Derailed

Issue 37 • Spring 2018 • Fiction

19:00 Report received on this fifty-six-year-old female patient, day three post-thoracotomy for a biopsy of a suspected malignant mass. Patient’s history includes smoking, skin grafts, and alcohol abuse. The initial assessment revealed her shoulder sockets angled backwards, straining for an “itch” she can’t seem to scratch. As the patient’s manicured coral-colored nails aimlessly swiped, her gold Rolex, of questionable authenticity, but remarkable shine, rode her forearm. Crisscrossed ridges of contracted skin grafts screamed across the patient’s back. No rash, nor urticaria seen. Scribe of these notes (henceforth known as the “Nurse”) admonished her patient (henceforth known as the “Patient”) to stop scratching for isn’t it wiser to leave the past behind? 

As the Nurse applied hydrocortisone 2% cream (per MD’s order) to the skin grafts, the Patient recoiled from the touch, stating that the nurse’s hands felt like, “a cheese plane peeling my skin.” The Nurse hoped this rudeness wasn’t a premonition for the twelve hours ahead because she had not slept well, if at all, before coming to work after receiving the postcard from the Priest. His pious handwriting demanded to know if she would greet her no-longer-presumed dead, no longer missing-in-action husband (or what was left of him) at the station when he arrived the next morning. 

Chest tubes draining serosanguineous fluid into the pleur-evac container bubbling on the side of the patient’s bed. White gauze dressing at chest tube insertion site dry and intact. Vital signs stable. 

Addendum – please ignore all mention of postcards, premonitions, and husbands. This being a nursing note, the Nurse cannot alter what has been written or history. 

20:18 Call light on. The Patient tapped the face of her questionable Rolex, accusing the Nurse of “not answering the call light for fifteen minutes.” The Nurse reassured the Patient that the call bell had rung not for fifteen, but for five minutes, during which she had called her eight and ten-year-old daughters. The babysitter, once again, had not shown, and though the Nurse’s belly seized at the thought of her girls at home alone, the hospital administration was sick of the Nurse’s sick calls. The Nurse neglected to mention that in that five minutes she’d also locked herself in the staff bathroom and reread the postcard from the Priest. The time in the bathroom had been measured by the blinks of her eyes and not the sweeping second hand of her watch. She had not blinked once. 

“God damn, this bed is uncomfortable.” The Patient tore at her sheets. God be damned, the Nurse agreed and the government too, who sent her husband to Iraq, the sharpshooter that he was (is?). She couldn’t imagine that he’d still be able to fire a gun without his hands. She pictured his train hurling through the night. The Nurse assessed the Patient’s chest tubes, peeking underneath the gauze and Vaseline coated dressings. She explained to the Patient that dislodging the tube from her fifth intercostal space could result in a life-threatening situation, and tonight the Nurse was not up to saving anyone’s life. Vital signs remained stable.

22:34 Call light on (again). This time the Patient demanded to know if her “bastard husband” had called the nurse’s station. He was supposed to bring the Patient something to drink. No call had been received from the husband, but the Nurse had received many calls from her own husband, ever since he’d learned to clamp a pencil between his straight white teeth and guide the eraser tip to tap the numbers. Her husband had been missing for months. The Nurse had grieved his presumed death and now she grieved his limbless life. She had ignored her husband’s calls from Walter Reed, where he’d been recovering, if one can ever recover from such trauma. Twenty calls a day for three days, and then she’d changed the phone number. She didn’t know what to say. Maybe he’d become missing again. 

The Patient stated she was thirsty. The Nurse bit her cuticle and offered the Patient cranberry or apple juice, even a stick of Juicy Fruit from her own pocket to quench the Patient’s thirst. The Patient arched her severely plucked eyebrows and snatched the gum. Her hands fumbled and were noted tremulous as she struggled to remove the wrapper. Note the importance of hands. 

Instead of thanking the Nurse for the gum, the Patient inquired if the Nurse’s children had a father. The Nurse answered that he was “away on business.” What business, the Nurse did not elaborate, but suddenly became acutely aware of the pricking postcard in her back pocket. If her calculations were correct, her husband’s train was already stuttering through Texas, edging the Mexican border. The Nurse fingered the malachite necklace her husband had given her on their honeymoon in Cabo many years ago. Sometimes when the Nurse was on top of Juan Carlos RN, coworker and lover, the stone struck him in the nose. She brought the stone to her lips. The cool, green reminded her of her newlywed husband’s lips as he’d bent down to kiss her on the sandy beach. Without his legs, she’d be the one to bend now. How could the Nurse have envisioned that “through sickness” would come to this? Or should she consider her husband to be “in health”? The Priest had written that her husband had had a “miraculous recovery.” Though, his arms would never wrap around her waist again. The Patient happily jawed the gum. Vital signs stable. 

