Bucknor Fiction - aaduna in exile spring 2021 issue, Vol. 10 No. 1

 

Meet the Author

Matthew Bucknor (photo provided)

Matthew Bucknor, MD is an MFA student in the Warren Wilson College Program for Writers. His work has previously appeared in Intima; was a finalist in The Sewanee Review’s second annual Fiction Contest and received an Honorable Mention in Glimmer Train’s Short Story Award for New Writers. Dr. Bucknor is also an associate professor of Radiology at the University of California, San Francisco where he helps medical students process their experiences in medicine through narrative, with a particular interest in challenges faced by health care workers and patients of color (https://profiles.ucsf.edu/matthew.bucknor).

How Do You Really Know? 

In the moment between the still black night and hesitant blue dawn, Devon finds himself in a large concrete stairwell. Fluorescent white light cascades off the walls in lilting waves. He shields his eyes with his hands and steadies himself against the railing. He cannot recall the intent that brought him to this fourth-story landing. He has already forgotten the wretched smell of the last patient’s room, recycled air laced with spores, the flimsy yellow gown donned over his short white coat. The plan that had been made to defer further plan-making until morning rounds. He is only aware of fatigue, the urgent need to lie prone, to fully supplicate himself to gravity’s will. A sense of weariness lingers heavy on each step.

His eyes close. He imagines the world gone dark, that particular shade of blackness, or its absence. The same void the feverish blind man in Room 418 once noted only as a curious departure from all the light he had ever known. Even just a few seconds here, though, is more than Devon can bear, and his thoughts seek an escape. He vaguely recalls that blindness accentuates both smell and touch. Eyes still closed, he breathes deeply through his nose and takes the railing firmly in his hands. His fingers wrap around the cold smooth metal. This seems like enough for now, and he begins a slow, palm over palm, descent.

His feet drag on the uneven concrete floor, then sink hard into each step. Occasionally, he trips, but manages to catch himself each time. Still, his thoughts turn to falling. The brief sense of weightlessness replaced by the shock of ground against body, limbs flailing limply like a ragdoll, the world turned over and over. How long would he lay there until he was found?

Inevitably, he scolds himself for the imagined trauma, begrudgingly opening his eyes. And finally, he sees her. The crumpled body resting against the final step. Her turquoise hospital gown fans out in a broad sweep, as if floating on the surface of a pool. For a moment, he simply stares, unsure whether she is real or an apparition. He blinks hard, wipes roughly at the corners of his eyes. She’s still there, motionless, chin tucked carefully to the thin brown rail of her forearm. A curtain of rope twist braids flows halfway down her back. He looks up and down the stairwell. His instinct is to run, but he is too tired to take full measure of his fear.

He draws nearer to the body, sliding toward her on the worn soles of his clogs. His gaze settles on her inert chest, willing it to move. Without deliberate intent, he begins to count points of lightness—chin, shoulders, the nape of her neck—all the places where her flesh runs thin against bone, as if her body had once tried to escape itself, this fate. He kneels on the edge of her gown, takes her wrist in his hand, and presses two fingers in the small hollow where her pulse should be. Her skin is ashen and rigid. His hands wrap her palm, as if trying to convey his warmth into her, as if he could transfer the soft brown tone of his own skin to the places where her color is lost.

Devon lifts her head into his lap and winces. She couldn’t have been dead more than a few hours, but her eyes are sunk deep in their sockets, orbital frame tenting skin. Thin black wires of hair tumble out from beneath her braids in patches. She was dying long before she was dead. The dual lumens of a central line sprout out from her jugular, oddly floral. He traces the skin along the device, in the space where the carotid normally bounds, but feels nothing.

She is wearing bright red lipstick. He tries to imagine her standing in front of the tiny mirror in her room, knowing this is the day she would die. Weren’t there a million different ways this day could have been different? Tears run down his cheeks and land on hers. He wipes the thin film of liquid away with his thumbs, but he can’t keep up. He is weeping uncontrollably. A long minute passes. He lowers her head to the floor and doubles over on his knees. His breath comes faster than he can manage.

“Are you okay? What happened to her? Is she breathing?”

He looks up at the voice, dazed. A small older woman in scrubs breezes past him, jams her fingers insistently against the lifeless carotid. She whips a stethoscope over her shoulder and places the bell against the dead woman’s sternum. He doesn’t understand where she came from, how long she has been there. Her breast pocket reads Claire Singletary, Critical Care RN, in bright red letters. Her hair is short cropped steel, a serious kind of hair that has been schooling inept medical students for more years than he’s been alive.

