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  Trouble

  Jesse Kellerman’s debut thriller wowed the critics. His latest sets the bar even higher.

  Young, idealistic, and overworked, Jonah is living the lonely life of a medical student in New York City when he accidentally stumbles across a murder in progress: a woman, being stabbed to death in the middle of the sidewalk. Without thinking, he rushes in to protect her-inadvertently killing her attacker in the process.

  Thrust into the media spotlight, crushed by guilt, Jonah quickly learns that heroism isn’t all it’s cracked up to be. He receives a shower of unwanted attention-and hostility-from his superiors. The district attorney wants to "interview" him. The family of the dead man wants revenge.

  Everything is further upended when the woman whose life he saved shows up at his apartment. What begins as a thank-you drink turns into a wildly passionate love affair. As their relationship deepens, however, Jonah realizes that she isn’t quite the woman she appears to be. His nightmare has only begun, and the price of kindness will turn out to be higher than he could have imagined.

  TROUBLE

  Jesse Kellerman

  Copyright © 2007

  by Jesse Kellerman

  Dedication:

  To Gavri

  Epigraph

  She spread a salve to soothe his aches

  He suffered from its bitter taste

  THE BOOK OF ODD THOUGHTS, 5:7

  ONE

  SURGERY

  • 1 •

  THURSDAY, AUGUST 19, 2004.

  COLORECTAL SURGERY, WEEK ONE.

  Jonah Stem heard a scream.

  HE WAS WALKING to Times Square at two forty-five in the morning to buy new shoes. The staid, sturdy Rockport Walkers that had survived two years of theoretical medicine had finally succumbed to its uncontrollably runny realities. Befouled beyond repair, they made a squishing noise and left a trail, like overgrown snails. Salient among the novel qualities they had come to possess was the stink of human shit.

  Shoes were shoes. Their destruction didn’t bother Jonah per se, except that it acutely underscored his own incompetence—something he didn’t need to be reminded of these days, with people lining up to do it for him.

  For this mess, as he did generally, Jonah blamed himself. He knew the rules; he’d read the Book, heard it from the Ghosts of Third Year Past. Once your day was over, the only safe strategy was OTD—Out the Door—ASAP. If you lingered and got caught, you were SOL. Particularly on surgery. Surgeons—surgical residents, rather—didn’t especially care that your day had been over for twenty minutes. (Attendings didn’t especially care about you at all.) When they needed you, you went. The best way to avoid being needed, then, was to get out of the building supersonic fast.

  Instead he’d dawdled. He had twelve weeks here; it paid to take the time to learn his way around. Asking too many questions—even innocuous ones like Where are we meeting or Where’s the bathroom—made you look unprepared. It primed the pump for getting pimped, because while the Gods of Surgery might forget your name, forget that you had other obligations, forget that you were a person with a beating heart and an independent will, They always, always remembered your weaknesses. They took note of who copped to ignorance, and on that person They pounced, eager to impart Their full-tilt no-holds-barred balls-to-the-wall medical pedagogy until he sobbed and sniveled like a little pants-wetting baby girl.

  Jonah liked hospitals at that hour, the alleged end of the workday, when patients finished their early dinners and settled in for TV and Toradol and complaining. Midtown–St. Agatha’s—a thrumming snuffle-upagus of sterile linoleum, wheelchairs, high-rising paperwork, hypoallergenic pillowcases, accident victims, cancer victims, moans, kidney stones, sample closets, graywater mop buckets, insurance fraud, viruses, bacteria, prions, fractures, lesions, lacerations, nociceptors firing and relaxing—took a breath. A place like St. Aggie’s was never truly silent, but like all large medical institutions, it seemed to hiccup at around six thirty P.M., granting an illusion of peace; an idea of what peace might be, if you weren’t imprisoned in a goddamned hospital.

