By Lucas Johnson
Author’s Note:
Names are tricky. When you name something, you give it teeth. I was told that my first year of medical school would mark the beginning of the decline of my empathy. Studies showed that as you get closer to becoming a physician you become less able to connect with the people you set out to help. Knowledge for humanity, this was the trade. I scoffed at this. I was a true believer. I was the righteous exception. I had made it almost one year before I noticed the decay. I was the boiling frog. During a school event I was asked the name of a standardized patient, I did not know it. I didn’t care that I didn’t know it. The water was warmer.
Names have stories, stories make patients real. This is an effort to renege on the deal I’ve been offered. For all the cadavers that had nail polish, and all the names I didn’t learn. I’m not scared of your teeth.
Patient #1: The Ballad of Chip and Petunia
Petunia ran the Dairy Queen down on South Garrison Avenue like Jesus Himself might come down from Heaven and order a Blizzard any minute. That is to say, Petunia was a woman unequaled in precision and authority when it came to all things dealing with frozen dairy royalty. A precocious child, she would have no doubt risen to great heights of success given the right ingredients. Instead, she was given a family of seven and developed a keen distaste for chaos. At sixteen she was out the door.
Petunia was 17 when she met her husband. He was a farmhand that she caught huffing paint behind the DQ. A blossoming young woman with appetites that needed sating, she began her endeavor in holy matrimony in a hurry. Ladders climb walls, drills hang pictures, hammers drive nails, Chip too served his purpose. Although it is unlikely that the hammer ever loved its line of work the way Chip loved his. Petunia was not a sentimental woman, but Chip took her enthusiastic physicality to be proof of her love. Chip lived in blissful ignorance, and Petunia did her best not to regret her choice in husband. These were the salad days.
Some people are born romantics, and romance is a thing that defies all logic. Chip slid into this world pacified. He didn’t cry when his mother brought him into existence in the back of his father’s two door Chevy. He didn’t cry when she hit the bottle a little too hard and showed his daddy the back of her hand. He didn’t cry the day she ran off and left him and his daddy to fend for themselves. But bless his little pea-picker, he sobbed his damn eyes out the day he married Petunia.
Chip was initially given a very small parcel of emotions with which to understand his world. His father taught him these very quick. These emotions were angry and drunk, usually in that order. Lacking much discipline anywhere else, his father was doggedly adherent to maintaining a solitary vice and he tried his best to pass this onto his son.
If you grow up perpetually hungry, you get used to it. If no one explains to you what satiety is, you’re liable to look around for a very long time before you find it. Left high and dry in the maternal department, Chip was in the market for role models. He prayed for a mother and was answered with a second father. Chip was just starting to sprout fuzz from his chin when his father’s brother got out of prison. His uncle was without the shred of discipline held by his brother and encouraged Chip to explore the worlds around him, imparting to him a rhyme. “Pills and powders stay away, if it comes from the ground, it’s probably okay.” Of course, Chip would quickly grow to play fast and loose with what he considered to be “probably okay.” Yes, Chip inherited the best of both worlds, taking the affinity for homemade alcohol from his father and fondness for scavenged hallucinogenic substances from his uncle.
In Jr. High Chip added to this list of feeling, expanding his heart to include stoned (using anything he could sniff, smoke, or huff) and lustful (using anyone that was fool enough to engage with him). It was Petunia who taught him love, the last one he’d ever need. For all her begrudging indifference, Chip would always treasure his wife for flipping that switch. Once on, Chip had a great deal of loving to dispense.
Petunia had only one pleasure that demanded to be fulfilled each day, her evening bath following work. The ritual had begun after standing in line for cigarettes one day. Petunia was a creature of habit and did not go to the gas station for smokes. She preferred the Dollar General. She liked the ambiance of the General’s handicap stall for her morning constitutional and the reading material kept in a basket between the throne and the wall. She especially found peace in the pages of People magazine.
She had been thumbing through an issue when she caught a perfume ad, one with a model in a bathtub surrounded by candles and drinking a glass of champagne. Petunia thought this was just about the classiest damn thing she’d ever seen. In addition to her pack of cowboy killers, she decided she’d also relieve the General of his entire stock of Citronella candles. They kept the biting flies away and she was partial to their sweet and sour aroma. Besides, being a fiscally savvy woman, she’d be damned if she was going to own a candle with no function. Come 7:15 p.m., Petunia would be in the tub with an ice-cold Miller High Life in her hand (three more in reaching distance) and eight Citronella candles burning across the lip of the tub. God help the soul that stood between her and this pleasure.
