When Gods Die by Maria Alexander

written by Maria Alexander

Titans and ambulances rage as they emerge from their caves, and sleep, twilight-bound and restless, when they return...

“Head injury, 15 minutes!”

The radio room PA system beeped frantically with the paramedic call for the latest trauma patient. Nine-year-old Rachel Anne Roberts tested at a “1” for every phase of the Glasgow Coma Test: unresponsive. Triage quickly ushered her gurney through the double-layers of automatic glass doors and into the trauma room. Blood draining from her right ear. Many cuts covering her frail body...

“Hypoxemia and hypotension? What are you fucking waiting for?” I yelled. “Get her stabilized, goddammit!”

Nurses in cobalt blue cotton scrubs scrambled to intubate the girl so she could breathe and x-rayed her skull: Three cranial fractures. As we raced her gurney down to OR, she suffered an epileptic seizure. She was very seriously injured, but she was in good hands: mine. I was Dr. Timothy Samuel, the best neurosurgeon at UC Davis Medical Center. That’s not ego; it’s record.

I gave her a 30% chance to live.

She closely resembled my first cousin Maggie, a little girl with straight blonde hair and wiry fingers, who caught lizards and made up sweet songs. She died when she was 12 in a flooded river near the family home in Missouri...

But that was a long time ago.

Later that night, I explained to Rachel’s parents that she might die. We had to see if the swelling decreased in her braincase.

Her mother, a short Southern woman, wiped her wet red cheek with her open palm. She asked if her daughter was in pain, and I assured her she wasn’t, although I frankly didn’t know or care. She was unconscious, not likely to feel anything. Her very tall, Norse father nodded silently as I spoke, his neck stiff like a hobby horse. Sometimes he’d close his eyes, and the lids trembled – raw, pink, and sallow – over his tears.

Their fundamentalist preacher arrived later, dressed as a priest so he would be admitted to her ICU room to pray over her. Hospital policy apparently influences who dies shriven and who doesn’t.

Rachel remained in ICU, slowly improving, for one week. An ICU room proper has only three walls: the fourth is a draped blue sheet. When I’m in one of those rooms with a patient, the shapes of the nurses and other doctors passing by remind me of a puppet show curtain. They unnerved me that morning, the puppet actors and their shadows, suggesting more vividly than usual their illusory roles on my morning rounds. I needed to examine Rachel’s scalp sutures and the bolt in her skull measuring the pressure in her braincase. She was tethered to many, many machines tracking her vital signs. And she was comatose.

I didn’t believe in miracles. My only miracle was being accepted on staff at the Medical Center – it was my first choice of residency. No one ever receives their first choice, no matter how well they do academically. I graduated magna cum laude at UC Davis, valedictorian of my class. No miracle: That was dedication. And superior intellect.

But I suspected her father believed in miracles very much.

When I arrived, he was unburdening a litany of guilt to sleeping ears still flaked with blood. I waited somewhat impatiently beyond the puppet curtain until he finished. He did not look at me, but stood by his daughter’s bed, holding her fever-warm hand. Then, “Dr. Samuel, do you believe in God?”

“I’m afraid I don’t,” I replied curtly, yet honestly. Inured to such talk, I made some notes as I checked her sutures.

“I suppose you don’t believe in the Devil, either,” he said quietly.

Nothing makes me more uncomfortable than talk about religion or God. Not since Maggie died. I stopped thinking about those subjects long ago. I turned my curiosity about abstract matters to gray matter because it’s far less...sensitive. I focused on the machines and shook my head.

“I don’t, either.” His sallow face reddened. “When I was a little boy, my Scandinavian Grandma – my bestemor – used to tell me of the old religions. The old gods. I swear,” he said, trembling, “this looks more like the work of Loki than any of that nonsense the preacher tells us.”

Loki...

“Look at her. My baby looks like she’s asleep but she can’t wake up.” His voice cracked, watery, and he looked directly at me, his blue eyes accusing. “If there’s a Devil, he’s a trickster like that Loki,” he said. I felt strangely self-conscious and afraid, even though this man was obviously so simple. Then he grew somber. “Bestemor said Loki was so evil that the gods bound him underground in this gray place where twin snakes drip venom on his face until the end of the world. Until the final battle of the gods of Ragnarok.”

