The Aleph

Chapter 1: Vectors, part 1 + 2

Take my hand, my child of love

Come step inside my tears

Swim the magic ocean

I’ve been crying all these years

Chapter 1

Vectors

Jada lay motionless on a stretcher. Light was everywhere. Her black hood was pulled over her head and her hand, hidden in her sleeve, covered the rest.  Around her alarms pulsed, dinged, and screamed while voices came over the PA yelling out numbers and names and people cluttered about and hurried by.  Each individual sound was its own experience, directed at her specifically, with varying effects on her nausea and headache.  The nausea was a gritty thing that seemed to get deeper with every noise, the headache a wavering pressure that bulged with the dings of the alarms.  The worst place to be dope sick, she realized, was the hallway of a busy ER.

If she stayed home though, she wouldn’t have made it.  She had bottles of Ativan and Klonipin and Xanax there and, even worse, her phone.  Now she cursed herself for leaving it, for leaving her house at all.  She kept imagining the hypnotic sleep the Ativan would bring, or the way the heroin would muffle this scene like a pillow pressed over her face just gently enough to keep her alive; the nausea would recede and her head would be like endless falling feathers.  She kept trying to imagine that but the sickness was too strong, it wouldn’t allow any uplifting thoughts, just dark things that slammed her from every direction and each was a reminder of how stupid she was.  It would’ve been so easy to slip the phone into her pocket, or a bottle of pills, and she ran through in her head what it would feel like for a few Xanax to slide stabbingly down her dry throat, kept pretending she’d called Tony and he was walking up to her bed to drop a bundle off for her to shoot in the bathroom. 

Sitting under the lights with aches exploring her body, she became aware of the depths of her joints, the location of the pain almost indeterminable, vast empty reaches she didn’t realize existed in her knees and between her vertebrae.  She fantasized about a tingling wave of light passing through her body, lighting up the otherwise inaccessible folds and hidden places. Heroin doesn’t flutter about your insides like luminous fireflies, she knew, but that’s always how it felt, little tingling pinpricks of gentle insect wings brushing all about your brain and a pleasant heaviness in your arms like they’re wrapped thickly with cotton.  Shocks of nausea slammed her from time to time but she wasn’t throwing up anymore and hadn’t dry heaved in a few hours. 

She sweat intermittently and felt grimy like she’d been exuding sap onto her goosebumped skin.   A nurse came and sat next to her and she couldn’t turn to face him, she knew it would displace her swollen brain and send shooting waves of pain down to her gut and rile up the latent nausea there, and she didn’t want him to see her anyway.  She’d been shitting diarrhea and felt like that was the most obvious thing right now, that he must know how filthy she was and she tried feebly to sniff herself but she didn’t want to make it obvious and decided she didn’t care.

“Jada?  Jada let me see your arm, I need to draw some blood.” She shot her arm out.  He pulled the sleeve up and looked at the whiteness and to him it just looked white, to her it was a pallid lump of dead flesh with rot and putridity emanating from it.  Her whole body was.  He gracefully slid his gloved hand up and down, stroking the skin and disturbing the fine hairs there.  It felt like sandpaper rubbing across her skin and she wanted to withdraw.  His touch left a burning residual mark, almost visual, and his voice sounded like he was pressing his mouth right up to her eardrum.  She fixed her eye on his lips to help focus on the words, and the sheen of saliva made its own moist, sickening sound, like a cloth being swished around in fetid water.  His breath was really a pleasant mint that melded perfectly with the warm moisture that brushed her face with each word, but every sensation, even that, stirred her nausea a little bit, just enough to make her want to send him away.

“I just need to check your blood work.  Do you have any good veins?”

“Yeah” she managed to say, “they’re all good.” His eyes scanned around her arm as he pressed here and there several times.

“Yeah they are, you haven’t been at this long.”

“A few years”

“So you’ve been smoking?”

“Everything.  Snorting. Pills.  Shooting.  All of it.”

“Well you’re lucky.  You don’t seem too far gone” he worked as he spoke, taking his phlebotomy equipment out and wiping her skin with alcohol.  The smell assaulted her with the fierceness of a needle stabbing up into her brain, but only for a second.  She was left with the smoldering smell like a house a day after its burned down.

“I hate that”

“the alcohol smell?”

“yeah”

“There was this one guy,” he said, tying a tourniquet and taking her arm firmly in his left hand, “a prisoner,” and he pressed his finger into her flesh.   Letting go the pressure he wiped the spot once more with the alcohol and peered closely, reaching for and producing a butterfly needle without looking.  “He was really beefy, a white guy, tatted up, full sleeves.  Guys like that usually have stovepipes all over, but this guy didn’t have any, just huge tracts of white and I could tell they were nothing but scar tissue.”  Without warning he pressed the needle into her arm and blood filled the narrow plastic tail.

