Dr. Knox

Black Maps

Death's Little Helpers

Red Cat

Thick as Thieves

THIS
IS
A
BORZOI
BOOK
PUBLISHED
BY
ALFRED
A
.
KNOPF

Copyright © 2016 by Peter Spiegelman

All rights reserved. Published in the United States by Alfred A. Knopf, a division of Penguin Random House LLC, New York, and distributed in Canada by Random House of Canada, a division of Penguin Random House Canada Limited, Toronto.

www.aaknopf.com

Knopf, Borzoi Books, and the colophon are registered trademarks of Penguin Random House LLC.

Library of Congress Cataloging-in-Publication Data

Names: Spiegelman, Peter, author.

Title: Dr. Knox / by Peter Spiegelman.

Description: First American edition. | New York : Alfred A. Knopf, 2016. |

“This is a Borzoi book.”

Identifiers: LCCN 2015040150 | ISBN 9780307961273 (hardcover) | ISBN 9780307961280 (ebook)

Subjects: GSAFD: Suspense fiction.

Classification: LCC PS3619.P543 D7 2016 | DDC 813'.6—dc23 LC record available at
http://lccn.loc.gov/​2015040150

This is a work of fiction. Names, characters, places, and incidents either are the product of the author's imagination or are used fictitiously. Any resemblance to actual persons, living or dead, events, or locales is entirely coincidental.

Cover design by Oliver Munday

v4.1

ep

They call me and I go.

It is a frozen road

past midnight, a dust

of snow caught

in the rigid wheeltracks.

The door opens.

I smile, enter and

shake off the cold.

W
ILLIAM
C
ARLOS
W
ILLIAMS,
“COMPLAINT”

Mia should've been it for the day. She had bruised ribs and a slash down one long white leg, though not from shaving. She was worried about a scar, and that it might hurt business. She swung her dark hair over her shoulder and fluttered painted eyelids at me. “ 'Course, for some guys it might be a draw,” she said. Her voice was low and scratchy.

“Charge them extra,” I suggested.

Her Adam's apple bobbed as she laughed. “You got a flair for marketing, Dr. Knox. Do I need stitches?”

“Just a tetanus shot and butterfly strips,” I said. “Jerome do this?” Jerome was Mia's boyfriend, her pimp, and her alleged fiancé. He said they'd get married after she had the surgery, but I thought he was full of shit. I was pretty sure that—deep down—Mia thought the same.

She batted her eyes again. “He doesn't mean anything by it.”

“Jerome's an asshole.”

“He was pissed 'cause Azul lost to Tigres last weekend, and he lost a bunch of money.”

“So he's a degenerate gambler, a sore loser,
and
an asshole,” I said as I ran an alcohol swab over her wiry arm. “The trifecta. One day you're going to get hurt for real.”

Mia winked, and winced as I stuck the needle in. “
Ow!
You gonna take me away from all that?”

“I'm too old for you.”

“You got mileage, sure, but you still got it goin' on. You got that lean, aging surfer thing working—or maybe it's an aging ski-bum thing. Either way, girls notice. Guys too.”

“You've got the aging part right,” I said, and pressed a Band-Aid over the injection site.

“Not to worry, baby,” Mia said. “I got energy for two.” She laughed deeply and waggled a finger. “And look—you're not too old to blush.”

“I lead a sheltered life.”

“Bullshit,” she said, giggling. “You've got some crazy in you.” She touched a fingertip to my tattoo—a tribal braid that ran around my biceps, just below the short sleeve of my scrubs. “You get that in the library?”

“A momentary lapse in judgment. Keep the leg clean.”

“I keep it all clean,” Mia said, “every inch.” Then she winked again and glided from the exam room.

I looked at my watch. Nearly 7:00 p.m. Nearly there.

Before Mia, there'd been Greggie, an ashen, greasy-haired wraith, shivering, mumbling, and shopping for 'scrips again. I'd offered him B
₁₂
, a sandwich, and a rehab referral—which I did whenever he came in looking for drugs behind some bullshit symptoms—in response to which Greggie had rubbed his hands together over and over and finally said,
Fuck yerself.
Every two weeks, like clockwork with Greggie.

And before him, lined up since early morning, there had been the bleak parade of the homeless. Beneath sedimentary layers of rotting clothes, I'd found three pneumonias, a conjunctivitis, a diarrhea, four staph infections, two cases of lice, knife wounds, contusions, rat bites, and countless varieties of ulcerated skin crud—and each patient with a stench so earthy and powerful it was like a suffocating hand over my face.

