Fancy Delaware was covered in blood. This was not an uncommon occurrence, especially on a Saturday night. There was an old song she thought of when they’d start wheeling in fun’s victims: Some people like to go out dancing, but other people like us gotta work. Bartenders and bass players; cooks and cops; strippers and firemen. Emergency Room doctors. Your good time is their livelihood, their burden, their longest shift of the week: gimme Tuesday afternoon any day, Fancy thought. Full moons were bad–she didn’t give a shit what the mathematicians and skeptics said about confirmation bias; she was there and saw it with her own eyes–but Saturday nights were the worst. Everyone was so fucking brave on Saturday night, Fancy thought. So brave and so lonely and so fucking drunk.
If ER doctors ruled the world, there’d be no alcohol (except for their private supply). No heroin or coke, either, but at least those substances had useful adjutants: western medicine was dependent on morphine and lidocaine, but what help was alcohol? Wash your scalpel in it, she guessed, but there were other ways to do that. Stinking! That’s how they came in, every time. Shotgun to the belly, knife to the shoulder, epee to the ass; whatever the wound, the stench was the same: at least a hundred proof. Stupid juice, Fancy called it. Here, drink this: it’ll make you dumber. She didn’t get it. Ah, well. Not her job to figure them out, just patch them up. Stitches and a discharge slip. Set an arm, leg, tape up some ribs. Sometimes, she would keep people alive until the surgeons were free. She pitied the drunks, but she hated the surgeons: the drunks were assholes due to chemical impairment, but the surgeons were assholes by choice.
Quid hoc fecisti, ut tibi was chiseled into the arch above the mechanized sliding doors of St. Agatha’s ER. It was just big enough for the neighborhood, except for Saturday nights, when it resembled an after-hours bar; drug dealers had to be thrown out of the waiting room, and occasionally a deejay would start spinning until the security guard put an end to it. The guard’s name was Rufus Bobtooth, and Fancy thought that he was maybe more vital to the operation than anyone else. If the doctors stopped working, she figured, some people would die; if Rufus stopped working, then many people would die. That waiting room got damned rowdy; it was nigh-on-impossible to explain the concept of triage to someone who had drunk a bottle of schnapps and stuck a flashlight up his ass.
“I was here first,” Flashlight Ass would bellow, and Fancy would say,
“Yeah, but that lady’s got a javelin sticking out of her neck,” and Flashlight Ass would think for a second, and say,
“But I was here first.”
Generally at that point, Fancy would begin handing out opiates. There were almost no problems in the waiting room that could not be cured by the catholic distribution of vicodin. First of all, people appreciated the gesture. Then, the pills would kick in and they would sit there gabbing away with their neighbors in the blue plastic seats, instead of taking their pants off and screaming. The hospital’s pharmacist had challenged her on this practice once, and so Fancy made the pharmacist spend a Saturday night in the ER’s waiting room; the pharmacist never brought it up again, and would in fact recommend drugs for Fancy to use in special circumstances.
Keep people alive. That’s what ER doctors do. Keep people alive until the medicine kicked in or the drugs wore off. Stanch the bleeding: tie off the artery if you have to, quick and ugly, they’ll fix it later; in the ER we keep people alive there are no cures no fixes you will not be good as new but just still alive Airway Breathing Circulation first, ABC first and then so many more mnemonics–Fancy once counted 62 mnemonics she used regularly; medicine was nothing but mnemonics–to keep them alive. Breathing? Not a blood sprinkler? Know who the president is? Good, then get the fuck out: we need the bed for the next idiot we have to keep alive. Fancy Delaware wore a white coat, but she felt blue-collar: she did manual labor, and she clocked in and out, and she got dirty when she worked.
Like now: she was covered in blood.
You can’t just pull a knife out of someone: the vessels the blade has severed are usually being plugged by said implement, so just yanking the sucker out is discouraged by the literature. What you need to do is visualize the vascular system, slide your clamps in through the wound, pinch off the arteries. Then, the knife. But sometimes people have arteries in the wrong place and one doesn’t get clamped, and when the doctor pulls the knife free, she gets splattered.
Not too far away, ten minutes’ walk, that’s where Fancy Delaware grew up. Tidy two-bedroom cottage on Raspail Street. She enjoyed dissecting animals she caught, and still has the notebooks with her drawings of frogs’ digestive tracts and birds’ circulatory systems in a box somewhere. If you dissect something without taking careful notes, you’re going to be a serial killer, but it you write stuff down, then you’re destined for a career in the sciences. She was smarter than the other kids, and spent half her high school days at Harper College taking Syncretic Pathology and History of Memetic History. The dean, Carter Spants, took notice. Sized her up. Yale material, he thought. Four years undergrad, and another four at the medical school, and when it came Match Day, her grades were good enough so she’d be guaranteed her first choice, and she didn’t even have to make it: she wanted to go home. No more winters, fuck snow, and the sticky summers that buzzed in your eyes. And the trees. They just had the wrong trees in Connecticut, Fancy thought, and so the young-ish woman went west, because Americans go west, and she went home, because Americans go home.
