Sanguinity Point

Midway upon the journey of our life

I found myself within a forest dark,

For the straightforward pathway had been lost

Dante Alighieri, Inferno Canto I

For a brief moment, just twelve minutes before he’d become an accessory to murder, Dr. Benjamin Snow had nearly persuaded himself that he was no longer an outsider. In the neon haze of the nurses’ station of the Pediatric Intensive Care Unit, he thought he had at long last found, not just a refuge, but the place where he belonged.

Sitting next to him, Pork Chop Malloy peeled the paper wrapper off of a tongue depressor, split the wooden blade in half to create jagged edges, and used one of the splintered ends to dig under the nails of his stubby fingers.

“No kidding?” Malloy said. “That was your first one?”

“First one by myself,” Benjamin said. “I’ve assisted on a couple.”

“Well blow me down Olive Oil!” Malloy said. “I just helped deflower the enigmatic Dr. Snow White. Know what that means?” Benjamin shook his head. “It means you’re the only Peds Resident in the hallowed halls of Houston Children’s that can slip a sub-clavian line in a kid without bleeding it half to death.”

That was as close to a compliment the second-year Critical Care Fellow had ever bestowed on a Resident and it was enough to make Benjamin blush. Comradeship can be an acceptable substitute for friendship when one has no friends, even more so in times of war. And for Benjamin this residency had certainly been a war — a war of attrition he had managed to survive on his own terms. The other residents, that band of grovelling sycophants, young men and women bereft of substance, with their snazzy clothes and dippy minds, whose depth of medical knowledge was as shallow as the abstract section of the journal articles they scanned, skated their way through the various rotations by cozying up to their attending physicians, somehow always managing to pluck a suitable comment from their boiler plate arsenal of cliches, always flashing the correct expression to alternately feign interest or compassion, as the situation demanded. As a rule, Benjamin struggled to find the right words. His usual facial expression, lips pressed together, eyes vacant as he focused on the problem at hand, was easy to misinterpret as aloofness, disinterest or something more sinister. Benjamin knew he put most of his attendings on edge, not because he challenged them or defied their authority, but perhaps because they sensed there was something deep and dark lurking under the still surface of his reticence, an idea that Benjamin found both frustrating and amusing.

He told himself he didn’t care. His objectives were not those of his peers. And he had long become accustomed to being an outcast. But he found himself enjoying this moment with Pork Chop Malloy, a fellow warrior he’d somehow stumbled upon in the smoky haze of the battlefield. He could almost smell the acrid smoke now, feel the glowing warmth of an imaginary campfire where the two sat triumphantly — Benjamin having survived his baptism of fire; Pork Chop, his gruff lieutenant, branding him a warrior with a mark of blood.

The moment was fleeting. A nurse in pale blue scrubs, “Donna Hill, R.N.” embroidered in pink thread over her breast pocket, trudged into the nurses’ station, her shoulders sagging. She leaned with one hand onto the counter, pressed her eyes shut and kneaded her temple with her thumb. Pork Chop craned his neck to ogle her cleavage, then glanced at Benjamin, gave a quick jerk of his head in Donna’s direction and stretched his lips in a smirk.

“Malloy,” Donna said, her eyes wide open now, “you gotta do something about the father in six-oh-two.”

Malloy tilted his head and said, “What seems to be the problem, toots?” pulling off a surprisingly good Humphrey Bogart impersonation.

“Okay, so all week I put up with the crucifixes, the prayer beads, the postcards of Mary and Joseph and the apostles plastered all over the place. But now he’s rubbing his son in some kind of embalming oil.”

“You mean, anointing oil,” Malloy said.

“Same difference,” the nurse said. She curled her lower lip. “The man is so damn creepy. For the last hour he’s been standing bed-side, rocking back and forth, mumbling all this mumbo-jumbo in his strange language.”

“Spanish?” Malloy said.

“Not the kind of Spanish I’m used to hearing,” she said. “And now, the oil rub-down. Are you kidding me?”

Malloy turned to Benjamin. “What’s the story with six-oh-two? You know him?”

Benjamin said, “Yeah, I’m following him.” He cleared his throat as he always did when he was about to present a case history and Malloy must have picked up on the mannerism because he interrupted Benjamin before the first word came out.

