by Mark Brand
forum: Narcoleptica
speculative fiction for the internet generation.

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        When the withdrawal hits, it doesn't hurt at all. It feels like gentle death, and life too.

        You will see a number of things working in the OR on the third shift. As much as cabbies or bellboys or bartenders, for sure. As much as cops, firefighters, and various assorted nocturnal radar daredevils. At 4am, the only heroes are the people who bring us corpses already stone dead before they ever hit the emergency grocery-store doors. The whole thing plays out like a movie some nights. Dramatic square-jawed protagonists are shot down in the street and their loving family played by James Woods and Kim Basinger sit in the waiting room pacing back and forth. EMTs bring in some careless dick with a crotch full of 3rd degree burns for a little background music.

        I am in the middle of my third bite of a microwaved plate of pork when the "three-three-three" code comes over the anteroom loudspeaker. When I was just getting started at this, which was back when the president was bald and sleep hadn't been invented yet, I used to jump right up and charge into the room like Chris Brown in the Falkland Fucking Islands. By now I had learned to just eat my supper. It wasn't getting any earlier and the first two minutes was probably just going to be a bunch of screaming anyway.

        My nurse liked to chain-smoke unfiltered clove cigarettes in the two-by-two-foot staff shitter, and I nodded at her as she coughed out the light and flushed the toilet. She used to turn the fan on and clear out the air a little, but lately she had been forgetting. She grabbed a fishing tacklebox full of tools to cut and stab people with and headed for triage. The actual triage nurse was just some third-year college kid that apparently didn't make the cut for easy work-study jobs like re-shelving library books or taking off her underpants for Fun and Profit. Her name was Sheryl or Shirley or something but I always called her Beverly because I couldn't remember her name.

        So Mary (my nurse), and Beverly are in the little triage cubby dealing with something loud and histrionic while I'm washing my hands in the staff kitchen sink. I never use the anteroom sink because it's filthy. That's where you wash the gore off after a trip to the moon, and when a resident finishes his rotation we toss him into it just to break him in a little. I've seen attending physicians take a piss into the anteroom sink when they have to go in the middle of putting some Motorcycle Hero back together. If there's a chance that I can get my hands genuinely clean before I go into surgery, it's in using the kitchen sink. It's not that much of an issue anyway; with the antibiotics we shoot people up on, I could sneeze on their spleen and they'd be fine.

        Anyway, I'm getting off track. Beverly and Mary are dyking it out in triage and I'm washing my hands when something weird happens. I blink my eyes and all of a sudden the faucet sounds different. It's almost like the OR is an LP and it skipped five minutes of the track and started up somewhere completely different. I hardly notice it, but when I look down my hands are wrinkly under the water. I turn it off with my elbow, and walk to the door, giving it a kick with my shoe. Mary opens the door and gives me a shitty look while she's gloving me up.


        She keeps it to herself.

        "How is it?"

        "He," she said. "It's a he, I think. MVA."

        "What does he have?" I ask, as she flips up my facemask.

        "Pretty much everything."

        I walk out into the room thankful that someone decided to crank up the AC. Most people don't know this but in sufficient quantities blood stinks like shit. I probably learned why at some point, but even in medicine there are some cases where knowing the answers doesn't make you a happier, more well-adjusted person. The wretched pile of blood and pajamas on the table in front of me looks like a roast that someone put in the oven the night before and forgot to turn on the heat. My eyes lose focus for a moment and I blink to clear them.

        The people in the room are waiting for me to say something.

        "How long has he been out?"

        "I sedated him twelve minutes ago."

        That Mary always had a smart mouth on her.

* * *

        I used to know an attending who would brag to his residents that he hadn't bought a pair of sunglasses in fifteen years. After all, they didn't make such a thing as darkglasses, and if he wasn't in the OR, darkness was all he ever got to see.

        I made it home after the faucet incident at about 8am I figure, or roughly about the time that the sun was full up. This is an important detail for reasons I will explain later, but for now picture me reaching for sunglasses in my glove box that were so unused that the dust on them had turned them from softly-tinted to almost opaque.

        One time or another I had bought a box to sit under my television and record TV shows while I was out saving lives, but the only thing I ever really liked getting on it was soft-core pornography, and even in a bull market it doesn't make sense to spend twice as much on your cable bill to watch Japanese schoolgirls flatten cans between their breasts while colorful kanji characters describe whatever strange narrative had been devised to make it all seem natural.

