The Hyfrecator (and Other Marvels of Modern Science)

    The first recorded mention of diabetes is from 1550 BC, on a sheet of Egyptian papyrus that mentions something called "honey urine." (A common symptom of diabetes is dark, thick piss, though I've never experienced that.) Until the1920s, when insulin was discovered, diabetics were doomed to short, uncomfortable lives. Insulin, from the Latin word for island, was derived from pigs and cattle until 1978, when medical firm Eli Lilly developed human-based insulin. I was seven years old at the time. Six years later I started giving myself injections of this miraculous substance, and have done so ever day since.

I take two different types of insulin. Lantus is long-acting, I take it twice a day. Humalog is short-acting and I take it every time I eat. I’m down to my last vial of long-acting, and I only have two vials of short-acting left, so I go to the pharmacy in the back of Safeway to get them refilled.

I don’t hear back from them, so after a few days I stop in after work. The usual pharmacist is working, a surly young hobbit whose beard looks like it’s attached with spirit gum. I give him my date of birth and name and he stares at the computer for a long time. I look at the Labubu dolls in medical scrubs, huddled on an high shelf along with a crowd other stuffed toys, including a plush box of Xanax that sports a sign that reads “NOT FOR SALE.” 

  Eventually he says, “I have your Humalog ready but the insurance company is contesting the Lantus.”

“What do you mean, contesting it? I’ve been taking this shit for decades.” 

“They’re doing this all the time now. Refusing to cover all kinds of medications with no explanation.”

“But it’s not like I can choose not to take it. These aren’t boner pills.”

“We’ve contacted your doctor. They’ll need to talk to the provider and fill out a consent form.”

I pay for my Humalog and once I’m home I immediately write an email to my doctor, just to make sure he has actually been informed of all this. I don’t trust that hobbit. 

“So how long you gonna be on that thing, anyways?” asks the bus driver whose door was smashed last week. 

“I wish I knew,” I say. 

“Did you have surgery or something?” she asks. I know that for the most part people are just trying to be nice, but I’m tired of explaining my situation to strangers. Sometimes I cheerily tell them I had my toes chopped off, which tends to bring the conversation to an abrupt halt. Usually I just do what I do now and say it’s diabetes-related, which usually leads to an outpouring of pity and/or stories of a family member who lost a foot or a leg. The driver just tells me she hopes I heal up soon. 

upstairs. Jenny leads me to room two. All week I’ve been feeling especially lonely and desperate for human interaction, so I’m chipper and chatty with both her and Bridget, who says she just got back from Hawaii.

“That’s funny, my folks are flying back from there as we speak. Did that storm hit you?”

“It wasn’t much of a storm. They shut everything down and nothing happened,” she says. “Lot of turbulence coming back though. Worst flight I’ve ever been on. A couple of times it really felt like we were going down.”

Jenny is ecstatic when she unwraps my foot. “Wow. Drainage is small, in fact the whole thing looks smaller. No maceration, no undermining. This looks amazing.”  Her cheeriness is infectious, and even though I know better, I catch a glimpse of hope like the tip of an early crocus. 

“Hey, let me ask you something,” says Bridget. “Have you heard of a drink supplement called Juven?”

I laugh. “Is this something you’re selling to raise money for the high school band?”

“No. But we had the rep in today talking about it. It’s got collagen and amino acids  in it and is really good for wound healing.”

“Sounds suspicious. Is this a pyramid scheme? Did they give you samples to get people hooked?”

“As a matter of fact… do you want to try some now?”

“Sure, what the hell,” I say. She disappears and reemerges with a cup of orange liquid. “It only has a few carbs in it so it’s approved by the American Diabetes Association. If you don’t like it you can just chug it.” 

I take a sip. “It’s actually not bad. Tastes like Tang. Do they still make Tang?” 

“The astronaut drink? I don’t know. But here are some samples and coupons.”

         “Wow, twenty dollars off? This shit must be expensive.” 

       “It’s a little spendy. But believe me, it’s really good.” 

“We had a couple who used to come here who worked for Amway,” says Jenny. “Every once in a while they would start dropping hints about how much money we could make.”

“you should’ve gone for it. Use the money to spruce up the office. buy decent chairs. doors for the rooms.”

Dr. Thompson is also in a cheery mood, and she chatters away merrily as she slices away at the callus.

“This looks good. Bleeding a lot. Maybe a good time to try out that hyfrecator?”

“Oh yes!” says Bridget. “Let’s try the hyfrecator!” 

“We need to see how it works!” says Jenny.

“Let’s do it!” I say. “Also, what’s a hyfrecator?”

“It’s this device to suck up extra blood,” says Jenny. “Shelley found one sitting around and none of us has used one before.”

“Are we doing the hyfrecator?” calls Vicki from behind the curtain. 

“I cleaned the dust off it,” calls Shelley.

“Let’s go take a look,” the doctor says, and Jenny follows her out.

“Are they really going to use that thing?” I ask excitedly. 

“Do you really want them to?” asks Bridget. 

“Look, it’s the same thing week after week here. I’ll do anything to break the monotony. What does this thing look like, anyway?”  

“It’s like a pen,” she says. 

“Oh,” I say.

“I thought they were coming right back,” she says, and leaves to find them. The office is very quiet. I take out my phone and discover that the hyfrecator (short for high-frequency eradicator)  “emits low-power high-frequency AC electrical impulses via an electrode mounted on a handpiece.” Bridget returns and says they’re all just standing back there looking at the mysterious contraption. “Looks like your bleeding has completely stopped anyways,” she says. 

“I can get it to start it back up again,” I say. 

Eventually they all return and Vicki sits at the computer while Bridget prepares the cast. Karen shows me footage of the dachshund birthday party she took Dolly to. “The one with the dress is the birthday girl,” she explains. “Isn’t she precious?” All the dogs have black, beady eyes like a crab. “We have a club now. We call ourselves Wien PDX.” 

“That sounds filthy,” I say. 

“You’re, uh, gonna want to wrap that more,” she says to Bridget.

