The Best American Short Stories 2014 (17 page)

“Are we prepped?” I asked the nurse, Sandy, who herself smelled of cherry sanitizer. She nodded with remote calmness. Sandy was the one you wanted intubating a preemie with a blocked airway.

“OR 5, Dr. Railsback. Dr. Beverly's finishing up with an epidural.”

I prepped in a deep-basined metal sink. Shirtless—a quirk, but you really can't be too clean with surgery. One hand washed the other. The right: huge, thick-knuckled, bones lashed by a mesh-work of heavy ligatures. The left: long and bony like the hand of Nosferatu, metacarpals projecting beneath the thinnest stretching of skin—the bones in a bat's wing. The right arm: a bowling-pin-like forearm roped with freaky striations, a grapefruit-bulge of biceps. The left, a pair of sticks jointed at the elbow.

There's a line where the two halves of my body intersect. It begins to the left of my throat, centers itself between the points where my collarbones meet, cleaves the breastplate and rib cage, then snakes to the left down my abdominals and carves right again before finishing at my groin. To the right: densely muscled, proportionate. To the left: austere devastation. The line of demarcation is plain: the vascular round of my right pectoral dips into a trough where it meets my breastbone and fails to rise again, in a flat expanse so devoid of muscle that every thump of my heart shivers the flesh. The ribs on my right are banded by stout tendons. The left stick out like the spars of an unfinished boat.

My left side still
works
. The muscle, what there is, flexes. The nerve clusters fire. My left foot is 2.12 inches shorter than my right, and my left arm 2.84 inches shorter than its mate—I had a colleague take the precise measurements. My face is unaffected. Should you see me walking down the street in trousers and long sleeves, you would not notice much amiss. Were we carnally acquainted, however, you might wonder if I'd not been born so much as
fused
from separate selves. During maiden intimacies it's my habit to disrobe slowly, explaining things. An educational striptease.

Dr. Beverly waited in the OR. Our patient lay on the surgical table. Wracked with tremors—brainstem release phenomena. Isla, pronounced
Eye-la
. Beverly set her on the digital scale. 3.55 pounds.

“I'll start on inhalants,” he said. “Nitro to speed the uptake, then something with a slower wash-in. You looking for total bodily torpor?”

“I'll be inside her head, Bev. Can't have her squirming.”

“Run with a quarter milligram of hydromorphone, but if she reverts to a pattern fetal circulation we'll risk acute hypoxemia.”

Hypoxemia: CO
₂
chewing black holes into Isla's brain. Beverly painted a Mercurochrome square on her back and located the L3 caudal space between her spinal discs. The epidural catheter—a shiny segmented tapeworm—pierced the flesh in the square's center. The girl's eyes, set in wrinkled webs of flesh, did not open.

Bev slipped a tiny mask over Isla's face, pumped in nitro to open her bloodpaths. He switched the drip to isoflurane, a powerful analgesic. Isla's chest shuddered. Infant breathing patterns can be random. You had to ignore it. The number 12 scalpel rested in my left hand, classic pencil grip.

In med school the question had been: “Is Jasper Railsback surgeon material?” I wasn't the prototypical specimen, but I did possess the physical basics and the intangibles: force of will, self-confidence. Plus there was the matter of my hands . . .

True surgeons, or “blades” as we're known, are defined by our hands. Look at our fingers: willowy and tapered, seemingly possessed of an extra joint. A concert pianist's hands. A surgeon must possess extraordinary dexterity and be steady in the cut. You could eke by as an orthopedic surgeon with so-so digits—that's basically meatball surgery. But if you go blundering around in an infant's skull, things die. In school we'd practiced on bananas. Draw a dotted line on the skin, carve out the “lesion” using the slide cut technique. I'd bought bananas by the bushel—green specimens first, working my way up to speckly black ones. While my fellow students were exceeding the bursting strength threshold and slicing into the banana “meat,” my dynamite left was popping out perfect plugs.

My right is a bricklayer's hand. It can be taught blunt-force tasks. But I can feel music through my left hand. The right is my hammer. The left, an instrument of God.

