Medical Ingenuity

I’ve got nothing to do, and I’m too nervous to sleep, so I end up driving. Sergei’s SUV is still dead, and he’s staying with me and Maggot Arm Joe, for reasons of his own. I’m guessing trust is eroding here, and none of us will talk about it. I’m still mad that they want to deal with Fudge, but no money’s shown up as a result of my plan, either. On the way over to the experimental clinic, which is down by the city’s storage yards by the old railroad tracks, Sergei starts talking about Harry Fudge and the lists we are, maybe, going to sell him.

“I think tonight I talk to Mr. Fudge,” Sergei says. “Get best deal.”

Maggot Arm Joe says, “Best deal how?”

“Bluff rich man into better price.”

Maggot Arm Joe laughs.

“What?” Sergei says.

“Dude, you couldn’t bluff your way out of a kindergarten game of Go Fish. You are so easy to read.”

“This not true.” Sergei seems surprised and hurt.

“Tell him,” Maggot Arm Joe says to me.

I try to think of a nice way to let Sergei know that his emotions are as bold and awkward as a drag queen doing Joan Crawford. “You’ve got a pretty bad tell,” I say.

He looks confused.

Maggot Arm Joe says, “A tell—a tic or series of tics that tip everyone off when you’re about to bluff.”

“This not true,” Sergei says. He pauses. “Nick Ray—this tell—when do you see it—where?”

I decide to tell him the truth. I take my right hand off the steering wheel. “You tip your index finger up and down.” I’m still wondering how it became decided by these two that we were dealing with Fudge. I sure as hell didn’t sign off on it, and if they think it’s been decided, they’re way off base. Then it hits me that maybe they have decided—behind my back.

“Can keep hand in pocket,” he says. “Keep hand under table—around cigar.”

Maggot Arm Joe says, “You can’t keep your eyes under the table. The man might think it was strange.”

“Why didn’t you tell me about tell?” Sergei says.

“Because we win money off you,” I say. “You never tell your opponent about his tell.”

“What do I do with eyes?”

And I want to say what don’t you do with your eyes, but I’ll keep it simple. “You twitch them,” I say. “A lot. Around the eyelid, into the right cheekbone.”

“You’re like a fucking contortionist,” Maggot Arm Joe says.

“Something must be done,” Sergei says as I turn off Oregon Avenue, and curve around what used to be the Los Angeles River before they cemented the whole thing in about a quarter mile west of here. I park in a dirt-and-gravel lot near the clinic.

When I get out of the car I think about how this used to be a river, the ground I’m on, and it’ll someday probably be a river again. You can nudge nature, but you can’t control it. The next big earthquake, the cement riverbed will pop loose and the river will come right back to Oregon Avenue, where it was a hundred years ago.

And that next quake will come. We all know that here, we just don’t talk about it much. We’re in what seismologists call a “seismic siesta” and the next one might rock and shake the world enough to make future generations wonder just what the hell people were thinking when they plopped down five hundred thousand bungalows dead center on the fattest fault line on the continent.

I ask Maggot Arm Joe if he’s excited about the arm getting unwrapped.

“Don’t want to get too excited,” he says. “Could still be bad news.”

“Then what?” I say.

He shakes his head. “Got me. Surgery, I guess.”

Inside we meet Maggot Arm Joe’s doctor, who insists we call him Arlo and not Dr. Gonzales because Dr. Gonzales is so formal and Arlo just can’t stand formal people. He invites us into the examination room, and I say no, but he presses and Maggot Arm Joe doesn’t seem to care, so we follow them in. Sergei and I sit in these little chairs against the wall while Maggot Arm Joe hops up on the high padded table and starts to unbutton his shirt.

“So,” Arlo says to Maggot Arm Joe. “How have we been feeling?”

“Not bad,” he says, and takes his shirt off. I see the gauze wrap on his arm and get a greasy feeling when I realize he’s had those maggots eating his flesh for weeks. “A little itchy.”

