The Snake

Two

Five minutes after the start of his panicky flight, Torres stopped running long enough to rub the surface of his revolver with his shirt, and drop it into a trash basket. Then he began to run again.

He had been running headlong, as fast and hard as he could, from the moment the snake had crawled across the sailor's body toward him. For a while, he kept turning his head to see if it was chasing him, though he knew that no snake could possibly travel at that speed. From time to time he reached down to touch the place on his thigh where he had been bitten. It wasn't swollen and it didn't hurt-just the little pinsand-needles feeling-and he took comfort from that. Maybe the goddamn mile-long whore of a snake wasn't even poisonous.

But he began to feel lightheaded, like he had been drinking too much wine, and he was having some trouble breathing. Also, it was taking him too long to get out of the park. He had stayed on the winding footpaths except for once, when he tried to take a shortcut through an uphill bushy area, and he had lost his bearings and almost gotten hysterical until he found his way back to the paths. He always thought he knew the park as well as he knew his own asshole, but now he couldn't seem to find the way out.

After he found the paths again he felt played out and had to take a rest.

So he just sat down on the pavement, facing in the direction he thought he had come from, so he could see the snake coming if it was still following him. Estupido! He had lost it a long time ago. But the fucking animal had scared him shitless, and he couldn't free his mind of the way it kept sliding out of that box, and the way it bit him so fast that he couldn't hardly see it move.

Sitting down and resting didn't seem to do much good. If anything, his breathing was getting worse, and his mouth was filling up with some sticky kind of crap. He couldn't spit the stuff out and had to try getting rid of it with his fingers. He got scared all over again, and he knew he better get to a hospital fast, but he had a hard time standing up. His legs felt weak, and fie was starting to feel sleepy. But he finally pulled himself up and took off again, though he was staggering more than running, and he couldn't breathe good, and the gummy stuff in his mouth was dribbling down his chin now.

He began to sob, and tried to beg some saints to help him, but he couldn't think of any of their names. He was sucking for air, and his arms and hands felt so heavy that he could hardly move them. At last he remembered his name saint, but when he tried calling out to him he couldn't talk, only make sounds like a frog.

He couldn't feel his legs at all now, just saw them going up and down like in slow motion. The pins and needles were spreading upward in his body, and his head kept falling down until his chin bobbed against his chest. After a while it got too hard to try lifting his head, so he just let it hang down. He didn't feel like running no more, either. All he wanted was to lay down and go to sleep. But he kept going, and a little bit later he saw an exit out of the park onto Fifth Avenue. It puzzled him that he was way down near 64th Street, when he should have come out in the high Seventies.

He stumbled through the exit, but couldn't stop himself at the curb. Ms momentum carried him into the middle of the street, where he collapsed.

Through his closed eyelids he saw the brightness of headlights coming toward him, but he didn't try to move. He knew his legs wouldn't work, no part of his body would work. He heard the bad noises he was making when he tried to breathe, and he knew he was gonna die, right there, laying down in the middle of Fifth Avenue.

Patrolman John Nebbia, driving sector car Boy-3, saw the figure stagger out of the park and into the street, where it collapsed.

"See that?" he said to his partner, Patrolman Frank Finnerty.

Finnerty nodded. "Look at the cars. They go right around him, like dodging a pothole. Nobody stops."

"Who stops and gets out of his car at three-thirty in the morning? I'm not crazy about it myself."

Nebbia sped up a bit until he reached the figure sprawled in the street.

There he made a short U-turn that brought the car around in front of the figure, setting up a barrier to protect it from the oncoming southbound traffic. Finnerty was out the door before the emergency brakes were set.

Nebbia turned on his revolving roof light before he got out.

Finnerty was down on one knee, leaning over the man. "What's the matter, feller?"

Nebbia watched the man's brown eyes open and stare upward. He was having trouble breathing, and a heavy gluey mucous discharge glistened on his lips and chin.

"OD'd," Nebbia said. "One more I-Espanic OD. I'll call for an ambulance."

