Dr. Knox

CHAPTER 3   We took surface streets north and west as the sky ripened from pink to purple, and lights came on all over town. San Pedro to First; First into Beverly; Beverly to Vermont to Franklin to Outpost and into the hills. Like everything about Sutter, his driving was fluid and nonchalant, and it was only on close inspection that you noticed the precision and speed.   Sutter was thirty-five, five years younger than me, and at six feet tall, an inch shorter. His heritage was an elusive thing—African, Asian, Scots, Native American, maybe Hispanic too. Sutter himself claimed not to know the precise recipe, but, whatever the mix, the result was striking. His features were sharp and angular, as if chipped from coffee-colored stone, animated by a nimble intellect and a sometimes merciless wit, and softened by laugh lines around his mouth and pale eyes.   The rest was muscle. He was cobbled, plated, and wired together with it, and the first time I’d stitched him up it seemed amazing that anything could pierce that armor. But three bullets had, along with an ugly chunk of shrapnel. Even that torn up, he’d refused treatment until he saw that his wounded teammates and the children they had brought in—a boy and girl, both eight, pulled from the remains of a refugee encampment, and caked in ash and mud—were being looked after.   That was six years ago, at a Doctors Transglobal Rescue field station in the Central African Republic, halfway between Bangui and Berbérati. I was running the place—little more than a tin-roofed shed with tarps for doors—and Sutter, who’d cashed out of the Special Forces by then, and cashed into the private security business, was babysitting some German geologists. The geologists were unscathed but full of complaint over detours and delays, and before I’d started pulling bullets from him, Sut­ter had threatened to shoot them if they didn’t shut up.   He took a left on Mulholland, ran the window down, and hung his elbow out. The evening air was soft, and smelled of eucalyptus and dust. I drummed my fingers on the dash, and Sutter looked over. His gray eyes were bright.   “Lydia seemed less happy to see me than usual,” he said. “Something going on?”   I told him about the boy, his missing mother, and the men peering through the clinic’s windows. He squinted, and I told him about Lydia’s impulse to call child services and my desire not to.   He raised a skeptical eyebrow. “She’s got a point.”   I shrugged. “I don’t want to hand him over to those clowns unless I have to.”   Sutter smiled. “You want help looking for the mom?”   “I’ll let you know.”   We drove in silence for a while, along the twisting road. “Hard to believe she still doesn’t like me,” Sutter said. “After all these years.”   “Lydia doesn’t like me that much, and I sign her paycheck.”   “Which makes you part of the oppressor class. But me—I’m a workingman. Plus, I’ve got a way with people.”   “And modesty too.”   I looked out the window, at the shadowed hillsides and can­yons along Mulholland. Then I unzipped the black duffel at my feet.   It was an ER in a hockey bag: surgical kits, anesthetics, pain meds, tranquilizers, antibiotics, sterile gauze, splints, rolls of tape, packs of surgical gloves, IV kits, bags of Ringer’s lactate, and bags of saline. I took another count of the surgical kits, then looked into the back seat. There was a matching duffel there, packed with a surgical stapler, a blood pressure cuff, a portable EKG, a portable sonogram, a laptop, and more gauze and gloves. Next to that was a small cooler filled with ice packs and three bags of O-negative blood. I opened them both and scanned their contents.   Sutter was watching me. “This makes four times you’ve taken inventory.”   “I’m a nervous guy.”   He snorted. “If only.”   “Meaning what?”   “Meaning I served with nervous guys and with eager guys, and I know the difference. I’d feel better if you got less of a charge out of walking into a room full of guns.”   I sighed. We’d had this conversation before over the years. “I didn’t think tonight was that kind of gig.”   “Any gig can turn into that kind of gig.”   “Some rich-kid slacker in the Hollywood Hills—seriously?”   “Any gig.”   “Usually, the patients don’t shoot at me, because they need me.”   “Until they don’t.”   “Isn’t that where you come in—making sure I don’t get shot, and that I get paid?”   “It’s easier when you’re less eager.”   I shrugged.   I’d been working these night jobs with Sutter for more than three years, since I took over the clinic from the ancient Dr. Car­mody and discovered after the first month that I could make payroll or make rent, but not both. Sutter, ever the entrepre­neur, had an answer. The arrangement was simple: house calls for cash, paid up front, and no questions asked beyond the med­ical ones. No paper filed—with cops or anyone else—about gun­shot wounds or drug overdoses or STDs or patients who might be persons-of-interest in connection with . . . whatever. And no names exchanged—not theirs, not ours, not ever.   