        This recorder box, then, was reduced to the functionality that didn't involve deviant performance art. It had a clock on the front of it. A great big clock with red numbers two inches tall glowing brightly from under the dusty, plugged-in painting of a coal mine. When I was starting to throw together the BLT I had been thinking about, that clock said 8:31. The extra "." was supposed to let me know that it was the AM and not the PM, in the event, for example, that the sun failed to shine.

        The little blip that curved through my shift when I stood at the faucet was on my mind as I sliced through the bleeding tomato. When I looked up, it was 8:32. What should have felt reassuring only made me further wonder. My home life generally didn't include things that would make five minutes disappear.

        I don't call it my social life because there's nothing social about it. There is only work life and home life, and my home life is a fucking playlist. It's like the rotation of a boring top ten hits radio station or a mix-CD someone made for you the week you graduated college and you still haven't grown out of.

        Track 1 is my drive home. This is accomplished with little difficulty through traffic that would give rheumatoid arthritis to the white knuckles of most of middle America. If no one cuts me off or passes me on the right hand side with two wheels basically on the sidewalk, I start looking around for the speed trap everyone knows about but me.

        Track 2 follows it up by Eating Food. Little known fact about physicians: they eat almost the same five things over and over again for years at a time. In a world where variety is shoved down their throats at their job, most of my colleagues choose to enforce a comforting monotony regarding the other things that get shoved down their throats.

        Track 3 is the Consumption of Popular Culture. Regardless of who gets voted off the island, I spend most of my time rooting for the alligators.

        Track 4 is almost always pornography.

        Track 5 is an experimental piece called Un-Assisted Nap followed by Some Sort of Ancillary Snacking.

        Track 6 is an extended, three-hour, instrumental version of Surfing The Internet Until My Eyelids Feel Like Lead Aprons.

        Track 7 wraps it all together with a brief reprise of Track 4.

        Track 8 is Sleep, and Sleep brings the fucking house down.

* * *

        I like a Lexus to drive. I know they're Japanese, but we're not talking about some ramped-up fuck-all Toyota like the young Hispanic kids drive to impress their clown-car girlfriends. A Lexus conveys a certain kind of importance that goes hand in hand with being a physician. It says "Yeah, I paid off my school loans."

        I drive a Lexus LS460L which provides 380 horsepower and 387 foot pounds of torque over the time it takes for my toe to extend all the way to the floor. More than enough to stay ahead of the streetcar kids who put fart-cannons on their second-hand Honda Civics. I swear to god, if all it took was a movie for teenagers to start this awful trend of souping up winter-rat throwaway Japanese cars, you'd think that someone would get smart and make a movie about how slick and cool it is for teenagers to cut off each other's fucking heads to incrementally increase the IQ of the human race. It would work for the same reason that the street-racing movie worked. Only the stupid kids would do it.

        So I find myself behind the wheel of my love-machine on the corner of Urban Cool and Suburban Snobbery, and I hear the honk. This isn't a friendly honk of someone who wants to inform you that you've missed your green light or you have a disembodied arm with a hook on it attached to your rear door-handle. This is the Douchebag Honk. Reserved purely for those who have long ceased to believe in the existence of God or happiness, and choose instead to make a life out of bringing as much additional unnecessary chaos into the world as possible. I turn to my right and I'm face to face with the douche in question.

        I am unsure at first if it was him that honked, given his drawn and turtle-headed demeanor. He is staring right at me, a broad upper forehead tinted in wine-stain liver spots. A cheap tie pokes up under his Adam's apple, and pins together the grimy collar of a shirt that might have been white at some point but is now the color of dishwater. He's about fifty, and looks like he remembers every day of it. I decide the appropriate measure is to roll my window down. I've found that the older I get the more likely I am to solve problems by escalating the situation faster than others can keep up.

        It has been my experience that most traffic altercations begin with one or more party rolling down windows, and don't get much further than that. By the time the motor in your door rolls that puppy all the way down, the light usually changes and you're off in separate directions and you're telling the empty air inside your car what an asshole you think the driver was. By some freak chance, though, today the window goes fast enough for me to get out a single word.

        "WHAT?" I yell.

        Instead of an answer, I get this same look, but this time he arches his eyebrows and telescopes his head at me as though his jaw is on glider-hinges.

        "WHAT THE FUCK IS YOUR PROBLEM?" I start to shout, hoping that my voice carries the eight or nine feet of traffic noise, but by the time I am done, he had vanished.

