Beat the Reaper: A Novel (15 page)

Coat closet. Lots of rubber boots. I pushed it shut again.

Between the closet and the front door there was a painting of Jesus that seemed so incongruous I lifted it up. Controls for the intercom and the front gate.

I considered just running for it. Opening the gate from here and trying to make it to the woods on the other side of the fence.

But that was a lot of open ground to cover, and an obvious move. And whatever my odds were, Skinflick’s were half that. I motioned for him to come out of the hallway and follow me, and crossed to the open archway.

This led into the room at the right front corner of the house. We had crouched under its front-facing window when we’d first gotten out of the truck. Out the side-facing window you could see the shack. The room itself had a large-screen TV, a couch, a weight bench, and some shelves with plaques and trophies on them—most, apparently, for skateboarding. Above the couch there was a framed poster of Arnold Schwarzenegger from his bodybuilding days.

As I glanced at it, my peripheral vision caught motion out the side window, and I ducked and pulled Skinflick down with me.

It was a tall thin guy coming around the side of the shack toward the front of the house with the kind of fast cross-step you only learn in the military or from gun-maniac videos. He had an aluminum riot gun in his hands that he kept focused on the shack.

“Clear out back!” he yelled, by which he seemed to mean behind the shack.

His voice was weird. Also he was weirdly skinny, and his cheeks and forehead had the kind of acne you could see from twenty feet away.

Jesus,
I thought. There was no way he was over fourteen.

I looked up just in time to knock Skinflick’s gun aside from where he was about to shoot through the glass above me.

“What the fuck?”
he whispered.

I yanked him down below the sill. “Don’t shoot without telling me, don’t shoot glass that’s right in front of my face, and if your target is talking to someone, wait till you can see that person. And don’t kill any children. Understand?”

Skinflick avoided my eyes, and I pushed him onto his back in disgust. “Just stay the fuck down,” I said.

A man’s voice yelled, “Randy—get clear!” It sounded like the voice from the loudspeaker at the gate.

A machine-gun roar came right through the wall at us. Skinflick and I both covered our ears as much as we could without putting our guns down.

I rose just enough to look over the sill.

The shack was gone. Torn up islands of green fiberglass drifted toward the ground like leaves, and spun all the way into the front yard. It was like someone had just taken out the shack with a leaf blower.

I turned to the window at the front of the house. The kid with the shotgun was there, three feet away, in profile. If he had looked in he might have seen me. Instead he started walking back toward the spot where the shack had been.

Two other men came into sight from the back of the house and met him there.

One of the two was another teenager, but older—eighteen or nineteen. He had a Kalashnikov assault rifle.

The other man was a nasty-looking middle age, with a foam-front baseball hat and untinted aviator glasses. He was about five nine, with a lot of the kind of hard fat they don’t teach you about in med school, but which you see all the time on guys who like bar fights. He was carrying something that looked like a chain saw, only with a Gatling gun where the blade should have been. Smoke and steam pulsed off the whole length of it. I had never seen anything like it.
*

The two men and the kid kicked through the shredded fiberglass, then the middle-aged one noticed the hole in the side of the house. “DON’T LOOK LIKE WE GOT EM,” he shouted. It occurred to me that none of the three were wearing ear protection.

It was clear that they were about to move closer to the side of the house, at which point we would have to lean out the window to shoot them.

Skinflick, on his knees next to me, said, “We have to shoot.”

He was right. I made a tactical decision. I said, “You take the fat one. I’ll shoot the kids.”

We opened fire, and the window collapsed in front of us.

What I was thinking when I divided up the targets was that I would shoot both sons in the leg—ideally in the lower leg—and that Pops was so fat even Skinflick couldn’t miss him.

The problem was that
I
kept missing. It’s not that easy to shoot someone in the leg. It took practically my whole clip to shoot the older Karcher son in the shin and blow the younger one’s foot off.

Meanwhile, Skinflick fired off
his
whole clip without hitting Karcher once. At which point Karcher turned the motor gun on us.