I remembered the myth from the University. My geology professor read myths about geological phenomena from the old Norse bible, the Poetic Edda. Something about a woman – His lover? His sister? – catching the venom in a cup until it filled. While she emptied the cup, venom dripped on his face. His cries of agony caused earthquakes. Or so the story went. Those lilting, haunting rhymes of ancient bards were then triggered by Rachel’s father...By the River fettered Fenrir will lie,‘till the twilight of the Gods draws nigh; and nigh to him, but thou hush thee now, thou breeder of ill wilt be bound...

“Sounds like he’s under control to me,” I said, checking my watch. I slid open the puppet curtain to leave, glad to be leaving this warm room swimming with religious doubt and grief.

“Never been a literal man,” he continued, “not even with the Bible. That’s my wife’s doing, that preacher.” Mr. Roberts paused. “I think Loki’s trying to break free. If he hasn’t already.”

He hadn’t.

*****

After that week, Rachel stabilized. We removed the bolt from her skull and moved her to Room 303 in the pediatric section of that ICU floor – a real room with a door. “Miracles” happened in those soapy-smelling halls. The comatose awakened. The lame walked. Hope returned. But there was no guarantee. That day, her mother took me aside in the hall and asked me hesitantly, “What are her chances? I mean, with the brain damage.” Her father looked on, cynical and silent.

“Well,” I said, “in a year or so she will be more or less the same girl.” I lied. The human mind is really too variable. But we can’t let them know when we don’t know the future. They would lose faith in us. When God has stopped talking to them, we are still there with our knowledge, even if it’s incomplete.

Their tired, grief-worn faces lit up. Nancy, one of the ICU nurses, most likely told them Rachel would never awaken, and if she did she would stay a “vegetable” the rest of her life. We often rotate Nancy out of the ward because of patient family complaints, even if what she says is true. “Thank you,” the mother said. She started to cry again, this time with tears of hope and relief. “Thank you.”

I shook her pliable hand – I don’t trust a weak handshake; it infers a weak mind – and the clammy but firm one of her husband. I’m not lying technically. It isn’t completely impossible, I assured myself. The human brain is a mysterious organ. Take the function of dream. The night before, I dreamt of Maggie and her empty casket. They never found her body. I found it interesting how the image of that hollow casket broke into my REM sleep, especially on rainy nights.

Brain surgery we can do. Dream surgery we can’t.

I excused myself and left them in the hall as I rushed, chart in hand, to my next patient. Actually, I don’t rush well. I’m a taliped: I have a clubfoot. I limp when I walk, but I’ve mastered it somewhat over the years. I also have a little scoliosis that tips my shoulder forward, but I’ve managed with that, as well. And I haven’t sympathy for anyone who can’t.

Only three halls comprised the third ICU floor of UC Davis Med Center. I knew them well. My next patient rested three doors down, a woman in her 50s who had suffered a stroke. I doubted she would ever fully recover her sight or the use of her right hand. I scanned the chart before entering, but halted suddenly.

The room was dark. A figure in the bed shifted its head slightly and sighed, a low, hushed groan. "Good morning, I'm Dr. Samuel," he said.

I flipped the light switch. Nothing. I double-checked the number on the open door and squinted into the darkness. "Well, you're not quite Mrs. Carroll, are you?" I joked.

"Come in, Dr. Samuel," he replied quietly. "This is the right room."

Confused and compelled by the darkness, I entered, navigating the bed by the light from the hallway. "Seems we have a mix up with the records."

Darkness shuttered his face. The light from the hall reached only as far as the foot of the bed in this windowless room. From what I could see, he seemed an unusually tall man. He sighed again. "A little chaos is always welcome...as are you," he said, his voice low and garbled like water retreating into a drain.

"Thank you," I said. Oh, he's a character, I thought, turning over the chart and readying my pen. "Now, can I get your name so we can straighten this out?"

Above and to my left, the television flickered on, throwing bluish gray light across the bed and the face of my patient. Shadowy images flapped silently on the screen and more faintly, like wind-drawn clouds, across my patient's elderly, distinguished face. A nature show about birds, apparently. Crows? Ravens? They moved in uneven oily streaks across a gray sky.

