Beat the Reaper: A Novel

Примечания

1

And you can compare this to your lower leg, where the same setup is vestigial. The two bones of the lower leg, the tibia and fibula, are locked in place. The outer one, the fibula, doesn’t even support weight. In fact you can take most of it out—to use as a graft or whatever—and as long as you don’t fuck up the ankle or the knee, it won’t affect the patient’s ability to walk.

2

Doctors always know how old you are. We use it to tell whether you’re lying to us. There are various formulas for it—compare the creases of the neck to the veins on the backs of the hands and so on—but they’re not really necessary. If you met thirty people a day and asked them how old they were, you’d get good at it too.

3

The tattoo on my left shoulder—winged staff, two snakes—turns out to actually be the symbol of Hermes, and therefore of commerce. The symbol of Asclepius, and therefore of medicine, is a nonwinged staff with one snake. Who knew?

4

Scrub suits are reversible, with pockets on both sides, in case you need to run anesthesia or whatever but are too tired to put your pants on correctly.

5

“Stat” is short, though not very, for Latin “statim”, “immediately". “Calling a code” is what you do when you want to pretend you don’t know someone’s already dead.

6

In fact, the medical word for pubic hair, “escutcheon,” “shield,” although in free-range humans only women’s pubic hair is shield-shaped. Men’s is naturally diamond-shaped, pointing up toward the navel as well as down toward the groin. Which is why women who shave their pubic hair into a diamond shape subconsciously skeeze you out.

7

This is an actual job, though it’s not interesting enough to go into.

8

Think more money can’t buy you worse healthcare? Forget the endless studies showing that the U.S. spends twice as much per capita as any other country, with results outside the top thirty-six. Take a look at Michael Jackson.

9

This was Konrad Preysing, aka “The One Good German.” Preysing made thirteen separate presentations of Holocaust evidence to Pope Pius XII, who in 1941 announced that Nazi policies did not conflict with Catholic teachings. When Pius gets sanctified, I hope they cite that as his miracle.

10

Auschwitz a death camp—Birkenau—but it also had Monowitz, which was a slave labor camp. That made odds of survival at Auschwitz 1 in 500, which is why you’ve even heard of Auschwitz. Odds of survival in the death camps were 1 in 75,000.

11

My parents had long since gotten divorced. My mother had become a real estate agent, and my father, who was Italian—but not, I should say, Sicilian—had moved to Riverside, Florida. Last I heard he ran an upscale franchise restaurant I won’t name. They both have different names now, and I am not in contact with either of them.

12

The actual amount that will stroke out any particular person is highly variable, because 30 percent of people have a hole in the wall between the right and left sides of their heart capable of sending a bubble that would otherwise go to their lungs (and from there into the atmosphere) directly into their brain. But most pieces of IV equipment are a lot harder to clear than a syringe, so nobody bothers to do it.

13

Electrocardiograms are abbreviated “EKG” because “ECG” sounds too much like “EEG,” which is an electroencephalogram. Or maybe Willem Einthoven, who invented them, called them “electrokardiograms.”

14

“Peter Brown called to say / You can make it O.K. / You can get married in Gibraltar near Spain.” Peter Brown was the longest-serving roadie for the Beatles.

15

This basic interaction—Good morning, sir/Sorry, kids. I’ll teach you something later—is the primary activity of the last two years of medical school. The primary activity of the first two years is a PowerPoint presentation by whatever bitter, unpaid PhD was too slow to avoid getting tapped by the dean that morning.

16

“CVA” stands for “cerebrovascular accident,” or stroke. A brain artery either getting jammed (usually by a clot, usually from your heart) or outright exploding. Meet the Reaper: it’s the number two cause of death in the United States.

17

Michael drops the gun after shooting the cop in because the kid drops the gun after shooting the cop in Where it at least makes sense, since during the Algerian Revolution the French had checkpoints every other block.

18

Oops, I said it.

19

Ishmael was my code name inside WITSEC, though no one except Prof. Marmoset ever actually called me that. WITSEC is the abbreviation the Feds use, helpfully, for the Federal Witness Protection Program.

20

Expand the mind, and the body will follow, you might say, but it never seemed to make me fat, and Skinflick was fat already.

21

Like a woman’s escutcheon, if you’ve been paying attention.