Of course, for some people in the market for undocumented medical care, anonymity was impossible: their faces stared out from TV and movie screens, from magazine covers and billboards, from every corner of the Internet. What those patients wanted above all was silence, complete and absolute. After three years we had established a reputation for it among the lawyers, agents, PR flacks, crisis consultants, and the other breeds of handlers and fixers who rang in the middle of the night. Or Sutter had established a reputation for it. It was my fervent hope that I had established no reputation at all—that I was entirely unknown. With every one of these night calls, I bet my license on it.   “This lawyer didn’t say anything about the wounds?” I asked.   “You got what I got: multiple GSWs. End of message.”   My knee bounced up and down in four-four time. “But you actually know this guy—the patient?”   “Turns out I knew his pops. He’s a director. He makes these crappy, basic-cable action flicks—commandos versus monsters or aliens or some shit. I was his tech adviser on a few of ’em. Wanted me to show his starlets how elite special operators would grease zombies.”   “SEALs learn that?”   “Whole chapter on it in the counter-insurgency manual.”   There were still cars in the dusty lot at the top of Runyon Canyon when we passed, and a couple of runners cooling down in the gathering dark. Five minutes later, Sutter turned the truck onto a brick drive that climbed around a hillside for fifty yards and then was interrupted by brick pillars, a wrought-iron gate, security cameras, and an intercom. We rolled to a stop by the metal box.   “You order the Korean fried chicken?” Sutter said to the speaker. There was no answer, but the gates swept open.   The drive curved upward some more, and ended in a brick plaza and a low-slung house of glass, red stone, and sharp edges. There were desert plantings around the house, and lights among them, and they cast jagged shadows over Sutter’s truck, and on the yellow Turbo Carrera, the black Lexus, and the battered green Accord parked out front.   Sutter checked the load in his Sig Sauer, slipped it in a holster, and mostly covered it with his Ozomatli tee shirt. I hoisted the duffels from the truck, and he picked up the cooler, and we headed for the big front door. I stopped as I passed the Porsche and pointed my chin at dark splotches on the paving.   “Somebody’s leaking,” I said.   “And not oil.”   The door opened before we reached it, and a pudgy young man with thin arms stepped out. He was short and flushed, with sweat in his thin blond hair and damp spots on his polo shirt. His khaki pants were too tight around his waist, and didn’t quite reach the tops of his boat shoes. He spoke in a quavering voice.   “You’re the doctor?” he asked Sutter.   “He is,” Sutter answered.   The sweating man put out a tentative hand. “Doctor . . . ?”   “Dr. X,” Sutter said. “You’re not the guy who called.”   “That was my boss. He . . . he couldn’t be here. He’s in court on Mon—”   Sutter cut him off. “You’re what—an associate?”   The man nodded. “Second year. And you are . . . ?”   “The office manager. You have something for me?”   The man reached into his pocket and handed Sutter a white envelope. It was wrinkled and damp but the right thickness. Sutter tucked the cooler under his arm, and riffled a thumb through the cash. “Where’s the patient?” he asked.   “He’s in the den. I . . . I’m going to wait out here.”   I nodded, and followed the blood trail through the door.     CHAPTER 4   There were acres of polished stone and wood in the house, and long runs of floor-to-ceiling glass, and everything smelled of lemons. The rooms were large and flowed one into another, and they all had wide, twinkling views of the city. I followed the blood and the sound of moaning. After a while, I heard voices.   “You’ve got to keep still,” a young woman said.   “I can’t keep still,” a man whined. “I can’t keep any fucking way that doesn’t hurt like a—Oh, Jesus, look at this. I’m gonna puke again.”   “Here, baby, I’ve got another towel—lift up a little.”   “Ow! Son of a bitch, Astrid—that fucking hurt!”   “If you just stay still—”   “I can’t!”   The den, when I finally got there, was not a room full of guns. It was dominated by a massive window, and by a sectional sofa in fawn-colored leather and bloodstained towels. A woman in her late twenties hovered over the sectional. Her body was tanned and curved, with strong calves and arms, and her hair fell in stiff blond waves around a tanned, feline face. She wore cutoffs, a peasant blouse, and an expression of irritation mixed with anxiety as she looked down at the bleeding man. There were patches of dried blood on her arms and legs.   The man was younger, maybe twenty, and he lay on his side with his knees drawn up and his hands tucked between them. He was lumpy and pale, and his face was a sweating beige potato. His hair was dark and frizzy, and there were acne scars on his cheeks and beneath his underfed soul patch. His lips were chalky, his arms and elbows scraped and bleeding. He wore jeans that were wet from waist to knee with blood, and it looked as if a bear had bitten off his left rear pocket, along with a good-sized chunk of what was underneath.   