Lydia Torres, my nurse and the manager of the clinic, called it
underpass disease.
I thought of it as
San Julian syndrome,
after the street not far from here whose doorways and curbsides were the closest things many of these folks had to an address.
San Julian syndrome:
the slow and not-so-slow decay of the luckless, the mad, the addicted, damaged, damned, and forgotten. TB and its complications, diabetes and its complications, hypertension, Hep C, HIV, bipolar disorder, schizophrenia, PTSD, and that most desperate diagnosis of all: poverty.

I'd seen many of today's homeless before, several under different names. There was no particular reason for the serial aliases, I'd learned—sometimes their old names just didn't suit anymore, or had been forgotten, or simply couldn't bear the weight of more history. And, really, who couldn't understand that.

I peeled off my gloves, tossed them in the can, and took a deep breath. The air in the exam room was used up—crowded with the smells of disinfectant, Mia's perfume, the lingering reek of street folks, and traces of my own sweat. I leaned over the steel sink and looked into the steel mirror. Angles, planes, a web of lines about narrow, green eyes, and gray streaks in short, straw-colored hair.
Aging surfer, aging ski bum.
Aging right before my eyes. I ran the water and sluiced some on my face.

Not a bad day, all in all, and far from the worst. No screamers—not really loud ones, anyway—no violence to speak of, no sudden deaths, and, thank God, no kids. No great victories, but I'd stopped expecting those a week into my residency. Medicine was by definition a play for time, a holding action—skirmishes fought hand to hand or with small, inadequate armament. But always—no matter how long you dragged it out—the outcome was preordained. A rigged game.

I dried my hands and face and thought about the joint upstairs, on my kitchen table. A shower, a change of clothes, a six of Stella from the fridge, the lawn chair on the roof, the joint, and the May twilight over L.A. These private fiestas were something of a ritual on Friday evenings. On other evenings too, of late—perhaps on too many others. I closed my eyes and pictured the view from up there, the low, shabby skyline of the neighborhood—
Skid Row–adjacent,
one of our hilarious part-timers had called it—the downtown towers looming in the west, and the sunset behind them, the sky banded in acid pinks and reds. I could almost feel the gritty wind.

I went down the hall to what passed for my office—a wood-paneled, windowless nook with a three-year-old Real Madrid calendar caught in perpetual February on the wall. The desk was a heap: perilous stacks of forms to be signed—state paper, federal paper, private insurance paper—all to chase reimbursements that didn't cover the rent; more bills to be paid, most on second notice, some on the third; and on top of it all another letter from my landlord, Tony Kashmarian.

This one was mostly the same as the several he'd sent recently: a reminder that the clinic's lease was up at the end of August—three months from now—and that, unless I wanted to exercise my right of first refusal, the building was going up for sale. This one, though, named a listing price—a seven-figure one.

I shook my head at the number—its size and lunar distance, the mockery it made of the down payment I'd been scraping together. How was I supposed to conjure a number like that, when every payroll was a scramble? Certainly no banker in his right mind would lend it to me, and lately they were all in their right minds when it came to mortgages. And if I didn't find the money, where was my little operation supposed to move? And where was I supposed to live? I'd been asking those questions for months, and knowing Kashmarian's price just put me further from the answers. I thought again about the joint in my kitchen and headed for the stairs.

I was at the stairwell door when I heard cries from the waiting room—a woman's voice, choked, high-pitched, animal—and then Lucho pounding down the hall.

Lucho—my greeter, my bouncer, officially my physician's assistant and the clinic's assistant manager—filled the corridor. He was pale and sweating. “It's a kid,” he panted. “He's blue.”

“Fuck,” I whispered, and took a breath as if for a deep dive.

Not just a kid, but a little kid—no more than five. He wore navy shorts and a blue-and-white striped polo shirt, and he was thrashing and gasping and sliding off one of the plastic chairs. His mother—I assumed it was his mother: they had the same chestnut hair, and the panic in her eyes was a mother's panic—knelt beside the boy, slapping him on the back and speaking in a terrified voice. Arthur, Lucho's boyfriend and our IT consultant, stood behind her, frozen in mid-offer of a cup of water. I picked the boy up. He was maybe thirty-five pounds.

“Where's Lydia?” I said.

“Home by now,” Lucho said.

Fuck.

I carried the boy to an exam room. The mother followed, talking and stifling sobs. I didn't understand a thing she said, but it sounded like Italian to me, though not quite. Great. And then my vision sharpened and narrowed, and I was pulled down the bright, rushing tunnel of emergency.

The boy's skin was clammy and white, tinged blue at the fingernails. His lips were cyanotic too, and swollen, and there were hives on his cheeks and neck. He flailed in my arms like a just-caught fish. His eyes darted, and he reached for his mother. There was wheezing and whistling in his chest—the sounds of an airway closing fast. The boy twisted again, nearly out of my grasp.
Shit.
The fight for breath was hard enough on the boy's heart, but panic and thrashing would add to the strain, and up the risk of cardiac arrest. If he didn't asphyxiate first.

