Josh Bazell: Beat the Reaper: A Novel

Copyright © 2009 by Josh Bazell

All rights reserved. Except as permitted under the U.S. Copyright Act of 1976, no part of this publication may be reproduced, distributed, or transmitted in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher.

Little, Brown and Company

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First eBook Edition: January 2009

Little, Brown and Company is a division of Hachette Book Group, Inc.

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The characters and events in this book are fictitious.

Any similarity to real persons, living or dead, is coincidental and not intended by the author.

ISBN: 978-0-316-04030-3

In Memoriam

Stanley Tanz, MD

1911–1996

So I’m on my way to work and I stop to watch a pigeon fight a rat in the snow, and some fuckhead tries to mug me! Naturally there’s a gun. He comes up behind me and sticks it into the base of my skull. It’s cold, and it actually feels sort of good, in an acupressure kind of way. “Take it easy, Doc,” he says.

Which explains that, at least. Even at five in the morning, I’m not the kind of guy you mug. I look like an Easter Island sculpture of a longshoreman. But the fuckhead can see the blue scrub pants under my overcoat, and the ventilated green plastic clogs, so he thinks I’ve got drugs and money on me. And maybe that I’ve taken some kind of oath not to kick his fuckhead ass for trying to mug me.

I barely have enough drugs and money to get me through the day. And the only oath I took, as I recall, was to first do no harm. I’m thinking we’re past that point.

“Okay,” I say, raising my hands.

The rat and the pigeon run away. Chickenshits.

I turn around, which rolls the gun off my skull and leaves my raised right hand above the fuckhead’s arm. I wrap his elbow and jerk upwards, causing the ligaments to pop like champagne corks.

Let’s take a moment to smell the rose known as the elbow.

The two bones of the forearm, the ulna and the radius, move independently of each other, and also rotate. You can see this by turning your hand from palm up, in which position the ulna and radius are parallel, to palm down, where they’re crossed into an “X.” [1] And you can compare this to your lower leg, where the same setup is vestigial. The two bones of the lower leg, the tibia and fibula, are locked in place. The outer one, the fibula, doesn’t even support weight. In fact you can take most of it out—to use as a graft or whatever—and as long as you don’t fuck up the ankle or the knee, it won’t affect the patient’s ability to walk. They therefore require a complicated anchoring system at the elbow, with the ligaments wrapping the various bone ends in spoolable and unspoolable ribbons that look like the tape on the handle of a tennis racket. It’s a shame to tear these ligaments apart.

But the fuckhead and I have a worse problem right now. Namely that while my right hand has been fucking up his elbow, my left, having somehow come into position by my right ear, is now hooking toward his throat in a knife-edge.

If it hits, it will crush the fragile rings of cartilage that keep his trachea open against the vacuum of breathing in. Next time he tries, his windpipe will clench shut like an anus, leaving him at ReaperTime minus maybe six minutes. Even if I ruin my Propulsatil pen trying to trache him.

So I beg and plead, and coax the trajectory of my hand upwards. Past the point where it’s aiming for his chin, or even his mouth—which would have been disgusting—to where it’s aiming for his nose.

Which caves in like wet clay. Wet clay with twigs in it. The fuckhead crashes to the pavement, unconscious.

I check to make sure I’m calm—I am, I’m just annoyed—before getting heavily to my knees down next to him. In this kind of work, as in every kind of work, probably, planning and composure are worth a lot more than speed.

Not that this particular situation requires much planning or composure. I roll the fuckhead onto his side so he won’t choke to death, and bend the arm that isn’t broken under his head to keep his face off the frozen sidewalk. Then I check to make sure he’s still breathing. He is, in fact with a bubbly joie de vivre . Also the pulses at his wrists and ankles are reasonably strong.

So, as is usual in these situations, I imagine asking the Great One—Prof. Marmoset—whether I can leave now.

And, as is also usual in these situations, I imagine Prof. Marmoset saying No, and What would you do if he was your brother?

I sigh. I don’t have a brother. But I know what he’s getting at.

I put my knee into the guy’s fucked-up elbow and pull the bones as far apart as the tendons feel likely to bear, then let them come slowly back together into their positions of least resistance. It makes the fuckhead groan in pain in his sleep, but whatever: they’d just do the same to him in the ER, only by then he’d be awake.

I frisk him for a cell phone. No such luck, of course, and I’m not about to use my own. If I did have a brother, would he want me getting hassled by the cops?

So instead I pick the fuckhead up and fold him over my shoulder. He’s light and stinky, like a urine-logged towel.

And, before I stand, I pick up his handgun.

The gun is a real piece of shit. Two pieces of pressed sheet-metal—no grips, even—and a slightly off-center cylinder. It looks like something that began life as a starter pistol at a track meet. For a second it makes me feel better about there being 350 million handguns in the United States. Then I see the bright brass ends of the bullets and am reminded how little it takes to kill someone.

I should throw it out. Bend the barrel and drop it down a storm drain.

Instead, I slip it into the back pocket of my scrub pants.

Old habits die harder than that.

In the elevator up to Medicine there’s a small blond drug rep in a black party dress, with a roller bag. She’s got a flat chest, and the arch of her back boosts her ass, so she’s shaped like a sexy, slender kidney bean. She’s twenty-six after a bit too much sun exposure, [2] Doctors always know how old you are. We use it to tell whether you’re lying to us. There are various formulas for it—compare the creases of the neck to the veins on the backs of the hands and so on—but they’re not really necessary. If you met thirty people a day and asked them how old they were, you’d get good at it too. and her nose is the kind that looks like a nose job but isn’t. Freckles, I shit you not. Her teeth are the cleanest things in the hospital.

“Hi,” she says like she’s from Oklahoma. “Do I know you?”

“Not yet, no,” I say. Thinking: Because you’re new on this job, or you wouldn’t have such shitty hours.

“Are you an orderly?” she asks.

“I’m an intern in Internal Medicine.”

An intern is a first-year resident, one year out of medical school, so typically about six years younger than I am. I don’t know what an orderly is. It sounds like someone who works in an insane asylum, if there are still insane asylums.

“Wow,” the drug rep says. “You’re cute for a doctor.”

If by “cute” she means brutal and stupid-looking, which in my experience most women do, she’s right. My scrub shirt is so tight you can see the tattoos on my shoulders.