22

For those following along in their in medicine the solar plexus has been called the celiac plexus for the last few decades. About as long as it’s been since anyone read

23

Like you care what this means.

24

My favorite Lech Wałesa story is from shortly before I went to Poland. Realizing he was about to lose the presidency, Wałesa announced that his opponent was secretly Jewish. He then denied he was a bigot, saying, “Actually I wish I was Jewish myself. Because then I would have a lot more money.” Funny guy!

25

I. G. Farben, the chemical company that ran the labor camp at Auschwitz—it isn’t named after a person, it’s short for “International Dye Company” in German—stayed in business after the war by claiming it needed to pay reparations to its former slaves, of whom it had used 83,000 at any one time. It then went on to portray itself for decades as being unfairly hounded by greedy, vengeful Jews. In 2003 it found itself on the verge of being forced to actually pay out two hundred and fifty thousand dollars (total, not per person), and declared bankruptcy instead. But not until it had spun off Agfa, BASF, Bayer, and Hoechst (now half of pharmaceutical giant Aventis), all of which prosper to this day.

26

”status post” abbreviated “s/p,” is a common medical term meaning “after” and implying “but not necessarily caused by.” It’s Latin for “Try suing me now, Fucker.”

27

“Lesion” is a nonspecific but extremely useful (because it sounds like a crater of pus) term for any abnormality.

28

Medically it’s not all that clear. A woman who mates with her first cousin adds about 2 percent to her chance of having a kid with a birth defect. (For comparison, a woman who conceives at age forty has a 10 percent chance that the fetus will have Down’s Syndrome.) On the other hand, offspring of cousins may benefit from an increased chance of family stability. Either way, the human genome is already far more “conserved,” i.e., inbred, than that of any other known mammal, so we’ve already done a lot more cousin-jumping than, say, the rat.

29

I should admit here that my failure to communicate with my parents has been more than just a WITSEC formality. You’re allowed to exchange messages and even talk on the phone with your family through the Virginia clearinghouse, and if you do this often enough the agents will eventually “slip up” and give your family your direct contact information. I just never tried.

30

Supposedly from the expression “bitchin Camaro.” He did kind of complain a lot.

31

I say “at one point” because this progression is what we think about when we think about Kübler-Ross. But what we avoid thinking about when we think about Kübler-Ross is how she later changed her mind and decided we’ll all be reincarnated. I wish I was shitting you.

32

Antivirals are not antibiotics because viruses, unlike bacteria, are not “biotic”—they’re not alive. They’re just pieces of genetic code that your body interprets as orders to make more, identical pieces of genetic code, then spread them around. Some viruses, like HIV, your body will even insert directly into your DNA for smoother copying, making them part of your identity.

33

Most bottled water in hospitals has 5 percent dextrose. This is to prevent the phrase “Liter of plain fucking water: $35” from appearing on your bill.

34

Magdalena looked which medieval Europeans called “Gypsy” because they thought the originated in Egypt. They originated in India. It’s a pretty good joke that Romania, which is historically one of the most racist countries on earth—when it got its first political party primarily based on Jew-hating, in 1910, both its Liberal and Conservative parties were already officially “anti-Semitic”—is also one of the most racially mixed, because it lies in a mountain pass used by every army in history. Unless you think jokes should be funny.

35

This brings up an obvious paradox, which is that everything blue in an OR is supposed to have been sterilized, but our scrub suits, which are blue, have all been in at least one fast-food restaurant since the last time they were washed. What can I say? It’s an imperfect science.

36

Apparently they’re hoping the squeaking noise will drive away the parents.

37

People think (and their attorneys often encourage them to think) that a malpractice suit is a no-risk proposition because 90 percent get settled prior to trial. But you can’t just a malpractice suit. In most states the statute of limitations on personal injury is so tight (two and a half years in New York) that no insurance company will take you seriously until you actually file a claim and agree to deposition. And at that point you’re marked for life—either as a litigious, possibly fraudulent complainer, or (of even more interest to employers, who are the primary consumers of this kind of data) as actually having ongoing health problems.

38

Rule One from Never try to spare your clothes.

39

It turns out they usually can’t, since healthy urine doesn’t have cells in it. And if you dropping so many cells that a lab as bad as the FBI’s can strain them out of mud, prosecution is the least of your worries.

