Psychostasis Read online

  Stop. Focus on the road. When he’s home, he’ll get everything in order, have a couple of bumps and a hell of a party.

  And for what?

  His friends don’t like him, his money sits in a box, and he lies awake, writing a tragedy which will never make it to the stage. He’s a coward.

  He isn’t destined for anything great. He’s destined for nothing: no legacy, no greater purpose, no pleasure lasting longer than a three-day binge. No matter how far he chases his fizzling spark of truth through this predictable, cyclical existence, he’s never going to catch it. He shares the fate of obscure occultists and roadside schizophrenics: a lonely enlightenment. Nobody loves or respects him, and nobody ever will.

  Chapter 5

  Elliot opens his textbook and only sees colors: lymph nodes nestled into tissue like white, bloated ticks; vibrant blue veins and red arteries. When he first opened Agatha—that was his corpse’s name—he discovered a mess of grayish lumps with none of the elegant delineation his studies led him to expect.

  They’ll open him up. The cogs are in motion. He sent the deposit, and when they see his insides, at 10am on April 4th, in the makeshift operating theater at 4309 Marble Street, he won’t be gray. He’ll look like these illustrations: living tissue in miraculous cooperation.

  His churning stomach wrenches him from the daydream. He should eat something solid. He stands on his toes to search the top shelf and finds some old bran cereal in Tupperware, checks it for mouse droppings—just paranoia; they can’t chew through plastic this thick—and dumps it into a mug, followed by the last of the milk.

  “Baby? You awake?”

  He smiles, replaces the spoon in its cup, and steps into his mother’s room. She’s still lying flat, listening to the television. Her long braids fan around her head like Medusa’s snakes. “I heard you come in last night,” she says.

  “God, I’m so sorry.” She doesn’t look angry, but she’s never angry enough when he fucks up. “Didn’t mean to wake you up. I went to the library again late.”

  “Come here.” She pulls him close and kisses his eyebrow. “My sweet boy.”

  “I’m sorry,” Elliot repeats. He sets the mug on the table. He can afford to skip breakfast occasionally—he’s getting chubby anyway. “Here. That’s all we got, but I’ll get groceries soon as I can. Did you take your meds this morning?”

  “Mm, I was waiting for you.”

  He smiles, grabs her bedpan, and rinses it out. She’s sitting up when he returns with her medication: Baclofen, Midodrine, Methylprednisolone. He’s weaning her off the last one against doctors’ orders. It hasn’t been recommended for long-term use since 2015, but her PCP obviously hasn’t kept up with the literature.

  “What’re you watching?” He asks, depositing the pills in her palm.

  “Just the news.” She pops them in her mouth, takes a sip of water, swallows. “I don’t want you staying out late, Elliot. That serial killer in Rhode Island, you know they interviewed his neighbors—”

  “Hey hey hey.” He sits on the bed and nestles into her shoulder. “He’s dead, mom. And last week you told me that reading in the dark will make me go blind. You can’t believe everything you see on TV.”

  “I worry,” she says softly.

  “I know.”

  They sit in silence for a moment, Elliot relishing the familiar smell of her hair, her skin. She wanted to design perfume, at one point. She was halfway through a Bachelor’s in chemistry when she gave birth to him and everything went wrong.

  “Rounds start this week,” he says. “I guess I should be there early, but I’m nervous that I won’t—”

  “You thought you weren’t smart enough to get into medical school, too. You said that. We were in this room and you were wearing those same damn shoes.”

  “Mom, I was—”

  “July 2nd, 2014, you said you didn’t have enough extracurriculars for an accelerated Bachelor’s. October 19th, 2003. I took you and Travis to the playground at Fairmount park, and you sat in the grass re-reading A Wrinkle in Time because you thought you were gonna fail your book report.”

  “Okay, I get it,” he says.

  “I’m not done. Did anyone else in your year graduate with a 4.0?”

  “Amy Shearman did, I told you.”

  “And how old is Amy Shearman?”

  Elliot averts his gaze. “Twenty-seven.”

  “And how old are you?”

  “Twenty-three,” he mumbles.

  “There you go. That school should thank God they got you.”

