Selected Poetry: 1974-
Paul Seifert, M.D.
"The angel of the ELEGIES is that creature in which the transformation of the visible into invisibility, which we are accomplishing, appears already fulfilled. For the angel of the ELEGIES is that being which stand security for recognizing in the invisible a higher level of reality—therefore ‘terrible’ to us because we, its lovers and transformers, are still clinging to the visible. All the worlds of the universe fling themselves into the invisible as into their next deeper reality; some stars heighten directly in intensity and pass away in the infinite consciousness of the angels—"
Rainer Maria Rilke
COWBOY O’ROURKE AND THE BIG BRASS BAND
Published in The Third Coast: Contemporary Michigan Fiction; Wayne State University Press, l982
Cowboy O’Rourke opened his eyes and felt his pain like burning faggots impaled along the courses of his neck and throat. Like the end of a dream nothing had changed. He stared at the depressing squalor of his room. With his good ear he could make out faintly the fluttering of peeling strips of wallpaper as the electric fan at his head swung through the course of its rotary arc. His eyes caught for an instant a dingy certificate hanging askance upon the wall in its grimy dimestore frame:
JEFFERSON COUNTY CALF ROPING CHAMPION
The protective glass cover was shattered and the underlying paper torn and stained near the left upper corner from the impact of a random bottle of street wine that he had hurled against the wall during one of many recent nights of near drunken oblivion and rage, when the ultimate significance of such certificates had glistened momentarily in his mind like the flare of a match in the darkness. Cowboy O’Rourke leaned up toward the award to scrutinize it more closely. Along the bottom edge of the frame lay a dead cockroach pinioned between the glass and paper, having wedged itself there during a senseless struggle to free itself from mindless entrapment.
The change in his position allowed Cowboy O’Rourke the feel of a momentary cooling draft from the fan, which played across the left half of his face, the side that had nerves and could still feel the normal sensations of faces, instead of the wooden numbness he had been left with on the right since the surgery. Numbness, and yet now—like some sickening cheap joke—inexplicable pain.
Cowboy O swung his legs over the side of the bed, sweeping aside with his feet the random filth that cluttered the floor. He sat there for a moment, naked save for his piss stained underwear, feeling with the fingers of his left hand the indurated thickening of his right lower face and neck, and feeling with disgust the landmarks of his previous existence. A cobweb encrusted case of empty beer bottles caught his eye, lying beneath a rickety card table strewn with half eaten scraps of food—its surface at once a graveyard and vast treasure for the flies that descended to a transient gluttony. He observed with detachment the yellow stained and streaked porcelain sink with its gray blue pool of stagnant soap water and incessant drip that coincided at times in the night with the throbbing pain in the side of his head. The sound and the pain either drove him mad or drove him to the streets.
Cowboy O’s eyes briefly found the taped, but still torn, window shade that shielded him from the sounds and sights of indifference three stories below on the street, where the concrete oblivion was at times so tempting. The bare light bulb of a lamp still shown through the rents in its five and ten shade. There were old newspapers and heaps of debris and dust. There were stains of innumerable sources and descriptions, like the serpiginous yellow monster on the ceiling—an overflow and leakage of puke, piss, or beer—that gave free rein to his imagination as he lay on his back in the evenings, trying in vain to forget the countless frustrations and failures of his wasted life. There were stains of sweat in the mattress and a small blot of what could have been menstrual blood. And there were yellow stains of nicotine on his fingers.
Cowboy O’Rourke fumbled beneath the iron bed springs for a recalcitrant boot, but the effort and straining brought on a paroxysm of now familiar agony—a stabbing pain in the right side of his jaw and face, then a terrific burning that suddenly vanishes with the same diabolical certainty of its appearance, leaving him outraged and grimacing. He slipped on his jeans and the boots and stood up, reeling fleetingly with nausea and giddiness. He grasped the iron bedstead momentarily for support and then walked faultlessly and with determination to the garish bureau, with its flaky chipped black enamel surface and gold filigree and dull gray mirror, that stood a disparate hulk against the wall near the window.
Cowboy O glanced briefly at loose change and a dirt infested comb and his keys, most of them for long forgotten locks and trunks. His wallet, containing the few dollars left to his name, old photographs and tattered cards, caught his eye with nostalgic temptation. He picked up instead a tablet of codeine, which he chewed to a paste with the few remaining teeth in the left side of his mouth, and then swilled down with half a glass of stale water left over from the last dose he had taken in the middle of the night. The codeine helped some, but less each time, especially lately.
Cowboy O’Rourke surveyed himself in the mirror. The disgust and revulsion were one of the few stable aspects of his life—that and the pain that never left him. Even Socrates looked like a cherub compared with him, an angel of the second highest rank. They had sure fucked him up, especially Dr. Boucher—"the butcher". Cowboy O’Rourke had been aware of the sore on his tongue for a couple of months before he had checked into the clinic in Boulder. Most of the dudes on the circuit were doing Skoal or Happy Days. O’Rourke had not paid much attention to the sore, figuring it was just an irritation from the tobacco.
But then they started talking cancer. He had refused to believe it until they showed him the pathology reports from the biopsy. Under the microscope, there was no question about the diagnosis, and so O’Rourke had been transferred up to the big hospital in Denver for treatment.
When Boucher first described the proposed surgery, O’Rourke concluded he had to be crazy. The operation was called a radical hemiglossectomy or "Commando procedure." In effect, Boucher planned to take off half of O’Rourke’s head, including the right side of his jawbone. Boucher had finally got him to sign the consent by showing him a series of before and after photographs that implied that the deformity would only be temporary and that after the tissues healed, plastic surgery would follow. Boucher implied that O’Rourke would be both cured and as good looking as ever within six months at the latest. Without the surgery, O’Rourke was told that his disease could only be arrested with Cobalt 60, but that he would have maybe a year to live at the outside. In retrospect, the discussions with Boucher had made about as much sense to O’Rourke as Lucky’s speech in Godot.
Cowboy O’Rourke leaned closer to the mirror and twisted his neck as far as he could turn it to the left. He stood scrutinizing the operative and irradiation fields for new signs, by slowly running his finger tips over the bluish-red, nodular, and thickened wasteland of what had once been his neck and face. O’Rourke’s neck was misshapen and thin. The effect gave him the appearance of a puppet with its little wooden head on the end of a stick. The tissue over his jaw was hideously flabby in places.
Before the pain had become as severe as it now was, O’Rourke would sometimes stand in front of the mirror gloating at himself. He would stuff all of the flabby tissue into his mouth, sucking the loose flesh in and grabbing at it loosely with the remaining half of his jawbone. The maneuver would cause him to look even more grotesque.
O’Rourke would sometimes laugh at himself luridly, making horrid, distorted faces in the glass. Sometimes, he would find himself snarling and growling like an animal. He could imagine himself frightening off women and children, like the monsters who come up out of the fog at night in old black and white movies, his hands raised in threatening gestures like claws. He noticed that there were only two tablets of codeine remaining. He would have to go back to the Salvation Army Clinic today.
O’Rourke could no longer understand why he had finally consented to the surgery. The prospects of the operation had terrified him. No doubt, his greater fear of death had swung the balance in the end. Surgery was too much of an unknown, lying out on the fringes of reality beyond the absurd, in a world alien to him, where there was no possibility of control over any of it and no way to avert the bad shit before it was laid down on him. He knew his end on that table might be quick and final, like getting picked off by a sniper with a scope. The thought of forceps and stainless steel instruments dissecting away his flesh while he was asleep and helpless had unmanned O’Rourke in the days before the operation, and he had trembled with the thought of the pain he would feel when the procedure was over.
At 8:00 A.M. on the morning of March 3rd, 1967, the orderlies had wheeled O’Rourke to the operating room. He found himself in a blaze of bright light that reflected into his squinting eyes off green tiles. O’Rourke had his long hair pinned up under a tightly fitting skullcap. His face was intact for the last time in his life.
There were about eight people in the room, all dressed in green gowns and wearing masks. Everything seemed theatrical to O’Rourke, terrifyingly tragic, but comical at the same time. He could just make out the outlines of the women’s bodies through their gowns, and he remembered feeling horny for the last time in months. Boucher was there with his head and face covered, but he was recognizable by his eyes and his voice. Someone in control, with a tone of exaggerated authority when he spoke, pushed a syringe full of clear fluid into the IV that was dripping into O’Rourke’s bloodstream. Everything abruptly faded, until Cowboy O woke up a hundred years later in the Intensive Care Unit, with no jawbone and half a face and no more luck at all.
The staff was encouraging at first. They gave him shots for the pain and the nurses kidded around a lot about how O’Rourke was the best looking cowboy in the West. But then they gave him a mirror for the first time. His appearance was more shocking than the worst of Boucher’s pictures. He could hardly believe it when he saw his swollen, blackened eyes and shrunken lower face, with the fat little roll of tissue Boucher had plastered up against his jaw that resembled an ugly hunk of white sausage.
In no time, the really bad news started pouring in. First, Boucher had informed O’Rourke that the pathologist had found evidence, under the microscope, that the cancer had spread from its primary site in the tongue into the lymph nodes of the neck, which meant the operation could no longer be considered curative. O’Rourke would now have to undergo post-operative irradiation anyway. But then the Cobalt 60 had to be delayed, because O’Rourke’s wounds became infected. Boucher ordered the nurses to irrigate the pus out of O’Rourke’s head with syringes twice a day, which made Cowboy O almost go out of his mind with pain worse than he could ever have imagined.
The surgeons then decided they needed to probe into the wound every morning to cut out the dead and infected areas. O’Rourke would break into a cold sweat and become nauseated. He vomited once, which pissed off the nurse in attendance, since the sterile field had been broken and she had to change all of the sheets and his gown so the resident surgeon could start all over again. Sometimes, even now, O’Rourke could feel them picking away at the wounds like rats in his sleep. In his many nightmares, he often killed Boucher and the others, tearing them apart with his bare hands to get even for what they had done to him.
"Give me back my face!" became O’Rourke’s constant litany when the surgeons came into the ward on their rounds. He could slowly feel them losing interest in his case, because he was so angry and because their treatment of his disease had failed.
O’Rourke had spent almost a month and a half on the post-operative surgical ward in Denver. The ward population was a diverse group of down-and-outers, the bulk of whom had been operated upon for cancer of the head and neck. Heavy cutters, were the surgeons on the staff of that ward. O’Rourke marveled at what he had seen removed from the human body there—noses, tongues, sections of necks, lungs, even testicles. Anything that a cutter could remove and still leave a remnant alive to work on had been removed from at least one patient on that lousy ward.
There was another patient on the ward, like O’Rourke, who had had a Commando procedure. The two had very little to say to one another, even though each had learned to understand the other’s speech faster than the rest of the patients had, or cared to.