“My brain’s like mush,” Bridget says. Her undercast certainly is a sloppy mess. “I don’t remember how to do anything. I think I was on vacation too long.” With Karen’s gentle guidance, she finishes up and prepares the water. 

“Not too cold now. She froze her fingers last week,” I say. 

“It’s silly but my one superpower is getting the water temperature right,” she says. 

Sure enough, Dr. Richmond reaches in for the first roll of casting and says, “Perfect. Absolutely perfect.” She’s wearing the same cap as last week, and I notice that the lyrics to “You Are my Sunshine” are interwoven with the hearts. 

I ask her how she feels about Juven. “It’s great,” she says. “I took it myself after I had surgery. Really speeds up the healing process.”

As she’s working, she talks to Bridget about Hawaii. 

“You were on the Big Island?” she asks. “I was stationed there in the Air Force. God I loved to fly. You know, I’ve loved every job I’ve had.” As she’s winding the wet Fiberglas, she tells us about pilot training. “You had to swim a mile and a half either in open water or a pool, wearing your flight gear. I chose the pool and got kicked so hard by another swimmer I passed out and nearly drowned. Got water in my lungs. They told me I could finish it later but I said, no way, I wanted that shit over with. I was in incredible pain but I finished it right then and there.”

She tells us about a device called the Dilbert Dunker that simulates what it’s like to have your plane crash into the ocean. “You know, like in An Officer and a Gentleman?” The Dunker is a metal framework like a cockpit that plunges into a pool and spins you around. It was invented during World War II, just a few years after the hyfrecator. “They tell you to follow the bubbles,” she says. “That’s the only way you can find what direction the surface is in. It’s completely disorienting.” 

She says they also make you fly a plane with the front windows blacked out, to teach you to rely completely on your navigation devices. 

“Isn’t that dangerous?” I ask. 

“You have a copilot in the seat behind you,” she says, as she rubs and rubs and rubs the cast. 

  It’s still sunny and mild when I get out. The haggard woman gets on the bus with me again. She looks worse than ever. I wonder if she’s sick. I want to give her a hug.

I stop by Safeway, expecting the worst, and sure enough, the doctor wrote me a new script and the insurance company rejected it. I ask how much it will cost without insurance. “$71 a vial,” the woman behind the counter says. It’s not horrible, but it’s not great, especially when you take into account that each vial costs Eli Lilly a single dollar to make. That’s a seven thousand percent markup. The net worth of their CEO is $710 million.

“Seventy-one bucks to keep from dying for another month? That is a fucking bargain,” I tell her. She says she will set a vial aside for me in case I can’t get in touch with my doctor. The toothy Labubus leer down at me from their shelf as I wheel away.

When I get home I call the endocrinology office but they’re closed for the night and don’t have voicemail. While I’m eating supper, the woman from the pharmacy calls to say my doctor just sent them a script for a generic brand that insurance will cover. I finish my meal and lie 

down next to the kitty, who meows at me until I rub her tummy. Maybe everything I’m going through is just a simulation to prepare me for when the real disaster strikes, for when my plane finally plunges into the black, icy waters. Maybe this is all just teaching me how to weather the storm, to keep my head through the approaching chaos. Reminding me to follow the bubbles.   

Spaghetti in the Microwave

     The bus is running late. When it pulls up, I notice that the glass of one of its front doors is a starburst of cracks. The door opens normally but it looks like it could explode at any moment into a shower of shards.

     “Looks like I missed the party,” I say to the driver. 

    She laughs. “Yeah a passenger ran on and said this guy was chasing her so I shut the door and he threw himself at it over and over until it smashed.”

    “Wow. You ok?”

       

“Oh I’m fine. We might have to change buses though… in fact here’s Gary. Everybody we’re going to get off and get on the bus behind us.” 

    I feel antsy and bored the entire ride, tired of looking at the same buildings and trees twice a week. Everyone on the bus is on their phones and I’m tempted to take out mine but I don’t want to get sucked into the vortex of depressing news. 

    Upstairs they say it’ll be a while, that they’re running late, but when I come out of the restroom Shelley fetches me immediately. “Back in the corner,” she orders. 

    “Nobody puts baby in the corner,” I say.

    “Are you saying you’re a baby?”

    “I think you know me well enough to know the answer to that.”

 Jenny is back there and compliments my shirt. We talk about shirts until Shelley fires up the saw. When it’s cut she has to use the crackers to pry the halves apart. 

    “The crackers are my favorite part,” Jenny says.

    “Me too,” Shelley says.

    I laugh. They say this every time. 

    “This looks really good,” says Shelley. “Not a lot of drainage. We can probably go down to once a week.” 

    “Oh hell yes,” I say.

    “It’s measuring smaller as well. I think the doctor is going to be very pleased.” 

    She says the doctor is running really late, but i only wait a minute or two before dr Thompson arrives.

    “You know for years I’ve been trying to get them to put doors on these rooms.” She says, “but they don’t see patient privacy as a priority.” She complains to Shelley that there won’t be new episodes of Outlander until March. “This looks really good,” she says as she carves and slices.

    

    Despite her griping, she’s in a jovial mood. Her surgical cap is covered in hearts. When she leaves I ask Shelley, “so no assistant today?” She says no, that she thinks her training is done and that she’s back at the st Vincent wound care center, which is where she’ll be working. “That place is huge, and everything’s new. They even have doors on the rooms.”

“So you’re telling me I should start going there?” I mean, maybe I should. It’s about the same distance in the other direction. That really would be a chance for a new beginning, a whole new chapter with a whole new cast of characters. New scenery to stare at through the bus windows.

    As she prepares for the cast, I ask Shelley if her car’s been fixed yet, and she sighs and says no and proceeds to regale me with the latest complications with her kitchen. “I just want to use my stove again. I’ve figured out how to make spaghetti in the microwave but it gets a little funky.”  

Our deeply fascination  conversation distracts her enough that she runs the water too cold. She pours some out and adds some hot but when Thompson reaches into the bucket she says, “this is cold. What are you trying to do to me?”

    “I know I’m sorry, I tried to fix it.”

    “Well it’s not too bad. Hopefully it’ll set okay.”