  He meandered varicose corridors, shucking the stickiness, the soreness, the self-pity. He was here to learn. He was going to be a doctor; he spent years toiling to earn the right to be so abused. He had taken college courses and review courses. He had spent hours glued to books, had bushwhacked the MCAT and pummeled the Boards. All to get here. Finishing work feeling like a used condom was a privilege. Who cares about the antiseptic smell; the harsh, bluish lights; the overenthusiastic pastels, like chunks of Miami air-dropped smack in the middle of Manhattan. He felt better, and then there were fingers snapping in his face.

  “Hello. Are you there.”

  This was how they were. You accepted it or you dropped out. You found ways to cope. You imagined yourself in a different milieu—say, at a party—where you had the asshole in question beat by at least thirty yards.

  You totted up your victories. One: hygiene. Residents didn’t get out much, and this one in particular suffered from excess cerumen production, which two years ago Jonah would have called by its more descriptive, real-world name: a Colossal Avalanche of Earwax. Advantage, Stem.

  Two: style. The resident’s spreading waistline had succumbed to an infestation of beepers and PDAs, phones and Blackberries, making him look like Batman minus the pointy ears and award-winning physique. Advantage, Stem.

  Three: charm. Obviously, he had that locked up; look at the guy, poking him in the arm and ordering him downstairs with that imperious smirk, advantage, St—

  “Stop staring at me like you’re deaf.” The resident’s badge bounced as he gesticulated. His name was BENDERKING DEVON PGY-2. He had a harelip, currently twisted into a sneer. “I know you can hear me.”

  “Sorry.”

  “We need hands.”

  Jonah loved that. The rest of his body, including his brain, was irrelevant.

  His shift was long done; he didn’t belong to Benderking’s team; he needed to get home for his four hours of sleep. But this was his third day on the service, and he wanted to make a good impression; so he smiled and said I’m there and jogged along toward the OR. Unless a doctor asked you to wash his car or fellate his poodle, you did it, and you did it with love.

  As they hurried downstairs, Benderking gave him the essentials: Caucasian F 37 stomach pain. After an unattended hour in the ER, the nurses find her flailing around, tachycardic, hypotensive, pushing 103°, respiratory distress, distended. Eighteen months status post gastric bypass, she had experienced a weight loss of one hundred and twenty-five pounds plus. Like setting a person down after a twenty-year piggyback ride.

  Through the double doors and there she was: loose skin flapping, the skin she no longer fit, a drab pink wedding dress she could not remove.

  The room was madness, everyone running to prep as they waited for the surgeon, pausing only to engage in the choicest OR pastime: yelling at the medical student. Jonah fetched a gown and gloves, and the scrub nurse yelled you contaminated it, get another, even though the items were still sealed and sterile, as though he was uniquely, grotesquely infectious. He shuffled to and from the supply room, dutifully shlepping another gown, another pair of gloves.

  Into this squall sailed a gray-haired, gray-skinned, epicene man in his sixties: Gerard “The Slice” Detaglia. He wiggled his pianist’s hands and said, “Shall we dance?”

  Scrub-in. Detaglia buffed each side of each finger with five strokes from a Betadine sponge. This behavior—carried out with a priest’s solemnity—marked him as decidedly old school; surgeons under forty favored instead a quicker but equally effective chemical rub. But Jonah wasn’t going to make the same mistake as yesterday, when he’d used the rub while the surgeon sponged, and the rest of the team shot hi
m a look of horror, and he instantly gleaned that he’d screwed up.

  They were everywhere, these laws that nobody told you about but that ensured a beatdown when you broke them. Which you did. You couldn’t help breaking them. Nobody had told you about them.

  The guiding principle of medical education was that people learn best under threat of mortification.

  Standing at the back of the line, waiting for his turn at the sink, Jonah reflected that there was truth to this proposition. As soon as he’d committed the scrub faux pas, a new rule—do as the surgeon—had automatically appeared in his brain, produced by the same mechanism that spurs skunks to spray, anemones to contract, birds to wing at the sound of a gun. He knew; and he wouldn’t mess up again.

  The Gods of Surgery were jealous and punishing, and he had sinned. As a third-year, he could not be expected to do much more than suture, retract, suction. Like any apprentice, his real purpose was not to help but to validate the hierarchy. As every doctor before him had suffered, so must he.