22:45 No more than five minutes had passed when the Patient pressed her call bell again, as if the Nurse wasn’t mid wipe with her other patient. The Nurse ungloved, washed her hands, and upon entering found the Patient thrusting her call bell at the TV. CNN paraded the war across the screen. On dusty roads tanks rolled, hemmed by cheering (or were they jeering?) crowds. The camera zoomed in. The screen filled with an attentive soldier standing in the turret mounted on top of a Humvee. His hands held a gun, saluting the sky. The Nurse was particularly interested in the soldier’s hands. Now there were man hands, hands that could cup a breast. What sort of hands did her husband have now? The Nurse shuddered. Her eyes followed the jut of the soldier’s jaw and the curve of his lips. She quivered for her husband’s lips, a longing that disgusted her. 

Between the wiping of the other patient and the call bell ringing of this Patient, the Nurse had still found time to calculate the percentage of arms and legs to trunk and head. She wondered if in her calculations the brain and heart should yield a greater percentage because of their weight, not in kilograms, but in their importance for sustaining life and perhaps as residence for the soul. She’d always considered her husband her soul mate until learning that his arms and legs were blown from the Humvee and left in a thousand tiny crumbles mixed with foreign soil. Would a trunk and head be enough? The Priest had scrawled on the postcard – “Despite all, he is still a man and still your husband.” She wondered where his cock was. Had he left it behind, along with his arms and legs? She’d read the blogs of other military wives about how this could happen. She couldn’t imagine to whom or how to pose such a question about her own husband. The CNN footage looped on the screen. Was that the very road where the Nurse might find what she had lost? 

The Nurse squared her shoulders and snapped off the Patient’s TV, pronouncing that war was not good for anyone’s health. With the open-faced innocence of a child, the Patient asked, “Did you bring my drink, Juliet?” The Nurse pointed to her nametag. “My name is Valerie, not Juliet.” The Patient stared at the Nurse’s armpit. “I never said it was.” The Patient’s eyes roved around the room as if confused by her surroundings. The Nurse assessed the Patient’s orientation, asking, “Do you know where you are?” The Patient answered, “Do you think I am daft?” The Nurse frowned. She had not yet decided if she could do what the Priest had asked her. “Has your itching stopped?” the Nurse asked. “What itching?” the Patient replied, and the Nurse wondered if the Patient had dreamed the whole goddamn thing. Vital sign stable. 

00:30 The Nurse returned from her smoke break and discovered that the Patient had wedged her legs between the bed’s side rails and had wrapped the call bell’s cord around her neck. She held her cell phone and said she’d been “texting my husband.” The Nurse called for Juan Carlos, RN, to assist the Patient back into bed. Noted spilling out of the Patient’s Prada purse were several wadded tissues, a half-empty pack of Winston cigarettes, two rattling prescription bottles, and three empty minis. The Nurse reminded the Patient that cell phone use was prohibited in the cardio-thoracic intensive care unit because cellular wavelengths interfered with pacemakers and emergency helicopter transmissions. The Patient clicked her coral thumbnails, tapping her text and said, “Who gives a shit?” “Please stop,” the Nurse said. She grabbed for the phone, and before the Nurse knew it, she was grappling with the Patient. The Patient had a surprisingly strong grip. She breathed an aroma of week old meat into the Nurse’s face. Where the hell was Juan Carlos? Beads of sweat bloomed from the pores running alongside the Patient’s nose. The Nurse suspected that this was the beginning of DTs because in hospitals martinis are not served at 4 PM. The Patient twisted her wrists and whined, “You’re hurting me.” The Nurse released the Patient. She readjusted the stethoscope around her neck. She laid the back of her hand on her Patient’s forehead, checking for a fever (a sign of DTs). The Patient scratched like a feral cat, leaving a burning welt on the Nurse’s hand. The Nurse licked her wound. 

Enter Juan Carlos, RN. His swarthy hips glided to the Patient’s bedside. He lifted her wrist to admire her Rolex. He gave the Patient a generous smile, revealing his gold-rimmed front teeth, which the Nurse has tongued numerous times. Juan Carlos was the salve and the dressing change to the piece of flesh that had been blown out of the Nurse’s chest by the same IED that had masticated her husband’s arms and legs. Though her husband had been found, the return guarantee had expired, and besides the goods were damaged. And then there was the question of his cock. 

