The Last Hiccup (2 page)

Two days later, after several sleepless nights for her son, Ilga herself was exhausted. She had tried every trick from every old wives' tale in her repertoire, each to no avail. Vladimir's hiccups stayed at the same interval of 3.7 seconds the entire time, never speeding up and never slowing down. Ilga poured herself a cup of tea, added a dab of honey and a shot of Kubanskaya, and then approached Vladimir in the living room, where he was drawing in his schoolbook. She leaned over his shoulder and was horrified by what she saw. Instead of the rural scenes and ponies young Vlad would usually draw, he'd constructed a graveyard with his oiled chalk sticks. The nighttime scene was replete with dark birds, scattered corpses and tipped-over gravestones. In the center was a mysterious man, his face broad and sinister. Beside him a skeleton stood half the size of the man. Above this cadaver, Vladimir had spelled out his own name.

With panic in her eyes, her hands shaking, Ilga grabbed Vladimir by the collar of his shirt and dragged him to the front door. “Some exercise will do you good,” she said. Ilga forced the boy into his boots and coat. Vladimir looked up with tired eyes that were red from secret crying. Ilga, herself almost in tears, placed her hand square on his back and, with all the force she could muster, pushed him out the door. Vladimir took exactly six paces in the snow before wavering. His left leg wobbled first, then his shoulders hunched forward. There was a single moment in which Ilga thought the boy was going to right himself. “Please, Vladdy,” she whispered under her breath. “You can do this.” That moment, however — so brief, so fleeting and so hopeful — was only a deceit. In one swift motion, Vladimir fell forward and planted his face in the snow. Ilga shrieked out loud and ran outside in her bare feet. She rolled her son over.
Hiccup. Hiccup.
Young Vlad was too exhausted to speak.

“I'm taking you to the doctor,” Ilga said. “I don't care how much it costs. We'll fix you.”

Three hours later, Ilga and Vladimir, dressed in their very best attire, arrived by automobile in Igarka, a sawmill and timber-exporting port along the Yenisey River that, though larger than their village, had only recently been granted township status. The car Ilga drove belonged to their neighbor. Unsympathetic to Ilga's plight, he had forced her to barter for use of the vehicle. The two haggled for several tense minutes before eventually settling on the cost of three full bags of flour. Normally Ilga would have balked at such a steep asking price, but she had no other resort.

As she and Vladimir sat in the doctor's crowded waiting room, Ilga looked in her purse. Her son's health care was supposed to be paid for by the state. Officially that was the policy. But local doctors routinely charged additional fees for arranging appointments. This far north, the system was unregulated. Ilga had just enough money to cover one appointment, no more. Vladimir's father, a military man pressed into service in a foreign country, would not be sending back any more funds for at least three months. This was their only chance.

The doctor entered the waiting room. “What's that noise?” he said. An older man with gray hair and failing eyesight, he had popped his head in to speak to the receptionist and was visibly disturbed by the yelping sound. The receptionist pointed to Vladimir, sandwiched between his mother and an elderly lady suffering from the gout. As if to announce that he was indeed the culprit, young Vlad let out the loudest hiccup yet. “Bring the boy in first,” the doctor said, effecting an audible groan from the other patients who'd been waiting longer. The elderly lady beside Vladimir did not groan, however. When he was called into the office, she was so overjoyed that she gave Vladimir a little push to help him on his way. The elderly lady let out a slight chuckle, one that would turn out to be her last, as eleven days later she would succumb to a combination of food poisoning and uranium exposure unrelated to the gout.

“How long have you been making that noise?” the doctor said. He was going through his usual list in his physical examination of the boy. He checked Vladimir's heartbeat, looked in his ears and searched the boy's hair for lice.

Vladimir's mother answered for him. “It's been several days now. He can't sleep. Look at the lines around his eyes.”

The doctor squinted heavily to inspect the dark puddles of skin that had formed under the boy's eyes. He removed his stethoscope, sat back in his chair and shook his head. “There's nothing I can do medically in this case,” he said.

“Nothing?!” Ilga exclaimed.

“Nothing. The boy has the hiccups. That's all. Have you tried scaring him?”

“Yes.”

“Hmmm.” The doctor rubbed his chin. Suddenly, in one surprise motion, he leapt from his seat, lunged at Vladimir and yelled “Boo!” at the top of his lungs. Vladimir didn't flinch. His eyes didn't even close. He only stared back at the doctor with the same look of confusion, wonder and helplessness.