I put the duffels down, unzipped both, squeezed antiseptic on my hands, and pulled on surgical gloves. The man and the woman turned to look at me, and relief swept over their faces like wind across a pond.   I was relieved too. The man was conscious and alert enough to whine, so right there we were ahead of the game. And though he was bleeding, blood wasn’t actually spurting out of him—at least not that I could see.   “You the doctor?” he asked. “I’m Teddy. This is Astrid.”   “I don’t need names.”   The woman squinted. “You a real doctor?”   “That’s what my diploma says,” I answered. “The Web site I got it from even threw in some Latin.”   Astrid looked alarmed, and so did Teddy. “That was a joke,” I said. I pulled a blood pressure cuff and a stethoscope from one of the duffels, and an IV kit and a bag of fluids from the other. “Give me your right arm, and tell me where you were hit.”   Teddy hesitated, and looked at Astrid. Then he put his arm out. “I was in the Valley, out by—”   “Where on your body.”   Teddy swallowed hard. “My . . . my ass,” he said. “My ass and my thigh.”   I crouched by the sectional, and slid the blood pressure cuff over Teddy’s arm. I put the stethoscope on and inflated the cuff.   “BP’s low, but that’s not surprising. You have any health problems? Diabetes? HIV? Asthma? Anything?”   “No . . . I . . . my doctor said I could lose a few pounds.”   “You’ve made a good start. On any meds—prescription, recreational, anything?”   “No . . . nothing. Weed sometimes.”   “Allergies?”   “Uh . . . I get hay fever. And cats—I’m allergic to cats.”   “You weigh what . . . one ninety, one ninety-five?”   “One ninety-one.”   I slipped the cuff off. “Left arm now.”   Teddy shifted, and held out his other arm. I wrapped a tourni­quet above his left elbow, and tapped for a vein. Then I swabbed the arm and tore open the IV kit. I glanced at Astrid, who had stepped back and was watching openmouthed, with wide eyes.   “You mind her being here?” I asked Teddy.   “Astrid? No, no . . . it’s fine if she stays.”   “And you?” I asked Astrid as I took out the catheter. “You’re not going to faint on me?”   Her eyes narrowed. “I’m fine,” she said.   “Great. Get me garbage bags.”   “Like . . . plastic ones?”   “The bigger the better.”   Astrid looked at Teddy. “In the kitchen,” he said, “under the sink.” She trotted from the room.   “You’re shocky, so I’m giving you fluids. Then I’m going to stop your bleeding, patch what I can, and give you antibiotics and some pain meds. Sound good?”   “Can I have the pain meds first?”   “We’ll get there,” I said. “Now, this’ll sting.” I popped the cover off the catheter, pressed it against Teddy’s inner arm below the elbow, pulled the skin, and slid the needle into the vein.   “Fuck!” he yelled. “That fucking hurt.”   “I bet,” I said, and taped the tubing to Teddy’s arm. Astrid returned with a fistful of white garbage bags. “Give me the bags,” I said. I pointed at a brass floor lamp. “And bring that closer.”   Astrid wrestled it to the sectional, and I hung the Ringer’s lactate bag from it. Then I checked Teddy’s pulse at his neck, his wrists, and his ankles.   “You’re running fast.”   “Is that bad?” Teddy asked.   I shrugged. “It’s about par, all things considered. But your pulse is strong at your extremities, and that’s good.”   “My ass hurts something fierce,” Teddy whined.   I held up a syringe. “Got your ride waiting,” I said, and I injected morphine sulfate into the IV port.   “How am I really?” Teddy said, a trace of sleepiness already in his voice. “Am I okay?”   “If your wallet was back there, it’s KIA,” I said. “Otherwise, you’re not too bad.” I looked at Astrid. “How about some music.”   She looked confused. “What?”   “Music,” I said, and pointed at a bookshelf, and an iPod mounted on little speakers there. “Something with a beat.”   Astrid hesitated for a moment, and went to the shelf. In another moment Raphael Saadiq came on. “Heart Attack.” I smiled. “Turn it up.”   Line cooks must know the feeling—slicing, stirring, firing—assembling dish after dish from menus as familiar as nursery rhymes. Magicians must know it too, working one feint, one precise trick, after another—show after show, anticipating the gasps from the audience, and every round of applause. Certainly I’d known something like it back in college, when my soccer coaches had run us through endless three-man passing drills—against two, three, four, five defenders—moving in shifting triangles up and down the field. It was as much about muscle memory as about conscious thought—maybe more so. And that’s how it was as I worked on Teddy.   So on went the surgical mask, out came the bandage shears, the jeans were sliced away, the gunshot wounds—a messy but uncomplicated through-and-through of the left glute, and a deep furrow in the right quad—were flushed with saline. Coagulant powder went into the ass wound, then pressure, then dressings. The thigh wound got sutures. After that, a slug of prophylac­tic antibiotics—Ancef would do the trick—and then a tetanus booster.   