My patient wasn't watching the television, but stared steadily at me with frosty blue eyes beneath soft milk-white hair. Those eyes telegraphed the chronic pain of the terminally ill, the lids wrinkled tightly in an unending throe. Into each nostril was firmly implanted a forked nasogastric – NG – tube filled with pearly fluid.

He said nothing. And then, I wasn't certain he'd spoken at all.

"Dr. Samuel, call 213. Dr. Samuel, 213."

"Excuse me a moment," I said, leaving to respond to the page.

I stepped out of the room and into the well-lit hall. Nurse Nancy strode down the hall past me. She stopped, her narrow eyes scanning me. "Dr. Samuel," she asked teasingly, "who were you talking to in there?"

"I didn't get his name. Send maintenance to fix the light." I stepped past her, thinking nothing of it. The teasing gleam in her eyes turned sharp and discriminating as she looked into the room.

It was empty. And the light was on.

*****

Being a good student of Western science, I let my rational mind temporarily catalogue the event as a daydream. In a trauma center, a neurosurgeon is on call 24 hours a day, 7 days a week. I think my daydreaming was due to exhaustion. I rarely vacation, and when I do I go to the desert where it's quiet and empty. Dry. The beauty of the desert is unchanging, unlike most things. It's something I can trust, something I will never lose...

Responding to the page, I entered the waiting room for the ICU floor. There stood Mr. and Mrs. Roberts with an attorney. "We hear you have Rachel on large doses of Thorazine," Mrs. Roberts said angrily. "How is our Rachel to come out of the coma under that much Thorazine?" Mr. Roberts was silent as usual, but this time he was grim and distant.

"I understand your concern," I told them, "but without the Thorazine, she risks having another epileptic seizure, which might induce a stroke. We'll definitely risk losing her then." I silently cursed them for questioning me. It's not uncommon for families who feel powerless to attempt to influence the treatment plan using legal brawn.

The parents looked to one another, then the attorney, who shook his head. "The Roberts request you reduce the Thorazine dosage, Dr. Samuel. They've weighed their options. It's their right."

I considered the odds for her survival. To my surprise, my knees started shaking, my stomach acidic. "I'll look into it," I said weakly. "I have to speak with the Chief of Staff. And there are papers to sign."

"We'll be waiting," the attorney said.

Rachel's room was at the end of the pediatric hall. She was now lying peacefully in her bed. Much of her blonde hair had been shaved away for surgery and her face was bruised. After the surgery, she had suffered another epileptic fit. An NG tube fed her stomach through her nose and an I.V. in her right arm contained the Thorazine drip, a crucial ingredient to keeping her alive. The drug limited her brain activity and therefore the epilepsy. Doctors once used it to treat schizophrenia, as it inhibited hallucinations. Reducing the dosage would most seriously endanger her life.

Then again, she might wake up, too.

As my foot crossed the threshold to her room, icy darkness washed against my leg. For the briefest moment, I waded into the nightmarish river that swept away Maggie's body, the muddy waves slapping my face as I gasped for air. The flood water surged into my mouth, my nose, and soon my lungs as I flailed for the shore. The storm rained frosty nails on my head. I could barely open my eyes...

I found myself lying on my back, windless, watching the black birds flutter in their gaggle or murder across the flickering television screen. The hard tiles bit into the back of my skull, shoulder blades and tail bone. One flailing hand found the steel carriage. Above me hung the NG bag swollen with luminous, pearly fluid. One large dewy drop ran off the bag, about to fall on my forehead like a clear drop of rain.

I sat up quickly before the fluid hit my skin. I listened for a splash, but it never reached the floor. The distinguished old giant rested in his bed as before, the door beyond closed. He regarded me urgently, as he still seemed to be suffering.

"I need your help," he said. "I've been in pain for far too long."

"Who are you?" I asked, standing and backing away. I'm not a large person. In fact, I'm a bit short, maybe 5'5". I wear lifts, which raise my height an inch. But even though my patient hardly looked able to cause me harm, he still frightened me.

"Look at my tubing," he demanded. "I want you to remove it."

