Shedrow (19 page)

“Is this the entire record?” Gianni asked.

“It is a new patient,” Amara answered. “I’ll show you our whole system later. It’s rather simple but serves us well.”

Gianni thought about how medical records back at home seemed to expand more every year, mostly driven by lawsuits and
defensive medicine. The simple record in front of him reminded him of a chart from the 1950s that he had once encountered while doing some research. It was the record of an admission for a tonsillectomy procedure and it consisted of only five pages. The same record today would fill a binder an inch or more in thickness.

“Any fever?” Gianni asked the nurse.

“39 degrees. I wrote that in the chart,” Amara said.

That’s 39 degrees Celsius…roughly 102 Fahrenheit
, Gianni thought. He spoke to the mother next. “How long has he been swollen?”

“Four days, maybe more,” she said.

The boy sat quietly, though he clearly looked ill and was likely having considerable pain.

“Is he eating and drinking?” Gianni asked.

“Not for the last day or so.”

“Can I look in your mouth, Lavon?” he said to the boy.

The child began to whimper. His mother scolded him in French patois and he instantly became silent. It seemed to be difficult for him to open, but Gianni could see that the inside of his mouth was also swollen, and that he had a permanent molar tooth that was decayed and broken off at the gum line.

“Are there any oral surgeons here?” Gianni said to the nurses. “This is a very bad infection and it seems to be coming from a tooth.”

“There is one in Castries,” Amara said. She only comes here once every two weeks.”

“How far is Castries?”

“Thirty miles,” she said. “That’s a two hour drive on a good day. With the construction and repairs on the dirt roads now, it could be
twice that.”

“Well, I suppose I can drain the abscess, but he’s going to need general anesthesia and he’ll eventually need that tooth taken out.”

“Dr. Gianni, would you mind if I give you a little more local information? They can take care of the tooth later. We have only one staff dentist, assisted by whatever volunteer dentists we can recruit for a week or two at a time. As for anesthesia, there are many patients waiting, always patients waiting. I have seen them do cases like this one right here in the clinic. If you take him to the operating theatre, then all the others move down the list and everyone waits longer still.”

“An abscess this big? On such a young boy? No general anesthesia?

“Some local anesthetic maybe,” she said. “It looks like it’s about to burst, no?”

“I suppose so,” he said, studying the tense skin just below the boy’s jaw line.

“Mother and I will help keep him still,” Amara said.

Amara went to the sterilization area and came back with a crude surgical setup. There was a tray containing a syringe with a single carpule of local anesthetic, a scalpel handle with a blade attached, and a curved hemostat that could be inserted into the incision, then spread open to facilitate more drainage of pus. There was a single, three inch gauze pad and a small piece of rubber tubing, one inch wide, which could be placed into the wound to keep it open for drainage.

For an instant, looking at the stark surgical tray, he flashed back to that dreadful day when the man named Hector had cut off his fingertip. The simple setup looked strangely similar. He glanced down
at the finger, fully healed, though still squarish at the tip.

Gianni studied the sparse assemblage of instruments and planned his approach. He could inject only the skin with the anesthetic. Injecting directly into the abscess would be far too painful, and the acidic byproducts of the infection would render the anesthetic useless. If he were quick enough, he could make a stab incision, quickly insert and spread the hemostat, then replace it with the rubber drain, all in a matter of seconds. He would have to be right on target.

“Can I have some betadyne or alcohol,” he asked as he donned sterile gloves.

Suzana, the second nurse, brought a gauze pad saturated with an orange-colored antiseptic solution and placed it on one side of the tray.

Gianni gently wiped the solution on the boy’s swollen face, barely touching it. He placed a sterile cloth drape below the swollen area, covering the neck and shoulder area. The boy began to whimper ever so slightly. Again the mother scolded him in French. Gianni reached for the syringe and carefully injected a small area just underneath the skin. He had to work quickly now. The child began to cry loudly as Gianni reached for the blade. Then without warning, the mother grabbed the boy’s arm and bit it, clutching it like a dog unwilling to release its favorite toy.