Having overexerted himself, the doctor lowered carefully back into his seat. “Have you tried having the boy stand on his head and recite the alphabet?”

“Yes.”

“Did you have him recite it backward?”

“What difference would that make?” Ilga said.

The doctor opened a file folder and made some notes, then stood up from his chair. “Bring the boy back in one week's time. We'll see if he's stopped making the noise by then.”

Vladimir's mother was nearing her wit's end. “But I can't afford another visit. The trip here cost us dearly. Is there nothing you can do?”

The doctor reached into his pocket and produced the thickest, widest pair of bifocals Ilga had ever seen. He placed them squarely on his nose, reached out and playfully tousled Vladimir's hair. “You needn't worry,” he said. “In all my years I've never seen a case of the hiccups that lasted more than a few hours, let alone a few days. This will pass, I assure you.”

“What if it doesn't?”

“If it doesn't, come back in a week's time. My cousin Sergei is a renowned physician from Moscow. He's coming to town for a wedding next week. If your boy still presents the same symptoms, I'll make sure Sergei sees him.”

“What about the appointment fee?”

“Tut-tut,” the doctor said as he walked them to the door. “If the hiccups last another week, payment will not be necessary. Sergei will want to see this for himself.”

Exactly one week later, Ilga and Vladimir returned to the doctor's office. When the doctor entered the examination room, he was shocked by the boy's appearance. Vladimir's skin had turned alarmingly pale since the last time he saw him. His eyes were darker and more world-weary. He seemed to have lost weight and, surprisingly, a few bald patches were scattered atop his head. Vladimir had still not slept. The doctor was met with the same frog-like yelp emanating from the boy's mouth every 3.7 seconds.

“My God,” the doctor said under his breath. Even without his thick-rimmed glasses, he could see the boy's condition was dire. When he put his glasses on, he became instantly worried that young Vladimir would die from exhaustion before the day was over. “Sergei!” the doctor called out the door. “Sergei, you must come have a look!”

A few moments passed before the three of them were joined by one Sergei Namestikov. Nearly two decades younger than his cousin, Sergei was a strong, broad-shouldered man in his early forties with a full head of hair and a confident white smile. He didn't seem the least bit startled by Vladimir's appearance. Instead, he introduced himself first to Ilga, took her hand and placed a kiss on her wrist. Instantly smitten, Ilga did a partial curtsy the likes of which she hadn't performed since she was a little girl. Sergei closed his eyes and listened to the sounds emanating from the boy. He used his wristwatch to time them. Sergei crouched down, looked Vladimir in the eye and spoke softly. “How long have you been making this sound?”

“Over a week, sir.”

“It's been almost two weeks,” Ilga said.

Sergei stayed focused on Vladimir. “Does it hurt when you hiccup?” he said.

“No.”

“Do you feel any different than you did before the hiccups started?”

“I can't remember what it was like before.”

Sergei examined Vladimir's head. “How did his hair fall out?”

Ilga looked at the ground when she answered. “He pulled it out himself at night.”

“In frustration because he couldn't sleep?”

Ilga nodded.

“Has anyone tried scaring the boy?”

“Yes.” Ilga stroked Vladimir's head with her hand. “Many have tried. It has no effect.”

Sergei placed his hand to the tip of his nose and stood in absolute silence. Sergei's cousin, Ilga and Vladimir could each have taken turns counting to thirty during the time Sergei spent pondering the child's symptoms. Finally he pulled his cousin aside for a brief consultation. When he returned, his diagnosis was grave. “The boy will die within a week's time if he does not receive proper care.”

Ilga broke into tears. The examination room filled with her wailing. Young Vlad, for his part, stood entirely still, exhibiting no emotion as the hiccups continued. Sergei had fully expected the boy's mother to start crying. He waited for her to calm down, then spoke. “Madam, the boy has singultus — hiccups in layman's terms. It's caused by pressure to the phrenic nerve. This, I'm afraid, is the most advanced case I've ever seen. There is a chance he can still live and be cured. We need to admit Vladimir to the hospital here in Igarka so he can get some sleep. Once he's suitably rested, if the hiccups do not abate on their own, I would like to take Vladimir to Moscow with me. There, at my hospital, my colleagues and I can get to the bottom of this.”

