CHAPTER 17
Alexei
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The garage is colder than outside. Fine.
Let it be colder. The bay holds last night’s chill in its corrugated bones and the floor drain breathes up at me like a man with bad teeth, and I have been here forty minutes already, and I have not slept since Sunday, and there is a woman asleep in a TriBeCa loft I left at four-forty-five because I am the kind of man who walks out before sunrise to keep something he wants.
Krasivaya. She was between Stefan and Nikolai when I closed the door. The mezzanine staircase rang under my Red Wings on the way down and I let it ring. Eight treads. Nine. Twelve. I do not count. Fuck.
The Murmansk man is at the bay door with two paper cups of something brown that is not coffee. He hands me one. I drink the not-coffee anyway because my mouth tastes of last night's whiskey and Elena's hair, and I would like one of those tastes to leave.
"He is at the loft above," he says, meaning my loft, the one over our heads. "Walked in on his own feet. Couch since five."
"Bullet still inside him?"
"Shoulder. Right. Through-and-through tried and failed. He is white."
"He should be white. Get him down. Slow. I will set the bay."
The second with the broken-nose is laying the instrument stand out for me — the wheeled stand from the Albany surplus, the maker's plate ground off.
He has done this six times in two years and his hands move without his face.
The Pelican on the back tray, lifted, the bones of it laid out — #11 blade, the ringed forceps, two mosquito hemostats, suture, the Israeli pressure bandage I want anyway, even if I will not need it, because blyad, I am not a man who walks toward a wound without an exit ready.
Lidocaine. Five percent with epi. The Pelican's bottom row. Two vecuronium ampoules. Sealed. Sugammadex behind them in the blister. The vials I carried out of the Lab B cabinet on the tenth of this month under a paper bag of pirozhki Stefan thought he was hiding from me. He was not.
"Doctor. " The redhead at the door comes down the stair on his own legs, which surprises me.
Six-foot, gaunt, the brick-red hair he has had since Brighton Beach paled to wet rust. One hand pressed flat against his right shoulder, the other flat against the wall, doing the math of how to get to the lift without his knees opening up under him.
A wad of gauze the size of a fist taped over the entry under his jacket, the tape brown.
Gray at the lips. He is forty-eight. He looks sixty this morning. Suka.
"Sit," I tell him.
"I am sitting."
"You are standing. Sit. There. On the gurney."
He folds onto it as a man folds onto a chair when he no longer trusts the chair. The Murmansk man wheels him under the back-bay light. I crack my neck. Left, then right. The small mechanical click of my own vertebrae is the thing I have instead of a prayer.
"Talk to me. What did he hit?"
"Coat. Phone. Shoulder."
"Phone in the inside pocket?"
"Yes."
"Phone is fucked?"
"Phone is fucked."
"Lucky. " I am cutting his shirt off with the trauma shears, sleeve to neck, and the air in the bay smells of cold motor oil and chlorhexidine.
The exit wound is the lie. The entry is the wound; the round skipped the head of the humerus and slowed, and the slowing put it in the muscle belly an inch and a half deep, lodged at the lateral edge of the joint where my finger says it is.
Fragment small. Bleed venous. He has done his own pressure for six hours like a man who knows how to wait.
"Bleeding time," I say, mostly to myself. "Six hours. Hemoglobin probably nine. He is white because he is six hours into a steady bleed, not because he is going. He has another four in him if I want him to. I do not want him to."
The redhead breathes through his teeth.
"You are going to feel me push lidocaine in two places. It will burn. Then it will not. Then pressure. Then nothing. The nothing is the part where I take it out. You with me?"
"Yes."
"Three counts. One. " I push the bevel under the dermis. "Two. " I redirect, drop deeper, lay a bleb at the bullet's edge. "Three. " I push the rest. "There. Burn first."
"Bozhe," he says, which is the closest I have ever heard him to a prayer in fifteen years.
"Burn second."
"Bozhe."
"It will fade now. Count to ten with me. Odin, dva, tri —"
He does not get past four. The Murmansk man brings the back-bay lamp on its arm and adjusts the head until the light hits the field at the angle I want and not the angle the lamp wants.
The broken-nose man has the kit open at my left hip.
I am left-handed. I work at the patient's right shoulder from his left side. The instrument stand is at my left.
