The Refugee

Philip Russell

I’ve given up sleep now, like everyone else, traded blankets for books and pillows for papers—flow charts and flash cards, diagrams and drawings. Through my window the moon is setting; it’s past two in the morning but still I’m cramming, trying to memorize the Krebs Cycle now, the biochemistry of human energy. That sounds interesting, even metaphysical, but actually it isn’t. It’s just phosphates. ADP. ATP. An hour ago it was clotting factors, and an hour from now it will be something else, if I can stay awake—bacteriology perhaps, or maybe some pharmacology. But it’s not just tomorrow’s comps.

I can’t stand my dreams anymore. Too many times Daniel has come back, the boy I knew like a brother, the man I didn’t know at all. The dreams have no boundaries. Sometimes I glimpse the person he will never become now, and sometimes I dream of Daniel as he was, long before I ever knew him. I see him at five or six, sneaking into his father’s bedroom. I watch him open a bureau drawer, take out a belt, run the dark leather through his hands. He looks puzzled, as if he were trying to understand. The belt is as wide as his fingers and supple as a snake, although the brass buckle is already pitted with greenish corrosion. He raises the leather to his nose and inhales deeply. His eyes are closed, and his forehead is as wrinkled as an old man’s.

I’m tired of this. Exhausted really, bone weary, thoroughly sick of everything—anatomy and histology and microbiology, the life cycles of pathogens and the natural history of disease. Outside my window, I can smell the late spring, the cool moonlit night. A gentle wind rustles perfectly formed pale green leaves against the screen. I push my papers aside, and I can’t get Daniel out of my head, and as usual everything else feels pointless. Stupid.

What I’ll never understand is why he needed to kill himself. Came back to Connecticut on the cusp of salvation only to follow his father’s path, to hang himself in his childhood bedroom. The room we shared in high school, still full of the shelves we built, bricks and boards collected from the dump at Brooksvale Park, stocked with books and bones and the music we listened to. A place of ideas and sharing, Richard and Daniel, one mind touching another. Emerson and Thoreau. Self Reliance. Walden Pond. Where once I thought we could create our own selves. Whoso would be a man must be a nonconformist.

His sister found him. Spinning at the end of whatever it was—a rope, a wire, his father’s belt. I don’t know. There are some questions I can never ask. In my dreams, I’ve seen his toes trying to reach the chair just kicked away, his fingers trying to get under the thing at his neck, that dark line twisting into his flesh, cutting off his air. Black tongue swollen and distended. Pants full of urine and feces and semen. I don’t need to ever dream the details again. In most of my dreams, Daniel uses his father’s belt.

His father committed suicide when Daniel and Sarah were still in grammar school. Hanged himself also, showing his son the way. I will make the focus of my graduation thesis depression and despair. Alcoholism. Suicide. There is a responsibility to the people we haven’t become yet.

In the daytime, hustling through the clinics, there is no time to think. There’s too much to do and you’re always on the defensive, open to challenges from anyone, everyone—fifth and sixth year students and the residents and staff physicians and attendings. They think it’s their job; they consider it teaching. There’s too much to remember. All the different signs and symptoms, the tests and normal values, the drugs and the glittering machines. And although it’s true that a lot of this stuff works, unfortunately it depends on what you’re starting with.

It was so raw in Pensacola, detox units primitive everywhere, physical and pharmacological restraints, and the beds filled with people screaming at horrors only they could see. We call them delirium tremens, but actually, the hallucinations are their own history; the snakes and rats they can’t throw off are bits of their own past sucking at them like leeches. Memory crawling under closed doors, desire slithering out of every closet and bureau, the patients sweating behind their rope nets. It might have been Victorian London, the hospital at Bedlam. It made me want to give up drinking myself.

Still, Daniel came through all that. And when he returned last winter, I was full of hope—I thought he was saved. I thought I had saved him.

Winter is over now, and Daniel is gone. Although everything else just continues as usual, as if nothing of consequence ever happened. Daniel has journeyed from life to death, and I’m still sitting in the same chair I was in when he telephoned me last January. Three in the morning the night before our mid-year exams, Daniel calling to report he was about to commit suicide. The first time he’d called in years. He talked about childhood, and he talked about his father—fishing with him on a river somewhere, the dark green canoe and the bright shiny lures. How once when he was five or six and terrified after watching a horror movie, his father came up to tuck him into bed and brought him a stuffed animal even though he was too old for stuffed animals. But he also talked about all the dinners his father missed, and the fighting that woke him at night. The birthdays and vacations that never happened. He talked in a rush, and he made no sense, and when he hung up, I tried to call back, but he didn’t answer. So I called the Pensacola police, and they gave me a hotline number for their local crisis group, and the dispatcher there said she’d send someone out. Then, I called his family in Connecticut, but I couldn’t wake anyone at Sarah’s house, even though I let the telephone ring and ring—Sarah and her mother were always luxurious sleepers, jealous and guarded.

