Several new posts at Criminal Element

Since I last posted here, I have completed several new essays for Criminal Element. They have since been posted. I hope that you visit that site and read mine as well as the other writer's works. The blog has many interesting essays about crime, and crime fiction. It deals with many media forms including the written word, television, and films. It also deals with the history of crime fiction. Many successful authors post on it and there are excerpts from newly published books there as well.

Here is a direct link to that Macmillian sponsored blog Criminal Element

Hunt the sight and find what you want.
Good Luck Hunting. No Matt Damon plagiarism there.

The Mad Mutt.

It's been a while

Sorry I have neglected to post for some time. It has been a very busy two months. I have had four of my essays posted on http://www.CriminalElement.com. I have several more which I hope will be published in the near future.

I have a short story waiting for a final decision, thumbs up or down from Alfred Hitchcock Mystery Magazine.

I have a manuscript with the first fifty pages sitting on the desk of a real live literary agent. How the hell did that happen? I pitched it to him at the Edgar Cocktail Party. He must have been drunk.

During this excitement, I managed to cultivate a gangrenous gallbladder and had it taken out laparoscopically. I am researching my next novel manuscript, and reviewing one of the best books I have found so far on editing your work. Stein on Writing by Sol Stein.

I have another short story that is running around in my head, but that will have to wait until I see what happens at AHMM.

So please drop by here and http://www.CriminalElement.com to see what silly thing I have ranted about now. Enjoy.


Lewis Preschel MD aka TheMadMutt aka Dr. Madison Muttnick.

It’s been Launched!

Macmillan Publisher has a new website: http://www.CriminalElement.com.

It is a collection of essays and excerpts from manuscripts by previously published mystery writers and neophytes like yours truly. My first essay Don’t Try This At Home was published on April 24^th, 2011. It was received quite well to my happy surprise. See why Mel Gibson is full of shoulder when he slams his joint back in during Lethal Weapon ii. See the error of an award winning author in a best selling Novel, that is in paperback. I will be writing often about medical errors in popular novels, but I will also write about television mysteries, and the historical basis of criminology, such as fingerprinting and the use of DNA.

I’ll be posting a serial of articles on fingerprints through history and literature. I should interest those who like minutia as well as interesting historical stories. My subtle sense of humor is sprinkled through out like a two year-old boy who is watering the lawn because he can’t hold it in anymore.

So tell your friends who like and read mysteries and those who like to watch mystery shows on television that this site will have many interesting essays. In the future I plan to diagnosis Dr. Megan Hunt’s parathesias. She is the star of the ABC television show, “Body of Proof.”

There will also be a piece on the problems I have as a physician with the logic and premise of some of the mysteries that are very popular, by authors who are best sellers. I am fearless in tackling reality as portrayed in fiction.

So here is the link to http://www.CriminalElement.com.

Go there. Have Fun. Leave me a comment.

To go to the first several Chapters of The Fatal Blow, A Madison Muttnick Murder Mystery, use this internal link. In the beginning Or go to the archives of this blog, Date of posting 21April 2011.

TheMadMutt aka Dr. Lewis Preschel

Aren’t you Mad too?

The Fatal Blow - Lewis Preschel M.D.

Oh please don't read this version of All Evil Needs is Opportunity. It has been re-written and now is called Part of the Solution. But to read that, you will have to wait till it is published. For now, Go to KarmicKnightMadisonMuttnickMD at blogspot and see the world that Mutt and Darvesh Mack Singh, his mentor, inhabit.

Chapter One

Six PM February 17^th the door to Hades slammed shut. I locked it. I am the gatekeeper. Another day from hell at the office had finished. Leaning my back against the door, I tried to suck all the oxygen out of the waiting room, and then blow it out as a sustained middle c on my imaginary trumpet. It didn’t cleanse me. My soul needed more than that.

Then the Emergency Room called on the private line. Willie Washington, my car’s mechanic, had a motorcycle accident. Everybody knows a Willie Washington, a guy who’s inexplicably happier than he ever should be. They’re infectious. Willie forgot to wear his helmet. They’re called brain bucket for a reason. He knew cars, but had no concept of neurology, neurosurgery and brain death.  