Some of the patients had undergone tracheostomies, or "trakes," as the procedure was called on the ward. A "trake" was a plastic tube inserted into the windpipe, which allowed the individual to breathe until all of the swelling in his neck subsided. Other patients—called "chronic lungers," because their lungs where shot from smoking—often needed permanent "trakes" if they required surgery. A man with a "trake" couldn’t talk, because all of his air entered his lungs below his vocal cords, unless he plugged up the hole his fingertip. The nurses bitched about that little trick, because doing that supposedly increased the risk of infection. The "trake" patients did it anyway, especially at night so they could join in on the ward conversation. Some of the patients with "trakes" even learned how to smoke through the holes in their necks without choking too much.
Patients died like flies on that ward, and sometimes it was bad too. Every now and then one of the terminals would strangle to death right in front of everybody. There was nothing anyone could do for them except scream for help. Not even the doctors or nurses could do much for the really bad ones like that, except pull the curtains and shoot the guy up with morphine. With the curtains pulled, no one had to watch, but everyone still had to listen. O’Rourke had not actually witnessed it himself, but the old-timers on the ward once described at night how one of the head and neck terminals had hemorrhaged to death on the ward. Apparently, the patient had tried to run for help. After the guy had finally died, the staff had had to transfer everybody off the ward and close it down for a couple of days to clean up the mess.
The ward was especially tough on the old guys. They would bring them in to get them ready for their surgery, and then cut on them a day or two later. After that, the whole ward would be up half the night listening to them crying out or moaning with their pain. The old guys would get constipated sometimes from lying around in bed because of their weakness. One of the attendants would have to dig the impacted shit out of them by hand, and the old guy would scream like a baby from behind the curtains until the disimpaction was over. Or their bladders would become distended and the staff would have to take their piss off into bags that the nurses would hang at the side of the patient’s bed so they could measure the volume of his piss every shift.
Suddenly, one of the old guy’s heart would give out on him and he would be carried off the ward again, wrapped up in white sheets, after one of the doctors had pronounced him dead and the attendants had tied off his cock and plugged up his asshole behind the curtains. O’Rourke had discovered how they processed the dead by accident when he had walked by one day on his way back to his own bed from the crapper and had witnessed the death ritual. The attendants had not closed the curtains all of the way. O’Rourke had been able to watch them working on the corpse for awhile until they had finally waved him on.
O’Rourke’s infection had finally healed near the end of March. For weeks he had been afraid that gangrene was going to set in, because the pus they drained off his face was bloody and green in the beginning and his whole head stunk like dead meat. He feared the flies on the ward, especially when the nurses began to leave his wounds open to the air. O’Rourke feared the flies would settle into the wounds at night and that he might get maggots. The old-timers swore that had actually happened once and that even the head nurse had vomited when she saw the maggots squirming around in the depth of the patient’s wound.
Despite his fears, O’Rourke’s infection had finally cleared up. He could hardly sit down with his full weight on his haunches by that time, because of all the intramuscular injections he had been given. His arm, too, looked like a street junky’s because of all of the fluids and drugs they had infused into his veins day and night.
"OK, O’Rourke! Your goddamned IV’s infiltrated again."
He could still hear the attendants bitching at him in his sleep and he could still feel the nurses probing around in his arm with a needle, searching blindly—or so it often seemed—for a new vein.
Cowboy O’Rourke’s reverie was broken by the sounds of street life that began drifting into his room from the Cass Avenue Corridor that he was living along. A cycle of activity began there every morning with the clean up of the detritus of the existence of the previous evening. O’Rourke could hear the roar of the delivery trucks and the clinking of bottles, as stocks were replenished in anticipation of the needs of the coming night. More and more of his time, though, was spent in the past, going over his nightmare again and again, trying to get a handle on his present reality in order to make some sense of it, all the while wishing he could just make the recent past go away.
O’Rourke gathered his gear off the bureau and made a brief stop at the sink where he pissed into the soap water. He had made a habit of pissing in the sink lately. Doing so was less trouble than hiking down to the community john near the end of the hall, which stunk of stale shit, puke, or cheap red wine. Because the pimps and whores hung out there on a regular basis, there was good cause for concern about disease, even though Cowboy O was careful to cover the toilet seat with paper, whenever there was any. The wooden seat down there was broken and threatened to pinch your ass if you didn’t sit just right. The drunks got it good from that seat now and then, or one of them would just fall off of in their stupor and lay there all night on the linoleum floor that made the room more easy to clean. Someone might try to kick or drag the drunk out of the way, or they might just leave him there and piss on him for the fun of it. If the drunk was a female, one of the guys might fuck her right there on the floor where she lay. Until she became aware of the come in the morning, Lady Jane would have had no idea what had been done to her.
Drunks were fair game for anyone. Every now and then instead of being drunk, one of them would be dead. Through a crack in your door—if you didn’t have anything better to do—you could watch the drunk being carried off in a body bag. That happened a couple of times a week on the average. Just some drunk, O’Rourke mused.
Cowboy O would only use that community john if he had the shits, or needed to take a regular shit so bad there was no choice but to use it. The room had one of those high ceilings with a bare light bulb protected by a wire cage, sort of like a baseball catcher’s face mask, to keep anyone from breaking the bulb which was left burning day and night. The window had been painted over with gray paint, but the paint was peeling in places, and the occupant could see out into the surrounding buildings. You could catch a glimpse of a naked whore or watch people fucking. Fags seemed to get off on sucking each other off in front of windows. O’Rourke speculated that most of them seemed to be students of J.D. Salinger.
O’Rourke had sat many a night on that broken seat with terrible cramps, trying to shit and trying to keep the drunks from busting in at the same time. There was no lock on the door, because the management was afraid the whores would try to turn their tricks in there. Also, if a drunk died in there, busting down the door to get him out and then repairing the frame could get very expensive. So, you never had much privacy without any locks on the door.
If a drunk wanted to get in there bad enough to break down the door, generally the bastard really needed to use the head. O’Rourke had to confess to a perverse sense of pleasure listening as the desperate drunk shit his pants in the hall, while cursing the universe from heaven to hell before stumbling back to his room. Some crapper that one. The management had actually hung a white cardboard sign with a little border of violet flowers in there that read: Cleanliness is next to Godliness.
O’Rourke searched around his room for his Stetson, which he finally located beneath the bed stand where he had not noticed it at first. He would have hated to lose that hat, which he had had now for several years, and to which he had become accustomed in the way a cowboy gets to feeling about a Levi’s jacket that he has had for years. A jacket like that gets faded and worked in from laundering until it becomes unique and special to a cowhand even though there are at least 50,000 jackets just like it in every big town in the West. Hats got to be like that too.
Cowboy O adjusted the Stetson in the mirror, as he was preparing to leave the room. He had learned how to conceal a good deal of his deformity by wearing a bandana, and by turning up his collar and keeping his neck and chin scrunched down onto his chest when he walked along the streets.
Out of some perverse sense of the absurd, perhaps, now and then O’Rourke would tie the bandana over his face as he stood before the mirror, so he would look like an outlaw. He could imagine himself looking behind the mask the way he had looked before the surgery. He would remember how it had been when a woman would look at him appreciatively. He would speculate about the chances he might get laid. Sometimes, he would even jack off in front of the mirror. But today he couldn’t afford any indulgences in auto-eroticism. He was running out of codeine and he had to get back to the Salvation Army clinic. He was hoping the doc there might have something stronger than codeine, because the last tablet he had taken had not touched his pain.
Back in Denver, irradiation therapy had been started in an attempt to contain O’Rourke’s cancer in early April. By completion of the first six treatments, he was so sick he couldn’t eat or drink. As he lay on the table, O’Rourke could imagine the invisible rays burning through his tissues, tearing and rending everything on its path like a cut loose steer with its hooves flashing like steel teeth in the mid-day sun.
Cowboy O continuously pestered Boucher with questions about how long it would be before the surgeons could start to put his face back together. At that point, Boucher had first intimated that reconstructive surgery might in fact be impossible, because of the extensive damage that had been done by the infection, in addition to the scarring and induration that would be added by the irradiation. Plastic surgery would now be much more difficult to accomplish, if not impossible to carry out at all. Boucher suggested that O’Rourke concentrate instead upon survival.
The sheer magnitude of his deformity had become a fixation for O’Rourke. He recalled the startled aversion of patients and their visitors as he would pass them in the halls. He remembered the shock written on their faces. He soon began to hide himself from them and their superior view and the complete way they appeared to look. Boucher, too, had obviously lost interest in O’Rourke’s case, seeming aloof and suddenly very busy and in a hurry to get somewhere whenever he and his patient would meet.
O’Rourke’s rage and overwhelming sense of having been innocently victimized had continued to swell until, on a Friday evening just after supper and about two hours before the Veteran’s Auxiliary prayer meeting, he had decided on impulse to split. The staff forced him to sign a release of responsibility for his actions before they would give him his clothes. Some of the nurses coaxed him to the last minute to stay on for more treatment, but his inflexibility and sarcasm had caused these discussions to degenerate into emotional harangues, with thinly veiled death threats on their part in the end.
Looking back at the hospital as it loomed to become a white hulk in the dark of early evening, Cowboy O swore he could see death personified stalking its high beams out of the corner of his eye. O’Rourke realized the eye could play tricks like that. He had laughed the vision off until recently.
Everything the honored medical profession had told him had turned out to be bullshit, so he had concluded that any opinions Boucher held about how long O’Rourke would remain alive would be just more opinionated verbiage. If he knew he was really going to die in the immediate future, the first thing O’Rourke would want to do would be to go back and get Boucher. He had been thinking a lot recently about methods, such as amputating Boucher’s cock at its root, so he would really begin to understand surgery, or maybe peeling off Boucher’s skin in sheets the way flaying was done in the Middle Ages. O’Rourke would take before and after photographs, of course, so the next patient would be convinced the procedure was safe and consent, the way he had done like a fucking ass.
The naked hallway outside O’Rourke’s room descended past hidden doorways, along lines of perspective into darkness and shadows, where a dimly lit form lay in a hulk against the wall, its identity as human barely discernible beneath the inevitably burned out light bulb vaguely outlined against the ceiling. Another god-damned wino drunk!
"Fuck the son-of-a-bitch," O’Rourke said aloud. "Leave him to the management and the rescue squad!" He had to get to that clinic.
The sun was up and was hot and bright on the street. The light hurt his eyes after the darkness of the hotel, as O’Rourke walked along Cass Avenue, past the alley-ways and doorways where the light and heat had crept in, waking the real down-and-outers who had flopped for the night in the street. Through blank and vacant eyes they stared up at him, shaking off the stiffness and cold numbness of the night, some burning with fever. Dirt encrusted patches were visible on their faces and hands, or visible beneath rents in the disheveled remnants of their thermal underwear, the latter begged, borrowed, or stolen to ward off pneumonia—the old man’s friend and inevitable avenger.