    “Just to be clear, I’m not coming in Monday, right?,” I ask Shelley as she brings my ride.

    “Right. We’ll see you next Thursday.” She says. 

    As I leave, Karen runs up to me to ask how I’m doing. How can I think of abandoning these kind people for those spoiled primadonnas at st Vincent’s? 

    I make it to the bus stop in time but the bus doesn’t come, mysteriously vanishing from the schedule. The mild day has been swept away by a bitter wind, and I think about going inside to wait but I don’t want to struggle with the hill. 

    When the next bus finally arrives, the crowd at the bus stop is joined by that attractive older woman I see occasionally. For a moment I don’t recognize her; She looks haggard, like she’s aged greatly since I last saw her. I wonder how much older I look since I’ve started coming here. It’s hard to believe, but Valentine’s Day will mark two years since my first session in the hyperbaric chamber.  

    When we get to her stop I watch her cross the street. Her hair is unkempt and she walks with a pronounced stoop. If she wasn’t so nicely dressed, she could be mistaken for a homeless person. In my current condition - greasy, rumpled, unshaven- I could as well. 

 

 

Groundhog Day

    Punxatawny Phil once again sees his shadow, as he nearly always does. When I roll out the door and down the ramp after work, I see my shadow as well, dark and crisp against the new sidewalk. I’m distracted by it, and instantly topple over, landing right on my knee. A filthy man with a bag of cans asks if I need any help. 

    I cautiously make my way down the hill with plenty of time to spare. The bus comes and after a few stops a coworker gets on; he lives not far from the hospital. We talk about a fellow employee who used to say he wanted to work in security at the hospital. I imagine him skulking the corridors in silence with his dead stare, waiting for someone else to respond to calls for help with the code grays. 

    Earlier in the day, another coworker, who I don’t know well, asked me about my cast. I told him I lost some of my toes due to diabetes and he said he had his foot torn off by an IED in Iraq. Even though it was completely blown off,  they were able to reattach it and he can walk almost normally. 

    They take me right in to wound care when I press the blue button. The nurse whose name I can never remember tells me to take the big room. Her name tag says Dierdre. Dierdre, I repeat to myself. Dierdre, Dierdre, Dierdre. She looks a lot like an older version of Original Karen. Whatever happened to her, anyways? Maybe she got a new job, or is just busy on the hyperbaric side, or died. 

    Vicki sits at the computer while Dierdre Dierdre Dierdre takes my vitals. I pull up my pants leg and they exhibit an appropriate amount of horror at my fresh wound, which is brilliant red but doesn’t look too deep. 

    “Seann are you showing any signs of sickness?” a woman from the counter asks. “Or have you been around anyone showing any signs of sickness?” I do a double take; she looks exactly like Shelley. But I’ve never seen this woman before, and never had anyone ask these questions aside from the receptionists downstairs. Is everyone in the office slowly turning into Shelley?

    Dierdre picks up the saw and turns it on. Nothing happens. “Do I need to plug this in?” she asks Vicki. 

    “Well, yeah,” says Vicki.

    “Is it working better? It was acting up last week,” I say. 

    “The guy came to fix it and it's been fine,” Dierdre says, and proves it by slicing off my cast with no trouble. 

    “Drainage?” asks Vicki. Dierdre gingerly reaches into the garbage for my dressing which she has discarded without looking at it. 

    “I’d say small,” she says. “You got this put on on a week ago?”

    “Four days ago,” I say. 

    She looks at it again. “Definitely small.”

    While she's cleaning up the wound, I tell Dierdre I haven’t seen her in a while. She says they haven’t had much work for her lately. “It’ll pick up in spring, summer. That’s our busy season.” I feel like chatting but I’m failing to remember a single detail about her life. To be fair, the ignorance seems to be mutual, because she asks me where I work. When I tell herm=, she says, “I should take the kids there, I’ve never been.” She says she has two preteens at home and three adults and I'm surprised, then remember how surprised I was the last time she told me as well. I assume we’ll have this same conversation six months from now, during the busy season.

Since there’s no bereavement on Mondays, Dierdre prepares the precast immediately. I’m the only patient left so she keeps the curtain open, and I catch glimpses of Jenny and Kaitlin restocking supplies and cleaning up for the day. KC sits at the counter with her mask off, slowly spinning in her chair with a dour look on her face. 

A few minutes later Dr. Taggert comes strutting in, paper gown flapping.

“Where’s the water?” she asks. 

“Knew I was forgetting something,” says Nicole. 

Taggert asks how the cast was and I say it was a little rough. She looks upset and I say, “Oh, not yours. Yours was fine. Not fine. Amazing. I meant Thursday’s was a little sloppy. Judy did it.”

“Oh. I don’t know what kind of experience she has. I haven't even met her yet,” she says.

 “It was kind of a weird visit,” I say. “Dr. Thompson barely said a word.”

“Well she’d just gotten back that day. Though she didn’t actually go to Sri Lanka after all, I guess?” says Taggert. 

“She seemed pretty miserable.” 

    “Yeah I don’t know what happened. Maybe she got sick and couldn’t go? She was talking about it for a while. She really does go some crazy places.” She turns to Nicole. “Remember she got to ride elephants? Where was that? Thailand? I don't get to go anywhere.”

    “Do you want another roll?” Nicole asks.

    “Who am I, Doctor Thompson? Though now that I look at it it’s maybe not quite enough in the back.” She runs her hand across my calf. “I guess it’s okay. See the back is what holds all the weight.” But I’m not supposed to be putting any weight on it, I think, so why does it matter? “I remember when they put them on us, you could really feel them strain in the back.”

    “You had to wear a cast?”

    “Yeah, they did whole department,  so we could see what it's like, back when we started doing these three, four years ago…”

    “Wait, so these are that recent? What did you use before?”

    “We still used total contact casts, but they weren’t hard like these. They were sort of sock type things. The patient had to lie on his stomach with his leg bent back, it was really a pain. They were impregnated with plaster and we had to rub them for exactly four minutes so they would cure. They drove me nuts -you know me, I have trouble standing still for more than five seconds. Patients would bring in songs to time us by. This one guy brought in Highway to Hell and we all started singing and dancing to it. One of the other patients started filming it and we had to tell her to stop. I mean, what if that had found its way online?”

