commands at the same time.
I blew up a tourniquet at the root of his thigh. Easier said than done, because he had a new joint between his knee and his foot. When we lifted the leg, the foot wobbled back to rest on the stretcher while the knee stayed up in the air. Lifting required three sets of hands. With the tourniquet inflated and the bleeding from the leg stopped, his pressure stabilized.
We had another major dilemma. Filling him with blood and fluid expanders like Dextran, to keep his blood pressure up, would also increase the pressure in his head. The skull is a closed space and bleeding, has no place to go. It’s like blowing up a concrete balloon with gas under high pressure. Eventually the brain gets no oxygenated blood and it dies.
We could give him a functional blood pressure, but the same blood replacement would kill his brain. It was a no win situation. The pressure had to be relieved with holes put in the skull. The CT Scan confirmed the need for burr holes, a growing blood clot on the brain. But there were no neurosurgeons to do that, and no scope to operate through.
I cleaned his wound. Fish helped me tossed white wet plaster behind his legs from toes to groin. Then we wrapped it in six-inch Ace bandages. The tourniquet baked into the hardening splint, and would be a bitch to remove. Who cared? He was orthopedically ready to ship. "Where was the ambulance?”
Fish yelled, “His rate is 160. Shit. We’re goina lose him.”
The markedly elevated heart rate predicted cardio-vascular shock.
Orthopods don’t deal with that kind of stuff, but I knew this wasn’t good. I’m a betting man, and I wouldn’t take a million to 1 that Willie was going to survive. He arrested and went flat lined at 9:30 just as the ambulance for transfer arrived outside the ER door.
The code failed.
Modern medical treatments require updated software with hundred thousand dollar price tags. OR equipment, that saves patient’s lives, demands up keep and overhauls that cost money. Every day hospital administrators make decisions that shunt money toward good purposes. Money is never available for everything a hospital needs. Priority rules. But Shark-face’s ass rides on leather seats in a hospital bought Mercedes Sports Coup, a perk of being Vice President of Medical Affairs. Whose good purpose does that serve? Whose priority?
My Johnny-coated patients slide bare assed into a CT machine whose last software update was in the twentieth century. Another friend Saul Goodman lies in a box, ready for the deep six. Saul needed emergent surgery, and the tools were not ready because the second sterilizer had broken down and wasn’t repaired. That money bought hospital CEO Marcus Campbell his top of the line BMW 735ix sedan. I had a remedy for these problems.
My mantra became Benedict “Shark-face” Nyestine MD must die.
Chapter One – Let the Coma Begin Chapter One
Grandma said, “Don’t wish others evil, it’ll boomerang back to you.”
By May Day, I lay unconscious, on an ICU bed, unable to open my eyes, like a physician in role reversal therapy. For my benefit they gave me an intravenous Mickey Finn, Succhinylcholine. The injection paralyzed me. The respirator pipe down my throat breathed for me. Beats an immediate all-expense-paid trip to the great hereafter, like Saul’s.
Benedict “Shark-face” Nyestine MD had paid full price for his one-way journey. While I rested, the image of his battered head repeated in my brain. It resembled a purple over-ripe cauliflower that had sprouted six-inch strands of silver hair. Succhinylcholine arrests your muscles, not your thoughts, and all of mine ran to regrets. I’m a hard man, as innocent as a priest, who gets things done no matter what. Now, I had regrets.
I wanted to open my eyes and tell Art, Pam and Rosemary, who stood around my bedside, that I was going to be all right. I would make everything cool, but . . .
The way to detour my brain – and stay sane – was to distract it. I catalogued all the gaffes I had made since February 17th. That was a Monday, cold, with dark clouds, but no snow. The day Willie died, and I planned putting the bulls-eye of death on Shark-face.
That and two prior decisions almost did me in. I’m lying here circling the drain, like the last of the emptying bathtub scum, aren’t I? At the time of those decisions, I thought my life not worth much more than tub scum. Today that’s changed too.
The initial mistakes in chronological order, number one: Rosemary Angelucci, aka Rose or Ro, the woman I stopped myself from loving. I figured out she no longer wanted my friendship and would dump me. I’m more dump-able than a truckload of trash on Staten Island. That evening my office x-ray tech, tenant and unofficial computer wiz fumed at me. I couldn’t separate Rose’s frustration from her anger.
I returned home from the ER past 10 PM and yet I stopped to play the white knight for the Higgins’s Calico cat. Trapped in the bramble beside my house, it wails would do a dead Arab’s funeral proud. The situation demanded a rescuer. Doctors brim with that.
Rose glared at me through my shore house’s bow window, as she put a hammerlock on my dog, Bubs. Not feline aficionados, they showed impatience for my return inside.
Climbing the steps to the house afterward, my tired legs wished for a rope tow.
When I opened the door the Wheaton Terrier - Poodle mix-breed greeted me with a cold nose and dog food breath. Her tail wagged her shaggy haired body. “Good girl.” I patted her neck. Only the study lights were on. I stood in the twilight light, throwing a long shadow.