The street people muttered incoherent curses from beneath their newsprint blankets as O’Rourke passed, catchwords of forgotten alms and bitter declarations of his better lot in life.
"Fucking parasites," O’Rourke thought. "Scared and wounded and coming out of the walls to begin their day."
The street unfolded before his eyes as Cowboy O’Rourke walked on. He passed broken down apartment houses and sleazy hotels interspersed with the inevitable bars sporting garish neon signs depicting names: Jim’s, Shooter’s, Harry’s or The Red Dog. A theater confidently proclaimed Jesus Saves in large irregular letters from its marquee. There were grimy little establishments that fronted the loot of countless rip-offs, where you could pick up a lead on a speakeasy or some street grass if you had the inclination. O’Rourke ambled past the beloved beer and wine store where the busy proprietor found it necessary to barricade himself behind a solid wall of half-inch Plexiglas. His arsenal was prominently on display behind the glass as he stood laconically before the turnstile cut into the wall, through which he was able to take in cash and push out hooch safely, in order to stay both in business and alive.
The pimps and junkies and the hookers were already working the street. The whores were willing, even at this early hour, to go around the world for fifty bucks with any john who could rut and fuck his brains out on some roach-infested mattress and come out of it alive and healthy, if his rubber didn’t break, and the real street freaks were not desperate enough that day to kill for fifty bucks. Squad cars full of big old cops drifted by, keeping a half opened eye on the happenings, just to make sure the level of action stayed inside the nebulous bounds of civilization.
As he ambled along the street, O’Rourke casually surveyed an abundance of signs depicting bargains of all descriptions, entreaties and commandments, the announcement of candidacies, an invitation to salvation, gastronomic delights, shoe shines, haircuts, and abortions, 522-6663. He never failed to spend a second or two peering up at the big billboard with its cruelly seductive depiction of the vast open ranges of Marlboro Country, a sad reminder of how far he had fallen.
A couple of blocks from the Salvation Army Clinic, O’Rourke turned into a White Castle grill, since he had twenty minutes to kill and he knew he had to eat to keep up his strength.
The waitress was dumpy, but still desirable. Her ample breasts were silhouetted nicely beneath her black and white uniform. An elderly black guy sat on a stool at one end of the counter, whispering suspiciously into a white coffee mug before him. He glanced furtively at O’Rourke, his ministrations becoming more clearly audible momentarily, before he returned to the visions apparently emanating from his coffee cup. The waitress tapped her temple with an index finger, while glancing sidelong in the old man’s direction. O’Rourke found a stool safely removed from the Amens and hosannas originating from the far end of the counter and sat down.
"OK, Mack, what’ll it be?" the waitress asked, surmising from the Stetson, which O’Rourke had made no effort to remove, and from the bandana and the stiffness with which her new customer held his head, that this one was possibly no prize either.
"Covvee," O’Rourke enunciated as clearly and succinctly as possible, without betraying any more of his deformity than necessary.
"The coffee I got, Cowboy," she responded, sliding the cream and sugar his way and marking the order slip in pencil, "but you are gonna have to shoot that last one by me again."
O’Rourke could feel her eyes begin to dissect and probe the visible distortions of his face and neck. He could feel, after long months of experience, her incipient revulsion.
"Souk…souk!" he repeated, anxiously scanning the walls for a possible picture, but finding none and beginning to pale with anger and frustration. He grabbed her pad and the pencil and quickly printed beneath the "C" she had previously scrawled:
"Soup—any kind—not too hot."
"Oh, OK, soup," she said. "How about some nice hot bean soup, only not so hot?"
O’Rourke nodded curtly and then cowered deeper into his up turned collar, trying hard not to stare at the curves of the waitress’s ass as she relayed his order to the cook in back. He was disgusted with himself for coming into the place at all. He hated bean soup. It wasn’t worth the effort to change the order, so he just sat there and waited, toying with the coffee and listening to fragments of the Word of the Lord arising from the far end of the counter.
The waitress positioned herself at a safe distance from both of her customers and feigned an intense involvement in paring her fingernails and waited too. A siren screamed by outside on the street, blessed in a fashion by the old man, but disregarded by the counter woman and O’Rourke.
As O’Rourke sat waiting for his soup, he relived yet again the odyssey along the back alleys and side streets that had brought him from the hospital in Denver with thirteen bucks in his pockets to this grimy White Castle, an odyssey marked by intense determination to keep away from knives, alcohol sponges, untouchable nurses in tight white uniforms, and from butchers like that bastard, Boucher.
After leaving the hospital, O’Rourke had stopped home in Pueblo long enough to pick up a little money he had stashed there. He had visited the old family farm out on Route 23. A few miles outside of town, the place had been sold off years before. The buildings were deserted and the plowed fields had gone to weed. O’Rourke had stood there looking at the place for awhile under a blue Colorado sky, then he had lit out East to odd-job his way across the country and keep out in front of his death for as long as he could.
From that point on, the course of O’Rourke’s life had traced a slow descent into the fringes of human existence. The economic realities of his declining fortune had forced him further down the back streets, into the slums of the cities. Jobs had been harder to come by than he had anticipated. The impact of his deformity had become increasingly poignant as time passed. O’Rourke had tumbled slowly, but inexorably, down a cascade of social stratification and human worth, as his financial reserves had waned. He had entered upon the hard winter of his disease.
He had swabbed out latrines and swept out bar rooms and had witnessed repeatedly the seething brutality that pulses with a swift and remorseless energy at the frayed edges of civilization. He had sought and found a formless refuge at the bottom of countless bottles, especially more recently since his pain had returned. The pain had brought along with it a nameless fear that wrestled impotently with the specter of his approaching death. He had fought hard for his pride and his self respect, but had lost them slowly beneath the layers of silt that had accumulated during long nights of painful retching in the flophouses and hotels of skid row, living from job to job and from hand to mouth.
"OK, Mack, soup’s on," said the waitress, pushing the bowl into place before O’Rourke, along with a package of crackers and a spoon.
"That’ll be four bits with the coffee."
O’Rourke paid up and sat for a minute playing with the beans and small flecks of ham with the spoon. He hadn’t eaten anything solid in two days. He found himself surprisingly hungry.
The first two swallows went down easily. In fact, O’Rourke was beginning to enjoy the meal when his airway suddenly closed off without warning and he started to cough. He thought he could clear his windpipe with some hard gagging, but nothing would budge and he began to strangle. As he tried to suck in air with a stridulous rasp, he found he could not get his wind and he began to panic. The waitress had come around to his side of the counter and was pounding forcefully on his back between the shoulder blades. Despite these efforts, O’Rourke rose reflexively from the stool in an effort to escape the horrible suffocation he was experiencing.
O’Rourke’s body convulsed toward the floor, his arm sweeping the soup and the silverware and the napkin holder off the counter with a crash, as his fingers reached up to tear open his throat with his bare hands if necessary. He knew he was going to choke to death like Joseph K’s dog in the street. Sweat poured from his body. O’Rourke felt a ringing swirl of darkness engulfing him as his body settled into the beans and broken glass on the floor.
Then, as suddenly as the strangulation had begun, something broke loose and he was able to take in a massive breath of air. His body was wracked by a spasmodic fit of coughing and gasping. This, too, gradually cleared in a space of time that seemed an eternity to O’Rourke. He knew at last that he would probably survive.
Cowboy O lay on the floor with his eyes closed, clearing the residual mucous and the particles of soup from his throat and lungs. He winced from the massive spasms of pain that his exertions had precipitated. The spasms coursed up his neck and throat and on up into his ears with a throbbing synchronous with the pounding of his heart.
O’Rourke opened his eyes as the words of the old man, who was bending over him with an expression on his face that evinced both piousness and arrogance, reached his consciousness.
"The wrath of the Lord is wreaketh upon sinners in all manner of ways," said the old man, in the firm tones of a southern Baptist hell fire preacher.
Cowboy O’Rourke rose to his feet in one continuous determined motion. Reaching out with his right arm, he struck a tremendous blow upon the old man’s breastbone, which sent his adversary sprawling to the floor on his back. The old man lay there staring back at O’Rourke with firebrand eyes.
Cowboy O staggered out of the White Castle into the street, clearing his throat intently and rasping. Death had reached out to him in that White Castle and had made loving caresses over his eyes and ears and had run its fingers through his hair. O’Rourke had beaten death this time, but the effort had left him terrified and shaken.
He bolted blindly down the street, knocking passers-by out of his way from the steady stream of whores, pimps, elderly Italian ladies, and children who confronted him. He careened into an intersection, listening to a screech of brakes, which betokened the collision that might have ended all of his misery. A horn screamed and a relieved, but angry, voice urged him to get the fuck out of the street if he didn’t want to be killed.
O’Rourke finally came to a halt where he stood leaning against a lamppost. He clung to the cold steel surface, still frightened by what had happened and shaking like a baby. The pain was at least substantial, something he could push away from, an agony familiar from his own experiences, the pain of being thrown from a horse or beaten in some alley for peanuts or cheap thrills. Not even the vicarious fear of witnessing the dead, like those burn victims he had once encountered in Oklahoma, had affected O’Rourke so much. The concept of not being able to breathe was alien and horrifying. An eerie shudder coursed down O’Rourke’s spine, followed by a twitch of his entire body. He felt like screaming out loud like a wounded animal.
Cowboy O made it to a service station washroom where he cleaned up the blood and the rest of the bean soup as best he could in a filthy plugged up sink. He read all of the graffiti, straightened his bandana, and tried not to think. Thank God, he had not forgotten his hat! Luckily, the Stetson had not been spoiled.
Waves of anguish passed over O’Rourke, as he walked back out into the sunlight. He was trying desperately to regain control. But his situation seemed suddenly hopeless. He was completely aware that he had run out of options. Cowboy O sauntered over to the curb and sat down for a minute near a bus stop and tried to collect his thoughts. He prayed that he might be hit by a truck.
The Salvation Army Clinic was located in an old red building that looked like it dated to some time before the Civil War. In addition to housing the clinic, the Salvation Army building was a haven for street people like O’Rourke. It offered a place where a dude could re-group, get a hot meal and dry roof over his head, or the booze or the dope out of his system for a few days, in order to think his situation through and make decisions. In most cases, the decision was to go back out onto the street.
The Salvation Army provided some social services and the building housed a methadone clinic. A volunteer doctor showed up twice a week to hold sick call in a free clinic. The faces of these doctors changed a lot.
The flop pads were up on the second floor. While waiting downstairs in the medical clinic, patients could hear the boards creaking overhead as somebody paced the floors above them.
O’Rourke arrived at the clinic about ten minutes late and signed in. There were three other patients already waiting. The worst of them looked about sixty, but could have been O’Rourke’s age. He was a self-proclaimed wino and said he had been shitting pure blood for the past three days. He was one of those annoying vocal types who insisted on providing everyone in the waiting room with the infinitely boring details of his medical history. He was the kind who, in O’Rourke’s experience, just kept droning on, even if it was obvious that his supposed listeners were more interested in problems of their own.