“Does he have to go away?”

Sergei stepped closer and took her hand. His eyes penetrated Ilga's. “I'm afraid so. Do we have your permission?”

“Yes,” Ilga cried. “Anything to save my Vladdy.”

That night Vladimir was taken to the local infirmary. There was no hospital to speak of. Igarka's infirmary consisted of three ramshackle rooms and a single nurse in a rundown shanty behind a sawmill on the pier jutting out into the Yenisey River. One could actually see the chilling flow of water and fragments of ice bobbing under the gaps in the floorboards. Vladimir was placed on a sanitary mattress and given a dosage of morphine one and a half times the recommended amount for a boy his size. Sergei and Ilga watched as the drug took effect. First the boy's expression grew drowsy. Then his limbs fell limp, followed by his eyes slowly shutting. The hiccups, which up until this moment had steadfastly maintained their regular interval, suddenly paused. Three-point-seven seconds passed and there was no sound. Then it was four seconds and then five. Ilga looked to Sergei as though he'd cured her boy. She was about to leap into his arms and express her boundless gratitude when, at the 7.4-second mark, the hiccups returned. They hadn't stopped. Only one hiccup had been missed. Incredibly, Vladimir continued to hiccup in his sleep.

Sergei looked over at Ilga with a somber expression on his face. “It appears the situation is more dire than I first imagined.”

Later that evening, Ilga signed a release form over to Sergei for Vladimir's treatment. At 4 a.m., she was sent home to rest.

When Ilga returned to the infirmary the next day she discovered an empty bed where Vladimir had been sleeping. Fearing the worst, she asked the nurse if her son had passed away during the night. The nurse informed her that Vladimir was still alive. He had been taken to Moscow for treatment. Ilga looked out the window and into the endless fields of snow heading west. Tears streaked down her cheeks.

Ilga reached into her purse and pulled out a flask of partially distilled vodka. She took a swift swig and then another. Ilga looked down at the phial. She lifted it to her mouth and consumed the rest in six successive gulps. Vladimir's mother wavered on her feet. She felt the Earth start to slip beneath her and reached her hand out for the windowsill — a terrified, panicked grasp of five fingers consolidating into nothingness — but missed and collapsed in a heap on the floor.

Her son was gone.

The initial attempts to cure Vladimir involved subjecting him to a series of sudden terrors, each more horrific than the last, in an effort to scare the hiccups out of him. A snake was brought in and placed at the boy's bedside. Next, several hospital workers dressed up as ghosts and surprised the boy as he slept. Eventually, Sergei commissioned an aspiring father/daughter circus-clown duo at a steep, almost extravagant price to cackle demonically as they chased Vladimir through the courtyard in the middle of the night. All attempts failed.

The boy, it appeared, was quite fearless.

After consulting his staff, Sergei decided that it had been presumptuous to try to stop the hiccups altogether. Instead, he made it his mission to slow them down. To begin with, they established that the hiccups were indeed repeating at an interval of 3.7 seconds. Once this was accepted as fact, Sergei ordered the boy to be hooked up to a machine to monitor his convulsions. A curriculum of heavy medication followed. Each day after the drugs were administered, Sergei's assistants would crowd around Vladimir to scrutinize the duration, intensity and volume of each involuntary yelp. Except for the one hiccup Vladimir skipped when he entered the rapid eye movement portion of sleep, there was absolutely no change in his condition. The interval didn't change. The sound didn't change. And the minor tremor it caused in Vladimir's young body did not change. After months of trying, Sergei's team was forced back to the drawing board.

In the subsequent months, several other theories were put to the test. First, an attempt was made to subject Vladimir to periods of extreme hot and cold. Not only did this undertaking meet with abject failure, but it resulted in both second-degree burns on the child's right leg and the loss of Vladimir's left middle toe to frostbite. Next, steps were taken to induce vomiting in the boy, the notion being that Vladimir could not continue to hiccup were he busy expelling food and water through his mouth. This process proved to be both too messy and too difficult to quantify. Quickly abandoned, it was followed closely by the administration of electroshock therapy. Notes weren't taken during these sessions and few details were made public, but the results were clear — the hiccups had not abated and a mishap during the third treatment resulted in the attending physician losing partial movement in his arms. Electric shock was never again attempted on the boy.