  Elliot kisses the top of her head, slides out of bed, and says, “You drive me crazy, Mom. I love you.”

  After a week of excruciating orientation, he’s thrilled to be in the hospital, floating on the edge of a cluster of his peers, listening to them speculate: Who’s supervising? What cases will they see in eight weeks? He joins them in a rare, silent camaraderie.

  A woman he’s never seen herds them into the lecture hall, tells them to quiet down, and takes attendance. The students continue talking. They’ve already learned the hospital hierarchy; they tune her out because she’s ‘just’ an LPN. She won’t be writing recommendation letters. They’re biting their nails, whispering to each other, giggling. Amy Fucking Shearman desperately scribbles down the nurse’s every word, but aside from her, nobody’s listening.

  The nurse takes her time handing out assignments, no doubt enjoying the small power trip of holding them in suspense. Most placements are met with frustrated sighs. A handful of students exchange fist-bumps. Elliot sits with his hands folded in his lap and waits.

  And his mom was right. He gets surgery, along with a round of snickering and pained groans. “She took my spot,” somebody mutters behind him.

  One by one, their attending physicians filter in to collect the underlings who will follow them like goslings these next few weeks, but nobody comes for Elliot, Amy, and their group. The nurse leans against the podium. Every few minutes, she glances at the wall clock and lets out a dramatic sigh.

  “Alright, let’s find him,” she says at last. His classmates chuckle.

  As soon as they step into the hallway, Doctor Frost’s quiet, severe voice drifts toward them. He’s in the midst of crushing some poor RN’s self-esteem; no doubt she wasted his precious time. He stops mid-sentence when he catches sight of the group, straightens his lapel. “Ah, so we’re doing this.”

  “You volunteered,” the nurse says under her breath.

  “What was that?”

  “We sent out the packet two weeks ago, but it might have gotten lost on its way to you. These are your students. Take good care of them, Doctor.”

  He shoos away the LPN and glances at his clipboard, then at his group. Elliot has this deranged fantasy of their eyes locking, of exchanging sparks as Frost recognizes the intensity of his dedication, but Frost barely looks at him.

  “I didn’t get that packet, and I don’t have anything too interesting for you today, but you may witness my routine. Please stay quiet and observe my number one rule: no touching patients. Repeat that back to me.”

  Elliot frowns. Surely they can’t practice first aid or knot-tying without touching anyone. Still, he joins the world’s most educated kindergarten class in their chant: “No touching patients.”

  He doesn’t bother getting to know his cohort, and for the most part, they leave him alone. Amy congratulates him. He smiles faintly, says you too, and turns his gaze back to Doctor Frost. If he’d just pay attention, he’d notice that Elliot is far beyond the “no touching” zone, but Frost has an irritating habit of addressing the group as a single unit, interchangeably, like they’re a bacterial culture or a congress of brain-dead lawmakers.

  They have exactly one conversation in Elliot’s first week, and it’s a failure on all counts. Frost mentions to the group that he graduated Summa Cum Laude; Elliot catches him alone for a moment and says he’s on track to do the same, and does he have any tips on getting the most from rotations?
/>   Frost peers at him over the rim of his glasses and says, “Stop worrying about your grades. Worry about what you know and how you put it into practice.”

  “But I don’t get to practice,” he says. “I could do half of what you do today if you’d just let me try.”

  Frost raises an eyebrow and asks, “Could you?”

  He fidgets through a poorly constructed excuse and ducks into the bathroom. It sounded a lot cockier aloud than it did in his head.

  The syringes are tucked into his backpack’s pen holders. His Adderall IRs are now pure amphetamine salts, extracted with equipment he stole from the chemistry lab. Baking soda, heat, and water produce an amphetamine free-base suspension, which he evaporates using ether and reverse-engineers back into amphetamine salts. It’s a complex process, but worth it. Now water is an effective solvent, and the resulting solution is perfectly homogenous.

  It’s cheaper and easier than the battery of cognitive tests which could net him a prescription, even though he’s sure he has undiagnosed ADHD. Seventeen pills can last him two months if he’s careful. He draws the solution into the syringe, measures twice, and sticks it up his ass. Phenethylamines have a higher bioavailability when absorbed through the colon.