“The Cliff Note version, ace. Don’t give me War and Peace.”

Benjamin was caught off stride. He tried to gather his thoughts while Donna flashed him a get-on-with-it look. “Three-year-old Hispanic male,” Benjamin started, “traumatic brain injury, cerebral blood flow studies show-”

“Wait, let me guess,” Malloy said. “The kid’s brain-dead.” Benjamin nodded. “A Mitchell patient?”

“How’d you know?” Benjamin said.

“What’s the legal angle?” Malloy asked.

“Legal angle?” Benjamin said. “I’m not sure what you mean.”

“When the chief starts tilling the vegetable garden, there’s always a legal angle. Dad’s not in jail, so how’d the kid get jelly-for-brains?”

“Mom’s boyfriend beat him up,” Benjamin said. “The parents are separated.”

“Well, ain’t life a bowl of alphabet soup,” Malloy said. He studied the tongue depressor he’d been cleaning his fingernails with, brought it to his nose and gave it a whiff before tossing it in a trash bin. “So, who called the full-court press?”

Benjamin furrowed his brow. “Mom is pretty distraught. She doesn’t want to withdraw support. Said she’d get a court-order to keep life-support going.”

“She won’t need no court order,” Malloy said. “Mitchell will keep the kid plugged in. He’ll also fold her laundry and wash her windows if that’s what it takes to avoid a media blitz. This thing has circus written all over it.”

Donna placed her arms akimbo and thrust out her chest. She said, “So what are you going to do about this dad, Malloy?”

“Nothing. Absolutely nothing. The poor bastard is saying good-bye to his kid,” Malloy said.

“In some cultures, family members anoint their loved ones as an act of purification,” Benjamin said. The nurse ignored him.

“Exactly. That’s it,” Malloy said. “It’s all about the purification, baby.”

“It smells,” Donna said.

“Everything here smells, my dear,” Malloy said, switching back to his Bogey voice. “The urine, the stool, the blood, the people. It all smells to high heaven I tell ya.”

“He was going to light a prayer candle,” Donna said.

“Well, don’t let him do that, toots. What with all the oxygen we’re pumping in there, it’s liable to blow us all to the day-after-tomorrow,” Malloy said. “Tell you what, if something medical happens to the kid, just whistle. You do know how to whistle, don’t you? You just put your lips together and blow.” He turned to Benjamin. “Como se dice ‘blow’en Espanol?”

The nurse glared at Malloy. She removed her hands from her hips, loosened the bow of her scrub pants, tightened the cord in a snug new knot and slogged out of the nurses’ station without uttering another word.

Malloy curled his lips and said, “Of all the gin joints, in all the towns, in all the world…”

Benjamin managed a weak smile before turning his gaze to the floor and shifting in his seat.

“Look, Snow, if you can’t stomach a few kids dying from time to time, you’re just not cut out for this line of work,” Malloy said. “You’re better off getting out now. Join a practice in the ’burbs. Treat the odd diaper rash, tell cute neurotic moms when they should introduce solid foods, and still find time to shoot the back nine at the country club Wednesday afternoons.”

“No way, man,” Benjamin said. “I’m going critical care all the way.”

“Then indulge me a moment, if you don’t mind me asking,” Malloy said. “What the hell’s your major malfunction?”

“What?” Benjamin chuckled but felt himself blushing again. “What do you mean?”

“Don’t get me wrong. We all have a major malfunction. Hell, I have at least a dozen. What I mean is, here you are, you got brains, you got skills — Christ, you even got some heart by the sound of it. And your looks are utterly unfair for the rest of us mortal slobs. Hell, if I was queer I’d do you in a heart-beat.” Benjamin laughed. “Which I’m not,” Malloy continued. “So don’t come sneaking in my call room tonight. The thing is, you got the whole package, you know what I mean? You should be the golden boy of this program. So why didn’t Mitchell pick you for Chief Resident?”

“I don’t want to be Chief Resident,” Benjamin said. “I’m starting my critical care fellowship in July.”

“That’s not what I asked,” Malloy said. “Why the hell didn’t he pick you? Are you some kind of ax-murderer? Or did he catch you in his grand-daughter’s knickers? You tell me. I can’t figure it out.”