"He can hardly breathe," Finnerty said. "See how blue his face is? Probably a heart attack."

"Me, I diagnose it overdose," Nebbia said. "He's too young for a heart attack. I'll call an ambulance." He straightened up, but instead of going back to the car, yelled at a driver who had stopped alongside them, with his window turned down, to watch the scene. "Move along, move along, chrisesake. You got no home to go to?"

"He looks like he might go out any second, John," Finnerty said. "Let's put him in the car and take him ourself."

"I don't know," Nebbia said.

"What don't you know? He could go any second."

"That's what I don't know," Nebbia said. "You know as well as me that if he dies on us we have to hang around and wait for the M.E., and Christ alone knows how long it takes the wagon to get here, and then we have to inventory his possessions…" He paused, and assessed the tightening of Finnerty's spare Irish face, and shrugged. "Okay, okay, we'll take him ourself."

They carried him to the car. Finnerty got into the back seat with him.

Nebbia spoke into his microphone. "Nineteenth Precinct sector car Eighteen-twenty to Central. K."

In the back seat, looking down at the slumped figure beside him, Finnerty heard Nebbia inform Central that they were transporting a serious OD to East Side Hospital. After Central acknowledged, Nebbia. turned his siren on.

Not OD, Finnerty said to himself, not OD but a heart attack. He tried to remember the emergency procedure he was trained to follow. The only thing he could think of right now was mouth-to-mouth resuscitation. and he wasn't sure he could bring himself to do it with all that crap that was clogging the victim's mouth and oozing down over his chin.

"Move it," he said to Nebbia. "Will you move it?"

As the snake headed into heavy brush, a squirrel fled before its approach. The snake was hungry, and it might have taken the squirrel, but its primal impulse was to seek a place of safety. It crawled deeper into the brush, constantly probing with its deeply forked black tongue. It paused at the base of a tree, erected its head on the taut anterior portion of its body, and looked upward. Then it began to crawl up the trunk of the tree, winding around it swiftly and smoothly, using its prehensile tail for leverage.

It stopped two-thirds of the way up the tree in an area of heavy foliage, and draped itself over the branches in a seemingly patternless arrangement of loose random loops that were designed to distribute its weight evenly.

The snake was eleven feet, two inches long, and slender. Its head was coffin-sided and comparatively small for the length of its body. Its eyes, dark brown and round, were wide open. It was unable to shut its eyes because it had neither eyelids nor nictitating membrane.

The snake was asleep.

With the exception of weekend nights, when the traffic was heavy and continuous until dawn, the emergency ward of East Side Hospital was normally at its busiest between 4 P.m. and midnight. Those were the hours when most of the patients flocked to emergency for nonemergency treatment they would normally have sought in the clinic, which closed at four o'clock.

Now, at 3:45 A.M., the reception room was empty except for a sleeping wino with a stiffly bandaged forefinger. He had been treated more than an hour ago, but showed no disposition to leave. Probably, Nurse Rosamund Johnson thought, glancing at him from behind the reception desk, because of the air conditioning. Well, he was peaceful enough, poor old bum, so let him hang around.

She was working on a sheaf of Blue Cross claim sheets when two cops came in with a patient. His feet were dragging, his head lolling, and he seemed to be semicomatose.

"Found this on Fifth Avenue," one of the cops said. "He's got the blue face."

Nurse Johnson punched a key on her intercom and said, "Billy, bring out a stretcher, stat," then punched another key and, after a moment, said, "Dr. Papalco, we have a patient in a cyanosed condition who's having trouble breathing. Come immediately, please." She listened for a moment and then said sharply, "Look, doctor, you better come immediately, Stat."

"Overdose," one of the cops said. "I seen hundreds of them."

The nurse, grimacing at the intercom, said, "How's he ever gonna be a doctor if he don't learn how to wake up?"

"He can't breathe," the other cop said. "My opinion, it's heart attack."

An attendant came through an inner door rolling a stretcher.