        The word "problem" fades off into nothing, and I feel my voice withdraw unconsciously from it. I did not remember him saying anything else, turning away, or driving on. He's just gone. I look up and the traffic light is green. I realize as I pull away from the intersection that a different song is playing on the radio than the one that had been there when we stopped. I don't yell at the interior of my car, but I do wish I had had the chance to tell the guy to go fuck himself. Those are satisfying words to say sometimes.

        I have seen a man vomit a gallon of blue toilet water and three live fish on the eggshell-colored floor of my room at work. I have cut out a man's gangrenous tongue while he looked up into my eyes from the table, awake. I have seen rookie surgeons snap elderly women's thighbones like buffalo chicken wings. This was the first time I had seen a car and driver disappear into thin air, but it seemed otherwise unremarkable. Peculiarity alone, it seems, had lost its ability to move me.

        I hit the accelerator and the sky seemed bluer.

* * *

        A guy named Sid Merriweather invented sleep in the middle of summertime about four years ago. He didn't invent the Transcranial Magnetic Stimulation. That was discovered by a British guy named Tony Barker in Sheffield. They used it for decades to treat things like psychosis, homosexuality, and being poor. The journal Lancet put it right above "bullshit gypsy snake-oil" in their study of efficacy.

        For a while, there was some evidence that people who heard voices in their heads could benefit from TMS. Apparently the electromagnetic pulse did a better-than-Thorazine job of shutting them the hell up. And it helped the whacked-out insomniacs who were seeing giant roaches and disembodied heads get some shut eye. It wasn't till Sid Merriweather came along and put two and two together that we found out what TMS was good for.

        TMS, when applied in a carefully-calibrated manner to your frontal brain, causes almost immediate deep and restful sleep. REM is induced after a matter of minutes rather than hours, and you can get a 9-hour block of restfulness that feels like you slept in on Saturday morning on the beach in San Juan with a naked blonde for a pillow. The kicker? You can accomplish it in only two hours.

        By then, there were portable MRI units that could be converted to sleep stations for people to rent time in to get sleep when they didn't have the time to go home and get into their own beds. It was enormously popular among the Corporate Douchebag circuit, and for a while we saw talk shows with rich, too-busy people that boasted of getting only four or five hours of sleep a week.

        Right about the same time I hit the third year of my residency in emergency medicine (that's the year after you want to kill yourself, but before the year where you want to kill everyone else) someone bought a TMS bed and put it in the staff room. Suddenly we're all bright-eyed and bushy-fucking-tailed round the clock. Go home? Nah, I'll be back in a couple of hours for another 15-hour shift elbow-deep in intestines.

        Suddenly we were all more or less rested enough to care about ourselves and our personal reputations. The mind-bending old school of medicine fueled by months and months of sleep-deprivation and debasement at the hands of older physicians started to crumble away. You can imagine the sort of trouble that a boatload of otherwise cocky, overworked, jumpy, socially-challenged kids like us got into with a machine like this.

        The first bed we had didn't have cutoffs for extreme parameters. A nap on that thing was like taking a vacation in two hours. You could crank it up a little and get stoned on it, too. You'd be so groggy when you woke up, and so simultaneously rested, that you felt like you had just won the no-hangover lottery after the bender of your young college life.

        By the time I finished my fifth year as chief resident there were three beds in the hospital for staff to use, and the year I got my first OR privileges, I bought one for my condo.

* * *

        "You don't understand, man, Prince is the guy who basically shaped all of music in the 1990s."

        "No, it's you that don't fucking understand," I say to Dr. Greenstein, over the open abdomen of an elderly man who had suffered from an acute, impacted bowel rupture. We were bringing his small intestine out loop by loop and washing and inspecting it for ulcerations. The Glamorous Life of Emergency Medicine reduced to basically washing someone's shitpipe and checking the line for kinks. I hear some plumbers make $60 an hour now.

        "Prince is the icon of all that was wrong with music after the 1980s. Men don't wear baby blue women's power suits with frilly white blouses underneath."

        "It's his originality. He's completely original." Greenstein suctioned out Mr. Bowel Impaction's peritoneal cavity with a flexi-tube, and then waved it in the air to accentuate his point. The tip of the tube sucked bloody air.

        "What was original about him?" I asked. Greenstein looked about to say something but I cut him off. "Nothing is fucking original about this guy. He's the biggest sell-out, rip-off of the late 20th century. What, because he pretends to be girly that's supposed to be original and edgy? David Bowie did that two decades earlier than Prince, and everything that Bowie did right Prince did wrong."

