J. Stephen Nix
Her eyes slid over the surface like fields of muddy snow with the bare skeleton branches of winter twisted and tangled and sprawling where they lay. Closer she went until she could sharply see the cell bodies of neurons stuffed with black briar patch tangles. Here, a black flame leapt up in an anguished spiral. Here, a black plaque lay like a tombstone marking the ghost of a neuron long dead from disease, that black disease that impregnated and twisted and tore the mind.
Sometimes she imagined each neuron as a memory. And sometimes she would imagine the life of the person, the faces seen, the face of a mother, a brother, a lover. The last thing remembered. Was it always wires and machines and beeping and breathing pumps? Did the dying remember at the end? Or did it even register? Did they remember a childhood’s summer or a teenager’s wet kiss? Or was a whole life twisted and tangled together so that it was nothing at all anymore, nothing but the black tangled vines creeping through your memories and slowly strangling them until it was nothing but mismatched light and sound.
And then the ticking was in her ear. She looked up from her microscope at the clock on the bookshelf. It was a gift from a former student, a novelty clock fashioned after the painting by Salvador Dalí. The upper half of the clock face anchored to the flat of the shelf. The rest drooped over the edge where the twisted hands pointed at melting numbers. 9:55, it read.
Like clockwork itself, a knock came at the open door, and Kate walked in carrying an armful of cardboard trays filled with glass pathology slides. She set them on the desk next to a taller pile and took a seat.
“I just previewed these autopsy cases, Dr. Salazar. One of them looks interesting at least. What have you got there?” Kate pointed to the slide on the microscope stage.
Dr. Laura Salazar wasn’t paying attention. She was thinking about the brain downstairs. Michael’s brain. And Fran.
“Is that the Parkinson case?” Kate asked again.
Laura’s eyes refocused on the neuropathology fellow in her green scrubs and thick black glasses and her hair pulled back in a ponytail. Then she looked at the microscope stage and back at Kate.
“Oh, that’s just the Alzheimer case we were working up. They sent the special stains to me first by mistake. I was just glancing at the silver stain.”
“I was wondering where that was. I’ll grab it after brain cutting. Are you ready to head down?” Kate asked as she climbed out of the chair.
Laura nodded, but she wasn’t ready. Today was Michael’s brain.
She followed Kate down the hall thinking about when Fran called her. It was late, she remembered that, and Fran was crying. She said she was sorry for calling her that late, but Michael was dead. Hit by a car late at night. God knows why he was out there. And she was sorry she hadn’t called, but things had been bad for a while. Michael had changed. After twenty-five years of marriage he had changed. He was cursing all the time. At her, at everyone. You remember, Michael, Laura. He was never like that, never. He was always so soft spoken. And then he just changed. Twenty-five years of marriage and he just changed. He got fired from his job. First it was just the cursing and showing up late and not working. Then he felt up his secretary. His secretary, Laura. He grabbed her while she was working late and–. Can you—
I’m so sorry, Fran.
The voice cracked on the other end of the line. I am, too. I didn’t know what to do. He was never like that. You knew him. Never in twenty-five years. I just—hold on a second.
The sound of a nose blowing on the other end.
Laura, I want you to do the au—the autopsy. I want you to see if—if it wasn’t him that did it.
Laura held the phone tightly against her ear. Fran and Michael had been good friends in Little Rock. She was a pathologist, he an accountant. They’d stayed in touch at first after Laura took the job in Texas. But that was a long time ago, and she hadn’t heard from Fran in years save the occasional Facebook comments and “how are you” texts. She hadn’t heard anything about Michael, and now she was about to consent for his autopsy. All the questions she knew by heart. But the questions had always been asked to disembodied voices. Not to Fran. Not to her friend.
Yes, yes, Fran, I’m here. I’m just so sorry.
Please, will you do it?
It all came out as it had so many times before. All the questions in order. Date of death. Time of death. Had the medical examiner declined the case? Email address to send the consent forms. Prices. That was the worst. $3,500 for a full autopsy, and you’re responsible for the transportation cost to Texas, Fran. $3,500 to cut your husband apart.
The elevator dinged, and Laura lagged behind Kate’s long strides down the hall to the autopsy suite. Leaning against the door was a short white coat, the medical student’s coat. Gilbert. Gilbert waved enthusiastically. Laura forced a smile.
Gilbert was a second year medical student who had shown up in her office a few months prior with questions about neuropathology and more questions about neurosurgery. Neurosurgery was a difficult field for a student to enter, and Laura had helped her fair share of students trying to join the ranks of the brain surgeons. She had no problem with these students. What irked her about Gilbert was that he insisted an interest in her field despite all signs to the contrary.