As I yanked Skinflick backwards, the roar lit up again. Entire chunks of the corner of the wall we’d been kneeling against just evaporated, like in one of those movies where a time traveler changes something in the future and things start to vanish in the present.

The air filled with plaster dust and shrapnel and it became impossible to see. Skinflick squirmed out of my hands and I lost sight of him. I crawled inward, away from the corner, then behind some fallen masonry. Only when I noticed I was coughing did I realize I could barely hear.

After an amount of time I couldn’t judge, a gust of November wind pumped through the house, and the air cleared. The front and side walls of the room were mostly daylight. Big chunks of the ceiling were missing, showing a bedroom up above and some pipes spraying water down the remains of one wall. I could see all the way across the foyer. The Jesus painting, and the controls behind it, were wreckage.

Karcher himself was standing near what was left of the foot of the stairs. Skinflick was on his back at Karcher’s feet.

Skinflick still had his gun, but the slide was blown back to show how empty it was.

“OH, YOU ARE IN SOME FUCKIN TROUBLE NOW, BOY,” Karcher screamed at him. Apparently his hearing was coming back a lot slower than mine was.

“I AM GONNA KILL YOU SLOW, THEN FEED YOU TO YOURSELF.”

Deliverance
is
The Godfather
for crackers.

It occurred to me that Karcher didn’t realize there were two of us.

I took my time standing up, and shot him cleanly through the head.

The rest you’ve read about. You’ve probably seen reenactments of it on true-crime television.

The older Karcher son, Corey, whom I shot in the shin, bled to death. The younger one, Randy, I tourniqueted. He might have lived, except that when I went to get the car, Skinflick shot him in the head. Welcome to the mafia, Adam “Skinflick” Locano.

When we loaded the three bodies into the trunk, the women came out on the front lawn and watched us, the older one howling on her knees, the younger one just staring. Later that night the bodies got divided into a half-dozen children’s coffins by a tech in the Brooklyn ME’s Office who owed the mob from betting on the
Oscars
, for fuck’s sake, and the six coffins were buried at Potter’s Field.

Before Skinflick and I left, I located as many of the Ukrainian girls as I could. There was one on the rack in Karcher’s “office,” who I couldn’t get to wake up, and who I would have taken with us if I’d thought we could get her to a hospital any faster than the cops would.
*

There was a still-alive girl chained up in the upstairs bedroom of one of the sons—by pure luck not the room above the TV room. And there were a couple of dead ones hanging from chains in another shack.

The entrance to the storm cellar, where the rest of them were, was around back. It was the worst thing I smelled until I went to med school.

Skinflick and I stopped at the same payphone I’d used to meet up with the delivery kid, and I called the cops to tell them where to go and what to expect when they got there. Locano we called by cell phone. After we’d dropped the Karchers’ bodies off, we went home and took showers, and Skinflick got drunk and high and I went off to find Magdalena.

Skinflick and I had barely spoken to each other since the shooting began. We were both deeply shaken, but we also both knew that Skinflick’s decision to cap a wounded fourteen-year-old was enough to destroy our friendship, and would have been even on a day when nothing else went wrong.

And two weeks later I was arrested for the murder of Les Karcher’s two wives.

17

The instruments nurse gives me a tiny-headed scalpel. I pull it lightly down the center of the newly inked line on Squillante’s abdomen, causing the ink, iodine wrap, and skin to spring apart about an inch. For a second, before the cut fills with blood, its fatty walls look like cottage cheese. Then I hand the scalpel back. It won’t be used again this operation. Scalpels cut cleanly, but they can’t stop bleeding.

Friendly says “Clamp.”

I say “Bovie and suction.”

A “Bovie” is an electrocautery, a device shaped like a pen with a cord coming out the back and strip of metal extending from the tip. It looks like a tiny cattle prod, so it’s unfortunate that “Bovie” is the name of its inventor, and not short for “bovine.”