  The team backed into the OR, hands elevated and dripping. The scrub nurse passed out towels to Detaglia and the residents, leaving Jonah to fend for himself. In the end he didn’t have time to find one, and was still wet when they gowned and gloved him, leaving him squirmy and humid inside two layers of latex.

  “Medical student.”

  Another way they kept you in check, by never using your name. Obey unthinkingly, Nonhuman. In this case, the scrub nurse was giving him the light handle covers and saying Get on with it already.

  He obeyed.

  Strangely, surgery went much faster with the stereo off. Detaglia dove through skin, fat, muscle; he commandeered his nurses like a pasha; they moved at his bidding and flirted shamelessly. After an hour of retracting, Jonah’s forearms blazed with pain. It’s worth it, you’re going to be a doctor, Doctor Stem, Doctor Doctor oh Doctor, Christ it hurts it hurts stop shaking everyone is looking at you. They weren’t, of course; they weren’t paying any attention to him. He had to stop thinking this way. If he was going to make it through the year—day three—he’d have to thicken his skin. He had never been the hypersensitive sort—at least, he didn’t think so—and this was the wrong time to start. He tightened his grip.

  The patient’s innards bulged in the wrong places, embarrassingly so, and prying her open felt intrusive, like barging into someone’s bedroom before they’ve had a chance to pick up their underwear. As Detaglia worked, Jonah thought of the scene in Raiders of the Lost Ark when they spring the Door Best Left Alone and everyone within a mile turns to fondue. He forced himself to look. Get in there, see what’s going on, you can’t learn unless you stare it straight in the face. Many of his fellow students—had they bothered to listen to Benderking—would have checked out mentally by now. But Jonah had a strong, almost Victorian sense of Duty, and having committed to being in the room, he intended to be there. It was disgusting, but that was life, sometimes you did things you didn’t want to do. He was further gripped by the notion that he’d paid tuition for this, and dammit if he wasn’t going to learn. He wanted to barf. He blinked. Look.

  As he leaned forward to observe the incision, the peritoneum burst, and a blast of bloody guts spilled across the table, his chest, the floor, his—

  His shoes.

  He looked down. In his haste, he’d forgotten to don booties.

  The Slice sighed and said, “Oh, heck.”

  The organs Jonah knew from books and labs were robust, smooth, warm. This lady’s reminded him of a Brunswick stew; they resisted categorization: poking through, tearing, melting. She leaked. Shit and bile and cells, all curdling in a vile juice. The terminology Jonah used to organize the situation—acute mesenteric ischemia, bowel infarction—did not capture its true disorder, as her shocked body ceased to respect its God-given blueprint.

  And she hemorrhaged. Blood slickened the floor. The circ nurse mopped like a fiend, snarling at Jonah to express her displeasure. Medical student would you get out of the goddamned way. Medical student please lift your goddamned leg please. I’d like to pick that up medical student but I can’t because you’re in my goddamned way.

  He contorted to accommodate her, struggling not to lose his grip.

  Worst of all was the smell; the body gave off gas like a downed zeppelin. The stench reminded him of a frathouse, Sunday morning circa ten thirty A.M. The sheepish, post-bacchanalian miasma of seemed-like-a-good-idea-at-the-time: putrid meat and stale flatulence, comically magnified. To prevent himself from passing out, Jonah focused on the irreparable damage done to his shoes.

  It took five hours to remove eighty percent of her intestine, which came out black and kinked, like a harvest of seaweed. When Detaglia revascularized the little that remained, the tissue flushed pink, the cardinal color of life rushing to reclaim its seat. Jonah was impressed. Everyone was impressed. The Slice was known as a clutch hitter, but this was special. Assuming she did not die overnight, the patient might go on to lead a full and rewarding life. With a colostomy bag.

  “Well,” said Detaglia, glancing at the red biohazard sack, heavy with guts, “she wanted to lose weight.”