“How’s it going, Dr. Salazar? I had some free time after class, and Dr. Allen didn’t have any surgeries today. You ready to slice some brains?” He pantomimed a sawing motion in front of his obnoxious blue and green plaid tie. “By the way, did you get that glioblastoma case from yesterday? It should be a good one. The resident said it was a really big resection, and they were wanting to know the molecular status of the tumor. It really doesn’t matter with a glioblastoma though, does it? Six months versus nine months to live doesn’t make much difference.”
Laura ignored the comment as she considered sending him packing to the neurosurgery floor to bother Dr. Allen and his residents. But this was a teaching hospital, and she was a teacher and he was a student. She painfully pulled the corners of her lips into another smile.
“We only have two brains to cut today, Gilbert, but you’re welcome to join us,” she said as she swiped her keycard to enter the suite.
The autopsy suite had white walls and light-blue floors and the faint smell of bleach. Silver metallic tables with gridplates installed to drain the blood and fluids stood center in each of the smaller rooms of the suite. In the corners were large dial faced scales with dangling silver buckets for weighing the organs, and against the walls were workbenches with disposable blades, probes, forceps, and white plastic buckets. The two previously prepared brain buckets, each labeled with letters and numbers and brain weights, sat upon the nearest dissection table. She already knew the number for Michael. AUT17-155. Thank God she didn’t have to extract it, she thought as she read the number on the white plastic bucket. The technician and the resident had done that two weeks ago and let the brain soak in formalin fixative until it had firmed enough to cut. Today. Could she have done it? Made the incision as those eyes she knew stared blankly at the white ceilings. Strung out the guts of the man who kissed Fran on that New Year’s night so many years ago? Scooped him out until he was hollow?
“Which case first?” Kate asked as she tied a plastic gown behind her back.
Laura read the number of the second white plastic bucket, and like an automatic recording Kate spouted the history of the patient. 65 year old white man, multiple cardiovascular risk factors, found down in the stands of a football game, died in the emergency department, suspected myocardial infarction. With the relevant patient history reported, Kate lifted the gray, dripping brain from the formalin-filled bucket and placed it on the cutting board. Gilbert looked bored.
“Just a normal brain, huh?” He asked dismissively.
Laura searched the back of her eyelids for patience. “Kate, why don’t you take Gilbert through the Circle of Willis?”
Kate flipped over the dripping gray so that they could all inspect the arteries that formed the vital vascular loop on the bottom of the brain before branching out to deliver blood throughout the tissue. Gilbert flushed behind his plastic face shield as he struggled to name the branches of the arteries. Laura refrained from pointing out the importance of knowing the blood supply of the brain to a practicing neurosurgeon.
“And if you look here, Gilbert. Do you see that hard yellow stuff. That’s atherosclerosis, the gunk that clogs arteries and causes strokes. Feel how hard the blood vessel is.” Kate instructed.
Gilbert clumsily mashed his gloved index finger against the artery, burrowing into the brain tissue below with a repulsive squish.
“Not so hard. Just feel it,” Kate continued patiently.
“Alright then. Are you ready to cut, Dr. Salazar?”
“Wait,” Gilbert interjected. “Can I cut it?”
Laura and Kate exchanged glances. It was a forward thing to ask at his level of training, but it was a teaching hospital.
“You can cut the cerebrum after Kate takes off the brainstem and cerebellum.”
Kate deftly inserted the blade and swiped until the brainstem separated. Then she whittled the cerebellum from the stem and placed all parts down on the cutting board. She took an empty long-blade handle and delicately slid a fresh disposable blade in place and screwed it tight. She placed it on the gridplate for Gilbert, who picked it up clumsily and lunged for the cerebrum.
“Slow down, Gilbert. Let me tell you how to cut it.”
“Just like a bread loaf, right?”
It wasn’t the traditional way of cutting brains, but it was faster. Laura often used the “bread loaf” technique on brains where neuropathological findings weren’t expected. It sounded exactly how it was done. The blade was guided straight down along the two gyrated hemispheres of the brain like a kitchen knife slicing bread for sandwiches. She nodded for Gilbert to continue.
The first cut sawed crooked and deep. Two lopsided chunks of brain rolled off of the cutting board and onto the table. Kate replaced the chunks and withdrew her hands just in time for her fingers to dodge the second slice through the brain, more crooked than the first. The thick slab of neurons fell with a sickening splat on the cutting board, splashing the bare skin of Laura’s forearms. Laura dropped a hard, gloved hand on Gilbert’s wrist to steady the blade.
“Be careful, Gilbert. Let me see the blade.”
The white coat butcher handed it over reluctantly. She slid the blade through the brain to even the cut and then repeated her slices one by one, gently lowering the thin, neat cuts onto the cutting board for examination until all the slices were arranged in order from front to back. The gray matter, where the neurons resided, formed ribbons around the inner, white matter where the axons ran.
