The Arms Of God

Screen shot 2013-11-06 at 9.49.38 AMIf you open your eyes,
night opens, doors of musk,
the secret kingdom of the water opens
flowing from the center of night.

And if you close your eyes,
a river fills you from within,
flows forward, darkens you:
night brings its wetness to beaches in your soul.

Octavio Paz, “Water Night”

 ONE

“Are you sure it didn’t come today?” I asked, trying to appear, and sound, calm and non-chalant.

“Yes, Senor, I checked this morning when you called.”

Why doesn’t this asshole even look up at me…  did he even check?  I bet he didn’t even check… asshole…

“It is very important to me that you are sure – I’m sorry, it’s just… it’s just very important, do you understand?  Es-muy-importante.   Nothing for Joe Brian, nothing for doctor Joseph Brian?”

The man nodded his head as if indicating “yes”, but didn’t answer.  He was looking down at a computer screen, distracted, and typing on the keyboard.

Son-of-a-bitch isn’t even paying attention to me…

I leaned in close to his face, and slammed my open palm down, hard, on the polished granite counter – WHACK!!

I NEED YOU TO BE SURE, GODDAMIT!  PAY ATTENTION!  PAY ATTENTION TO ME ASSHOLE!”

His head came up and his hands jerked back from the computer keyboard as he moved back quickly from the counter.  His dark brown eyes were wide with surprise and confusion.  A door behind him flew open, and another man leapt out, wearing what looked to me like a security uniform designed by Walt Disney – turquoise short sleeved shirt and long pants with orange trim piping, replete with a gold star-shaped badge on his left chest pocket and the right tricolor floral logo of this place on the right.

I noticed that he wasn’t carrying a gun, or any other obvious weapon.

Why am I looking to see if this guy is carrying a weapon…? What am I doing?…  Jesus.

I looked down at the floor, and shook my head in self-disgust.

After an awkward moment, the desk receptionist regained enough composure to speak, in a trembling voice tinted with both fear and what I was certain was resentment of me – just another “ugly American tourist.  “Senor… senor please… please do not raise your voice…, this is… this is disturbing the other guests.”

I turned my head and looked behind me.  The lobby of the exclusive Cancun resort, a three stories high round, thatched roof structure, open-air on all sides, was filled with vacationers, most clad in expensive resort wear – a colorful and slightly disorienting cacophony of clothing – palm leaves, parrots and beach umbrellas.  Several of them had stopped in their huarache-sandaled tracks and were now looking at me more with curiosity and expectation than with fear – as if I were just another form of resort entertainment.  A sunburned cherubic toddler in a stroller, wearing a blue-jean sailor’s cap emblazoned with a red and white striped “POLO” across the brim started crying as his mother, who had been in line behind me, backed away several steps, stumbled, and almost fell down as one of her pink and white rubber sandals folded over on itself.

“Sorry… I’m sorry,” I said, while still looking at the mother and the crying child.  I then turned back to the receptionist and the security guard, lowering my voice as much as possible, just above a whisper, motioning with my shaking hands for effect – “really… I’m sorry, it’s just that I checked online this morning, and the Fedex site told me that it… my package… had been delivered here yesterday… that’s all… sorry.  I thought for certain it had arrived.  That’s… that’s… what the online site said…”

The security guard had inched back a bit toward the still open door behind him, but didn’t give the impression that he was about to leave.  He was swarthy, with a thick black moustache, and what I guessed was a more or less permanent five o’clock shadow.  The brim of his baseball-style cap, also turquoise and orange, was pulled down so low I couldn’t see his eyes.  I smiled at him feebly, but his expression, at least the part I could see on his lower face, didn’t change.

I glanced to my far left and saw that another man, this one dressed in a fitted dark suit and tie had walked up to the end of the reception counter.  He was wearing one of those secret-service type earphones, and was staring at me ominously.  His left hand was resting on the counter and his right arm was across his chest, with that hand out of view far under the lapel of his coat.  I shook my head again and chuckled nervously to myself. 

 What do you expect for a thousand bucks a night…?           

 Ascertaining that I was probably more of a nuisance than a threat, the receptionist by now had completely regained his confidence – looking past me and smiling at other guests, and nodding to indicate that all was well.  He then reached out and patted my hand.

“Senor… senor… please… you look terrible.  Perhaps you should consider seeing the doctor – we have a doctor here twenty-four hours a day, and a very good one.  Please, may I call him for you now?  It is no trouble.  Con su permiso?  It is no trouble, really, senor, I insist…”

I looked in the mirrored wall behind him, at my reflected image.   My thinning hair was unkempt – uncombed and unwashed for several days.  Even from this distance, and with blurred vision it was also obvious that there was a several-day beard, sunken dark-circled bloodshot eyes, and an ashen-grey swollen face.  No wonder my family was so worried.

“NO!… I mean, no… no thank you… I am a doctor, actually…  I just have the flu, that’s all.  It’ll be okay, please forgive me… so sorry…

I glanced nervously back at the secret service-looking guy again, and then turned and walked toward the elevators, wiping my nose, which was running profusely.  My eyes were watering so badly that I had trouble finding the up/down buttons on the wall.  Although here were a couple of other people waiting for the elevator, they elected to let me ride alone.  Once the doors closed, I lifted my arm and sniffed… I wouldn’t get into a tight space with me either right now…

I found the magnetic key in my pocket, and opened the door to our room – a big two-bedroom suite overlooking the azure Gulf of Mexico from five stories up, replete with a five hundred square foot balcony, a full dining room and well-stocked wet bar.

Thank God they’re already at the beach…

I fell onto the bed… The sensations that came with this particular illness, which in fact was not the flu, were strange, but I knew them well.  My skin felt uncomfortable and tight, as if it didn’t fit my shape. My bones ached – really bad, and it seemed that… if I could just reach in, grab them one at a time with my hands, and squeeze the blood out, squeeze the blood out… that they would stop hurting.

I got up and stumbled into the bathroom where I fell down onto my knees in front of the toilet.  Curiously, even though my kneecaps struck the beautiful dark green marble floor with enough force for the dull popping bone-on-something-solid sound to echo around me, it didn’t hurt, or at least there was no sensation of pain – a wavefront of nausea was occupying my sensorium at that moment.  I had a habit of counting things – “a touch of obsessive compulsive disorder”, a psychiatry colleague had once suggested during my residency training… I stopped counting the number of times I had retched after eleven.

I let the crown of my head dip into the water and vomitus – goddamn that’s cold…  It occurred to me that I might be able to submerge my entire head and drown myself, but I knew I would pass out and fall away from the bowl, only to be found later by my wife and daughter, who would then take me to a hospital and find out what I couldn’t let them know.  I slumped back, straddling the base of the porcelain bowl with my legs and extending my arms upward to grab the seat-ring on either side and hold myself up.  I could see my reflection in the shower glass-door.  I looked like a crazed street person trying to ride a bathroom toilet bowl chopper-bike.  I thought about laughing for a moment, but couldn’t.

I’ve got to get the hell out of here…

Although it wouldn’t have been obvious to anyone if they walked into my hotel room at this particular moment – I was a famous surgeon… a small-town Texas sports and academic prodigy who grew up as the only son of parents that didn’t finish high school.  I had been an undergrad at Duke University, where I lettered in two sports, then on to Harvard Med, and following that, a Mayo Clinic surgical trainee.  I was now on staff at one of the top medical schools in the country – promoted to full professor by age thirty-seven.  I was by all measures on the very top of my game… I had the respect of colleagues worldwide, spoke at expert conferences, and made close to a million dollars a year.  I operated on homeless people and world leaders, saved many lives in the process, and comforted the dying and their families with compassion when that wasn’t possible… I was married to a brilliant, beautiful woman, and had one child, a daughter that was the love of my entire life – my sweetheart… my everything.  I was with them now, on vacation for the first time in three years, at the most exclusive resort property in Cancun.

I was also hopelessly addicted to pain medication – narcotics.  On a good day, I took enough of them to kill ten people.  Unfortunately, due to a combination of improbable and unfortunate recent events – I hadn’t used for more than ten days now, and as a result was in full-blown, life-threatening opiate withdrawal.

I crawled out of the bathroom on my hands and knees – both coated with what had should have remained in my gastrointestinal tract, but had found its way to the outside world – I had evidently missed the toilet a few times.  As I moved forward, my sticky hands made a “THWICK, THWICK” sound as they first stuck, and then lifted up from the floor.   I grabbed the edge of the bedspread, pulled myself first to my knees, up onto wobbly legs, and fell face first onto the bed.

My usual supplier had promised me that he would get me Oxycontin two days before we were to leave for vacation, but had never shown up in the hospital lobby at the time we had agreed to.  This was highly unusual – he hadn’t missed a drop in six years.  I assumed that he had either been arrested or killed – you weren’t able to support a habit like mine for twenty-plus years unless you had seen several of your sources come and go.  None of them were brilliant.  In the end most were either too greedy, or used too much of what they were selling themselves, and eventually made mistakes.

I on the other hand, if not brilliant, was very, very careful.  As was the case with my career in surgery – I did not make mistakes, and always had a backup plan.  I had bribed a local, financially-strapped elderly primary care physician to falsify some records indicating that he was treating my wife for a gynecologic condition which included unremitting pain – I even told him exactly what to write in her fake record, giving him all of her medical history and even telling him where her few minor physical imperfections, moles, etc., were located, to make his documented – but never actually performed exam – ring true…

…“DIAGNOSIS AND PLAN: Gravida-one para-one Caucasian female with probable severe endometriosis…  suggested hormonal therapy, but she refuses due to previous adverse effects, including possible pulmonary embolism.   She asked to provide pain medication to be used during the perimenstrual period on occasion when necessary, has used non-steriodal meds without good result, and episodic opiate administration seems reasonable at this time… She has signed an opiate treatment contract and has provided a negative drug screen” 

I kept him on a healthy monthly retainer – for insurance against events just like this – “on call” for me, if you will.  He was only clearing about a hundred thousand a year and had three divorces and a young girlfriend to maintain – he was a ridiculously easy sell.

According to the Fedex tracking system, which I had pulled up on my laptop in the hotel room thirty or forty times the past two days, the old bastard had evidently held up his end of the agreement, but the package never arrived.  As a result, someone working at the resort mail room was having a party, and I was dying, listening to marimba music and the laughter of children at the pool waft up from below and into my open balcony doorway.

 §§§§§§

TWO

At least I have a prescription for this one… I gulped a sleeping pill down with a mouthful of gin and tonic – one that would put most people out for eight hours or more – put my head back on the first class seat headrest, and woke up a couple of hours later.

The guy sitting next to me poked me in the arm with something – hard.  I jerked my head forward, and blinked my matted, constantly watering eyes several times before they adjusted to the dim light in the plane.  I had the distinct impression in my disoriented state that it had been the barrel of a gun, but it turned out to just be his Ipad.

“We’re here man, flight’s over” he said, “Jesus… I hope you’re feeling better, you look like hell.”

I looked down at my lap – there was an airsickness bag more than a third full of fluid.  I had evidently thrown up into it at sometime during the flight, but had absolutely no memory of it.  It reeked.  I reeked.  I mumbled an apology.

I had only been able to keep down a couple of pieces of hard candy the night before, and the smell wafting up at me now – gin and strawberry mixed with vomit, reminded me distressingly of Bourbon Street in New Orleans, where I went at least once a year for a medical conference – the smell of “recycled” Hurricanes on the pavement.  Judging by the tense, angry stares of the other passengers in first class now filing past me to disembark, I wasn’t the only one who noticed.

I had convinced my wife to stay at the resort the last several days of our planned vacaction, as the… “room is paid for, and you know it cost a fortune… really, you and Maria enjoy yourselves, and I’ll go back and see someone in the medical center – better than getting admitted to some crappy hospital in Cancun… It’s just Influenza, that’s all… just a bad case of Influenza… some intravenous fluids and some meds and I’ll be good as new…” Amazingly, even though obviously worried, she had agreed.

I stumbled through customs.  As I waved my passport by him, the customs agent asked, in a matter-of-fact tone, “Montezuma’s Revenge, Huh?”

“Yeah, something like that,” I stammered, cleaning my nose with the sleeve of my wrinkled dress shirt, which was caked in dried mucous from a thousand previous wipes.  I grabbed my bag from the luggage carousel, found my car in the parking garage, and plugged in my phone – I had a couple of very important calls to make.

I called in a one hundred eighty milligram tablets of Oxy at two different pharmacies.  I used the old doc’s DEA number and his office phone, and used my wife’s name on the prescriptions.   I was taking about six of these a day, on average – this would last me a while.  No mistakes…

I knew that I was dehydrated, and dangerously close to needing to be admitted to a hospital, but that if I could get one dose down that I would be much better in a few hours – I picked up a Gatorade at a news-stand on the way out of the airport.

Once through the first pharmacy drive-through, I pulled my car into an adjacent apartment complex lot.  If you are in withdrawal, your body really starts to freak out once you know you are about to use again – you start shaking all over, and your eyes water so bad it’s almost impossible to see.  I struggled to get the child-proof top off of the bottle…  I hit the steering wheel hard with my hand grasping the bottle – “C’MON GODDAMIT, I NEED THIS!!!”  I rolled my window down, took a couple of tremulous deep breaths, and focused again on getting the lid dislodged.

Finally…

I took two tablets out and put them in an extra large coffee cup I kept in the car for this very purpose, just big enough for my Iphone to fit inside.  I used the top hard edge of the phone it to grind the tablets into a coarse powder, with great difficulty – I was shaking so badly that the phone rattled around in the cup sounding as if I were playing some weird percussion instrument completely out of time with the music that was blaring out of the car stereo – whatever that was, I was almost incoherent.