The wino said he had been admitted to the City Hospital on the Fourth of July, which according to him, was a very bad time to go in, because all of the new doctors in training started their rotations on July 1st. The wino said the new doctors needed at least a week or two to learn their way around. There were statistics, he insisted, that proved that the death rate in teaching hospitals was higher during the first two weeks of July than at any other time of the year. According to the wino, the data was hushed up by the government and the hospital administrators.
He had been told during his admission that he had end-stage cirrhosis of the liver and that if he ever drank again, he would be dead in a month or two. The wino figured all of that crap was just another scare tactic, because he had been around the City Hospital plenty of times and the staff there was always coming up with something crazy as hell. Like the time they decided to run an experiment of some kind on DTs. They put out an offer to give out pure hooch to anybody who would volunteer to become one of their subjects. This brought the drunks out of the woodwork by the carload and they had to cancel the study.
Besides, the wino declared, what else could a doctor do, except tell you to stop eating, smoking, fucking, and drinking, and not necessarily in that order either. So the wino had kept on drinking like usual—he had given up of the rest of those things a long time ago.
He insisted on showing O’Rourke and the others the holes the doctors had made in his stomach to drain off fluid from his belly. The fluid was still leaking out a little, so the wino had to carry a roll of toilet paper around and keep plugging the holes up with little wads of it to keep the fluid from running down his leg. He admitted that taking the fluid off had improved his breathing. But then this morning, he had puked up some shit that looked like coffee grounds, which had puzzled him, because he had not been doing any coffee grounds. He had finally decided to come in to the clinic because he was dizzy when he walked and he was becoming short of breath again. He also said he had headaches and pounding of the heart.
The wino continued to drone on, regaling his less than captive audience with the details of his admission to Ward 4-2 at the City Hospital where most of the patients had cirrhosis of the liver. The patients could watch one another’s progress every day, since it was an open ward with nothing but drapes for privacy. The wino described how the young student doctors would come around and ask them all about how it was living on the street. The students would joke around with the patients and treat them like regular guys, unless one of the staff doctors had come around that day and chewed out the students’ asses in big terms none of the patients ever understood.
When you really get bad with cirrhosis of the liver, the wino explained, the disease puts you into a coma and turns your skin yellow. The doctors put a football helmet on your head with the ends of these tubes they would thread down into your stomach tied to the facemask. The tubes were supposed to keep you from hemorrhaging from varicose veins that developed somewhere in your intestines when the cirrhosis got that bad. Guys would puke up blood anyway, even with the tubes down their throats. The doctors would come by on their rounds everyday and check the tubes and the helmet and the IVs in a guy,s arm. They would test the guy by holding his hands up. If his hands flapped up and down—which was some kind of sign—the other patients, especially the bastards who didn’t have cirrhosis of the liver, would joke about how the guy was waving goodbye, because in maybe two or three days after that sign appeared, the guy would be dead.
The wino insisted on showing O’Rourke and the others the signs on his own body that proved he had cirrhosis of the liver. He pointed out his yellow eyeballs and the red spiders in his skin and his red palms and the swelling of his ankles. He even told them his cock was swollen up to three times its normal size so he was hung like a nigger. This pissed him off more than anything, he said, because he couldn’t get it up to fuck a preacher’s wife.
When the wino came back out, after seeing the doctor, he told O’Rourke and the others that he had to go back into the hospital, because he was bleeding to death internally. The old doc in there had told him he would be dead by the end of the week if he didn’t go back in. According to the doc, the coffee grounds was blood too. At least it was August, the wino said as he left.
One of the other patients waiting with O’Rourke had an ulcer on his leg. The volunteer docs were treating the sore by swabbing it with silver nitrate. He had to keep off his feet, so the Salvation Army staff was letting him use a flop bunk upstairs, on a temporarily permanent basis. He came down to the clinic for treatments whenever a doctor showed up. The guy was too scared of losing his leg to consider leaving just now. He was called next.
The second patient’s departure left O’Rourke alone with the last of three waiting that morning. This third dude was younger, maybe in his early thirties. He was sweating and tremulous and kept looking around very suspiciously. O’Rourke didn’t trust him. The guy looked like he was in the early stages of DTs, or maybe into withdrawal from downers. O’Rourke had seen guys like this one go berserk without warning and bust up a place. O’Rourke tried to ignore the guy and concentrate on the note he was writing in his best drifter cowboy style to explain to the doctor what had happened to him at the White Castle. He wrote it all down, carefully selecting his misspelled words and grammatical errors. Thomas O’Rourke had read all of the classics of western literature, a lot of them three or four times. Disguising his level of education was peculiar, he admitted. Maybe, O’Rourke surmised, hiding his identity gave him some sense of control over his life.
While O’Rourke continued his note, trying not to pay any attention to the hallucinations his fellow patient was obviously experiencing, the younger guy began to verbalize his visions. He began to point at O’Rourke, including cowboys in a strange litany of accusation and paranoia.
Suddenly, the younger guy jumped up and began to pace the floor of the waiting area with a jittery step. He was shivering from head to foot. O’Rourke tried to ignore him, but he kept the guy constantly in view out of the corner of his eye. O’Rourke was trying to decide whether to yell for help, when the guy suddenly tore off all of his clothes. Lurching over to the corner of the room, he squatted down and shit out about a gallon of rank smelling liquid all over the floor. All this time, he sat with his eyes fixed ominously on O’Rourke and grimacing with the left side of his mouth.
O’Rourke was just about to bolt for the door, when the guy jumped up again and ran up the stairs to the second floor flops. O’Rourke could hear footsteps running across the ceiling above him. Then there came a series of shouts and some other sounds, the nature of which was not clearly discernible. Finally, there came the very loud report of a door slamming shut.
Things settled down after that. O’Rourke never saw the guy again. As he sat there waiting to be called, he monitored the leading edge of the stream of brown liquid oozing slowly across the waiting room floor. O’Rourke appended an addendum to his note that read:
"P.S. I didn’t shit on your floor."
O’Rourke’s name was finally called. He rose too fast again and had to wait for a few seconds for the dizziness to pass before he could make it into the room the doctor worked in. O’Rourke’s physician was an old guy about sixty, with a scowl on his face that didn’t make him look any too friendly. He had a strictly business air about him. He had a full head of bushy gray hair. He was sitting at his desk wearing an ugly pair of black horn-rimmed bifocals. He was reading what O’Rourke surmised must be his clinical record when Cowboy O walked in. The old guy motioned to O’Rourke to take a seat while he finished reading the medical record. O’Rourke handed him the note he had written. The old doc took that and read it too.
O’Rourke took off his shirt and bandana, so the old doc could take a good look at his face and his neck.
The doc was an old guy named Woodlansky. He asked O’Rourke to get up on the examining table. This Woodlansky washed his hands in the sink and then walked over and began to examine O’Rourke’s head and neck, looking down his throat with a light, and holding O’Rourke’s half a tongue out of the way with a stick that nearly gagged him. Woodlansky spent a lot of time feeling the tissues of O’Rourke’s neck from the ears to the collarbones, which stuck out like ridges from the weight he had lost.
This Woodlansky kept coming back to the soft area where O’Rourke’s jawbone had once been. He pressed repeatedly into the nodules that had grown down beneath the sausage-shaped roll of skin that Boucher and his assistants had plastered up where O’Rourke’s jawbone used to be. Woodlansky kept asking O’Rourke if it hurt when he pressed in on those nodules. O’Rourke figured that the way he winced every time Woodlansky pushed in was answer enough, without his having to say anything.
O’Rourke speculated that maybe this Woodlansky had never seen a patient who had had a Commando operation, the way he seemed so fascinated by the details of the procedure. Then Woodlansky made O’Rourke breathe in and out repeatedly, while he listened to his chest with a stethoscope. Breathing so deeply caused O’Rourke to become dizzy and affected his vision. He thought he was going to pass out before Woodlansky allowed him to quit.
Woodlansky asked him if he had had any trouble swallowing before today. O’Rourke shook his head no.
Next, Woodlansky gave O’Rourke a cup of water and told him to take a drink from it, just a few sips, he said.
After just one swallow of the water, O’Rourke started to gag and began to choke again, only not as violently as had been the case with the bean soup.
Woodlansky casually asked O’Rourke where he lived, after O’Rourke had managed to clear his throat and could breath normally again. Woodlansky asked him if he lived alone.
O’Rourke nodded affirmatively to Woodlansky’s last question.
Woodlansky returned to his desk and stood leaning back against it. He told O’Rourke that he had advanced cancer of the tongue which had spread (metastasized) into the lymph nodes of his neck and quite possibly into his lungs as well. Without X-rays, he couldn’t be sure about the involvement of O’Rourke’s lungs. Woodlansky also said that he suspected that O’Rourke had developed what he called a tracheo-esophageal fistula, which—in layman’s terms—was an abnormal communication between the windpipe and the gullet. He said that O’Rourke would not be able to swallow anything at all without special treatment. To give him additional tablets of codeine would be fruitless, because O’Rourke would not be able to swallow the tablets either. The only chance he had was to enter a hospital, if for no other reason than his continuing comfort.
O’Rourke knew he had to have something for the pain. He shrugged his shoulders and agreed to be admitted, offering no resistance.
Woodlansky said he would make the calls.
During the six-block walk over to the hospital from the Salvation Army Clinic, Cowboy O’Rourke tried to formulate his options. At least for the time being, he didn’t seem to have much choice but to accept the hospitalization. The pain in his neck and throat was almost unbearable. Something had to be done about that. O’Rourke figured he ought to see if anything could be done about the problem with his swallowing.
O’Rourke didn’t see how Woodlansky could be so sure the tissue in his neck was malignant, either. In Denver, a biopsy had been necessary to determine that. With the infection and all of the irradiation he had been given, there must have been enough structural alteration to make it difficult to say exactly what the situation now was. A complete reassessment seemed like a reasonable idea. O’Rourke knew for sure, though, he would permit no more surgery.
Cowboy O approached the hospital along the south side of Willis Street. The building was ancient and comprised a conglomeration of distinct structural elements that undoubtedly reflected the hospital’s architectural evolution during the many years of its existence. O’Rourke could envision its role as an old post-Civil War hospital, perhaps constructed by the city fathers to provide a refuge for the returning sons of the Midwest. He could imagine the Veterans of the old conflict pondering within those ancient walls the realities of cannon shot and the consequences of the heroic. He could see them sweltering amid the groaning and the stench of infected war wounds displayed in prolific array within the surgical wards. O’Rourke recalled a series of photographs he had encountered in an old medical journal in the hospital library in Denver. The pictures were a series of faces of nameless souls peering meekly from timeless scenes of nurses stiffly posed. O’Rourke glanced up at the eyes of the hospital, its windows, where an occasional winsome face peered back at him. He acknowledged an isolated wave. Hospitals never look friendly, he concluded.