40

For the gun freaks: this turned out to be a .60 GE M134 “Predator” motor gun, firing a kind of depleted uranium bullet supposedly available only in China.

41

It’s true, by the way, that up close you could still read the “Home Depot” stencils on the planks of the rack. The ones that weren’t too covered in blood and shit.

42

Cancer talk!

43

“Reverse Trendelenburg” means the patient’s feet are lower than his head. “Trendelenburg” means his feet are higher than his head. No surgeon on earth would be caught dead saying “head up” or “head down,” though. In case you’re wondering why your appendectomy took four hours.

44

Look, I’m sorry to call her “Tits,” but everybody did. Even the prosecution, including one time in though it mysteriously failed to appear in the transcript.

45

The idea that you can’t be tried twice for the same crime in the U.S. turns out to be horseshit. You can be tried twice on the same—once in Federal and once in State court—and you can be any number of times for the same crime. For example, my own Federal trial was on charges (two counts each) of: First-degree murder; Manslaughter in the first degree; Murder committed by the use of a firearm during a crime of violence or a drug trafficking crime; Murder during a kidnapping; Murder for hire; Murder involved in a racketeering offense; Murder involving torture; Murder related to a continuing criminal enterprise or drug trafficking offense, or drug-related murder of a Federal, State, or local law enforcement officer; Murder related to sexual exploitation of children; and Murder with the intent of preventing testimony by a witness, victim, or informant. The large number of charges was designed to make sure the jury convicted me of and also to hike my potential sentence to four figures. But even then the Feds retained the option of trying me again on other charges, and of throwing me over to the State.

46

And sounds even more Dr. Seuss–like when paired with “bitch,” which is another of their favorite words.

47

A Brooklyn wiseguy once told me you could choose Leavenworth by having a bed there “cleared,” i.e., by having someone killed. Sounds like bullshit to me.

48

She could still have been compelled to testify about crimes committed prior to the marriage, but juries still think it’s illegal, so prosecutors don’t like to do it.

49

“Baboo,” which is a common nickname for the youngest male of an Indian household, obviously isn’t Prof. Marmoset’s real first name. His real first name is Arjun.

50

Supposedly, FBI agents are still required to say “the LCN” because when J. Edgar Hoover had to explain to the McClellan Committee why he denied for so long that the mafia existed—despite, for example, Hoover’s own tapes of Sam Giancana calling in orders to the floor of the U.S. Senate—he tried to pass the whole thing off as a semantic misunderstanding. Like everyone else had just been using the wrong name.

52

By the way, the medical term for something getting skinned, intentionally or otherwise, is “degloving,” but any part of your body with skin can be “degloved.” In the ER, for instance, dicks that have been stuck into vacuum cleaners are perennial favorites.

52

This was because I had cut the soles off a pair of shoes three sizes too small and glued them to the bottom of some shoes that actually fit me, so that according to the size/depth chart the Feds use to extrapolate body measurements from footprints I was five foot four and three hundred pounds. I don’t flatter myself that this fooled the detectives, but try explaining it to a jury.

53

You see this all the time—not people actually killing their relatives, but people sorely disappointed when their relatives survive. It usually takes the form of someone asking you to take their mother off life support even though her surgery went great and Mom’s up and walking around and about to check out.

54

“R/O” means “rule out,” as in “You deal with it.”

55

All right, fine. A nurse there turned out to be keeping his patients tied up and sedated for days at a time while he “experimented” on them.

56

Time between John Gotti being nicknamed “The Teflon Don” and getting sent to prison for life: eighteen months.

57

People think the ocean’s about life, and freedom. But beaches are the most impassable barriers in nature. People worship them like they worship outer space, or death, or anything and anyone else that says no to them and means it.

58

They were tiger sharks or nurse sharks or something. Who gives a shit? Any shark that large will attack a human if it thinks it can get away with it. And all shallow-water sharks are brown on top and white underneath, so that fish above them will think they’re sand, and fish below will think they’re sky.

59

Toxic shock is an immune response set off by contaminants in your blood such as bacteria—which make up 20 percent by weight of human feces, all grown within your intestines. (Cows can survive on this bacteria, “eating” grass just so the bacteria, their real food, will grow on it.) During shock your veins open up to let white blood cells into your tissues to fight the infection, and the fluid that leaks out with them causes your blood pressure to crash.