A common misconception people make about backwater towns in places like Nowheresville, Arkansas, is that they are populated by small-minded people. The problem was never that rural America was full of unintelligent dullards, the problem was it wasn’t. Conspiracy, government distrust, alcoholism, drug use, petty crime. These pastimes arose to do just that, pass the time. And if energy and creativity with no outlets creates a recipe for disaster, then Chip was Chef Boyardee.
Things got sour around year seven. Petunia’s appetites had cooled, and Chip began to get the picture. It was year eight when Chip realized he didn’t love his wife. It was year nine when he realized he did love his horse. Ever present when he called, steadfast in working the field, and capable of long hours with little conversation, Chip had developed a very strong bond with the animal. His feelings grew so strong that he took to caring for the horse fastidiously, brushing his steed’s mane several times a day. He found the act so calming, that after fights with his wife or on nights when he couldn’t sleep, he would sneak off to the barn to drink grain alcohol and brush his horse. It bothered him terribly to be on unequal footing with the animal when it came to intelligence. It reminded him of his wife and her wretched superiority. He disdained the idea that he might be placing his horse in a similar position. He yearned for equality.
Chip knew it was time for his biannual haircut when he could no longer discern the difference between the pubic hair growing on his shoulders and the wiry grey locks snaking down the back of his head. Capability can be a dangerous thing in small towns. The truly capable do not seek to lead, they’re called to it by an authority named necessity. One that is educated, moral, socially minded, and holds good standing in the community will very often hold many positions of leadership. Chip’s barber preached every Sunday at the local Church of Christ and volunteered as a firefighter on the weekends. With the community being 45 minutes from the nearest hospital worth a damn, the barber was also known to throw a stitch or two when the situation called for it. For Chip, the barbershop was as close as he ever got to a church or a hospital. For Chip, the barber was the supreme authority on all things righteous, scientific, and social. His barbershop was a holy ground, an extension of this authority. In short, it was a place that a man could get some ideas.
Chip’s barber was a learned man that had married a brilliant young teacher. Together they had produced a litter of wily pups. The barber’s youngest son was the most cunning and happened to be sick the day of his basic science oral exam. The barber had not believed the boy but had not been able to prove his deceitfulness. Caught halfway between proud and pissed, the barber was sentenced by his wife to a “bring your son to work day!”
Not to be bested by his child, he decided to make the day an educational one. On the way into work, he stopped in at Video Villa and found the driest scientific videotape he could. He placed it in the VCR and sat his son down in front of the television in the corner of the shop. The videotape had just reached the section on bacterial fission when Chip walked in. Chip knew very little about the physical world apart from the things he could observe himself. He was enamored with the video. He was particularly interested in the portion regarding plasmids and the pilus that was used to communicate them. On the screen he watched as one bacterium extended itself and passed knowledge to another. He listened as the narration explained how they were now equals. Chip began to get some ideas.
Science is a matter of faith, same as religion. Both can inspire some outlandish behavior. Both are especially potent to those previously unindoctrinated with their beauties. With a fresh haircut and his heart on his sleeve, Chip returned to the farm born again. He began his work with the horse right away. Mysticism, when paired with a chronic abuse of a variety of inhalants, can lead to some extravagance.
Petunia was unconcerned when Chip began returning to the house late into the night. He would arrive breathless and sweaty, muttering something about working the field late. Either piss drunk or had drunk piss. Said he couldn’t remember which. When the sewing machine disappeared, she was irritated but still considered the anomaly to be well within the standard deviation of her husband’s jackassery. He had taken things to pawn plenty of times in the past. Best case scenario he’d found a new project to take his energies away from her. Worst case scenario, he had found someone else who would give him a poke. The way she saw it, the more he found it elsewhere, the less he’d ask for it from her. It did bother her that he had taken her sewing machine to finance his extramarital carnality, but only because she felt that she had been disrespected. She could give a rat’s ass about Chip’s favor, but she didn’t like that another woman was profiting from her property.
It was the citronellas that did it. In all honesty she asked very little of the world, and she rarely complained. She was stern, but fair. She drew a hard line and advertised well the consequences of crossing it. When she arrived home the eight citronellas were not on the lip of the tub. The 10 backups were not under the bathroom sink. The four she kept in the living room were not in the living room. The remaining 15 were not lovingly arranged across the back and front porch.