I began at the supraorbital node, five centimeters above Isla's nasal shelf. One must remember that an infant's bones are porous or, in some cases, nonexistent. Soft heads, flabby gizzards. In many ways they are only token humans. The scalpel bisected the fontanel. I avoided the cortical veins running bluely under the skin and checked the incision before hitting the transverse sinuses. A brief freshet of arterial blood. A lateral incision bisected the first: an X. I tweezed back the flesh, pinning the flaps down.

“Suction.”

Sandy removed the occluding blood with a vacuum wand. Isla's brain shone within its encasement of cerebrospinal jelly. I searched for what I'd seen on the ultrasound: a tumor developing within the runneled folds. A teratoma, as it's known: a congenital defect composed of foreign tissue such as muscle, hair, or even teeth. Teratomas are rare; normally I'm looking for cortical dysplasia—a mutation of the brain cells—or pre-epileptic markers.

“That's a lot of blood,” said Beverly.

“Coagulant, then, Bev.”

He said: “Getting close to peak toxicity already, Jazz.”

“Suction.”

I switched to the harmonic scalpel; it'd coagulate any severed vessels. Sandy slipped a pair of magnifying spectacles over my eyes; Isla's brain expanded in intimate detail. Spread the hemispheres with a pair of forceps; they pierced the cerebrospinal sac soundlessly. Oxygen licked at the pink loaves of her brain, tinting the surface cells gray. I snipped nerve clusters, avoiding the corpus callosum, spreading the spheres until I could make out the Vein of Galen.

There's an instant in any procedure when you understand that you hold everything. The God Moment. Each surgeon feels it differently. For me this was a moment of awesome, near-paralyzing love. For the child beneath my blade, for its life and its capacity to do great things—or if not great, then productive,
valuable
.

“Light, Sandy.”

She illuminated the cranial vault. Below the hub of the angular gyrus sat a foreign mass: off-white, oddly ribbed, crushed between the thalamic folds.

“I'm titrating up,” Beverly said. “But I can't hold this level for long. She's nearing catatonic shock. Sandy, give me four and a half ccs of plasma replacement.”

She handed Beverly a syringe with a tablespoon of crystalloid plasma 3:1. I reached in with the forceps. The metal brushed Isla's olfactory bulb; her nostrils dilated involuntarily. I gripped the foreign mass. Teased it out.

“What in God's . . .”

A tiny, stunted foot. My forceps gripped its big toe. I grasped its neighbor and pulled gently. The toe released from the medullar fold with an audible
plik!
The entire foot came out slick with glia—brain glue, essentially. No calf, no knee. Just a disembodied foot, no bigger than a vitamin lozenge.

“Parasitic twin,” I said. “Consumed in utero.”

“Signs and wonders,” said Beverly.

 

Two nights later I busted a poor guy's arm. Classic greenstick. Radius and ulna bones. Three percussive pops as the flexor and brachii muscles unshackled from their moorings. Then the first of two wet, fibrous snaps: the ulna, which sounded like a pistol fired into wet sand. There's something madness-inducing about the sound of breaking bone. A rip in the fabric of things, a glimpse into a vast realm of polar whiteness. Sounds silly, I know . . . In the operating theater I break bones
purposefully:
incise with a number 5 scalpel, slit the silverskin-like fascia, spread the overlapping musculature, and split the bone with a surgical chisel called an osteotome. A controlled break, but still: always that glimpse.

But this happened at the Ontario Arm Wrestling Association's Arm Melter event, the semifinals of which were held in the basement of the K of C Hall on North Street. Low popcorn ceiling, steel cistern of rotgut. A passel of old Knights with pale suety faces slapping down dime bets on the Crown and Anchor wheel. A pair of padded arm-wrestling tables set up on the warped parquet. The type of crowd you'd expect when roller derby passes through town.

I'd been arm wrestling for years. My right arm—
the gorilla
, I like to call it—is the perfect weapon: a grapefruit bulge of biceps, bowling-pin forearm, vise-grip fingers. The battering ram to my left hand's lock-pick set.

My opponent was your standard Barbell Billy: fireplug-squat, vein-riven biceps jutting from a sheer wife-beater. He stuck his arm out as if he was
giving
me the damn thing. I only pull right-handed. I'm a specialist—plus, you know, the left is my moneymaker. Can't let one of these big goons crush my livelihood.