Shit, he thinks. He smooths the crumpled front of his white coat and rights himself to his feet. “I...I don’t know. I just found her like this. I’m a student.”

“You just found her? How long has she been down? Have you started CPR?”

“Yeah, I checked. She, uh, she doesn’t have a pulse. I was just coming down the stairs. No pulse, no chest rise. I think she’s dead. I don’t know how she got here. I don’t know.”

“Did you call a code?”

“Call a code?”

“Go fucking call a code!”

He scurries toward the door, stumbles over his clogs, and looks back. She is already positioned over the woman’s chest, fingers interlaced, elbows locked. She begins forceful compressions, counting off each recoil to herself in a loud whisper. The entire body pulses under her weight. He can hear the ribs break.

She glares at him, exasperated. “Go!”

He runs.

 

*          *          *

 

Devon doesn’t call the code.  He runs past the closest nursing station and straight out the main entrance, down past the red brick façade of outpatient clinics that surround the hospital. He looks back every so often, as if he is being chased, and keeps going until he reaches the curb of Potrero Avenue near an empty MUNI bus stop. Here, he pauses to catch his breath, his shoulders pressed back against the plexiglass enclosure. He is crying again now, either from grief or fear, or both. He slides down along a collage of graffiti until he is sitting in a small pile of newsprint litter. The sun edges up over the Berkeley Hills and the air fills with a burnt orange glow. His breathing slows. The morning rush hour begins, cars lining up in neat rows but hardly moving at all. A bus pulls over, but Devon waives the perplexed driver off with a half-smile and raised eyebrows.

He stands up and begins to jog the few blocks over to his apartment in San Francisco’s Mission District. But he doesn’t get far. He has already forgotten the earlier difficulty he had running in clogs and, at the corner of 23^rd and Bryant, tumbles over an uneven slab of sidewalk. The fall is remarkably graceful, and would not have otherwise caused damage, but for a broken bottle of ginger beer abandoned in his path. A small glass shard slices his right palm with scalpel-like efficiency, a two-inch skin flap lifted clean from the thenar eminence. He sucks the air hard and clasps his palms together, almost as if in prayer. His body rocks over the pavement. Then he releases his grip and inspects the damage. The wound is long, but not deep; no major tendons or vessels as far as he can see. Tiny red pools widen and flow over a fine gravel coating. He feels a mixture of rage and relief, swears again into the concrete. Then he presses his hands back together and walks quickly the four blocks home.

Inside the small studio apartment, Anna is already home from her nightshift, coiled in the fetal position in one corner of the bed, fast asleep. She’s the chief resident on labor and delivery this month. He thinks of the horrific delivery stories she has told him over the last year. At least no one’s baby died, he thinks. Then he recognizes the disquieting error in his thought and frowns to himself. Blood drips across the hardwood floor as he tiptoes past her to the bathroom. He lightly rinses the cut, but stops short of a full washout, unwilling to choose sterility over the rest he has sought for hours. There are no band-aids in the apartment, so he wraps the wound many times over with toilet paper, finds a roll of masking tape buried beneath a pile of anatomy textbooks, and tears off several pieces with his teeth to anchor the bandage.

He looks at his phone to check the time—it’s a few minutes past seven and the overnight team will begin rounds soon. With his one good hand, he scrawls out a text to the surgical resident directly responsible for his whereabouts.

“Had a fall down the stairs, severe pain in back, went home.”

It’s funny, between the feigned enthusiasm during hospital rounds and this unprecedented level of fatigue, this lie about his back and the stairwell feels like the most natural thing in the world. However, a back injury doesn’t quite feel like enough, so he adds, “Cut hand on a loose nail. May need stitches. Sorry. [sad emoji].” His team will not be happy about his absence, and he may have to endure several passive aggressive remarks about “professionalism” but, hopefully, nothing more. At least the hand injury will be visible, he thinks.

Finally, he collapses in bed. Even though he catches his injured hand on the edge of the nightstand, the feeling is glorious. His limbs sink straight through to the undersurface of the mattress. Anna rolls over onto him and throws her hand across his chest. Her eyes dance wildly behind closed eyelids. He traces her thick eyelashes with his good thumb, draws a line from the spot between her eyes, up the slight incline of her broad nose, across the spit bubble cresting her lips, finally settling on the small point of her chin. She gurgles a brief slew of gibberish. Her straight black hair scratches his neck, but he resists the urge to move. He shifts her hand to the spot where his heartbeat is strongest; feels the regular quiver of her hand underneath his, until he falls asleep. 

