All the Way Home

 Shelly calls me at work and says they just found out I need to have an x-ray taken before insurance will approve an MRI. “They may as well just lop the fucking thing off,” I snarl. 

“Don’t say that,” she whimpers.

Luckily the diagnostic imaging center is open late, so after work I wheel across town to the medical center across the street from the hospital. In the waiting room I think back on all the different departments I’ve been in. It’s confusing; some of the offices are actually outside entities that rent the space, and some are part of the hospital. I’ve had x-rays done in this same office, and blood taken across the hall. I’ve used the pharmacy and eaten at the café when they used to actually make food. I got my COVID boosters and flu shots in the room directly above where I now sit. I’ve been in infectious disease and orthopedics and ophthalmology and innumerable podiatrists back when they had a podiatry department. I’ve had shoes and orthotics made and adjusted and adjusted again. I’ve spent a lot of time in this ugly building.

The next day the hospital emails me the results. 

Lytic destruction of the fifth toe PIP joint consistent with septic arthritis/osteomyelitis within the adjacent soft tissue ulceration. 

Post infectious/inflammatory changes along the second metatarsal head. 

5 mm needlelike foreign body within the plantar soft tissues along the distal fourth metatarsal. 

Up to this point, my only hope had been that the bone was not, in fact, infected.  To be sure, it had been a microscopic hope, but with its removal a sinkhole yawns in my stomach and I feel myself fall into it, sucked into myself, through myself, turned inside out, down and down into the darkness. 

The second item on the list is obviously the toe that has just been healed by the hyperbaric treatment, as this one theoretically could be. I should be comforted by this, but I’m not. My work schedule will be completely upended; I will have to go on medical leave again, with the nightmare of paperwork that will entail. Maybe I can work another shift; they are desperate for night guards, though I fear the twelve hour shifts will annihilate me, never mind having to work all night. And even if the two months back in the chamber work their magic, who’s to say my ulcers won’t flare up again the moment I’m out, like they did this time, and the time before that, and…

The third item is the most puzzling. This foreign body showed up in the x-rays I had in the hospital and podiatry office as well. No one had any theories as to what it could be or how it got there. 

The same thought keeps spinning through my head: I can’t believe this is happening again. I can’t believe this is happening again. I can’t believe this is happening again. I try to change this droning mantra to: everything is going to be okay. Everything is going to be okay. Everything is going to be okay. I don’t believe it for a second, but maybe if I repeat it enough I can brainwash myself. 

I hoped to have a year free of foot problems, and would’ve settled for six months, but I don’t even get a single goddamn day. The unfairness of it makes me want to scream, but I’m afraid that once I start, I’ll never stop. 

My appointment is the next day. I wheel into room one and sit down and pull off my walking boot and shoe and sock. I am an automaton, doing as I am programmed, feeling nothing. Aaron and Gladys join me. 

“I thought you were off Thursdays,” I say to Gladys. 

“I’m usually in the chamber but they needed me out here. Also I’m highly over-caffeinated and have been making fun of Aaron all day.”

“She has,” he says. 

“Where are your little protégés?” I ask. 

“They’re working remotely. You get the O.G.s today,” says Aaron.

“A patient told me he thought I was thirty five today and I almost hit him,” says Gladys. “I’m twenty-five dammit!” I knew she was young, but…twenty-five?

She makes short work of the cast and looks at my foot and says, “Oh.” 

There is a huge burst blister on the end of my foot. 

“I thought the cast was supposed to prevent that,” I say, my voice flat. 

“It is,” she says. “Have you been walking on it a lot more?”

“Not really.”

“Maybe it got wet in there somehow. This whole thing’s macerated.”

I’m beyond crying, beyond being upset. I have burrowed deep into myself.

As they wait for the doctor they prattle on about the Democratic Convention. I didn’t watch any of it, but I’m glad it was a positive affair, giving people a moment of hope when the world seems to be teetering on the edge. 

“Don’t worry, Trump will fix everything once he gets elected,” Aaron deadpans.

“Don’t you even start,” warns Gladys.

Doctor Ronda comes in and looks at it and shakes her head and cleans it up. She tries to pull my chart up on the computer. 

“Dammit, I hate these things.” Aaron can’t get it to work either.

“I’ll put in a ticket to IT,” says Gladys. 