On suspicion that Vladimir might be experiencing an allergic reaction to his surroundings, the decision was made to sanitize his environment. A small, sterile room was painstakingly prepared. First, all furniture was removed. Second, the window overlooking the courtyard was boarded up. The floor was scrubbed, cleaned and disinfected, all of the walls fitted with thick, anti-allergen plastic. Finally, the light bulbs were removed from their fixtures. Two attendants placed the boy inside this dark room with only a sound transmitter and then sealed the door by boarding it up as they left. An hour passed with Sergei's team listening to Vladimir hiccup through an intercom. Then a second hour went by. It did not look promising. Finally, at the eleven-hour mark, the hiccups started to grow faint. Forty-three minutes later they stopped altogether. A great cheer erupted amongst the hospital staff. Doctors embraced nurses. Strangers shook hands. Congratulations were declared. The celebration spread down the hall to where Vladimir's fellow patients launched into a voracious rendition of the Russian national anthem. Sergei found himself so caught up in the excitement he even allowed two of his coworkers to raise him on their shoulders.

Only Ilvana Strekov, a flat-chested, mouse-like nurse's aide with a history of pilfering her relatives' glass figurines and an almost debilitating narcoleptic affliction, hesitated in joining the merriment. She walked up to the sealed door and placed her hands on the boards. “Doctor?” she said.

Sergei didn't respond.

“Doctor?”

Sergei had just been lowered down by the jubilant revelers and was shaking hands with the hospital administrator when he saw Ilvana. “Yes, my dear?”

“How is the boy able to breathe in that room?”

Sergei stopped dead in his tracks. His expression morphed from joy to bewilderment to shock and then fear all in one fluid motion. “Get him out of there!” he bellowed. Nearly a hundred faces turned and stared blankly at Sergei. “I said get the boy out! He can't breathe!” Sergei pried at the boards with his hands. Quickly the maintenance crew leapt into action. Within seconds the boards were removed and the protective seal was slashed open. Sergei opened the door and ran to Vladimir. The boy wasn't breathing. Sergei started performing mouth-to-mouth. “Stand back! Give the boy air!” He pounded on Vladimir's chest in between breaths. “Live, damn it, live!”

The next morning, on a day of thick, driving rain, Sergei met with his colleagues in the hospital's conference room. The faces of those assembled were characterized by dejection. Yes, the boy was still alive. Sergei had just barely managed to resuscitate him. But the hiccups remained. Sergei stood up from behind a mountainous stack of papers. “Everything we've done so far, every attempt we've made, has been to no avail,” he said. In a sudden, unexpected fury, he threw the case file in the air, scattering pages around the room. “We've spent almost an entire year treating this boy and still he suffers. Still he must be put to sleep with drugs. Still he hiccups. Collected here are fourteen of the most gifted medical minds in all of Russia. Surely we must be able to solve this mystery. Does anyone have anything new to add?”

A single hand shot up.

“Yes?”

“Perhaps we could replace the patient's phrenic nerve with a man-made device. Or a transplanted nerve from a recently deceased patient.”

“No.” Sergei shook his head. “We would be stretching ourselves too far if we entered the delicate arena of nerve replacement. Anyone else?”

In the corner, a short, nondescript physician, thirty years of age with tortoise-shell glasses and an eager expression on his face, stood up. Having long allowed his wife to write his research papers for him, he'd snuck into this meeting uninvited alongside one of his more esteemed peers. All week he'd prepared for this moment. Were his suggestion to be accepted amiably, he would no longer have to carry with him the overriding, unstoppable awareness that he was a fraud. He spoke with all the courage he could muster.

“Perhaps we should step back and think about this case from a metaphysical point of view,” he said. “Has anyone considered that the hiccups might be the boy's soul gasping to get out of his body?”

Sergei shot the man a look so full of violent, disgusted disregard that the others in the room shuddered. “If I was in the military,” he said, “I would have you shot.” He leaned on the table, clearly exasperated. “Does anyone have an intelligent suggestion?”