“How bad is it?” I asked. I had my coat on prepared to brave the 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.” Dr. Fischbein, a glass-wearing Zen master of an internist, ranted. Fish was my friend too.     

“Shit. You must be kidding.” I drove to the ER, running two red lights and surviving.   

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. They, instead, shipped stiff and cold to the morgue.    

My job as Willie’s orthopedic surgeon was to splint his legs, so he could travel to a hospital with a neurosurgeon to decompress the pressure on his brain.     

When I rushed through the ER doors, the smell of alcoholic blood, sweet like a dessert wine, along with the bustle in and out of the trauma room signaled serious injuries and blood loss. Just outside the trauma room, I bumped into Dr. Beller, the orthopedic version of the Hulk in Armani rather than tattered clothes.  

“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, I’d wrap him or he’s fresh produce. You know?”  

Produce as in head-injury patients became vegetables, waiting for the some one to harvest their organs. Selfishly, I wanted Willie to keep his innards to himself for a while.     

“He’s my patient.” I said. “Thanks for the look in.” The exchanged took seconds.

“Glad I didn’t waste my time. He has no insurance. Bikers rarely do.” Beller hustled away to his Ferrari parked in the ER lot next to my Honda. 

Fish called to me, “Hey, the left leg’s bleeding through the gauze. Come on man.”

Unwrapped, the white bone stuck out, contrasting against it’s red marrow. Infection was another way for Willie to die.

Willie’s scalp laceration bleed onto his forehead. An ER doc was suturing it. 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, lifting required three sets of hands, because he had a new joint between the knee and ankle. With the tourniquet inflated and the bleeding from the leg stopped, his pressure stabilized.

I heard Fish take a deep breath as if the situation had improved. 

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 his bleeding had no place to go. It’s like blowing up a concrete balloon. Eventually the brain gets no oxygenated blood, or is crushed and it dies. It was a no win situation. The pressure had to be relieved with holes put in the skull.

The blood clot on his brain grew like a flooded pond behind a very tall dam. The CT Scan confirmed the need for burr holes, but there were no neurosurgeons at our hospital to do that, and no scope to operate through thanks to our administration.     

I cleaned and bandaged 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. Open up that second line full.”

The markedly elevated heart rate predicted cardio-vascular crashing. 

Orthopods don’t deal with shock. Internist says we’re carriers. I’m a betting man, and I wouldn’t take a million to 1 against Willie’s next stop being the basement morgue and the necrophiles. He arrested and went flat lined at 9:30 just as the ambulance for transfer arrived outside the ER door.

The code failed. 

I slumped in a chair outside the trauma room, while Fish used a black pen to fill out the death certificate. 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 at Bloomfield- Cooper, 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. The first was steaming a load for 45 minutes. That cycle couldn’t be interrupted. That delayed his surgery and croaked him.

Hospital CEO Marcus Campbell bought his hospital-owned fully loaded BMW 735ix sedan three weeks before. I had a remedy for these problems.

I had to start my crusade somewhere. Biblical an eye for an eye.

My mantra became Benedict “Shark-face” Nyestine MD must die.

Chapter Two

By May Day, I lay like a slab of beef unconscious, on an ICU bed, gorked out, repenting my evil desires. They gave me an intravenous Mickey Finn, Succhinylcholine, paralyzing me. My eyes remained closed while my mind was open. The respirator pipe down my throat breathed for me with the whoosh of a concertina. Beats an immediate all-expense-paid trip to the great hereafter, like Saul’s. I learned the difference between being willing to die and knowing that you are going to. The difference scared me, but I could do nothing about it now. 

I got what I wanted. Benedict “Shark-face” Nyestine MD had paid full price for his one-way journey to infinity. 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. I get things done no matter what. . . . 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 . . . I couldn’t.

The way to detour my brain – and stay sane – was to distract it. I catalogued all the gaffes I had made since February 17^th. 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 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, as if that matters.    

Mistake 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. 

Pounding up 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, throwing a long shadow.   