Doctor Woodlansky had arranged an appointment for O’Rourke with a social worker named Linda English. He spent about an hour in her cramped office in the basement, filling out forms in order to make him eligible for admission as a "clinic patient," as they called the charity cases in this hospital. O’Rourke had spent more time than that searching for Linda English’s office along the hothouse corridor outside the laundry, ducking with his head the steam pipes that hung from the ceiling.
In the close quarters of that stuffy little office, while he awaited his admission authorization, O’Rourke realized that his body was permeated with that distinct odor of the unclean, in consequence of his not having had a decent bath in over two months. Linda English tried to make out like she wasn’t aware of O’Rourke’s stench, but it was plain to him that she was. She even gagged a couple of times, but she tried to pass that off as an illness, probably out of kindness.
Linda English sent O’Rourke up to the second floor, where there was an outpatient clinic for cancer patients on Corridor O. The staff called the clinic the Angell Memorial Center. O’Rourke noticed a portrait of Todd M. Angell, M.D. hanging from one of the walls in the waiting room.
Several other people were waiting. They all looked O’Rourke over when he arrived, the way people always do when they are bored and have nothing better to do anyway while they sit waiting to see doctors. Except for one old guy who looked like he had just been liberated from Treblinka, most of the patients looked like they were in good enough shape, for cancer patients anyway.
This one little kid who looked like she was about fifteen or sixteen was being given a blood transfusion. The bag was suspended from an IV pole next to her chair. O’Rourke found it almost impossible not to count the drops as they fell into the plastic chamber and flowed into the kid’s arm. The kid didn’t act like it was any big deal. She was playing checkers with an older woman, who could have been her mother. O’Rourke turned his eyes away every time she looked in his direction. The kid had needle tracks all over her free arm, just like a junky’s.
About an hour passed before O’Rourke was called in to see one of the doctors. O’Rourke had been assigned to a big guy named Mike Morgagni, who looked like a pro football player. O’Rourke presented his Salvation Army note and a letter Woodlansky had written. Morgagni read both of these over and then asked O’Rourke about a hundred and fifty mostly yes or no questions about the cancer and the operation and the rest of O’Rourke’s life.
During the physical examination that Morgagni gave O’Rourke, he found lice and demonstrated for O’Rourke some nits he had on his pubic hairs.
Morgagni made a lot of notes and drew diagrams of O’Rourke’s neck. He told O’Rourke that he would also like to take some photographs. He explained that during O’Rourke’s first few days in the hospital, he was going to run blood tests and take some X-rays. As O’Rourke had expected, Morgagni wanted to take a needle biopsy of one of the nodules in O’Rourke’s neck. Morgagni told him he could have injections for his pain, but that he couldn’t have anything by mouth until he had confirmed Woodlansky’s diagnosis of the tracheo-esophageal fistula. In the meantime, O’Rourke would be on IVs.
Morgagni also informed O’Rourke that he was going to call Boucher out in Denver to get some additional information about the original surgery and the pathology reports. He said he also needed to confirm the dose of Cobalt O’Rourke had been given to determine if O’Rourke could tolerate more of it. O’Rourke didn’t ask Morgagni to say hello to Boucher for him when he called.
While Morgagni finished writing up the admission notes on his case, O’Rourke sat on the examining table watching him. Morgagni was a young guy—O’Rourke figured he was somewhere between twenty-five and thirty—with a very intent look on his face. He didn’t smile or joke around much. O’Rourke noticed right away that Morgagni had dark circles beneath his eyes and concluded his bosses must be working him pretty hard.
After Morgagni finished the "paperwork," as he called it, he sent O’Rourke to the admitting office. He told O’Rourke that the main chemotherapy ward for the hospital was on Corridor O, but that the oncology service had "metastasized" all over the hospital and he didn’t know yet where O’Rourke would be. As it turned out, Cowboy O was assigned to Ward 11 on the first floor.
An orderly had to push O’Rourke to Ward 11 from Admitting in an old-fashioned wheelchair with a high wooden back and a wobbly front wheel that clattered like a supermarket cart. The big hallway that ran the entire length of the hospital was congested with people. The orderly had to maneuver O’Rourke’s chair in and out of traffic, past a swarm of humanity. Some of the people they passed were moving very purposefully with obvious urgency. Others drifted by more slowly, at his or her own pace, while a few were standing still and looking lost and alone.
Doctors raced past in green scrub suits with long white coats trailing off behind them and stethoscopes jangling from their necks, appearing to be on their way to strained encounters. Nurses emerged from patient’s rooms holding used syringes or stainless steel bedpans covered with gray muslin shrouds which masked all but the stench that swept past O’Rourke’s nostrils in the draft. Other patients floated by in wheelchairs like O’Rourke’s or on stretchers, unconscious and moaning and reeking of ether and alcohol.
A series of rooms with one or more hospital beds in them opened into this main hallway. Periodically, smaller hallways branched off that led to areas designated as Corridors or Wards. These were either numbered or lettered, resulting in unusual combinations, such as Corridor E or Ward 6.
Halfway down the main corridor of the hospital, an attractive young woman rushed out of a room, with a matronly nurse in an immaculate white uniform on her trail. The patient stopped O’Rourke’s wheelchair and threw herself to her knees beside it and began to pray at his feet in beseeching Catholic phrases. She told O’Rourke that her name was Margaret and heatedly warned him to leave at once.
"You’ll never get out alive!" she dramatically proclaimed.
The nurse tried to calm O’Rourke, explaining Margaret away in impressive medical terms that were lost on him, except for the fact that Margaret had cancer in her brain. Suddenly, O’Rourke wanted to hold and comfort her, but she was ushered away and he was wheeled on toward Ward 11.
O’Rourke and the orderly passed a few other patients standing in their doorways watching them go by, including one young man with a machine at his side that held at the bottom a large glass receptacle bubbling with bloody froth. From the machine, several plastic tubes snaked up beneath his robe. He smiled a strange Da Vinci smile at O’Rourke as the wheelchair passed his room and limply waved him on his way.
O’Rourke began to feel weak and nauseated. He thought he might be sick, but he fought it off by concentrating on the pink and gray pinafored uniforms of the younger nurses who—he later learned—were students.
The orderly finally hung a sharp left and wheeled O’Rourke off the main hallway into Ward 11, bringing the wheelchair to a halt next to the nursing station. He handed O’Rourke’s chart to the ward clerk.
O’Rourke, left to his own devices while they processed his admission, looked the ward over from his chair. Ward 11 consisted of a large main room, which contained some twenty beds, each potentially separated in a fashion from the others by draw curtains. A smaller room in the back, called "the porch," contained an additional eight beds. This smaller unit had actually been designed as a solarium for the patients when the hospital had been constructed, but as the need for more beds had gradually increased through the years, the function of the smaller room as a sun porch had been preempted. There were two large windows in the main unit.
Leading off from the main unit of Ward 11 to the right was a series of interconnecting smaller rooms that connected to a sister unit down the hall, Ward 13. These smaller rooms served as a communal kitchen, central supply area, and utility room for the two sister wards. The patient bathing, shower, and toilet facilities were also located here. Another smaller room led off Ward 11 to the left from O’Rourke’s perspective. Here the medications, IV solutions, syringes, and needles were stored under lock and key, in order to protect the occasional junky who wound up on the ward from engaging in the dangerous sport of shooting up with sterile works.
In the center of the ward sat a large cart on wheels that had steel canisters and glass jars on it filled with gauze bandages, alcohol sponges, tongue blades, and small cotton-tipped wooden sticks. On a bottom shelf, the cart contained an Ambu breathing bag and a defibrillator. O’Rourke had witnessed a defibrillation in Denver. The shock had caused the patient to jump up from the bed and clap his hands together in midair, but the procedure had not done much for the patient’s heart. He remained very dead despite several such shocks that stunk the ward up with the stench of burning flesh because the electrical paddles became too hot. The attendants had informed one of the patients on the post-operative ward in Denver that the heart was usually already dead before the staff could get the machine wired up properly, at least in most cases. The staff felt obligated to try the shocks anyway, for the practice, if for no other reason.
Cowboy O’Rourke surveyed the occupants of Ward 11. There were a few empty beds scattered here and there, but the ward was—for the most part—full. O’Rourke noticed the hawk nosed profile of an old man propped up on pillows, with a green plastic oxygen hose hissing into his nostrils. The guy seemed to be concentrating on the infinite complexities of each breath he took. Against the far wall, where the foot of each bed projected out into the ward in his direction, O’Rourke spotted the bearded chin and nostrils of a patient barely visible amid an array of pillows that had been stuffed between his body and the side rails of the bed. A nurse busied herself about this bed, checking the patient’s blood pressure, timing his pulse, adjusting the rate of his IV infusion, and noting the volume of amber fluid in the urine container hanging from the frame of the bed.
Draw curtains were closed around some of the beds. O’Rourke sat watching the rapid movements of the nurse’s legs in white stockings beneath them, and he listened to orders to cough or instructions to expectorate. The responses were muted complaints, feeble groans, or curses.
One of the patients was getting a breathing treatment with a small green machine called a bird. O’Rourke noticed the intense cooperation of the patient with the expansile pulsations of the machine’s plastic tubes, as it forced its mechanical breath past the mucoid resisting phlegm that coated the patient’s constricted airways deep into his diseased and congested lungs. O’Rourke knew the guy would cough up green and yellow pus from his lungs for hours after the treatment, having seen it all before in Denver.
Visitors had pulled up chairs around some of the beds. The outsiders seemed drawn between attending to the sick they had come to visit and the strange activities going on elsewhere around the ward. The action was a pageant difficult to resist. The patients themselves seemed entranced. Some played solitaire at their bedside tables, while the healthier types strolled around the ward, engaging those unoccupied in brief conversations about their tests and their treatments.
A couple of guys were staring at O’Rourke sitting there in his wheelchair with his Stetson and red bandana. The two were whispering together as they watched Cowboy O. One of them was a young black with a very street wise look about him, who O’Rourke thought he might have recognized from one of the Third Street bars. This dude and his buddy—who O’Rourke later learned was called Black Leroy, the Sickler—were in stitches at O’Rourke’s expense, doing a little number on horseback, riding along with Kleenexes over their faces like masks. O’Rourke managed to get off a little fuck-you sign in their direction, before the head nurse stepped up in front of his wheelchair.
"I’m Kosinky, O’Rourke," she said, looking down at him after surveying his chart.
Cowboy O’Rourke lifted himself up in the wheelchair, grabbed ahold of an imaginary guitar, and broke out without sound into a few chords of a pantomime Country and Western song. He tipped his hat, pointed to his mouth, and shrugged his shoulders. Then O’Rourke pointed to the angle of the right side of his jaw and winced.