A Bovie not only cuts but also burns, so it closes blood vessels as you go. (It also leaves a trail of ugly carbonized flesh, which is why you don’t use it to cut skin.) The idea is to suction the blood out of the incision, then quickly spot the cut ends of the arteries and use the Bovie to fry them shut. You have to do it fast, because suctioning only gives you a split second of visibility. Then it’s all just blood again.

I hand the suction to my student, who won’t look as stupid overusing it. Every time the student sucks the blood out, I wait until the tiny dots of blood appear, then pick one and try to electrocute it before it goes back to spurting.

At this rate the operation will take several days, and on top of that my periods of consciousness and unconsciousness are starting to alternate, lasting a thousandth of a second each, like the peaks and troughs of a radio signal. Sweat drips off my forehead into Squillante’s incision.

Eventually Friendly gets bored and starts poking around with his “clamp,” which looks like a pair of needle-nosed pliers. He grabs at arteries I can’t see, so that all I have to do is touch the Bovie to the metal of his instrument and fry the arteries by conduction, on faith.

When the bleeding’s stopped, Friendly jabs down into the gunky membrane at the bottom of the incision and spreads the jaws of his clamp, tearing the membrane apart. Then he picks out some more vessels for me to burn.

As he does so, Friendly looks at the instruments nurse, who’s a black man in his twenties. “So I can’t say ‘gay’ in the OR,” Friendly says. “Too many fragile people in here. I need to ask
permission
first. I forget the whole thing’s
collaborative
now.”

The instruments nurse doesn’t respond, so Friendly turns to my med student. “You know what ‘collaborative medicine’ means?” he says.

“No, sir,” the student says.

“It means an extra ten hours of unpaid bullshit a week. Look forward to it, kiddo.”

“Yes, sir,” the student says.

Friendly turns back to the instruments nurse. “Can I say ‘black’ in here? Or do I have to say something else?” He pauses. “How about ‘the artists formerly known as Negroes’? Can I say
that?
Or do I need to ask permission to say that, too?”

Operating rooms, I should say, along with construction sites, are the last safe havens for sexists, racists, or anyone else with a Tourette’s-like condition. The idea is that harassing people teaches them to stay calm under pressure. The reality is that sociologists could study ORs to learn what workplaces were like in the 1950s.

“What do you say, Scott?” Dr. Friendly says to the instruments nurse.

The instruments nurse looks up at him coolly. “Are you talking to me, Dr. Friendly?”

“If I am, I have no idea why,” Friendly says. He tosses his bloody clamp right into the middle of the instruments tray. “That’s it. Let’s open up.” He digs his fingertips into the incision, then leans over and tugs it wide like an enormous leather change purse. You can see Squillante’s beet-red abdominal muscles, which have a bright white stripe down the middle where we’ll make the next incision, because this stripe has almost no blood supply.

“Sister Mary Joseph negative,” Friendly calls out to the circulating nurse, who’s now at the computer. “There’s also no Virchow’s node, though you’ll have to take my word for it.”
*

I Bovie along the white stripe.

“Will you be using Japanese or American lymph-node guidelines?” my med student asks.

“That depends,” Friendly says. “Are we in Japan?”

“Sir, what’s the difference?” my other student asks, from the floor.

“In Japan they spend all day hunting down nodes for preventative resection,” Friendly says. “Because in Japan they have socialized healthcare.” He pulls the twin bands of muscle apart. “Retractor,” he says. “We’re in the abdomen.”

The instruments nurse starts assembling the retractor, which is a large hoop that can be locked into place to hold the incision open.

While we wait, Friendly looks back at the student who’s not scrubbed in. “Don’t worry, we’ll get the socialized stuff over here soon enough,” he says. “Stacey. You want to check my beeper?”

“Sure, Dr. Friendly,” Stacey says. “Where is it?”

“In my pants.”

Suddenly there are a lot of downturned eyes in the room. Stacey gamely walks over and pats Friendly’s ass.

“Front pocket,” he says.

As I think I’ve mentioned elsewhere, scrub pants and shirts are reversible. So that while the back pants pocket is on the right, outside your pants, the front one’s on the left,
inside
your pants.