“C’mon… Shit… C’mon baby…  GOOD ENOUGH!!”  I opened the Gatorade and poured some of it onto the powder, sloshed it around, spilling a little on my pants “GODDAMIT!!”  The drug wasn’t soluble in the cold liquid, so most of it collected on the top of the green fluid, some of the larger pieces floating around on the top – they reminded me of little tiny lifeboats circling a whirlpool… they are lifeboats… I put the cup to my lips, and…

Yes… yes… thank you, God… thank you… yesss… Jesus… yesss

I put my head back on the headrest, and then fell asleep sitting there in the apartment complex parking lot for an hour or so.  When I awakened, I felt a little better.  I knew it would take three to four doses to get my blood level where it needed to be, but it was amazing how one big hit could bring you back from the brink.  I could actually hear the music now, and put the satellite radio on my favorite channel.  I drove through the second pharmacy pick-up window and obtained the second prescription.  I tore it out of the paper bag, counted the pills by turning the bottle around and upside down, and threw it into the passenger seat with the other bottle.  It dawned on me that I wasn’t expected back at work for more than three days – I would have plenty of time to recover.  I’m gonna take all of this shit…  As I drove out of the pharmacy parking lot, a warning light blinked red on the dashboard, and I remembered that we had been a little low on gas rushing to the airport days earlier.   Not a great part of town, but I probably should pull off and get some – Don’t want to run out of gas and risk having to deal with a policeman right now…

I took the the next exit and pulled into the first gas station I came to on the service road – one of those tiny ones – a couple of islands and a ten by ten foot “store” where the clerk was stationed.  This one had an iron grate over what looked like a bullet-proof window for customers after dark, at which time the door was probably chained closed.  From a distance, it looked as if the main items for sale inside were condoms, tobacco and beer.

Really great neighborhood…

I opened the car door and looked at the pump – it didn’t have a credit card option, so I walked over to the clerk, and went inside.  He was a young man, no more than twenty I guessed, and middle eastern.

“Give me thirty, please”

“Thirty dollars?  Pump four, sir?”

I looked out at the pumps.  My car was the only one parked outside.  I looked back at the smiling young man with a bit of incredulity.  “Uh… yes…”

“Very nice car, sir”

“Thanks”

“Is it expensive?”

“Yeah, I guess so.”

As I walked out, he followed me to the metal and glass door, and stood there looking at the car.

I noticed that when I had got out of the car, I had left the driver-side door open, so I shut it, put the pump nozzle in the receptacle, and put the thirty dollars worth into the tank.  I was feeling better all the time, even a little giddy as I plopped into the car and closed the door.  Then I looked over at the passenger seat.

Didn’t I leave the bottles sitting here?

I felt the first twinges of physiologic panic, cutting painfully through the narcotic-induced calm of a few moments earlier like a shard of sharp glass – the noticeable quickening of the heart rate, and the little brightening of your field of vision as the pupils transiently dilate in response to the adrenaline as it is squeezed out of the adrenal glands, and into the bloodstream… I looked in the floorboard – nothing.  I yanked open the glovebox – nothing.

“SHIT!!!”

I jumped out of the car and ran around to the passenger side, yanking open the door, looking in the space between the seat and the doorjamb – nothing.

Then it hit me…

Did someone take them?  Someone took them… Someone stole them…  “GODDAMMIT!”

I raised up quickly, and scanned the horizon.  It was early afternoon, and there was no one walking around.  This was a fairly desolate stretch of service road – a couple of abandoned and dilapidated old buildings on either side, a greasy chicken drive-through a half block down, and this crappy little place.  I looked again at the service station building, the clerk was still standing at the door, watching me.  Then, I noticed a door on the back right hand side of the building slightly ajar – a bathroom?

I ran around the front of the car, pulling myself around the last gas pump to keep from slipping on some loose gravel.  I got to the bathroom door, grabbed it and yanked it completely open.  There was someone inside, someone standing at the sink with his back to me.

“What the fuck do you want?” he said, turning his head slightly and looking at me over his left shoulder.  He was peeing in the sink, holding his penis in his right hand.  He had the characteristic odor of a street person, and was wearing a tattered military jacket with the sleeves cut off.  He had very long, stringy hair and a patchy, untrimmed beard.  His left arm was hanging by his side, and I could see needle tracks all up and down its length, some fresh, from the door… and in his left hand were two large bottles of pills.

“Get the fuck out of here before I kill you, fuckhead” he said, coughed, and laughed.

I snapped.

I leapt into the space with him, and grabbed his hair, yanking him around to face me, his penis still hanging out of his fly.

“SHIT MAN, GET OFF ME!  I’LL KILL YOU!”

He was emaciated, and I was bigger than him, by maybe a hundred pounds.  I pushed my body hard into his, and his lower back bent at a bad angle over the sink behind him.

“SHIT, MAN!  MY FUCKING BACK!”

He dropped the bottles, and reached into his left pocket. Out of the corner of my eye, I could see him pull out a huge pocket-knife.  He struggled to open it, but couldn’t with one hand.  I was leaning in hard, and had him crowded into the sink bending over backwards – my chest and abdomen in contact with his.  He couldn’t reach around me with his right hand.

He started hitting me on the back of the head with the butt of the knife, but he was too close in once again to generate much force.

I impulsively reached for his throat, and everything slowed down at that moment…  way down – and it felt as if I were watching, but not actually doing… not actually involved.

I knew exactly where to grab – I know the anatomy, I know the anatomy, goddamn you… I knew how to kill him… to kill him… kill him.  I grasped his neck between my thumb and fingers – hard, hard, harder.  Twenty years of surgery had left me with an incredible grip.  His neck was thin and the skin loose, and my fingers dug deep into his flesh and found the space between the large strap muscles and his trachea.  He tried to grab my hair with his right hand, but couldn’t get a grip – it was too short.

I tightened my grip on his carotid arteries, which I sensed were being pressed up against his firm airway in my grasp, and I felt his body beginning to lose tone, lose interest in the fight – I was cutting off the flow of blood to his brain… Kill him… Without loosening my grip, I let my hand slide up higher his trachea, right below his thyroid cartilage, and squeezed  harder… harder… harder.  I felt the cartilage in his upper trachea crack, and crack again. I readjusted my grip and it buckled and cracked a third time – it felt like hard kernels of popcorn being crushed in my hand.  My face was no more than an inch from his… His eyes bulged, his tongue protruded like it was about to be completely expelled, and thick, dark bloody foam bubbled out of the corners of his mouth.

I let go of him.

He dropped to the urine-soaked maroon concrete floor, grabbed at his throat with both hands, let out a couple of pitiful squeaking sounds, and passed out.  I stood over him and looked at my watch.  I had to think about it to notice that I was panting.  At the three minute mark – I counted all one hundred and eighty seconds – I reached down picked up his wrist. There was a faint, very slow irregular pulse.  He wasn’t dead, but he was about to be.

I picked up the bottles and walked to my car.

§§§§§§

THREE

Context… we see the world through its prism – the familiar patterns and known colors of refracted reality.  What we expect to see, and what we feel we need to do in any given environment is shaped in part by the environment itself – it’s one of the main ways that we make sense of the world.  In actuality; however, context is nothing but a setting – a theatre for events, and not the events themselves.  Even though it is theoretically unlinked from “what comes next”, it is what we use to orient ourselves, and predict what will or should occur.

For example, even though it is entirely possible, you don’t expect to see a clown in a morgue – it would be disorienting.  You wouldn’t expect a high school marching band to play a fight song at a daytime church funeral, or to find exotic dancers performing at an elementary school open house to throbbing loud hip hop.  You might not expect to see a well-dressed surgeon strangling a heroin addict to death in a seedy bathroom in a really bad part of town, or two flak-jacketed city policemen and a state trooper walking into an academic medical center outpatient surgical clinic with their guns drawn.

I was arrested four days before my wife and daughter returned from vacation.  The fact that I had seen them for the last time as a free man, through bloodshot and watering eyes at some glitzy, overpriced resort in Cancun, didn’t even cross my mind until the arraignment – I was just worried about having to go through withdrawal again, and scheming how I might get Oxycontin in jail.

The trial was short, accelerated largely by the fact that I pled guilty. My lawyer – a very expensive criminal attorney from Dallas that wafted a transparent cloud of Polo cologne in a twenty foot radius around his body, and whose hair seemed like a plastic appliqué, had convinced me at first to plead not guilty due to temporary insanity related to narcotics use.  He even produced an expert witness that said that “the huge amount of Oxycontin Dr. Brian was taking had to have changed his brain chemistry and function, and therefore, changed his behavior”.  I agreed with all that crap, but I freely admitted that I killed the guy – I was climbing out of withdrawal the whole time the proceedings wore on, and just wanted to get the whole incredible hopeless mess behind me.  Of course, despite the expert witness’s fine testimony about my neuroanatomical derangement, at the same time that I killed a man with my bare hands due to bad brain chemistry, I was also performing complex surgical procedures, and leading what appeared to everyone else to be a normal, enviable life.

My mind wandered a lot during the trial proceedings.  I knew that it was a pro forma exercise once I decided to just get it over with, and that the only question was how bad the punishment was going to be – so why pay close attention?

I hadn’t thought about how I got hooked on the pills for a long time…

I knew a lot about addiction due to my background as a physician – and even though I wasn’t really listening to most of what he was spewing out at the jury for what was likely a five hundred dollar an hour human rental fee, the expert witness’s nicely rendered diagrams jogged my memory on the topic.  The opiate family of drugs, which all mimic to some degree the parent drug morphine, are little molecular structures that want to bind, or stick to / into another molecular structure somewhere.  The things that drugs want to bind to are called receptors.  When I was a medical student, it helped me to think about drugs as keys, and receptors as locks that they fit into.

The receptors for opiates are located in many places in the human brain, but most importantly in the anatomical areas where we sense reward and pleasure.  Taking an opiate, to the brain, is like having a piece of the best New York pizza known to man after two days of fasting, or having sex at age 25 after a long hiatus – it’s a neurochemical event that the brain “remembers”, and wants to experience again if possible.  Another way to think about it is that the drug molecules and receptors aren’t keys and locks at all, but rather sexual organs – each dose leads to a billion-billion penetrations as the drug finds its targets, and a billion-billion molecular climaxes – the brain’s pleasure is intense.

If you take them often enough, the brain begins to want to experience it again, over and over – who wouldn’t want a billion-billion climaxes?  The expert witness was right, at least in part – some of the chemistry and function of the reward system nerve pathways in the brain do indeed begin to change over time such that the drug is expected, not just desired.  However, it is important to note that there is a sinister thing happening as you begin to use opiates more frequently that sucks you in at the level of not only the brain’s reward and pleasure pathways, but of the brain’s very cells, your own personal biology as well.  As you take more opiates, and as they get into the brain and bind to the receptors, the number of receptors in each brain cell decrease – requiring that you take larger and larger doses to get the same effect.

During my senior year in high school, and against my father’s best judgment and expressed wishes, I bought a used lime-green Suzuki 250cc motorcycle with the money I had saved up from a job the summer before.  On a rainy day in April, on a Farm-to-Market road a few miles outside of my town, I skidded going around a corner doing eighty, and hit a truck broadside, breaking the femur in my left leg cleanly in two.  I still remember the pain – like someone had ripped my upper leg in half, poured hydrochloric acid on both raw ends, set them on fire, and then for the next hour, tried to put the fire out with baseball bats.  The first dose of intravenous morphine in the emergency room was my first experience with a billion-billion climaxes – I never looked back.

In college, it was relatively easy to score pain-killers.  At the state university, you didn’t have to walk more than a hundred feet to find someone that knew a source.   Even though I was waist deep in my addiction by my sophomore year, I impressed my parents a great deal by holding down a job and making close to a 4.0…

“…we are so proud of you son, and all the initiative that you are showing”….

What they didn’t know was that I was holding down a job only so that I could buy drugs.

As the years passed, I became an expert in finding, buying, and concealing narcotics.  As you become a hard-core addict, the “external” signs of abuse – lethargy, mood changes, and so forth, decrease over time, so as you use more, it becomes easier to hide it physically.   My brain was a neurochemical sex fiend – a second, needy and controlling organism housed in my skull.  The rest of me – surgeon, father, husband, man – only existed to find, buy, and conceal drugs for him.  I didn’t take care of patients out of any sense of responsibility or altruism, I took care of patients so that I could buy Oxycontin.  I didn’t take my daughter to her soccer games because I enjoyed the experience or felt responsible, I took her so that people would think I was a normal, loving Dad, and not an addict.  I didn’t lay down in bed each night next to my wife because I really wanted to have a relationship with her, I did it because I needed her to help me maintain the relationship with the being in my head.

Based on their buying the expert’s argument, and my clean record, the jury was merciful – rather than sentencing me to death by lethal injection, which is the third most popular sport in the state of Texas behind college football and running for president, they just gave me 70 years with a chance at parole in 35.  The judge added six months up-front in a prison drug rehab facility.  I celebrated my forty-forth birthday during the proceedings – the math really sucked.  I only turned around and looked at my family sitting in the gallery behind me once – it was just too much.  I didn’t need to see them to know what I had wrought – I could hear my daughter’s quiet, stifled sobs and muted whimpers behind me each day, all day long, as I sat at the defendant’s table with my legal team.  It was an ancient, heavy oak desk – I had purchased a few antiques over the years, and thought that it must have been at least fifty years old, if not more.  At first I wondered why the surface nearer the middle aisle, where the lawyers sat, was smooth and polished, and why the area in front of me was so worn – the finish scratched and pitted.  It became obvious.

I did manage to convince myself to glance at them out of the corner of my eyes as they led me out of the courtroom, but wish I hadn’t.  My wife’s face was stern, and unemotional – I had expected that.  This represented many things to her other than losing her husband, whom she now knew she never really had – among them were betrayal, lies, and economic upheaval.  We lived well, but we lived from large paycheck to large paycheck – life as she had known it, and had expected it to be forever, was lost.