"I can't do that," I spat, irritated at him as if he were a normal patient, yet my heart galloped with horror. "And I can't help you unless you tell me your name." I wondered if I was dreaming, but I've never had dreams like this. Perhaps I was lying in one of the beds of the trauma center downstairs, an oxygen mask over my face and fingers on my pulse, or farther down in psychiatric... I was somewhere; anywhere but here.

He violently threw back his head in a spasm of agony, his lips curling from long, sharp white teeth. "Please," he whispered.

Reluctantly, I moved forward and withdrew the penlight from my white coat pocket. The light shook in my hand as I trained it on my patient's face. For all his appearance, there was something vaguely inhuman about him. Correction: something extra-human. As I drew closer I noted the unusual girth of his jaw and the irregular shape of his iris. His pupils dilated, oval-shaped, and he regarded me cruelly. His skin smelled faintly of ash and salt peter.

The NG tube forked, parting for his septum as it plunged into his throat, but it did not remain tubing. Rather, it solidified as it entered, blood-stained and scaly, ivory prongs swelling tightly against his large nostrils. Even the capillaries closest to the surface of his nose had swollen and broken against his skin in strawberry starbursts.

I then examined the carriage and unlabeled NG bag. Pearly. Glistening. "Who administered this?" I asked, lulled into this weird reality by the ordinary feeling of cool plastic under my fingers.

He closed his eyes and exhaled softly. "My family," he replied.

"Look," I told him, "I can't help you unless you tell me who your doctor is. This NG is feeding you because you can't eat. If I remove it, you'll die of starvation."

"I have suffered long enough!" he growled, his voice a trembling chorus. Cold wind blasted my back. I turned, thinking the door had opened, but it remained swallowed in shadow. "Only a god can help me," he said more calmly, regaining his composure. "And you are a god. A god of this age."

Perhaps it was true. But at that moment that was not how I felt and I certainly wasn't going to advise him of it. I edged away from him again and looked for the door, now outlined by the hallway light shining through the cracks.

"You'll soon acknowledge the power you have over life and death," he said. "And suffer the guilt true gods bear with it. When you do, you'll help me."

I quickly found the door and opened it, warm golden lights spilling on my legs. As I walked into the hall I heard him again say, "You'll know. You'll feel." His voice rumbled like running water.

Footsteps clapped down the hall. The chief neurosurgeon, Greg Armstrong, arrived smiling. "Tim," he said, "good work with the Roberts girl."

My body slumped, suddenly sluggish. I checked my watch and, to my astonishment, some nine hours had passed since I spoke with the Roberts family and their attorney.

"You must have chosen the correct dosage," he said as I listened through a haze of exhaustion. "She's awake."

I thought I'd just been to Rachel's room, but my nightmare occurred on the opposite side of that ICU floor. When I arrived, the crowded room tittered with happy relatives and friends who had previously only held vigil. Now the dead awoke and even their pastor joined them to witness the miracle.

"It was G-g-god, Mommy," Rachel said, her speech slightly slurred, as her mother wiped her soft, pink cheeks with a damp wash cloth. "She saved me and brought me into a big cave where it was foggy and gray and cold."

It's quite normal for those who come out of coma from traumatic brain injury to attribute their waking to the hand of God. They often become hyper-religious and evangelical for some time thereafter. But clearly whatever Rachel was evangelizing did not sit well with the Roberts' pastor, who grinned through coffee-stained teeth.

"Dear child," the pastor said, taking her hand, "God is a man. Our Father. You mean 'he' not 'she'."

"No, Pastor W-williams," she protested. She pulled her hand away, shaking her head. This level of agitation was normal. "It was a really scary lady." Rachel clawed at one side of her face with her freshly clipped fingernails. "Her face peeled and smelled bad, like the r-rabbit we found in the ditch one day. She said her name was Hel, and her daddy is L-l-loki." Almost vacant from her injured intelligence, the little girl's eyes wandered earnestly from relative to relative.

Just as Pastor Williams began to correct that “hell” was a place and not a person, Mr. Robert's eyes widened, ringed with fear, and his cheeks blanched. He pulled Rachel close, desperately whispering lilting words – undoubtedly from his bestemor – in her ear. Her mother, Pastor Williams, and the rest looked at one another uneasily.