Arlo nods. “Of course. But no fevers? No surface heat?”

“Nope.”

“Good,” Arlo says. “Now let’s see what our little friends have been up to, okay?” Arlo puts on a pair of medical gloves and uses those dull-end stitches scissors to cut the white tape. After a couple of snips, the tape and the gauze flop away, still bent and elbow-shaped, to the floor. Arlo’s back is blocking my view of Maggot Arm Joe’s wound.

Arlo says, “Nice. Nice. Very good.” He turns back to me and Sergei. “This is amazing, really. Years ago, this would have been a gruesome operation. Cutting into live muscle. Very painful. Very hard on the patient.”

I’m wondering how this isn’t gruesome, but I let it pass.

Arlo picks up the gauze wrap and says, “They’re all near death. Very slow, very sluggish.” He looks back to the arm. “Here, too—very sluggish.”

“So?” Maggot Arm Joe says. “No surgery.”

“I should say not,” Arlo says. “Thanks to our friends.” He takes out a blue curved dish and what looks like a paintbrush and starts swiping up and down the arm. Maggot Arm Joe looks away.

Arlo says, “Just another minute. Then we’ll get some ointment on there for the itch.” He sweeps the arm a few more times, then scrapes the gauze wrap into the blue dish and turns with the dish toward me and Sergei. He carries it over and holds it in front of us. He says, “There we go.”

Inside the blue dish are a bunch of plump maggots that are as yellowed as old newspapers left in the sun. Most look dead. A couple of them move with very slow pulses of their entire bodies.

“Isn’t that something?” Arlo says. “Medicine today, gentlemen—it’s quite something.”

“It is,” I say.

I walk over and take a look at Maggot Arm Joe’s arm. The inside of his arm looks like someone took a chunk of it out with a mellon bailer. There’s a big recess, and the skin’s all slick, it catches the light, shiny as a latex miniskirt.

I say, “So that’s healed? That’s how it’ll look?”

Arlo says, “That’s close. Some muscle will fill back in. But when you destroy muscle, you change the shape of the body.”

I look down at the slick recess in his arm.

Maggot Arm Joe says, “It’s not so bad.”

“You are a lucky man,” Arlo says. “Medical ingenuity—there should be a thank-you section in Hallmark for medical ingenuity. The scars that a surgery would have left in that beautiful arm of yours would have been just savage. There would have been a big ugly hole in that arm.”

I look down at what looks like a big ugly hole in his arm.

Arlo says, “The man that invented local anesthetic—you know how he proved how it worked?”

“How?” I say.

“He operated on himself. Took out his own appendix and filmed it. I have a still photo of it.” Arlo goes into an adjacent room and comes back a moment later with a framed grainy black-and-white photo of what looks like a man slouched over with his shirt open sleeping off Thanksgiving dinner—but when you look closely, you can see he’s cut himself open and he’s carving around inside of himself.

“Gruesome,” I say.

Arlo shakes his head. “Not gruesome. Medical ingenuity. That’s what you’re seeing there. What a profession—it’s a blessing, I tell you, a blessing to do what I do. To be in such a blessed profession.”

Sergei says, “Is there something medical ingenuity could give to someone with tic?”

I hand the photo over to Maggot Arm Joe, who looks at it, winces, and places it facedown on a countertop.

“Tic?” Arlo says. “Like Lyme disease?”

Maggot Arm Joe says, “I think he means a facial tic.”

Arlo says, “I see. You mean to stop the facial tic?”

And I’m thinking does he have anyone who wants to increase their tic?

“Yes,” Sergei says. “To stop tic.”

“There is something relatively new—something quite wonderful. It’s called botulism Toxin A.”

“Toxin?” I say.

“It’s the toxin that causes botulism,” Arlo says.

“Doesn’t that kill people?”

Arlo taps his temple, points at his diplomas. “Dosage, dosage, my friend. Proper training. Medical ingenuity, you see.”

“It stop tic?” Sergei says.