My daughter looked distraught – her face was wet with tears, and her cheeks red with confusion and shame.  Her hands looked so small at that moment – at her mouth, fingers trembling.  Maybe I never really did love my wife, never really knew her – the being inside of my head wouldn’t, couldn’t let me have another real adult relationship.  However, he did not keep me from loving my daughter – loving her since the first moment I had held her tiny fragile form in my arms.

An incredible wave of guilt washed over me, and my limbs literally went limp right as the bailiffs stood me up out of my chair.  Without hesitation or emotion, they grabbed me hard, under each armpit – simultaneously propping me up, and moving me methodically toward the door.  It struck me that this was a short walk they had made thousands of times – the distance from the desk where I had sat the past few days, to the exit at the back of the witness stand.  I counted their steps as they drug my feet along – twenty-seven… twenty-eight… twenty-nine.  I would only make it once.

The needle would have been better. 

§§§§§§

 FOUR

People like to say that they “fall into” routines, as if there was some sort of gentle gravitational process that effortlessly moves you from one situation or place and into another.  However, by no means is that the way it works in prison.  There is no falling, or easing, or sliding, or transitioning “into” anything.

Steel is wrought into its various final forms by the process of “extrusion”.  The metal is heated into a semi-solid state, and then forced through an opening of a particular shape, with the metal taking on that shape, in a linear fashion, on the other side.  For example, a square opening gives you a long rectangular piece of steel, and a circle gives you one that is cylindrical.  The way you adjust to prison life is similar to this process – and there is nothing gentle about it.  The thick doors of the prison walls are the opening through which you pass to take on another form – to move from the life before, to the life now – to be shaped into what you are now from what you were then – you are extruded.

I was surprised by the fact that the other inmates already knew a lot about me before I arrived.  I came to know that this was the normal situation – information provided by newspapers, friends and relatives on the outside, as well as what the guards and trustees knew ahead of time.  Although I didn’t know it, and as luck would have it, I had three things going for me.

One, I was a doctor, and for various reasons, many of the other prisoners still had some residual respect for that.  I could perform a little first aid from time to time when access to the infirmary wasn’t possible – but that wasn’t what was valued most from “Docky”, as I came to be known. What was valued more than what I did was what I knew.  Many of the inmates had parents that were ill, and every now and then, there was a medical issue on the outside with a brother, sister, spouse or child.  I was more or less a source of free consultation, advice and at times, condolence.

Interestingly, what was most appreciated was the “truth” – even when the news wasn’t good – they valued greatly my ability to tell them what to expect with the things that they worried about at a distressing distance – the father with metastatic lung cancer to the bones and brain, or the grandmother with a hemispheric stroke that couldn’t come off of the ventilator, or a small child with strep throat.  I found an unexpected parallel to my previous discussions with cancer patients as a surgeon, and my discussions with these men.  Cancer patients will often be relieved when they get the news – when they finally understand what they are up against – when they can give the tumor a name – when they finally “know”.  One of my medical school professors used to say that it is not the fact that the monster is coming for you that is most troubling, but that it is hiding in the dark, and you don’t know what it looks like, and can give it no name.  Both groups are often characterized as desperate – these men that I was imprisoned with, and those afflicted with cancer.  I came to know that desperation is stoked and fueled by the fear of not knowing.  In prison, as it turned out, there was a lot of “not-knowing”.

Second, I had killed a man with my bare hands.  In addition to this, I was a fairly large man, larger than most of the other inmates.  Even though I garnered a small amount of respect from many of my fellow inmates due to my previous profession and what value that brought to them, I knew that no male lion ever got his choice of mate, or avoided the attacks of younger challengers due to his ability to draw the glycolysis pathway, make an incision look pretty, or read an X-ray.

Finally, I had killed within my same ethnic group.  There is no need to belabor this point, but suffice it to say that there were three groups of prisoners that ate together, hung out together in the yard, and protected one another’s interests fiercely – the whites, the blacks, and the chicanos.  During my third month a bad white cop had been brought into my cell block – one that killed four young unarmed Mexican-American boys, ranging in age from 10 to 14, literally children that he was strong-arming to sell drugs – forcing them to give him healthy cuts from the profits made in exchange for the favor of not arresting their parents and older siblings on fictitious charges.  His trial had gotten a lot of attention in the media, and was a source of conversation on the inside long before he showed up.  He was dead in four days – stabbed 40 times by a “shank” made out of a toothbrush and a coat hanger.  In my first official medical consultation from the state of Texas as an inmate, two of the guards had dragged me out of my cell and into the yard to see if I could assist the guard performing CPR on him.

“How long have you been doing CPR,” I asked the guard, as I squatted down next to him.  I noticed that I felt no particular emotion associated with asking.  As was my habit, I began to compulsively count his compressions.

“Dunno… maybe twenty minutes…,” he answered, continuing to pump on the bare, bloody chest – the guard was paunchy, and short of breath from the exertion.  His cap was perched way back on his boxy, crew-cut head, sweat was pouring down the sides of his face and increasingly darkening the armpits of his grey rayon shirt.

“Stop for a second,” I said.  He did, and I felt for a carotid pulse – “nothing, start again.”

I reached up and lifted the inmate’s eyelid up and down, covering and exposing the pupil in an alternating fashion.  I repeated it on the left.  I could hear the guard wheezing next to me.

“I need to give him some mouth to mouth,” he said, his breathing was audible, and it was an obvious struggle to speak “its been a coupla minutes…”

I noticed that there was an abrasion on the inured inmate’s right temple, and significant swelling.  I palpated the area and felt a depressed skull fracture – literally a golfball-sized piece of bone knocked out and down into the surface of the brain – pushed down at least an inch into the soft, light pink tissue of sentience lying below.  I then looked down at his chest – almost all of the stab wounds were to the left of midline, just beneath his ribcage.  I glanced reflexively at his neck veins – even though he was a stout guy, I could see them bulging under his skin.  Whoever had done this was an accomplished killer – this guy had been rendered incapacitated by a blow to the head with some object which likely alone would have killed him, and then stabbed in the heart repeatedly and accurately.  The distended neck veins meant that there was a lot of blood around his heart, trapped by the pericardium, or the tough but flexible sac surrounding the fleshy organ.  It is well-known that one or more fairly small puncture wounds to the heart, if well-placed, can be more deadly than one large one.  A large stab, one which makes a bigger opening in the heart muscle and the outer covering pericardial sac as well, allows the blood to empty completely from both the heart and the sac and into the larger surrounding chest cavity, but small ones may not.  In this latter scenario, the blood escapes from the heart, but gets stuck in the sac in which it is enclosed.  Once there is enough blood in the sac, it presses on the heart, and it can’t fill any longer with blood coming back from the brain above, and the other organs below – a condition we call “tamponade”.

If the heart can’t fill with blood, it can’t empty either, and no oxygen is distributed.  One of my medical school professors, a trauma surgeon, was fond of saying during treatment of patients that were bleeding – “its not blood that’s important, son – its oxygen… its not the damn cars that keep the railroad in business – it’s the cargo”.

“You can stop now,” I said, “his pupils are fixed and dilated… he’s been dead for about ten minutes.”

So, there was a lot of “not knowing” in prison, but this was not to be confused with a lack of knowledge.  There was a codex written in the cracks of the concrete walls of the prison cells and scratched just under the surface of the grassless recreation yard, and all had knowledge of this manuscript.  In it was found a chapter with the details of what brought you in – who you were, and what you did and what that meant to those already there.  In it was written as well the “rules” – the scriptures that mandated behaviors and traditions that had been a passed down, like genetic material, from generation to generation of the incarcerated – in it was written that if you kill a child, you will be killed – and if you kill a child of another race, you will be killed more quickly.

After about nine months, by which time I was determined to be a model inmate that caused no trouble, and attracted little, I was asked to begin to help out in the infirmary.   At first I was ambivalent, but over time came to enjoy it as a means of passing time, and garnering additional favor with the other inmates and guards.  The facility wasn’t too bad, actually.  There was a little front room, where there was a desk and several filing cabinets in which inmate medical charts were kept, and a locked steel refrigerator with a small supply of common low-abuse potential drugs like antibiotics and insulin.  Immediately behind this room were three reasonably equipped exam rooms, and farther back, a small open ward with six inpatient beds.  The walls were bright white painted concrete blocks, and the floor was covered in pale green ceramic tiles – nothing fancy to look at, but a visual respite nonetheless from the grey walls, floors and bars of the cell blocks.

There was a prison doctor on-site every day, along with a male nurse on some days, and a guard.  If there were patients that had to be kept overnight, a nurse would be called in on-call.  Most of those that had to be kept overnight were the elderly inmates suffering the usual ravages of advanced age – most often pneumonia, exacerbations of emphysema, or heart failure.  On occasion, we would keep someone there that had been involved in a fight and needed observation for a concussion or other similar injury.  Not infrequently, we would recover inmates that had been sent “out” for surgery as well – most were transferred right from the hospital recovery room back to us at the prison infirmary – it was a lot cheaper for the state to recover them there than in an expensive hospital bed in Galveston or Houston. In addition to these relatively consistent players, there were a number of doctors-in-training that were in and out of the infirmary – mainly family practice residents from the medical school in Galveston.  Some of these residents were “moonlighting” outside of the usual curriculum of the training program, called in when there were inpatients that required a bit more supervision, and getting paid for their time, and others were on “rotations” in prison medicine – completing electives of their choosing during the last year of training.

I did whatever was requested of me – I would see patients alongside the prison physician in the outpatient clinic, to speed up the schedule, and even though it wasn’t considered “legal”, at times he would ask me to see the last few clinic patients by myself so that he could leave early.  Other times I would fill in with the inpatients when we had a full house, assisting the nurses or residents, and at times substituting for them when they couldn’t make it in for one reason or another.

After several years, I became a fixture there, and was allowed to opt out of a number of prison activities and the everyday singsong schedule of prison life as a result.  It was a good deal for the warden as the on-call nursing and moonlighting residents were not needed as often, thus allowing him to pad the budget to the tune of what must have been a few thousand dollars each month.  I was released from my cell in the morning, and basically spent the entire day down working in the clinic most days.  I ate breakfast and lunch in the infirmary, and was able to schedule my rec time around the clinic’s schedule rather than the cell block’s, and therefore avoided a lot of daytime lockdowns, and other similar pleasures.

Rather than making life inside seem more reasonable; however, over time these liberties only served to increasingly remind me of what I had lost.  It’s not the absence of freedom that leads to a desire to have more of it – ironically its just the opposite.  Incarceration is not rehabilitative – it’s numbing and amnestic, and it creates a tolerance for more of the same. The problem with working in the clinic; however, was all the time I spent with those that were actually free to come and go.  What evidently drove the inmates crazy at Alcatraz was not the rock itself, or even the isolation.  It was the ability to look out of their cells and across the bay at beautiful downtown San Francisco, and when the wind blew in the right direction, to hear traffic noises, the ringing of church bells, and the merry sounds of those celebrating holidays.  The doctor, visiting nurses and the trainees coming and going from the clinic were my own agonizing view of a figurative place across the water that I could see, but had no hope of reaching… or did I?

It was during this time that I decided that I would escape.  I decided that I would use the same practice of medicine that I had used to gain access to this tormented place to free me once again.

§§§§§§

FIVE

My wife visited me one time – within a little more than one month of being incarcerated, and a little less than one month before the divorce papers came via prison mail.  The conversation was short, terse and completely bereft of either eye contact, or emotion.  Basically, it was a rundown of all of the financial travails I had left her to “fucking deal with alone.”  All I could think of while she shared her morbid catalogue with me was “wow, she really loved me.”

My daughter didn’t say anything at all, lurking behind her mother at the table where we sat in the big open visiting area, alternating between nervous looks around the room at the other inmates and their visitors and then looking down at the concrete floor while chewing on her fingernails.  But on leaving, she literally grabbed me and held me, her head on my chest and her eyes closed tight, for almost five minutes before my wife finally suggested, her arms crossed and her foot tapping, that “its time to go, honey… your father has to get back to whatever he does in here.”  I could still feel my daughter’s small hands grasping my arms so tightly that those same fingernails, half covered in flaking pink nail polish, left indentations, and later, marks that lasted for two weeks.  I would look at them every morning after she left, and run my hands up and down over the tiny dark red quarter-moon shapes.  I would then go over and sit on the edge of my bunk for several minutes – trying to figure out what I was feeling.  Was it sadness?  Was it guilt?  I wasn’t sure – at that point, I was just trying to remember what an emotion felt like without pharmacology involved.

She was too young to drive, so that incredibly pleasant visit with her mother was the last time I saw her.  She wrote me religiously; however, despite the fact that that she had become a teenager, and was most likely experiencing all the emotions and parental loathing that I imagined had come with that.  The letters were relatively short, mostly superficial and self-consumed, but she had kept at it – once a month most months, for more than five years.

It was about the time that I settled into work in the infirmary that I began to have dreams of my daughter.  Actually they weren’t really dreams at all initially, just, well… flickerings – like what you might see from an old Super 8 projector sputtering on and off as the electricity supplying it was inconsistently applied, or perhaps the illuminating bulb was faltering and about to burn out.  At first there were fleeting images of her as a baby, and then more substantial ones of her as a toddler, and then – full-blown dreams of her as an adolescent.  It was funny – I was sure that the images were real, but I couldn’t really remember being consciously aware of any of them before these dreams – I didn’t remember noting any of this in real time, as it was happening over the past several years.  The settings and some of the environmental details were familiar – I did have recall of some of those – things like the pattern on her nursery quilt, or perhaps the colors in her plaid private school skirt.  It was her that I was missing – what I was missing were accessible memories of my daughter during my waking hours – they more or less didn’t exist, likely blanked out by my heavy drug use in addition to the work schedule of a busy academic surgeon.

However, these dreams were special, and I was intrigued by them… these dreams suggested that my subconscious had either done me an incredible favor, or perhaps played a cruel joke on me now that I was separated from my daughter – my subconscious had stored these memories away for me, safe from the drug-addled war zone of the rest of my mind – protecting images and vivid memories of her there. They were like a child placed into a storm shelter during a tornado, placed there so that I might be able to retrieve them later, safe and intact.