        Dr. Greenstein peered at me over his mask. One eye was made to look telescopically tiny by the surgical loupe he wore for close-up work. It was a look of utter irritation that indicated without a shadow of a doubt that he wanted me to continue.

        "First of all, Bowie doesn't sing like he has no testicles. When Bowie did Ziggy Stardust, he was skating along the edge of the 1960s, where all sorts of shit was happening but you could still get your ass killed in the wrong town on the wrong day if you were a homo. What the hell did Prince prove by dressing up like a half-mulatto, half-Thai transvestite pimp and getting collagen injections in his lips?"

        By now, we had reached the near end of the colon, where the pipe meets the pipefitting, or so it seemed. Greenstein decided not to try to interrupt me.

        "Fucking nothing, that's what he proved. Prince is the face of how un-cool it is to be a man these days. It stopped being good to be a man right about the same time that Bowie was wondering if we could evolve beyond the gender war in the '70s. Now anyone who is cool is a woman. You ever wonder why women like Prince so much? It isn't because he's four feet tall and uses the same foundation makeup they do, it's because he's essentially a woman with a cock. Equipped with what they need to perpetuate the species, but unthreatening, gelded, and slightly pathetic. Kind of like you, Greenstein."

        I looked up from Impaction's rectum and there were two Greensteins in front of me. Then three.

        "What," I said, "the hell."

        Greenstein number four motioned to my hands and I looked down. Instead of intestines, Mr. Bowel Impaction's abdomen was full of pulsing black leeches.

        I must have stood there for a minute or two, but it felt like just a second. I was never the awkward type that froze up when giving speeches, so a little silence felt comfortable enough.

        "Let's wrap this up, then," I say. "We don't want Neely getting his hands on this one, right guys?"

        This was my standard pre-recorded ER banter filed under Serious Conversation. Dr. Evan Neely was a general surgeon who hung out around the ER during the hours when he wasn't talking someone into getting their gallbladder electively removed. Surgeons are not so unlike dentists. They'll see you for the cleanings, but it's the cutting, drilling, and grinding they get paid for. You go to see one of them at their clinics without a problem they can chop into you for, they'll pawn you off on their residents or medical students that are probably not being paid. No root canal needed? Go see the hygienist.

        Neely was the ghoul of our ER, and he hung around like a vulture waiting for something to make the mistake of crawling out into the open sun. The orthopedic surgeons were the same way, they'd sit in the break room playing cards waiting for someone to walk into the ER with a potential case. Every time some kid broke his collar bone at football practice, it was like someone threw a huge wad of hundred dollar bills on the floor and ten hungry middle-aged men with huge German cars and hateful alcoholic wives would pounce on it in rugby-scrum-like fashion. These men would look at you as if they were wondering how much they could get for fixing you if a piano fell out of the sky and crushed every bone in your body.

        Car accident? That's a double femur fracture with extensive follow up care, diagnostic imaging, and physical therapy, all performed by leased subsidiary companies of the orthopedic group they worked for. If the patient is over 65, well that's a double hip replacement. Sorry, ma'am, it's the standard of care these days. It would be irresponsible if we didn't do it.

        Neely took a page from their book and would try to scare the living hell out of the patients that came in for routine or planned procedures. He treated human organs like plastic surgeons treat beer guts. Getting a liver biopsy? Why not have me take out your gallbladder, too? Or your appendix? It could rupture one day and kill you. Having a hernia fixed? I can do a vasectomy while you're out! Let's just get rid of that pesky uterus…

        I spend the next forty minutes stuffing and pinning a pile of writhing leeches and eels into Mr. Bowel's peritoneal cavity. I kept one eye on the Greensteins the whole time. After all, with four of them in the room, there was sure to be an Evil one.

* * *

        X-ray machines consist of a large power generator that converts wall current to high-voltage output, a stabilizing arm, and a cylinder shaped like a large beer can. This cylinder contains an electrical anode and a rotating tungsten cone inside an airtight bath of coolant oil. This is the "tube." The tube is encased in a half inch of lead except for the small aperture where the x-rays escape and travel at physics-class speeds through your flesh, organs, and bone, and strike a photosensitive crystal screen that imprints a negative image of your anatomy on a piece of multi-layered emulsive plastic. An entirely separate lead-lined room exists for the purpose of containing the photoelectric ionizing radiation that occurs when various milliamps per second course from the anode to the tungsten cone, creating a God-like arc inside the tube. All this happens in darkness, as most feats which harness the power of the building blocks of the universe do.