“It would,” Arlo says. “Would you like to make an appointment? I’ll need your medical records sent over in the interim.”

Sergei shakes his head. “Need to stop tic today. Give me your botulism.”

Arlo says, “It’s not possible. This is a state-run clinic. There are rules. There is paperwork.”

“Give hundred dollars for shot.”

Arlo chuckles. “I’m afraid that’s not possible. This is a state-run clinic.”

Sergei says, “I give five hundred. All I have.” I see his twitch and realize he’s carrying more than five hundred. Any five-year-old could read his tell and I don’t suppose Arlo has missed it.

Maggot Arm Joe says, “How much money would it take for my friend to benefit from your extensive training and medical ingenuity?”

There’s a pause. Arlo puts down a pair of shiny scissors and they clang lightly on the metal tray.

“Two thousand,” Arlo says, and points to me. “And I’ll throw in an ointment for his face.”

“We have deal,” Sergei says. He hops up on the table in the center of the room. “Let us do this.”

Arlo stands by his desk. “Not that I don’t trust you,” he says. “About the matter of payment.”

Sergei shoves a hand deep in the pocket of his leather pants. “Yes, yes,” he says, and counts out two grand in hundreds. While his money’s still out he gestures to me and Maggot Arm Joe. “How much for friends?”

Before Arlo can answer, Maggot Arm Joe says, “Fuck that—no way the man’s shooting me full of botulism.”

“Oh no,” Sergei says. “Man has maggots in arm but doesn’t want a little shot.” He shakes his head. “Nick Ray like to fix face?”

I tell him no, I’ll stand pat.

Sergei gives Arlo the two grand, sits back, and closes his eyes. Arlo goes into his cabinet, gets a little bottle with the rubber top. He pulls some fluid back into the syringe and walks up to Sergei. “Now this’ll be a bee sting.”

Sergei opens his eyes, winces, as Arlo injects a series of shots, skin popping, put in at an angle in a skin fold, like people do when they’re afraid to shoot into veins, under the skin all along the hairline. When he’s done there, he injects one shot in each of the crow’s-feet around Sergei’s eyes. Blood seeps from every injection site.

Arlo says, “That’ll do it.”

Sergei smiles. Frowns. Smiles. Frowns. It looks like he’s doing community theater and the director’s saying Happy-sad-happy-sad. He says, “Can still move face.”

“Of course you can,” Arlo says. “It’ll take five days for the poison to be fully absorbed.” He pauses. “This is muscle tissue we’re talking about.”

“Need new face tonight,” Sergei says.

Arlo shakes his head. “It’s not possible.”

Sergei stands, he hovers over Arlo. “You fix,” he says. “Need no tic by tonight.”

“Sir, please calm down,” Arlo says.

“Give back money,” Sergei says.

Arlo says, “There is something I could do.” Sergei stops leaning into Arlo. “But it’s rather unusual.”

“It fix tic by tonight?” Sergei says.

“It could.”

“Then do it.”

Arlo tells us that a combination of a higher, though still medically prudent, dosage and some minor electric stimulation of the facial muscles could do the trick. He reinjects Sergei’s face; from the looks of it, he’s tripled the dose. I wonder how much of this toxin a person can take before it causes botulism.

“Electromuscle stimulation,” he says. “You’ve, no doubt, heard the benefits for weight loss, for sports medicine. You electronically stimulate the muscle thousands of times—hundreds per minute—over and over and it’s like doing exercises without effort. It’s quite ingenious.”

Arlo starts hooking little wires, small, like they’re from the crystal radio sets I built as a kid, onto Sergei’s face. He tapes them down with clear tape. There are two wires up near Sergei’s forehead and two more on the upper cheekbones. The wires connect from Sergei’s face into a small metal box that looks like the power station for a toy train. It has a circular wheel on it, like a volume knob, and when Arlo turns it to the right, Sergei’s face jolts wide open like a flower. Arlo turns the knob all the way up and flicks a toggle switch. “This will set it on a high pulse,” he says. “We’ll try it for five minutes, and we’ll see how we’re doing.”