In the front row, directly across from Sergei, the shoulder of one Alexander Afiniganov began to roll in a forward motion. Alexander, whose long-standing rivalry with Sergei had earned him the unofficial designation as Sergei's nemesis, was the most brilliant doctor in all of Moscow. Ever since grade school, when Alexander's diorama depicting the directional flow of molten lava had bested Sergei's cross-pollination of plants in a junior achievement science fair, no matter what success Sergei achieved, Alexander had managed to eclipse him. In every facet of life, Alexander always stayed a nose ahead. When Sergei finished second in his high school class, Alexander finished first. When Sergei was permitted entrance into the most prestigious university in all of Russia, Alexander accepted a full scholarship to study at one of the world's oldest and most respected institutions in London. In medical school, while Sergei was busy composing a paper on anxiety disorders, Alexander beat him to publication with an exemplary dissertation on the combined effects of triskaidekaphobia and coulrophobia.

Alexander was a better chess player.

His ice hockey team routinely defeated Sergei's.

Even in love, Alexander always managed to win. The day after Sergei announced his engagement to a beautiful, kind woman with a big heart and a healthy dowry, Alexander made public his engagement to one Natasha Krilsolov, a slightly more beautiful woman with the heart of a saint and an overwhelming, almost outlandish patrimony endowment. Years later, after the two men had been assigned as senior residents at the same hospital and Sergei was reaching the end stages of a bitter and at times devastating divorce, Alexander had informed him, with an almost gleeful look in his eye, that his wife, Natasha, had died suddenly in an unfortunate ice-fishing accident, leaving Alexander the bulk of her estate and what could only be described as a harem of potential young brides.

In each instance, Sergei would watch as Alexander's shoulder began to roll. Slowly at first, the ball of his shoulder churned forward. Alexander would crack his neck to the side and then quicken the pace. Standing at the front of the conference room, Sergei watched Alexander grind his shoulder. It could mean only one thing — Alexander knew something about his patient that Sergei did not.

“Yes, Alexander?”

Half of Sergei wanted to grab his nemesis by the throat and shake him until he stopped. The other half couldn't wait to hear what he said. Vladimir was Sergei's prized patient — he had long protected the boy from the other senior residents. Were he to cure this boy's hiccups, the presentation of his research would receive an ocean of accolades. Despite his worry that he might lose Vladimir to his archrival, Sergei stepped to the side and encouraged Alexander to speak in front of the group. Alexander did stand up, all confidence and deserved bravado, churning his shoulder in front of everyone. He reached a single hand up to the widow's peak where his hair met his forehead and then adjusted his round metallic glasses. A hush fell over the others as his powerful baritone filled the room.

“You have all been involved in treating this boy. You have attacked his hiccups with heat and cold, with sudden fright and the deprivation of oxygen. You attack and attack and attack, all the while failing to understand that you are combating the symptoms, not the root cause of his ailment. If you have a gash on your arm and you place a towel on it, does it stop the flow of blood? Sometimes, yes. But what if the blood does not stop? You can apply the towel a hundred times to the same wound and still it will bleed. It is only when you go beneath the surface to find the severed artery that you can rationally decide on a prudent course of treatment.

“I urge you to stop wasting your time on these futile attempts at halting this patient's hiccups. Instead, you must discover why this is happening. Find the cause of his convulsions. Flush it out by any means necessary. Then, my dear colleagues, you may return to your attacks, only with focus and purpose.”

The room fell suddenly silent. All eyes were on Sergei. Even Alexander, who rarely looked his rival in the face, waited on Sergei's reaction with bated breath. Sergei rubbed his chin pensively, something he often did to buy time when he'd already made up his mind but wanted others to think he was in the process of coming to a rather difficult decision. His rivalry with Alexander was a thing of local legend. For years it had been well documented in both hospital gossip and, surprisingly, a feature story in a state-run newspaper. Many of those assembled today had witnessed a physical confrontation between the two doctors last year in the cafeteria in which, following a pointed exchange of words, a plate of turnips had been smashed, several punches had been thrown and threats of further violence had been uttered. The general consensus was that Sergei would bristle at his adversary's proposition. Sergei, however, knew better than to dismiss Alexander out of spite. With one simple analogy, Alexander had distilled Vladimir's dilemma to its core. All this time Sergei had been treating the symptom, not the disease.

Sergei swallowed hard a mixture of saliva and pride. “It appears I've needed your help all along, old friend.” He offered his hand to Alexander. “Shall we work on this together?”

Alexander, who was neither Sergei's friend nor in the practice of helping others, surprised himself by accepting his rival's handshake. And, despite his skepticism, he agreed to help. “Together we will cure this boy.”

A smile formed on Sergei's face. “Then let's get started. We have a great deal of work to do.”