“Ah fuck!” she exclaimed.

“You don’t like that?” Trevor grinned.

“No I fucking hate it!”

“Anyway, I had to start an IV on him like, immediately.  I forgot why but he was sick and he really needed it, and I was like ‘dude, I don’t know what I’m gonna do.  You ruined all your veins.’  And he said ‘put it in the left eye of the skull on my right forearm,’ and I looked and there was no vein, I couldn’t see it or feel it, and I told him there was nothing there, and he’s like ‘it’s there, trust me, just put a needle right through his eye.  An 18.’  So I took an 18 gauge and stuck it through the eye, and there it was, a vein right there.  I was like ‘holy shit.’” He filled a few tubes of blood and pressed gauze hard into the wound, pulling out the needle and snapping off the tourniquet. “So now I always ask junkies where the good veins are.”

“No shit” she said, which almost made her puke and she shut her eyes against the headache.

 “But yours were pretty good.  I didn’t even see any marks.  You sure you shoot up?”

“Yeah dude, why do you think I’m here?!”

“I’m just kidding.”

“Why do you need so much blood?”

“To make sure you’re not otherwise sick, they don’t want you in detox if you have any other medical problems going on.”

“I have seizures”

“Yeah there’s medication for that.”  He stood up and walked away.

She thought the story was cool.  She thought he was cool.  She liked him and wanted to feel happy he was nice and that he talked to her, but she couldn’t deal with any of that now.  She figured he had more interesting stories, being an ER nurse, and would’ve liked to have heard them in some other setting, but now he just made her sick.  His body heat made her sick, the inescapable sensation that blood was coursing all through his body and making little squishy and runny sounds as it went around corners and pressed through his lungs and kidneys and spleen and it made her feel ill, worse it made her want to see him rip open and everything spill out and have him turn inside out and collapse in a steaming heap and she knew if he just went away, if he just shut the fuck up she could lay back and close her eyes and focus on suppressing the waves of nausea.

There was a boy in the stretcher next to hers, a sickly white teenager who looked worse than any junky she’d ever seen, except he had teeth and his skin was smooth so you knew he wasn’t a junky, just sick.   He looked high, sitting there sort of wavering slightly gnawing his bottom lip with his eyes not really closed but puffy and heavy, and she’d seen people like that before and usually she would get excited little feelings inside that almost made her want to giggle and her stomach feel an empty, expectant sensation, but now she didn’t care, she didn’t want him anywhere near her.  She slumped back into her fetal position and put her sleeve over her face and smelled the plasticky smell of the stretcher.

******              

Most of the stretchers lining the shadowless hall were filled with patients and their families, but Michael sat on his alone, head down and feet planted before him on the thin mattress, his knees bent to his hollow face as it hung from his skull. Vaguely he perceived the bodies on the nearby stretchers and all the nurses, doctors, and patients hurrying and hobbling by. The air was disturbed and the ground thudded as two stomping medics sped past with someone on a gurney. He’d spoken to a doctor at some point, whom he’d told he was in pain, but had no idea how long ago that’d been. Until he got some drugs time would elongate with him here, exposed under the artificial lights of no day and no night, the future forever swallowed by this agonizing moment. Eventually someone came to his bedside and dropped several items onto his stretcher and began arranging them.

“Are you my nurse?”

“Yes Michael.  Its me.”  Michael slowly turned his head to see Trevor, a nurse who’d taken care of him many times.  Michael presented a kink in the corner of his mouth.

“Hey Trev.  How much do you have?”

“Just one.”
“Fuck.”
“I know.  I told them.  They always start with one.”
“Don’t they have my records?  Don’t they see I always need at least 4?”
“They do.  But still.”  Trevor sat next to him on a stool and in one motion took Michaels right arm, rolled up his sleeve, fastened a tourniquet, and began palpating his antecubital.

“It’s there” Michael assured him.

“You’re not a difficult stick Mike, I’ll get it.”  He took a swab and scrubbed Michaels arm vigorously, and Michael heard packages tearing and saw plastic glittering down and wrappers scatter on the bed.  Trevor had a plastic cap in his mouth and was hunched over Michaels arm and suddenly a needle sprouted from it, siphoning blood into little plastic tubes that Trevor quickly inverted and tossed onto the stretcher as they filled.  He underwent some other movements and Michael experienced a salty taste in the back of his throat.
“Saline” he said.

“You taste it?”
“Yeah.”  Slowly Trevor infused another syringe and asked

“What’s this taste like?”
“Medicine” Michael said, and Trevor quickly flushed another saline syringe through the IV.  He stood staring at Michael while Michael sat motionless.

“Anything?” Trevor asked.

“No.”