Every fucking thing I have ever needed in a bay has been at my left because that is how a left-handed surgeon survives a service designed for the other ninety percent.
Krasivaya. She figured it out the day she walked into my trauma bay and ordered me to put my ring down because the ring was on the right thumb and the right thumb is my stabilizer hand and she had read me in twelve seconds as she reads a seven-year-old in pain on a pediatric floor. Fuck. Focus.
The vecuronium is the question; it stays off the field for now.
The redhead is conscious and consented at the door — he initialed the Practice intake card with a hand still steady at five-forty-five — and I do not need him paralyzed to take a fragment out of a deltoid.
I need him still. Still is not paralyzed.
Still is a man who does not want to be still and is doing it anyway.
"Hold still. Three counts. One, two, three.
" The #11 blade slides through the prepped skin in a one-centimeter line over the palpated edge of the fragment.
I do not dig. The blade just opens the door.
I lay it down. Ringed forceps in my left hand, mosquito hemostat in my right, and I spread the muscle as I would spread a curtain at a window — gently, gently, the fibers part along the line they want to part along, and the fragment is right there, dull-bright at the bottom of the small canyon I have made, gray as a winter sky.
"There you are," I tell it.
The redhead makes a sound that is not a word.
"Hemostat at the lip. Forceps at the body.
Pull straight up. Two seconds. " I have it between the rings of the forceps and the small bright thing slides out of him with the wet sound of something that does not want to leave the place it has been.
I drop the fragment into the steel kidney bowl.
It clinks. Blyad. That is the sweetest sound in my professional life.
"Pakhan says you keep the bullet," the broken-nose man says behind me. "He wants the make."
"He will get the make. Nine-millimeter. Hollowpoint. Lead deformed at the nose. Brass jacket intact at the base. A primer mark with a small offset to the left, which means somebody's gun has a worn channel. Tell him I would say Glock if I had to bet."
"Pakhan will not bet."
"Then tell him I am betting and he is not. He likes that joke."
I do not look up. I irrigate. I lay TXA into the field and let it sit.
I find the venous bleeder under the second muscle layer with the ringed forceps and lay a small Surgicel patty over it and hold it in place with the back of the forceps' jaws for a thirty-count.
The bay is quieter than any trauma room I have ever been in. The lift hisses. The fluorescents hum.
And then the welder fires up on the south side.
I forgot. I had asked the Murmansk man to start on a chassis weld for the night-shift Caprice yesterday and he is getting to it now because that is what you do on a Tuesday morning in a working garage when you have a customer expecting a car on Friday. The torch bites the rod.
The arc strikes. And the blue spark throws a flash across the back-bay wall — that sharp electric blue, the blue that lives in the air for half a second after it leaves the rod, the blue that smells of ozone and hot copper, the blue that has been the only color of my professional life since I was sixteen and that has never once reminded me of Yuri.
Every other color in the world has. That sharp blue is mine.
"Rolig," I tell the redhead, who does not speak Norwegian and does not know I am speaking it. "Breathe. Stay with me. Almost done. You bleed, I work."
Field clean. I close the small line with three interrupted nylon stitches because three is enough and four would be a lie.
I trim the tails. I lay a sterile dressing over the field and tape it with the bias tape that does not pull at the skin when the bandage comes off.
I do not use the vecuronium. The vials go back into the Pelican's bottom row, sealed.
Stefan will count them on Friday. He will know I did not use them.
He will say nothing and he will mean good, the way Stefan means good, which is the way another man means I love you.
"Sit up slow. " I help the redhead sit. The Murmansk man slides a stool under him.
"Sore for ten days. No driving for three.
Nothing heavier than a gallon of milk on this side for two weeks.
If the dressing soaks through tape it back with whatever you have and you come straight here, you do not go to a hospital. "
"Understood."
"Whose was the gun?"
He gives me the half-smile of a man who has already done the work in his head while I was working on his shoulder. That is why he came in on his own feet at five.
"BQE branch," he says. "The Murmansk man knows the one."
"Then say it to my face after four hours' sleep. Couch upstairs. Move."
"I know your couch."
"Go."
The Murmansk man walks him to the stair.
He moves up like a man who has been given a second small Tuesday morning and intends to spend it sleeping.
The blue spark snaps once more across the back-bay wall and dies, and the bay smells of ozone and copper and chlorhexidine and motor oil, which is my version of incense.