Kate began to point out brain structures such as the hippocampus and the lateral geniculate nucleus. Gilbert nodded absentmindedly. Students like Gilbert were never interested in knowledge that wasn’t tested, and the lateral geniculate nucleus was hardly ever tested on national board examinations. There was no knowledge for knowledge’s sake or curiosity in that type of student. It all came down to board scores and quick-to-publishing research papers and flattery for letters of recommendation.
Kate described the relevant findings within the brain slices to Laura’s approval before jotting down the findings on a paper towel with a black Sharpie. Next, they took sections of tissue for additional testing as Gilbert studied the clock on the wall.
“If it’s alright with you, Dr. Salazar, I need to get going to a student interest meeting,” Gilbert spurted.
“That’s fine, Gilbert. You can go.” Laura replied. It was a relief, really. Having Gilbert there would only make things worse.
Gilbert began disrobing his disposable personal protective equipment into a red biohazard trashcan while Kate recited the case history for AUT17-155, Michael H. Vernon. 55 year old male, changes in personality over course of two years, hit by automobile while crossing street, private autopsy requested by wife of the deceased, Frances Vernon.
Gilbert paused at the door and then crept back to the dissecting table like a dog sniffing for fallen gristle. Laura felt her stomach turn over.
“That’s a neat case. Do you think you’ll find anything cool?”
“It could be a frontotemporal dementia case. It happens a lot with younger patients when personality changes are prominent,” Kate answered while unroofing the lid of the white bucket that held the brain of Michael H. Vernon.
“Oh, wow. I bet you don’t see too many of those. You don’t think this could be a case report, do you, Dr. Salazar? I would love to help you publish a paper on it.”
Laura felt her fingers tightening around the cold, metal sides of the dissecting table. “No, Gilbert, I don’t. Why don’t you go on to your meeting. We’ll finish things up here.”
“Are you sure? It seems like this could be an interesting case. Maybe I’ll just stick around some and help out.”
“No, that’s alright. I wouldn’t want to hold you here.”
“Aw, that’s alright, Dr. Salazar. Let me just put on some new gloves.”
The word burst loud and strong like the resuscitating jolt of CPR paddles. Kate dropped the plastic lid with a clunk. Gilbert froze with his hand half submerged in a purple glove.
“Just go to your meeting, Gilbert.” The calm was now back in her voice, but her heart was pounding in her chest. Gilbert turned sheepishly and slinked from sight. The ticking of the clock on the wall grew loud in the silence until Kate broke it with a near whisper.
“Is everything alright?” She made to touch Laura’s arm but stopped at the sight of her own glistening gloves.
“Everything’s ok, Kate. It’s just,” she took a breath, “it’s just I knew this patient.”
“I’m sorry. I can do the case if you want—”
“That’s alright. Thank you for offering, but that’s alright. If it doesn’t make a difference to you, I’d like to do the case alone. It has nothing to do with you. It’s just, I’d rather do it myself.”
Kate nodded. “I understand.”
Laura stood alone in her gown and shoe covers and gloves and face shield. The brain before her was still in the white plastic tub, submerged in the clear liquid formalin like a drowned man sunk to the bottom, and then she was looking down at dark water with city lights sparkling in the crests of waves made by a riverboat. Michael was holding Fran. He was wearing a plastic yellow top hat with “Happy New Year” spelled out in glued-on sequins. She was wearing a gaudy green lei necklace over her pearls and black dress. The people on the boat were shouting the countdown. And then it was one second to midnight, and then Michael was kissing his wife.
The blade sheared through Michael’s brain. Neurons ripped apart. Another slice. The whole of a man’s life and experiences, nothing but dripping gray slabs. Dead meat on a plastic cutting board. Another slice.
She laid out the pieces and felt them with her latexed fingers. She felt for softness where the architecture had given way and tumbled him into what he became. She looked for the shrinking decay of disease in the convoluted folds of gray where what was him had wilted and blown away. She searched for anything she could tell Fran that would make it better. Because betrayal by disease was better than betrayal by a loved one. That there was something to blame that wasn’t the arms that held you at night. That her memory of him would not be twisted and wrenched apart.
But she found nothing.
Laura sat at her desk and listened to the ticking of the Salvador Dalí clock dripping from her bookshelf. The notes laying on her desk were sparse, and Fran would call soon and Laura would have nothing to tell her. There were more tests to run, she would say, and microscope slides to scrutinize, but for now there were no obvious signs of disease. There might be when the slides returned, she would say. But not now. For now there was no comfort. No enemy to point to, no monster that did this. No reason as to why. There was just a dead husband and a dead brain and a widow. And there was no comfort in that. There was no comfort in memory.