        I bounce a golf ball off of the tube in our x-ray room while our third shift radiographer scours the table beneath it with a disinfectant so strong it comes in a glass bottle rather than a plastic one. The room smells vaguely of feces.

        "Do you get much sleep?"

        "About two hours, usually," Andy replies. He has a kid at home, I know, and another on the way. A girl named Stephanie and an unborn fetus named I Will Never Again Own a New Car.

        "Sometimes I get one and a half, but I don't like cutting it quite that close. If I don't get the full two hours, I just don't feel right."

        "You ever take naps?"

        "Shit," he says, looking sideways at me. He stacks up x-ray films on a desk and starts marking left and right on the corners with a black Sharpie.

        "What?" I say.

        "You're a lazy motherfucker." I can always count on Andy for the truth. "Just turn up your bed. Try maybe two and a half hours. You won't be able to sit still after that much sleep. You'll be bouncing off the walls."

        My golf ball continues to bounce off the x-ray tube.

        I want to tell him that I've already tried that, but I don't. I picked this little strategy up at some conference or another in Arizona in the middle of the winter. A study was done by some focus group of vicious, slobbering medical office managers who had been let out of their cages long enough to cross-breed and perfect their torment of the rest of the working world.

        They discovered that when your employees, which Andy technically isn't though he is part of my support staff, think you're ignorant or empty-headed, they tend to work harder. They assume you'll crash and burn if they don't step in to help you, and playing against the guilt they'll feel if they don't is a motivating force not unlike that of a child obeying their well-meaning but chronically helpless parent. In other words, the way to make sure you get the last $0.01 out of every hour you pay your help is to make them feel like they're working for their mothers.

        I miss a catch and my golf ball rolls under the generator. I don't go after it. I have an entire bag of miscellaneous golf-related shit in my locker that my patients have brought me. Someone even gave me a putter shaped like a foot with a laser pointer attached to it. I don't know what's more insulting, my patients assuming I have time to play golf or the fact that they think I'm a bad enough player to need a laser-guided putter.

* * *

        At some point, I realized I was in the middle of surgery on what used to be a young woman who had been dragged on a chain behind a sport utility vehicle over a mile and a half of gravel back-road.

        "I think I'm hallucinating," I said, to no one in particular.

        "That's what she said," came a reply from someone in a mask and scrubs. He gestured to the woman, whose anesthesia had sunk in enough that she could barely manage a whimper.

        "Fuck you, I'm serious," I say. My face shield fogs slightly when I breathe out. "You think I'm kidding?"

        The unfortunate ingénue of this evening's tragedy lets out a "huhnnn" that is less than heroic as I scrub flecks of gravel out of her rectus abdominis muscle, which is open to the air given that the flesh of her torso above it was taken off as if by a belt-sander. Cleanliness, right next to Godliness.

        "What are the risk factors for hallucination?"

        "What is this, continuing ed?" My colleague rolls his eyes. It's not Greenstein, but since I just got here I don't know who it is, exactly. "How the fuck should I know? Being a big jizzbag, for one, probably."

        The surgical tech behind me snorted, and I turned to look at him. He gaped in terror. I am covered in blood from sternum to knees, and I'm doing my best to look pissed. Remember: whenever challenged, escalate.

        "What the fuck did you just say?"

        "Nothing," he mutters, suddenly very interested in the tray of surgical steel in front of him.

        "What are the risk factors for hallucination?" I've forgotten the patient on the table entirely. I pick up an emesis basin full of someone's flesh and blood and I plan on tossing it at him if he flinches.

        "Uh… psychoactive drug therapy, alcohol and drug withdrawal, dementia, sleep deprivation, and head trauma…"

        I look at him for another moment and the corners of his eyes flicker. I wonder how many minutes go by.

        "That's what I thought," I say. I hand him the emesis basin and head for the door, pulling off my mask as I go. Blood sloshes onto the floor, but I ignore it and him.

        "Where are you going?"

        "I need a nap," I say over my shoulder, to no one. As I hit the door I look up to see another door. I open this one into an identical hallway with another door at the end. And another, and another.

* * *

        "Hi, I was just calling from North Union Hospital. This is Sandy. We're calling to make sure everything's okay with our favorite doctor! Call us back when you get a minute, I've got a few messages for you."

        I think I turned the phone off, I don't really remember. I have some vague vision of putting the key in my condo door and hearing it grind loudly as I turned it, but after that all I felt was soft blackness.