Kosinky was a big old gal made of reinforced concrete. She had a twelve-cylinder frame and two pistons the size of grapefruit. She had no rings on her fingers and no rings on her toes, but she had a class pin in her starched lapel and a swing to her massive ass. She introduced O’Rourke to the two ward LPNs and to the two students, Miss Handsoff and Miss Loveless. She then herded O’Rourke off to the shower stall to Kwell his lice.
The staff collected all of O’Rourke’s clothes, including his old Levis jacket and his boots and bandana. All of these items were placed into a plastic bag. Kosinsky explained that O’Rourke’s duds would be laundered and fumigated, but he refused to relinquish his hat. Kosinsky ordered Miss Handsoff to spray it out with an aerosol to kill all of the lice and their nits that she was sure were living in it. Next, she gave O’Rourke a hospital gown, a robe, and a pair of brown slippers made out of corrugated paper to wear on his feet.
After his shower and delousing, the staff put O’Rourke into the second bed. Miss Loveless showed him where he could find a toothbrush and hospital issued shaving gear which the VFW Auxiliary had placed in his bedside stand. Whiskers didn’t grow out of the right side of O’Rourke’s face since he had been given the Cobalt 60, but he liked to shave the left side every couple of days to keep it from itching. Miss Loveless gave him a pencil with a big rubber eraser and paper to keep handy at his bedside, so he could write notes to the staff for things he might need. Then one of the LPNs supervised as Miss Loveless started O’Rourke’s IV.
Kosinsky looked down at O’Rourke lying there propped up on pillows with the Stetson pulled down over his eyes and asked him point blank what the chances were that he would be going into DTs.
O’Rourke wrote: "I just drunk wine when the codeine wouldn’t kill my pain."
Kosinsky kept his note as a handwriting sample to use for comparison with future specimens. Kosinsky had encountered guys like O’Rourke many times before, and she knew that steadiness of hand was the first to go when a guy got the shakes. Then she let the student give O’Rourke 2mg of Dilaudid into a muscle.
The shot hit O’Rourke like he had been kicked in the head at a rodeo, but several minutes elapsed before he realized he had no more pain. The Stetson was down over his eyes, but he could see every inch of its brim in striking detail. Very little seemed to be happening way out there beyond the foot of his bed, except the gentle sway of evening trees and the steady rush of the wind. O’Rourke felt like he was riding in slow motion over miles and miles of the most beautiful range he had ever ridden. He could appreciate figures riding beside him. These were the Four Horsemen of the Apocalypse, but they all seemed very ludicrous to him now—especially Famine and Death.
O’Rourke could feel himself moving into a smooth glide along the forgotten wheelchair streets that wound their way like snakes through the hospital, dodging adversaries and human contact, as he moved in and out of the traffic down the great booming hallway. He felt himself sliding over the rough spots in mid-air, narrowly avoiding tremendous collisions, gnawing with his gangrenous jaw at curses couched in hospital language, and wielding his mandible like the jawbone of an ass. O’Rourke felt mysteriously sluggish in the midst of the congestion and the strange hollow echo of pneumonic raking coughs and the hacking spasms of all of the lost breaths anyone had ever found. He felt himself enmeshed in the strands of an iron web, reaching out with his narrow fingertips and kneading the anxious pelvic organs of massive blue women, who were red in the face with distended necks, and who cried out in protest at love’s inevitable end.
O’Rourke starts. A young woman in a purple robe rushes sensuously into the hall and stops the wheelchair with a plaintive permissive sigh and then collapses along the rim of the wheel, kissing the spokes and naming them all ceremoniously with ritual and mystery. She whimpers a strange poem written by ghosts on the wind, sending a solitary and melancholy tone ringing out over the twilight meadow air like the flight of a black bird alone on the wind shafts and uplifting blows, crying out for its love long gone.
"My name is Margaret," she offers. "There were a million tiny cysts imbedded in my flesh, but now I have a strange malignancy of the heart. Take my breast which I have undraped, O’Rourke, into the distorted cavern of your mouth. This is a ritual for me, as in the final chapter of another tale of anger."
Margaret places O’Rourke’s hand against her naked breast. His bony and wasted fingers encircle her erect and hardened nipple. She explores with her tongue his half tongue and the sickly little excrescences that line the distorted floor of his mouth. She sucks up his saliva and caresses the thickened nodules of his neck.
"You will never get out alive," she warns him, blowing hot air over the surface of his ear and whispering her instructions to O’Rourke, who listens intently like a trapped existence chained for a time to his wheelchair.
O’Rourke offers her his bandana—nothing more. She leaves him, as they drag her away from him into the mist beyond the rim of his Stetson. She turns back to him now and then to wave the bandana, her eyes searching for him—it would seem—as she fades away into nothingness.
"O’Rourke, O’Rourke," someone called out, "you have fallen off to sleep."
The hollow echo of Kosinsky’s voice boomed off at the distant edges of O’Rourke’s opiate diminished consciousness. He could hear other voices, more excited and less assured.
O’Rourke strained to make some sense of it, gazing out past the brim of the Stetson at a band of medical students who were bobbing about in a strange dance around the perimeter of his bed. The students were intently probing his body here and there where the pain used to be. One of them insisted upon stinging O’Rourke’s eyes with an intense little light with a green filter and grid that seemed to be scanning Cowboy O’s brain the way a searchlight scans the summer sky. O’Rourke was entranced by the tiny flashes of light and by a clicking sound that reminded him of a cigarette lighter that wouldn’t burn.
Another student squeezed his arm with a compressive band that hissed like the gas machine in surgery, which O’Rourke remembered from Denver. The band killed his arm and left it withered like the black limb of a winter tree until the arm was resurrected by short spurts of blood which inflated it again like puffs of air blown into a limb balloon.
The students grasped O’Rourke’s half a tongue with forceps and clamps and gagged him repeatedly with sticks so they could all see. One shoved his finger up O'Rourke’s ass and squeezed his testicles so hard that O’Rourke got sick and puked all over the sleeve of the medical student’s short white coat.
"Faggots," O’Rourke remembered thinking after they had left him, just before he drifted off to sleep.
In the morning the tests began. A coquettish Creole woman came by with a basket filled with cotton swabs, needles, syringes, and various test tubes with different colored stoppers. The technician slapped a tourniquet around O’Rourke’s arm, talked up his veins with soothing black woman talk, drew off five or six tubes of O’Rourke’s blood, and then mixed it with anticoagulant by tilting the tubes back and forth to keep it from clotting. She stood watching O’Rourke out of the corner of her eye, and hummed.
The wheelchair jockeys came for O’Rourke about eight. With his IV hanging from a pole that fit into the back of his wheelchair, they whipped O’Rourke up to the X-ray department on the third floor.
Patients were lined up in wheelchairs, or on stretchers, along the hall, waiting to be called in for their studies. O’Rourke noticed that the action was fairly tight. Sweet little technicians were running here and there wearing the same green scrub suits stretched over their tits and asses that were used in surgery. A few strange looking dudes wearing red goggles and heavy black aprons ambled in and out of the X-ray rooms, giving orders and shuffling the bare-assed patients who could walk into position on the tables. None of the patients had much time to cover themselves, what with the big split up the back of the gowns they had to wear.
A patient sitting nearby was instructing O’Rourke to hold it, if the technicians stuck any barium up his ass. The staff did that in order to visualize the rectum and bowels, this guy expounded. God help you if you shit any of that barium out onto their X-ray table. The staff played all kinds of hell with anyone who did that, because the barium fucked up all of the X-rays in that room for the rest of the day. The staff could make you feel like you had just shit in your own mother’s ear.
The outpatients sat in their wheelchairs in another row further down along the hall. Some of these were in casts and some had open wounds. Some banter went on among them, but most of the patients seemed lost in thought, in a mood of morbid apprehension. At least, as outpatients, they could hope for negative films and a ticket home.
The technicians put on a glorious display of bouncing tits and ass, as they hurriedly carried silver-rimmed, black photographic cassettes and recently developed films in and out of the various rooms. A noticeable scent of developing fluid hung in the air.
O’Rourke could just catch a glimpse of a darkened den, dimly lit, where a coven of eager physicians seemed to be intoning monotone prayers into silver throated microphones, while flashing bones, shadows, and foreign body artifacts—like crucifixes and Saint Christopher medals—onto florescent screens and solving perplexing problems.
O’Rourke’s mentor and general informant in the wheelchair just behind carried on his tutelage in a monotonous whisper. He pointed out a band of neurosurgeons as they passed en route to their forbidden operating rooms, situated conveniently to X-ray. The neurosurgeons were dressed in the garb of the ancient medieval clergy, with strange Ku Klux Klan hats and sterilizers hung over their mouths. Nothing else was visible above or below their eyes
"Stay away from them!" O’Rourke was warned. "Neurosurgeons inject air into your brain or drain off spinal fluid into vials through large, unsharpened needles. They bore holes in the skull to let the brain seep out of. They flush the wounds they inflict with fetal blood, or they carve away large sections of the brain or skull.
"Neurosurgeons have been known," O’Rourke’s informant assured him, "to take air contrast, video X-rays of their diabolical cuttings and publish these in esoteric journals never seen by anyone who might be sane.
O’Rourke sat in his wheelchair trying to take all of this in, but the effects of the Dilaudid Kosinsky had given him back on the ward had pleasantly distorted his thoughts and his perceptions. The portable X-ray machine—similar to the one he had seen used in Denver—had become, in his narcotized consciousness, a medium sized dragon, which the technicians piloted past his chair. Its mythical veins twisted sinuously about the outside of its body and its conical beak shot flaming X-rays from its mechanical nostrils. The portable unit was generally used at the bedsides of the lost or the lame, who were too weakened or infirm to leave their beds for graduation pictures—like those O’Rourke was posing for—graduation pictures that would signify the end of some miserable life.
An old man was wheeled up on a stretcher. The orderly happened to stop the gurney such that the head and face of the old man and O’Rourke’s face were juxtaposed, one to another for a few moments. O’Rourke could unfavorably appreciate the fetid breath of the old man, who miasmic exhalations wafted across Cowboy O’s nostrils. The old man assured O’Rourke that his flesh, too, was rotting, just as he was certain O’Rourke’s must be rotting about the regions of the mouth and throat. He knew the scent well from his own western days, when the carcasses rotted and putrefied in the flaming New Mexican sun. O’Rourke too, he went on, would be bones by winter.
He had cancer himself, the old man explained, growing out of his ass and causing him to bleed into the sheets at night, like a virgin’s first monthly or a few drops of Christ’s tears. He told O’Rourke, before they wheeled him away, that his grandchildren had insisted that his skull case be X-rayed to see if certain recent changes in his personality might be the result of the spread of his disease into the blood creeks of his brain. He knew in fact that all of this testing was useless. He went along with the procedures, because he wanted to keep his grandchildren happy. The old man supposed that O’Rourke was a short timer too, from the rank look to the side of his neck and his little half a tongue, which he had noticed when O’Rourke had tried to smile.