  By the time Jonah had ditched his scrubs, it was half past two. Rounds began at six A.M. If he went home, he’d get at most ninety minutes of sleep before having to hop back on the subway. He should have asked for the day off but considered it gauche, not to mention spineless, to start taking liberties with his schedule after three days on the job.

  The thought of being on his feet for another eighteen hours—in those shoes—made his skin crawl. This was New York, though, capital of late-night solutions.

  He hit the street.

  It was hot out and he could hear traffic skating the West Side Highway. Except for the hospital, Eleventh Avenue above 50th consisted of auto dealerships proffering luxury vehicles unsuited to Manhattan life. Above the locked-down driveways of body shops, broken windows glinted scaly and blue-black, fish netted in an oil spill. Near the pile of dirt and pigeon waste that was DeWitt Clinton Park, someone had left a toilet—tank, bowl, the works—out on the sidewalk like a Dadaist sculpture. He gave it a title: My Life Is Poop.

  The moon was stingy; the streetlights weakly flickering.

  THAT WAS WHEN he heard the scream.

  Coming from 53rd Street, it had an operatic quality: a pure, shrill, hellish beauty.

  Following it around the corner, he saw a woman on all fours. Behind her stood a man in a flaccid overcoat several sizes too big. He seemed in no particular hurry, slumped casually against a Dumpster, watching her crawl away.

  oh my God he stabbed me

  Despite the pressing heat, she was dressed in a down jacket and dark stockings. She jerked like a windup toy, listing to avoid her left hand, her left arm dripping with dark black blood. Screaming and screaming and screaming. The jagged hull of an adjacent demolition site reflected her voice at unexpected angles.

  please help me

  please help me

  please help me

  She looked straight at Jonah, her face incandescent with fear, striped by swinging hair, a pale sheet of need. Help me help me.

  She was speaking to him. Help me.

  Later he would come to understand that most people would have walked away. A few would’ve called the police and waited, watching from a distance. But to Jonah the situation presented itself quite differently. What he saw was the man, the woman, the moon—and he felt not only disinclined to leave but an overwhelming obligation to stay, as if the woman’s voice—help—was in fact the voice of God, funneled and filtered and broken but no less imperative: a moment chosen for him.

  And he was going to be a doctor.

  He did not think.

  He ran forward, waving his arms. Hey.

  The man glanced up and immediately reconfigured himself in agitation: shifting from foot to foot, rolling his shoulders, scratching at a tangled beard and tugging gnarls of incoherent hair. He muttered to himself. Shirtless beneath the coat, its sl
eeves dangling past his hands, making him look childish and lost. Jonah recognized the man’s state; he knew it intimately, embraced it regularly; and he felt a wash of calm. He knew what to do.

  He said Please look at me.

  The man looked at him.

  Jonah said Nobody’s going to hurt you.

  I’m dying screamed the woman.

  Without turning around, Jonah said to her You’re going to be okay.

  dying

  dying

  I’m dying

  Can you do something for me? Mister? Please. Take a step back.

  The man grimaced with impatience, like Jonah had jumped a cue. He sidestepped and Jonah stepped to match him.

  Okay, hang on. I don’t want to—

  The man tried a second time to go around him, and Jonah came forward—

  —listen I don’t want to nobody wants to

  and everything accelerated.

  Hair and heat and suffocating body odor; a wrenched limb; down; the ground; and then, for the second time that night, Jonah bathed in a great deal of blood.

  • 2 •

  “PLEASE DON’T take me back to the hospital.”

  “Back?”

  Two EMTs stood over him. One checked his pupillary response while the other asked if he knew his name, the date, the president.

  He said, “I have a concussion.”

  “You sure do, Mr. Smarty-Pants.”

  “Ow. Ow.” He jerked his elbow away.

  “C’mon, honey, be good.” The EMT held up a piece of gauze, orange with iodine. Jonah relented. He couldn’t see the size of the scrape, but his entire arm beat with pain. More gauze; ripping tape. Then the ambulance door opened. Red light and radio crackle. Quiet. He was alone.