“I really wanted to show you the x-ray,” Doctor Ronda says. She hobbles over to the drawing board. I ask her how her broken foot is doing and she says it hurts.

On the whiteboard, she draws a foot with six toes. 

“So each toe has three bones in it,” she says, drawing some lines to represent them. “On your little toe, the main bone is great. That’s the one you put all your pressure on, unless you’re like me and curl your toes when you walk. Do you curl your toes when you walk?” she asks Shelly, who has suddenly appeared. 

“I don’t think so,” Shelly says. She takes a step. “Oh, I guess I do.”

“The second bone is the one that’s infected. Your third bone,” she points to a tiny dot, “is no longer there. At all. It’s just gone.”

“What?” I say.

“It’s weird, but sometimes they get absorbed by the body. Or maybe it’s because of the infection, I don’t know. But it’s no longer there. So what I’m thinking, and I almost never say this, is that we should just remove the whole thing.” 

“I thought you might say that,” I say. 

“I know it’s not ideal. But you should be able to walk just fine. And you have really good circulation. Alternately, we could throw you back in the chamber for forty days, but I don’t know if it’s worth putting you through all that again.” 

“Well, I guess it’s okay, since I already have a spare,” I say, pointing at the drawing. She shakes her head and rubs out the extra toe.

“And then there’s this foreign object,” she says. “I don’t know what to make of that. I guess you must have stepped on something at some point. Maybe that’s affecting all this, but I doubt it. We need to get you an MRI and I am going to get your antibiotics refilled. Then I am going to put in an order for a wheelchair.”

“So I need to be in a wheelchair all the time,” I say, my voice a featureless horizon. 

“Well, both of your feet are having problems,” she says, “so yes.”

“But not forever, right, Doctor?” Gladys says loudly.

“Oh no. Just temporarily. You should be able to walk again with no problem.”

“See, that’s what I wanted you to hear from her,” Gladys says, touching my arm. “I heard when Dr. Rochelle said you’d be in a wheelchair for the rest of your life and thought that was asinine.”

Dr. Ronda looks confused. “What’s that? No, we’ll have you walking again. But it’ll be a couple of months.”

“Dr. Rochelle can get a little overexcited,” says Aaron. “Kind of like when a certain somebody has too much caffeine.”

“Hey,” says Gladys.

The doctor asks if I have any other questions. I say no. “You will. I just threw a lot at you. We’ll discuss it more next week.” 

Jenny is suddenly beside me. Has she been here this whole time? How many people can cram into this tiny space?

“We’re here for you. Just call us anytime,” she says, patting my arm. I thank her, feeling myself turning to stone. To lose a toe so suddenly, after having spent months saving its neighbor, doesn’t feel like a sad irony. It feels like an inevitability.

Gladys wraps my foot in a soft cast instead of another hard one. It looks like shit. “This looks like shit,” she says. The caffeine is wearing off. “Here, I’ll show you a trick. KC taught me this.” He folds a piece of foam in cotton batting and wraps it neatly around itself. They redo the cast with the foam inserted underneath, then strap on a new post-op shoe. They bring me my scooter and I wheel away without saying goodbye. 

Plaster

I get a text from my mother in the middle of the day saying that my aunt’s husband Richard just died. Richard had been deep in the throes of dementia for some time, and I didn't know him well, but he's another bit player gone from the production, and I feel a little sad. 

When I get to my appointment, I find there is another new nurse. His name is also Sean. He is handsome in a predictable kind of way. His muscular arms are covered with tattoos. He’s probably driving KC nuts. I immediately dislike him. 

Aaron walks him through instructions for cutting off my cast. “Oh yeah we used these saws in the ER,” Sean says. 

Kim, no longer the new kid, stands to the side and watches. “The pupil has become the teacher,” I say to her. A few seconds later Sean tears into the cast like he’s chain-sawing a log. The saw grinds and squeals unhappily.

“There’s no hurry,” Aaron says. I’ve never heard him sound nervous before. “Okay, no see now you’re… I love the enthusiasm, but it’s not really… here, maybe I should... you know what, let’s turn it off for just a minute.” 

“This isn’t anything like the saw we used in the ER,” grumbles Hot Sean. 

“No, they’re kind of different,” Aaron says. Kim doesn’t say a word. 

After three complete passes, Sean has finally gotten the hang of the saw and pries my cast off then leaves for the day.