        Apparently I've been unconscious for hours. The inside of my mouth feels like indoor/outdoor carpeting, and I've urinated on myself while I slept. I've not missed a day of work in seven years, twelve if you count residency. I thought they'd be a lot angrier than they sound. Sandy seems nice.

        I make the call to the hospital and tell them I'll be in tonight.

        "Oh, that's fine. Dr. Greenstein covered for you. He did leave a message that you should try the office bed next time, whatever that means."

        "I know what it means."

        "You feeling okay?" she asks.



        "…you've been more than helpful."

        I hang up.

        For all his lack of good taste in music, Greenstein did a good job of jumping from one lily pad to another.

        Every nerve cell in your body consists of a long cable with a synapse at each end. The cable part of the cell is made up of fatty membranes that conduct electricity in the form of tiny, single-electron currents called action potentials that occur between sodium and potassium. When the current reaches the end of the cable, it jumps to the next strand by secreting a chemical that helps the current flicker across the gap. These chemicals have familiar names like serotonin, dopamine, epinephrine, and acetylcholine. When these currents jump to muscle fibers, you get a contraction. When they jump to a gland, you get secretion. When they jump to your brain cells, you get a boner, and so forth.

        That's all you are, you clever bipedal meat-Gods. Just electricity sizzling down cables made of fat and squirting across a little space between. This is another of the things that knowing doesn't an otherwise blissfully ignorant life improve.

        So Tony Barker has this thought well in hand when he positions the first TMS patient's pre-frontal brain directly between the poles of an MRI electromagnet. Barker is doing this in the '80s, so he's very progressive that way, but he is not so far removed from the old days that he flatly dismisses the gains made by psychiatrists in the '50s and '60s when they plugged people right into the wall current and put a rubber block between their teeth so they didn't snap them off. MRIs are safe, though. It's just a little current change. Hardly noticeable. The first two letters of MRI stand for Magnetic Resonance, and that's exactly what TMS does. It causes the electrons on a molecular level to resonate. Instead of blowing the fuse entirely, the TMS just flips the breaker on and off, on and off, thousands of times per second.

        All Dr. Sid Merriweather did was discover the frequency, the note played across what amounted to a seventy-thousand-dollar electric guitar string, that reset the right sequence of synapses. Do Not Pass Go, Go directly to Stage-4 REM sleep.

* * *

        "There were a few pieces of ferrite dust on the magnet's face, but not enough to throw off the cycle."

        "What is it, do you think?" I asked the repairman on the phone. I dislike people being in my apartment when I am not, but this could not be avoided.

        "You may want to just try another bed if you have access to one."

        This bit of diagnostic wisdom is becoming tiresome. It may be a while still before I go all the way over the high side, but I can feel it coming. Mary, prescient soul that she is, has started hiding my car keys.

        "Where the hell are they?" I ask her.

        "What, doctor?"

        "My keys."

        "Haven't seen them."

        As she walks away, the pocket over her left tit jangles.

        "Mary, I believe in the sanctity of the workplace and all that high-minded bullshit, but there's only so much a professional can take."

        She sends me a look that pretends she has no idea what I'm talking about.

        I grab a random chart off of the wall, and head into the adjacent room.

        "That lung has to come out."

        The ten year old boy on the bed looks up at me in terror. He and his mother look at each other over the cast on his leg and then back at me.

        "Excuse me for just a moment," I say. "Mary!"

        A medical assistant that I was firmly against hiring from the start looks up from a handful of used needles. I grab the front of his white coat and shove him into the nearest room. I hear the sound of either him crying or broken glass. The hallway overhead fluorescents start to pulse with my heartbeat.

        "Mary," I bellow down the hall, "the Doctor needs you!"

        She rounds the corner in a pretty flourish of professional cleanliness. Only I know that she has not taken her scrubs home to wash them in over two weeks. Her filthiness is mildly arousing.

        "I wonder about those armpits of yours," I say. She gives me a smile that says I am one charming dog.

        "Is there something you need?"

        "I need my lung. Where did he go?"


        "Where did she go?"

        "Room ten."

        "No," I say, putting an arm around her shoulder. We walk toward room ten and on the way she walks me straight into a wall. "I was just in room ten, and my lung was definitely not in there."

        "Try again," she suggests, helpfully.

        "That lung will have to come ou…"

        I open the door in front of her. Sitting at a card table, are three large greyhounds counting a stack of money. They peer up at me with lively, suspicious eyes. The one on the far left gives me a look like I might owe him a favor.

        "Pardon me," I say, closing the door quickly.

