The last detail I could remember was that my car smelt funny. Every breath I drew sizzled in my chest so strong I heard the sounds of frying bacon. I felt my ribs stabbing into my organs, one at a time, like mean children.
My eyelids were dry and scraped like matchbook covers, and pale fluorescents burned my retinas. “There you are, dearie,” a woman said to me. I could see a blur of red over white that solidified into a cross on the forehead of her habit.
Then I felt the scrape of needles beneath my skin, and I tried to move, but I was strapped with leather to the table. “Mustn’t hurt yourself,” she muttered as she left the room, smiling sweetly to herself.
I woke again. I didn’t remember falling asleep, or even becoming drowsy. It must have been one of the needles. Why were they drugging me? But when I moved, I found that everything was gone except a single tube in my right arm. The straps were even gone. I sat up and kicked my legs off the table.
The door to my room immediately opened, and a man with a pleather briefcase entered. He had a dark, curly beard that made him seem like someone’s father, and wore a plain, brown suit like my high school English teacher wore to chaperone dances.
“I’m your public arbitrator, Louis Anden. I’m here in anticipation that you will contest the health care costs enforced upon you by Faith Emmanuel Hospital.”
“Enforced? Don’t you mean imposed?”
“No, I don’t.”
“And what costs? I haven’t seen any figures,” and I stopped. I was in Faith Emmanuel Hospital. Oh my God.
“In exchange for removing the bullet from your torso, the hospital staff removed a kidney, and some of your plasma. As you were unconscious the contract was entered into at their discretion. However, the incision they made to remove your kidney became infected. As you were once again unconscious, the contract was entered into at the hospital’s discretion. Since they have already removed all discretionary organics, they have opted to remove your left hand, or, ‘20% of all separable internal organs,’ end quote.”
“What the hell are separable internal organs?” Louis smiled weakly, and adjusted his glasses, and I knew I was about to be humored.
“Not all organs can be separated successfully into fifths. If you remove only a portion of the heart, for example, that section will cease to function, so there’s no point in using it as payment. All the hospital would receive is a dead lump of tissue. The same can be said of the testicles, and the intestines. Although there are rare cases when they will extract 50% of a person’s intestines, advanced bowel cancers, usually, but that’s rare.”
“They want to steal my organs?”
“They can’t just take your organs. We live in America, not the fucking Middle East. You get an arbitration meeting. I’m the public arbitrator. I’m actually very good. I’ve won several cases.”
“One hundred and fifty-seven.”
“Is it too late to cop a plea?”
“Oh, right. Josh is the one who lost his feet this morning.”
“Jesus Fucking Christmas.” He splashed his fingers from shoulder to shoulder, then to his forehead and his heart. “Are you a Christian.”
“I was until I turn 21.”
“Why, what happened?”
“The church had me excommunicated when I went to law school. They’re still kind of sore about that separation of church and the judiciary thing.”
“Have you ever won a case like mine?”
“No. In fact, I’ve never won a case that didn’t involve gross malpractice, sexual misconduct, wanton violence or attempted murder.” I furrowed my brow.
“But you’ve only won three cases.”
“There was some overlap.”
“I want you to answer this, and I hope you will take it in stride, but are you a complete idiot?” He bristled.
“Not at all. In fact, I live far below the standard of my peers because I believe that all individuals, regardless of finances, deserve representation when confronted with extraordinary medical expenses.” Somehow that didn’t make me feel entirely better.
“How long do we have to prepare.” He checked his watch, and I knew I was screwed. “You’re saying we don’t have days or weeks.”
He shook his head. “We have four and a half minutes left.”
“Medically, what would you suggest.” He opened his briefcase and produced a single page print out. “Removal of twenty percent of internal organs would shave between five and eleven years off of your life.” I rolled my eyes and took the paper from him. It was covered in ones and zeroes.
“Crap. I don’t speak binary.” I handed it back to him.
“That’s assuming all of the separate surgeries go well.”
“And so far they’re one for two.”
“As far as how much your left hand is worth to you, that’s more a question of quality of life. My left hand sucks. I can’t write with it. Can’t drive with it. Can’t play guitar because of it. The only thing it’s good for is ma-” Louis turned red, then bit his lip, weighing it in his mind. “I guess it’s not all bad.”
“What would you do?” Louis took off his glasses and looked across the table at me.
“I’d take a deep breath, Josh, and make the choice. It isn’t an easy decision. And you’re always going to regret having to make it. But you don’t have any other choice. While you’re on hospital property they have complete sovereignty. They could just take whichever they wanted from you without giving you the choice. Hospitals don’t like to do that, because it tarnishes their reputation. They can’t force people through their doors, and there are always other hospitals. But once you’re here, you either pay with green or you pay through your spleen.”
“What the hell was that?” He put his glasses back on.
“Sorry. It’s something Faith Emmanuel’s counsel says. But it’s true. The hospital industry had a very powerful lobby that eliminated excessive malpractice and dismantled the insur-”
“Will any of your history lesson help me keep my hand?”
“No. But hand is easier to say than the other thing.”
“Organ bits?” He smiled helpfully.
“Let’s not call them that.”
“But you need to come to a decision, because-” his watch started to beep. The door opened, and three doctors in freshly pressed white coats filed into the room. They stood in a line in front of the door, with startling uniformity of posture. “Have you decided, Mr. Bertram?”
They took a moment to introduce themselves, and I immediately couldn’t remember which name and specialty belonged to which. I mentally catalogued them as Skinny, Sweaty, and Lady.