    She’s told me part of this story before. How many times do I have to live through this day before I get it right, before I can move on with my life?

    "Now keep that knee covered," Taggert says. "You say you fell? Were you going too fast? Promise me you'll be careful."

    "Yes, Mom."

    "Look, the only thing I'm good for is mothering people," she says. "That's why I'm here." I think I detect a note of melancholy, a whiff of self pity. 

    "I already have a mother," I say. "Not including the eight more I have in this very office."

    My knee hurts as I roll up the hill to the bus stop. I’ll do it all again in three days, then again in four, then in three days again. But if my drainage continues to be minimal, I’ll be able to cut back to once a week. Maybe I should let Judy pray for me.

    When I get home I see that there are thousands of internet clips of nurses dancing in their wards, most of them from China during the pandemic. I don’t see any footage of the fine medical professionals of Providence Wound Care Clinic shaking their asses to AC DC. Which is probably for the best. 

Postcards from Sri Lanka

I roll into the office and see Dr. Thompson behind the counter. “You’re back!” I cry. I’m happy to see her, and I can’t wait to hear about how Sri Lanka was. She stares at me without a word. 

I wheel back out and sit down next to an obese old man who is watching his phone with the volume turned up. A man is talking very fast and in an unnatural tone of voice, so that I wonder if it’s AI. It is very difficult to make out what he is saying; something about talking to his father-in-law about hedge funds. It is one of the most boring monologues I have ever heard, but the old man watches with rapt attention until Shelley mercifully comes to get me. 

In the far room, she takes my vitals and says, “Your blood pressure is only one point above what it was last time. Isn’t that bizarre?” She fires up the saw but after she has cut three inches down my leg it sputters out. She looks at me. It starts up again. She continues to cut and a few minutes later it cuts out again. She unkinks the hose and bends down to look at the machine, giving me the saw to hold. She turns it back on and finishes cutting the cast without any problems. 

“Not much drainage,” she says. “It doesn’t look that bad.” She takes a picture and measures it. “A little bigger. Not much.” She pokes a Q-tip into it. “A little less deep, but it’s kind of boggy. You know what I mean?” I say no. “Boggy. Like mushy. So it’s deeper than it seems. Not too bad. But really boggy.” I ask her what causes that and she says unhealthy skin and slough. “I’m not too worried,” she says perkily. “So you shouldn’t be either.” I tell her I’m not. After all, this is only my second visit to this exciting new office, and I trust all these nice strangers to take good care of me.

She squirts some Lydocaine onto a pad of gauze and presses it onto the wound, then pinches the cord they all keep their necks and says, “Call Russ Morgan.” 

“Calling RUSSELL. MORGAN,” the cord says. 

“Ruh,” A man’s voice grunts.

“Russ, this is Shelley in wound care.”

“Herm.”

“I’m having issues with our saw and I wondered if you could look at it. It kept pulling to one side the whole time I was using it, and it went dead a couple of times.”

“Up,” the man says. 

“Thank you Russ!” She disconnects and starts talking about how boggy my wound is. I wish she would stop saying the word boggy. “Oh, and Judy the nurse practitioner will be doing your cast,” she says. I’m surprised; I thought only doctors could do those. 

She leaves and I listen to a woman talking to Karen in room two. “The one healed up but this other one has been there for years,” she says. “I don’t want to lose my foot.”

“We don’t want you to lose your foot either!” says Karen. “Now have you heard of something called debridement?”

“You mean when you die?” the woman asks, alarmed.

Karen laughs. “No, that’s bereavement. This is debridement.” The woman laughs too.

A few minutes later Judy comes in, wearing paisley purple Crocs. Behind her is Dr. Thompson, in ordinary scrubs with a plain blue cap on. 

Judy asks how I’m doing, if I used that app she recommended. I tell her no, but that I’m feeling okay, though things have been up and down. She looks concerned. 

“Sometimes it just helps to talk to someone about things,” says Shelley. 

As Judy adjusts the chair with the pedal, she puts her hand on my shoulder, which seems odd. I excitedly ask Dr. Thompson how her trip was.

“I didn’t go on any trip,” she says, sounding confused and a little annoyed. 

“Oh, they told me…but you were gone…”

“It was a staycation,” she says in a dead, flat voice. I suddenly feel uneasy. I want to ask more but my gut tells me to keep my trap shut.

Shelley hands Judy a scalpel. As she unseals the plastic, Judy exclaims, “Oh I forgot to record. Do you mind if I record this?” I say no, even though I do, and she sets her phone up on the computer stand.

“Beginning debridement of wound,” Judy says. The doctor watches Judy as she slices at my calluses. 

“You have good circulation down here,” Judy says, dabbing at the blood. 

“See how boggy it is,” Shelley says.

“That’s the top of his metatarsal there,” says Judy, poking.

“I don’t think so,” says Dr. Thompson.  

“What about all this bruising?” Judy asks. 

“I… think that was there before,” says Shelley. She looks at the computer screen. “Yeah I think that was there.” No one mentioned any bruising before.

“Well it looks like it’s healing up,” Judy says. She grabs her phone and they leave. As Shelley wraps my leg back up, she tells me about the car accident she got in last week. Some woman plowed into her at a four way stop. I ask if she’s biking to work. “No, I wanted to use a jetpack but I was afraid ICE would shoot me down.” She giggles. It’s the first time I’ve heard her reference current events, but I don’t feel up for getting into all that. 

Perhaps distracted by thinking of the car accident, she doesn’t put as much padding on as usual. “The cast went up pretty high last time,” she says. “Did that work okay for you?”

“It was fine,” I say. 

“I better go up higher then.” She cuts an extra length of padding and wraps it just below my kneecap. Perfectionist that she is, she has never had to do this before. Now it’s way too high.

“You’re not done?” Dr. Thompson asks Shelley when they return.

“I’m just finishing running the water.”