The ref cinched our hands with a leather thong to keep us gripped. When he said “Go!” the guy hit hard sideways, head down and snorting. Technique? Forget it! I fixed my elbow on the pad and let my shoulder absorb his thrusts; I felt the joint straining, idly concerned that he'd pop the humerus knob out of its cup of bone and destroy that fragile arrangement, but it held and I was able to hook his wrist, get my knuckles pointed skyward, and gradually peel his wrist backward—which was when his forearm went kerflooey.

The shock wave juddered through my body, dissipating into the skeletal muscle. But my veins were blitzed on adrenaline; I kept trying to pin his wrist. The guy wasn't aware of the trauma he'd sustained: the signals weren't routing through the proper synapses, so his body kept fighting. Twin tusks of white where the bone had shorn through. He stared at his assways-hanging arm and gave a quizzical half-laugh, as if his arm were a riddle I'd unceremoniously solved.

There was something terribly intimate to that moment. Your instinct is to pull back, give the man space to bleed—but we're strapped together, right?

“I'm a doctor,” I told him. Pointlessly.

He hiccuped in shock. I elevated his arm. We were still lashed together so I looked like a ref holding up a boxer's hand post-victory. One of the Knights humped into the kitchen. He came back with paper towels in one hand and a roll of aluminum foil in the other.

“This is all we got,” he said. “We do Friday Fish Fries, not busted arms.”

Afterward everyone gathered outside in the cooling night. The guy sat on the steps, arm mummified in bloody paper towels. His wife showed up.

“What the hell did you do to yourself?” she said.

Everybody laughed. That was how women were around here—you do something idiotic, something
male
, your lady gives you both barrels.

The last light of day—briefly intensified as it slipped below the curve of the earth—softened through the roadside firs, a blade edge of light limning the car's contours and turning the woman's face a mellow gold. I thought about the coming hours: the two of them under the stark halogens of the ER, the bonesetter's tray, the crisp
snik!
as the carpals locked back in place, dissolvable sutures, coagulant, and pain meds. Maybe she'd drive him home to their small, clean house, and by then she may've softened, forgiving him for the bizarre things men do. She'd lead him to the bedroom as she might a child—he'd have a goofy oxycodone smile—settle him into bed, and work her body against his with concerned control. Hell, I'd suffer a broken arm for that. I'd suffer a dozen.

A Knight came over. Red fez cocked on his skull at a jaunty angle, face like a bowl of knuckles.

“One hell of an arm you've got, son. Too bad they aren't a matching pair.”

His face shattered in laughter. The old prick.

 

“State your name for the record.”

“Dr. Jasper Railsback.”

“Place your right hand on the Bible and repeat after me: I swear to tell the truth, the whole truth . . .”

Niagara Regional Courthouse. Youth Services Court. Three pewlike benches. Penny Tolliver, a Children's Aid Society worker, the only spectator. One Crown attorney, one for the defense. The object of discussion: a ten-year-old boy with slight facial malformations. I sat in the witness box, having been summoned by the Crown.

“You operated on this boy shortly after he was born, Dr. Railsback—is that correct?”

“It is.”

“Explain the nature of the operation—what did it address?”

“The boy's mother is a meth head.”

“Objection,” the defense council said. “Irrelevant.”

The judge cocked her head at me. “Sustained.”

“I operated on the boy, Randall, because his mother suffered a placental abruption. She suffered this because she smoked methamphetamine for the duration of her pregnancy.”

“Objection. Conjectural.”

“Sustained. Dr. Railsback . . .”

I returned the judge's look evenly. “Due to the placental abruption, the boy was delivered early. He exhibited tremors, sleeplessness, and muscle spasms, which are symptoms consistent with infant narcotic withdrawal.”

“
Objection
. Conjectural.”

“Overruled. Could these be symptoms of other conditions, Doctor?”

“It's doubtlessly possible. Due to his being delivered early, Randall's brain was not properly formed. He suffers from lissencephaly—
smooth brain
. His lacks the normal folds and grooves. The most common side effect is severely retarded motor skills. My procedure split the corpus callosum, severing the hemispheres in hopes of addressing those issues.”

The Crown said: “Was it a success?”

“Most children with lissencephaly die before they turn two. If you're asking if the operation
cured
Randall, then no.”