“At least someone is good.” Rosemary shouted from the study. Her constant smile 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. Car accidents die in that ER you know.” She didn’t realize the irony. “I’m tired. See you tomorrow. Breakfast’s Special K? 15 pounds to go to Doc Fischbein’s golden 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, singularly focused 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 walked out of my life more than ten years ago. The way they addressed me, they would never return. Don’t ask what I did to them, because well . . . I don’t know. I remain a man committed to family values without a family, like a discarded glove in a blizzard 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. My purpose became improving medical care, by killing Nyestine and then maybe Campbell. That was the plan. That was my worth. Would I get a parade to celebrate? 

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 17^th, 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. I finally inherited my father’s mindset. It’s only death so what.    

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. Where was Occam razor when you needed to cut through the bullshit?   

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 junior officer exploded a grenade outside Machiavelli’s tent confirming his character. During his treatment, I learned chess. He taught me the principles of conscienceless duty. From our matches, he thought I’d make a great Military Police Investigator. 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, as did my ambivalence to murder.               

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. Was this really going to happen?      

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.   

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 18^th 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.          

Chapter Three

Daybreak at the Jersey shore, on the boardwalk the frigid wind pierced my waist length parka, and tugged my tartan scarf. It played my ears like the rim of a beer bottle. Icicles formed in my twitching salt and pepper mustache, but I’d get it done today.

I scanned monotony. It mirrored my life. No need yet for the field glasses strung around my neck. The boardwalk was deserted. Destiny called like a lone coyote on a mesa.        

Waiting to perform a crime, you blend in, and fade to unnoticeable. A man and his dog on a beach, no hassles, some people might enjoy the solitude. I had impatient anxiety.

The Jersey shore is flat like a target range. The off-white sand melds with the tides, crawling onto shore. The slow repetitive whoosh mimicked the breathing of a runner starting his homestretch kick. The blue-gray trex-deck boards formed a costume jewelry necklace surrounding the beach from here to the horizon, but going nowhere. 

The Jersey’s winter hues, and moods are gray, contrasting with my Technicolor dream.    

Each night, they strapped my arms and legs to the chair inside the gas chamber. The wood felt hard and smooth. A gray door clanked closed, locking with a thud. It echoed with airtight finality. My plan had worked. I’d killed Benedict. Success is exhilarating.   

My departed daughter Pam appeared as a scrawny gapped-toothed teenager to drop the Cyanide pellet. It exploded on the floor. Gray smoke clouded the chamber. It burned my lungs, and breathing became difficult.    

Every night I woke coughing. Upset because I wasn’t a hero, yet happy for the opportunity to be one.   

This morning memories haunted me. Pam’s smile, as we laughed while playing tag at the beach. Bubs as a pup, joined in, snatching our pant’s cuff, then chasing and barking.   

Bubs was arthritic now, but still pulled on the leash, asking for attention.

How many head trauma patients freakin’ ran out of gas, FROGged? Shark-face wouldn’t authorize the purchase of a neurosurgical operative microscope, too many shekels out of his pocket. In our hospital head trauma patients automatically became fatal head trauma statistics.            

“With Willie, Five this year.” My mustache tasted of ice. The wind caused tears. “Ain’t that a bitch?” I patted the Colt holstered on my belt. “I’ll be the hero.”

Bubs stopped her aroma search to listen. She cocked her head toward me in puzzlement.                   

The beach’s playground slide, twenty yards from the boards, was the perfect height for a shooter’s nest. The plan formed of its own momentum. It was meant to be.

The boardwalk was abandoned, and the stores boarded up. No police on bikes, no cars on Ocean Ave to witness the report of my piece. Yes, God wanted this done by me today. He was my co-conspirator. His consent echoed in the silence.       

To the south lightening bolts broke the morning sky, displaying the rough undersurface of the invading black clouds, and then the advancing rumble of thunder. Monmouth County’s famous thunder-snow, malevolent darkness, and dainty white flakes, a murder scene ala Poe, I would add the cadaver with one screaming bullet.             

The whoodle tugged on the leash. Pam conned me into buying the mini-mastodon. She skipped out on “Bubbles,” named for her champagne color, and me. Over the years, we, the dog and I, grew used to Bubs.

