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The Fiction Issue 2015

A Short Story About the Damage Caused by a Depraved Doctor

'The Terminal Artist,' by David Means

This short story appears in the June 2015 Fiction Issue of VICE Magazine.

At the time, her death had seemed in the order of the way things sometimes go, when bad luck and the physiological nature of the trauma—in this case swelling of the brain after cancer surgery—combine to betray the curative efforts of the medical establishment. We mourned her death as a natural event. Right away (even the day we got the news) we felt her absence as a part of the wider—again natural—scheme of the world. She had simply gone the way other living things go, succumbing to the frailty of biological systems. The cancer had been excised in a clean and sharp procedure, but then another factor had come into play. This is not to say that the loss wasn't great, but in the end her death seemed part of yet another beautiful tragedy. What was hoped for and what happened were at odds. Her children—two young daughters—would never have a mother, and her wonderful voice—she sang in a gospel group—would never be heard again. For a few months our grief continued to sharpen and then, day by day, it tapered off until what we could remember about her—that lively, light laugh, her lovely eyes—began to erase the painful day of her burial.


Six years later the Terminal Artist—as the media dubbed him—confessed to having killed patients in an upstate hospital. He had tweaked the medication on several post-op patients (always doing so in a professional manner: easing them over the line with clinical care, never just simply pulling a plug or drowning them in ridiculous amounts of morphine. He performed mercy killings that were meant, he claimed, to save—his words—a world of suffering). When he came to light, the hospitals and insurance companies were forced to review cases and slowly, over the course of several months, began to solve the mystery of several deaths that had been attributed to natural causes. Perfectly fine post-op cases, young men and women with strong physical constitutions and powerful wills, with the odds on their side, often came out of anesthesia, lived a few days, and then died quietly in the middle of the night, resisting heroic efforts before they fell into the void forever. While the so-called Terminal Artist was busy admitting that he had killed four or five patients in an upstate hospital, authorities went back and traced the history of his employment to ten institutions that had eagerly hired him over a 15-year period because not only was he a nurse, in high demand at the time, but a male nurse to boot. Not only a male nurse but a highly trained one, highly personable, with a clean-shaven, tidy disposition and a voice that seemed pleasant, calm, and bright. The kind of man you would want at your bedside, thoughtful and considerate while at the same time efficient and orderly. One of those careful chart checkers and hand washers. A man who probably lived a somewhat lonely, austere, bachelor life, working the long hours the job required out of a dedication to the profession. I'm a mercy provider, he explained in court a year later. I dole out mercy. I ease burdens. I relinquish pain. I help provide a smooth transition to the afterlife. I'm obligated to God. I do God's work. The Lord is my heart. His will will be done. I end lives to provide salvation. Only mercy, all the time. He went on like this until the judge put his hand up and ordered him to stop.


At the hospitals where he had worked, those cases that had been most certainly natural, a part of the order of the natural world, became automatically suspect. Whereas certain cases, at least the ones that he had admitted to outright, about ten, maybe 15, and a few others, were immediately reclassified as homicides. Each (confessed) death (suddenly) had an exact cause: a micromanaged drip of morphine, just enough to induce heart failure that looked somewhat natural; an extra dose of digoxin that sent a patient—just out of open-heart surgery—tumbling over the life-death line in a way that looked to be a matter of simple physics. With pride in his voice, he spoke of providing mercy with the application of what he called calibrated pushes, nudges that simply served to augment what otherwise were perfectly natural (his phrase) situations, so that, for example, the muscles of the heart, already tired and weak after being put into a holding action, released their energies and gave up in a way that was a relief to their fibers (he said); or in the case of a young child who was in an induced coma, simply allowing her to continue her journey to God instead of allowing her to rebound back into a life of earthly hell. All of this just to say that when my friend died, after brain surgery, in a small hospital in upstate New York; died in the dead heart of a wintery night, alone, in a room in the intensive-care ward; when her brain swelled in a post-operative condition and the unrelieved pressure somehow—this is pure speculation—caused her heart to fail later the next day, it was originally chalked up to an act of God, if you believed, or just one more natural failure of the body. One more tragic cancer death that left behind two children and a father and an empty silence beyond reckoning. It seemed to be the type of death that allowed only a certain vantage, because to get too close to it, to hone in on the loss, would be to touch a kind of madness and to admit that there was only raw chance and nothing else involved, and to fully admit to that would—at least for me—be to give in to the purest kind of terror. All I could do at that point was try to get as close as possible to the elemental loss: mourn her absence; remember her lean, lovely face and soft laugh; pray, or not pray, that her soul would live on in one form or another, if not up in some heavenly place then at least in those who held memories of her life here. But then, six years later, a story appeared in the media that the above-mentioned Terminal Artist had been caught, or tracked down through careful scrutiny of two similar cases in the same upstate hospital.