The doctor turns and addresses me for the first time.

“How are things at the museum?” I tell her things have calmed down now that the renovations are done, and encourage her to come check it out. “I haven’t been there in years,” she says. I want to ask her what she saw last time she was there, but Shelley turns off the faucets and lugs the bucket of water over.

Judy is the only one wearing a paper gown; she’s apparently going to do the cast herself, which surprises me. I thought only the doctors did those. 

Dr. Thompson looks at how high the undercast is, thentouches the skin of my knee, which is red and shiny from the scooter. 

“He wanted it that high,” Shelley quickly says. “He likes it. He said it was really comfortable.” I shoot her a look but her focus is elsewhere.

As Judy clumsily wraps my foot, the doctor stands to the side, watching. An oppressive tension fills the room like a cloud of noxious gas. Shelley plops the rolls into the water and occasionally  helps Judy smooth out the Fiberglas. My yellow leg is covered in dancing blue gloves. The doctor offers an occasional comment or question. “”I like to alternate back to front to keep it even. You don’t want it to soak that long. Are you going to leave it like that?” 

After the third roll, Judy lowers the chair and asks me to stand on the cast. Neither of the doctors have ever asked me to do that. I place my foot flat on the floor and she says, “No, put all your weight on it.” I hold onto the chair’s flimsy arm and she rubs the cast, then has me sit again while she applies one last layer. Doctor Thompson wanders off without a word before she finishes. 

“Does that feel tight?” Judy asks when she’s done. It does, but I tell her it feels fine. It’ll only be on four days anyways.   

When I roll out of the office, I find that the handicap restroom in the waiting area is out of order, so I use the tiny one next to it. Once I squeeze in, I have to get off my scooter and rearrange it so I can close the door. I feel shaken by my visit, by the sudden change of climate in the office. Why did everybody tell me Dr. Thompson went to Sri Lanka, of all places? Why not just say she’s on vacation? Did she have a health scare, or a mental break of some sort? It’s all so strange. While I guess I should be grateful to have the monotony shattered by a whiff of mystery, instead I feel deeply unsettled, like when someone you trust reveals some ugly impulse.

When I get out, Shelley is in the waiting area telling a tiny woman, “They just called a Code Gray. If you feel you need to be somewhere safe, just press that blue button and you can hang out with us.” The woman stares at her, uncomprehending.

“My mother’s in there,” a man sitting nearby says. “What’s a Code Gray?”  

“It’s when someone is having a really bad day, and gets upset,” Shelley says, as if she’s talking to one of her kids.

I head downstairs. I don’t see anyone having a bad day in the lobby or at the bus stop or during the ride home. But as I’m waiting for the walk signal across the street from my building, a wide, scantily-dressed woman is screaming in a baritone voice at a dumpster a few feet away from me. Dance music blasts from a speaker slung from their shoulder. There is no one else in sight.

“You shut your fucking mouth, nigger,” they scream. “You shut your fucking mouth. Tell me to turn my music down nigger? I’ll turn my music down nigger. Do I look like a can of paint to you? Do I look like a fucking can of paint? Fucking nigger.” 

They turn their attention from the dumpster and start to lumber towards me, still screaming. 

I decide to brave the rush-hour torrent and cross against the light. 

The Sun King

             I overdid it with my insulin –or underdid it with my lunch- and by the time I reach the hospital, my blood sugar is well below the level I need it to be to allow me to function normally. I'm dismayed to see that the stanchions have been removed from the metal detector and its green lights are beckoning. A man sits leaning on the conveyor belt. I roll up to him and he says, "Oh I don't work here, I'm just waiting for a ride." I roll off before any guards materialize. 

Fortunately, my appointment is later than I thought, so I have plenty of time to roll into Starbucks for a box of apple juice. As I sit in the waiting area upstairs sucking it down, Bree dashes out of the office with her coat on. 

“Done for the day?” I ask. She says yes and I ask if I should tell them I’m here. “Oh I told them,” she says, though I don’t know how she knew. Does she have a surveillance camera in there?

An old man shuffles out of the office with a cane. When he presses the elevator button he releases a loud, wet fart. 

    Bridget comes out as well, pushing a wheeled contraption with a series of straps and buckles dangling from it.

“Ooh, is that for me?” I ask.  

I throw out my empty juice box just as the office door opens again. 

    “Get in here, you.”

    When was the last time I saw KC? August? I knew she worked Mondays, but I wasn’t sure if I would actually see her this visit. I warn her that my sugar is low. She says she can get me some animal crackers and peanut butter, then leads me to the far room. “We won’t be bothered back here,” she says and as I plop into the chair, she hops on my scooter and speeds away on it. “Whoa, this thing is wobbly,” she says. 

    “If you break it you have to buy me a new one,” I say. 

    She returns and closes the curtain and then it’s just the two of us. I’m the last patient of the day and the office is quiet. 

    “I heard you were talking about how violent I am,” she says, and starts pummeling my arm. 

    “I hope you don’t abuse all your patients like this,” I say. 

    “Only the special cases.”

    “The ones who come here for years and refuse to get any better?” 

    The blood pressure machine bleats pitifully to warn that its batteries are dying. She ignores it. My blood pressure is too high for her liking. I tell her it’s probably because someone’s been punching me. “Try not to think of anything,” she says, her breast brushing against my arm. Between her proximity and my lack of glucose, my head is spinning. I close my eyes and try not to think of anything. 

She examines my foot. I’ve warned her that it’s been looking pretty rough. “It just gets bigger and bigger no matter what I do,” I say. 

“I don’t know, it doesn’t look that bad to me,” she says. “Moderate drainage." She keeps adjusting the paper ruler. "And it’s about the same size as it was last week. Point six, point seven.” 

“I'll take point six,” I say. She measures it again, and then again. I ask how her holidays were. 

“Not great to be honest,” she says. “The whole year really blew. I had to have a front tooth pulled,” -I remember her talking about that months ago- “And it took forever for them to replace it. It was supposed to be eight months but it turned into nine, then ten. But you know how that goes." I ask if she stuck a piece of corn in the space and no one will ever know, vaguely aware that I've made this joke before. New start my ass, I'm already starting to repeat myself. 