We stopped walking. Bubs pulled toward home, and then looked up to me and sat. 

“No AWOL for you.” I crouched cheek to cheek. The dog blocked the harsh wind. My black-leather gloved fingers dug into the curls on Bubs’ neck. “Marines finish what they start.” Ironic as that sounded to me. “We hang. He’ll be here soon.”   

I scouted the boardwalk, the beach, the sea and waves. The air tasted of salt. The rising wind foretold of the storm as the temperature dropped. My short jacket gave me easy access to my holster. The wind was too cold. I regretted my choice of coat. I regretted the wait.    

Bubs grew impatient. She squinted into the wind, imitating a pointer, facial fur blown back, waiting for last night’s cat to burst from cover. Master and dog hunted their prey.      

Over a half-mile away, a single stick figure moved toward us on the boards. It wasn’t an athletic gait. He loped as if touching the boards would make his new Nikes dirty. 

Bubs bared her incisors with a growl. Her schnozz can sense vermin at a thousand yards.                

I trained the binoculars on the runner. Short, 5’7” and thin, wearing a dark training jacket with the hospital logo, his silver hair leaked from his black St. Moritz ski hat to cascade down to his shoulders. His I-Pod buds in place, eyes focused straight ahead. Shark-face approached.

Apprehension twisted my stomach, like a taffy-pulling machine. My hands inside my gloves sweated to tropical humidity despite the frigid cold. Once I started, there was no going back. Till now I remained a virgin to criminal behavior.

I laughed. This would be stamped on my permanent record. Good for me.    

I raised the glasses and monitored his progress.   

Nyestine and CEO Campbell use hospital funds to buy a retreat condo in Santo Domingo, taking their girl friends to the beach. That should have been a new C-arm for the OR. Their administrative aide, Penelope, drove a hospital-owned Lexus. Shark-face scoffed at donating 9-11 healthcare, or veteran’s care but the hospital bought him a full coverage policy, drugs, dental, and catastrophic coverage.

“Cat-as-trophic coverage.” I said it out loud. It made me braver. 

I pulled my Colt .45 from my belt. His casaba-sized cranium would become an exploded bag of crimson popcorn from my hollow-nosed shell.

“Off the Pig. Power to the People.” As I was about to cock the semi-automatic’s slide, two ladies riding bikes approached. I flicked the safety on and re-holstered the gun.

Shark-face was 500 yards away. If the bikers continued on I still might be able to . . .

They stopped ten feet away and walked toward me. One served on a charity run committee with me, “See, isn’t she a love.” She tilted her bike against her leg and gave Bubs attention. My dog went belly up to receive a good stomach rub. The lady’s riding companion joined in. “This is the good doctor Muttnick. If you have a broken bone, go to him.” 

By the time they pedaled off, Nyestine was 50 yards away. They remained witnesses, worse yet, witnesses who knew me. Like some insane film director, my brain said, “cut, cancel today’s shoot.” 

Nyestine continued toward me, his head tilted skyward, like a proud stallion. His snorts matched the beat of his feet. A shark’s eye winked, luxuriating in performing.     

This chiseler had crippled his child in a car accident. From his son’s hospital bedside he walked to his girlfriend’s apartment, leaving his family and his marriage. What a bastard. 

Shark-face drew even with me. His face shined my way. His smile enlarged, exposing an irregular row of jagged teeth in his lower jaw. He stopped running, jogging in place. He pointed to a blue sign mounted on the silver railing of the boards. “It is against city ordinances to walk your dog on the boardwalk. Don’t want dog shit on my new Nikes.”

“The only shit on those Nikes is inside them.” I answered. “Bubs pro-tect.”

The whoodle crouched low on all fours and growled baring her teeth at the putz. 

“Control that mongrel or I’ll call the police.” He took out his iPhone.  

I pulled twisting to restrain my dog who lunged forward frantically barking and growling.

“Get it away.” Nyestine shouted, “Oh shit, you’re carrying a gun.” Backing away, he took a picture of my holster, and then the dog. “You’re crazy. You better see me later today, if you want to stay on staff.” He sped off, escaping like a frightened gazelle zigging and zagging across the boards in a random pattern, as if to throw off my aim.     

