Richard Powers - Operation Wandering Soul

Figure in the assaults by things that as yet have no medical name. No matter; every injury is of a piece. The precise etiology of reality's strike is almost irrelevant. All impairment flows from a shared subterranean source. Her pedes are broken by a first disease long before they are hit by the particular trauma that dispatches the ambulance. Malnutrition, psychodisorientation, pellagras, anemias, dementias, the regional varieties of abuse distinctive to city hospitals: all leave traces, a common pallor that shellacs her every child's skin.

That culprit, the Ur- wrong, underwrites even accident, the leading destroyer of under-eighteens. It lies beneath the hungry ingestions of household poisons, the handgun mistakes, the training wheels spinning their mangled aluminum sidewalls in the air after a hit-and-run. Even burns are at best secondary: she's read the study showing that half of all arsonists are children looking for love.

Among her floor and outpatients this week, she has Chuck, the child born without a face; Jorge and Roberto, twin preteen overdosers; the girl Joy, darkness creeping up her ankle; the brutally ectomized Davie Diaz and Suzi Banks; a new boy, Nicolino, wasting away freakishly; Ben, the double amputee. She has only a single treatment to bring them all back. And she will return them, as far as they are willing to run. She can do nothing for the parts irreparably lost. But she has something to leave in the dark reaches, the space in each one where the earliest, inviolable fable of self still stands intact, ready to respond to a little food, workout, heat, and play. She can plant a start in that place waiting to be proven wrong, a plot that will still heal at the first touch of fresh, outrageously naive narrative.

She possessed the germ well before the six years she spent up north, studying by the bay. It was built into her posture already as an undergrad, that era of cotton and arm down when she lived in a state of permanent expectation engineered by temperate breezes. Her personal knowledge turned heads from across the medical quad. It lent her a come-on, broad-based cheerleader appeal without any of the attendant, affected sorority girl contempt. She knew, just by living, how to thrive in the health profession, without once having to book for a single hourly in the subject. She was born knowing it, the single greatest advance in contemporary medicine, the one that at last set organized care on its unfolding path: the discovery that healing only begins with treating the wound.

This was the breakthrough forced on an industrialized world by the arrival on the doorstep of a permanent surplus of maimed child veterans who, for the first time, survived their treatments in numbers beyond ignoring. She gleaned it by second nature, even while her professors mouthed the formula from their operating theaters. The kindergartner who shoots screamingly awake from an anesthetic dream to find a huge, paste-oozing, suture-stubbled, crimson gash-work down the length of her abdomen tends to resort to her original conviction, buried under ancient keloid scar tissue: I knew it. You tried to kill me. You cut into me with knives. Fail the patient here, fail to talk that scream into remission, and all the mediating incisions, however beneficial, will remain forever open, pussing subcutaneously until final discharge, the hour of the child's second street death.

How best, then, to reassemble what the king's combined cavalry and foot labored over impotently, powerless to transact? (She wonders, mouth twisted in healthy skepticism as she reads that rhyme out loud, what, pray tell, horses were supposed to contribute to restoration.) If musculature alone were at stake — relearning how to swing a bat or kick a sprocket — a few simple professional references would address everyone. Even the subtle ruddering of a pencil — that immensely complex navigation across empty expanses of paper — can be brought back from nowhere, relearned in committee.

Warmth, water, a little oscillating current, passive tensor-flexion aid, and a sprinkling of weights can work wonders. As much as you can, as steadily as you can. You learned it all from scratch once; you can repeat the process, from crawl on up, with whatever parts fortune has left you. That much is simple routine. Rigorous, brutal, overwhelming at times, but straightforward. A little technical know-how, some trivial persistence, and that would be the extent of the job description.

Still-forming bodies can heal, sometimes faster than she can prompt them with suggestion. Baby bones refute excision. Unripe brains reshape to compensate for lost capacity, almost as if youth still remembered the starfish and lizard trick of regenerating lost parts. Near-full functionality returns almost as quickly as it was struck down. Espera's infallible algorithms even return words to the mute. She has taught pseudolaryngeal speech to a roomful of croakers barely out of tadpole stage. Suck in a gulp of air, swallow it like food. Belch it up from your esophagus, shape it with gullet and nose and tongue to produce real names. Ready now: in unison. She's had them singing, industriously belching out "Up a Lazy River." And she would have yanked them kicking and buzzing through "Flight of the Bumblebee" had they not used up their available esophageal supply on gales of laughter.

Walking, swinging, singing, eating, bending, grasping, blinking, breathing, peeing, flipping, sitting, seeing, shouting — all the procedures of earliest urgency can be taken out for a reconstructive spin. They can be approximated by brute, repetitive, accumulating rote no different than the afternoon hours upstairs with a music stand, wood-shedding on the clarinet, the clarinet, goes doodle-doodle-doodle-doodle-det. But her job is to carry off that old joke: to get them playing the instrument again, even when they'd never played before.

There is a catch. All destructions dip layers deep. Knives sever through much more than muscle, than mere mechanics. Every child who shuffles up her office ramp is a shattered hierarchy. Whole systems have been shaken loose, one from the other. The skeleton may move impeccably after a year or three. The circulation routes generously reopen, but the larger links are lost. The simplest gesture, the pressure of an overhand curl contracting the hand into a wave goodbye, no longer means what it used to. Will becomes detached, as cleanly as retinas in a playground brawl.

The leaning, eager hesitance of ducking through a jump rope only begins in the feet. The legs are just the first fuse. Once quadriceps do their buckle and flex, a spark must spread outward, catch fire. The real rope skip is desire. Motive must magellan its way across the cerebral map until the whole quorum organism grows ready to hurl itself through the rotating whips. Try to teach timing the delicate diplomacies of depth perception and projection. Instruct in wish, give daily classes in confidence retrieval. Try to instill want, the belief that shooting through the twirling ropes has some primal significance. Convince them that the brandished, braided lasso cycloiding its playground arcs, wobbling like the precessing equator above a navigator's head, is not glass infested, will not slice like the collector's scythe. Ah! To teach that, one needs an advanced degree.

What's more, the skipping per se is trivial. The tribal jingles that go with it are the tricky part.

Who are these children that the surgeons palm off on her to recondition? Here, in the sunny Southern Caliphate, they make up a smorgasbord of least-favored nations. There's not a single schoolbook innocent among them. She's had little girls who needed propping up in bed, glaze-eyed and indifferent to everything but broadcast. She has treated the spreading allergies of the underclass, those puffed black bruises that can be only one thing. She converses with furious patterers who growl in hyped-up rhythmic pidgins she cannot understand.