"Hello, Rachel," I said, entering the room cautiously. With each step I felt slightly more sane, more grounded in the real world, with so many mortals around me. The hem of my white coat certainly felt holier. "How are you feeling?"

The bruises had mostly healed, but ghostly yellow splotches clung to her temples. She focused her shining eyes on my face solemnly. "Dr. Samuel," she said unsteadily, "Hel sends you a message."

For my life and my sanity, I could no longer dismiss quasi-religious missives. Images of the large old man and the ravens flickered in my memory like that television screen as I crouched by her bedside. Listening intently. My heart beating savagely...

Rachel leaned toward me, her breath sour with thrush but her voice oddly and infinitely steadier. "Hel says, 'It is better for you to hang yourself from the tree than to release my father from his sentence.'"

*****

I went home.

Before I left, I instructed the staff to watch Rachel carefully for signs of epileptic activity. I told the nursing staff to page me should there be the slightest change in her condition. I asked Greg to reassign my trauma center call duty and I took a cab to my house, my nerves too worn to drive.

The cab dropped me off at my lovely, two-story home, not far away. A local, award-winning architect designed and built it three years ago. Generous skylights and vaulted ceilings covered the dwelling; I rejected the terrarium and tall trees she'd suggested. Geologists claim Sacramento lies in a floodplain that floods every two hundred years, making insurance for my home almost prohibitive. I live there alone. I've little social life, by necessity and choice. After Maggie's death, I was shunned, so I made solitude my practice for life.

I wearily ambled up the concrete pathway to the oak door with the stained glass inlay of a curling rose and unlocked it.

I opened the door and walked into a river.

Huge winds beat colossal trees and scolded the earth with vicious howls. Fingers of rushing air probed my mouth, nose, and ears as I screamed. "Maggie! Maggie!"

I couldn't see her. Then: "Timmy!" Faint but clearly her voice. "Timmy!"

I ran gawkishly toward her voice, my tennis shoes alternately sliding and sticking in the mud. Sheets of water unfurled from the river's edge as the depths rose from the rain. Angered that I would dare to press onward as quickly as they drove, the winds turned against me. The cold and the wet punished me almost as harshly as my panic and guilt as I ran down the river's embankment, blinking against the wetness in my eyes.

And then I saw her, just her blonde hair and frail hands. She clutched a jagged tree root for dear life, waist high in the torrent. She was so small the river could carry her away like a paper boat and fold her body under one of its rippling arms. I cried out to her again as I straddled the root, digging my fingers and heels into the flaking bark. "Hold on!"

Her wiry little fingers gripped my outstretched hand and the sleeve of my windbreaker as I grasped her wrist. The last time I had held that wrist, I pulled her close and told her I didn't care if we were cousins. I didn't care what the adults said. When we were old enough, we would get married. She kissed me on the cheek with those raspberry lips and smiled at me with dandelion-green eyes. If I knew love, it was then in the blue veins under the peach skin of her wrist and in the gentle ping of her giggle as it echoed along the river before the rains began.

All I knew now was terror. Her wrist slick with mud and river water, it slipped from my hand. Before she could scream, the current pulled her under and away. As I ran downstream, frantically scanning the turbid, rushing water for flecks of peach and blonde, I wished we hadn't run away. I wished we hadn't fought. I wished...

A flash of lightning. Then, thunder exploded in the heavens and a tremendous groan creaked above. Blindly I fled the falling tree's crushing limbs as they crashed toward me in a swell of leafy whispers. My weaker ankle twisted painfully beneath me and mud smashed against my neck and cheek as I slid over the edge into the water.

Cold. Weightless. Dream-like. What seemed so terrifying, so threatening, now soothed me. I relaxed, bits of leaf and debris scraping my skin, as my body settled into the freezing dark. I inhaled.

Not air. Death...

I opened my eyes. No longer floating, I awoke on a stretcher in an ambulance, vomiting leaves and water and dirt.

And pain.

I opened my eyes. No longer on a stretcher, I twisted in the sheets of my bed, crying out hoarsely. My throat scratchy, my skin hot. I'm over-worked. I'm exhausted. I'm hallucinating...