Benjamin felt a trickle of perspiration forming just below his hair line. He was relieved to see nurse Donna storm back into the nurses’ station.

“Now he wants to talk to the doctor in charge,” she said.

Malloy turned to Benjamin and said, “Did you hear that, Dr. Snow? The father of your patient in six-oh-two would like to have a word with you.”

“I’m not the doctor in charge,” Benjamin said.

“Why, how true. As the critical care fellow, I outrank you. But as it so happens, it’s T-minus-fifteen minutes to Adult Swim on Cartoon Network and I have to stop by to see Mildred first.”

“What? Who’s Mildred?” Benjamin said.

“Mildred,” Malloy said in an incredulous tone. “The brisket lady at the cafeteria. How do you even stay alive?”

“Guys!” Donna said, cranking her thumb like a hitch-hiker, pumping it in the direction of room six-oh-two. “Tonight!” She rounded the curve of the counter and plopped down in front of a computer terminal, tapping her password on the keyboard with more force than necessary.

“Look, I don’t know what to tell this father,” Benjamin said in a hushed voice.

Malloy slowly rose, and reached up to adjust the collar of his white coat. Benjamin shot to his feet in reflexive deference. The Fellow frowned and took a step back.

“Listen, Snow,” Malloy said. I don’t talk to family members when I’m on call, okay? That’s your job. But since I’m in a charitable mood, I’ll give you the best advice you ever heard.” Malloy stepped in closer now. “For starters, when it comes to talking to parents, be sure to never say anything concrete. You know what I mean? Don’t ever paint yourself in a corner. And never, ever forget Malloy’s golden rule of communication.”

“Which is?”

“Platitude…” Pork Chop Malloy waved his right hand through the air like a birthday party magician, “is the attitude.”

“Platitude is the attitude?” Benjamin said.

“That’s right. Platitude is the attitude. Let me give you some examples: God works in mysterious ways, okay? The kid’s off to a better place. Haven’t you ever watched Oprah? You gotta tap into the cultural kitsch. The key is to use phrases — cliches are always good — that don’t actually communicate any information. Jesus! and the last thing you want to do is to try to educate. So don’t give them anything that will make them think. Family members don’t want that. They never remember anything of substance anyway, or nine times out of ten they get it all wrong. But they sure as hell remember the tone of your voice, so watch out for that. What they really want, what they expect of you, is to fulfill a social function, like saying, ‘Good morning’, ‘Have a nice day’, ‘How about this weather we’re having?’ So later they can tell everyone that will listen to them that they talked to the doctor, don’t you know, and the doctor said Johnny’s off to a better place. Boy, the Lord sure works in mysterious ways!”

“Platitude is the attitude,” Benjamin repeated.

Malloy gave Benjamin a slap on the cheek, meant to be playful, no doubt, but the force was poorly measured and Benjamin felt more than just a sting. “You got it, ace,” Malloy said. “Say anything you can come up with that is so blatantly false yet so cliche’ that it carries the ring of truth. And remember, platitudes are like bit Bitcoins: they’re the new currency of communication.” Malloy cocked his head in mock surprise. “Boy that sounded good. I better write that one down.”

Benjamin rubbed his sweaty palms together. Something wasn’t right. He was trying to listen to Malloy while in his mind he played back Donna Hill’s words — words which now seemed to carry a solemn heaviness, words that resonated in Benjamin’s ears like the muffled thud of a falling boulder.

Benjamin did not believe in intuition but he was sure getting a queasy feeling. Something wasn’t right. In high school he had been able to look at an algebraic equation and sense that it was unsolvable even before going through the required steps. There was something unsolvable about this situation. Benjamin considered the possibilities: unaccounted variables everyone was ignoring, undefined numbers in the denominator…

Malloy said, “You’re in charge, Snow. This is your moment. You want to do critical care? Do it right now. Just don’t put any babies in body bags while I’m gone. Comprende?”

Benjamin nodded. “No problem, I can do this.”

“That’s right. Just relax, walk out there like you own the place and do a Fred Flintstone.”

“A Fred Flintsone?” Benjamin said.