“I’d like a medical opinion-” Louis turned his head quickly, and his eyebrows shot up, and he interrupted, “assuming the consult is a part of this discussion and not an extra expense.” Sweaty got redder in the face, but Dr. Skinny smiled warmly.
“What are the pros and cons of each choice?”
Dr. Lady looked to Dr. Skinny, who nodded slightly, and she began to speak. “Partial organ donation cannot be reversed. Once you’ve given us a part of your liver, you will always be running at 80% capacity. It’s possible to some day purchase another, whole liver, but the costs of total organ replacement are extraordinary, as most organ transplants are partial conglomerates. By contrast, whole hands are often taken in lieu of monetary compensation. The cost of replacement is far lower.”
“And you concur?”? I asked, looking from Skinny to Sweaty. Sweaty was perspirating through his coat, perspirating angrily, if that was possible.
“Are you asking for another consult?”
Skinny looked down at Sweaty. “Now, Jeremy…” He turned back to me and smiled, softly. “Laura has particular expertise in this. Her opinion is medically sound and socially reasonable.”
I nodded, and gave a terse smile. “Dr. Lad-”
“Laden,” whispered Louis.
Sweaty stepped forward, glaring. “I’m Dr. Laden.” My eyebrows went up, and I had to stop myself from correcting him.
“Would it be possible to set my hand aside, temporarily, until I could purchase its return?” Sweaty’s mouth hung open, as he groped for the words.
Skinny winced, and smiled apologetically. “While that is a possibility, I’m afraid the interest rates we charge would most likely place it outside your abilities. And on top of that is the rather stiff reattachment fee.”
Cold shuddered through me, and air wouldn’t go into my lungs. Skinny stepped forward, and started to take my pulse. “Are you all right?” Louis stepped up to him.
“My client is fine, and requires no medical assistance at this time.” Skinny took his hand away, and I found I could breath again, shallowly. The first thing my eyes registered was the smile that dropped off Sweaty’s face.
Louis looked at me, apologetically. I was actually glad he was there, but my face wouldn’t smile. My guts were rotting. I could feel them decaying in my stomach, and I spat out the first thing I could think to stop it. “I was a certified EMT B for a while a few years back. I was hoping I might be able to recertify and repay my debt in trade.”
Dr. Lady repositioned her glasses on her nose. “The sisters do lack fundamental training.” As she continued, she turned towards Skinny, to the exclusion of Sweaty. “Any medically acquainted personnel are always a valuable-”
“And we’re supposed to trust this deadbeat?” Sweaty snorted, pushing his weight into Skinny. “He wants us to forfeit our compensation for services rendered on his word that he’ll return to school, finish his education and, in what, two years, return to work for us for a period without pay until his debt is cleared?”
“I’m not a deadbeat. I’m only twenty. And the only thing I owned outright was stolen from me, during which I was shot.” Sweaty glared at me, and Lady avoided my gaze. Skinny nodded his head sympathetically.
“It’s a terrible situation, truly. And we do sympathize. But Dr. Laden does have a point. And it isn’t you we don’t trust. It’s just a poor way to run a business.” Louis sat up straight in his chair, and stared at Skinny.
“I was always under the impression medicine was more important than business.”
Skinny smiled patiently. “I understand your concerns, Mr. Anden, but I can assure you, this hospital never allows financial considerations to interfere with medical ethics.”
“Then perhaps you can explain to my client how he is supposed to remain gainfully employed without the use of his left hand. Or, if he chose the organs option, the maximum level of promotion he can hope to achieve, because companies don’t like to risk training executives in anything but peak physical condition?”
“Mr. Anden; Louis. You voice very dire concerns for the well-being of your client, and I am touched, as I assume are my colleagues, by your dedication. But it is beyond our collective training to offer your client-”
“Josh. His name is Josh.” Close enough.
“It would be irresponsible for us to offer Josh any kind of career consultation. Have you any further mitigation to add?”
“Mitigation? What kind of mitigation?” I asked, no longer foolish enough to be hopeful.
“If you were a woman, there are greater options. Ovum are still a medical commodity, and if you were pregnant or willing to become pregnant,” Skinny stopped, “but I’m afraid these options aren’t open to you.”
“I don’t want to lose my hand.” I was staring down at their shoes. Sweaty was wearing tennis shoes that were new, and Skinny had a pair of worn black dress shoes. Lady had brown old woman shoes that made me wonder if she was older than she looked. I exhaled. My shoulders dropped, and my hole body crumpled inward. “I don’t want to die early, either.”
“I know,” said Skinny, setting his hand on my shoulder. I knew his eyes would be full of concern; that’s why I didn’t look up.
Louis slapped his hand away, and stepped between Skinny and me. “Why don’t you just go to hell?”
Skinny smiled, but there was something uncalm in his eyes. “Don’t be sore, Louis. This wasn’t a competition. It isn’t as if you’ve lost.”
“My client has. Every time you bastards win like this we all lose. Every goddamn one of us. And don’t you ever call me Louis.”
Skinny glared at him. “Very well. I pray for your health, Mr. Anden, because your business will no longer be accepted here. And Josh, I’m scheduling you for surgery within the hour. We’ll expect your decision within five minutes.”
“John.” I said.
“My name is John.” Sweaty opened the door for Lady. Skinny stood at the door. Louis tried to look at me apologetically, but he couldn’t meet my eyes, and left the room. Skinny didn’t smile at me.