Then, on a night like any other, I had one that changed everything.

This time the memory was of her at the beach in Mexico – the last time I saw her before leaving and coming back to the States.  I was sitting under a big white canvas umbrella, oblivious to the beauty of the Gulf and the pale yellow sand – drinking wine to try to stave off withdrawal, and scheming about how to get some Oxycontin.  Although I was sleeping in my prison bunk, I knew that I had a waking memory of those things, but again those things only – the environment around her, but not her.

But in this dream, unlike in real time, I did see her there, standing on the beach.  She was wearing a baggy green sweatshirt – it had been mine, but she loved it.  I could see her face in profile – the perfect shape of her little nose and her long upturned lashes.  She was looking at the ocean, and her form was motionless except for a few tendrils of hair – moving up and away from her face in the wind.  It looked almost as if each tendril were alive, as if there was some sort of purposeful energy moving from the water, to the sand, and into her body.  She turned to me and smiled, and I smiled back at her.  I realized that even though I hadn’t been fully cognizant of her standing there in the moment, that my subconscious mind, and my soul clearly had.  At that deeper level, I knew she was there, I “saw” her there, and loved her desperately.

I have to get out of here… I would not accept this sentence.  I would not be able to wait until old age, to see her.  I would not be willing to take the risk that I would die in here, like the old bastards I saw in the clinic every day, never seeing her at all.  Something dormant within me had been reanimated – something emotional that had been locked away, like my physical being was now, by time and drugs and ambition and career.

I woke with a start, and sat up on the edge of my bed.  My roommate shifted in his bunk above me, but didn’t awaken.  I yawned and stretched and pondered again what I was feeling – if I was feeling anything, and knew immediately that this time I was, indeed.  I put my head in my hands and sobbed quietly until wake up call, three hours later.

The harsh horn blast reverberated in the cell block at six a.m. sharp – bouncing off of the concrete surfaces and metal doors and eventually being reflected into the cells themselves, where they then rhythmically vibrated the hearing apparatus of my middle ear, transmitting a nervous signal to the part of my brain that processes and analyzes sound.  If the neurons that did the final work of that analysis had been able to do so, they would have noted that a nearby group of other neurons, usually silent, were now firing rapidly, and purposefully – speaking to one another in muted sparks and whispers, laying down a new circuit, formulating a plan.  Within a few days, and following a couple of trips to the library to study Texas maps, I was ready to move forward.  Actually, the plan was three separate plans, arranged sequentially.  First, I had to physically get out of the prison… second, I had to move through the Texas countryside south to the Gulf, and third, I had to leave the country.  I was dangerously confident about the first two, but would have to figure out the details of the third on the fly.

The medical clinic would be able to provide me with the fulfillment of the first plan – getting out of the prison itself.  For the second, I would rely in part on some intact pre-narcotic era experiences as a teenager that I could clearly remember – when I forded and canoed most of the Brazos River east and south of Houston to the Gulf.  The “Brazos”, as most now referred to it, was originally named Los Brazos de Dios – The Arms of God.  I wished at times, as I mulled the plan over and over again in my mind, laying in my lower bunk at night, that I didn’t actually know that obscure fact.  It struck me that I perhaps didn’t deserve God’s embrace after all that had transpired, and therefore had made no plan to ask for it.

The doctors-in-training that visited the clinic had become more and more comfortable with me as time had passed with several cohorts of them, and would frequently smuggle things in at my request, like liquid soap, or various contraband food items.  With my wife out of the picture, no one was sending me care packages filled with familiar items from home, and the local school kids didn’t tend to send cookies as often, with accompanying crayon-crafted cards, to guys that strangled people in gas station bathrooms like they did with the soldiers overseas.

I knew not to ask for anything that would bring attention to my relationship with them, because my liberties in the clinic could be revoked if someone became suspicious, and if I was yanked from the clinic, I didn’t know that I could come up with an alternate means of escape.  When they arrived, two or three times a week, they always wore scrubs from the hospitals where they worked.  I asked them for a couple of pair that would fit me, explaining that “they’re a lot more comfortable than these white canvas outfits”, and as well that “every now and then I’m forced to wear someone’s vomit for twenty-four hours, and this will allow me to change in and out of my regular prison whites while I’m down here.”  I didn’t know if the prison doctors would be concerned about this, or if the guard that was stationed in the clinic daily would object either – there were no real individual fashion statements allowed in prison – there was only one uniform that inmates were supposed to wear, period.

Once they obliged, I started out by just wearing a scrub top every now and then with my prison-issued pants, and after noting no objections from anyone, added the scrub pants as well.  Neither the guard, nor the clinic staff seemed to notice.   The clinic had it’s own washer and dryer – making it easy for me to keep a pair clean at all times.

In addition to helping me and the clinic doctors wade through the usual work each day in the outpatient and inpatient areas, one of the residents would also often accompany inmates on the ambulance ride when they were transferred out to the two hospital facilities that were contracted car for them if we felt that they needed subspecialty care, or were too sick to keep in the facility.  They called it a “ride out”.  They were paid extra moonlighting fees for this.  I had taken a particular interest in that activity, but not for financial reasons.  As the residents were not there every day, some patients were transferred without a doctor accompanying them, and the staff doctors never themselves participated, the few hundred extra dollars not worth their time or trouble.

I had walked out to the waiting ambulance a few times with the residents, and noticed that the drivers and EMTs were almost never the same crew.  I also noticed that they really didn’t pay attention to the residents themselves, just basically saying “hello”, half-listening to a cursory report about the patient being transported, and then closing the doors behind them after they each crawled up to sit on the metal bench next to the stretcher, where they immediately took out their cell phones and started looking at Facebook, rather than performing any real patient care.  I had watched this process take place, and the ambulance leaving the premises perhaps twenty-five times – the guards at the two sequential gates would peer into the shaded windows to make sure the bay wasn’t filled with whites-wearing inmates, and then wave them on.  I also noticed that on most of the ambulances, you were really unable to make out the features of anyone’s face when looking through those windows.

If I was going to go on my own “ride out”, several things would have to fall into place – we would need to transfer a prisoner out when there was no resident, the prisoner had to be either sick enough, or comatose enough to not know who I was.  This would be difficult, as many of those that bounced in and out of the clinic on a regular basis had gotten to know me very well.  Finally, there had to be a staff doctor in the clinic, or if not, we had to be at the end of a clinic day, with no more scheduled patients to see.  The latter worried me a little, as only one of the three regular staff doctors bothered to stick around most days, the other two basically letting me do the work.  If I were the only doctor on-site and there were patients scheduled after I went on a ride-out, they would discover me missing too quickly, and likely stop the ambulance.  Last – I had to be out of the clinic proper, but accessible to the parking lot when the patient was transferred, or at least out of view of the guard, so that I could get into the vehicle without his observing me.  It all seemed unlikely at times.

On a sun-drenched day in mid-May – when the cornfields in south Texas were filled with six-foot tall, sturdy green broad-leafed plants, and the thunderheads were just starting to roll over the flat coastal plains, fueled by the warm moist Gulf air moving up from the south, and the Midwestern cooler air moving down from the Edwards Plateau – it surprisingly all just happened to come together.  It had been eight months since that fateful night when I decided that it was worth risking the possibility of never being released from prison, and even losing my life if necessary, to try to be with my daughter.

Joseph Cleveland Brown was an eighty-year old black man that had robbed a small Dallas bank in 1955, and in the process, had shot a security guard in the back, paralyzing him from the waist down.  That was his ticket for a one-way ride with the Texas Department of Justice – a lifer.  “JB”, as he was known affectionately, was one of the prison’s elderly mascots, a guy that everyone knew and loved.  It was easy to love the old guys, as it turned out, because they weren’t a threat to anybody.

JB unfortunately had a bad case of Parkinson’s, and had been hospitalized in the clinic several times in the last two years with urinary tract infections.  Like most men his age, he had a large prostate, and this obstructed his urethra from time to time, the tube that connected the bladder to the outside world.  Other inmates with this problem had been taught to self-catheterize when necessary – to literally put a skinny soft plastic tube up through the penis and into the bladder to allow the urine to pass.  JB was unable to do this; however, due the cruel “pill rolling” tremor that his neurologic disease had caused.  The description of the tremor originated in the days when pharmacists and others used to “roll” pills from compounded ingredients, between the fingers and thumb.  The hands of Parkinson’s patients look as if they are constantly rolling pills, or perhaps trying to snap their fingers to some demonic jazz tune that no one can hear.  To make matters worse for JB, these tremors tended to intensify as any manual task was attempted, like inserting a catheter – an “intention tremor” in medical terms.

JB came into the clinic late in the day on a Monday, transported by wheelchair, and was in bad shape.  He had a fever of 103, shaking chills, and was delirious – he didn’t know who he was, who we were, or what was happening to him.  I got him into a bed and placed a catheter into his bladder – a torrent of turbid dark yellow blood-flecked fluid poured out of him – looking more like thin pus than urine.  We got an IV started and some antibiotics, but he worsened overnight – the infection had likely spread up into one or both of his kidneys.

“I think he should be transferred, Dr. Phillips,” I commented to the prison doctor the next day – by chance, he was the one that always showed up and worked his own shift without sloughing off on me, “looks to me as if he’s heading for an intensive care unit somewhere.”  Dr. Phillips came over and looked at his chart.  “Fever still high, and urine output down since the catheter was placed… Hmmm… Creatinine up to 4.0… I agree, he’s in renal failure and flirting with full-blown sepsis.  I’ll make the call downtown.”

I felt both sick and excited, but remained pokerfaced – I knew that this was my chance – there was supposed to be a resident from U.T. Galveston in that day to work with us, but he had called in and told us that he had been booked for ER duty there, and had forgotten.  I watched and listened nervously, while Dr. Phillips made the call in the front office.  Once he started talking, I walked over the medicine cabinet and took out a bottle of Ipecac syrup – the stuff we give to induce vomiting – used for instances such as when the occasional inmate tries to take an overdose of smuggled sleeping pills.  I slipped it into the back pocket of my scrubs and took my shirt-tail out so that it would be covered.  The guard on duty that day was an aging veteran who was nearing retirement – he had a lot of tenure, and got to pick his detail.  He was in the clinic about twice a week as a result, where the work was easy and relatively safe.  I had noticed over the past few months that he was constantly nursing a cup of coffee, and so I made him a pot in the tiny galley in the clinic each day first thing when I saw him on the schedule.  He had walked over to see JB and was trying to talk with him – they had known one another for more than thirty years.  While he was standing at the bedside at one end of the clinic, and Phillips was still on the phone on the other, I walked over and put some Ipecac into his coffee cup.

Phillips hung up, and the guard walked back over to his perch in the corner of the inpatient ward and sat down.  JB hadn’t answered any of his questions – he was barely conscious and mumbling under his breath something unintelligible.  “Looks like that there aren’t any more outpatients today,” I said casually, looking at the paper schedule that was tacked up to the bulletin board.  I think I’ll take a walk around the yard, if that’s okay with you guys, and go back to the cell block.”  “Fine with me docky,” the guard said.  He pushed his cap back on his head and rubbed his ruddy forehead with his slightly deformed arthritic, I thought to myself, never really noticed before… fingers, then waved me off, “have a good one, docky, see you later in the week.”  I had done this a hundred times before – there was absolutely nothing for him to be suspicious of.   “See you next time,” Dr. Phillips said, who by now had hung up the 1950’s era black landline receiver on its receptacle, and strode over to the desk where he had plopped his briefcase, “I’m getting out of here too.”  He picked up his things, strode over the front door that opened directly onto the gravel-filled parking area, and then he was gone.

I nonchalantly walked out the side door of the clinic, where there was a short covered walkway leading to a small adjacent supply building – out of line of site from the guard tower, and not likely to be traveled by anyone.  About the time I heard the guard inside retching, the local ambulance service showed up.  Damn… perfect timing, I whispered.   I stood and watched the EMT and the driver walk in the clinic front door, and then come back out about ten minutes later wheeling JB out on metal stretcher with wheels.

“Did you get a load of that old guard?” I overheard the driver ask the EMT.

“Yeah, he looks pretty bad, maybe we should grab him and wheel him out next – poor bastard,” he laughed.

I had never seen either of them before.

I strolled over just as they were about to close the back door of the ambulance.

“Mind if I do a ride out with you guys?”

“You the resident?” the EMT asked, suspiciously, “aren’t you a little old?”  He looked me up and down, and the driver moved a couple of steps back and looked at one of the distant observation towers – the only one that had a clear view of this small parking area.  I knew that one of the guards in that tower would notice the hesitation, and the driver’s nervous gaze, if we stood there for more than a few more precious moments.

“Yeah,” I replied quickly, resisting the urge to look up at the tower, my heart pounding, “you know… second career thing – first one didn’t work out so well”

“Yeah? What was that, doc?” the EMT asked.

“Uh… I was working a lot with pharmaceuticals”

“Whatever,” he grunted, “hell of a thing to do at your age, training to be a doc – I would have picked something easier – like maybe ditch-digging.  Yeah sure, come on, I can sit up front with my buddy here and you can hold this old fart’s hand.  He smells like shit.”

He looked over at the driver, who just shrugged his shoulders.

I climbed up next to JB, and sat on the metal bench next to him in the little area cleared for that purpose, an oxygen tank to my left and several clear plastic bags containing various emergency medical supplies hanging from a metal mesh rack bolted to the wall on my right.  The EMT slammed the door shut, and I listened to the gravel in the parking lot crunch under their feet, as he and the driver walked to and opened their respective doors.  I noticed that I was holding my breath as I counted their steps, four… five… six… seven… eight…

I looked down at JB – he had been basically comatose now for almost forty-eight hours.  I exhaled, slowly, and even allowed myself a little chuckle.