  He and Frost don’t speak for the rest of the week, but it’s just as well. He fills his minuscule human contact quota by taking patient histories. He feels sorry for some of them, like the pale young woman who presents with melanoma, or the single mother who needs an appendectomy for her kid but hasn’t met her massive deductible.

  Others command less empathy. Frost attempts to repair a child’s misshapen foot, which could have been avoided had his parents chosen to vaccinate him against polio. A man with three teeth insists that he’s allergic to every painkiller but morphine.

  Two days before his scheduled top surgery—that’s how he’s been tracking time—he has the privilege of watching Frost amputate both gangrenous feet of a diabetic man who is so large that they have to get him a special bed. The next afternoon, Elliot stops in to find out how he’s recovering. He’s eating a bucket of fried chicken that someone must have snuck in.

  He doesn’t know what circumstances bring a person to that point. He tries to think of him as a real person suffering from a real addiction, but when Frost mentions the case later, Elliot can’t keep the tinge of disdain from his voice: “He’s already noncompliant. He’s going to lose the rest of his legs at this rate.”

  Frost gives him a sharp glance and, for the first time since their disagreement, addresses him directly. He says, “Bedside manner shouldn’t end when you leave the patient’s room. Your attitude can be the difference between life and death.”

  Forty-eight hours later, he’s trudging toward his grave.

  The housing development is eerily silent. Even in the suburbs, someone should be outside at ten in the morning. Someone needs to build walls and lay pipe, but from the moment he gets off the bus, he doesn’t encounter a single living soul. His footsteps ring like gunshots.

  There’s no turning back, though—he already sent half the money. The rest is in the lining of his coat, burning a hole through his ribcage.

  4309 Marble Street. Last house on the left.

  He wanders down an embryonic cul-de-sac, past dirt lawns and street dumpsters. What he wouldn’t give to own one of these cookie-cutter houses, to mow a lawn, to build a fence and keep his neighbors at arm’s length.

  A large, bald man is smoking on the steps of 4309. Elliot stops plucking at his hair and shoves his hands in his pockets instead. He can’t help but picture the knife this guy must have holstered to his belt, the irreversible trauma he’ll cause when he drives it between Elliot’s T12 and L1 vertebrae. “Uh, hi,” Elliot says. “Is this the right place?”

  “Depends.” He taps his cigarette against the stoop. “Who are you looking for?”

  “Stop fucking with ‘em!” A female voice calls from inside. The man grunts and moves out of the way of the door.

  Her sandy brown hair is pulled into a sloppy bun. No makeup. She’s aging like bruised fruit, but there’s something elegant about her crow’s feet and hollow cheeks.

  “Are you…?”

  “The surgeon, yeah. Name’s Vic,” she says. “You must be Elliot. Come on in.”

  The interior walls are unpainted. Muddy footprints cover the wood floor. He wasn’t expecting a sterile operating theater, but this is dingy. She leads him to an arrangement of plywood and milk crates approximating a coffee table, motions for him to sit on the floor, and pulls a notebook from her bag and a pen from behind her ear.

  “Do you need anything before we get you on the table?”

  “Uh, I’m good.” He’s trying to place her accent so he doesn’t have to absorb what she’s saying. Boston? Brooklyn?

  “Alright, down to business.” Vic extends her hand.

  Elliot blinks at her through his fog of hunger. No food before surgery. Only when Vic glances to his pocket does he realize the lady wants money, obviously. He scrambles to remove it from his jacket lining; Vic counts it twice and nods once.

  “Papers?” She asks.

  “Uh, yeah.” Elliot always keeps photocopies of his medical records. Inappropriate documentation was a hot topic in second year: FLK, SLS, GDA. Funny looking kid, smells like shit, gonna die anyway. It’s only a matter of time before someone writes a non-standard acronym in his file, and when it happens, he’s hoping for a payout.

  “Is this the best number to reach you?”

  Elliot nods.

  “You don’t have testosterone listed here.”

