The Flayed Man

Chapter 1

MIDNIGHT IN THE EMERGENCY DEPARTMENT brINGS the squeal of old tires and reckless laughter.

An antiseptic gasp like an agonal breath, and the big glass panes of the automatic doors grind down the sand in their tracks, revealing the gift left behind by a pickup full of teenagers: one of their own, nineteen at best, swaddled in a stained gray hoodie.

He breathes out through a mouthful of broken teeth, and the stains multiply.

He smells like malt liquor and tobacco-swilled backwash and the dust-and-dog-shit mélange of the concrete he busted his face on. He smells like blood.

I’m hungry.

Chaney mumbles something and slips out of the other swivel chair as the kid shuffles up to the desk, looking like I’m about to give him detention.

He makes a noise like all the fight’s gone out of him.

It’s because he’s alone, I know it without having to ask him.

His friends ditched him and he’s scared, and he’s supposed to know what to do. And he doesn’t.

“I think I broke my nose,” he slurs. Fat, shiny red drops hit the desktop.

His blood stinks of reheated food from cans and boxes and flat Diet Coke choked down on a legally mandated thirty-minute break, of furious bursts of iron and desperation as his heart demands he answer for his crime of living.

I’m tempted to sweep a finger through the pooling droplets and pop it into my mouth—I don’t know the last time I actually tasted blood—but I can’t do that here. Someone’s always looking.

I slide him a clipboard. Bruising has already stained the bridge of his nose, beginning to stretch beneath his eyes. The muddiness of his words owes less to the liquor and more to the blood trickling down his throat.

Somewhere above my head and a little to the right, Chaney coughs. Black coffee scalds my nostrils. Buys me a second to clear my head.

“You okay?” Chaney drums at her steaming paper cup with perfect almond-shaped nails. “You look like you could use some coffee too.”

Chaney smells like vanilla body wash and does her own French manicures and wears pastel-pink scrubs like some kind of triage ballerina.

She’ll move on from the night shift in a couple months, like everyone does, and she’ll meet someone nice and have a couple of kids, and when the white wine comes out, she’ll describe the horrors of the ED to her in-laws.

I won’t figure in those stories. She’ll remember my face, maybe, but she’ll have forgotten my name.

She’ll wonder, briefly and without interest, where I ended up.

And the answer will be nowhere. I’ll still be here, cycling through the same endless nights and pitiful days filled with a different, worse kind of suffering.

Anyway, Chaney’s all right.

“I’m good,” I tell her. “Bathroom break.”

Some days I relish pushing the boundaries of my hunger.

Breathing deep when a bloody patient rolls by, holding off feeding till my veins rattle.

Proves that I’m in control: of my appetite, and of other things too.

Like disappointment. Like anger. But some days, like today, I leave it a bit too long.

Enough to remind me that it’s not a game.

I head for the hall and swallow a couple of times to get my saliva flowing, sniff a few more to clear the clinging afterglow of the kid’s blood from my nose.

Just make it to the break room. To the lunchbox in the back of my locker, to the Vacutainer vial inside, waiting for me to—

“Karsten!” My name pulls me up short just as the PA crackles to life. Dr. Avagyan to the emergency department. Dr. Avagyan to the emergency department.

Avagyan means a trauma case. The nurse who shouted for me closes in, a blur of maroon scrubs and squealing sneakers. “Lady flipped her car with her kid in the back,” she pants. “ETA four minutes.”

“E32 and 33 are open, I’ll—”

“Chaney’s on rooms, I need you to log the EMS report.” She shoves a clipboard into my chest. “Here’s everything they called in. We need patient names to get them in the system.”

I could get to the break room in four minutes, maybe. But probably not back again, and the medics rarely stick around long.

I find a corner and gulp down half a cup of black coffee so hot I feel it in my nasal passages. Then the ambulance screams up and the doors gasp open, and I smell blood and asphalt and plastic and dirt and blood and blood and blood.

Mom comes in first, bag valve clutching her face like a parasite.

A gold hoop dangles from one ear. The other ear, the whole other side of her, is cracked cartilage and bone ground down where it shouldn’t be.

Nurses descend and the salt-and-pepper medic hands her off and she’s down the hall.