The driver started the ambulance, and as it shifted into drive, there was a jolt, and the stretcher jerked violently a few inches forward and then back – its loosely-latched metal rails rattling loudly.  JB opened his eyes for the first time in two days, propped himself up on his right elbow and looked directly at me, startled.  In the small space of the ambulance bay, his face was only about eight inches from mine.  We were friends – he even called me “Docky Joe”.  I looked back into his bloodshot eyes, and his sweaty face, and froze.  This could screw everything up… He squinted, and his deep gravely voice boomed, “Mabel? That you baby?”  His expression then changed quickly from confused, to blank, and then relaxed.  He laid back down and shut his eyes – smiling.  Right before he lapsed again into his fevered slumber he added, while smacking his lips – “Sho was some good cookin’ – you got any more of them pork chops handy sweetie pie?”

I swallowed hard, and regained my composure.  With my back to the window, I leaned over JB as the ambulance moved slowly forward, acting is if I were checking the intravenous line in his right forearm.

We stopped twice to let the guards peer in through the frosted glass, and then JB, Mabel and I were on the road.  I counted the telephone poles as they passed by out the window.

§§§§§§

SIX

When we were about twenty minutes out, I allowed myself to lean back, and peer out of the window.  JB was stable – the portable ECG machine clamped to the stretcher showed a normal heart rate, and the automatic blood pressure cuff readout was good.  I reflexively felt his forehead – he was febrile – but not more than 101 or so, I thought to myself.

We would either shoot into Houston, or we would go around the south side by way of the Beltway, hit I-45 and go all the way down to Galveston – to one of the two hospitals that had a contract with the Texas Department of Justice to provide advanced care for inmates.  However, I would not be making the trip to either one of them if possible.

I tapped on the window to the cab, above the head of the stretcher, and the EMT slid open the glass.

“What’s up doc?” he asked.

I tapped my scrub pocket, as if something were there.

“My wife just texted me, and wants to know where she should pick me up.”

“Tell her that she can catch us at Rick’s Men’s Club at about 2 am…” he replied.  He and the driver laughed.  “We’re heading down to UTMB in Galveston doc, that okay?”

“You know… we live in Pasadena,” I replied, “unfortunately, we can’t afford to live inside the loop on a resident’s pay… could you drop me somewhere between Houston and Galveston, so that she doesn’t have to drive all the way down to the island with the kids after school to get me?”

He looked at me and shook his head, “speaking of pay… you know you won’t get any dough for the ride out, doc, if you don’t stay with us and the patient all the way to the hospital, right?  It’s the rule – I didn’t make it, but all the same…”“Yeah,” I replied, “I know, but keeping the little lady happy is worth more to me – I’m… just trying to stay out of jail, if you know what I mean.”  “No shit!” he replied, laughing again.  He tapped on the wedding band on his left hand, which was grasping the windowsill, and then leaned over and mumbled something to the driver.  “Can we drop you at the corner of the Beltway and I-45?” he asked, “there’s some gas stations and stuff there.”

“Perfect,” I answered, “I’ll text her in a minute and let her know.”  “No problem…,” his expression turned serious, “you know doc, she must be an angel to let you do something like this at your age.  And you got kids too?”  “Yeah, I replied, “she’s great – literally lets me get away with everything – just short of murder I guess…”  He winked and closed the window, and we snaked methodically through the south Houston traffic.  Forty-five minutes later, we pulled off the highway, and into a convenience store parking lot at the planned drop off.

The EMT jumped out, came around back and opened the door.  “You see her yet?  She here?” he asked, looking around.  “No, she won’t be here for another fifteen or twenty minutes, but it’s no sweat, really.”  I patted JB on the forehead, and clambered out the back.  “He’s stable right now.  His BP dropped to the eighties for a little while, and I gave him a 500 cc bolus of saline – came right back up.”

“You chart it?” he asked.

“Yessir,” I replied.

He pulled himself up onto the seat where I had been, and gave me a salute – I noticed with some relief that the driver hadn’t stopped the engine.  “Seems like you like this guy.  Don’t worry, we’ll get this old geezer down there safe and sound – that’s what we do… see you on next ride out, doc,” he said.  I smiled, waved, and shut the back door.  They eased out of the parking lot, and onto the service road.  I looked over my shoulder once they were out of vision, and through the big plate glass windows of the convenience store.  There was a digital clock with giant red numerals, embedded in the middle of an elaborate Budweiser sign bolted to the wall above the refrigerator case, replete with Clydesdales and two giant illuminated plastic cans of beer.  It was five o’clock.  Under the usual circumstances, I would still be in the clinic.  The only guy that knew I left early was the guard that had drank the ipecac – it was a good, if not sure bet that he had gone home before his shift was up.  When dinner started at six, I might be missed, but at times the clinic ran into the dinner hour when we were really busy.  But after dinner… by seven o’clock at cellblock check-in – I definitely would.

My plan was to steal a car, if I could, and get out into the country about thirty or so miles east of here, where I would then set out on foot.  There was a lot of desolate farm country in that area, and I was going to try to make it to the Brazos River that way – I knew that I was much less likely to be caught than if I tried to drive all the way to the coast, or to Mexico – those two approaches were completely predictable.  I also knew that it was Spring, and with the corn and alfalfa was all grown up and awaiting harvest – higher than a man’s head, that I could hide from helicopters if they came searching.  This part of the world was flat as a pancake, and you could hear the rotors for miles.  However, I knew that they probably wouldn’t – the state troopers and local law enforcement would be looking for me in a car, or trying to hide out anonymously in the city.

The convenience store was busy, and looked relatively new.  There were three separate islands for self –serve gas, one each in front, and to the left and right of the store itself, with four pumps at each island.  There must have been ten cars in various states of either being actively fueled, or awaiting the return of their occupants – inside paying for gas, or buying something.  I walked inside, nonchalantly, and picked up two cans of Vienna sausage, and a large Coke – I had five dollars total, and needed calories – it might be a while before I got to eat again.  After I took my turn in line, I scanned the lot.  I watched as an elderly woman with an impressive towering grey bouffant hairdo methodically pumped gas into her late-model white Toyota Camry, put the nozzle back into the receptacle, and then walked ever-so-slowly, with the assistance of one of those three-rubber footed aluminum canes, into the store.  I took a big swig of my coke and walked past her casually.  She smiled as she passed.  I just kept walking toward the island where her car was located, as if my own was there.  I turned and glanced over my shoulder, and saw that she was heading in the direction of the bathrooms in the back of the store.  She’ll be in there for a while, I thought to myself.

I picked up my pace, and reached the passenger window of her car.  As I had hoped, the keys, with a small plastic picture frame dangling from the ring – no doubt sporting a favorite grandchild photo, were in the ignition.  No one was paying me any mind whatsoever – the Houston area is the medical-care capital of the world, and every day there are thousands and thousands of people walking around in scrubs – in the shopping malls, at gas stations and convenience stores, everywhere…

I capped my soda, walked around and slipped into the car, tossing the bottle the plastic bag containing my precious high-fat meal onto the passenger seat.  A somewhat dated cell phone was sitting in one of the drink holders – I grabbed it, turned it off, and then tossed it out the window and into a trashcan.  I started up the car and drove slowly out of the lot, onto the service road.  I had lowered all of the windows so that I would know if anyone in the had discovered me and was yelling at me to stop…

Does that ever work, does anyone stealing a car ever really stop when they yell “stop”?

Nothing.

The rush hour traffic heading down to Galveston was bad, and that made me a little nervous – but I took some modest comfort in the fact that there were more than twenty thousand cars stolen in Houston each year, and the police didn’t get too worked up about them in real time.  I figured it would take the old lady more than twenty minutes to get in and out of the bathroom, maybe buy an item or two, and finally discover her car was gone.  It might be close to thirty before the police were even called about it, and then they would have to get there in the same traffic that I was driving in if they were going to actually take a report.  I should be getting off of the interstate by then.

I was finishing the second can of Vienna sausage when I turned off of the I-45 and onto a sparsely traveled two-lane farm-to-market road – heading west.

§§§§§§

SEVEN

They tell you that as a medical student that you learn more than sixty thousand new words, and at least as many facts and figures as well, created by putting those words together in meaningful ways.  Here the learning is a progression – you begin with the normal – the normal cellular components, the normal cells, the normal tissues and organs and “normal” bodies  – and then move on from there, once you have a platform on which to work, to the abnormal – the disease states.

After medical school, when you are training to be a surgeon, this progressive pattern is repeated.  You may have learned the normal anatomy as a student, but not well enough for the operating room, and therefore you must review “normal” again and again during the first couple of years.  Then, as you move up in rank and experience, you begin to collect a personal library of normal versus abnormal – collating and coordinating thousands upon thousands of mental images, a database to carry into the operating room each time you go there.  You must have a variety of examples of how the decidedly abnormal looks and feels in that database – organs and structures affected by the growth of a tumor, or the blood vessel-choking deposition of atherosclerosis, or perhaps simply by the strike of a baseball bat on the skull, or shock wave created by a bullet passing through the intestines.  There are thousands and endless thousands of abnormals to learn, because every patient is, in fact, unique, and abnormal.

Memorizing the maps was therefore fairly easy for me.  Even under the influence of drugs, my mind was trained for years to learn best from visual patterns.  The great thing was that here there was no abnormal anatomy to catalogue and recall – the veins, arteries, bones and fleshy mounds were all in “textbook”, predicted locations.  I had studied the maps for this part of Texas over and over again in the prison library, and had developed a mental image of not only the roads, but also the lakes, rivers and streams, the railroads and pipelines, the hills and arroyos, and the settlements and property boundaries.  I was totally prepared to “operate” here.

I had given a great deal of thought months earlier as to whether or not to just go directly to the river, and then try to make my way down to the coastline just past Brazosport.  However, I chose otherwise.  For one, it would require that I stay on the road longer than I thought would be safe, and it would also require me to ditch the car nearby the river, tipping them off to look for me down-stream.  Second, I was afraid that law enforcement might search the river early on – during the first day or two after my escape.  I wanted to leave the car far removed from the river, move across the farmland on foot for a couple of days, and let the excitement die down.  Then, when I was not likely going to be sought there, I would use the river as my conduit, as my vital arterial connection to the Gulf, and then from there, somewhere south.

I drove along the farm-to-market road south and west of Houston at a leisurely pace, passing through Alvin, Texas.  About 15 miles south of there, I pulled off onto a poorly paved road, heading to a small lake that I had memorized the location of for this specific purpose – Garrett Lake.  It was more of a large pond than a lake, but it was only about three miles off of the state highway, with one small boat ramp and no fishing.  It was also just deep enough to submerge a car.  I found some twine in the trunk of the car and tied the accelerator down to the floorboard with the car in Neutral, while parked at the top of the boat ramp.   I then opened the door, and slammed the stick into Drive.  The car lurched forward, kicking up dirt and gravel from the crude ramp, and disappeared in a cloud of steam and bubbling water beneath the surface of the lake.

It was eerily dark in the country by this time, around ten-thirty at night.  I looked over my shoulder to the West – nothing but pitch-black sky.  I could seen lightening on the horizon, but there was no accompanying thunder, suggesting that the light show was more than twenty miles from here, easily discernable on the absolutely flat coastal plain.  Once the bubbling and fizzing of cool lake water on hot steel stopped, it grew quiet, and the sound of hundreds of tiny frogs positioned on the lake’s periphery began to echo – a disjointed chant that sounded as if a large band of percussionists were striking thousands of tiny wooden drums.  I hadn’t heard that sound for seven years.

The Brazos was about a seven-hour walk from here as the crow would fly.  My plan was to take my time, and do it in two days.  Between here and there, north of the town of Angleton, was nothing but farmland, and that was what I wanted, what I had planned for.  I struck out on foot, crossing back over the still-warm asphalt of the state highway within five minutes, and through a barbed-wire fence into a recently cut field of alfalfa.  There was no moon, as the storm system to the west had blotted out the skies with a hazy, cottonball-edged blanket of leading moisture that I had seen rolling in as I drove.  I needed to get a good distance away from the road before lying down somewhere to sleep – it would take about two thousand steps to make a mile.  I squinted into the darkness and started counting as I walked.

I crossed through two more barbed-wire fences, one recently re-strung and difficult to traverse – modern gleaming razor wire taught and spaced only about eight inches

apart between strands – I ripped the back collar of my scrubs as I ducked between them.  The second was ancient, loose and rusty with those little pieces of cut wire barbs wrapped around the main strand every few inches – I just stepped on the sagging top strand and hopped over.

I was exhausted.  Even though the day hadn’t consisted of any incredibly taxing physical activity, rather just riding or driving in automobiles, the stress of the escape had taken its toll.  I found a fresh, shallow irrigation ditch that had been recently created next to a cornfield which looked as if it were almost ready for harvest, and lay down.  The rich coastal soil smelled good – loamy and briny at the same time.  The limestone residue portion of the scent, built up over the millennia as sea creatures and their shells were deposited in an ancient ocean floor was unmistakeable.  I noticed as I lie there that the ground was compact and still warm from the day’s sun.  I was asleep within seconds of folding my hands beneath my head, and pulling my knees up to my abdomen.

I woke up with a start, and in pain, a few hours later…

“SHIT!” I exclaimed, trying not to yell.

I was lying on my left side, and my left foot was on fire.  It literally felt as if someone had soaked my sock in gasoline, and then had stuck a lighted match into my tennis shoe.  I felt down reflexively, and my hand met a moving thing… no, hundreds of moving things, tiny, and now crawling onto my arm.  Goddamn ants.  Fire ants had invaded the southern regions of Texas more than two decades ago, up from South America, and in some areas, they were everywhere.  Recently-used irrigation ditches are not uncommon areas to find their mounds – they are attracted to the moist soil.  I hadn’t disturbed a large mound a couple of feet from where I was laying, but my body heat had attracted the colony’s attention.  I swatted them off of my arm, leg and foot, sustaining a handful of additional painful little venomous bites in the process.