Malloy smiled. “Just Yabba-dabba-do-it, baby.” He headed toward the exit, turned to do an imitation of Fred Flintsone driving away in his floor-less car, and left the unit.

Benjamin stood there a moment, shaking his head. He ambled next to Donna, hoping something she might say would bring clarity, or at least a sense of reassurance that his misgivings were out of place. He waited stiffly as she ignored him, and finally asked her, “What is it with Pork Chop and cartoons?”

The nurse shrugged. “He’s an asshole.”

The intensive care unit reminded Benjamin of a corny museum exhibit from his youth where, in an alcove behind a glass barrier, a group of wild-eyed Neanderthals made of wax remained frozen in time, spears in hand, eternally hunting a very pissed off woolly mammoth, while off in another corner, a group of decidedly more domestic early humans sat around a campfire and fashioned stone tools to their own utter amazement. Each room of the PICU had a glass partition you could peer through to spy inside, each room depicting a scene for Benjamin to study, to learn from, to categorize with a diagnosis, prognosis and treatment plan. But unlike that old museum, the scenes here would change from day to day, the characters switched out with stunning regularity. Proof that there was an infinite supply of pain and suffering in the outside world.

Benjamin looked through the glass showcase of six-oh-two. The lights inside were dimmed but he could make out the silhouette of a slight man standing by the bedside. He wondered what lesson this exhibit had in store for him. He pushed on the sliding glass door and stepped inside.

The man turned with a jerk, startled by Benjamin’s entrance. “You the doctor in charge?” he asked.

He had large dark eyes that jutted out. The rest of his facial features appeared to have been lifted straight out of Mayan petroglyphs. His shiny black hair was braided into a ropy pony-tail that reached down to just above his waist. Droplets of perspiration covered the cinnamon complexion of his stony brow, and that alone should have alerted Benjamin that something was amiss. That and the fact that the guy was wearing one of those tan, duck-bomber jackets construction workers and cowboys favor during North Texas winters. This was Houston, oppressively hot and muggy in early June.

But Benjamin was too preoccupied with remembering his hastily rigged script to bother with what was happening around him. “Poor situational awareness,” the report commissioned by the hospital’s ad hoc investigative body would later read, “was a significant contributing factor to the events of June the eleventh.”

Benjamin stood tall, flashed the empathetic smile a medical school classmate had recommended he practice in front of the bathroom mirror and said, “I’m Dr. Snow.”

“You in charge?” the man said.

“I’m the senior doctor here,” Benjamin said. It wasn’t really a lie. Since Malloy had slipped out, Benjamin was also the only doctor in the unit.

“No more,” the man in the pony tail said. He had a thick guttural accent and spoke in a timbre that was hard to perceive in the din of monitors and alarms.

“I’m sorry?” Benjamin said.

“No mas. Please, no more.”

No more what? Benjamin wondered, and continued repeating the question to himself even as the man reached into his jacket, fumbled for a moment, and pulled out a stubby pistol which he lifted nonchalantly and pointed at Benjamin’s chest. For a few seconds, Benjamin’s brain was numbed by puzzlement, his neural circuits scrambling to try to make sense of what was happening. Then the gush of adrenaline hit him.

Fears may germinate at any age, but the seeds of raw terror are sown in childhood. And the sight of the gun hovering near his chest roused dark specters from a sooty corner of Benjamin’s memory. A familiar heaviness swelled in his chest, spread to his arms and legs, pinning him to the patch of linoleum on which he was standing.

“No mas,” the man repeated.

“No mas, what?” Benjamin asked. He struggled to get the words out.

“What you’re doing to my boy,” the man said. “Please, no more. Everything off. Enough.”

“Oh, I can’t do that.”

“You’re in charge,” the man said.

“I’m just the doctor in charge right here-” Benjamin’s voice cracked. He swallowed hard. “Just in charge right now. I would need to call-” He froze, unable to get another word out. The man had pressed the tip of the gun’s barrel on his chest. Benjamin felt an electric charge spreading from the point of contact on his sternum, around his torso and up the back of his neck where the hairs stiffened and stood up. Benjamin slowly raised his hands above his head and felt utter self-contempt for doing so. If there were any lingering doubts, he had just proved to himself that he was just as weak, just as cowardly as he had been on that torrid afternoon, so many years ago.