Devon wakes around one o’clock to the smell of strong coffee. He rights himself in bed, squinting out the midday sun streaming through the Victorian bay windows. Anna is sitting at the small kitchen table in light blue scrub pants and a tank top. Her dark brown eyes dart left and right behind round tortoise shell frames, reading a travel magazine about Napa, which strikes him as a unique form of torture. She splashes a few tablespoons of coffee into a bowl of ice cream.

“Morning sunshine,” she says to him without looking up. “Want some coffee?”

“No, thanks.”

“Want some ice cream?”

“Ice cream is not a breakfast food.”

“A) It’s seasonal and handmade. And B) It’s way past breakfast,” she says, holding up the carton of honey lavender.

“Isn’t all ice cream handmade?” He rolls out of bed, sits next to her, and spoons a large scoop from the carton.

“You got home early,” she says. “I wasn’t expecting you until closer to now.”

“Yeah, I cut my hand.”

She peers over her magazine at the pink-tinted wad of toilet paper falling apart around his hand. “Right. Flesh wound?” she asks.

“Yeah.”

“Want me to take a look at it?”

“Yes, please, Dr. Kwon.”

She leads him to the bathroom. He sits on the toilet, places his palm over the sink. She unwraps the matted tissue, each unfolded layer more crimson than the last, until she reaches the wound. “Jesus, how did you do this?”

“I made the mistake of trying to run in clogs.”

“Not advised. What were you running from?”

“The soul crushing experience of medical training.”

“I know that one,” she says. “You need stitches.”

It hadn’t fully occurred to him that this part of his earlier text message might in fact be true, even though it was obvious now. “Wait, can you do it?”

She laughs straightaway. “No.”

“Please,” he asks. “I know you have some sutures around somewhere.”

“I don’t think you would make a particularly great patient.”

“At least better than average I should hope.”

“Doubtful.”

He frowns and slides his hand into her lap.

“Devon, you don’t want me to do this. First off, you need quite a few stitches. Second, it’s your hand, and if I mess it up, you’ll hate me. Third, I think you’re going to want some drugs.”

“I’d rather be here with you than spend hours waiting in the ED.”

“Sorry, not happening.”

“Okay,” he says, looking away.

“Look, I’ll clean it out for you, but then you need to go find a provider you’re not sleeping with.”

“Yeah, okay.”

“Sit tight.”

She gathers a bottle of peroxide from the cabinet, a few wads of gauze from her white coat, and a pair of surgical tweezers. She studies the wound.

“Can I ask you a question?” he says.

“Yes.”

“What do you do when you think something bad happens to a patient because of their race?”

            She tilts his hand as she considers his question. “I guess there are times when I’ve wondered that, but how do you really know?”

            “Right.”

            “Why do you ask?”

            “Just wondering.”

            “Something happen to one of your patients?”

            He pauses before he responds. “No, not one of mine. Just something I heard about, this patient they found dead in a stairwell.”

            “Jesus. Was she Black?”

            “Yeah.”

            Anna washes her hands and shakes the excess water off in the sink. “Actually, do you want to hear something strange?”

            “What’s that?”

            “I think the same thing happened a few years ago.”

            “You’re kidding me,” he says.
            “I kid you not. Also a woman, but I think she was white that time.”

            “Oh.”

            “Equal opportunity stairwell tragedies it seems.”

He wants to say something more, but the words fail him, and without looking, she touches his cheek softly as if to say, “don’t worry,” and gingerly lifts the skin back. She runs warm water through the gash for a full minute, gently tilting the wrist so the debris flows out. Then she firmly braces his forearm.

“Close your eyes and think of the ocean,” she says softly.

“Which ocean?” he asks, eyes tightly shut.

She makes a hushing sound and pours the peroxide at the split edges of skin. He grimaces but keeps his hand and arm still. She keeps pouring until the margins are clean and sterile to her liking, then methodically layers ointment, gauze, and a clean dressing. She leans his forehead to her lips and kisses him there. He folds himself into her until he can no longer feel the weight of his body against the ground. He wants to cry—he wants tears to come so fast and hard that they blur out his vision. But instead he whispers, “thank you,” stands up, and returns to bed.