I scooted back and several more feet away on my bottom, and slipped off my shoe and sock.  It was too dark to visualize, but I could feel about two hundred or so little bumps on the bottom, top and sides of my foot.

“Goddamn little bastards…” I murmered under my breath, and then started laughing, “there are no fire ants in prison…”  I rubbed my foot, which after a half hour or so stopped burning, and began to itch like crazy.  I sat up and leaned back against the wall of the ditch, and closed my eyes.  Fifteen minutes later, the rain started.

At first, I welcomed it.  I was thirsty, so I simply leaned my head back and let the drops collect in my mouth, swallowing whenever I felt it filling up.  The raindrops in this part of Texas, which come right off of the Gulf, are about twice the size as normal ones – when you’re driving and they’re hitting the windshield of your car, you literally can’t tell if they are hailstones, or just rain.  I listened to the individual drops as they struck the dry ground around me – “clut-clut-clutclut-clut”, and lulled by the monotonous sound, began to drift back to sleep.

Right then a bolt of lightening hit the ground no more than thirty feet from where I was sitting.  There was a blue flash, and a strong smell of ozone before I heard anything.  The noise then enveloped me concussively.  I felt a strong tingling sensation and was knocked knees and face down into the now muddy bottom of the man-made ravine.  The soil didn’t taste nearly as good as it smelled.  My eyes took at least minute to recover – for several seconds all I could see was a painful bright light.  I crawled up and out of the drainage ditch, without laughing this time, and fell asleep once again with my back lying against several firm cornstalks.

I woke up just as the sky was changing from deep purple to glowing dark blue.  The rain had stopped, and as I lay there without moving I could hear drops of water dripping from the corn plants, down the stalks from the upper to the lower leaves, and onto the ground.  In the distance, a rooster was hoarsely crowing – his voice cracking and inconsistent, but committed – it was his job to demarcate the day from the night, and he knew it.  He was also demarcating the first such transition for me as a free man in years – I was committed as well to the concept that it would not be the only one.

I sat up and rubbed the dirt and sleep out of my eyes, and looked down at my scrubs – now covered with smeared mud in several areas.  My left foot was bare, and swollen from the ant bites from last night.  I looked over into the irrigation ditch for my shoe and sock, but what I saw was a new little running river of water, created by the rain.  I looked up and followed the ditch all the way to the horizon.  My shoe and sock were now lost somewhere south of here, perhaps miles away, washed into the irrigation system of this farm.

I pulled my knees up to my chest, and sat still for several moments.  The glowing sky continued to gradually lighten.  I looked up and squinted – the clouds had moved east, and it looked clear to the west.  I realized that I was hungry… starving.

I knew that I was a little exposed sitting at the edge of the cornfield, so I stood up and took several steps into the stalks.  They were taller than me, and planted less than a foot apart in rows that were separated by no more than two feet.  I reached up and pulled a couple of cobs off of a nearby plant, sat down and went to work stripping the leaves and the silk from the underlying ripening corn.  It was still a little green, but entirely edible.  I ate three before my stomach started cramping, the crunching noise and the starchy grassy-sweet flavor drowning out all other sensations until then.  Realizing that I might have missed something while crunching away like a madman, as I swallowed my last bite, I held my breath and listened for the sound of a helicopter’s rotors, or a tractor’s engine.  Nothing.

I knew that a fairly large state highway, SH288, was about two and a half hours away on foot to the West.  Once I was clear of that, it would be basically nothing but farmland until I reached the Brazos.  There shouldn’t be an incredible amount of traffic this far south, but crossing it would still be risky – I needed to do this under the cover of night.  SH288 was named the Nolan Ryan Expressway, after the former major league baseball pitcher that grew up in Alvin – the last town I had driven through before ditching the old woman’s car in Lake Garrett.  Not only had I had the time to memorize the names of all of the landmarks down here while I planned my escape, and waited, and waited to actuate it – there was plenty of time to read the background material as well on those names and places.  He still holds the record for major league no-hitters, I thought to myself, sitting there in my muddy scrubs, with my swollen uncovered left foot.  At this point, anyone seeing me would take notice, and I would be at high risk of being caught.  I reached up and grabbed another cob, pulling the stalk down toward me and ripping it from where it was attached.  I looked at it for a couple of seconds, then held the cob in two hands, as if it were a baseball bat, and swung close to my body, careful to avoid the green plants all around me.  I didn’t remember much that my father, emotionally and physically distant, had taught me as a child, just a handful of aphorisms that seldom seemed useful.  Interestingly, at that very moment while I was contemplating Nolan Ryan, one came to me – the statement that he would use when I was feeling less than confident about something I was about to embark on, or try…  “Son… you have to get into the batter’s box to get a hit, and once you’re there, you have to swing… there’s just no other way…”

Later that evening, I crouched in some tall Johnson grass next to the highway, and waited.  I had found a spot where I could see that the fence across the highway was damaged.  The most dangerous time in the crossing would be traversing the fence on the other side of the four-lane thoroughfare – if I was hung up there, a passing vehicle might have the time to appear and spot me.  I was certain that I looked fairly suspicious now.

My foot was a problem.  There were a lot of fossilized shells in the soil, and years of plowing them under exposed sharp edges and points.  I now had a number of sizeable cuts in the sole of my foot, and I knew that the combination of inflammation secondary to the ant bites and dirt could lead to an infection.  It hurt like hell.  I stopped every few hundred yards as I walked west, and sat or lay down, picked the pieces out, and surveyed the land around me for a worrisome sight or sound.  I had not seen a human being the entire day – the rain had kept the tractors and harvesters out of commission.  At one point, I did hear the engine of a truck or a car as I walked across a large open area where there were several hundred head of cattle grazing – probably someone putting out feed – but I wasn’t able to localize it.

There was no traffic for about twenty minutes, but I eventually saw lights approaching in the distance, southbound.  Using these headlights as a reference, I calculated that it took at least three minutes for a vehicle to reach here once its lights were visible – almost three miles away if traveling at the speed limit.  The featureless terrain acted in my favor.  Two tractor-trailers passed by and I looked both ways – no more lights in either direction.  I stood up, my knees aching from the unusual position, and clambered out to the edge of the road.  As I began to cross, I could feel the tiny sharp pieces of gravel of the aging paved surface coming loose and digging into the tender sole of my left foot.  I limped across the two lanes quickly, across the grassy median, and then the two lanes on the other side.  Within seconds I was at the fence.  I looked up and down the highway, noted a set of police or ambulance headlights coming in the distance, and hopped over into a pasture, panting wildly for having only run about fifty yards total – I noted with alarm that there was little cover – all I could see at first was a stand of trees that I would not be able to reach in time.  I found a three-foot tall creosote bush about fifty yards in, and crouched behind it – my foot was killing me.  An ambulance whizzed by, moving at least at ninety miles an hour, its siren silent and its blue and red lights flashing and illuminating the landscape in rotating and gradually dissipating beams, for a half-mile or more in every direction on the flat landscape.

§§§§§§

 EIGHT

I made it to the stand of trees, sweating from the pain in my left foot.  A three-quarters moon had come up, I rolled up my scrub pants a couple of turns, and looked down in the dim light.

Shit… lymphangitis

There were characteristic sinuous red streaks over the surface of my ankle, moving up and onto my calf – like an evil octopus, its head buried in my foot somewhere, reaching its tentacles up and around my lower leg.  Bacteria had made it into the lymphatic vessels in my foot, and were marching upward.  I had seen patients lose their legs ignoring these sorts of infections until they began to rot the tissues from the inside out, like a bad piece of fruit left in the sun.  I also knew that it was possible, if the bacteria found their way into the bloodstream, for this sort of thing to kill you.   I found a large rock and drug it over so that I could lean my back against a tree trunk, and elevate my foot – easing the throbbing a little.

I was literally three hours away from the river walking at a regular pace, but now had two major problems – one, I had an infection that could get a lot worse, and even kill me, and two, I had no boat.  The boat was one thing I just couldn’t plan for ahead of time – I had just decided not to think about it until it was necessary to do so.  It was time to start thinking about it now, but I considered the fact that the first problem might make it irrelevant.  I slept fitfully there, dreaming of operating as a resident years before, amputating limb after septic and diseased limb – the patients wheeled into the operating room and wheeled out, but their extremities staying behind, where they were piled up – socks, hosiery and shoes for some reason left intact – in the corner of the operating room like cordwood.  I woke to the sounds of a small roost of blackbirds calling out in the trees around me.  I noticed that there were three or four spots on my pants legs where they had crapped on me from the limbs above.

Great, lovely addition to the wardrobe…

The red streaks were almost to my knee now.  I felt flushed, and a little shaky.  I probably have a goddamn fever… not a good sign…

I struggled up to my feet and looked around.   I could hear an occasional car on SH288, about a mile and a half away.  There were no fences visible to the West, just unimproved pasture with an occasional clump of trees.  I started limping slowly in that direction – knowing that it would take me six hours instead of three to reach the river at this pace.  After a couple of hours I found a little stream, and lay down to take a drink.  Some large and hungry horse-flies started immediately competing for a lunch spot on the bottom of my foot as I stretched out and exposed the sole – I didn’t even have the energy to scare them off, and besides, I couldn’t feel much through the constant throbbing that was already there anyway.

“Eat up, boys…”

The water was clean, clear and delicious.  I was hungry as well, but knew that there was likely no relief in the cards for that until I could make it to the river, and perhaps catch a fish or two – maybe I can just use my foot for bait?  I lay there on the ground for several minutes, the wild bright green Bermuda grass that had grown up next to the stream cool and soft on the side of my face.  I closed my eyes.  It was very quiet.

Then, I heard what sounded like a whinny, from a horse, at some distance.  I opened my eyes, but didn’t move.

Was I dreaming?

I held my breath, and listened, and then, I heard it again – it was a horse.  My heartbeat quickened, and pounded in the ear that was applied to the ground.

If I had been in Vermont, the sound of a horse nearby wouldn’t mean much to me as an escaped convict, but in Texas, it could definitely mean something.  If you weren’t a fugitive, Texas would seem like an ideal place in regard to crime – with several overlapping layers of law enforcement, perhaps related to its reckless and free-wheeling past.  Most towns had a constable, the municipal police, a county Sheriff and/or his or her deputies, the Texas Highway Patrol – or State Troopers as they were known, and if you really needed the big artillary, the Texas Rangers could be called into action.  The Rangers were the cream of the crop – picked from the ranks of the State Troopers, and you did not want them looking for you, period.  They were well trained, and most were over fifty years old.  The big artillery metaphor was actually appropriate – they were licensed to carry any weapon they wanted inside the state’s borders, and were righteously ruthless – those that they sought were frequently killed “resisting arrest”.  Most importantly, at this very moment was the fact that both the sheriff’s departments across the state, and the Texas Rangers often worked on horseback.

I lay very still, and listened.

The horse whinnied again, but it was not getting closer… then again.  I realized that I was in a very flat, open area, with no cover.  If I rose up to take a look, and someone happened to be looking this way at the same time, I was done.  I couldn’t run with my foot issue, and even if I did run, I certainly couldn’t outrun a horse.   I decided to wait it out.  If they were traveling perpendicular to me, then they wouldn’t see me – it sounded as if they were too far away.  If they were heading away from where I was lying?  No big deal.  If they were heading right for me, then I was done anyway.

Several minutes passed, with no sound.  I listened carefully for the leather on steel slapping and jangling noises that you hear as a horse and rider approach, but they didn’t come.  Then, another whinny, from the same location, and a snort.  The horse hadn’t moved.

Maybe they saw me, and are waiting for backup…

A passenger jet passed overhead, above the clouds.  Another whinny.  I continued to lay still, there on the ground for at least an hour.  The heat was beginning to rise, and I could feel an occasional stirring on the ground nearby – a bug or lizard?  There are rattlesnakes out here… Nothing I can do… hope that there are no goddamned fire ants …  I bent my head down as far as I could, to look at the terrain past my feet.

If they did see me, and are waiting for backup, then I’m done anyway – with this foot.

I moved my head, very slowly, so that I was looking at the horizon in the direction of the horse, but couldn’t see over the low brush.  I moved my elbows under me, and lifted up.

There, about a three to four hundred yards in the distance, was a horse – with no rider.

No rider… no rider…   For a moment, I panicked…  He’s on foot… maybe nearby.

Enough…  I stood up slowly, with my hands above my head.  “OKAY,” I said, loud enough for anyone to hear, “I give myself up, I surrender… don’t shoot, don’t shoot!”  I stood there, waiting for the impact of the Texas Ranger’s bullet – which would naturally be required as I was obviously violently “resisting arrest”.  Nothing happened.  “I’m not armed,” I continued, “I have no weapon!  I give up, I can’t go any further, I’m hurt… I’m injured!”

I turned slowly, keeping my hands up in the air, and looked in all directions.  There was no movement.  There was no glint of sun on a stainless steel Sheriff’s badge, or automatic weapon.  The lizard that had been rooting around behind me on the ground scurried away, rattling a couple of dried up bushes as he ran.  I turned my body so that I could look at the horse, it was eating a mouthful of grass, it’s tail swishing flies off of its hindquarters absentmindedly.  I started slowly limping toward it, keeping my hands up for the first fifty yards or so, then letting them drop to my sides. “I’m approaching!” I said, “I’m not armed, I’m turning myself in!”

The horse took another mouthful of grass, and snorted at me.

When I was twenty yards or so from the horse, I heard something, and dropped reflexively to my knees, putting my hands back up in the air.

It was someone groaning.

“Is somebody there?” I asked.  There was no response.

I got up slowly, and started limping forward once again.  I heard another groan, this one louder, and I thought I made out the words, “goddamit… shit!…”  The horse was well-appointed, with an expensive-looking heavily tooled but very well worn saddle.  There was a rifle scabbard strapped on the side, but the rifle was still there, strapped in with a thick band of leather across the butt.