All the while, the garbage bags filled up with the shreds of Teddy’s pants, bandage wrappers, bloody gauze pads, bits of tape. The music played, I tapped my foot, and now and then paused to check Teddy’s pulse and BP, which, along with his color, stabilized and then improved. And Teddy—with loopy morphine logic and a steadily thickening voice, and despite my insistence that I wasn’t interested, that I really didn’t want to know—talked and talked and talked. About how hard it was to get a business off the ground, about how much he hated the Val­ley, about what a cheap prick his father was, but mostly about his very bad day.   “You even know where Tujunga is? It’s past Pacoima, for fuck’s sake. That’s like the ass of nowhere. You drive farther east, you’re in New York or something. Took me fucking forever to get there. And I’m at this . . . I don’t know what the hell it was. One of those self-store things, where people keep the garbage the garbage man won’t take. It’s up on this hill, and I’m waiting for . . . for some people. I’m standing by my car, looking down at Foothill. There’s a big-ass truck jackknifed across most of the street, and there’s melons or something rolling around everywhere, and some insane backup, and then this dick in a Hummer—he leans on his horn, pulls out of the crowd, and drives up on the fucking sidewalk. Must be doing fifty at least, and people are waving and jumping out of the way. I take a couple of steps forward, ’cause I know there’s gonna be a serious crunch and I wanna see, and then it’s like somebody kicks me—and I mean fuckin’ hard—right in the ass. I thought I was going down that hill, for chrissakes. And then there was another kick, and I was on the ground, and my pants were wet. And not in a good way.”   Teddy thought this was funny, and he chuckled to himself, and noticed Sutter leaning in the doorway.   Sutter held up the little cooler full of blood. “You gonna top off the tank?” he asked me.   “Not yet.”   Teddy squinted at him for a while. “Who’re you?”   “The nurse,” Sutter said. Astrid smiled at that, and Sutter smiled back and winked at her.   Teddy scowled, but the morphine and the ebbing of his own terror were making him drowsier by the moment. He shook his head. “You sure? You don’t look like a nurse.” Sutter chuckled softly, and Teddy scowled more and went back to his story.   “Then I’m down on my belly, and I just want to get the hell out of there, so I drag myself to the car. I get in and get down to the street somehow. I couldn’t feel anything then—my leg was practically numb—but by the time I get on 134 my ass is like on fire. I don’t know how I made it back in one piece.”   Sutter nodded sympathetically. “The holes I saw in your Porsche—you were lucky to make it out at all. What were you doin’ there in the first place?”   Astrid shot Teddy a warning look, which he didn’t recognize. “Doing?” Teddy said. “I was supposed to meet some people is what I was doing.”   Another concerned nod. “Business meet?” Sutter asked.   “Should’ve been no trouble,” Teddy said. “A simple swap. Now I don’t know—”   Astrid coughed elaborately. “Teddy, babe, you should take it easy. Right, doc? Shouldn’t he keep quiet?”   I didn’t look up from my suturing. “That’s never bad advice,” I said.   Teddy yawned and looked at Sutter. “You’re not really a nurse, are you?”   “What gave it away?”   “You—”   “Teddy!” Astrid said sharply. “You’re fucking high on pain meds. How about you keep quiet, baby? Just rest.”   I peeled off my gloves, tossed them in the garbage bag, and stood. I stretched my arms over my head. “That should do it.”   “You’re finished?” Astrid said. “Teddy’s okay?”   I nodded. “He was lucky—the bullet didn’t hit gut or bone. He should be all right if he takes it easy and gets some looking after.”   “What kind of looking after?” Astrid said.   I began stowing gear in the black duffels. “He’s going to need antibiotics for at least a week. I can leave you some, but he’ll need more. And his ass needs maintenance. A wound like that, there’re always foreign bodies in it—bits of fabric, maybe bullet fragments, grit, who knows what. It needs to be drained, cleaned, and re-dressed periodically, watched for infection.”   “Aren’t you supposed to do that?”   “I’ve done what I can for now. As far as anything else, I’ll tell you what I tell everyone I see in these circumstances: he should see a qualified health professional for follow-up care.”   Astrid squinted and looked at Sutter. “What the fuck does that mean? Isn’t that you?”   He smiled. “We get paid, we’ll be here, hon.”   Astrid shook her head. She said nothing, but her look was eloquent: Assholes.   On the way down the hill, I asked Sutter if he thought Astrid would call for follow-up care for Teddy. He laughed.   “He’ll be lucky if she doesn’t turn him into barbecue.”   Excerpted from Dr. Knox by Peter Spiegelman. Copyright © 2016 by Peter Spiegelman. Excerpted by permission of Knopf, a division of Random House LLC. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.