I laid him on the table, laid a hand on his chest, tried to find a pulse in the small wrist. The boy yanked his arm free, smacked me in the eye, in the mouth.

I grabbed both his arms, bent to his ear, and whispered, “It's all right, pal. We're gonna be fine.” I put two fingers to the boy's neck and found a pulse. It was rapid and thready.

The woman pulled at my arm, saying something, yelling it. She raised her hand to her mouth, again and again. The boy made a rattling gasp that ran like an electric current through his mother.

“Arahide,”
she said.
“Arahide!”

“Something he ate?” I asked, and the woman nodded. “What? What did he eat?”

“Arahide,”
she said again, and her brows came together. “Peanut!” she yelled.

Lucho was standing in the doorway of the exam room, and I waved him in. “Tilt the table,” I said, “head down, feet up, and don't let him fall off.” And then I ran down the hall.

I fumbled my keys, cursed, and got the med closet open. I scanned the metal shelves and grabbed EpiPens, an IV kit, a pediatric gauge needle, a bag of saline, a vial of IV Benadryl, an intubation kit, which I hoped I wouldn't need, and a trach kit, which I prayed I wouldn't. I ran back to the exam room, dumped the supplies on the counter, and tore open an EpiPen. I took out the injector and popped the safety cap.

“Hold his leg,” I told Lucho, and then I pressed the pen into the boy's bare thigh, and kept it there for a five count through his scream.

It took four minutes for the epinephrine to kick in, which passed like four hours. Finally, the boy's wheezing and whistling began to subside, and the blue tint faded from his lips. With easier breaths and more oxygen, his panic faded too, and so did his mother's. She combed her fingers through his hair, and cooed at him in what wasn't Italian. I waited five more minutes and hit him with half of another EpiPen.

Twenty minutes later, the boy's color was good, and so were his pulse and BP. Lucho hauled an oxygen bottle from the med closet, and I held the mask up for the boy to eye suspiciously before I slipped it over his nose and mouth. I'm good with an IV—accurate and fast, from lots of practice—and I had the line in and the tubing taped down before the boy could do more than yelp in surprise. I pushed Benadryl through the port, and between the antihistamine and exhaustion, sleep took him fast. I watched the boy's breathing and checked his pulse, and then I stepped away from the table.

I leaned against the wall. There was an adrenal tremor in my knees, and my scrub shirt was patched with sweat. Kids. I took slow, deep breaths to steady my pulse.

The woman tapped my shoulder and said something to me I didn't understand. I looked at Arthur and Lucho, who shrugged. “English?” I asked the woman. “Español? Français?”

She nodded slowly, and her brow wrinkled again. “The boy is good?” Her voice was soft, and her English heavily accented. Something eastern European.

“It was an allergic reaction—a pretty bad one—but he should be fine. We need to keep an eye on him, though—watch him for a while. And no more peanuts for him—ever.” The woman let out a long, shaking breath and took my hands.

“You understand English?” I asked. She nodded, and I took a closer look at her.

She was young, not twenty-five, and just a shade over five feet tall. Her body, in jeans and a pink tank top, was slender but strong-looking—conditioned, trained for something. Too slight for a swimmer—a gymnast perhaps, or a dancer, or an aerialist run off from the circus. Run from somewhere, I thought. Her skin was waxy and shining with sweat, and her hair, bound in a chestnut braid, was long unwashed. Her eyes were dark, wary buttons in an oval face, and her mouth was a downcast bow, sullen and perfectly shaped. A guarded face—barred and bolted—but pretty. More than pretty. And that was with all the bruises.

They were everywhere—under her left eye and along her jaw, on her neck and down her arms to her wrists. I could see the shapes of palms and thick fingers in some places, and divots where the fingers had worn rings. The damage wasn't fresh—a week old perhaps, and starting to heal. Beneath the bruises—despite them—something radiated from her: an insistent, thrumming sexiness. It was like an electric field that bristled the hairs on your arm as you passed, or a riptide that pulled at you even on dry land.

I snapped on a fresh pair of gloves and reached for one of her bruised arms. She jerked away, and her eyes flashed. Her fists were clenched and raised—ready.

I pointed at her arm and her cheek. “Those need looking at.” She stepped back, shaking her head. “I won't hurt you,” I said.

She wrestled down her impulse to fight and spoke again. “Is toilet?”

I pointed to the far end of the corridor, past the med room. “End of the hall, on the left. And then I want to look at those bruises.”

She took my hands and stared down at them. “Thank you,” she said softly. It came out as
tank you.
“I come back.” Then she headed down the hall.