There was a man on the ground next to the horse, face down, alternating between groaning and cursing.

“Goddamit… ohhhh… get me the hell up…. Ooooohhhhh….”

I walked over and knelt down next to him, he was impossibly thin, wearing a white western-style shirt with long sleeves, incredibly loose jeans tied up with a length of twine and working boots.  A straw cowboy hat was several feet away on the ground, upside down.

“Are you okay?” I asked, tentatively.

“SHIT NO!…” he replied, “oooohhhh that hurts… TURN ME OVER YOU SONOFABITCH”  I reached down, and rolled him over.  He couldn’t have weighed much more than seventy pounds.  I wasn’t prepared for what I saw when my face met his.  He had twenty to thirty black lesions on his face, and his left eye socket was completely replaced with a very large one.  There was a similar lesion on the back of his left hand.

Melanoma… damn… that’s bad… metastatic melanoma, he’s eaten up with it…

 His good eye blinked up at me.  “You got any water, mister?” he asked, “I’m mighty thirsty… I’ve been laid out here… oooooohhhhhh!… shit! …laid out here since daybreak.”  “No, sorry,” I said, “I don’t have any water, nothing to drink.  I’m thirsty too.  What happened?”  “Shit if I know… I was ridin’ my horse and my legs got to feelin’ numb, and then they wouldn’t do nothin’, and then I fell off my goddamned horse…  Can you get me to my house, mister?”  “Sure,” I replied, nervously, the thought of taking his horse and leaving him here coming immediately to mind, “is… is anyone there… at your house?”  “Hell no… ooooohhhhh my goddamned back hurts like HELL!,” he gulped, and his very prominent Adam’s Apple, made more pronounced by his near-skeletal appearance, moved up and down rapidly.

“No, no one, but I got some water there, and think I probably need to get into bed, maybe get straight with these goddamned legs.  I’d be mighty obliged.  If you hadn’t come along mister, them goddamned fire ants would have found me and picked me clean.  Mighty… oooohhh that hurts!!!… mighty appreciative…”  I looked at his disfigured face, still contemplating the expedient option of leaving him here for those same ants that had a taste of me a couple of days before,  “Where is your house from here?”  I asked.

“Bout one and a half miles due north,” he replied, “…like I said, mister, I would be mighty thankful if you could help me out.”  I stood up, and looked around the horizon again.  There was no one in sight.  I looked back down at him.  He was in a lot of pain.  My guess from what he had told me was that he had a spinal metastatic lesion, perhaps in one of his vertebral bodies, and that he had suffered a pathologic fracture while being jostled in his saddle, which in turn pressed on his spinal cord – instantly paralyzing him.  I reached down and pinched his thigh, hard, under his jeans.  No response.  I lifted his right heel off of the ground, and let it fall – it was completely lax.  He smelled of feces and urine – that meant that he had lost bowel or bladder control.  I was probably right, and he was definitely screwed.  He grabbed my arm, hard – his grip, likely developed from a lifetime of hard manual work was still strong.  He spoke again.

“Listen mister,” he said, “I don’t want to die out here, take me back to my house, please.  I grew up there, and would like to die there too if I could.  Don’t let these goddamned ants and field rats eat me up, please.”  I reached down and picked him up – there was no sense taking any precautions regarding his spine, it was too late for that.  I laid him up and over his saddle face down, he was groaning miserably at first, and then fell silent.  I reached up and checked his carotid, concerned that he may have died right then and there from spinal shock, but his pulse was strong, and he was breathing.  He had simply passed out from the excruciating pain.  I took the reins of the horse, and started limping north.

§§§§§§

NINE

 His place was small and very simple, but spotless.  Two bedrooms, a front room where there was a ancient television, and two cheap recliners, a couch and a coffee table, and a kitchen in back.  The kitchen was a throw-back as well, brick floors and a cast iron white enamel stove from the 1950’s on one wall.  There was an even older black round cast iron stove with a chimney in the corner.

His bedroom was decorated with what I took for family photographs – many looked as if they dated to the turn of the last century.  I laid him down on top of his bed, and slipped his boots off.  He was still unconscious and snoring, so I left him there and went into the kitchen – where I drank what seemed like a gallon of water, and ate a half of a block of Kraft cheddar cheese that I found in the refrigerator.

I walked in to the bedroom to check on him a while later, and he was awake.  He had managed to roll himself to his side, and looked down at my foot.

“You got a problem there, mister,” he said, in a matter of fact tone, “that foot looks like its been shot at and missed, and shit at and hit…”  He rolled himself back over onto his back, and moaned, but then continued, “If you’ll go out to the barn, you’ll find a small refrigerator out there with some medicine for the livestock.  I’m pretty sure that there’s some penicillin, and it works just fine on human folks – I’ve given myself a shot or two.  There’s some needles out there too.  Maybe before you go, you could bring me a drink of branch water, and when you get back, make me some toast and butter.  These legs don’t seem to want to work just yet.”  I came back in a little later, with his toast.  I had not only found penicillin, but some topical antibiotics and dressings as well.  If the bug was sensitive, it would be better by in a day or two.

“Pull up a chair mister,” he said, as he took a bite of the toast, “there’s a metal foldin’ one over there behind the door.  I think you got a story to tell me.”

“Why’s that?” I laughed.

“Cause it ain’t every day that a feller walks up to you in a pasture saying he ain’t armed, and he’s a-givin’ himself up,” he replied, “you in trouble?  Not that it makes a fiddly-fuck at this point, nothing I could do if you wanted to rob me blind.  Just curious.”

“Yes,” I said, without hesitating, “I escaped from prison a couple of days ago, and I’m trying to get to Mexico.”

“He laughed,” you’re that goddamned murderin’ doctor, ain’t ya? I heard about you on the truck radio a couple of days ago.  They said you was dangerous!”  He laughed, “looks to me like you were anything but dangerous out there limpin’ around in a pasture and a handin’ yourself into a horse and a broken down old man.”  “Yeah,” I’m not really dangerous.  I chuckled, more pitiful than anything.  “So, did you do it?  Most folks that are in prison deny every goddamned thing.  You innocent too?”

“Nope,” I replied, “I killed a man with my bare hands when I was high on drugs – he was stealing some drugs from me, and at that time in my life, I would have killed pretty much anyone for that reason.”  “You still a druggie?” he asked.  “No,” I replied, clearing my throat to try to sound confident, “straight for seven years in prison, don’t plan on going back there.”

“Well, I guess you can’t blame a man for tryin’ to protect his things, even if they’s drugs.  Hell, I shot a man when I was sixty for trying to steel a hubcap off my truck out here in front of the house.  Didn’t kill him though – got him in the ass and he was too embarrassed to complain about it – not to mention that he was my own cousin.”  He looked up at my face for a long moment… “I ain’t worried about it.”  He was looking me carefully in the eyes, as if he had seen something that made him decide I was probably worth the risk, “as a matter of fact, if you’ll help me out until my legs get better, maybe for a few days, I’ll let you hole up here – how does that sound?”

“I would appreciate that very much,” I answered.

“Deal,” he replied, “now…  I think I shit myself, but I ain’t certain.”

“That’s okay… I’ll take care of it,” I replied, chuckling, “but in regard to my staying around for a couple of days… do you get visitors?”  “Hell no…,” he replied, “my daughter Alice lives in Pearland, but she don’t come around no more than two or three times a year, and I ain’t seen my son, Boyce Jr., for twenty.  Talked to him on the phone once or twice in the last year – we don’t see eye to eye.   I own two thousand acres here… worth some money.  He wanted me to sell and split up the proceeds, and I said hell no – this land’s been in the family since 1852.  He’s waitin’ on me to die, but I took his lazy ass out the will.”

“Sorry,” I replied, “family arguments are tough.”

“No argument,” he said, “just the way it has to go now… say… you can use the kiddo’s room if you want, you’re probably beat, doc.”

The other bedroom looked as if it hadn’t been touched since his “kiddos” had left.  There were 5×7 black and white school photographs of two children, both around seven or eight years of age, on a dresser next to two single beds covered in patchwork quilts that you couldn’t buy anywhere.  Judging by the looks of the hair and the clothing in the photos – they were taken in the early sixties.  I plopped down on the bed nearest to me, and fell asleep immediately.

We went on like that for several days, and around the fourth night he woke me up, moaning loudly.

“You okay?” I asked.

“Its hurtin’ awful bad, awful bad… I’m sorry.  I’m sorry… oooooohhhhhh….. I think I need some of them pain pills.”  “You have some pain medicine here?” I asked.

“Yes, go into my bathroom and look in that shoebox under the sink… I got some there…”

I walked into the bathroom and turned on the light.   I found the shoebox under the sink, and set it up on the dark-green tiled countertop.  I opened the lid, and found several rolls of money – actually, not just money, but rolls of hundred dollar bills.  There must be two or three thousand dollars here… I murmured to myself.

Buried underneath was an extra large orange plastic medicine bottle.  I picked it up and turned the label around – it read “Oxycontin”.  I immediately peered around the corner to see if the old guy was looking this way, and saw the bottle in my hand, but he was just moaning with his eyes shut.  I quietly closed the bathroom door, and sat on the toilet.

I rolled the bottle back and forth several times between my fingers, reading the word “Oxycontin” over and over again – it echoed in my head.  A cold sweat broke out on my forehead, and my heart raced – I got that queasy feeling of expectation in the pit of my stomach that I used to get when I was on my way to the swimming pool as a child, or when I knew in high school that my girlfriend was about to take her blouse off…  the unconscious brain-body response to something that was about to be pleasurable.   I fiddled with the child-proof lid until I got it open, and dumped the white tablets on the tiled surface next to the sink.

I counted them carefully 25… 50… 75… …110, 115, 120 eighty millgram tablets…  What I would have given a few years ago, those first few months in prison, to have this…  I lined all one hundred twenty of them up in a row, and then in two rows of sixty, then four rows of thirty, counting them over and over.  I took one of the tablets and held it under my nose.  I stuck out my tongue, and just touched it a little – I tasted the familiar chalky sweet taste that used to linger in the back of my throat after giving myself a big hit of the crushed drug mixed with water – warm, and mucoid.

Then, with my hands shaking, I set the moist tablet back down on the counter-top and ground it into a coarse powder with the bottom of a drinking glass.  Next, I carefully scooped the powder into the glass, and filled it a third full with water.

I sat swirling and looking down at the water, as if it was a glass of expensive scotch or brandy, for several minutes as I sat there on the toilet.  I then gathered the other 119 tablets back into the bottle, and set it back in the shoebox.  I looked up at the mirror above the sink and peered at my face, holding the glass in my hand just below my lips.  I smiled at my reflection, turned and walked out of the bathroom with the glass in my hand.

I went over the the old man lying on the bed, and put my right hand behind his head, lifting it gently.  “Drink this partner,” I said, softly.  He opened his eyes, parted his lips and I tilted the glass.  After it was empty, I laid him back down, placed the glass on his night-stand, walked into the other bedroom, laid down and went to sleep.

The next night he told me that his name was Boyce Brucher.  He was 89 years old, and had been born in this farmhouse.  “I know I don’t look like much, mister, but I ain’t senile – I’m just et up with cancer.  Shit, I was cuttin’ brush the morning before my legs stopped working, and a shot a rabbit at a hundred yards with the rifle you carried in for me…  No, no… I ain’t senile – I’m just dyin’.”

I reached down and took his hand, and to my surprise, he didn’t withdraw, but squeezed mine hard – his palm was leathery, and the skin on the back of his hand was lax, like wet paper.

Over the next few days, my foot and leg improved immensely.  The old man’s shoes were a little small for me, but I found a pair of stretched-out work boots that weren’t too bad.  I continued to give him small doses of Oxycontin around the clock to soothe the terrible bone-boring pain of his spinal metastasis – it didn’t take much.  He spent most of the time sleeping.  I tried to find a channel on his television, but it was shot.  I did; however, go out each night and listen to the news channel on his truck radio.  The first six or seven days the announcer would mention my name and the escape, along with a warning that I was “likely dangerous” as well as the presence of a reward.  Ten grand doesn’t seem like much, they must not want me all THAT bad…

Seems that no one had really successfully escaped from the Jester prison, and that a few administrators and state officials were embarrassed regardless the amount of the bounty.  By the tenth day, the story was no longer mentioned.

Life with a dying old man was monotonous, but I was happy to have the chance to get better – with food to eat, and a bed to sleep in.  Every day’s events were pretty much the same – Boyce would sleep much of the time after a dose of pain medicine in the morning, and then would “wake up” around six or seven and want to talk for a little while before I made him something to eat.  He didn’t eat much, but would usually take a few spoonfuls of soup, or some pork and beans, or maybe a little tunafish.  Luckily, there were a lot of canned goods in the pantry, as I obviously couldn’t ride into town and buy groceries.

Many nights, I would lie in the room next to him, and hear him, restless with impending death, and talking in his sleep… One night, it was his son – BOYCE?  BOYCE?… You okay boy?  BOYCE?  You hurt, son… you okay?…  Another night, I guessed that it was his wife – yes honey… yesssss… mffff… zzzbfff… CLAUDIA?  Yeah, yeah, they’s over there,…mmmm the money…. Uh huh, love you… and on another, at least in his mind – to God – yes… yes… please… please… soon, okay?  okay? okayokayokaryokay?”

All the while – I took care of him.  He developed a huge bed sore, and I changed that bandage daily using the stock of vet med supplies he had stashed, trying to log roll him as we were taught in medical school to relieve the pressure.  Some of the metastatic melanoma lesions on his back started to break down as well, and these turned into ulcers that required attention too.  I wiped his bottom and changed his urine-soaked underwear… I fed him every day, and tried to relieve his pain as best I could.

One day, while peeling the dead skin away from the edge of one of his putrid wounds… I remembered Walt Whitman – it surprised me a great deal… I hadn’t thought about Whitman, or his essay The Dresser since I was in high school.