She laughs anyways. "I should've carved myself a wooden one! Healing is so slow," she says. "I didn’t leave the house the entire year except to go to work and the gym.” 

“I bet you got a lot of reading done,” I say. 

“Oh god no I hate reading,” she says. 

“What?” I laugh. 

“No really. I just hate it. I listen to audio books sometimes but even then I have to go back and relisten half the time because I get distracted. I mostly spent the time watching shows.” If this has felt like a date up to this point, this is the moment when you have to decide if you’re still going to try to take this person home with you or if you need to catch the waitress’s eye for the check. 

“I rewatched Outlander, and now I’m watching Versailles.” I ask if Versailles is any good. She shrugs. “It’s all about Louis XIV. Everyone dies young because he forces them to move into the palace then when they tick him off he has them killed. And oh God the men are so effeminate, with that long hair and these crazy high heels they clomp around in.” I ask if she’s ever been to Versailles. “No. I did get to Paris but I was only twenty. I’d like to go back.” 

I tell her I’d love to go to Paris for the art, and somehow find myself talking about the series of drawings I did at the end of the year. I tell her about how for a long time I’ve wanted to do pictures of homeless people, especially the ones frozen in place by their cocktails of fentanyl cut with animal tranquilizers. “You’ve probably seen them twisted in all kinds of crazy poses, standing bent over for hours. I wanted to capture that.” She looks at me intently the whole time I'm babbling. I can’t tell if she’s interested or just being polite but I can’t stop myself. This is the most important thing in the world to me right now and it’s all I want to talk about. Even if I’m probably boring the hell out of her. I mean, this sweet, adorable woman doesn’t even read.

“You know, my brother back east goes to a methadone clinic every day,” she says. “Otherwise he’d be back on the steeets.” 

She asks if I’m getting a cast put on today. I say yes, surprised she isn’t already aware of this somewhat important fact. “Okay then I’ll tell the doctor you’re ready for her,” she says. 

“No debridement today,” Vicki says, poking her head. Has she been sitting just outside the curtain this whole time? “Oh, hi Seann.”

“She’s not debriding?” KC sounds confused. 

“Nope, just doing the cast. Thompson will debride him on Thursday.”

“Alrighty then, guess I’ll get you ready to get casted up,” she says. “How long since you had one of these puppies?” I tell her it’s been since October. “What? Why has it been so long?” I tell her about being on vacation and the series of footballs and the holiday and Thompson being on vacation. “Oh yeah I heard something about you needing to wait for permission from work?” I tell her it was a miscommunication with Dr. Baylor. Her face twists in irritation –maybe I’m not the only one who isn’t thrilled with the substitute doctor- but she doesn’t say anything a she starts preparing the undercast. 

“All this news is getting me down as well,” she finally says. “I keep trying to limit my consumption but it’s all just so awful, I can’t look away.” 

“I know,” I say. “It’s horrible. And it’s frying all our brains trying to make sense of it all.”

“It all happened so fast,” she says, and looks like she’s going to cry. 

“Yeah but this has been building for years,” I say. “But how’s Cathy?” 

She instantly lights up. “She’s great!”

“Is Ghost still coming around?” 

“God he’s a nuisance,” she says. “He stops by four or five times a day when I’m home. I mean, it’s my fault, I keep giving him treats. He’s Cathy’s secret boyfriend. She pretends to be annoyed by him but I saw them boop noses just the other day. It was precious.” She takes out her phone but she can’t find the picture so she goes back to wrapping my foot. "I haven't done this in a while, I'm out of practice," she says. I don't take the bait. She goes about preparing the water and the rolls of casting. Bad date or no, I realize we’ve been talking a really long time. I wonder if Doctor Taggert is waiting for us; it’s nearly five.

Just then the doctor herself appears and gets right to work. Instead of scolding me about my wound, she congratulates me that my hemoglobin a1c is so good. I thank her without mentioning that the only reason it’s so low is that I keep bottoming out, like I am right now. But it's still progress. 

“You should be proud of yourself. Look at how far you’ve come since you started here,” she says. 

“You’re right. But I’m frustrated that this is taking so long.”

“Well you’ve got a new cast now,” she says, vigorously rubbing the wet Fiberglas to smooth it out. “Think of this as a new beginning.”

I laugh. “I am! In fact I planned on coming in today and pretending it was my first visit at this new clinic, with a new doctor and her new lovely assistant… what was your name again, young lady? CK, was it?”

KC laughs. Taggert laughs. We all laugh, safe in our tiny curtained room as the mad king’s minions murder people in the streets. The Sun King lived a long life, and died with his head still firmly attached. The powder keg wouldn’t ignite for decades. But KC’s right. Unlike the healing of a wound, or the replacement of a tooth, this is all happening so fast and no one can tell how things will  turn out.

In the meantime, I forgot how heavy these fucking casts are. 

Amnesiac

     Thursday afternoon, a coworker surprises me by arriving early to relieve me so I can leave for my appointment. It's nice not to have to rush down to the bus stop, but once I'm there I find that the bus is running late. 

    Karen leads me in to room two, where Jenny is waiting. I don’t feel any of the dread or despair of last week, despite the fact that my cultures did in fact come back positive for MRSA and another bacterium called proteus miribilis. All day I’ve been nervous about my appointment, but now that I’m here, I exhibit signs of a sort of nihilistic perkiness. 

    “It doesn’t look great,” I warn Karen. The last time I changed the bandage, the wound was huge and inflamed and rimmed with dead white skin.

    “Oh my,” says Jenny.

    “Yep,” I say. “Worse than ever.”

    “I don’t know”, says Karen. “A lot of this is callus. It doesn’t actually look any bigger than last week. She measures it. “Okay, maybe a little bit bigger.” 

    “Yeah I’ve pretty much given up hope of it ever healing,” I say cheerfully. “It’s kind of freeing.”

    “Don't make me smack you,” says Jenny. “She’s right, it really doesn’t look that bad. And it’ll look even better once the doctor cleans it up. And then you’ll get your cast on Monday and things will turn right around.”