The way Petunia lit out the back door was biblical. Righteous indignation filled her mind, and terrible premonitions filled the heart of every living being in a five-mile radius. She could smell it. Her quarry had the audacity to perform the infidelity on her property. She followed the scent to the barn. She was beginning to imagine the way that green fear would look when it filled Chip’s baby blues as she opened the barn door. She was unprepared for the scene she found.
Chip didn’t remember a lot from his bible schooling, but he did recall the story of Adam and Eve eating from the Tree of Knowledge. One might imagine this was because it was the first event in the bible to occur chronologically, but that was not the case. He remembered this with such clarity because in the King James Version of the Bible he had read as a child, there was a drawing of Eve nearly nude save for a few well-placed pieces of garland. This story, paired with the scientific education that had gone on in the barber shop is what lead Chip to water, love is what made him drink.
The bacterium had a pilus. God had a tree. Chip had a root. After a good deal of preparation, he and the horse had agreed the time was right. For months Chip looked for the right vessel and he had found it, a carrot. In a ceremony involving several homegrown psychoactive substances (to ensure fluidity of the mind), he had poured everything he had in him into this carrot. The sewing machine had been the horse’s idea. Adam and Eve had realized their nudity after eating the apple, the transitive property suggested the horse might realize the same after the consumption of the carrot. Chip had fashioned several of his old pairs of jeans into a shoddy pair of dungarees for his steed. Unable to find anything large enough to function as a shirt, he decided it would be easiest to take his off for the ceremony to maintain even handedness. The candles were for added sanctimony. Chip and his horse locked eyes, they watched the universe bend and shimmer in the reflection of their shared love. They leaned into one another. Enter Petunia.
If the cheating and the theft would’ve been bad, this she felt was much worse. She surveyed her bare-chested husband and his horse, a carrot shared betwixt two pairs of lips, the smell of citronella and peyote thick in the air. Chip’s horse whinnied knowingly. The ceremony was complete. Chip and his horse rose together, equals. A solitary tear rolled down Chip’s cheek as his horse uttered his first words, “Thank you.” The horse bent to take the bushel of carrots Chip had prepared for him, going forth unto the world to share the knowledge that he had been given with others. Under the strain of the emotion, Chip reports that he must have lost consciousness.
Petunia watched her fool husband get kicked in the chest. When he hit his head on his way to the ground, she figured he must be dead. If the head trauma didn’t do it, the candles he landed on probably would. A funeral is much cheaper than a divorce, so she didn’t mind all that much. As the flames began to lick the sides of the barn, she heard him moan. A manslaughter charge is more expensive than a divorce, so she pulled herself into action. It is worth noting that in Petunia’s version of the story the horse never spoke, and Chip shed much more than a solitary tear.
HPI: Charles Leroy Buchannan is a 42-year-old man that presents to the ED with chest contusions, smoke inhalation, and a concussion. He has third degree burns on the right arm and back approximately 15% TBSA. He arrived inebriated following a domestic incident involving a horse and a fire. His wife reports that Buchannan has a history of polysubstance abuse and was using while trying to “communicate” with his horse. Patient was kicked in the chest by the horse, impact site over the left sternum, visible bruising and mild swelling. The patient then fell into several candles initiating the fire and hitting his head on a board. Patient was unconscious in the smoke-filled barn for approximately three minutes before his wife pulled him from the burning building.
Patient #2: The Long Way
Your parents have been building a tunnel to heaven. They’ve been working on it for quite some time. They keep it in the garage. You’re not allowed in the garage, but you’re smarter than they think. You can hear it sing to you. You go to watch it when everyone else is asleep. The garage is much bigger on the inside.
The tunnel is 10 feet across and begins 15 feet off the ground. It extends straight upward, much farther past the ceiling of the garage, so far that you have to strain your eyes to see. The entrance to the tunnel is soft. The mouth looks like sails billowing in the wind. There is a welcoming, golden light that pours out into the otherwise dark garage. You feel as though you are looking at something beyond humanity. Like an infant seeing the ocean, like a man considering the vastness of space. Sometimes you stare so long you can still see it when you close your eyes. You’ve been looking at it so long now that you can see it’s shadow when you’re away from it, a black hole in the center of your vision. It reminds you to return.
You are now of age. You will be expected to join them in their work. You know because Father and Mother speak in hushed voices after your bedtime. You can hear Father advocate for you, he explains to Mother that they can no longer afford to keep you here. You emphatically agree, the work is too essential. All are needed. Mother cries, you suppose all she can consider is the danger. You do not begrudge her lack of faith. Mother is always the one to bring the pills, she smothers you with protection. She doesn’t know that you’ve outsmarted her again. You haven’t swallowed a single one in months.