        She arches her eyebrows and her hair seems to straighten and re-curl in front of my eyes.

        "Did you do something different with your hair?"

        "It's the door at the end of the hall," Mary motions with a seven-inch index finger.

        "We're going to have to have a talk about your bedside manner," I tell her as I proceed to the door at the end of the hall. The medical assistant springs on me like a trapdoor spider.

        "Sorry, doctor, I have Dr. Neely on the phone for you…"

        "TELL HIM TO GO FUCK HIMSELF," I scream at him, buffeting him about the head and neck with a clipboard. The escalation principle once again steers me clear of time-consuming negotiation.

* * *

        I have no idea what happened to the carcass on my operating table, but at some point it's clearly going to require a bucket and a mop. I have a vague sense-memory of cracking his/her ribcage with the spreaders and feeling the little joints along the spine where the ribs attach give way.

        "Do we have a patent airway?"

        I feel a moment of relief that they're not talking to me.


        "What?" I say. The third-year resident looks up at me for a second and I can see his synapses firing behind his eyes. For a moment I envy him. He has no idea how wild this kegger can get.

        "Uhhh… nothing. Let's get the spine exposed. So, let's review," I tell the room.

        "Doctor, I don't think now is the time—"

        "When would you prefer? Later with popcorn and a greatest-hits reel? It's doesn't matter what you fucking think. Review. Now."

        "Patient is a forty-seven-year-old male brought in after a motor vehicle accident involving a rollover. Lacerations about the midsection indicate that he was wearing a seatbelt that either failed or was improperly positioned. The impact crushed the third lumbar vertebral body, causing a comminuted fracture that is putting pressure on the nerve roots and causing a possible cerebrospinal fluid leak. Anterior-entry emergency decompression with fusion at L2-L3, and L3-L4 was indicated. Primary incision was made at 1:43am."

        "Fabulous, only why the hell are we cracking his ribs? L3 is way down here…"

        The room looked at me. Kids, the whole fucking pack of them. I felt like a math teacher.

        "Y… you did that," one said.

        "Right, but why?"

        More blank stares.

        "Fuck it, never mind that now. Can we see the spine?"

        "We have the anterior surface of the vertebral body of L3 in sight, though it is behind this layer of muscle and fascia. We stopped here because we didn't know how to proceed."

        "Here," I say, leaning forward, "you need a little bit of elbow grease, you monkeys!"

        I pull up hard on the muscle fibers that run the length of the man's spine, and I bite through them with my teeth.

        "There," I spit a mouthful of blood on the floor, "that's not so hard, right?"

        I see the door open and someone's ass disappearing into it. Retching sounds follow him.

        "Now, all you gotta do is take that one link out of the chain."

        I reach in and find the third lumbar vertebra, which feels like a plastic child's toy that has been slammed in a storm door. It crunches a little under my fingers. I reach around the muscle layers and grab it in my hand. The accompanying tissue makes it about the size of a tennis ball.

        "Maybe someone should call Dr. Greenstein…"

        "Fuck Greenstein," I say. "What are you going to do when I'm not here anymore and there's no senior attending to run to? Who are you going to call? Call the receptionists, maybe? They have more sense than you."

        "We're going to need some help in here…"

        "What do you imagine is next, you goddamned geniuses?"

        "Sir, Doctor, the spinal cord…"

        I give a pull with all my strength and out comes the offending little tennis ball with a crunching slurp. I see blood spicules hover in the air like droplets from a garden hose against a summer sun. The carcass on the table jerks like an electric love doll, and my residents' faces light up.

        "Now that is fucking medicine!"

        I feel jubilant claps on the back, there are shrieking cheers, someone is lifting me up in triumph. They grasp my shoulders and arms and I try to tell them that it's not allowed in a sterile environment, but what the hell? Let them have their moment of victory. Let them celebrate their hero. Let them carry me away.

        Attention all associates, cleanup on aisle 4, please.

* * *

        "You've gone fruity," he says. I forget for a moment who he is. Oh. Right. My physician. "You've been sleeping for real, haven't you?"

        "I have," I say.

        "What the fuck are you thinking? You've read the studies, we've all read them."

        I wonder briefly if this guy ever read the one about how it's not okay to be a douche to your patients. I didn't read it either, but I remember seeing it on the syllabus.

        "I thought I was losing my mind at first."

        "You are losing your mind. You can't real-sleep forever, man, it'll ruin you."


        "What do you mean why? You know why. The Morvan Principle. There's a physiological cutoff of relative hours of REM sleep necessary per hour of wakefulness."