    “But it was almost completely healed,” I say. “Twice. And now look at it.”

    “Apples and oranges,” she says. “Think of this as a new beginning,” she says. “We’re starting fresh.” 

    I laugh. “But what about all this time I’ve wasted up to now? All this time on the scooter, coming in here every week, only for it to get worse and worse. What was any of it for?”

    “Apples and oranges,” she says again.

“I don’t know what that means,” I say. 

    I have no more surprise or disappointment left in me so when Doctor Baylor comes in I greet her warmly. She doesn’t seem concerned about the wound or the infection, just cuts the callus -there is a lot of blood- and tells me in a chipper tone of voice that she’s prescribing me a different antibiotic to battle the proteus miribilis. When she leaves I ask Jenny if Dr. Thompson is still in Sri Lanka. 

    “Yeah, she’ll be gone for three weeks.” I tell her it’s already been three weeks. “No, she just left last week,” she says. 

    “But this is my third week with Baylor” I say. 

    “No, she’s only going to be gone three weeks.” 

    "So she'll be back next week."

    "No, she'll still be in Sri Lanka."

    To keep my head from exploding, I ask her how Dave is. She shows me pictures of the lanky blond tomcat. His fleecy fur looks like spun gold in the sunlight. 

    And the sun is shining a half hour later when I roll up the hill to the bus stop. The days are getting longer, if not warmer. So what if the past six months of appointments have been for nothing? It’s not really all just a pointless waste, is it? And even if it is, what good does it do to fixate on that? I’ve done the best I could and it wasn’t enough. The hole is larger than ever, I'm months away from even being close to healed up. And who knows how long that will last. A week? Two weeks? 

    But Monday is a new beginning. I can pretend none of this ever happened, that I’m preparing for my first day of treatment in an office I’ve never been to before, with a brand new team of doctors and nurses to get acquainted with. It’s all very exciting! I will wheel into that office like an amnesiac anxious to learn about this life he has no memory of having lived. 

*

The next day I leave work early again for my eye appointment. I haven’t had one since summertime; what with my weekly wound care visits, then vacation, then the holidays, I just didn’t feel up for it. But I need to get back on the eye-stabbing wagon.  

I sit in the big waiting room until I’m called, then stare into the mirror and recite the diminishing lines of the illuminated Snellin chart mounted on the wall behind me. I open my eyes wide as they check my eye pressure with an instrument the size of a pen. I sit in the waiting room for a while longer, follow the technician into a tiny dark room, gaze into the box at the blue circle and flickering red horizon line. I roll off to squeeze into the tiny waiting room. I could do this in my sleep.

    As I open my sketchbook, a baritone voice rumbles, “Hey, Seann.” I look up and see Mark from the Goose there. I feel vertigo that comes from seeing someone out of their usual habitat. I ask what he’s there for and he says he’s having some issues. He doesn’t elaborate. Mark used to be a submarine captain. I ask him a few questions and he answers them and then I go back to drawing. I can tell he’s nervous. In a few minutes they call his name and I wish him luck. 

    An elderly man sitting across the room takes the chair next to me so a couple can sit together. He watches me drawing intently, and eventually starts making small talk. He is a mechanical engineer from Missouri, friendly enough though not terribly interesting. I ask what kinds of things he worked on and he says he received a patent for a sewer pipe fitting. "It proved quite lucrative," he says. 

    In time they call him, and finally it’s my turn. An assistant administers the numbing drops, then leaves and comes back and administers more. She’s kind of blandly pretty, and when she turns her back I have an urge to grab her ass. After quite a while she returns. “The doctor’s dealing with an emergency, but you’re next,” she says. “In the meantime, I need to give you more drops.” 

    Finally the doctor comes flying in, gives me some more drops, flies away.

    After a long time, he dashes back in and uncaps the syringe and slides it into my eye. A blood-rimmed bubble blooms instantly in my vision. I must make a face, because in a concerned tone of voice he asks, “You doing okay?” 

    “I’m okay,” I say. 

    And I am. I’m alone and miserable and wracked with loss and tired of the endless medical drama and repulsed by all the loathsome acts being perpetrated in this country by all these cretinous buffoons, sick of the cringe and the cruelty and the sheer batshit craziness of it all… but aside from that, I’m doing okay. As I mount my scooter, my trusty wheeled steed with its ragged tires and wobbly handlebars, I look into the mirror at the Snellen chart. When lit, it’s a scrambled alphabet that spell nothing as it shrinks to the point of illegibility. Turned off, it’s just a black rectangle, all its backwards letters lost in the darkness. But still there.

High Levels of Exudate

     As I do every week, I remind my various coworkers that I need to leave early, and once again when two o’clock arrives I have to call over the radio to have someone relieve me. Two of them eventually arrive simultaneously, and while I know it’s not the end of the world, and that I will most likely make it to my bus on time, today I feel something snap inside and I am blinded by rage. 

    I don’t show it, though. I just clock out and speed down to the bus mall. 

    An old woman gets on the bus and sits across the aisle from me. Out of her left sleeve sticks a metal claw. Unlike last week’s unlucky fellow passenger, this woman’s misfortune does not make me feel better about my own. My foot looks like shit and my blood sugar, which has been well-controlled lately, has suddenly zigzagged out of control this week for reasons I can’t figure out. I try to use the training I practice in meditating to stop myself from worrying about this, but my thoughts fly to stress like nails toward a powerful magnet. 

In the waiting area, I feel myself sinking further, and I am too tired to fight it. By the time Shelley throws the door open, I have no energy for niceties. Warm, gentle Jenny is once again waiting for me in the middle room but I just grunt hello and collapse into the wide chair. 

    Vicki had ordered my medical supplies from a company that first calls you, then makes you pay in advance before they ship your order, so unsurprisingly my stuff didn’t arrive until yesterday. When I opened the package I was surprised to find that it contained nothing but a single box of ten foam dressings called Zetuvit Plus Silicone Border. There were detailed diagrams on the outside of the box, and inside was a set of instructions, microscopically printed in sixteen different languages on a thick sheaf of onionskin Though they are basically just fancy Band-aids, requiring you to just peel off the backing and slap them on, the instructions are astonishingly thorough and feature ten headings including Intended Purpose, Indications, Incident Reporting, Contraindications, and of course Product Disposal. 