Dr. Ronda looks at the wound on the left foot and pronounces it officially healed. “This will be your last cast,” she announces. Then she looks at the wound on the right foot. “This looks pretty good as well.” She scrapes away at it. “Hmm.” She scrapes some more. “This is pretty deep.”  She’s quiet for a moment. “I’m going to order you an MRI. I see bone.”

“Oh shit,” I say.

“I know. You might have to go back in the chamber. We’ll give it a week, see if the antibiotics help.”

It’s not so much that the specter of the chamber is so terrible –I know that it works, and that the only other option will be amputation- but there’s no way I’ll be able to keep working; sessions in the chamber take up three to four hours a day including travel time. All I can do is hope the antibiotics work, and that by next week things are starting to heal up. But if the wound is that deep, it will be a while before I’m back to any sort of normal. 

I’m beyond tears, beyond being upset. I chat and joke around with the nurses like usual, and when Dr. Ronda comes back I compliment her on her new footwear. She’s wearing a post-op boot on her left foot. 

“I thought it was just sprained but it’s broken,” she says. I wait for her to tell me how it happened, but she doesn’t. 

“Maybe you need to put it in a cast,” I say. “I mean, these things are really comfortable. As well as stylish.”

“I thought about it,” she says, wrapping my foot in its final cast. “You know, this stuff smells a little funky.” 

I catch a whiff of it through my mask; medicinal and rubbery. “It does smell funky.”

“I’ve never had this happen before. It’s always odorless.” She knocks my shin, my calf. “Seems normal.” She knocks again and again. She looks into the bucket, where the unused cores of the casting float around, and says, “What the hell?”

Aaron gingerly picks one up. “I’ve never seen them this color before.” 

“Me neither,” says the doctor. “I wonder if we got a bad batch. I think it’ll be okay, but if you have any issues, go right to the emergency room.”

In the elevator, a man gets in, holding a disk of plaster with a large handprint in the middle of it. Without thinking, I joke, “Nice art project!”

“Thanks,” he says his voice a husk. “It’s for my sister.” 

Oh shit, I think. That's the imression of a dying person's hand. 

I feel like I should apologize, but the doors open and we both go our separate ways, him deeper into the building and me wheeling out onto the street, gripping the handlebars tight.

Flyswatter

 I wake up feeling deeply exhausted and dissatisfied with everything. For the first time in a while, I have no desire to write down anything. When I force myself to do so, I feel like I’m trudging through tar.

This is partially due to the heat, which has been relentless, and today the air smells of smoke from the forest fires that are consuming much of the state. One of my coworkers says it’s probably from an Italian restaurant that had burned down across town days before. Between the heat and being tired of wearing this cast, I don’t have a lot of patience for the idiocy that seems to surround me at work. 

Happily, it’s my day to leave early for my appointment. I find myself attended to by Alan and Nurse Sponge, who seems much more confident today, and even cracks some jokes. It’s been interesting seeing someone develop over the past few weeks from a terrified fledgling to a member of the team. I guess I’ll start calling her by her name, which is Kim. Alan makes her do almost everything and watches carefully, answering her many questions. She’s conscientious but extremely slow, and this ends up being my longest visit ever. 

“This looks beautiful. I’m thinking maybe another couple of weeks,” Dr. Ronda says. “As for this other one,” she points at my right pinky toe, “A week of antibiotics and you’ll feel like a new man.”

“Good, because I’m really tired of the old one,” I say. I feel like crying and probably look like it. She looks at me sympathetically, and leaves while they prepare my leg for the new cast.

When I leave the hospital, a woman is crying on the curb a little ways down from the bus shelter. A man approaches her and sits a little ways away, talking to her. She quiets down a bit, then continues to wail. We all watch, unsure if we should do something, relieved that someone else is dealing with her. An enormous pile of garbage spills off a nearby bench; I assume it’s connected to the woman, though there’s no evidence of this. 

One of the bystanders is a tiny woman with insect tattoos on both her shoulders. When we get on the bus we make eye contact a few times. She’s pretty but extremely skinny; her ankles are so thin I could encircle one with my thumb and forefinger. She only rides a few stops but I keep glancing at the empty seat. 

The next day I wake up feeling deeply exhausted and dissatisfied with everything. Once again, I have no desire to write down anything. I was hoping for a story with a linear narrative but instead I find myself writing in circles. 