Sergei grunts every time the pulse makes his face open and big and he sighs a little every time the charge expires and his face relaxes. Every time the charge hits, his body goes rigid, like he’s in an electric chair. Every time the charge ends, his body slumps down.

Ugh. Sigh. Ugh. Sigh.

It looks like a special effect, like it’s not a real human face that’s expanding and contracting in front of me. I look at Maggot Arm Joe and he shakes his head and looks away. Sergei looks at me, he’s keeping his head straight, so he has to look from the corners of his eyes, and he holds out his hand. I don’t move. He gestures for me to come over. I walk over to him, and when I get close, he grabs my hand and holds on tightly. I see now there are tears in his eyes and his hand clamps down on mine whenever the charge hits him.

“I think you better turn this off,” I say to Arlo.

Sergei shakes his head.

I ask Arlo how much longer and he tells me a minute and a half.

And so, for the next minute and a half, which seems like much longer, I feel the rhythmic pulse of Sergei in pain in my hand when he clenches and unclenches and Arlo sends his charge through Sergei. When it’s over, Sergei collapses back onto the table. He lies there, catching his breath, for a minute, while still holding my hand. He takes his hands from mine and I feel the air, cool where his sweaty hand was.

Sergei rubs his chin. He touches above his eyes and his cheekbones. “Yes,” he says in a strange, dulled and slurred voice. “That much better, I think.” He rubs some more.

“Face hurts,” he says. “Hurts much.”

“Of course it does,” Arlo says. “It’s like your face just did two thousand sit-ups. It’ll be sore for a while, but that tic of yours should be a thing of the past.”

“For how long?” I say.

“A normal dose of the toxin’s good for six months,” he says. “This is a first—no way to tell how long this will last.”

I look at Arlo and wonder if he’s even really a doctor. But then real doctors cut off the wrong leg. Real doctors fuck up, too. A kid I knew in high school died on the table while they were taking out his tonsils. Arlo did fix Maggot Arm Joe and he seems to have locked up Sergei’s face. Arlo pats me on the back as he follows me out of his exam room.

Sergei tips Arlo $500 as we leave his office. In the parking lot, it’s dark. Even though the weather’s beautiful, the winter depresses me, no matter where I am. The sun goes down at 4:30 this time of year. Too much darkness too early. Winter reminds me of when I had a family, when I had a life. New Year’s Eve celebrations remind me of another year wasted. Nothing good happens in the winter for me. It’s a time to get through.

Sergei moves his jaw back and forth. I ask him if he’s okay.

He nods, but doesn’t talk.

“Can you talk?” I say.

“Hurts to talk.”

I give Sergei one of my Percodans. Maggot Arm Joe sees them, but doesn’t say anything. Sergei pops the pill.

“Can you eat?” Maggot Arm Joe says.

Sergei says yes.

“Want to hit the Colonial for the manager’s fat-ass special?”

The Colonial is Sergei’s favorite place. It’s all you can eat, which Maggot Arm Joe calls the manager’s fat-ass special. The food’s pretty bad, but you can get a ton of it. It’s better, I suppose, for meat eaters. All I can get there is a ton of starch that’s usually mixed with cheese. I spend most of my time picking what looks like bacon from what might be green beans. But this offer is Maggot Arm Joe being nice, saying thanks in his way for Sergei subjecting himself to this poison, and I’m not about to say no.

“Would like that,” Sergei says. He looks like a zombie, like Yul Brynner in Westworld, stiff and awkward and without emotion as he wreaks havoc on everything in his path. Arlo’s treatment worked—you can’t tell what Sergei’s thinking anymore and I realize this could hurt us as well as help. It’s creepy, his lack of facial gestures. He’s like a ventriloquist’s dummy—his mouth a slit that opens and closes. He gets in the backseat and closes his eyes as I pull out of the lot, the tires popping and crunching warmly over the gravel and loose dirt.