“At least someone is good.” Rosemary shouted from the study. Her constant smile had disappeared; replace by stern heat. “A call would have been nice.” She wore bulky boy’s plaid flannel pajamas over her petite figure. She stared into a mirror, but watched me. She released the large brown barrette from her bun. Her blond hair slid down to her shoulder blades. She was a babe. She’d correct this old gargoyle by saying, “you mean a hot chick.” That’s our different generations talking.
“Your dinner’s room temperature. Why do I bother to cook?” She swooshed her knit-slippers down the hall without a glance over her shoulder.
The study held the fragrance of Pleasures, my Christmas gift to her. I sneaked a deep breath. After two years of living together, the scent meant I was home.
“You stopped to save that feral cat, but couldn’t call me?” Rosemary paused outside her room. “I worried. I’m tired. See you tomorrow. Breakfast’s Special K? 15 pounds to go to Doc Fischbein’s number.” She slammed her door. In a second the light escaping from under it went out.
The grilled chicken was cold and rubbery. The lettuce on the teal china plate was impotently limp, along side a dried-out tomato. Such is life. No dressing and no flavor, no problem, my murderous thoughts prevented me from caring.
Mistake two: that things can never change, because there is no free will only deceit and delusion. My family departed New Jersey more than ten years ago. They could never return. A man committed to family values without a family was my destiny. I felt like a discarded glove with no hand to warm.
Recently the same could be said for my orthopedic surgery practice, which counted fewer and fewer returning patients. The emergency room stopped calling me. I was a healer with no one to heal. I am whom I make better, or so I thought. My purpose became improving medical care, by killing Nyestine and then maybe Campbell. That was the plan.
In 1969, paying back the Berry Plan with service at the military hospital in Subic Bay the Philippines, I had freaked over too many patients, so young, and missing limbs or mentally damaged or both. Recently, I worried about too few injuries to make a living. That change in attitude bothered me as well. I wanted it both ways. My practice functioned just this side of red. My staff trimmed from four down to two, because of cash flow.
On February 17th, the day before I would kill Benedict Nyestine, I diagnosed my life a terminal condition, an irreversible and unsolvable disaster of metastatic hopelessness. That gives you a free pass to do something beneficial for mankind without worrying about consequences. Nothing of value would be lost. My conclusions: the best ending was a heroic final act.
That February night as I slept in one-hour bursts, I listened to the clock in my unlit room tick, tick, tick like a time bomb. My mind was ready to detonate. The foundations of my medical career, the ethical arguments against causing injury and death, fought with my proposed duty to my patients, my community and humankind to remove this evil.
Pure evil does exist like Jack “the Ripper” or a self-interested hospital administrator.
At Subic Bay Hospital, I tended a Marine Military Police Investigator for over two months. A non-fatal fragging by a junior officer confirmed his Machiavellian character. During his treatment, I learned chess. He taught me the performance of conscienceless duty. From our games, he thought I’d make a great MPI. I could be that way with chess pieces, sacrificing without remorse, not with living men, not till now.
My military Colt .45 could champion the people. Maybe that MPI was right. I could be the man. Or maybe not. My morbid sense of humor remained intact.
I had cleaned and dry-fired my piece the week before. Tonight before going to sleep, I loaded it. I placed it on the bureau next to the scrapbook that archived my proudest achievement, my daughter Pam. But my family was no more, so . . . you live shipwrecked alone on a deserted island long enough, and you hear voices. I listened to them, knowing where they came from. I wasn’t loony, just incensed to the nth degree.
At 3 AM in the light of the bedside lamp, I fondled the album. I opened it to my favorite pictures, when Pam and I had skied at Aspen, or her traveling soccer games. The time her team placed second in the New Jersey Olympics of the Mind. Her smile with and without the braces that made her front tooth gap disappear. I put the album back. The fairy tale had reached its conclusion without me, somewhere out of my sight. My story would end without her knowing.
Happy endings cost. Someone pays for everyone else’s happiness. February 18th, I’d grabbed the tab, my treat. Repayment not expected. I hoped that God is a fair CPA.
5:45 AM I woke to approaching thunder.
Medical student Psychiatry: Neurotics can’t sleep and psychotics wake up early. I was neither, a little clinically depressed, whatever that is, but I had that problem saddled and ridden.
I looked at the Colt.
I watched the clock.
My mind kept busy so I wouldn’t think.
At the alarm, Bubs would scratch at the foot of the bed and put her furry face on the quilt. Soft brown eyes staring, unconditional love or overloaded bladder? I wouldn’t question which. You take what you can in life, and try not to sweat the small stuff.
Could she love a murderer? I doubt it.
Could I be a murderer? A more difficult question to answer, but . . .
February 18th a Tuesday was twenty-five degrees. It thunder-snowed.
At 6:10 AM the bedside alarm exploded. Bubs scratched at the bedpost then rested her head on my right arm. The day of community salvation had arrived.
The end of chapter one.
So long for now, till I see you too late to avoid you.
Chapter two will be posted in two weeks.
I'm out of here.
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