I swill more coffee over my aching gums.

Then the kid. I see the gravel-torn soles of her tiny sneakers first. The kind that light up when you stomp.

One’s flashing red, faintly. The second medic, stocky and snub-nosed with a shaved head, has her arms braced on either side of the girl’s skull, immobilizing her spine, and she’s curled over the girl, whispering something to her.

I’ve seen this pair before, rolling in with a woman stuck full of epinephrine and screaming about how she’d sue the cheap casino buffet that let the lobster touch her rice, and before that, with a happy-go-lucky college student drugged at a party, head lolling as her friend wobbled after her in ankle-turning heels.

Rodriguez is the older one. Rodriguez, and…

“Zawadski,” Rodriguez snaps. The nurses have closed in on the girl, but the younger medic—Zawadski—isn’t giving her up. Her shoulders heave, and she folds up tighter.

Rodriguez repeats her name. The PA blares. Someone is shouting about the handoff. The empty cup crumples in my hand, waxy and alien. Not food, never was food.

“Vera,” Rodriguez says, quieter than everything else happening around us, and Zawadski’s head snaps up. Nurses flow into the cracks. The girl disappears. Zawadski stares after her with brown eyes so big you could curl up and sleep in them.

“Get a coffee,” Rodriguez says, just as quietly.

Zawadski scowls. At him, at me. “I’m fine.”

“Get a coffee.”

She stalks past me, the sleeve of her medic jacket glancing off my shoulder, and under the chemicals and adrenaline I catch the faint scent of particle board and a scabbing cut.

When I turn back to Rodriguez, his expression tiptoes between vigilance and accusation.

It stays that way as he runs me through the patients’ names and all the details they didn’t have time to call in, scene description and treatment responses, and I scratch it all down on my clipboard.

There’s a tightness in my gut. Not hunger. A seeping second-hand shame. Witnessing Zawadski do something wrong, and worse, sticking around while she was reprimanded for it. I’m not sure I haven’t done something wrong too, just by being there.

The break room’s empty, the laminate tabletop littered with half-drunk Diet Coke cans and Starbucks cups.

No one stops me in the hall. I flip the lock of the bathroom and breathe in the bleach-burnt blank slate scent of tile and air.

The anemic hospital lights paint a pink film over the sink and toilet and fold-up changing table.

The weave of my jawbone hums as I wash my hands and check my veins, as I unpack the lunchbox and peel back the plastic backing on the disposable syringe, as I pull the blood into the barrel and make a fist of my left hand.

The blood smells like solvents and floor cleaner, and I’m so hungry I don’t fucking care.

When it hits my veins, my knees fail beneath me, and as I collapse into a heap of flesh and want and will, the curse locked inside my chest lifts its head, a howl rising behind its teeth.

Thirty seconds later, I’m in control again. I spit into the sink and swear I’ll quit testing my limits. I’ll be better from now on. I’ll be the daughter my mom deserves.

I want the break room to be empty when I return, but instead I find the pair of medics huddled around the table.

Rodriguez is muttering something too quiet to hear, his hand on Zawadski’s shoulder.

Less comforting her, more anchoring her in place.

She sniffs long and deep like she’s trying not to cry, and right then they both realize I’m there.

Rodriguez looks worn out, all the carnage he’s witnessed peeking through the places where his skin’s too thin.

Zawadski just looks angry. She chews her lip and glares at me with big, brown, shiny, furious eyes, and the blood-soaked animal inside me snaps to attention.

She looks like she’s daring me to get my teeth around her and bite down.

I could. Suddenly, I want to.

“Can I help you?” Zawadski snaps, and I remember what’s real and what’s not. What’s real is that these two are pissed at each other, and at me, and at least one of them is just pissed at the world in general. I’d better get back to work before the night gets any messier.

“Sorry.” My tongue’s too big in my mouth. Will she sense it? “Sorry. I’m leaving.”

They pick up muttering again as I dump my lunchbox and retreat, doing my best to pretend I’m invisible. I brush past Zawadski, feel her flinch away, and the last thing I smell is the salty tang of a scabbing cut, of a semi-healed wound picked open enough times to scar.