Josh Bazell - Beat the reaper

Copyright 2009 by Josh Bazell

All rights reserved. Except as permitted under the U.S. Copyright Act of 1976, no part of this publication may be reproduced, distributed, or transmitted in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher.

Little, Brown and Company

Hachette Book Group

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First eBook Edition: January 2009

Little, Brown and Company is a division of Hachette Book Group, Inc.

The Little, Brown name and logo are trademarks of Hachette Book Group, Inc.

The characters and events in this book are fictitious.

Any similarity to real persons, living or dead, is coincidental and not intended by the author.

ISBN: 978-0-316-04030-3

Contents

In Memoriam

Stanley Tanz, MD

19111996

If Nietzsche is correct, that to shame a man is to kill him, then any honest attempt at autobiography will be an act of self-destruction.

Camus

S o Im on my way to work and I stop to watch a pigeon fight a rat in the snow, and some fuckhead tries to mug me! Naturally theres a gun. He comes up behind me and sticks it into the base of my skull. Its cold, and it actually feels sort of good, in an acupressure kind of way. Take it easy, Doc, he says.

Which explains that, at least. Even at five in the morning, Im not the kind of guy you mug. I look like an Easter Island sculpture of a longshoreman. But the fuckhead can see the blue scrub pants under my overcoat, and the ventilated green plastic clogs, so he thinks Ive got drugs and money on me. And maybe that Ive taken some kind of oath not to kick his fuckhead ass for trying to mug me.

I barely have enough drugs and money to get me through the day. And the only oath I took, as I recall, was to first do no harm. Im thinking were past that point.

Okay, I say, raising my hands.

The rat and the pigeon run away. Chickenshits.

I turn around, which rolls the gun off my skull and leaves my raised right hand above the fuckheads arm. I wrap his elbow and jerk upwards, causing the ligaments to pop like champagne corks.

Lets take a moment to smell the rose known as the elbow.

The two bones of the forearm, the ulna and the radius, move independently of each other, and also rotate. You can see this by turning your hand from palm up, in which position the ulna and radius are parallel, to palm down, where theyre crossed into an X. They therefore require a complicated anchoring system at the elbow, with the ligaments wrapping the various bone ends in spoolable and unspoolable ribbons that look like the tape on the handle of a tennis racket. Its a shame to tear these ligaments apart.

But the fuckhead and I have a worse problem right now. Namely that while my right hand has been fucking up his elbow, my left, having somehow come into position by my right ear, is now hooking toward his throat in a knife-edge.

If it hits, it will crush the fragile rings of cartilage that keep his trachea open against the vacuum of breathing in. Next time he tries, his windpipe will clench shut like an anus, leaving him at ReaperTime minus maybe six minutes. Even if I ruin my Propulsatil pen trying to trache him.

So I beg and plead, and coax the trajectory of my hand upwards. Past the point where its aiming for his chin, or even his mouthwhich would have been disgustingto where its aiming for his nose.

Which caves in like wet clay. Wet clay with twigs in it. The fuckhead crashes to the pavement, unconscious.

I check to make sure Im calmI am, Im just annoyed before getting heavily to my knees down next to him. In this kind of work, as in every kind of work, probably, planning and composure are worth a lot more than speed.

Not that this particular situation requires much planning or composure. I roll the fuckhead onto his side so he wont choke to death, and bend the arm that isnt broken under his head to keep his face off the frozen sidewalk. Then I check to make sure hes still breathing. He is, in fact with a bubbly joie de vivre. Also the pulses at his wrists and ankles are reasonably strong.

So, as is usual in these situations, I imagine asking the Great OneProf. Marmosetwhether I can leave now.

And, as is also usual in these situations, I imagine Prof. Marmoset saying No, and What would you do if he was your brother?

I sigh. I dont have a brother. But I know what hes getting at.

I put my knee into the guys fucked-up elbow and pull the bones as far apart as the tendons feel likely to bear, then let them come slowly back together into their positions of least resistance. It makes the fuckhead groan in pain in his sleep, but whatever: theyd just do the same to him in the ER, only by then hed be awake.

I frisk him for a cell phone. No such luck, of course, and Im not about to use my own. If I did have a brother, would he want me getting hassled by the cops?

So instead I pick the fuckhead up and fold him over my shoulder. Hes light and stinky, like a urine-logged towel.

And, before I stand, I pick up his handgun.

The gun is a real piece of shit. Two pieces of pressed sheet-metalno grips, evenand a slightly off-center cylinder. It looks like something that began life as a starter pistol at a track meet. For a second it makes me feel better about there being 350 million handguns in the United States. Then I see the bright brass ends of the bullets and am reminded how little it takes to kill someone.

I should throw it out. Bend the barrel and drop it down a storm drain.

Instead, I slip it into the back pocket of my scrub pants.

Old habits die harder than that.

In the elevator up to Medicine theres a small blond drug rep in a black party dress, with a roller bag. Shes got a flat chest, and the arch of her back boosts her ass, so shes shaped like a sexy, slender kidney bean. Shes twenty-six after a bit too much sun exposure, and her nose is the kind that looks like a nose job but isnt. Freckles, I shit you not. Her teeth are the cleanest things in the hospital.

Hi, she says like shes from Oklahoma. Do I know you?

Not yet, no, I say. Thinking: Because youre new on this job, or you wouldnt have such shitty hours.

Are you an orderly? she asks.

Im an intern in Internal Medicine.

An intern is a first-year resident, one year out of medical school, so typically about six years younger than I am. I dont know what an orderly is. It sounds like someone who works in an insane asylum, if there are still insane asylums.

Wow, the drug rep says. Youre cute for a doctor.

If by cute she means brutal and stupid-looking, which in my experience most women do, shes right. My scrub shirt is so tight you can see the tattoos on my shoulders.

Snake staff on the left, Star of David on the right.

Youre from Oklahoma? I ask her.

Well yes I am.

Youre twenty-two?

I wish. Twenty-four.

You took a couple of years off.

Yes, but oh my God that is a boring story.

Its okay so far. Whats your name?

Staaaaacey, she says, stepping closer with her arms behind her back.

I should say here that being chronically sleep-deprived is so demonstrably similar to being drunk that hospitals often feel like giant, ceaseless office Christmas parties. Except that at a Christmas party the schmuck standing next to you isnt about to fillet your pancreas with something called a hot knife.

I should also maybe say that drug reps, of whom there is one for every seven physicians in the U.S., get paid to be flirtatious. Or else to actually fuck youIve never been quite clear on that.

What company do you work for? I ask.

Martin-Whiting Aldomed, she says.