Marc Joan

Packed Lunch

 

 

          I find that shutting my eyes helps. It’s not a head-in-the-sand policy so much as a valid reaction to disgusting stimuli. It is, in the final analysis, anti-emetic. So, when I feel my stomach clenching and my sphincters opening, then I close my eyes, and think myself into a special place, a clean place, a gleaming, sterile place.

 

          And in the days when I had patients, believe it or not, it actually gave them additional confidence in the consultation process. They interpreted my closed eyes as evidence of deep concentration; the outward sign of a medical expert who is utterly focussed on the well-being of his patients. In fact, I was utterly intent on not looking at them more than was absolutely necessary. Disgusting, stinking representatives of a pestilential humanity!

 

          These days, of course, I don’t have patients, as such; thank God. But I still need to shut out grotesque reality from time to time. For example, today, having been confronted by the cadaver of nightmares, a weeping, seeping well of pathogens and foul gases – what else could I do, on returning to my office, but close my eyes and find my gleaming sanctuary? It was an act of self-preservation. I had to escape, to find that imagined world of white surfaces and polished chrome, glistening with antiseptic. How could I have known that the corpse would follow me to my special place?

 

          You see, I’ve always been sensitive to the perils of transmissible disease. Paradoxically, that’s why I went into medicine. Paradoxically, I say, because, in my professional opinion, patients themselves are a public health threat, by their very nature. Filthy vectors of foul diseases, proudly presenting their flabby, crusty flesh to the medical profession, as though there were something special about their disorders! Shamelessly demanding that we poke and prod at their foul, oozing bodies, peer into their orifices and palpate their organs! And the smell of them! 

 

          Yes, the smell...I came to know every stink emitted by the human animal in its various afflictions -- the acid tangs of high fever, the mercaptenes of rectal fistulae, the ammonia of incontinence. But far worse than these malodorous vapours was the knowledge of the unseen, undetected emissions, the menagery of micro-organisms perpetually discharged by each patient, by each seething, human-shaped mass of pneumococci, staphylococci, retroviruses, bacteriophages, hookworms and protozoa. Even the thought of this permanent, invisible barrage was unnerving; but the practice of sitting in a closeted, claustrophobic office, knowing that microscopic pathogens, shed by the patient in front of me, and by all others who have passed through the office that morning, are floating around in the air, gently settling on my clothes, my hair, my skin, the lining of my airways.....eugh!

 

          Yes, patients are not only disgusting, but also dangerous. As a doctor, I cannot recommend them.

 

          That’s why I went into pathology, of course. I’d rather determine how people died than pollute myself trying to keep them alive. Not that the dead are any cleaner than the living; it’s just that I can better control the variables. Corpses don’t exhale; they don’t sneeze; they don’t blow their noses and then drop the tissue on the floor of my office and then pick it up and then put their hands on the edge of my desk to support themselves as they drag their excess weight out of my chair. Corpses don’t shake hands with me or ask for help with their catheters. Corpses are controllable, usually.

 

          You see, when a body is on the bench, I know it will stay there until I determine that it should be removed; and in the meantime, I know I can fully separate myself from the chilled flesh and its foetid emissions. In fact, I am an expert at it. I have a rigorous, carefully designed protocol. Listen: as soon as I go into the autopsy suite, I stop in the anteroom, and put on double surgical gloves, plastic overshoes, full-length disposable gown, plastic apron, cap, goggles and mask. Then I open the air-tight door and enter the autopsy room proper. I approach the body, which is waiting for me on the gleaming, sterile steel bench, under clean, bright lights. The bench has its own airflow system, a linear flow which is pulled across the body and down to the sterilising filters on the sides of the bench, so that any stray pathogens that may be liberated by my dissection are sucked away and neutralised. I always check that this system is working by holding a small piece of tissue in front of the vent, so that it is pulled against the grill by the air flow. And I always pause at this stage, checking once more that I am fully shielded, from head to toe. This is my favourite part of the procedure: the certain knowledge that I am invulnerable, that nothing the corpse might release can affect me in any way. Death, where is thy sting?

 

          Anyway, after I have done what needs to be done with the cadaver, and after any tissue samples have been removed and given to the assistant to store in the autopsy fridge for further analysis, I walk away from the bench, to the ‘dirty change’ area just inside the exit door. Just in front of this zone, it is sticky underfoot; I feel the tackiness pulling at my plastic overshoes. This is reassuring, because the adhesive surface, placed at the threshold, should capture anything that may have inadvertently stuck to my footwear. I shuffle from side to side on this mat, giving it multiple opportunities to soak up any contamination on my overshoe soles.

 

          Then I enter the dirty change area, and very carefully and cautiously remove my protective layers. First the apron, then the overshoes; then the outer gloves; all go in the bin. Then the gown, mask and cap, in that order; and finally the inner gloves. A large step over to the basin, trying not to breathe deeply, and a thorough, thorough handwash using the elbow-operated taps. Then I open the exit door from the autopsy room itself, exulting in the hiss as air rushes in to equalise the pressure between the anteroom and the inner sanctum. This assures me that no pathogens can follow me outside the autopsy room, for the flow of air is in the opposite direction. The door shuts behind me with a satisfying thock, as the seal engages around the raised rubber jamb.

 

          I used to be happy with all that. I felt safe; I felt clean. I could leave work without the sensation that my skin was crawling with ectoparasites. But then it struck me that a chain is only as strong as its weakest link. Because all my highly effective contamination avoidance procedures are for naught if I then mingle with colleagues who are less rigorous in their habits.