Stacey reaches under Friendly’s surgical gown and roots around his crotch. She wrinkles her nose at me while she’s doing it, in a way that’s actually fairly winning.

“There’s nothing there,” she finally says.

“We already knew
that,
” the scrub nurse says.

Everyone laughs uproariously. Friendly turns red, then blotchy, above his mask. He grabs the retractor out of the instruments nurse’s hands and wedges it roughly into Squillante’s abdomen.

“You know what?” he says when it’s in place. “Fuck all of you. Let’s get to work.”

We do. For a while, all you can hear is the beeping of Squillante’s EKG. To me, each beep feels like an alarm clock after an eternity of restless sleep. My Assman-injected forearm is starting to twitch.

But we’re making progress, at least. First we pile through Squillante’s intestines, each loop of which is anchored to a thin sheet of tissue that supplies it with blood and so on. So that while they can slide all over each other, like sharks in a tank, you can’t just unspool them like a rope. You have to leaf through them, like the pages of a Rolodex, or a phone book.

“Give me some reverse Trendelenburg,” Friendly says.
*

The reverse Trendelenburgness helps us finish folding the intestines out of the way, and at last reveal Squillante’s stomach.

As with the initial incision, the complexity here will not be in removing the stomach, since any Aztec priest could take out five of them and be on the links by noon. The difficulty will be in controlling the bleeding—finding and cutting off the dozens of arteries that enter the stomach like the spokes of a wheel—so that Squillante doesn’t die. Friendly picks up a second Bovie and starts picking out arteries on his side as I work on mine.

“Funny stuff, you assholes,” Friendly starts up again, suddenly. “How many years of training do I have? Eleven? Fifteen? More, if you count high school. For what? So I can spend all day with a bunch of uneducated morons, breathing in genital wart particles from the Bovie and watching my salary go to my ex-wife and half the HMO executives in America. I mean, you people breathe the particles in too. But still.”

His movements are getting a little jerky. Or else maybe that’s just my rapid sleep-wake cycle.

“Oh, but
that’s
right,” Friendly says. “
I
get to
save
people. People like this pinkie ring asshole, who’s spent his whole life eating beef and smoking cigarettes, and sitting on his ass.”

I say, “Suture,” and start tying off one of the larger arteries. The stitch breaks in my hand. I ask for another one.

“The fucking beef industry and the fucking HMO industry,” Friendly says. “Al-Cowda and the HMOsamas. They make my life hell while other people slack off. I bet tobacco’s a lot of fun. All kinds of things I never did are probably fun. Like when I was in med school, and you all were out in the park, smoking weed and listening to Marvin Gaye while you fucked each other.”

This time I tie my stitch more gently, and it holds. I’m surprised at how quickly the knot tying comes back to me, particularly with my forearm starting to make my fingers stiffen up. But anything someone teaches you to do first to the foot of a dead pig, then to the foot of a dead human, and finally to the foot of a live human, probably sticks in your memory permanently.

“Suture,” Friendly says. The instruments nurse gives a stitch to Friendly, but it gets tangled in Friendly’s fingers, and Friendly angrily shakes it off into Squillante’s open abdomen.

“You know what I should have done?” Friendly says. “I should have been a snake handler. It’s the same job but the pay is higher. Instead I save the lives of people who hope they’ll die on my table so I can get the shit sued out of me. Because that’s all anybody wants: a chance to take a queen out with a pawn.”

“Dr. Friendly?” the scrub nurse says.

“What?”
Friendly says.

“Who’s the queen in this scenario?”

There’s another round of mask-hidden laughter.

“Fuck you!” Friendly says, grabbing up the knotted length of stitch and throwing it at the scrub nurse’s face. It’s too light to make it that far, though, and it arcs toward the ground.

For a second none of us realize that Friendly’s other hand has plunged his Bovie into Squillante’s spleen.

Not just into it, either.
Along
it, slicing as it went. As we watch, the incision beads with blood, then starts to gush.