 

*          *          *

 

For days, the hospital is a zoo. Television news vans become a permanent fixture at the main entrance. Portable radio towers obscure the skyline. On camera interviews for the morning and evening news block the normal rush of pedestrians into and out of the building. It’s the second patient death in a hospital stairwell in as many years. Everyone is furious. Politicians and administrators point fingers in every conceivable direction. Students and staff gossip about who will get fired. Rumors swirl about the cause of death. Devon overhears someone from the sheriff’s office claim that the patient was hiding from hospital staff, that she was a known heroin addict and overdosed in the stairwell on stolen morphine. This seems to be the most commonly accepted theory. Others say that she had a rare metabolic disorder or that she had a severe kidney infection and became septic. No single theory entirely explains what actually happened. There’s talk of new on-campus police patrols, video cameras, and electronic locks for all stairwell doors. This strikes Devon as absurd, the tiniest little trees in an awful terrifying forest.

He lives in constant fear of running into the nurse from the ICU. Can’t walk down a hallway without turning to look back. He knows he shouldn’t have left her there, and he imagines “Wanted” signs going up with his face plastered on the hospital corridors until they find him. Then the parade of performance committees, counseling services, meetings with the deans.

But the days go by, and the memory fades from view. No one mentions him, the medical student who ran away from the barely cold body. He’s convinced himself of this at least—that she was dead when he found her, with no way to undie.

In his free moments between patients, he scours the internet for information about the dead woman. Her name was Tanya Johnson and he knows that she was twenty-seven years old and lived in the Fillmore district, but he can’t find out anything else about her. The stories trail off quickly after the initial frantic outburst. By the end of the week, the cameras and vans fade away and everything seems just as it was.

Everything except his hand. The wound did well the first few days but hit a plateau, and now he cannot grip a pen or type on a computer without considerable pain. His team has been remarkably accommodating, so he doesn’t complain. The resident he’s working with has given him half the normal load of patients to round on. Others offer to hold everything and anything for him: backpack, food trays, EKG graphs. Their attending takes particular joy in ducking down to the floor and demonstratively holding up his patient notes to Devon’s face for him to read, as if impersonating a sheet music stand. This carries on for three days. Everyone laughs obsequiously each time.

Anna’s schedule and his have not overlapped since the few hours that afternoon, so hiding the fact of his neglected wound is straightforward. That is, until exactly one week after the incident, when the occlusive bandage loosens, and an equivocally foul smell begins to emanate from his palm. In the early evening at the end of his shift, he plunks down on a bed in the call room and reinspects the damage. There’s a yellow film across the surface of the deep fascia. He’s not sure if it’s normal granulation tissue or something more ominous. This has gone on too long, he thinks. Reluctantly, he takes the elevator to the first floor and makes his way to the emergency room entrance.

At first, he loves the comedy of queuing the line to triage, hospital gear and badge in full display, obviously on the wrong side of the admitting window. But nothing is funny after three hours in the waiting room. He’s already texted Anna that he has to stay late, that she should eat dinner without him. After another hour, he’s parked on a gurney in the middle of a busy hallway. He catches a glimpse of himself in a mirror at the end of the hall. Bags of skin pool under his eyes and his normal color is faded, like he hasn’t seen sunlight in days, which is probably true. He wonders if the reflection is accurate or distorted. Finally, he’s escorted back to a narrow patient stall, flimsy privacy curtains with faded sunflowers on either side of the bed. His face drifts into his hands.

Another half hour goes by and then a medical student named Frank in a short white coat exactly like his own pulls the curtain aside to introduce himself and take a brief history. Despite Devon’s outfit, Frank fails to acknowledge that Devon is also a student, and Devon wonders if Frank thinks he has acquired this clothing through illegitimate means. As the conversation runs its awkward course, a nurse backs into the stall next to Frank, with a pile of tools in plastic sterile packaging packed high in her arms. At first, Devon is relieved to see her, assuming she is there to keep Frank from further maiming his hand. But then she turns, and he realizes it’s Claire, the nurse from the stairwell. They share a look of recognition and dismay. He is surprised to see her here, and not in the Intensive Care Unit.

“Oh, hi there,” Claire says.

            “Hey,” Devon returns with forced cheer.

            “So, here you are.”

            “Here I am,” Devon says, opening the palms of both hands.

            Frank looks puzzled but keeps his mouth shut. Claire nods, then asks Devon how he sustained the injury. He considers telling her the truth, but instead he replies, “So I was running from a crazed pack of premeds…” All three laugh politely. Devon exhales.

Claire lays out a large blue and white pad on the edge of the bed next to his hand, rolls a portable spotlight alongside the bed, and quietly goes to work, carefully undoing Anna’s excellent, though expired, bandage. She takes a minute to examine the wound under the light. “This doesn’t look infected,” she says. Relieved, Devon leans back in the upright bed and concentrates on the row of track lighting, trying not to care about what is happening to his palm. Claire and Frank reclean the wound and set up a small steel tray for their supplies. Frank does nothing unless Claire tells him to, which is further relief to Devon. Part of him wonders if an attending is available, but the other part of him knows better than to ask. He seems to be in experienced hands with Claire.