Gianni pierced the tense red skin and pus exploded out onto the sterile drape. Some landed on the lens of his safety glasses. He inserted the hemostat and seconds later replaced it with the rubber drain. With gentle pressure applied to the boy’s face, pus continued to pour out. The boy continued to yell but did not move.

The mother released her clench on the boy’s arm. A small
amount of blood was evident alongside the prominent bite marks. Once she released his arm, the boy let out a final, loud wail and fell exhausted into her arms.

Gianni, at first appalled by the mother’s discipline, now realized that she had actually been a quick-witted assistant in the primitive procedure he had just discharged. He placed a sterile gauze pad over the drain and secured it with adhesive tape.

Gianni said, “He’ll need to be on an antibiotic and I should check him again tomorrow. Can he remain in the hospital overnight?”

“If you order it,” Suzana said. “Right now you are needed in the operating theatre. They just called down.”

By his fifth day at St. Jude, Gianni had seen an assemblage of rare and unusual cases. There were a host of benign tumors, marring faces with lumpy masses the size of grapefruits. While an untreated malignant tumor will too often kill its victim, benign tumors may grow to monstrous proportions, grossly distorting the face in the midst of their growth. He treated another patient with a huge upper jaw tumor that had displaced the orbital contents, pushing one eye upward and out of its socket, like some ghoulish rubber halloween mask. There were adult patients with unrepaired cleft lips, shunned or abandoned even in their native land. Then there was the boy whose nose had been partially avulsed when he was bitten by a rat. Gianni was especially pleased that the boy’s first procedure had gone well.

Machete wounds were frequent on the island, as the machete was often carried to help clear passages through dense vegetation. On one of his first calls to the operating room, Gianni met a man in
his early twenties with a huge facial laceration, an insult delivered by a machete-wielding compatriot early one morning, following a night-long drinking marathon. As he repaired the damage, he was once again reminded of his patient in New York City, the one that had never returned.

Alice Bond provided the anesthesia for these complex cases, with aplomb, particularly in view of the limited resources. She also continued to provide a source of distraction. At one point, when she noted him doing his best to contend with a stiff neck brought on by an operating table that would simply not adjust to his liking, she offered him a neck massage. It sounded like
mass hodge
when spoken in her proper English. Gianni declined, proceeding instead to the library to check his email.

The hospital had a rudimentary library with two computer stations that could be rented by the half-hour. Gianni paid for an hour and when he checked his Hotmail account, his attention was immediately drawn to an email from Steven Highet.

SUBJECT: Urgent update

Anthony
,

There has been a new and frightening development. We need to talk. Call me as soon as you can.

Steven

GIANNI RAN NEXT DOOR to the Administration Office. There were two phones, and both were in use. He went back to his computer station and sent a reply to Highet’s email

Steven
,

Phones here are impossible. I’m going to town to buy
a cell that will work from the island tomorrow. Write more detail in an email now!

He hit the send button and thought,
Be there now. Be at your damn computer.

Then like an anxious and slightly irrational child, he continued to hit the refresh button every half minute, looking for a reply. Within two minutes, he had one.

Anthony
,

Go to the AOL Instant Messenger site. Link below. If you haven’t used it before, pick a screen name and we can text in real time (something my daughter showed me years ago). My screen name is Horsedoc.

Gianni followed the link and within a minute, he was ALG2 looking for his old buddy horsedoc in cyberspace.

ALG2: Horsedoc?

Horsedoc: That’s me. I just remembered your middle name… Louis.

ALG2: Good memory. Now what the hell is up?

Horsedoc: I had a visit from our congressman in Lexington— Ted Frunkle. He used to be a vet and we practiced together for a while. He was with another guy…some fat thug. They basically told me to close up my investigation of the Chiefly Endeavor death and to conclude there was no foul play. Then the thug made reference to my daughter Carla’s address.

ALG2: Describe the fat guy.