  “Uh, yeah. Those are out of date. I’m on .3ml of testosterone cypionate, 200 mg/ml. Subcutaneous, once weekly. I started six months ago.”

  Vic raises her unkempt eyebrows. He’s sure she’s going to comment on his wide hips or lack of facial hair, but she says, “Anything else? Maybe something you aren’t prescribed?”

  He shakes his head. Adderall won’t interact with the anesthetic.

  “Good. I’m not seeing a psychosocial history on here, so—”

  “I live with my mom. I’m in my third year of medical school,” he says. That encompasses his entire psychosocial history. He hasn’t thought about much else since ninth grade.

  “Yeah?” She asks. “How you liking it?”

  “I’m the best in my year,” he says.

  “Sure, but I asked how you’re liking it?”

  He runs his nails across his scalp, feeling all the tiny bulbous follicles scrape across his fingertips. “It’s fine, yeah. Where did you go to school?”

  Vic purses her lips and says, “Rochester. And before you ask, I’ve done a double mastectomy for breast cancer. You’re in good hands.”

  They don’t need to swap their life stories. Elliot stands, signaling that the conversation is over, and waits to be led to the operating theater—the kitchen, in this case. It houses a draped table and a rusted-out IV pole. No heart rate monitor, no anesthesia machine. Does that mean they’re sticking to local anesthetic? He’d rather be awake for this.

  He clambers onto the table and rests his head on the thin pillow. She pulls on gloves, swabs his arm, inserts a butterfly catheter into his vein. No more foreplay. This is really happening.

  “So…you are licensed, then? I’m just wondering why a licensed doctor—”

  “If you’ve gotta know, I lost it for stealing a shitload of drugs,” she says. “But the system bleeds you dry, and everybody’s gotta cope somehow. Deposits are non-refundable.”

  Elliot squints at her through the fluorescent glare of the overhead light. Though Vic is weathered, she looks kind. Her eyes are baggy and wrinkled and gentle and compassionate, and that’s probably all bullshit that Elliot made up because he’s about to fucking die.

  “I need this to work,” he whispers, twisting his hands in the sheet.

  Vic smiles. That’s genuine, right, if it touches her eyes? That means it’s real?

  “Me too.” She pierces the IV port and s
queezes a few milliliters of anesthetic into his vein.

  Beep beep beep beep!

  Vic groans. She strips off one glove and fishes a flip phone from her pocket.

  “Who’s that?” A cold, tingling sensation is dripping down the back of his neck. “What’d you give me?”

  Vic holds up a finger, signaling him to wait. “Hello?” She says. “Yes…I’m in the middle of that thing with…” She frowns. “What do you mean, rejected? What was wrong with—”

  Elliot searches for the bottle. The edges of his vision are blurring, but he can make out the label if he squints. Veterinary ketamine. He’s a trapped animal, chemically restrained to this table. It’s too much. He rips the IV from his arm and sits up, swooning.

  Vic’s hand is on his shoulder. She’s still on the phone, saying, “Fine, but I’m keeping his fee. Let me call you back.” Her eyes are locked on Elliot. Lie down and take it.

  He swings his legs off the table, but Vic snaps her phone shut and catches his ankles. “Shh shh. Relax. Nothing’s wrong.”

  “Lemmego,” Elliot mumbles.

  “There’s nothing to be afraid of.”

  He thrashes weakly, and though they’re both small, Vic isn’t sedated.

  “Who’s the phone?”

  “Nothing to worry about. Lie back, there we go. You’re already halfway there.”

  “Ketamine,” he says.

  She rolls him onto his side, smooths an alcohol wipe down the crook of his elbow, and gently slips the needle back in. “You’re safe,” she says. “Hear me? You’re safe.”

  The unfinished ceiling swims and doubles above him. Vic’s outline is wobbling like jello. He takes a shaky breath. It’s difficult to think as Elliot—he asks himself what is Elliot thinking, and every answer is vague and lacking context. Who is Elliot?

  “I’m gonna take care of you. Can you count backwards from ten?”

  Elliot’s flesh is the texture of wet cement, soaking the sheet and dripping off the edges of the kitchen island. He slurs: “Ten, nine…”