A technician finally came for O’Rourke and escorted him into a room where O’Rourke and his IV had to be supported by a second technician who wore lead gloves and a lead apron. He explained that he always wore lead to protect his nuts from the irradiation, so his future babies would not have crossed eyes, extra toes, or heart defects.
O’Rourke’s knees were wobbly from the Dilaudid, but—for support—the technicians hung the right half of his chin in a depression for chins in the middle of a horizontal bar that was part of the device designed to hold the film. Then they forced O’Rourke’s body forward onto the film cassette while they took an X-ray of his chest. They asked O’Rourke to hold his breath.
"Hold it. Hold it! Don’t breathe! Now breathe," yelled out one of the technicians, from a control cubicle that had windows in it so he could watch O’Rourke. The technician with the protected offspring then rotated O’Rourke’s body ninety degrees after the first picture had been taken. O’Rourke had to stand up straight with his hands clasped together over his head so they could shoot a side view of his chest.
After the chest films had been completed, a doctor named Heidegger came in wearing a pair of red goggles so he could see in the dark. This Heidegger handed O’Rourke his first drink since admission—a Gastrografin cocktail—which he warned might taste a little peculiar. O’Rourke did not bother to explain that he had no sensation of taste since the Cobalt 60 had burned out his taste buds in Denver.
Heidegger positioned O’Rourke in front of a fluoroscope, so he could watch the Gastrografin go down Cowboy O’s esophagus. Then he told O’Rourke to hold his breath, swallow, and not cough, no matter what happened. O’Rourke took a sip and immediately began to choke. Heidegger was calling out numbers to the technician in the cubicle. O’Rourke could hear a crackling sound like static electricity as the X-ray machine shot the pictures. But he couldn’t breathe. In what seemed like half a minute, O’Rourke hit the deck, ripping the IV needle out of his arm.
He lay up against the wall in a cold sweat, bleeding like a stuck pig, strangling and coughing and gasping for air. He could envision Heidegger taking pictures from various angles with a hand held Nikon, as if O’Rourke was a famous fashion model, instead of a dead cowboy on the floor. O’Rourke lost all sense of time lying there, trying to get up nerve for the next swallow. He vaguely sensed the placement of a pressure dressing over his bleeding arm. But then Heidegger told him the first set of X-rays was adequate and that he could go back to his ward.
There was a tremendous commotion in the hall, as O’Rourke was wheeled out of the X-ray room. Tension hung in the air like the quiet that builds up just before lightning strikes. The necks of the patients whose wheelchairs were directed in the wrong direction were craned toward the end of the hall. An old woman near O’Rourke was absorbed in prayer, picking away at her Psalter and rosary. The X-ray department staff and several physicians were huddled around the stretcher of the old man who had spoken to O’Rourke earlier.
The old man’s arms were hanging limply askance from the sides of the stretcher, bouncing flaccidly with each compression of his chest delivered by a determined young doctor, who was perched precariously on his knees high above the patient. External cardiac massage was being performed upon the old man’s broken thorax in an unbroken rhythm.
An anesthesiologist was attempting to intubate the patient’s trachea. The old man’s eyes were open and seemed to be staring blankly at the ceiling. The physicians worked on for several moments longer before agreeing to quit. One of the technicians covered the body with a sheet that left the feet sticking out into space.
When the traffic cleared, O’Rourke was wheeled past the partially shrouded figure and out of the silent and subdued department. The thoughtful eyes of the waiting patients seemed disconnected from their sockets and appeared to be seeing nothing or every thing, like ancient, sad owls perched in ranks along the limbs of trees.
O’Rourke was transported next to the EKG lab on the fourth floor, East Wing. Here, among miles and miles of scored and metered Burdick electrocardiographic paper and the scattered clippings of augmented limb leads, chest leads one through six, high leads, low leads, and the distorted, mistaken leads of the wrongly wired, electrocardiographers mull over P waves, T waves, complexes and segments, and millimeter after millimeter of normal beats, slow beats, premature beats, and pounding, frightened rapid beats. Cowboy O’s heart was wired for symbols and a tracing of its life’s work was made for the record.
An Armenian technician, with impressive tits that zoomed past O’Rourke’s face as she stretched innocently, but lewdly across his body to connect up the leads, kidded him about how she could throw a secret switch hidden in the leg of the bedstead. The resulting explosion, she chided, would blow his heart out of his ribcage and leave nothing but smoke, after six million volts had ended his many troubles.
O’Rourke managed only a wan and languid smile, because the Dilaudid was wearing off and his pain was creeping in again in the form of feathered frogs with razor blades for teeth and steel talons to land with after making terrific leaps into the mangled pain centers of his brain. He longed for Kosinsky and her magic syringe, that would cast out the heretic and unrepentant devils that burned like the stakes of funeral pyres imbedded in flames along the courses of his neck and jaw.
O’Rourke concentrated on the clicking of the machine, which was synched with his every heartbeat. He watched the breathing dance of the Armenian technician’s magnificent cleavage, as she scanned the machine’s regurgitation of tiny symbolic signposts that could have easily run out at any moment, like a series of billboards at the county line.
O’Rourke was impatient to return to the drug distorted scenes on Ward 11. His visions there reminded him of plays from the theater of the absurd, plays he had never seen or of the empty darkened stages he had performed upon, where the action only took place near the wing he was farthest from. The bad lines and the tragic ending he could take, standing before his audience with a rope in his hand like a philosopher in bluejeans. He could take all of that as long as he could lie in his bed beneath the rim of his Stetson with Kosinsky’s beautiful drug leaking slowly out of his muscles into his blood and his brain. He knew the drug would annihilate his thoughts and his fears so he could laugh insanely at the lurid face of death, his own or anybody else’s.
Later that afternoon, Morgagni came by Ward 11 to do O’Rourke’s biopsy, having filled to capacity with medical students the amphitheater of his tutorial prowess. Morgagni in rubber gloves, swabbed O’Rourke’s neck into an orange lake of Mercurochrome that drained in streams into his gown and sheets. Then, he grasped O’Rourke’s malignancy firmly, pierced its side open with a tremendous lance, stifled its bloody screams with the pressure of a gauze, and cut off its escape through the rents in the wound. With Morgagni’s anesthetic infiltrating his neck, O’Rourke hardly felt the thrust of the lance or the gnashing of the cancer’s teeth, as it struggled to protect its young against the deftness of the oncologist. O’Rourke’s malignancy was still quite small and had only in its youth journeyed along the lymphatic courses of his neck a considerable distance from the mother nest. Her offspring lay slain before the eyes of O’Rourke, their bodies imbedded in the fragment of grayish red tissue floating in a small jar of formaldehyde that was held up for his review by one of the students. The neck of the bottle was duly tagged with a cardboard label upon which O’Rourke’s name and numbers had been typed in letters vermilion.
But this battle lost would not be her last, nor would this defeat slow the inexorable progress of the disease in its descent along the track of the unanswered question.
Morgagni made rounds on O’Rourke’s ward twice a day with his entourage of students. On Thursday, he laid it all out on the line. The biopsy had been positive. The cancer had extended onto O’Rourke’s neck and had produced, as expected, a tracheo-esophageal fistula. O’Rourke also had nests of cancer growing in his lungs, "metastatic nodules", Morgagni called them. The next step was to place a soft latex tube into O’Rourke’s stomach, so he could be given high caloric feedings that would build up his strength. The tube would allow the staff to discontinue O’Rourke’s IVs. The plan was to present O’Rourke’s case to the chief oncologist, Dr. Michailovich, the next afternoon on grand rounds. Morgagni wanted to get Michailovich’s opinion regarding the best chemotherapeutic agent to use. There was no point in attempting further surgery. Irradiation was out of the question, because treatment of both lungs was impossible. In O’Rourke’s case, the metastatic cancer was in both of them.
"When will I die?" O’Rourke wrote.
Morgagni handled the question well. He expounded at length about the seriousness of O'Rourke’s situation. He talked about the advances that had been made in recent years in the treatment of malignant diseases. He explained that most of the drugs he had available to him had only been discovered within the past year or so. What he was trying to do for O’Rourke was buy time. If a breakthrough came and all of the billions of dollars being spent by the government on cancer research finally led to the ultimate cure, Morgagni wanted O’Rourke to be there to benefit from it. The drugs available now could not cure O’Rourke’s disease, Morgagni went on, but there was a very good chance that the disease could be arrested. If he—Morgagni—were in O’Rourke’s shoes, he would at least give chemotherapy a chance. Morgagni refused to say how long O’Rourke might live with no treatment at all.
Initially, the tube in his stomach felt like a garden hose lying in the back of O’Rourke’s throat, but after a few hours he became used to it. As time passed, he hardly noticed the tube at all. When feeding time arrived, Kosinsky would inject air through the tube and listen with a stethoscope over O’Rourke’s stomach for gurgles—hunger pangs, she called them—to make certain the tube was still in the correct location.
"We can’t pump tube feedings into your lungs, now can we, Cowboy?" Kosinsky liked to kid around a lot.
On the following Friday, O’Rourke’s case was presented to the oncology staff during grand rounds. The chief oncologist, who introduced himself to O’Rourke as Dr. Michailovich, was accompanied by a large entourage of about twenty-five people. Crowding around O’Rourke’s bed were a bevy of medical students in short white coats, physicians in long white coats or scrubs, a few nurses, some of these pinafored like Handsoff and Loveless, one or two people dressed in civilian clothes, and one Catholic priest. O’Rourke speculated that the padre was along to give last rites.
The group filled the space around O’Rourke’s bed and spread out into the ward. Cowboy O could catch an occasional respectful glance from one or another of the other patients on Ward 11. He felt temporarily very important, until he began to cringe beneath those incredibly diverse sets of eyes peering down on him. He felt suddenly sick, almost with stage fright or a species of embarrassed vertigo that made him wish it was time for his injection.
Dr. Michailovich was a tall, gaunt man in his late forties. He carefully examined O’Rourke’s neck and throat, as Morgagni explained the case in impressively technical terms, such that he sounded to O’Rourke like someone he had never met. Dr. Michailovich spoke in a soft voice with a European accent. He asked Morgagni a question now and then as the presentation proceeded. O’Rourke noticed that everyone present tried very hard to catch every word the professor said, especially when he began to elaborate about cases like O’Rourke’s that he had seen before. Now and then he would point out something on O’Rourke’s body to the closest medical student or he might ask a question of one on them. Depending upon whether the answer appeared to be correct, the student’s day would be made or broken by the interrogation.
O’Rourke listened carefully to the bedside discussion of his case. Except for the really arcane and technical terms, the gist of the presentation made it clear enough that he was in big trouble and that conventional anti-cancer drugs would not be of benefit in the treatment of his disease.
