I buzzered the nurses relentlessly, begging for extra morphine to satiate the snake, only to be told that it was not yet time. I demanded, pleaded, bargained, and cried; they insisted that they—fuck them—had my best interests at heart. Too much medication would prevent my internal organs from working properly. Too much medication would make me dependent. Too much medication would, somehow, make things worse.
A snake lived inside me. I was enclosed in a skeleton’s rib cage. The Vietnam War, apparently, had existed for my benefit. My fingers and toes had been lopped off, and I had recently learned that while doctors might be able to perform a phalloplasty, to build a new penis out of tissue taken from my arm or leg, I’d never be able to achieve an erection again.
In what way, I wondered, could more morphine possibly make things worse?
♦ ♦ ♦
When the nurses got tired of my pleas for more dope, they told me they were sending in a psychiatrist. The blue gown he wore over his clothing, for the protection of the burn patients, did not quite fit properly and I could hear his corduroys rubbing at the thighs as he walked. He had a balding dome, wore an unkempt goatee in an unsuccessful effort to distract from his double chin, and sported the puffy cheeks of a man whose entire diet came from vending machines. His animal equivalent would have been a chipmunk with a glandular problem, and he extended his paw like he was my new best friend. “I’m Gregor Hnatiuk.”
“No thanks.”
Gregor smiled widely. “Not even going to give me a chance?”
I told him to write down whatever he wanted on the evaluation form and we could pretend that we’d made an effort. Normally, I would have had some fun with him—told him that I’d breast-fed too long and missed my mommy, or that aliens had abducted me—but my throat couldn’t handle the strain of speaking so many words in a row. Still, I got the point across that I had little interest in whatever treatment he thought he could provide.
Gregor sat down and settled his clipboard like a schoolboy trying to hide an erection. He assured me that he only wanted to help, then actually used his fingers to air-quote the fact that he was not there to “get inside” my head. When he was a child, the neighborhood bullies must have beaten him incessantly.
I did manage to get a few final words out: “More painkillers.” He said he couldn’t give me them, so I told him to go away. He told me that I didn’t have to talk if I didn’t want to, but he would share some methods for creative visualization to cope with the pain. I took his suggestion to heart and creatively visualized that he’d left the room.
“Close your eyes and think about a place you want to go,” he said. “This place can be a memory, or a destination that you want to visit in the future. Any place that makes you happy.”
Sweet Jesus.
♦ ♦ ♦
Dr. Edwards had warned me that the first time I was conscious during a débridement session would be painful beyond the ability of the morphine to alleviate, even with an increased dosage. But all I heard was “increased dosage,” and it brought a smile to my face, although no one could see it under the bandages.
The extra dope started to take effect shortly before I was to be moved, and I was floating on a beautiful high when I heard Dr. Edwards’ clipped footsteps, from sensible shoes, coming at me from down the hall before she arrived.
Dr. Edwards was, in every way, average looking. Neither pretty nor ugly, she could fix her face to look adequately pleasing but she rarely bothered. Her hair could have had more body if she’d brushed it out each morning, but she usually just pulled it back, perhaps out of practical concerns, as it is hardly advisable for loose strands to fall into burn wounds. She was slightly overweight and if one were to make a guess, it would be a good bet that at some point she’d simply grown tired of counting calories. She looked as if she had grown into her commonness and accepted it; or perhaps she’d decided that, since she was working among burn survivors, too much attention to her appearance might even be an insult.
Dr. Edwards gestured to the orderly she’d brought with her, a ruddy chunk of a man whose muscles flexed when he reached out for me. Together, they transferred me from my bed to a stretcher. I squealed like a stuck pig, learning in a moment just how much my body had grown to accept its stillness.
The burn unit is often the most distant wing of a hospital, because burn victims are so susceptible to infection that they must be kept away from other patients. More important, perhaps, is that the placement minimizes the chance of visitors stumbling across a Kentucky Fried Human. The débridement room, I could not help but notice, was in the farthest room of this farthest wing. By the time my session was finished, I realized this was so the other burn patients couldn’t hear the screams.
The orderly laid me out on a slanted steel table where warm water, with medical agents added to balance my body chemistry, flowed across the slick surface. Dr. Edwards removed my bandages to expose the bloody pulp of my body. They echoed with flat thuds as she dropped them into a metal bucket. As she washed me, there was disgust in the down-turned edges of her mouth and unhappiness in her fingertips. The water flowing over me swirled pink. Then dark pink, light red, dark red. The murky water eddied around the little chunks of my flesh that looked like fish entrails on a cutting board.
All this was but a prelude to the main event.
Débridement is the ripping apart of a person, the cutting away of as much as can possibly be endured. Technically, it is removal of dead or contaminated tissue from a wound so that healthy skin may grow in its place. The word itself comes intact from the French noun débridement, which literally means “unbridling.” The etymology is easy to construct: the removal of contaminated tissue from the body—the removal of constricting matter—evokes the image of taking the bridle off a horse, as the bridle itself is a constriction. The débrided person shall be set free of the contaminant, as it were.
So much of my skin was damaged that removing the putrefying tissue meant more or less scrubbing away everything. My blood squirted up onto Dr. Edwards, leaving streams of red across her gowned chest, as she used a razorlike apparatus to take the dermis off my body, not unlike the way a vegetable peeler removes the skin from food.
Dr. Edwards made long— No, that’s too formal. Our situation made us more intimate than the cruelest of lovers, so why not use her given name? Nan made long swooping passes over my back. I could hear the blade as it slid along my body, disengaging the skin. The only way she’d know that she’d reached the good tissue was to actually slice into it. If I screamed in pain, she had burrowed deeply enough to find functioning nerve endings. As Blake wrote in The Marriage of Heaven and Hell: “You never know what is enough unless you know what is more than enough.”
Nan deposited the thin sheets of my flesh in the same metal bucket that held my dirty bandages. It was like seeing myself disappear, the flags of my existence being blown away a millimeter at a time. The pain, mixed with the morphine, caused the most interesting images to flash through my mind: Senator Joe McCarthy bellowing “Better dead than red”; a carpenter assembling the crosses upon which the crucified would be nailed; dissection in biology class, with eighth-grade scalpels cutting into frog stomachs.
Once I was fully débrided, the exposed sites needed to be covered with grafts, be they cadaver or pig. It never mattered much, because my body rejected them all. This was expected, as the grafts were never meant to be permanent; they were there mostly to prevent infection.
During my stay in the hospital, I was skinned alive over and over. In many ways débridement is more overwhelming than the original burning because, whereas the accident came as a surprise, I always knew when a débridement was scheduled. I would lie in the skeleton’s belly and dread each future sweep of the knife, previewing it a hundred times in my imagination