Shark-face made cockroaches a saintly life form.

I muttered. “You’re a dead man. If I have to, I’ll croak you with my bare hands.”        

“Safe” the command that stood Bubs down. She sat, and I patted her neck. “Good girI. You scared off the bad man. I wouldn’t let you bite anything so poisonous.”

Bubs violently wagged her tail, and then tried to chase a gull. I restrained her.    

My nose was too cold. The tip burned. My cheeks felt iridescent. My heat for Nysteine remained unabated. “Biannual Executive retreats, Maui, Baja, Hilton Head with diverted funds meant to improve the MRI machine’s magnet and pictures. That son-of-a-bitch.” No one heard.

Bubs tilted her head back and yodeled in harmony. She thought us the Andrew Sisters, or maybe Rose’s Lady Antebellum. Our harmony sucked, but she got me to laugh.      

Did I change at all from the Marine doc who enjoyed shooting his gun? I thought I had. Or did I channel my aggression into the socially acceptable outcomes of an orthopedic surgeon. We damaged people to help them heal, cutting out the bad and leaving the good behind, fixing the shattered, ultimately a positive result. I wanted to repair my family and failed. Now I wanted that for my life. Was it irreparable too?  

“The Board and Med Exec knows his priorities and ok’s them. I have to stop this.”              

Bubs wagged her tail, and gave a start, returning to sit, staring at me.     

“Get.” I confused my dog. “Home girl.” 

She sprinted toward the board’s exit ramp. The leather leash cracked taut. Bubs huffed against its restraint, digging her paws into the boards and imitating Fred Flintstone starting his car, missing only the yabbadabadoo.

I restrained my eager friend, expending the energy I failed to use earlier.      

Failures: In the Marines, I filed for a voluntary chapter 5-16 early discharge for education, my orthopedic fellowship. The brass and a shrink thought I qualified for an involuntary chapter 5-13 personality disorder because of my deep depression about wounded patients. We reached a compromise that avoided a DD, dishonorable discharge. I recovered stateside, self-sentenced to a lifetime of community service, the practice of orthopedic surgery. A surgeon leaves scars, and tries to begat hope. Doctor treat thyself.  

Maybe the Freud squad in the Philippines was right. I’m a little touched in the head, playing with a 51-card deck, but I’ll keep shuffling it. My deal is that I am who I am, too middle-aged to change.

He wants me off staff?     

I had the strength to kill that man. I had to act before he stopped me.

With the Colt, or my bare hands, who cared as long as he was dead.  

Chapter Four

My shore house was as noisy as a cemetery at 3 AM. Rose was gone? Was she that pissed about last night? Had she bolted? I’m friendless. Bubs sprinted to the kitchen and buried her head in the metal water bowl, lapping and panting next to the Sub-Zero.

No message taped to the fridge.

This morning, I needed a cheery hello.

The unexpected loneliness emphasized my failings.                       

I searched the study and alcove, with office papers stacked on the desk, the living room’s chess table in mid-game, an overstuffed earth tone couch with cracking leather, a wing chair, and an antique floor lamp, with a damaged shade, all neat as a pin. Museums change exhibits, but I changed nothing since Pam left.     

Bubs followed me room-to-room, concerned for my behavior. Her claws clicked on the wood floors. She whispered reassuring breaths through her open mouth. We were in this together. The den with two leather club chairs, a television and another brown couch, the furniture broken in and comfortable like the Little League glove I’d saved for a grandchild. The house remained as I left it less than an hour ago. Rose had vanished, leaving behind a fading whiff of Pleasures.

I could check for her clothes in her dresser, but her bedroom was off limits to me.  

Today was Peg’s early day. Rose wasn’t due in the office for two hours. We had enough food in the house. She’s not shopping. As bad as the day started, I needed her to greet me, saying . . . good morning.

That thought made me smile without thinking about it.   

The bedrooms were empty and no shower ran. No footsteps in the dormers.        