Juan whispered to the Nurse, “Where have you been? Your other patient is steeped in shit.” The Nurse dropped her gaze and noticed the loosening laces on her white shoes. The Nurse told Juan that the 1196 Union entitled her to a break, despite one of her patients sitting in shit, and the other hanging out of bed. Her break had lasted the time it took to smoke one or two cigarettes; she didn’t inhale. She’d smoked and walked and smoked and walked and by the time the first cigarette was a glowing stub, she’d crossed several desolate moonlit desert streets and had arrived at a vacant lot. She hid in the shadow of a three-armed Saguaro cactus, each arm one hundred years in the making, asking the moon shadow of herself, what of this merciless fate and this cruel Creator? This she would like to discuss with the Priest! 

The Nurse takes a tissue from the Patient’s bedside table and dabs her red-rimmed eyes. Juan Carlos didn’t mention the Nurse’s absence again. Instead, he maneuvered the Patient’s jiggling buttocks and thighs back into bed, fluffing and flipping the Patient’s pillow to the cool side, even flirting with her, though she was well past her prime and had aged in a way that too much drinking and smoking ruins beauty. Juan Carlos was a generous man. He didn’t know about the postcard in the Nurse’s pocket or the unopened letters or unanswered phone calls. The Nurse wished she could discuss her husband’s cock with Juan and whatever else might be missing—then she might be able to sort through her inconvenient contradictory feelings. Even with his affection for narcotics, Juan had always been level-headed. She wished to kiss him now. 

The Nurse had not expected a handwritten letter from her husband because his hands were minced in Middle Eastern dust. Before she understood that first letter postmarked from Walter Reed in Maryland was an IED, she’d ripped it open. Though the handwriting (note the word hand) wasn’t her husband’s, she’d recognized his words. Optimistic in nature, her husband had always lined her clouds with silver. Walter Reed served rare prime rib (his favorite). One of the nurse’s cut his meat, he exclaimed. 

Her husband wrote that he had a lead on a cabin tucked away in the shadows of the Sequoias for her and their girls. He believed, and begged her to believe too, that among trees of substance, they’d both find the courage to begin a life where the four-limb status quo was inconsequential. The Nurse would be able to keep her head on straight, and oh, how impressed their girls would be with their daddy, who’d learned to pop wheelchair wheelies using his new, high-tech arms. 

After reading that missive, she’d returned all her husband’s other letters unopened, until the postcard, which didn’t need to be opened, had hijacked her. Damn the Priest who sent the vintage postcard. The smiling couple waved from their convertible. Greetings! Why nostalgia at this time? The past should be buried, along with her husband. She couldn’t help but wonder, if he’d be better off dead. After all, “nurse” is not synonymous with martyr and this Nurse was proving that true. Perhaps a walnut, instead of a heart, was cracking in her chest? 

Juan waited quietly at the Nurse’s side, then lifted her ponytail and rubbed her neck. “Are you okay?” he asked. His fingers felt familiar, yet strange. The Nurse nodded at the Patient. “Only if her vital signs are stable.” 

01:30 “Can’t you do anything about my itchy back?” The Patient squirmed. The Nurse offered cold compresses and asked the Patient if she were having pain. The Patient replied that pain was a point of view. She agreed to take two Percocets. She insisted on chewing them, and then chased the gummy particles with a sip of water. The Patient said she wished her prick husband would get there and concluded no man could be counted on. The Nurse agreed. Vital signs stable.

02:05 At the two o’clock checks the Patient was noted to be thrashing in bed and thumping her legs on the side rails. She was given 2 mg. of Ativan IV for increased agitation. Immediately, the Patient’s eyes rolled back into her head and she dropped into a stupor with her limbs twisted at obtuse angles. Her gown flipped above her belly button. A tangle of scars, similar to those on the Patient’s back, were now visible on her pelvis and abdomen. Her pubic hair had been scorched. The innocent belly button obscured. The Nurse tentatively palpated the webbed ridges on the Patient’s belly, hot with the reminiscent terror of the fire. The Nurse closed her eyes. Her sighed breath cooled the back of her throat and the heat in her fingertips. Vital signs stable. 

03:00 The Nurse was in the middle of a pros and cons list entitled “Husband” when shouts tumbled out from the Patient’s room. A silent and odd man, assumed to be the Patient’s long awaited husband, stood at her bedside. He maintained an imposing stance as he held out his hand in greeting. His metal rimmed glasses glinted in the dim room. The Nurse drew her hand to her throat. The pleur-evac bubbled. He turned his palm up, as if offering his vulnerability and when the Nurse hesitated to touch his hand, his serene expression slid into contempt, as if challenging her scrubs, her nursing degree, her license, and her ability for compassion. The Nurse wanted to scream, I am limited, but instead laid her palm on top of his. When the husband withdrew, his fingernails grazed her skin. 