"Put the patient in Room D, Billy," Nurse Johnson said. "Dr. Papaleo is on his way."

The two cops strained, helping the attendant lift their burden onto the stretcher. "Dead weight," one of them said, arching an eyebrow. "If you know what I mean."

Nurse Johnson said, "Can you fellows hang around a few minutes in case the doctor wants to ask some questions? There's a coffee machine around the comer."

One of the cops nodded, and the other one said, "I'll call it in."

Dr. Charles Papaleo disliked the emergency ward almost as much as he disliked the surgery, which, in turn, he disliked more than obstetrics and less than medicine. He recognized that in terms of gross experience emergency ward service was invaluable for a first-year intern, but that didn't change his view of it. His problem was that he was abnormally shy, and had trouble in his dealings with people. Left to himself, he would have chosen another profession, something reclusive, no doubt, but his father and brother, both of whom were physicians, wouldn't hear of it, and they were overwhelming. Nevertheless, he had prevailed in making his own choice of a specialty-radiology. As a radiologist he would rarely have to face a patient from one year to the next, just his shadow imprinted on a sheet of film negative.

The patient on the table in Room D, Papaleo thought wryly, posed no problems in the personal sense. He was obtunded, semicomatose. On the other hand, his inability to respond to questions that might provide helpful signposts into the diagnostic process did pose medical problems. Looking down at the man, Papaleo thought, Overdose, I'll bet it's good old overdose. But he put the notion out of mind. Physicians were expected to follow form, especially first-year intems, who were discouraged from making snap judgments. "Even if you turn out to be correct," one of his professors was fond of saying, "the lightning-flash diagnosis in fledgling doctors-the Kildare syndrome-is either brilliance or dumb luck. Our science is based on neither brilliance nor dumb luck but knowledge."

So-attend to the symptoms. Cyanotic. Marked hypoventilation-the patient was breathing poorly, although he didn't seem to be fighting desperately for air, as people usually did who couldn't breathe. Meaningful? Maybe, but file it away for the moment. Meanwhile, the airway receives first attention. Oxygen. He found a nasal catheter and inserted it. Nostrils filled with heavy mucus-have to check to see that it didn't clog the catheter.

A nurse came into the room. Kelly, an old hand. It figured. They liked to have someone around to keep an eye on the first-year interns, and if no doctor was available, an experienced nurse was next best.

Without looking at her, Papaleo said, "Blood pressure cuff, please."

He opened the patient's mouth-slimy, thick mucous discharge, like the nose-and checked the tongue. No falling back of tongue-takes care of that.

Didn't seem to be any obstruction, either. He sniffed the patient's breath.

No alcohol smell, just a strong bouquet of… what? Chili peppers.

Nurse Kelly was winding the blood pressure cuff around the patient's arm, her movements deft, practiced. Papaleo said, "Never mind that for a moment.

The airway is more important. Will you get the suction apparatus, please?"

Kelly nodded and moved off briskly. Papaleo, suddenly remembering the old yam about the green intern who had diagnosed a day's growth of blue-black beard as cyanosis, examined the patient's fingernails, lips, and tongue.

All blue. Cyanosis, not need of a shave.

Nurse Kelly came back with the suction apparatus: a vacuum to suck up the mucus via a tube running into a clear bottle so the matter could be examined. Kelly maneuvered the tube in the patient's mouth with her right hand, and with her left wiped up the mess on his chin and lips.

Papaleo, his forehead ridged, fitted his stethoscope into his ears, opened a few buttons of the patient's shirt, and listened to the heartbeat. Fast but fairly regular. The speed was nothing like tachycardia, exertion could even account for it. He picked up the man's wrist and counted his pulse.

Fifteen seconds on the sweep hand of his watch: twenty-four or twenty-five.

Call it an even hundred. He finished winding the blood pressure cuff around the patient's arm and pumped up the auto-valve bulb. He released the bulb, and took the systole and diastole reading. A hundred over forty. Combined with the pulse rate, it was slightly under normal, and it failed to suggest anything of substance to him.