Father comes to you after dinner one night and explains that you’ll be leaving soon. You could barely contain your excitement. In your joy you learn that it is common knowledge that you don’t speak about the work you do. You know this because you tried to broach the subject that night with Father and were sharply reprimanded. He suggested you not mention it to Mother. How silly. Farcical. They leave each day through the tunnel. You can hear the clamor and laughter as they ascend. They return each day after 5:00 p.m. You know this because that’s when you have to leave the garage to evade being caught.
The night before you sneak out to look at the stars. They’re bright and they bite at your eyes. You long for the tunnel but it’d be bad luck to go tonight, like seeing a bride before the ceremony. You don’t have any neighbors, just the cattle. You’re grateful to not have many people to protect your family from. You know from your research that the nearest town is 40 miles north. It’s important to know where the enemy might come from. You value the privacy, and you value the austerity. God took the crops so Father would stop his needless toiling in the field. He made us gaunt so that our fingers would be nimble enough to navigate the linen walls of the tunnel.
It’s overcast this morning. You dawn the ceremonial white linens and pray for rain. Rain is lucky; rain cleans you before you enter a holy place. The house is empty. You walk to the shuttle and find your place among the others. They look nervous too. It’s cold out, but you leave the window down. You can see sweat bead on the metal roof of the vehicle. You concentrate on it, attempting to stare past the cold silver. The roof seems to melt away. Before long, you realize there is no roof on the vehicle. There must have never been a roof, your mistake. You feel the breeze on your cheeks. There is much chatter, and the ride is bumpy as you drive toward the mountain. You suppose the long way must be taken the first time around.
The wind sends waves across the sea of grass that covers the vista to your right. The trees shake their leaves approvingly on your left. You continue your ride up the spiraling mountain. Your house is quite a way downward now. When you return your attention back to the other passengers you notice that two are missing. Strange, but not yet exciting. Perhaps you miscounted when you first got on. A glance upward shows dark clouds, swelled with rain. The first raindrop plants itself on the crown of your head, anointing you. The peak of the mountain is now in sight.
You know your turn is coming but when? What if it doesn’t? What if you were wrong? You feel the cold hand of panic start to rake at your insides. It feels like ice in your throat. It tastes like metal. Haven’t you done this before? Didn’t you fail? You start to remember the place you got sent last time. Everyone wore white there. Mother and Father could only visit sometimes. They must’ve been ashamed of you; I mean really ashamed. They couldn’t even look at you, remember? You could see it in Father’s eyes. He detests you, you’re a worm. You disgust him and you revolt your Mother. But no, you’ll show them, you’re ready this time. You can join them. You won’t have to go back.
There are three more passengers gone now. Time is of the essence. Soon the vehicle will be empty, and the work must begin. You fixate now on the remaining passengers. You try and imagine which lucky soul will be gone in that great rapture next. As if to answer your question a passenger stands. The vehicle gives a jolt and bump as it hits a wayward stone, you hear the passenger stumble and fall. They’ve hit their head hard. You lose focus for a brief moment. The fallen passenger is gone. Their body must’ve been taken after the fall.
All at once you understand. The vehicle is going faster now. You try to explain to the others, but they’re too afraid. They won’t look at the truth. You steel yourself. You don’t want it to hurt. A sacrifice must be made, a show of faith. You picture the tunnel in your mind. You feel hands try and grab you, restrain you. You’re electric. You cannot be contained. You leap from the vehicle and angle your head toward the road. The long way must be taken the first time around.
HPI: Jonathan Greenway is a 23-year-old male that presents to the ED via ambulance one hour after sustaining head and neck injuries. Greenway was in transit to Arkansas State Psychiatric Hospital when he leapt from the moving vehicle reportedly traveling at 25-30 mph. He complains of numbness in both legs, pain in his neck, and a pounding headache. He is disoriented to time and place and is intermittently combative. Patient’s mother reports that he has a history of schizophrenia and has had several instances of cessation of medication use in the past.
Patient #3: Lullaby
I roll over and hear the clinks of bottles and rattle of cans beneath me. Oceans of endless stars. I shut my eyes and begin the courtship again. It’s as it is every night. Infinity or Oblivion, and I have chosen the latter. She’s coy, but after hours of pleas I can tell she’s giving in. She’s beautiful and she knows it, all-encompassing and quiet. Not at all like the other one. The one that’s in love with me, obsessed with me.