Trevor didn’t believe him, though he didn’t think he was lying either.  He knew that with Michael it was all or nothing.  With anyone who’d ever had narcotics more than a few times it was all or nothing.  Maybe pain was like trying to warm someone who was freezing, he thought.  When you crossed the threshold there was no thawing by degree, just the sensation of freezing and then, later, warmth.  Or else maybe that’s what being high was like.

“I’ll talk to the doctor and get you more as soon as I can.”
“Thanks.”

Trevor got up and walked away and Michael sat gnawing his lower lip, gently pushing loose stringy layers of skin that he imagined were a milky gray.  The gnawing gave him something to focus on as he bit the strands into tinier and tinier pieces until they filled his mouth and swam around in his saliva. Swallowing them made him ill, but the rhythmic chewing gave him something to pass time while the eternal star of pain burned in his stomach.  The pain wasn’t a focal point within an identifiable location, rather it was a raging entity that felt, maddeningly, like it was always about to spread viciously through him to other parts of his body and consume him.  It never did, but this constant feeling of impending consummation enfeebled him as much as the pain itself. 

On the stretcher in front of him was a girl who looked like she was very pretty, disheveled blond hair emanating from her hood with thin lips that hid moisture just inside. Her nose was small and her eyes were blue with long black lashes that made her look more like a drawing then a real girl.  Her beauty was obvious to anyone and it made him feel as vulnerable as a child alone in a dark room, too alert to sleep for fear that, were he to move the tiniest bit, the creature in the void would spot him.  He would’ve wanted to hide except he was too intent on his pain and there was nowhere to go, he needed to wait here for Trevor to come back.  She looked sick too though, pale and sweaty, and her mouth was pinned straight across her face and her eyes were dark and her face shadowed by her hood and dirty hair.  Trevor had drawn her blood and chatted with her, and fleetingly Michael wished he was able to do the same.  Now the girl was curled up on her stretcher and she faded from view as he nodded off.

*********

Trevor put the vials of blood in a lab bag, sent them away in the pneumatic tube and walked briskly over to his computer station, pulled up the patient tracker and scrolled through names until he found Jada’s.  He clicked on it and put check marks next to all the lab work ordered, then clicked over to her demographics page.  Past medical history included bipolar disorder, depression, schizophrenia, ADD, epilepsy... He looked down the hall and saw medics lined up out the ambulance bay doors, two to a stretcher each containing its own cocooned patient.  A shriveled old black lady who looked like a statue, a little child in a car seat whose mother stood next to him crying, a disproportionately obese woman with a serene face, and other people healthy enough to sit and wait for a spot to open. He looked back to the nurses’ station, cluttered with charts and computers and doctors and nurses typing and chatting, scrubs dull under the lights and stethoscopes around their necks.  He went over and grabbed a few chips out of an open bag, shoving them in his mouth as he went back and slapped his hands against his legs to get the grease off, feeling the dim stares of the hallway patients who wanted him to come over and do something or say something. 

He checked the time he gave Michael his first dose and saw a half hour had passed.  A little early but Kagan had just come on and he usually took Trevors advice on how to treat patients he hadn’t met yet.

“Kagan!”  He was sitting in a corner of the nurses’ station, the department laid out before him with his back to a wall of monitors.  He had a massive coffee in his hands and was explaining some sort of pathophysiological process to two med students.  He turned to Trevor and his face lit up, the med students instantly forgotten.

“Martinez! how does it?” Kagan returned.  Trevor gestured to their surroundings.

“You see.”

“All too well.”
“We’ll be on it straight through till 7am.”
“That we will my friend.”
“Lets clean this place up”
“Yes.  Give me some place to start”
“Michael Allister”
“Is…whom?”
“You got him on sign out, abdominal pain. Crohn’s patient.  You don’t know him?”
“He’s not in my inner circle.”
“He probably will be soon”

“Oh?”

“Yeah.  He’s over there.” 

Kagan looked. “Gnawing his lip.”

“That’s the one.”
“Needs drugs”
“He does”
“Which?”
“One of dilaudid.  He’s already had one.”
“Heavy”
“Look at him.”
“I am.”  The monitors over Kagans head displayed several levels of various waving colored lines and numbers, magenta and blue and red and lavender.  Trevor glanced quickly at them and saw some irregularities.  An alarm began dinging and Kagan and the students looked up, Kagan and Trevor looking directly at the source while the students scanned the wall, their eyes quickly falling on it once it started flashing.