"The oxygen doesn't seem to be helping his breathing any, doctor," Nurse Kelly said.

"Yes, well…" She was right. No answer for her. He frowned and said, "Let's give it a chance to take."

Nurse Kelly was silent for a moment before saying primly, "Shall I check the catheter to see if it's clogged?"

"Yes. Will you please do that, nurse?"

He waited until Kelly had removed the catheter. She stepped back from the table and began to clean it. Silently disapproving. Mustn't let her bother me, Papaleo thought. What now? Neurological check.

"Neurological check," he said aloud, and stepped back to allow Kelly to reinsert the nasal catheter.

Okay. Test for sensation-pinch and poke and press. Knee reflexes, okay.

Bang the tendons-okay. Response to pain, okay. Check head for trauma: lots of black hair, wavy, but can't feel anything amiss. Okay. Shine flashlight into eyes-pupils normal size and contract under stimulus of light. Heroin out.

The patient's hand rose feebly, reaching for the mouth. Trying to clear it of mucus. But Kelly had vacuumed most of the mouth clean. She was looking at him sidelong now, and fidgeting. She opened her mouth to say something, but Papaleo intercepted her. "Lungs. Help me to get him into a sitting position."

He started unbuttoning the rest of the man's shirt. Unbutton? He remembered what another professor had said: "Don't waste time with buttons, cut the garment off or rip it off-the moral being that saving a shirt is no substitute for saving a life." Balls. All he had to do was push the shirt up over the patient's back. Two birds with one stone-save the life and the shirt. Maybe.

The patient was dead weight as they tried to sit him up. His head lolled forward against Papaleo's chest. Kelly held him steady and Papaleo leaned over him, placed his ear against the smooth brown skin and tapped.

Sounded all right, but what could he really tell with the patient unable to breathe deeply?

"Let's get him back down, nurse, shall we?"

"Doctor, I think we-"

He cut her off with a frown. Got to keep them in their place, especially the old-timers, mustn't let them get ahead of you.

He picked up the patient's arms and studied them. No needle tracks. Well, the normal pupils had told him that. Overdose of some kind of pill? A possibility. Do a gastric lavage? He realized that he was sweating profusely. He wiped the sweat from his face with his forearm. Kelly watched, her lips pursed.

He said, "Who brought him in?"

"The police. I think they're still around."

"I'll step outside for a second and talk to them." Should have thought of that earlier, dammit. He started away from the table, then returned.

"Maybe some kind of overdose, though the signs are absent. Still… get some Narcan, will you, please? Yes, and set up an I.V. with five percent dextrose and saline."

Nurse Kelly nodded her head and her lips softened. Good, Papaleo thought, I'm on the beam, Kelly approves.

"Oh yes, let's protect against an insulin overdose. Add fifty percent glucose."

He found the cops in the anteroom, drinking coffee and chatting with the security guard. They told him what they knew. No help.

"What about his movements. Was he jerking? You know-you've seen epileptics."

The cops agreed that although he had been staggering he hadn't appeared to be convulsed.

"It looks like overdose to me," one of the cops said. "A lot of Hispanics overdose these days."

Kelly maybe, but a dumb cop no. Papaleo returned through the reception room to Room D. Kelly had already hooked up the I.V. and she was back working with the suction apparatus, picking away at the mucus in the patient's mouth.

"Not alcohol," she said. "No odor."

"I'm well aware of that. I have a nose, too."

Kelly's lips tightened up again. Papalco looked down at the patient blankly. What else was there, chrisesakes? Take a blood sample, check for sugar? But it would take at least a half hour. Some kind of GI haemorrhage?

"Could be in apparent bleeding," he said aloud.

"Doctor," Kelly said, "I think we're in trouble."

He thought so himself, but the declaration would have to come from him, not from a nurse. What the devil could it be? He ticked off items in his mind. Alcohol, no. Overdose, none of the signs. Trauma, no. Stroke — who knows? He decided to listen to the heart again. There was some change, and it was for the worse-beat more rapid now, and weaker. The patient's chest barely seemed to be moving. Paralysis, some kind of paralysis?