“Oh, fuck,” Friendly says, yanking the Bovie free.

The spleen is essentially a bag of blood about the size of your fist, to the left of your stomach. In seals, whales, and racehorses it’s large and holds an extra supply of oxygenated blood. In humans it mostly strains out old or damaged red blood cells, and also has places where antibodies can go to clone themselves when they get activated by an infection. You can live perfectly well without a spleen, and people who survive car crashes or have sickle-cell anemia frequently do. But you don’t want to rupture it suddenly. Because almost as many arteries lead to the spleen as lead to the stomach, so losing blood from there can kill you fast.

Friendly rips the Bovie out of its power source and throws it to the ground, shouting “Give me some clamps!”

The scrub nurse calmly says “Bovie down,” and tosses a handful of clamps onto the tray. Friendly grabs a couple and starts trying to pull the edges of the spleen wound together.

The clamps tear right out, taking most of the surface of the spleen tissue off with them.

Squillante’s blood starts to pulse out in sheets.

“What’s happening?” the anesthesiologist yells from the other side of the curtain. “BP just dropped ten points!”

“Fuck off!” Friendly says, as we both go into action.

I grab a couple of clamps myself and start hunting out arteries. Just the biggest ones, since they’re all I can see through the fountaining blood.

Friendly doesn’t hassle me when I clamp the left gastroepiploic artery, which runs toward the spleen along the bottom of the stomach. I’m not sure he even notices. But when I go for the splenic artery itself, which comes off the aorta like a spigot, he swats my hand away, causing me to almost kill Squillante outright.

“What the fuck are you doing!?” he yells.

“Hemostasis,” I tell him.

“Fucking up my arteries, more like!”

I stare at him.

Then I realize that he actually thinks it’s possible to save Squillante’s spleen, rather than tying it off and removing it.

Because if he saves it he won’t have to report slicing it open as a complication.

The alarm goes off on Squillante’s blood pressure monitor. “Get him under control!” the anesthesiologist yells.

Leading with my shoulder in case Friendly gets rambunctious again, I try once more for the splenic artery, and this time I get it closed off about an inch downstream of the aorta. The blood loss out the spleen slows to a wide, shallow leak, and the blood pressure alarm shuts off.

“Suture and needle,” Friendly says through his teeth.

Friendly starts to sew the wreckage of Squillante’s spleen into an ugly little lump. Halfway through, the needle breaks off.

“Stacey!” Friendly screams. “Tell those fuckers to learn to make sutures, or I’m going to Glaxo!”

“Yes, doctor,” Stacey says from somewhere that sounds far away.

The next stitch holds better, or Friendly doesn’t yank on it as hard or something. “Can I have one of my arteries back now?” he asks me.

“It’s not going to hold,” I say.

“GIVE ME THE FUCKING SPLENIC.”

I separate the handles of the clamp that’s holding the splenic artery closed. The spleen slowly reinflates.

Then it splits in half along either side of the sewn-up incision, and sprays blood everywhere. As Friendly hurls the clamp in his hand against the wall, I reclose the splenic artery.

“Clamp on the floor,” the instruments nurse says casually.

“I’m taking the spleen out,” I say.

“Fuck you. I’ll do it,” Friendly says.

“I want to transfuse,” the anesthesiologist says.

“Fine!” Friendly yells at him. “Hook him up, Constance.”

Constance opens up a Coleman ice chest that says “Friendly” on it in permanent marker, and pulls out two bags of blood.

“Is that shit cross-checked?” the anesthesiologist asks.

“Do your job,” Friendly tells him.

Together, Friendly and I remove Squillante’s spleen. It takes about an hour and a half. Friendly then orders one of my med students to run it down to Pathology, so that he can later claim he took it out on purpose, looking for cancer. Which I have to admit is a nice recovery.

After that, the actual removal of the stomach is slow but mindless. We’ve already whacked half the arteries in Squillante’s abdomen. There’s nothing left to bleed. He’s lucky he still has blood going to his liver and colon.