Like that child, that former self he thought he had outgrown and shed like molten skin, he wanted it all to just stop, to go away. He wondered what he could say to make the man put the gun away, to walk out of the unit as though nothing had happened. His mind was a void. Which was just as well, for even if had had come up with the appropriate words, he was, by now, far too breathless to mutter anything coherent.

Donna Hill marched into the room, turned on the overhead light and was striding to the bedside when she did a double-take. The plastic IV-bag she was carrying flew out of her hands like a wet fish as her whole body recoiled.

“Oh, shit,” she said, but as soon as the words were out, she seemed to regain her composure, if not her nervy attitude.

The father turned his attention to her but kept the gun pointed at Benjamin’s chest. “Lady, you help,” he said.

Benjamin lowered his hands slowly and let them settle by his thighs, embarrassed by the fact that Donna seemed far less affected by the sight of the handgun than he was. He half expected the man to wave the pistol at him to keep his hands up, the way bad guys are apt to do in the movies. That didn’t happen.

“What the hell is going on here?” Donna asked.

The father gave Benjamin a nod.

Benjamin said, “Uhm, we’re taking Anselmo here off of life-support, it seems.” Benjamin said.

Donna’s eyes narrowed. She shook her head. “The hell we are!”

“You do it,” the man said, “or I shoot the doctor.”

“Come on, man…” Benjamin said.

“Shoot him!” Donna said. “What do I care? I’m not losing my job over this.”

The man took the gun off Benjamin’s chest. Benjamin exhaled slowly, let his eyes close. His relief was short-lived. The next moment he felt the cold metal press against his forehead. Somehow, it brought on a ringing in the ears.

“I kill him,” the man said. “I kill him right now.” His voice was steady, dispassionate, eerily resolute.

Someone outside the room shrieked. Another voice said, “Oh my god!”

Donna said, “OK, fine. You win. Let’s do this. Just put the damn gun down already.”

Benjamin could have kissed her. “Yeah, let’s do this,” he whimpered.

It’s surprising how quickly a central line, an endotracheal tube and a Foley catheter can be removed from a child’s body when someone’s got a gun pointed at you — even when your fingers are trembling. The operation hit a snag when the boy’s father insisted Benjamin remove the bolt that measured intra-cranial pressure from the boy’s head. Benjamin confessed, with unabashed candor, that he didn’t have an inkling as to how to do that, the pretense of acting like the doctor in charge having fully dissipated by now. He was still trying to explain to the father that the instrument did nothing to keep the child alive when Donna leaned in with over-sized shears and clipped the connecting cables snaking out from the heavy dressing on the child’s head.

“There!” she said.

By now, a small crowd had gathered on the other side of glass partition, nurses and unit secretaries, partly shielded on either side of the room’s border, a head or two bobbing into view every so often. Benjamin caught a glimpse of a very pale Pork Chop Malloy standing several feet behind the sliding glass door, his jowls slackened, his unbuttoned white smock drooping on his frame like a wrinkled shroud. Behind Malloy, a hospital security guard was prancing his way toward the sliding door, one hand unbuckling the black leather holster on his belt.

Benjamin’s muscles tightened. He yelled at the guard, “Stop right there! Get the hell out of the unit. I mean it.”

The last thing he needed was to be caught in the crossfire of a shootout between two men who didn’t seem to have particular aptitude in the use of firearms. The security guard froze in mid-step in a floundering half-crouch, then straightened, stiffly took a couple of backward steps, his facial expression flitting between perplexity and disappointment, before settling into a grimace of indignation. The guard finally turned and headed for the exit of the Intensive Care Unit, cocking his head to talk into his shoulder-mounted radio on the way out.

The boy’s father nodded his head, a gesture that made Benjamin feel that he might have crossed a fateful line: that he was now no longer a hostage but a willing accomplice.