...but thou hush thee now, thou breeder of ill wilt be bound...

For ten years, I had little to fear. I knew the human body, and now the human brain. I knew all there was to know and I should not have been afraid.

But I was.

And, buried somewhere in my clothes, my cell was ringing.

*****

Mrs. Roberts flung herself at me as I entered the waiting room. Grief-stricken spittle flew from cracked lips as she beat my chest with her fists. "Why did you reduce the dosage?" she shrieked. "You knew this would happen! You knew!"

Friends and family mourned loudly throughout the waiting room. Mr. Roberts pulled her away from me and Dr. Armstrong stepped between us, exuding expensive aftershave and hospital authority. In his late 40s, he was a formidable surgeon, but a better administrator. "We're deeply sorry for your loss, Mrs. Roberts. But you were informed of the risks," he told her firmly but gently, "and you signed the forms. You chose to take those risks."

"But you knew what would happen!" she cried. "You shouldn't have let us do it!" She broke down, repeating the last bit over and over.

Her father's grieving body uncurled from its silence, fists clenched. His twisted face raised heavenward as his wail echoed in the death-stained, godless halls...

"LOKI!"

I excused myself ineptly, and, as soon as I broke through the door to the ICU halls, I ran. Like that frightened little boy, I ran stumbling down the halls of the ward, anguish breaking through my skin in a sweat. I knew Rachel had suffered an atonic seizure, a lightning strike to her injured synapses that generalized and short-circuited her brainstem. I ran to her room and knelt by her now empty bed. I placed my forehead against the mattress edge and cried in long heaving sobs, for the first time at all since Maggie's funeral.

The room grew dark around me. The television screen flickered, the ravens swarming over the neon grains. I raised my head and found my patient in the bed beside me. He cried out in agony, and the ground shifted beneath me.

"Cut the serpent's head!" he gasped as the last throe passed. "Cut it! It will end everything. It will bring Ragnarok," he intimated. "Save us both the pain."

"I'm no god," I sobbed. "I am no fucking god!"

"Oh, but you are," he growled luridly. "Your actions saved that girl and then killed her. And you lied to them. You tricked them. You're a trickster god...like me. The only one fit to cut the serpent's head!"

"I haven't power over life and death!" I cried, choking on the tears of self-condemnation in my throat. My face close to his, I saw deep into his pupils – snowy caves of malice and trickery. Then, the tears subsiding to hot anger, I remembered Rachel's words. "I've been warned about you," I told him. "Warned well."

"By a brain-damaged little girl," he said coldly, "babbling about God and hell."

I backed down, doubting. I was arguing with hallucination. I knew what this meant: I was insane. I must have been. My practice was over. My life...was over. Overwhelmed with this realization, I wanted to die. My body was never worth living in since Maggie died, but my mind was – until now.

"A brain-damaged little girl," he said, his voice drawling and spiteful, just like the sheriff who cursed me at Maggie's funeral, "worth no more than that blonde-haired, white trash little cunt you let die in that river." He licked his lips, then said cunningly, "You never really loved her, did you?"

The television screen exploded and glass rained on my back in a bedlam storm of blackened wings and otherworldly shrieks. Howling with me-hate, god-hate, all-hate, I grasped the tubing with both hands and pulled madly with all my strength. The giant roared triumphantly, the caitiff cry of the trickster. The skin of his nostrils tore, broken and bloodied, and the ivory spikes emerged venous, scaled and slithering...

Inhuman all were they, crying into the night. And inhuman all are we, struggling in the twilight. The twin-headed serpent bore into my skull, driving deep down, down, down once called the alimentary canal to my lungs and bowels. It drips its poison in pearly, glistening drops as I writhe in the gray, bound far beneath the ground. I see above me a beautiful young woman with raspberry lips and dandelion-green eyes. With her wiry fingers she removes a cup (or is it an NG bag?) and I scream. She says, "Loki," and I scream.

For here I am and here I will stay. Someone must suffer, they say. Until Fenrir the Wolf swallows the Sun and kills the light of day. Only then the gods each other they will slay. The gods of Ragnarok.

Until the gods die, I writhe here in the gray.

In pain.

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