She anesthetizes the area with lidocaine through a small needle. The pain catches him off guard, even just three short sticks and he is literally howling. He tries to laugh it off gently, like a bemused wolf.

“Sorry, dear,” Claire says. He is surprised by her use of the word “dear.” “Palms are always sensitive,” she adds. “Should be okay now, though.” They give the anesthetic a minute to set up and then Frank gets started.

It’s not okay. Two stitches in and the pain is searing. He can’t hear, he can’t think, he can hardly see straight. He doesn’t say a word, but he’s hyperventilating, and tears are pouring out of his eyes against his will. Every turn of the needle driver feels like a small act of torture. To Frank’s credit, his technique seems fine. An even row of simple interrupted stitches. None are too shallow and the spacing of the throws looks good. Frank stays remarkably calm and waits patiently for Devon’s signal between each stitch. But it’s as if the numbing medicine has done nothing at all. He tries to imagine childbirth or a heart attack or the dead woman in the stairwell or the hundreds of things undoubtedly more painful in a lifetime than this. It’s not enough. Was this a sign of infection? Or karma for the woman in the stairwell? As Frank continues, Devon turns his head into the pillow to muffle low-pitched wails. He claws at the mattress until tufts of cotton begin to pull through the seams.

They are only a third of the way through and Claire suggests they take a break.

“Do you have any music on your phone?” she asks. “That can really help sometimes. Just play something relaxing.” She walks away but then returns shortly with presumably the attending physician responsible for him. She is a young woman, just five years or so older than Devon, if he had to guess, with radiant long blonde curly hair that catches the overhead light and temporarily blinds him. Claire whispers something into her ear and the woman responds, “Keep going, close it up.” She smiles neutrally at Devon and walks away. It’s not clear to him what was discussed.

Devon fishes out a cheap pair of earbuds from the pocket of his fleece and plugs them into his phone. He takes a few breaths in anticipation of the next round. He sets an internet radio station to classical, turns the volume up, and motions for Frank to proceed. He closes his eyes. The music changes almost nothing at all except now there is an ominous background of one of Beethoven’s sonatas as the soundtrack to his muted cries. He tries to remember if he had ever learned this song when he used to take piano lessons from an elderly Liberian woman as a child. He pictures her taking his hands and setting them in place to form difficult chords. For a moment, he is completely distracted by that half-apparent memory. But the pain rushes through again. He screams. Claire announces another break and runs off.

“Sorry this hurts so much,” Frank says, then stares sheepishly at the stainless steel instruments, reordering them slowly into single file. A few minutes later, Claire returns again with the attending. Devon releases his death grip on the bedding so that he can turn his body to face her. Claire and the woman whisper back and forth, as Frank looks down at his gloved hands.

Then Devon realizes what they’re talking about. They’re trying to decide whether or not to give him pain medicine.

“This is a lot of pain for him,” Claire whispers urgently.

Devon hadn’t thought to ask for it. He should have, he should now, but he won’t. Does she not believe he’s in pain? He’s not there to get drugs. He’s a med student. He stares at the attending, silently. She stares back at him. Finally, she relents.

“Okay, five of morphine,” she says to Claire, and walks away.

Claire hurries to get the medicine and, upon returning, starts an IV, and pushes the medicine through.

“It’s not so much that it takes the pain away, but more like it kind of makes you not care so much,” she says.

The sense of ease rushes through him. Frank continues on with his work, but Devon is entirely uninterested. Claire was right. The relief is so strong, it feels like it’s leaking out from his marrow. He resolves that he should never try heroin. He wishes Anna was there to hold him. There’s a slight slur to his words and he begins to tell Claire about Anna. Of course, she already knows her from years of emergent deliveries. They laugh about the way Anna giggles when she gets really angry. Claire rubs his shoulder. Frank looks relieved.

Devon closes his eyes and drifts off to a coastal shoreline. He knows it’s not San Francisco, because the sun is rising fast over the ocean. He walks through a dark green low tide. He can’t see the bottom and the step-off is steep. Now he’s floating on his back. He dips his hands underneath the surface. Cool water rushes through his fingers. He drifts steadily away, until he can no longer see the shore, until there’s nothing but aimless waves and darkening sky. He thinks again about the woman in the stairwell. He wonders if this is a feeling that she once knew.

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