“That patient been in A-fib?” Kagan asked
“He’s going in and out” Trevor said.
“His pressure looks all right”

“He’s gotten some fluid.  He’s on a dilt drip” They all watched the monitor without speaking. Kagan turned and looked to his phone, sipped his coffee, and said to the students

“One of you pull that patients’ chart while the other one goes in the room and assesses him.  Everything: his IV, his meds, mental status, peripheral pulses, I want to know everything about his current condition and his past medical history.”  The med students dispersed and he looked to Trevor.  “We don’t want to be dicking around with piddly doses on someone whose got a tolerance while we have unstable cardiac patients and ambulances lined up out the door.”

“I don’t want to be dicking around with anything. I’ve given this kid 4 before.”

“Put some oxygen on him and give him one more of IV dilaudid. Please enter the order for me, I’m going to forget about this kid as soon as you walk away.  Come back in an hour, if he’s breathing and in pain, we call his doctor and have him admitted, if he’s breathing and pain free we send him home.”

“He’s going to refuse admission, his doc always recommends an ostomy.”

“I’d refuse admission too.  Regardless, that’s all we’ve got.  We need to keep bodies bouncing off stretchers”

“Agreed” Trevor replied as he turned and passed through a gauntlet of roving computers and various staff to get to the computerized drug dispenser, accessible only by security-cleared badge. He went into the med room and placed his finger on the ID scanner.  A list of names appeared and he pressed “Allister,” which brought up a blank screen, indicating no new meds were ordered.  He touched the “override” button and typed in “hydromor-,” then touched the screen over “hydromorphone 1ml=1 mg,” and he pressed “acknowledge” and typed a 1 into the empty screen.  A drawer of individually locked plastic containers opened automatically and he heard a click as the lock released on the dilaudid chamber.  He quickly counted the vials in the cubby and confirmed it on the screen, set one aside and threw the rest back in, slamming the drawer shut with his hip as he moved towards the cabinet to grab a needle. He stabbed it into the vial as he started walking back through the department, ripped the plunger out and aspirated the medicine into the syringe, the packaging from the needle floating to the ground as he went. He approached Michael and before he even stopped walking he kicked the lever on the bottom of the stretcher to elevate the bed.  Michael didn’t look at him as his body jerked upward with each kick, and Trevor noticed his lower lip. 

“What do you have there?” Michael asked.

“One”

“Oh.”  There was a silence between them as Trevor produced various products from his pocket, looking at them quickly before he tossed them onto the gurney: a pre-filled syringe of saline, an alcohol swab, a wadded up pair of gloves. 

“One more isn’t so bad.”
“No” Trevor responded.  “you should be ok after this.”
“I hope so.  It’s been at least an hour since the last dose.”
“It’s only been 30 minutes.”
“Has it?”

“Yeah”
“Huh.   Seems like longer” he said, his voice trailing off.

“I know” Trevor told him. He tore open the alcohol and quickly scrubbed the hub on Michaels IV.  He held the syringe of dilaudid up in front of himself with one hand, the other holding Michaels arm. He studied the metered lines on the needle as he pushed the liquid to the top and expelled all the air. He pressed the syringe into the catheter and slowly began infusing the narcotic into Michaels bloodstream. It simply disappeared into the tubing but Trevor pictured it seeping into a flowing river of red with bouncing cells and other dross, wondering if the blood stream was crowded with these dissolved particles or mostly just empty liquid.  Either way it seemed so calm, the silently pulsing fluid, compared with the noise and pace of the ED, and pushing this medicine into it with a controlled hesitancy settled him. Looking around he saw people scurrying about, nurses with bags of fluid or handfuls of syringes, doctors writing in charts and huddling around discussing treatment plans. Alarms dinged and screamed and EMTs strolled by with people strapped to big insectoid stretchers. It all created a hum in his brain that gave substance to the static that was already there, a dull vibration of lurking fatigue.

It must’ve been pitch black outside, he thought, though when he came in at seven the sun was just beginning to contemplate its quick descent. The world had probably underwent rapid and dramatic color changes before the ghost pale of dusk lingered ephemerally and gave way to the long shadow of night. In here it was always the same, always an electric white fluorescence, meant to illuminate orifices and cavities and wounds for medical inspection. The lights eradicated the sensation of time passing and created an ever-present moment that could only be measured by increments of fatigue.

He looked at the catheter. Only hallway through. If he slammed it in Michael would get hit with a shock of dizziness, an impossible light-headedness that would seem to defy consciousness, imparting a disembodied feeling and maybe some slight giddiness, though narcotic tolerant patients usually skipped the happy part and went straight to the lethargy. Many of them, all but the really hardened addicts, would feel the debilitating nausea that swept in right after the initial shockwave, and Trevor cursed himself for forgetting the Zofran. Michael, he remembered, usually ended up extremely nauseous, and now he would have to go back to the machine and take another med out, come all the way back here, go document it all, and then finally move on to another patient. 

Fuck it. He slammed in the rest of the dilaudid and ran back to the medication machine.