I placed the Colt on the pink Formica table in the kitchen, next to a napkin. It was a note. “Peg quit. I’ve left for the office. – Rose.” She wrote a heart for the last period. 

“Still got one friend.” Bubs panted up at me.    

Ms. Rosemary Angelucci, my live-in for two years but she wasn’t a shack up. Her former boyfriend arsoned her home, when she would no longer front him money for poker and dope.    

Rose got dibs on Pam’s old room and the comforter with the pink lace edging, rent-free. She percolated laughter and smiles in my dank dwelling.  

Using my blackberry, I called the office’s private line. “Hey kid. What’s happenin’?”  

“You’re so yesterday. Whas up? That’s now.” 

“I’m a square. Never be a cool cat.” I hung up Bubs’ leash next the front door.

“Never, but that’s alright Doc. That means you’re hot. LOL.”  

“What?”

“Wow Doc, Laugh Out Loud.” She did just that.

When laughing, the Sprite’s eyes crinkled to crow’s feet. She complained they didn’t match. Her right eye was blue-green and the left green-blue. Can you have two favorite colors? 

 “See, not cool. It’s lonely and spooky quiet without you here.”

A thunderclap rippled across Monmouth County.

Rose said. “Nothing better to do here than answer the phone, open the mail, clean up your desk.” She paused, “and put my hands in your drawers.”  

Whenever she cleaned up my desk, I worried that my in-house Bureau of Weights and Measures would confiscate my Snickers stash from its hiding place in the bottom drawer.

“Keep your hands out of my drawers.” That sounded worse than it was meant.

“You’re no fun. Just trying to straighten it up.” She paused. “Oops, your desk.” 

The next crack of thunder sounded louder over the phone than in person.

 “That’s what worries me. Use speakerphone. You’re chief cook and bottle washer.”  

Scandinavian-pale dynamite, Rosemary glided from place to place arms pumping, hips wiggling, as if she could ice-skate carpets. She stood five feet tall and had the demeanor of an atomic powered nymph.    

 “I’m essential? Awesome, do I get a raise?” Over the speaker, she sounded tinny. I heard letters being opened. She was doing the mail at my desk. Her sweet little ass was in my seat.

At times she seemed to want more than friendship. But I had to be a dumb bozo. The twenty-three year age difference . . . when I’m 70 she’ll be 47, how’s that work. She should be married already. She needs to get away from me for her good.       

 “Raising your salary, I’ll have to increase your rent, so that I could afford you.”  

 “Catch-22. You’re so military. Wait, what’s this letter? Notice: final chance to enroll in No-Bell Billing service. They do your bills and use special techniques to grow your practice. They enclosed a self-addressed response card. Oh cool. They can provide an electrical medical record system with off site server storage. Set-up and maintain a website too. Way cool. We could use new patients. Please, can I have it?”   

No-Bell was evil like Shark-face and Campbell. “Check no and send it back.” 

“Oh yeah, there a LOLINAD waiting for you in the ER. Intertroch fracture of the left hip.”   

“Who’s the Little Old Lady In No Acute Distress?”   

“Faith Gaffney. Bed 5.”    

“Faith? Oh Boy.” When would my luck change? 

“Yeah.”

“With her family?” Could I catch one break?

“Daughter numero uno, journalist Joyce. Have a nice day.” Rose restrained a giggle.

“Too late for that and too early for a double dose of wacky?” I needed to shower and shave.     

“Yeah. Remember the House of God, they can always hurt you more.”

“So?”       

“Shark-face sent you a return receipt letter. He commands a sit down, ASAP. It looks like he wants to throw you off staff. Then where will our patients come from?”

“Caught his saw-toothed mug on the boards. Reading a note’s less repulsive.” While talking, I eased the clip out of the Colt, and started undressing.     

“Checked the envelope, no Anthrax. It’s on the top of the pile.” Rose said.

The ‘berry on speakerphone, I paced the kitchen, toasting four pieces of bread, buttering and chomping each slice. Some people chain smoke, I eat; my lips smacked.   