Kelly said, "Doctor, I think we want a Code Blue."

Code Blue was the emergency call that mobilized a surgeon, an anaesthetist, the Chief Resident, extra nurses. It was clearly indicated, Papaleo thought, but suppose they all piled in and made a sure, quick, easy diagnosis? Christ! Better hold the Code Blue for another minute or two.

"Presently," he said to Nurse Kelly, and studied the patient hopelessly.

Why should he resist just because they might think he was a dunce? That's what everybody thought of first-year interns anyway. They would come in, fire questions at him with the same sort of hauteur he had used with the two cops outside… "Well, doctor?" Keily looked grim. "I think we're about to lose him!

Sweat was pouring down the sides of Papaleo's face. "Very well. Let's do a Code Blue."

Dr. Shapiro, the Chief Resident, was down in less than a minute. He ran his hands over the patient's chest, almost abstractedly, while Papaleo, earnest, sweating, filled him in. Shapiro's face was a mask. Before Papaleo was quite finished, Shapiro interrupted.

"Let's tube him," Shapiro said. "He needs air. Nurse, get hold of a respirator." Nurse Kelly, looking righteous, moved away from the table.

"He can't breathe because his muscles aren't functioning properly. We want a mechanical aid to help the chest muscles do their work."

Should have thought of it, Papaleo told himself, when I noticed that he didn't seem to be lighting for breath. Mechanical respirator: endo tracheal tube pushed into the windpipe, attached to a cock on wall that pumped oxygen directly into lungs.

Shapiro removed the nasal catheter when Kelly arrived with the respirator. He had some initial trouble incubating the patient, and Papaleo thought, Christ, if he has trouble, what would have happened to me? Other members of the Code Blue team had arrived, but there was nothing for them to do, as yet.

With the tube emplaced in the patient's trachea, Shapiro stepped back a pace and shook his head. "I don't know." He looked worried. Then, frowning, he stepped forward to the table again. "What's this, on his thigh?"

The light summer trousers were stained with a scuffing of grime, sweat, and a little blood. Papaleo hadn't noticed it before.

"He must have scraped it when he fell. The policemen who brought him in said he collapsed in the street."

"Hand me a scissors. We'll cut them off."

But, abruptly, Shapiro bent over the patient with his stethoscope.

"I swear," Papaleo said, "I can't figure out what's wrong with him," and then shut up because Shapiro was still auscultating.

Shapiro straightened up. "I can't raise a heartbeat. Let's get going."

The entire Code Blue team pitched in. Everyone worked with great intensity, injecting, kneading, pounding-Papaleo, with a shudder, felt a rib break under his fist-but to no avail. The patient's heart refused to start up again.

"You can all go," Shapiro said. "We've lost this one."

Before he left, Shapiro reminded Nurse Kelly to phone the Medical Examiner's office and ask them to send the death wagon around to pick up the body for autopsy. In death from an undiagnosed cause, Papaleo, recalled, no permission from next of kin was required.

"Death from cardio-respiratory failure due to unknown causes," Shapiro said to Papaleo. "Don't forget, the M.E. gets a duplicate of your report."

"I should have thought of the mechanical respirator earlier," Papaleo said.

"I'm sorry."

"Well, you'll think of it next time." Shapiro took a last look at the corpse on the table, said "Good night," and left the room.

The surgical resident, wearing white ducks and a dirty sweatshirt, shuffled into Room D. His yawn turned to a scowl when he was told that the patient had died and that the Code Blue had been canceled. He charged Papaleo and Nurse Kelly with wantonly disturbing his sleep.

"I'm doing a very difficult abdomino-peritoneal resection at seven o'clock and if I'm not at my best during the operation… Christ!"

Nurse Kelly flushed and said defensively, "Well, I'm sorry doctor. The patient's condition indicated a Code Blue, and we didn't know he was going to die."