Dr. Michailovich suggested that Morgagni treat O’Rourke with Porfiromycin (NSC-56410), know as "purple mycin" to the oncology service, or as "purple poison" to the more cynical among them. These designations arose as a consequence of the drug’s deep purple color and its disastrous hemorrhagic side effects, which had been discovered during phase I trials when the drug’s severe bone marrow inhibition had been discovered.
Dr. Michailovich and his group at Angell Center had been particularly impressed by the response to Porfiromycin by a 32 year-old woman they had treated during phase I dose determination trials they had conducted. The patient had been referred to them with disseminated squamous cell carcinoma of the uterine cervix. The tumor had metastasized to the lungs, liver, and brain. After a terribly toxic course, during which the patient had bled profusely from the rectum, vagina, mouth, nose, eyes, and even from the hair follicles in her skin, she had recovered and had gone into an unmaintained complete remission which had lasted for almost three and a half years.
Porfiromycin had shown particular promise in Dr. Michailovich’s experience against the more resistant squamous cell cancers in other primary sites as well. The oncology service was most anxious to complete ongoing phase II tumor spectrum studies now underway. Thomas Cowboy O’Rourke had disseminated squamous cell carcinoma of the tongue.
O’Rourke signed a very complicated consent form, which was necessary because NSC-56410 was an "investigational" drug. The term "experimental," was never used by the staff of Angell Center. Morgagni fattened O’Rourke up for a few days with the tube feedings. The young oncologist made detailed diagrams and careful measurements of O’Rourke’s disease, recording perpendicular dimensions at points of greatest linear separation of all accessible sites, in order to accurately gauge the response to treatment. Morgagni called the measurements of O’Rourke’s nodules and the "cannon balls" visible on his chest X-ray, "road maps of the soul."
Then, on September 8, 1968, "Injection" Georgia Parker gave O’Rourke a loading dose of 800 mcg/Kg body weight of NSC-56410 through the tubing of a rapidly running IV, which had been started in order to prevent injection of the drug into the tissues beneath the patient’s skin. Miss Parker explained that if purple poison got under one’s skin, the drug caused a horrible sloughing of necrotic tissue. Patients who had that happen to them were left with foul and weeping ulcers that were impossible to heal without skin grafting. O’Rourke was very glad to see how fast his IV was running, as the brilliant purple bolus of NSC-56410 swept along the plastic tubing toward his body and then disappeared rapidly from view. Injection Georgia told O’Rourke hilarious stories about a peculiar rush of warmth that Porfiromycin causes in a man’s scrotum. The sensation sometimes produced tremendous erections in older males who had not been able to get it up for years. Miss Parker felt she had to warn O’Rourke about the effect, so he would not get embarrassed by it, like a poor Catholic priest she had treated a couple of months ago. Another unusual reaction in some patients was a sensation that the patient had urinated, when in fact they had not. Patients used to wince and squirm and pretend as if nothing amiss had happened. Finally, one of the patients told Dr. Michailovich what had happened. Now the staff was able to warn patients beforehand. O’Rourke just lay there with a tremendous erection and pissed his bed, maybe.
There was nothing left to do now but wait. Morgagni intimated that several weeks might pass before they would know whether O’Rourke had responded to purple mycin.
Miss Loveless was assigned by Kosinsky to do a case study on O’Rourke, a kind of term paper for the nursing school. She asked him to write long notes to her about the events of his life. She gave back rubs to O’Rourke that brought her young breasts in their pinafore armor so close to his skin that his drug induced visions became lurid and obscene. Loveless helped him pass the time and fed his continuing fantasies about the treasures hidden behind her pinafore fortress. O’Rourke would plug her into his narcotized world where the curve of the universe became the silhouette of her breast and neutron stars hung from the golden hairs of her crotch. He wished Loveless could end his life by drawing him body and soul through the portals of her sex like a star falling into a black hole in space. He would sneak four by four gauze bandages from the dressing cart and lay behind his drawn curtains enveloped in Dilaudid engendered erotic dreams. He would stroke himself as he fantasized about upending the naked Loveless right there in his bed and penetrating her to the base of his stiffened shaft. O’Rourke ached to suck out her sweet little pussy with a completely restored and very sensual tongue. He would finally come in pent up jets of frustration, the creamy gobs of his waning life spurting into the absorbent strands of the bandage. He would store the folded bandage in his pocket until he was able to flush it down the drain in the head, concerned that it might plug up the drain like a Kotex was supposed to do, a shit eating grin all over the left half of his face.
Loveless and Cowboy O would converse in their yes and no fashion and she would read his lengthy notes. He continued to play his illiterate drifter role in those notes of broken punctuation and words pounded almost beyond recognition. O’Rourke would watch Loveless’ eyes to see if she might catch on, but she was too young and serious and intent upon nursing to recognize the real O’Rourke behind his wrecked face and distorted speech. He wrote to her about trucking and the lonely highways and riding the circuit and the rodeo girls. Sometimes, he felt like a father, reading stories to his daughter about Camelot. But O’Rourke knew Loveless could not see the beauty in life that he saw. Her study of his case would be done in minor key, behind an impenetrable mask.
Life on Ward 11 settled into its wonted consuetude, with O’Rourke beneath the flange of his Stetson contemplating the ebb and flow of the human comedy as redeeming, violent, or tragic stories unfolded on Ward 11 through the mist of his half sleep. His psyche was now in tune with the hospital’s wavy sadness and occasional heart rending conclusion. A panoply passed before O’Rourke’s eyes.
There were hand cases in boxing glove dressings, with metacarpals and phalanges mangled in the machinery of the city that had been meticulously strutted and stitched back together by portly technicians and plastic surgeons.
There was the occasional gold coaster who hit the ward in frenzy, gnashing his teeth and imperiously demanding immediate transfer from beds next to Negroes to the private pavilions where it was rumored there were bars in each room and night nurses who’d fuck.
There were shaking survivors of coronary events and sickle cell crises, or vice-like obstructions of the bowels or blood vessels.
There were loony bin callers just down off Jack Daniels, strapped to their beds like birds in a cage.
There were lonely old lovers, holding hands in the darkness, alone now at last at the end of the line.
And there was Thomas Cowboy O’Rourke out of Golden, Colorado.
O’Rourke was given 400 mcg/Kg of NSC-56410 by Injection Georgia Parker every week. Morgagni would make a new set of measurements prior to each dose. By the end of the third week, it was obvious even to O’Rourke that the nodules were shrinking. He would survive. Morgagni intimated the possibility that plastic surgery might even be done. O’Rourke was warm and dry and the hard winter was coming on.
One Sunday morning the ward was quiet. O’Rourke had drawn his curtains and was reading the weekend paper, when he noticed an abrupt sensation of liquid running very rapidly down the back of his throat. O’Rourke could taste something warm and salty and sticky. Suddenly, the paper he was holding erupted into scarlet blotches that ran down the page into his bed.
O’Rourke closed his mouth, but in seconds he experienced the sensation one might have if a rapidly running garden hose were forced into one’s mouth. His left cheek distended like a balloon. He opened his mouth and when he did so, great torrents of blood exploded through his lips, spraying the bed and curtains in crimson patterns. O’Rourke swung his legs to the side of the bed in an effort to gain his feet, but the swirling torrent of sticky liquid gushed into his lungs with the first breath he attempted, strangling him instantly and finally. O’Rourke’s body began to convulse as it descended backwards into the mattress. The last experience of his life, other than a sense of agonizing suffocation, was a delicate tracery of dripping blood that coursed along the curtain in a jerky dance, written there by the vermilion jet that was spurting through his teeth.
As O’Rourke’s head reached the pillow, only a few seconds after the hemorrhage had begun, the gateway to his trachea relaxed completely. His lungs were flooded by an instantaneous red death. His waning blood pressure forced blood out of his mouth as a gurgling spring that drained over his face into his eyes, covering his final view of the world with a scarlet curtain.
There was too little time to think. As O’Rourke struggled feebly with the overwhelming suffocation, the patient in the adjacent bed heard a strange gurgling sound. But O’Rourke was too far along a screaming track toward death to resist or escape. As he plummeted into nothingness, O’Rourke could see someone in a Stetson hat, wearing a red bandana, and leading a big brass band. He was confused. He fretted over the significance of it all, while the hemorrhage slowly erased him, the way he used to wash chalk from the blackboards in school.
Miss Loveless had heard a nondescript sound coming from behind O’Rourke’s curtains and had sauntered over to check it out. She pulled open the curtain just as a huge bolus of blood shot out of O’Rourke’s mouth, striking her full force in the face. Loveless stood riveted to the floor for an instant, watching O’Rourke’s body fall back into the bed, convulsing like some macabre marionette. Her scream seemed to come from another world as she lurched to the side. Her bone-white fingers clutched O’Rourke’s curtain and ripped it from its frame, as Miss Loveless staggered into the next patient’s bed, spraying him with the vomitus that spewed from her lips. She groveled into the terrified patient’s arms, retching and sobbing as Kosinsky looked up from the nursing station.
The ward began to react like a bomb had gone off. The blood that was now merely oozing from O’Rourke’s mouth had congealed into a gelatinous cast that covered the face and head and that appeared to made of the drippings of a red wax candle. Those patients with a direct view into the bed stood dumbstruck in the center of the ward. One of them, clinging to an IV pole, was retching and holding his stitches with a look on his face like one of the recently damned in a Northern Renaissance painting by Memling.
Kosinsky was out of her chair in seconds. She directed the LPNs to clear the ward, after placing a Code Blue call through the switchboard operator. Then she rushed to O’Rourke’s bedside. There was no detectable pulse and O’Rourke’s breathing had all but stopped. At intervals, the body shuddered and made a feeble effort to suck air through the coagulum that filled its mouth and airway. With each such effort, jelly-like clots would ooze out of the mouth and slide down the neck into the blood soaked sheets.
Kosinsky suppressed the waves of nausea that were passing over her body. She was paralyzed and simply stood there like a statue, glaring down at the hideous object that had once been Thomas Cowboy O’Rourke. For the first time in her nursing career, she did not know what to do.
After an interval that seemed like forever, Jack Fleming, the oncologist on call, arrived on Ward 11. He placed a stethoscope over O’Rourke’s chest and listened. Residual clots continued to ooze out of the patient’s mouth.
"He still has a heartbeat," Dr Fleming said, peering up into Kosinsky’s eyes.
They stood there together, Fleming listening with his blood stained stethoscope every few moments. He waved off the cardiac arrest team when it arrived.
"This big Mike’s case, Kosinsky?" Fleming asked.
After what seemed to Kosinsky like forever, Jack Fleming stopped listening to O’Rourke’s chest and stood up, placing the stethoscope into the pocket of his long white coat.
"It’s stopped," he said.