        "I seem to be doing okay so far."

        He stared at me for a moment, and his forehead wobbled slightly.

        "How much are you real-sleeping?"

        "Eight hours at a time, sometimes ten."

        "That still equals only about an hour and a half of sleep, maybe two on the outside, and anything can wake you up and ruin it in a hurry."

        I must have shrugged.

        "It's just not enough. Not for a regular 16-hour workday, and I bet you're doing more than that, aren't you?"

        "No," I lie.

        "You're putting your patients at risk, and yourself. Most importantly, you're putting the hospital at risk, and that we cannot have."

        "How the hell did they do it in the old days?" I ask.

        "In the old days, malpractice insurance wasn't 25% of their income, it was 60%. That's how. You're headed for trouble if you don't treat this."

        Dr. Whoever reached into a little cheap half-stack filing cabinet under his desk and took out a Xeroxed copy of a copy of some old graph.

        "You are here on this curve," he said, pointing just before the spot where it sloped, spiraled, and ultimately nose-dived toward Certain Doom. "If you continue to ignore the Morvan ratio, you'll start getting visual anomalies, heart function irregularities… Your hand is shaking."

        "No it isn't," I said, as it twittered against my leg.

        "Have you taken administrative leave yet?"

        "I'm going in later this afternoon. I have to relieve Greenstein."

        "No," Dr. Downer replied dourly. "You can't. And I can't let you."

        "So what's the answer?" I ask. "My bed doesn't work for me, and I've tried two others in the break room and neither of them work either."

        "It's not your bed, man, it's you. Pre-frontal lobotomy. It's your cerebral cortex that won't accept the TMS. We need to alter it."

        I know I'm fucking goofy now because I think I just heard him say pre-frontal lobotomy.

        "Let's not get carried away here," I say. Suddenly the sweat on my armpits notifies me that I am, in fact, nervous about this whole consultation idea.

        "You need surgery." He folded his hands over his chest.

        "The hell I do. I'm not your fucking meal ticket, cutie," I say, as I pull my shirt on.


        As I wobble toward the exit, a Kodiak bear in a lab coat carrying a clip-board enters the door and blocks it entirely. I try to rush him, but he sprouts six additional lab-coated arms and hits me with some incapacitating medication that feels like my face hitting a linoleum floor. I take a bow. Unconsciousness follows like the hiss of air after a tire-puncture.

* * *

        I am cognizant enough of the dream about Beverly hula-hoop-ing naked on my front lawn on a sunny day to be pissed off when it ends, and I see instead a ring of magpie-like masked faces staring at me in a room that with too much oxygen and no shadows.

        "You pig motherfuckers," I say, "I have a fucking sprinkler system."

        "Thicken him up a little," I hear someone say.

        "He's thick already."

        "What the hell did I just tell you to do?"


        "No, answer me."

        I hear the clanking of surgical steel against sheet metal. I can almost see the prissy attending tossing down his hemostat in anger. I can feel myself doing it. Am I doing it?

        "Thickening him."

        "Good, and when you're done, go outside and find someone else that can do your job because you're never coming back in here."

        I relax for a moment realizing that at least in this dream I'm not the resident again. I do feel something happen. Just something. I am in no pain, but that is always a shaky place to find oneself. I try to focus, but their voices recede. The attending, which might be me, leans back a little and yawns. His hands are full of steel and blood.

        "Fuck me, I'm tired."


copyright 2007 Mark Brand.

Mark Brand is a Manual Therapy specialist and Diagnostic Tech who lives in the northern suburbs of Chicago with his wife/editor Beth and his son/copilot John. He has been writing sci-fi and speculative sociological fiction for approximately fifteen years, and is a native of northern NY. While attending St. Lawrence University for Biology and Sociology, he co-founded, the predecessor of, with Paul Hughes in 1999. He is currently an associate editor for Silverthought, and assists with fiction contests and acquiring new talent and stories for the site. Highlights of his work include the critically well-recieved Red Ivy Afternoon, his second novel, which recieved the Bronze medal in the 2007 Independent Publishing Awards. Also, he has written a number of short stories that have appeared in print in Silverthought: Ignition and Alien Light: A Science Fiction Anthology, as well as being featured regularly on Additionally, he is known widely for having published one of the first comprehensive academic studies of the backyard wrestling phenomenon. "Backyard Wrestling: The Sincerest Form of Flattery" has been reprinted in over a dozen online and print publications, and cited in numerous follow-up studies and television documentaries.