"Well, somebody should know those things," the surgical resident said, giving Papaleo a dirty look. He turned abruptly and shuffied out. He was barefooted.

"Five minutes late for a Code Blue, and he's mad," Kelly said. "Surgeons, they're born that way."

Papaleo had once heard someone say that surgery residents begin getting difficult in their third year so that they could open their own practice with their arrogance at full bloom. But he had seen plenty of arrogant first-year interns who were preparing for surgery, so Kelly was probably right, they were born that way.

"It's a fact of life," Kelly said, "the way heart specialists are dangerously overweight and plastic surgeons are handsome, and orthopods are built like football players."

And radiologists are shy of people, Papaleo thought. While Nurse Kelly picked up the pieces-phoned the M.E.'s office for the death wagon, and got an orderly to wheel the body to the hospital morgue near the truck exit-Papaleo went to another room, where he put a butterfly suture under the eye of a man who had been kicked decisively in a brawl.

After that, his tour of duty was finished. But instead of going to bed, he went down to the morgue.

The patient's eyes were open, and they seemed to Papaleo to be bewildered, as if he too was trying to fathom the cause of his death.

Papaleo closed the eyes, not from sentimentality but because-he told himself with a nervous smile-he preferred working without anyone watching him.

He ran his hands over the torso absently, as Shapiro had done earlier.

The skin had begun to cool, and to gray down from the smooth brown of a young man who had been, Papaleo guessed, in quite good health. The mouth was open in a crooked gape, and the lips and chin were smeared with hardening mucus. He ran his eyes down the body from top to bottom, as if taking inventory. Then his eyes travelled upward again to the thigh, to the patch of bloodied grime on the trousers.

After a moment's hesitation he opened the belt buckle and started to roll the trousers down, but changed his mind. He took a scissors from the pocket of his jacket, and firmly slit the trouser leg up from the cuff to the hip. He spread the material carefully to the side and bent over the thigh. The skin was abraded and slightly stained by blood. Bending still closer, he noticed four small perforations in the skin, partially obliterated by the abrasions. So it was overdose after all, despite the contraindicative symptoms!

But his certainty was short-lived. Why would an addict use his thigh when his arm was clear? And how could he be thought of as an addict if there were only the four marks, and no signs of needle tracks? And why four marks, of equal freshness? The four perforations seemed to be in two sets: one pair about six inches above the knee, the other two or three inches higher. The perforations in each set appeared to be about twelve millimetres apart.

With his nose almost touching the thigh he studied the marks. They certainly could be an injection of some sort, though with a rather large needle. But who would inject in pairs? Bites of some kind? Fang marks?

But fangs would make much bigger and more ragged holes. Insect bites? Too large, and not with that spacing. No insect he had ever heard of bit that way, in pairs. Besides, who would stand still for four such bites or stings?

Fangs, then. What had fangs? Dogs, cats, lions, tigers… come on, Papaleo. Snakes? A poisonous snakebite in Manhattan? Anyway, snakes didn't strike that high. They might bite a hand or finger if they were held, but they usually struck the foot or lower leg. Besides, so far as he knew, snakes secreted a hemotoxic poison, which destroyed the red blood corpuscles and resulted in discoloration and swelling of the affected area due to local hemorrhages. Nothing like that here. Snakebite?

Forget it, Papaleo. Still, shouldn't he tell Shapiro about the perforations? Yeah, sure, wake him up, wake up the boss and face that curled lip and those glittering eyeglasses… Forget it, Papaleo.

Nevertheless, he decided to read up on snakebite in Beeson and McDermott before he hit the sack. But by the time he got back to his room he was feeling too damn exhausted to start rummaging for a book. Instead, he fell on his bed fully clothed and went to sleep.

A half hour later the M.E.'s death wagon backed into the receiving bay.

The attendant signed a receipt for Torres's corpse, and took it away for storage in the city morgue until the M.E.'s office could schedule it for post-mortem examination.