“Hey Doc, I sense carb absorption. Stop. The Special K and a bowl on the table. Drink coffee, no sugar. No one wants to see a totally fat physician flouncing around the examination table, tellin’em to lose weight. So chill.” She giggled. “Or I totally won’t look either.”   

I had undressed to my boxers whose waistband buckled under my gourd-like belly. I scanned the hairy panorama, shrugged, and put the loaf in the breadbox. “So you’re looking?”

“Doc, don’t ask, won’t tell.”

“See you’re military too. We’re a match.”

“Dream on. Big boy.” When she said it that way, my over weight wasn’t so bad.     

The java in the Delonghi remained warm from Rose. I picked up the pot, and sniffed. I thought of Bubs’ aroma search on the beach. It passed the test. My French press was a hassle.   

Rose said. “Office hours start at 12:30 sharp. Don’t make’em wait.”

“How’s hours look?”   

“Absolutely better than last week.” 

Rose’s charade couldn’t fool me. “Filled?”       

“Fifty percent, but there are two Independent Medical Exams. They’re money.”  

“After you chase the payer for six months and give them the third degree they cough up something. Collection is way down and cash flow is like a dripping faucet. Something’s going on. I just don’t know what.”      

“It’ll turn around. . . . We’ll get through . . . together.” There was a longer pause. “I’m with you. Don’t get quiet on me.”    

“First appointment’s at 1, huh?” I siphoned my cup with a slurp, tilting my head back.             

“Shoot for 12:30. Come on, please, make my day. Pretty please, with a Snickers on it.” 

“For a regular-sized Snickers, I’ll see you at noon. My New Year’s resolution was to be on time.” 

“You’ve been late all January. It’s February. New Years is ten months away, like try again next year.” As an after thought she said, “Doc, be totally careful driving, I-195 is black iced.”

“Yes dear.” 

So ends the first four chapters.

Let me know what you think.


Here is Louis Armstrong and the St. Louis Blues to help you along.


So long for now. Dr. Madison Muttnick aka The Mad Mutt aka themadmutt signing off to all those human ships at sea. 


Dr. Lewis Preschel creator of Dr. Madison Muttnick 

Life moves on and things change. "Ain't that a bitch." - Madison Muttnick MD

I have been very busy reading two books, Immediate Fiction by Jerry Cleaver and Stein on Writing by Sol Stein. They have absorbed my time like a kid sucking up a thick milk shake through a thin straw. Mmmm vanilla, I am not allowed chocolate because of the caffeine.
My approach to writing has elevated as if I climbed the Rockies. Combined they have given me insight into the craft of writing as if I were a swami with a third eye. Those gurus do sit on top of mountains, don't they?
Because of that, I have re-written the opening of my manuscript. It finally rings true to what I want to say. I hope it sings in your ear about my troubled little Mutty boy.
I have spent over four years working on The Fatal Blow as a murder mystery, but it is also a story about family, reconciliation and hope. It needed to be written in a manner that conveyed those themes while still having the hard edge of my favorites, Chandler and Hammett. I think I am getting as a close as a blood on  a gunshot victim to how I want to tell the tale.
So this weekend I will be posting the first four chapters of The Fatal Blow. I would appreciate feedback via comments or e-mail concerning your interest. Does the story draw your interest? Do I communicate Mutt's needs and wants? Let me know.
I have converted the prologue to chapter one, because I expanded it and things start cooking from sentence five onward. Thanks for bearing with me.

See you in the funny papers.

I leave you with Cab Calloway and Happy Feet because I is dancin'.

Dr. Madison Muttnick aka Themadmutt

Dr. Lewis Preschel his creator. ("What a pompous bastard"- The Mad Mutt)

Prologue and first Chapter revised on 20 March 2011- Let the Coma begin.

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.

Prologue

February 17^th 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 17^th. 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 17^th, 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 18^th 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.

Here is Fats Waller and he Ain't Misbehavin' either

Or maybe you Ain't Misbehavin' with Anita O'Day and the Nat "King" Cole Trio before the King started singing.

Or if you want a little Louis Armstrong Vip in your Ain't Misbehavin' here it is Satchmo style

Chapter two will be posted in two weeks.

I'm out of here.