The Patient chewed the inside of her cheeks. “Johnny, what about that drink?” He held a Sonic soda cup to her lips. Her lips puckered for the straw. Her thirst smacked dry. The Patient attempted to steady the straw with her own hands, but her fingers fluttered uncontrollably. Her husband stood by and watched her struggle. The Patient’s mouth gaped, and her tongue wagged with desire. The Patient grabbed the cup with such voracity, she inadvertently crushed it. Soda bubbles exploded in her lap. Her gown soaked to her skin. Did the Nurse smell bourbon? But the vital signs remained stable. 

03:45 Unable to fight the tidal wave of exhaustion, the Nurse rested her head on the nurse’s station outside the Patient’s room. She dreamt of a call bell echoing up from a craggy canyon carved by an endless river of patients floating in their beds. She wanted to dive into the canyon, but her legs could not find the agency to spring. The Nurse woke to the Patient’s husband stroking her back. The Patient was seizing. As she hurried toward the Patient’s room, she remembered the train steeling through the dark. Her knees buckled. The Patient’s husband caught her elbow. 

The Nurse righted herself and hurried to the medicine cart. Then she entered the Patient’s room with another dose of Ativan for her DTs. The Patient’s eyes wildly migrated until they fixed on the syringe that the Nurse injected into her IV line. “Give it all,” she said as if she knew how a syringe could be filled with normal saline and then injected into a patient, saving the Ativan perhaps for a nurse’s pain, not rooted in the body, but in the abysmal crevices of her brain, where fear twists the imagination into an enemy. The Patient sighed, the drug washing over her, soothing her in a way no human power could. The chest tubes were patent and the vital signs stable. 

04:00 The Patient’s husband held a Winston cigarette between the Patient’s lips. “No platitudes about smoking, please,” he said to the Nurse, grinning. The Patient sucked greedily on the cigarette, but the cigarette wasn’t lit. She dropped her head in defeat and said, “Won’t you scratch my back, Johnny?” He untied her gown and it dropped from her shoulders. He took in the thick rubber tube exiting her skin, took in her naked breasts. He smiled. The Nurse turned from their intimacy and stared out the seventh-floor window into the starless desert night. 

The Nurse remembered being on her knees and begging her husband to stay. In reply, the buffed backs of his regulation army boots clipped-clopped away. “You, fucker,” she’d cried. The children had huddled behind the couch. Months later a psychiatrist had prescribed lovely peach-colored pills to help the Nurse sleep. She slept with those pills before she’d started sleeping with Juan Carlos. Her friends at the hospital had looked the other way. She wished she had one of those pills now. The Priest’s postcard had unhinged her – that much can’t be denied. 

The Nurse’s focus sailed back to the Patient and her husband where a ripple of desire had begun to spread throughout the room. The Nurse got caught in their ripple. She missed her husband. The time had come to confess. Where was the Priest? 

“Disgusting, isn’t she?” the husband asked the Nurse’s unsuspecting reflection in the glass window, snagging her, the way the Army recruitment window on University had snagged her husband. The Patient’s husband tenderly fingered his wife’s scarred back. The Patient’s husband leaned over and rested his lips on the train tracks of knotted tissue. A shudder ran the length of the Patient’s body, surrendering something inside. The Patient’s nipples stiffened forcing the Nurse to find excessive interest in the bubbling pleur-evac. 

“There, there, you’re embarrassing the Nurse,” the husband said and tied his wife’s gown. He gestured to his wife and said to the Nurse. “You know the end of the story, but do you want to know the middle?” 

The Patient grabbed her husband’s hand and pulled him towards her. “How about another cigarette, Johnny? How about a drink?” She batted her lashes. The husband ignored her and said to the Nurse, “Those Winstons almost killed her once, and are killing her now. But she’ll never give them up. What’s drinking without smoking, right?” He twisted his hand away and said, “Shut up. I’m telling a story.” The Patient pouted and threw her head back on the pillow. The husband swooped down and pressed his lips to hers. He held them there for an interminable time, then jerked away and laughed. “Sealed” he said decidedly. 

The husband sat and crossed his legs. “She’s been to Betty Ford three times, and I can tell you Ativan never does the trick.” He pulled an empty mini from his pocket and sunk it in the trash basket across the room, dead center. 