Medical care had come a long way in Little Aleppo. The Pulaski had a medicine man, Tall As The Sun. His kotcha was separated from the village, closer to the woods than to the lake. Shamans lived on the periphery of the people, they were magic and feared, but Tall As The Sun was not a shaman, he was a medicine man and so he was not magic and feared but his roots, bark, mashed berries, weird pastes, unidentifiable oozes, and immense collection of strange mushrooms stunk to high heaven. If you were stuffed up, you would stroll over to within a hundred yards of his pharmacy and your sinuses would open up like you’d snorted white horseradish.
Birch bark. Soak it for three days, save the juice. Cures headaches, but tastes like shit. Dill shoots grew scraggly an hour’s walk from the village. Settled stomachs. Tall As The Sun could set bones. A flower, common, yellow or orange, aided with the pain. He had a needle made of deer bone and thread made of flax to stitch up cuts, and he knew how to wash the wound, to dress and re-dress it to keep away infection.
And more. Tall As The Sun had lived through three plagues. Two were the Coughing Sickness, one was the Fever. Young, old: the plagues did not discriminate or discern, just ate through flesh and life, and all he could do was pray with the dying sit with dying witness the dying that they were not alone and that they would not be forgotten, and even when there were not plagues there were infants too weak to live, born early, born wrong, and Tall As The Sun would accept the baby from the parents and disappear into his foul-smelling kotcha and when he emerged days later, no one would mention the child ever again. This was the Pulaski way. Tall As The Sun’s father had done the same, and so too would his son, had he not been murdered along with the rest of the tribe by the whites who had discovered gold and brought America with them.
After that, the quality of healthcare declined precipitously for many years. It was best to stay healthy, to remain uninjured. The Turnaway Lode was an industrial concern, and it created industrial wounds, but there were no antibiotics and surgical tools were wiped off on trousers between uses; infection took more than the machines knives guns booze loneliness; there was rot in the neighborhood, and it would get in you. There was opium, and its derivatives. Patent medicine, but that was mostly opium, too. It was simply the worst idea to need surgery.
So it remained for years: there were legitimate doctors operating out of their apartments, and quacks working from fancy offices, and on the whole it was better to remain divorced from medicine in any form; nothing good could come from it.
St. Agatha’s opened in 1938. Brick on the outside, washable walls on the inside. An ER, and departments for the young, old, and in between. A teaching hospital connected with Harper College. Carter Spants had led the charge to snatch up the New Deal money for the building, and he had beat out Harper T. Harper for the contract, so it was not named Harper Hospital.
“St. Luke’s. What else could it be?”
“St. Agatha’s,” Molly McGlory answered. She had graduated several years prior, but kept her job working for the Dean. She liked college, and didn’t see the point in leaving.
“Saint Luke is the patron of doctors.”
“As is Agatha for nurses, Dean Spants. Please don’t lecture a woman named McGlory on Catholic saints.”
“I would never presume,” he said. “Agatha’s?”
“It’ll piss off Harper.”
“It would, wouldn’t it?”
St. Agatha’s it was. A teaching hospital. Tomorrow’s doctors, today. July was dangerous: it was when the new residents would arrive in their spotless coats and begin killing people. The dirty secret of medicine is that it’s practiced. One of these days, it’ll be perfected; until then, surgeons poke around in bellies and maybe let’s try this pill maybe let’s try that. 60% precedent, 20% guesswork, 20% bedside manner. One of these day, we’ll figure it out.
But pain could be alleviated, Fancy Delaware thought, and though she did not believe in God, she thanked Him for that. Because the body healed itself, if you could live through the trauma. This is what she had come to believe. Her medicine had limits, patches and sutures and band-aids, and then the body took over. Sew up a slice. What are you doing? Merely insisting that the walls of flesh are in contact; after that, the body takes over. Scar tissue forms. All is one again. Diseases? They were for the strategists and chemists upstairs. Fancy dealt with injury and insult on the ground floor.
Black hair shot through with white, like shooting stars through her scalp, shortish but full. Bright red reading glasses hanging on a cord around her neck. White coat, longish, with Fancy Delaware, M.D., Chief of Emergency Room Medicine in baby blue script above her left breast. Stethoscope jammed in her pocket. Navy scrubs with a v-neck showing the freckles on her upper chest. A butt-chin, and thick eyebrows that walked up and down her forehead depending on how annoyed she was with you. Two small hoop earrings in her left ear, one in the right.
And what else? A pharmacy, she had a pharmacy: every drug available and cocktails, too, to shut this down or ramp this up. Sometimes you gotta get things a-moving. Instruments: oh, she had instruments, claviered clean and shining in the light of the high-watt lamps and laid out on the tray. Scalpel, but only sometimes, mostly the suture needle. Curved like a bow and trailing polydioxanone thread through the clingy flesh. Tools and pills. Other than that, medicine had not advanced much past what Tall As The Sun practiced.
Fancy Delaware was covered in blood, but the patient would live to fuck up another day. She was calm, far more so than most would be when covered in a stranger’s internal fluids, and she could smell beer as she reached for another clamp. Squirt squirt went the blood, and she thought Some people like to go out dancing, but other people like us gotta work and Rufus Bobtooth broke up a craps game that had broken out in the waiting room, and above the mechanized sliding doors was inscribed Quid hoc fecisti, ut tibi, and on the Main Drag it was Saturday night, but some people gotta work even in Little Aleppo, which is a neighborhood in America.