The issue with seducing Oblivion is that I must do it while being chased like this. It’s no wonder that she doesn’t come to me quickly, I reek of her sister. I come to her panting and wild eyed, hardly the way to approach a lady of that stature. And so, each night I drink my love potion, something to mask the way I spend my days. Cheap whiskey and beer grant me an audience. She loves the way it smells on my breath as I beg her for her favor. Some nights she grants it.
It’s beginning to look like one of those nights too. I hear the patter and thud of footsteps in the apartment above. Gus must be starting his morning ritual. I try to feel guilty and can’t, a good sign. Gus must be close to 50 now. It’s funny that when I think of 50, I still think of it as older than myself. I don’t know that we ever really make it past 35. The thought of my young neighbor brings thoughts of my daughter. Valarie hasn’t been home in a while. We knew Val was smart early. She took that smart and ran as far away from Podunk Shittown, USA as she could. I try to feel guilty again. This time it works.
Oblivion crosses her legs and looks away. A bad sign. I reach for the bottom shelf hidden between my bed and the wall. I take a painfully long draw, letting the cruel burn show my loyalty, my devotion to her. It’s harder to picture Val’s eyes now. The blue has dulled, and I can no longer read the anger etched into brow. Who was the sculptor again? I take another sip. She was such a happy kid. Fiercely happy. She’s a lot quieter now, she laughs different. She used to wake me up when she was having nightmares. Val always had the worst nightmares when she was little. Said there were monsters under her bed, said I could protect her. She told me once that she never had bad dreams when we shared a room, they only started when we moved to the new house. I used to find her sleeping on my floor, she grew out of it. I suppose she realized I couldn’t save her from her monster any more than I could save me from mine.
Infinity slaps my face for my infidelity. She invites me to gaze into her eyes, watch the never-ending swirl of her irises. She shivers with pleasure as I fall headfirst into the chaos. Last time Valarie was home she found her monster under my bed. She didn’t bother to make a scene, just began wordlessly pulling bottles and cans into a trash bag. That kind of quiet leaves you deaf. I screamed at her for finding me a coward, I whispered her praises when she left for being braver than I’ll ever be.
The secret eats you eventually, and why wouldn’t it? You feed it every day and it outgrows you. You don’t keep it, it keeps you. I heard it described like a dog whistle at a meeting once. You spend your whole life hearing this whine. When you’re young it makes you sullen, fearful. Either everyone else hears it and won’t say anything or you’re alone. That fear eventually hardens into anger, and you realize it doesn’t matter because you’re stuck with the whistle either way. Show me the boy at seven and I’ll show you the man. Well, I took my first drink at 13, that was the first hour I heard silence. That’s when you learn to hide. You take the sullen, and the angry, and the scared and you play pretend. You practice smiling in the mirror and pretty soon you’re pretty good at it. Valarie was four years old before her mother even knew the man she had married. Infinity blows her whistle louder.
What Valarie didn’t find was the pills. The pills are a last-ditch resort. Oblivion does see me as an attractive conquest, but she resents being jilted. She’s so greedy, just like her sister. She won’t take some, but she will take all. She holds a grudge for all the times I’ve had her and left in the morning. The pills always work. They show that I’m devoted, that I’ll leave something for her to keep.
Oblivion dons a white veil. She invites me to have another, to get down on my knees. I look but can’t find a reason not to beg for her hand. The room shakes. Was it two pills or four? Or was it eight? I’ve never seen her so pleased. Infinity weeps as her sister walks toward the altar. I marvel at the beauty and the terror of my bride. I know I’ve taken her to bed too many times to leave her again. I try to feel guilty. I can’t feel a thing. That’s when I know I have her. Maybe she has me. Maybe we have each other. She wraps her arms around me, and the heaviness comes. The ecstatic paradox of falling and feeling totally still.
My thoughts come in snippets, a fire spitting ember before it dies. I turn to see the clock on the bedside table, 5:13 a.m. I think I hear a knock at the door, but it’s too late. I’m not home anymore.
HPI: Richard David is a 73-year-old male with a history of alcohol use disorder and chronic knee pain managed by opioids that presents to the ED by EMS after being found unresponsive at home by his neighbor. The neighbor reports finding David alert and awake 12 hours prior. David was found in bed surrounded by empty bottles of alcohol and an open prescription bottle of hydrocodone, prescribed for knee pain. The exact number of pills ingested is unclear but the prescription, filled two weeks ago, was for 60 and was found empty.
Luke Johnson is a third-year M.D./MPH candidate at UAMS. In his spare time he likes to read, watch movies, and spend time outdoors.