Many, hearing the word upstate, couldn't help visualizing a series of particular images: cracked roads swaying along the Hudson River, which is always hidden down an overgrown verge; wide fields of weeds and grass leading to the second-growth forest that has overtaken whatever agriculture once flourished up there, if it ever did; rusted factories leaching PCBs into the river. The upstate of the imagination begins just about where the salt front, the upmost reach of the flood tide coming up from the New York Harbor, ends in Newburgh Bay. (My image of upstate has been shaped by the photographs of Richard Prince: abandoned clapboard houses, rust-smeared trailer homes, silent [also rusted] basketball hoops, roads with skid marks left by the obligatory rites of bored teenagers who find solace in jack-starting cars, fishtailing dramatic 360s. Muscle cars, powerful beyond everyday need, shudder outrageously while the long, lean contours of their hoods—glossed to a high polish—stretch out to lick the bleak horizon.)

The Terminal Artist, never venturing south of Newburgh, worked the second-tier hospitals that formed a constellation of upstate New York medical care stretching all the way up to the edge of Buffalo, which somehow escapes the upstate tag by being along the shore of Lake Ontario, which for its part touches the shore of Canada. All this just to say that the fact that he worked in upstate hospitals seems to resonate retroactively with the region itself and the fact that so many—not all, but many—of its population already suffered, and so had to suffer doubly from his actions. The assumption—in the media—was that his victims, by virtue of being cared for in hospitals upstate, actually lived upstate. This wasn't the case. Cherie was living in a small Hudson River town about 30 miles upstream from Manhattan when she had a divine vision in which God told her—she explained this to her friends shortly before the operation—to seek out Dr. Drake, a stout neurosurgeon with a prim manner and a few brain operations under his belt.


In any case, outside the hospital on that cold winter night was a landscape somewhat dismal, lonely, silent, abject, and sad, struggling mightily to hold up against tough economic times, working hard to shrug off a stigma that came from being beyond the cultural gravity field of the great city downstream. (In all honestly, until I got word of the Terminal Artist, I held the entire region implicit in her death.) For a long time after I got the news about the Terminal Artist, I found it hard to believe that this dear friend of mine had succumbed to a complex array of chances, an infinite range of factors that had combined to put her in a particular bed, in a particular hospital, to have a particular form of surgery, to solve a particular medical problem, and in doing so met with a particular ward nurse, who happened to have been on duty that particular night, and who had a particular derangement, or sense of obligation to a particular concept of mercy, and administrated a dose of some particular, albeit unknown, substance (the case is still open). Most found it nearly impossible to grasp the complex factors that had vectored together to put her life into the hands of a madman (case still open).