    Zetuvit Plus Silicone Border absorbs and retains up to high levels of exudate in the absorbent pad and the dressing is able to redistribute pressure. It features a micro-adherent silicone interface and adhesive borders, so no other materials are necessary to secure the dressing.

    Maybe I missed some important step because when Shelley pulls off my sock, the bandage is bunched up and has slid half off the wound. Despite this, it doesn’t look much worse than last week. The foot looks slightly redder than usual though. Jenny asks if it hurts and I tell her yes. 

“That’s odd, you don’t usually feel much pain,” she says. 

    “How is it on a scale from one to ten?” asks Shelley. I tell her three and a half. They exchange looks and Shelley places her gloved hand over the end of my foot. “Temperature seems okay. It really is red though.”

    “Maybe it’s finally time to chop it off,” I say, and I mean it. Let’s end this charade. Let’s stop pretending this is ever going to get better. Time to shed that last scrap of loathsome hope. 

    Karen pops her head in and asks if she wants to see the latest videos of Dolly. I shrug and she shows me the dog wrestling with her doggie best friend, who looks exactly like her. I watch without comment. 

    “Isn’t she the cutest?” she gushes.

    They leave and I hear Dr. Bayliss’ voice on the other side of the curtain and my spirits dip further. I take off my glasses with one hand and cover my eyes with my other, which would be a lot trickier with a metal claw. A moment later the doctor comes in, followed by the new nurse whose name I’ve already forgotten. Helpfully, he name Judy is embroidered on her white coat.   

“So we’re still waiting to see if you can get permission from work to take off so we can put the cast on,” Bayliss says. 

““I don’t need permission, I just need two weeks’ notice so I don’t fuck them over.” Though I’m not sure why I’m worried about fucking them over at this point, when they can’t be bothered to even show up to relieve me even once. “I was waiting for you to call me.”

“Well I guess we had a misunderstanding,” she says, cutting away the callus as the new nurse watches intently. “Hmm, this is red, and a little swollen. I’m going to get you some antibiotics just to be on the safe side. Have you ever had MRSA?” Holy shit, I think, does she think I have MRSA? Why does she think that? I feel like I would know if I did. I tell her yes, I had it once. She tells Shelley to take a culture, and she digs a tube and a long cotton swab out of a drawer. 

“I can’t take any more of this,” I say, a little louder than I mean to. The room is very quiet. Vicki slips in for some reason, and they all stand there and stare at me; Jenny, Karen, Dr. Bayliss, Vicki, Shelley, Judy. I am so fucking sick of all of them. “It’s never going to heal up, and even if it does, it’ll just open right up again. This has been going on for years and there’s no fucking end in sight. I’m starting to lose it.” 

“What does your podiatrist say?" asks Bayliss. "If there’s a spur that keeps growing, they can sometimes shave it down.”

“I know. They've shaved it down so many times that it doesn’t help anymore. I'm not seeing a podiatrist at the moment because none of them seem to know anything. No one has an answer except to never walk on it again. It’s maddening that this is all just because of a tiny hole. I don’t want to do this anymore. Nothing helps. I'm done.”

“Are you thinking about… harming yourself?” the doctor asks. 

    I think about last night in the tub, using the opportunity to finally have my foot unwrapped to take a

rare bath. I kept closing my eyes and picturing that painting of Marat. He looks so serene.

    “No, nothing like that,” I say. 

“Your primary probably has a counselor who visits the office, or else he can write a referral to see a…”

“When am I supposed to see anyone when I’m already coming here every week?” I snap. “I don’t have any sick time left.”

    “Have you tried to get permanent disability?”

“Yes and I got turned down. I know you have to try a number of times but I don’t want it it anyways. I’ll go crazy being at home all the time. I’m already starting to crack. I am so. Fucking. Tired.”

“Can you get people to help manage things?”

“What people? There’s just me. There’s always just me.”

Judy comes and shows me a meditation app on her phone. I don’t bother telling her that I already use one and I actually like it a lot. But it’s not enough. It’s hard to believe that a few weeks ago I felt like I had an okay handle on things. 

“I’m not sure what your spiritual beliefs are,” she says, “But I’m happy to pray with you.” 

    Oh for the love of God.

    “No thanks,” I say. “But that’s very kind of you.”

    “Well I’ll pray for you regardless,” she says. I tell her I think my mother’s already praying too much for me as it is and she laughs politely. 

    No, seriously, I think. Do not fucking pray for me.

Bree pops her head in and asks if I can come in two Mondays from now for my cast fitting. I say okay, and then they all filter out except for Shelley, who tears open a package of Aquacel and a foam dressing.

“Where’s Doctor Thompson, anyways?” I suddenly ask.

“Sri Lanka,” she answers. “Lucky stiff. I can’t wait until I can travel like that but it’s hard with the kids needing things all the time. And they want a little sister really bad.” She tells me about what a disaster her house is, what with the water leak and them having to redo the kitchen. She says her oldest came home from school last week and told her about another outbreak of lice. "She has really thick hair and she throws a fit when I brush it much less try to run a comb through it." 

    How long ago was it that she told me this same exact story?

    “It never ends,” she says. 

    “You can say that again,” I say. 

    No doubt, she will. And I'll probably be here to listen to her say it. And to hear her tell the story of the kids at school getting lice year after year until both her girls are out of elementary school and in middle school, then high school, then college, then having kids of their own to be afraid of getting lice. Year after year I will keep wheeling up here as the doctors and nurses age and retire and eventually die, and then it'll be my turn, passing on without ever having managed to fix that tiny hole that held out until my unquestionably bitter end, sticking to its guns, never backing down, getting smaller and bigger and smaller and bigger but never disappearing completely, exuding various amounts of drainage, my one constant companion I can count on to never abandon me.