Horsedoc: About 6 feet, 2 inches. Balding, with a big head and a round face. Big burly guy, but more fat than muscular. He had a bit of a baby face, at times almost friendly looking, but other times having this mean, penetrating stare.

ALG2: Damn it. What did his voice sound like?

Horsedoc: He barely spoke. But when he recited my daughter’s address, he stuttered. I remember…it was so frightening. I was hung on every syllable. He stuttered when he was giving her address.

ALG2: It’s Chet, Chester Pawlek. The bastard is alive.

Horsedoc: Anthony, what do we do now?

ALG2: You have to go to the police.

Horsedoc: But they threatened my daughter.

ALG2: You secure your daughter. Move her somewhere, not with you though. Then go to the police and insist on a 24 hour watch for her.

Horsedoc: He came with a goddamn congressman. How do I know the police won’t be on the dole?

ALG2: Call Detective Jones. She’ll involve the FBI. We can’t fight this alone any longer. This guy is on the most wanted list. He’s a ruthless killer. He’ll kill again.

Horsedoc: What if I just do what they want?

ALG2: Don’t do it. Don’t think that you or your daughter will be safe just because you comply. They’ll come back again to destroy their chain of evidence. I know how that bastard thinks.

Horsedoc: There’s more. That last morning you were at Midway, two men terrorized Ryan, the boy you met at the barn. One of them was a fat guy who threatened to put a pitchfork through his heart if he didn’t stop snooping around. It sounds like it was the same guy who came to my house.

Gianni was overtaken by an insurmountable sense of dread. He did not message back right away.

Horsedoc: Anthony…you there?

ALG2: I’m still here. Steven, go to the police and secure your daughter. Chet probably killed the gatekeeper that morning at Midway before he went on to Ryan.

Horsedoc: My God, why the gatekeeper? Why would he kill the poor gatekeeper?

ALG2: At this point that’s for the police to determine. But I did overhear the farm manager tell the police about some supposed link between the gatekeeper and one of the guys at the dump. Come to think of it, you better keep Ryan away from that landfill from now on.

Horsedoc: The poor kid has been a wreck. He’s with me or Travers all the time. He won’t go anywhere alone.

ALG2: I wish to God I could be there. Promise you will call the police as soon as we’re done here.

Horsedoc: I will. When do you come back?

ALG2: I still have another week. I’m totally conflicted and I want to finish up earlier, but I can’t leave just yet. You won’t believe
the things I’m seeing here. Be careful, Steven. I’ll get that cell phone tomorrow.

As he walked from the library back to his dorm room, Gianni paused again in front of the statue of Jesus. The lighting appeared different this time, coming more from the front of the statue. The venetian blinds behind the figure had been closed tight. Over the loudspeakers, he could hear the voice of Guy Montoute delivering the homily for the afternoon chapel service. The halls of the old military facility were full of loudspeakers, and Montoute’s voice reverberated from one hall to the next.

The old man left his bicycle on the side of the road and approached the entrance to the Clay City Diner. He carried a large, sealed manila envelope and a plain file folder filled with old magazine articles. He had a thick, white beard that had only recently been trimmed short. Two days earlier it had been a matted, unruly mess. His thin face was weathered and deeply crevassed, with blue eyes that still imparted a certain dignity despite his rumpled clothing, the faded corduroy pants and an ancient tweed sport coat. He had kept them for no particular reason and for the fleeting return to civilization today, his old professor’s garb seemed to fit the occasion.

At ten-thirty in the morning, there were no other patrons in the diner. He had intentionally caught the down time between breakfast and lunch, knowing that Millie would be working.

“You clean up good, Wayne,” she said, seemingly surprised by the new groomed look.

He stared at her with a somber expression on his face. “I have
business in Lexington,” he said, then he handed her the sealed manila envelope. “I expect to be arrested once I make my confession. You can read about it in the paper or watch it on TV. It will be headline news. But if you don’t read of my arrest or if, failing that, I don’t return here again on Friday, then I want you to deliver this to the Kentucky State Police.”

She looked at the sealed envelope, then back up at the old man’s face. “This is serious stuff,” she said.