 

          I remember clearly the disgusting event that served to irreversibly tip the balance. The hospital CEO had called a meeting of specialty heads; naturally I was there in my capacity as Head of Pathology. We were in a boardroom of inadequate size, somewhat cramped and poorly ventilated. I felt that this was unhygienic, but held my peace; after all, we were all doctors. But then a late attendee, a new employee, came in, and she was still wearing her white coat! The same coat that she had been wearing to do her rounds, to see and touch innumerable patients with their infinite varieties of bacillus, with their cohorts of MRSA and adenoviruses! I shut my eyes tight; I refused to look at her; I put out one hand, palm forward, to emphatically reject this egregious example of bad practice. Eventually she was persuaded to remove her filthy garment from the room, and I could open my eyes again and participate in the meeting. However, this made me realise how incautious I had been up to that point. All persons are hazardous; each medic, a potential Typhoid Mary.

 

          And so, to this day I abjure the staff lift, with its germ-ridden buttons greased by the fingers of a hundred strangers; instead, I walk up the four flights of stairs to the Pathology wing, pushing open the fire door at the top of the stairs with my foot, so as to avoid touching the door handle. In addition, I have stopped eating in the hospital canteen, which I suspect is a hotbed of multidrug-resistant cocci. Rather, every day, I pack my lunch hygienically in a boil-washed snapfit box. Each item in its own individual freezer bag, in the tight-shut box, stored in the little fridge that I have bought for the purpose and positioned next to my desk, in my office, in the Pathology suite. Perfect.

 

          And it was a great comfort to know that I had these precautions in place on a day like today, when the nightmare cadaver came to my lab. Not just another myocardial infarction, but a giant African immigrant importing some kind of haemorrhagic virus from hell. Congealed blood in the eyes, bloody mucus around the nares, dried brown froth around the mouth, buttocks encrusted with flaking black excrement.  And a run-away bacterial infection that was now causing rapid necrosis of the extremities. The body was falling apart in front of me. Literally falling apart -- some gentle manipulation and a massive index finger came off.  I proffered the oozing digit to my assistant with instructions to chill it for later examination and bacterial culture. She just looked at the finger obtusely, while I waved it at her, increasingly annoyed.

 

          “How do I chill it?” she eventually asked. She was new; I couldn’t see behind her mask, but I got the impression that her mouth was hanging slackly open. And all the time that her micro-brain was processing the situation, the giant finger, like a blackened gherkin dipped in mustard, was dripping, dripping; there was now yellowish-green pus on my glove. I may have shouted at her; in fact, I did.

 

          “The autopsy fridge, you idiot! Bag the finger and put it in the pathology box, in the fridge, with the other specimens!”          

 

          Sorry, but isn’t it obvious? Why do I always get the stupid ones? Anyway, she huffily left the autopsy suite without a word of apology. Probably gone to cry on somebody’s shoulder, I thought; good riddance.

 

          So I got on with the autopsy without her. It was a hideous procedure; most of the man’s insides seemed to have turned to liquid. I washed my hands for fifteen minutes solid after that ordeal, but it wasn’t enough. I still felt contaminated. Back in my office, I sat at the desk, shuddering, eyes shut, thinking myself into my special, clean place, where death is tidy and disease uncommunicable. A calm, fresh, sweet-smelling place, wiped clean by a dew of Dettol each new day.

 

          But this time, my special place wasn’t enough to calm my gut. It was as though something of the corpse had followed me. I felt as though the bacteria spewed from the cadaver’s organs were coating my teeth and tongue, crawling down my throat.

 

          Stupid, of course; I knew it was only my imagination. I breathed in through my nostrils, and out through my mouth, slowly, blocking the upwelling nausea by force of will. The thing to do was to give my brain a stronger, pleasanter taste, to drown out the imaginary flavours of putrefaction. Keeping my eyes closed, I reached to my left and felt for the door of my fridge. My fingers recognised the handle; gentle pressure and it opened. Cold, clean air flowed over my hand. I groped inside for my lunch box, and took it out. When you are a tidy person with a strict routine, you can find things without looking, because you know where they’ll be. 

 

          Still thinking myself into a state of heavenly uncontamination, blocking out the foulness of London hospitals with tight-squeezed eyelids, I found the snap catches on the box with my fingers. I opened them, blind, and explored the contents with my fingers.  Sandwiches: two sets, each in their individual bag. I didn’t need to open my eyes to know that one set was cheese and pickle, the other ham and mustard. And then, by touch, I found the unmistakable shape of my special treat, some French sausage, bought from the delicatessen yesterday. I had had an uneasy feeling that I had forgotten it, but obviously not. Good. This will take away the taste of death, if anything will, I thought. I decided not to open my eyes until the soft, pungent meat had weaved its spell of pepper and garlic around my tongue.

 

          I removed the sausage from its bag, quickly, and bit into it.

 

 

 

Marc Joan spent the early part of his life in Asia and Europe, and the early part of his career in biomedical research. He draws on this and other experience for his fiction, which is currently restricted to the more economical formats (short stories and novellas). Marc’s stories have been published in Hypnos, Madcap Review, Danse Macabre, The Apeiron Review, Bohemyth, STORGY and Smokelong Quarterly. Currently, he lives in England with his family.