The Nurse was impressed with his aim. 

The husband began. “I was driving home from work, inching along in traffic. The brake lights of the car ahead flashed. I had plenty of time to chew on how sick and tired I was of my wife. I exited the freeway and discovered a power outage had occurred in our town. For the last five miles the stoplights had become four-way stops and were blinking red. I gradually lost my patience with the other drivers’ politeness: the wave, the nod. Is it my turn to go? Is it my turn to go? Finally, I pressed the horn and barreled through. Like a madman.” 

The husband shrugged and the room grew exceedingly quiet except for the gurgling pleur-evac. The Nurse imagined their three faces, encased in one of its bubbles, foreheads pressed up against the taut membrane on the verge of bursting. The husband pinched his eyebrows together, as if forcing the memory of that night to crystalize, and then continued with reverence. 

“I loved her or hated her—I didn’t know then and sometimes still don’t. But that night, I convinced myself of hate.” The husband crinkled his nose as if his words smelled rancid. “I pulled into the drive, determined to let that be the last time I ever pulled into the drive. I saw an orange glow. Flames escaped our bedroom window. I was out of the car before it had come to a full stop.” 

He splayed his fingers, admiring his hands, then clasped them together. “She had fallen asleep with a lit cigarette. Later, the firemen brought me a Scotch bottle melted. Her blood alcohol level was so high she would have died from alcohol poisoning if she hadn’t almost burned to death.” 

The Nurse murmured something about love and courage, to which the husband replied, “It wasn’t love and it wasn’t courage. You never really know who you are or what you’re going to do until that moment comes. Did they teach that in nursing school?” 

The Nurse tried to remember. Her cell phone rang the bells of Notre Dame. The husband nodded for the Nurse to answer. She slid into the Patient’s bathroom. Her oldest daughter cried, “Mommy, I’m scared. I’m trying to be brave the way you said Daddy wants us to be.” At that moment the Nurse’s husband substantiated around her. The train was determined to deliver him, their father, home. The Nurse bit her lip, steadying her voice. “Tumble into fairyland,” she whispered and directed her daughters to take the little pink and white pleasant dream capsule (Benadryl 25 mg.) in the silver cup left on their bedside. As the Nurse listened to the pill being gulped down the gentle slope of their throats, she questioned herself for the thousandth time over the three years since her husband had gone to war, been missing, assumed dead, and then found maimed, whether working the night shift was worth it. She ran the numbers in her head: an extra $3 an hour, an extra $108 a week, an extra $432 a month. But with returning every single government check in protest, she circled back to the same conclusion. After the daughters had swallowed their pills, the Nurse instructed them to rest the phone between their lovely ears, and sang “Silent night, holy night, all is calm, all is bright,” not because it was anywhere near Christmas, but because the girls loved this hymn. The Nurse waited until their breath whistled with sleep and then pressed end. She looked at the phone. The train aimed its headlights at her and her heart flung itself against her ribs, throbbed in her throat. She held the phone between her legs and splashed hot water on her face until it stung, and then cold water until it burned. She dialed her husband’s cell phone number, memorized since their first date. A pleasant recording requested she enjoy the music and she did. She’d forgotten all about her husband’s love of classical music, she’d been so focused on his limbs and the space they no longer occupied. Now, she pictured that tiny, tender childhood scar, an X on his upper lip, a scar she could love forever. He’d lick that scar when nervous, and she’d take his hand to reassure him. What would she take now? Suddenly, the phone recording asked that the Nurse leave a message. Her mouth wetted, but words would not form. She closed her eyes and pressed her cheek to the cold antiseptic wall, being comforted by the slight smell of bleach. 

The unexpected hand of Juan Carlos on the Nurse’s shoulder jolted her. The phone dropped into the toilet. She fell to her knees, plunging her hand into the cold water, reaching for her husband’s voice. The message the Nurse left was a splash of the toilet. She handed the postcard from the Priest to Juan Carlos and as he read she hung onto his legs and shook. The Patient’s vital signs were stable, but the Nurse’s were not. 

05:15 The Patient slept deeply, her mouth ajar. The Nurse wiped the syrupy saliva from the corner of the Patient’s mouth. Chest tube insertion site intact, dressing dry. The Patient’s husband snored in a chair. The Nurse left the postcard from the Priest on the Patient’s bedside table. She knew the Patient’s husband would appreciate the nostalgia. The Nurse will leave the hospital and wait on the platform, her hands open at her side. The call bell is within the Patient’s reach and her vital are signs stable.

Issue 53 • Spring 2026

Fiction

Poetry

Fiction

Poetry