The Long-view of History

The physician describes the patient in his private notes:

Twenty-five year old male sex worker, arrived by ambulance, in the custody of police and emergency medical services status post intentional heroin overdose, per report. Pale, attired in blue paper scrubs furnished by the hospital. Denies current complaints. Musculature well-developed, hirsute. Black stubble, but scalp shaved. Well-healed longitudinal scar, one-inch, with loss of follicles over the right anterior mandible. Respirations non-labored, ambulates unassisted. The oral mucosa is moist, skin is not overly dry, and there are no active lesions on the face or trunk. Normo-cephalic without apparent trauma or signs of previous head injury. The mouth is full, jaw enviably square. Prominent vascularity in the extremities, track marks can be seen only unilaterally. Single visible tattoo between the scapulae, stated there is another over the pubis, showed to staff without request. "Helen". Piercings of the areolae with steel bars. Dysphoric-appearing, hypervigilant, but non-irritable, acquiesces to staff and other patients. Physically convalescing, has taken extended periods of sleep. Now attending to hygiene. Eating and toileting without difficulty. Denies abdominal pain or symptoms of withdrawal, mildly diaphoretic and tremulous at times. No obvious hallucinosis. There have been no paranoid or grandiose or morbid thoughts expressed to undersigned or nurse. Fluently masks guardedness, distrust. No self-injurious behavior or violence since admission. Has expressed in passing gratitude for unsuccessful suicide attempt. No expressed suicidal or homicidal ideation. Urine drug screen positive for fentanyl and cocaine, blood alcohol level 100 milligrams per deciliter on admission. Mildly elevated transaminases and macrocytic anemia. Vital signs within normal limits. Initial impressions: under-privileged, twenty-five-year-old male recovering from acute alcohol and opioid overdose, in mild withdrawal. Passively refusing care through denial of complaints. Appears at once older and younger than stated age, as if aged all at once then not at all; piercing blue eyes over an effortlessly masculine build. The world was generous to him with ways and gestures that are the objects of painful longing for other men, but which prove toxic in excess. Excess of attention from both sexes in youth, who would have found him desirable, and “hunted” him, deepening deficits in socialization and promoting promiscuity as form of intimacy. Suspect repeated occupational trauma, hypersensitivity to abandonment. Suspect altered empathic sensorium, with resultant functional impairment. Suspect limited experience of authenticity and altruism, relationships exclusively transactional or deeply co-dependent, expects and is comfortable with boundary crossings and anti-sociality. Maladjusted as a consequence of childhood physical, emotional, and likely sexual abuse. Prognosis limited by education and milieu, although there is normal intellectual functioning and general physical health, and hence theoretical potential for rehabilitation with total novelty—

“Were this feasible,” he whispers, now resting his forehead upon a hand. Perhaps I will sleep in the office. The physician puts down his pen, and leans back in his office chair, outside of the pool of lamplight. He is tired and night has fallen over Billings, and the State Hospital of Montana. It is, primarily, a forensic population. There’s a full floor of psychotic murderers here. It’s such a remote part of the country that a patient may be received from Idaho or even the Dakotas if there is a shortage of beds in those places. Cases like this are more the occasion than the rule. Suicide attempts, addiction, abuse, anti-sociality, brain injury, delirium, psychosis, panic, and fractures in the fabric of reality that alter the mood to the level of medical emergency are the palette of his existence. And from this seat overlooking the valley of humanity those colors ceaselessly encroach upon the earthen places where little shafts of light break through the churning hulk of cloud matter into golden tear-drops where the pear trees of civilization grow in blissful ignorance; they grow too slowly; this dire vista spread to the feet of distant snow-capped mountains, where people cannot go, and eyes cannot yet see.

Sometimes he wishes he had studied Classics. But then, as he listens to the archaeologists on the podcasts describe what was discovered within the strata of ancient cities, the forces that snuffed out cuneiform and Linear B, it is quite clear that the long-view of history is equally bleak. The conscious thought strikes him, what is all this for?

He thinks of his friends who are surgeons, as they wade through seas of blood. The colors of their existence are bursting appendices and the stitching of bowel perforations gifted by the edges of knives. He has friends who are radiologists who gaze in the dark upon the half-moons of subdural hemorrhage. He has friends who are pathologists who study the collapse of cellular architecture under hurricanes of invasive malignancy. Nature is a cunt.

He decides to go down the wide stairs to the front exit, and waves goodnight to the security guard. He winds through the last dying breaths of the Rocky Mountains in his BMW, parsing the dark, forty-five minutes from wilderness to wilderness. Reality is a lie, he reminds himself, as he finds his mind wandering through images of a bullet going through the sphenoid bone of his skull, exploding his brain stem, and finally, breaking free for all eternity through the occiput. He could make such beautiful crimson rain. That would really make a difference. That would change things. Stop it.

***

It’s Saturday. He will make some espresso and go stream fishing on a tributary of the Columbia.