I had memorized this for English class, and had recited it out loud to my classmates with all the melodramatic zeal that a sixteen year old boy, a boy that had a dream to go to medical school, could muster…  It was his recollection of working in civil war hospitals, as an orderly… a wound dresser…

“I dress a wound in the side, deep, deep;

But a day or two more – for see, the frame all wasted already, and sinking,

And the yellow-blue countenance see…

I dress the perforated shoulder, the foot with the bullet wound,Cleanse the one with a gnawing and putrid gangrene, so sickening, so offensive…”

 I stopped peeling for a moment, and shook my head… Wow… where the hell did that come from…?

 After two weeks, it was evident that the old man’s legs were not going to improve.  He had known it all along.  He stopped talking about getting better, and moved to other topics when he felt like chatting a little each night, with me sitting on a folding metal chair next to his bed.

“You must’ve found my money, it was right next to them pain pills…” he stated, matter of factly on one particular night, after a few sips of chicken broth.

“Yes, but I put it back,” I replied.  I had.

“Well, you’re gonna need some money if you get down south,” he replied, “I want you to have it – my kiddos don’t deserve a plug nickel of it, that’s for damn sure… but there is one catch.”

“What’s that?” I asked.  I wasn’t about to feign a lack of interest in the money – I needed it desperately.

“I gotta great-grandchild – name is Bowie… Bowie Brucher.  I tell you what… he is one blue-eyed and red-headed ball of fire, that little guy!” he laughed and coughed several times as a result.  I noticed a little blood at the corner of his mouth before he wiped it with the back of his wrist.  “Well, he looks a lot like I did when I was a little boy…, and when I looked at him the very first time, I said, ‘Boyce, that young’n favors you a fair bit…’  Then I got to thinkin’ a little later – maybe there’s somethin’ of me in him?  Maybe he is gonna keep a part of me livin’ when I’m gone… you know?”

“I bet he’s cute… how old is he?”

“Well, he was only about three when I saw him last, but that was two years ago….” He stopped as if gathering his thoughts.  “What I want you to do is take some of that there money, and buy something that will remind him of me when he gets growed up.  Don’t need to be much, but somethin’ that he will keep.  Whatever you don’t spend, you can keep.”

“It’s a deal,” I replied, softly.  Now, get some rest, Boyce.

I found him sobbing loudly a few nights later, right before I was about to give him his dose of Oxy.

“What’s wrong?” I asked.

He laughed, “you gotta be kidding me doc…  I’m never gonna walk again, and this melanoma is eatin’ me up.  My back hurts so goddamn bad sometimes that I don’t even know where I am, or if you’re here, or whatever.  There’s gotta be an ending to this sorry-ass story.”

“What do you mean?” I asked.

“I mean that God has gotta take me soon.  Why the hell am I still here right now?  To help a murderin’ doctor convict?” he laughed, and then winced in pain…  “He’s gotta take me soon, have some mercy on me.  Hell, I don’t deserve no mercy, but neither does anyone, really, right?”  He started crying again and mumbling, “soon… soon… please God, soon…”I looked down at him.  He was all but dead, and I knew it.  He even had the smell of death – most really old men get that smell a little while before the end – the smell of decay while still living, the smell of inevitability.

His head and face were covered in melanoma lesions, and the large one that replaced his left eye completely was constantly bleeding – he had to be terribly anemic by now.  With all of the lesions on his face, abdomen, chest and back – I could only imagine what his internal organs looked like – I had seen one patient as a surgical resident with a liver that looked as if it had been heavily peppered, in preparation perhaps for some sort of macabre cannibalistic feast – riddled with thousands and thousands of tiny melanoma lesions.

“Why the hell are you doing this anyways?” he asked me, “you coulda scooted outta here days ago.  Why are you still wipin’ my ass, and bringin’ me food?  You can’t be enjoyin’ none of this”  “I don’t know, really,” I answered, “ I guess in a strange way, I am.  I mean… I’m not enjoying seeing you suffer with this, but I guess that I don’t mind taking care of someone – you know, being a doctor and all.”  “You sound surprised by that… you don’t look to me like you just got done with schoolin’”

“No… no, I didn’t,” I replied, looking out the bedroom window at some branches blowing in a light breeze outside, “no, but I went a long time not knowing if I liked doing this or not – not really even aware of what I was doing… I guess.”

When I looked back over, he was asleep.

For two days after, he did nothing but moan and repeatedly murmur, “soon… soon… soon.”  He stopped eating, but still asked for water.  I knew that he might last a week or more like this.

“OOOOHHHHH!” he yelled one night, asleep, but not asleep, in so much pain that he had lost track of night and day and slept and woke at short intervals, or perhaps just floated in and out of consciousness.  He no longer spoke in his sleep, but just cried out in pain.  It had been almost a month since I had arrived here.  My foot was healed, and I knew I needed to move.  The authorities probably thought I was already in Mexico by now, and had stopped looking in earnest for me.  I didn’t know what to do about the old man; however – he would suffer miserably for days if I left him alone.  I got up and walked into his bedroom.

“You need some pain medicine, Boyce?” I asked him.

He looked in my direction, his eyes unfocused, but pleading.  He started to cry again and spoke for the first time in days, “soon, please… please… please… soon…”

Whitman… I thought to myself… Whitman…  Tears came to my eyes as I started to recite that same essay that had come to me days earlier.  I whispered the words to myself – tumbling out of my trembling mouth…

“Hard the breathing rattles, quite glazed already the eye, yet life struggles hard:

Come sweet death, be persuaded! O beautiful death!  In mercy, come quickly!

I walked into the bathroom and took twenty-four of the Oxycontin tablets out of the bottle in the shoebox.  I wiped the tears from my eyes.   I ground them up into the same coarse powder – as I had many times before for him.  I put the powder into the drinking glass with some water, dissolving some of it, with the remainder of the tiny pieces swirling around on the top, the mixture too saturated by so many tablets.  I walked in and lifted his head, and tilted the glass to his lips one final time.  He gulped down the fluid, and closed his eyes.

And that was how I committed my second murder.

I rose early the next morning, before sunrise, and dug a grave out behind the barn closest to the house.  I wrapped him in a canvas tarp before laying him down.  His body weighed little more than the bones that supported it.  I thought about marking the grave, but then thought better of it.  I thought about saying some words over him, but thought better of that as well – I didn’t know any Bible verses by heart, and felt like the words would just taste sour in my mouth anyway.  I assumed that God, if he existed, didn’t necessarily care for me saying them.  I sat down after I was finished, and thought about what needed to happen next.

I knew that the old truck could get me to the river, but needed some gas – I could start it, and had several times when Boyce was alive, just to listen to the radio – but it was almost empty.  There was a second barn about six hundred yards from the main house, and I walked out to take a look.

There could be a tractor I can siphon from, or some gas cans out there…  

I walked across the back yard and out into the field, now becoming overgrown in weeds in the old farmer’s absence.  This barn was ancient, and large.  The doors were on rusted hinges that looked as if they had been undisturbed for some time – it took several tugs on both of them simultaneously to get them to open.

In the middle of the barn was something under a tarp.  I had always been fascinated by those stories about classic cars being found in barns, up on blocks and untouched.  My eyes panned around the space, illuminated by rays of light streaming through the half-inch spaces between the sideboards of the structure, little flecks of dust reflecting in the air like light brown glitter.

Thank goodness, a couple of cans of gasoline in the corner – probably for the tractor.

 My eyes traveled back to the tarp.

 Wonder what Boyce was hiding out here? 

 I pulled the heavy oil-soaked canvas tarp slowly away – underneath was an old flat-bottomed wooden container, two foot tall on the sides, and open at the top, bolted onto two large hollow aluminum closed-end tubes of some sort.  I stepped back and looked at it from another angle.  It was something homemade… something…

It was a boat.

§§§§§§

EPILOGUE

A week or so after getting to Mexico, I called a friend of mine back in Austin that I had gotten to know in prison – Andy Gonzales.  Andy was number one in his class at the University of Texas law school, but had gotten involved in a gambling ring, losing his high-paying corporate job for a ten-year stretch.  Andy was a genius; however, still doing business for his firm while behind bars, and evidently making them a bundle.  They hired him back the day he was released – sent a long black car right to the Warden’s front door to pick him up.

Andy was handsome, and a playboy, and the ten years only took a tiny bit off of the shine.  He had dated starlets, hookers and up-and-coming female lawyers, but didn’t  distinguish between them in any way, and kicked them to the curb whenever he tired of them – usually no more than a few weeks.  However, despite the way he seemed to disrespect women, he loved his mother fiercely – she had raised him as a single illegal alien mother in Laredo, working three jobs to keep a roof over his head, and to pay his first year in college.  The scholarships had rolled in after that, when he showed the Polo and Izod-wearing gringos who was “El Hombre” in the classroom.  He had an older brother that he loved as well, but he died of tuberculosis in the barrio – no access to a doctor, no access to expensive antibiotics.

While in prison, Andy’s mom, who still lived in the same neighborhood in Laredo, developed leukemia.  He came to me in tears, and told me that money was no object – that that he needed the best person in the country to treat her.  I contacted one of my medical school classmates, who at the time happened to be the chief of the leukemia service at M. D. Anderson in Houston – she was treated with an experimental therapy, and was cured.

Andy told me that he would do anything for me in return, as long as he didn’t have to go back to prison “for more than a year”.

I didn’t have a very big request as it turned out, and he was able to take care of it in only a few days time.  I wired him a thousand bucks, so that “it can look like someone legitimate asked me to do this,” and just like that, Bowie Brucher was to become the owner, at age 21, of two thousand acres of land in southeast Texas – land that he could improve and develop as he wished, but could never sell – only pass on to another member of the Brucher family, as the Trust specified.

Ten years had now passed since I had Andy return that favor.

I waited impatiently at the airport in Cancun, amusing myself by listening, behind a pair of very dark sunglasses, to the American tourists arriving in the country, commenting on “how humid” it was… and how “I thought the airport here would be bigger,” and those leaving the country, many of whom were now sporting fluorescent pink from overexposure to the Yucatan sun, stating that – “I didn’t even get sick… did you?”  I absentmindedly began counting the people coming out of one of the nearby gates, disembarking from a flight.

I begged for work shortly after arrival, in a clinic in Mexico City, and lived like a pauper for a year, before being asked to help out at the University Children’s Hospital as a surgical assistant.  While there, one night I was the only doctor available, and I treated the Secretary of Defense’s grandson for a surgical emergency – I was granted Mexican citizenship, a medical license, and a new identity as a result.

I watched the arrival gate with great anticipation.  The plane had landed fifteen  minutes earlier – I had counted the nine-hundred seconds.

Stupid… fool… don’t get your hopes up… again… Why do I do this to myself?  I was told that there was no guarantee, just like the last two times… that it was complicated, and maybe even risky…

 I studied each passenger as he or she walked through the door, but none fit my mental image of what I had come to see.  Then…  I caught a glimpse of a slightly faded and very well-worn green sweatshirt, draped over the bony shoulders of a little girl.  She was very small… so small, in fact, that the shirt looked almost like a dress – exposing only her wrinkled pink-stocking covered ankles, and a pair of black patent-leather shoes, below its frayed edge.

Was it the sweatshirt that my daughter wore that last day on the beach, and the one that I remembered in my dream…?  That dream… that dream…. I had almost forgotten about that dream, that important moment sitting on that bunk in my prison cell when I regained my ability to feel.  That dream was a memory, a memory that had been hidden away, protected in my subconscious mind.  On that important night, it was released from the heavy drug-forged shackles that had held it there – released by some mysterious and wonderful and healing force that some will never experience, and that some cannot articulate or recognize when they do, and that others call love.

The little girl who was wearing that sweatshirt looked so familiar – but I did not know her, could not have possibly known her, and she couldn’t be my daughter.

You’re crazy… ridiculous, actually… too much time has passed, she isn’t a little girl anymore, she hasn’t been for a long, long time…  My shoulders slumped with resignation – I knew that I was just being delusional, and foolish.  My stomach burned with a hunger that I desperately feared would never be satiated by anything else in this life, and my lower lip quivered involuntarily with disappointment. 

Although I hadn’t noticed at first, the little black patent leather shoes walked right up in front of me, and then stopped.  I became so mesmerized by the sight of them, and then a few seconds later, the little girl’s beautiful face and darling smile that I continued to look down at her for a long while.  When I finally looked up at the woman that had, evidently, been standing behind her the entire time, I saw the same face, the face of a woman in her thirties, the loving and for some reason very familiar face of the little girl’s mother.

“Hello Daddy,” she said.

15 thoughts on “The Arms Of God

  1. Wow. Every post surprises me more than the last. I was recently in conversations with academic friends who research the prevalence of addiction in the medical field. Amazing how this story mirrors exactly what they were describing to me. Isn’t tremendous courage is required to reveal our true human nature? And yet, what great freedom there is in sharing and speaking truth about who we really are?

    • Dan, Thanks so much for reading, and for your kind comments. Please share the story with others (tweet, facebook, billboard, national public relations campaign, etc…), if you are so inclined! In all seriousness, best regards.

    • Thanks for reading, Donna, and for your kind comments. I hope that you are well. Share “The Arms of God”, “The Angel of Munitions” and other stories with your friends, if you wouldn’t mind. Best!

  2. Very powerful. Thanks. As usual, once I started reading, I couldn’t quit. It is time for you to be published.

    [cid:image001.jpg@01CED435.1DA634B0]

    Charlene Spoede Budd

    PhD, CPA, CMA, CFM, ToC, PMP, CGMA

    Professor Emeritus, Baylor University

    199 Air Strip Road, Jackson, GA 30233, U.S.A.

    770-504-9854; 254-717-0136 (cell)

  3. Molly, thanks for your kind comments. Please share the story with others if you are so inclined. It seems that our true human nature usually reveals itself regardless our desire to share it. The courage is in the admittance and ownership of our fallibilities.

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