When I get to work, I find a cheap plastic tennis racket sitting on the desk in the control room. It’s fluorescent orange, with a black and lime green handle. The color of parties, of Xtreme sports, of action. Cheetos and Mountain Dew. In the middle of the screen is the letter Z. Then I realize what it is. It’s not a Z, it’s a lighting bolt, and this garish object is an electric flyswatter. I feel nauseous. “Are there really that many flies in here?” I ask no one in particular. The other officers are delighted as they are by any new toy, especially one with violent capabilities. 

To try to cheer myself up, I spend a lot of the time in the galleries, giving breaks and looking at the art. I try to help a lot of people and succeed some of the time. I crack a lot of stupid jokes, with about a forty percent success rate. Thirty percent. I have a spirited discussion with an outspoken performance artist from Oakland named Bonsai, or perhaps Banzai. The museum is packed with beautiful women, who have dressed taking the weather into account, and by the end of the day I feel pummeled by the twin fists of loneliness and desire. I sit at my desk and try to find a path out of this labyrinth of misery but I find myself writing and writing in circles. I hear the cat thumping around in the other room; she’s caught a June beetle and is ecstatically torturing it as it tries to buzz away. I consider trying to rescue it but figure what’s the use. 

The Cast, Season 9 Episode 6

         The routine is getting dull, and yet there is no end in sight. I feel like I’m trapped in a hospital show well past its expiration date, like Scrubs. (I’ve never seen a single episode, but I’m assured this is true.) Every Thursday I check in at the front desk, take the elevator to the fourth floor, am greeted by Shelly, and plop down on the chair in the middle room. I am always the last patient of the day, and most of the rest of the staff has left. The few that remain busy themselves with doing inventories of bandages and ointments. These people have become family to me, and as family members inevitably do, they have started to irritate me. 

        For instance, I’m tired of Shelly only ever talking about herself. She has never asked me a single question aside from “have you changed medications” or “do you have any upcoming appointments.” The new nurse, Catherine, is assisting again this week. She has the personality of a sponge. Shelly lets her cut my cast off, and she does fine but takes a long time since she’s never done it before. “It’s always good to be someone’s first,” I say. She doesn’t respond. 

        Free of its cage, my leg is soft and chalky, and a shower of white flakes flutters onto the chair when I rub it. I wish Shelly would rub cream on it like some of the nurses do but she doesn’t because she’s Shelly. So I just enjoy the novelty of being able to twist my ankle until Dr. Ronda comes in. 

        I ask her how she is and she says, “I’m having an annoying day.” The wound on my right toe has gotten wider and deeper, though Shelly insists that it’s filled with clean, healthy tissue. The doctor asks her when I had my last culture taken from it. Shelly flips through my file but she doesn’t find anything, because I’ve never had a culture taken of it. 

        Dr. Ronda shakes her head and slides a long cotton swab on a stick from a plastic tube, and, saying “Ouch” to warn me, digs it into the open sore. “I don’t understand why this isn’t healing up,” she says. “Maybe this will tell us.” I ask her if I should get my shoes adjusted again and she says yes.

        As she prepares the undercoating for my new cast, Shelly complains that her mask is bugging her. It’s one of those heavy-duty N95 ones. She says she needs it because her husband has COVID. “It’s his first time!” she says. I say congratulations. She says the first time she had it, she was breastfeeding her youngest, who of course caught it, but was fine. “I was nursing for two,” she says, explaining that an acquaintance of hers wasn’t able to produce milk. “It was probably the thing in my life that I’m proudest of.” Her slights breasts are barely noticeable through her scrubs. I don’t know what to say.

        The doctor comes back in and puts on the new cast. She tells a story about a drunk man who came into the emergency room she worked in years ago. “Drunk people always say they had three beers. Every time it’s ‘Three beers, doc, I swear.’ But when I asked this guy how much he’d had to drink, he smiled at me and said ‘a lot. A whole lot.’ I had to respect that.” 

        She tells a couple of very mildly amusing anecdotes her pastor told her. For the first time I think she looks ridiculous in her yellow paper gown, gigantic blue slippers, and African pillbox cap. As she sloshes water around and once again enshrouds my poor, pasty leg, I think about how tired I am of her, of Shelley, even of the Sponge, new though she has barely been working long enough for me to get sick of her. She’s not right for the part, she’s been badly miscast, pardon the pun. She’s just one more sign that it’s time to pull the plug on this fucking show before it jumps the shark.