With some haste in his movements now, the boy’s father took a seat on a plastic-lined recliner, gun still in hand. Benjamin approached the padded hospital bed, slipped his arms under its tiny occupant and lifted the body of the child straight up, but the boy’s midsection folded and drooped between Benjamin’s arms, sliding back onto the mattress. He adjusted his grasp, clasping the bruised swollen flesh, palpating it with his fingertips, at once getting a better grip while searching for a quiver of life. He lifted the tiny body again, brought it up high, secured it at the level of his breast, then turned, stooped down and carefully placed it on the lap of the father. The man cradled his son and nonchalantly pointed the barrel of the gun in the direction of a chair across from him. It came off as an inviting gesture, as if he were lifting a glass of wine for a toast. He said, “You sit there.” Then he glanced at Donna and, with a nerve-jarring wave of the pistol, said, “You go.”

Donna walked towards the open doorway, stopped, turned, and folded her arms as she squared her body into an open foot stance. “No. I stay. Anselmo is my patient.”

The father seemed to consider this for a moment. He looked down at his son as if he were seeking the boy’s counsel. He nodded. “Esta bien. You stay there.” The coarse features of the man’s face softened, the corners of his mouth tugged down on his lips as he scanned the boy’s still form, as if searching for a sign: the slightest movement, even an agonal gasp of breath. There was nothing. He whispered something unintelligible, then cleared his throat.

“I know his soul want to go,” the man said. “It is waiting to go on the long voyage, farther than the stars.” The man set his gun on a cluttered bedside table and began to comb the boy’s hair with his slender, calloused fingers. “No man must to see his little boy die.” His voice caught on the last syllable. He pressed his full lips together as if trying to hold something from gushing out. And then he began to sing what sounded like a lullaby, and as he sang his eyes drooped heavily as though he were entering some kind of a trance.

Benjamin looked at the pistol lying on the table just a few short feet away from him. Maybe it wasn’t too late. With a lunge he’d be able to grab the gun and turn the tables on the father. There might still be time to intubate the kid, get him back on life-support before the electrical activity of his little heart extinguished — still time to save the life of a brain-dead child.

Benjamin’s head began to throb. Deep in his ears he heard the pounding of his own heart growing louder with each beat, the sounds around him muffled by the steady, rippling cadence of his pulse. He glanced at Donna. Her body was swaying to the rhythm of the lullaby. Tears trickled down her cheeks.

For some reason, this steeped in Benjamin an odd sense of relief, as though she too had sanctioned a kind of tacit acquiescence. There was nothing to do now but wait. Hadn’t that been his only option all along?

By now, what seemed like an eternity had passed since the boy’s last mechanically generated breath. The boy’s chest was stubbornly still, his skin the color of unpolished marble. The father stopped singing. He gave the boy a flit. A more forceful shudder. He raised his blood-shot eyes to look at Benjamin.

Quietly, Benjamin got to his feet, slipped his stethoscope on and stooped to listen to the boy’s chest. He moved the diaphragm of the stethoscope over the areas of the tiny chest that corresponded to the mitral valve, the aortic valve, the pulmonic, in the disciplined routine he had employed since his second year of medical school, knowing there was nothing to listen to.

He removed the eartips of the stethoscope from his ears, looked at the father and shook his head, hoping the gesture didn’t come off as too corny. The father nodded. The man lifted and turned the tiny corpse so that the boy’s head was on his shoulder. He said to Benjamin, “Please, sit.”

Benjamin shuffled and settled heavily in the chair. The father waited for Benjamin to be seated, then shifted his weight in the recliner. Benjamin got the sense that he was getting ready to get up and leave and take the boy’s body with him. He thought, oh no, you can’t do that, but said nothing. The father reached for the gun and Benjamin opened his mouth to reason with the man, but before he could utter a syllable the father spoke.

“Jach Dyos b’o’otik.”

“I’m sorry?” Benjamin said.

The father’s eyes gleamed. A smooth coolness spread over his face. Benjamin was utterly spooked.

“I… I didn’t get what you said,” Benjamin said.

The man smiled. “Jach Dyos b’o’otik,” he repeated. He raised the gun, sealed his lips around its greasy muzzle as if he were trying to suckle from an over-sized straw. A second later, a starburst of blood and tissue splattered on the wall behind him.

Benjamin flinched at the sound of the gunshot. He stared at the crimson blotch oozing down the wall and the oddest memory flickered to life for the first time in many years: the vision of a frazzled Mr. McNulty, his grandparents’ next door neighbor, plodding up the walkway of his best friend’s house with a roll of wallpaper under his arm.