When news of the Terminal Artist broke, her death was six years in the past, not much more than a blip of pain, an old memory that included the day I got word of her death, one dreary afternoon at the cabin upstate (not really upstate, at least theoretically: a small cabin near Goshen, not far from the Wallkill River, a place to hang my hat when I'm out in my waders—and somehow that stretch of river, drawing a wide array of rather rich folks from the city and suburbs, seems protected from the various associations one has with the term upstate); just sitting reading Isaac Babel while the baby dozed and Irene took a cat nap; nothing but a kind of deep silence—not even the murmur of the fridge, maybe the wind sweeping through the strand of Scots pines at the end of the property. Then my phone rang and my father-in-law, a doctor himself, went into it carefully, speaking in his precise medical voice, sticking with the facts: She had died overnight, deep in the night, the time not exactly known, and had succumbed to heart failure after swelling of the brain and so on and so forth. That memory—the deep white hiss, maybe, of wind through the trees and the baby's soft snoring, not so soft actually, really a rather loud sound to be coming from a six-month-old girl. That memory merged with memories of the funeral, a vast affair in a big domed church that had once been a music hall: everyone in white, except for those of us who had come up from the city, and the women wearing pants (those who weren't were provided with wide linen napkins to cover their knees, for the sake of modesty, I suppose). The entire service had a tone of jubilation, of joy and replenishment based on the idea, maybe the concept—no, much deeper, the knowledge—that she had passed forth into some much better realm; that she had been provided with a direct trip into heaven, so to speak. The tone was assured, brilliantly bright—with her own gospel group singing rapturously while we confused city folks tried to ride with it in an agreeable manner, holding our own as much as possible, trying not to draw judgments because her African American culture rubbed up against our whiteness and we, as whites, assumed the privilege of assuming we had no real ethnicity, just a void that was—I'm guessing here—the norm—tried hard to imagine our way into their attitudinal stance: painful joy over the foreordained status of being offered up into some holy receivership that was visualized as pearly gates, perhaps, wide-open arms, holy, draped in white. All this—in memory—was six years in the past when the news broke of the Terminal Artist's confession (case still open) and sparked a turning back to old memories that had been blurred and tarnished by time—and perhaps amplified: the smell of the lavender perfume of the woman who escorted us to our seats. Her father's large, morose face—beading with sweat as he sang. The delusional notions of the Terminal Artist, who claimed he'd been helping his patients along the path to heaven, blended with the jubilation at the funeral over the fact that she had made the trip to heaven and was at the feet of her holy maker, or through the pearly gates, or already up there in some cloudy realm, cottony and light.

There was that long period of time when we had no knowledge of the Terminal Artist, those beautiful days when we carried a sorrow born—we thought—out of somewhat natural processes. Not man-made sorrow. (Going down to the river, I was still thinking. Man made? That phrase is all I hold to because the rest of it—the interminable series of chances, the long retrospective chain of incidences, from the fact that she got cancer at that particular time, or at least spotted it, to her deciding upon that particular hospital, out of some deep religious idea, maybe [too many factors to name, I thought, heading down to the river, wading through the brush, the overgrowth of wild bamboo and thicker brambles to the stream edge], while, at the same time, the so-called Terminal Artist had moved from one hospital to the next, taking advantage of the high demand for nurses, moving from one upstate hospital to another, and then to a hospital in Lancaster for a few months before heading back upstate, leaving a trail of dead behind—seemed too much to ponder.)

In my work, I've described the way it feels to step into the icy water with waders on while the rubber compresses against your legs. The odd sensation of stepping with felt bottoms onto the slick stones and toeing along, always somewhat fearful of the plunge into the unknown but secure somehow after years of doing it, able to sense the dangers. I've used fishing as metaphor, but never shamefully. I've used the sway-back motion of the cast, the old-fashioned basics of tying the fly to the line. Once again I've turned to it because in the strange solitude at the center of the river, with the water flowing on both sides, I feel grateful that at least for six years we were able to think of her death as natural. I'd never be able to use her death in a story. I'd have to find some other way, I thought, and then once again I unleashed a cast and once again watched the line spread itself neatly across the surface so that the fly, at the end of the tapered leader, was invisible, sunk in the glimmer of light, floating ahead—one more image making me alive to that particular moment, with the hard, cold surge of flow all around me, floating beautifully along on an infinite number of chance vortices. But of course that day on the stream is six years old, and the funeral itself is six years behind that, so that 12 years have passed since our friend died and six since we got the news about the Terminal Artist. Six years have passed, and the story of the Terminal Artist has faded from public memory and been replaced by other, more current, and therefore seemingly more urgent narratives, so that all we can do, each day, is hold on to the hope of finding an attendant structure that might begin somehow, on a cold fall afternoon, in a hospital room, perhaps, or maybe out in the parking lot during a smoking break, when the killer nurse (dubbed the Terminal Artist) takes in the air and relishes the beauty of the afternoon breeze, bringing with it a briny, sea smell of the river's ebb tide. There is a pristine blue sky overhead, and across the street the leaves have changed on the trees, spilling brilliant colors into the air. Everything is hard and bright. He is thinking carefully about his next move, deliberate and thoughtful. There is the glory of God in the air, he thinks. He shuffles his feet a little bit and flicks his cigarette into the curb. He is anxious to get in and get started. He has work to do. Good, hard work. Then he bows his head and says a little prayer, offering his services directly to the Lord, just like Abraham did up on the mountaintop, clearheaded and unconfused, with his son in his arms awaiting the knife, offering up his soft, smooth neck for the moment at hand.