I packed a bag and called the airlines and wrote a note to the dean explaining why I was going to miss my mid-years, our most important exams except for the two-year comps, and then I was driving south through the winter night to Logan International, still two hours away. It snowed lightly the whole way down, and the roads were greasy and slow.

Over the last few years, Daniel and I had grown as distant as people can get, and it wasn’t simply geography, the thousand miles of American east coast. It wasn’t the bootcamp mentality of medical school either, the way every minute of my life was spoken for, planned out, co-opted by someone else. No. It was more like Daniel was evaporating somehow, slowly disappearing, like he was burrowing deeper and deeper into a place where you couldn’t really follow him. I think he was fundamentally embarrassed, that his failures had raised a wall between us. And I think he was scared; I think now he must have been aware every minute of the legacy from his father.

Daniel never finished his first year of college. He stopped going to classes, and he didn’t show up for any of his finals—in fact, he was still holed up in his dorm room after the semester closed and everyone else left for the summer. He’d spent that whole year drinking, doing drugs, building these elegant bookcases. I’d seen some early ones. They were beautiful things, tall and graceful, all bird’s eye maple with mahogany accents. I wonder where they are now. I was a senior in high school then, and we spent that whole visit staying drunk, even though drinking was already starting to frighten me, the way you woke up sick the next morning and despite all the nausea and your brain split open, still, all you could think about was the next drink. Daniel taught me about the hair of the dog. But later it seemed he’d just wanted a drinking buddy, any old drinking buddy, good buddy. That he’d forgotten me as a friend. And he never came north again, except that last time. Maybe he realized returning would close the circle too tightly. Year passed into year.

Now, I think Daniel was trying to achieve perfect drunkenness, and I guess you could say he made that his life’s work. I think he wanted to be drunk forever, permanently stopped at that moment on the curve when everything seemed ideal, that space between the nagging worry of alcoholism and absolute dumb narcosis.

I called his place again when I landed in Pensacola, but there still wasn’t any answer, and it occurred to me the number I had might be out of date, that the address could be wrong, as well, and I considered calling Sarah then, but it seemed better to have some answers first, so I called information instead, confirmed the number and address, then I got a cab and drove out to his place.

His door was locked, and I knocked loudly and for a long time, but there was no response except from a neighbor. I went around the unit looking in the windows until I saw Daniel lying on the floor in the corner of the living room, curled up on the rug like a dog before a fireplace. But this was Florida;, there was no fireplace, just air conditioning and wall-to-wall carpeting and, in Daniel’s case, wall-to-wall vomit and empty whiskey bottles and white plastic pill bottles and ashtrays spilling cigarette butts. I banged on the window, but there wasn’t any response, so I cut the screen with my jackknife and forced the window up, and I climbed into his house and went over to him.

The vomit was a good sign. Daniel was still breathing, and his pulse was steady, although not very strong. I tried to shake him into consciousness, calling his name, but I couldn’t rouse him. I made the neighbor call an ambulance, and I washed Daniel’s face with cold water, then I collected the pill bottles and sat down next to him to wait for the EMTs. I thought about calling Sarah and her mother, but I decided to wait until I knew something.

I spent the rest of that morning waiting on the wrong side of doors in the Pensacola Hospital, first outside the ER as they pumped Daniel’s stomach and gave him narcotic antagonists, then at the nurse’s station in the ICU while they put in IVs and hooked him up to different monitors. I spent a lot of time filling out forms and signing papers, making financial arrangements, offering myself as a guarantor. I gave Daniel’s history to several doctors. Finally, they sent me home, suggesting I not return until tomorrow.

I fell asleep in the cab on the way back, and when I got to Daniel’s condominium complex, I was disoriented, and I couldn’t remember his number. The driver must have thought I was some nodding junkie, because I couldn’t find Daniel’s unit, but the places were all identical, white concrete slabs set down on artificial grass like giant mausoleums. I wondered how he ever found his way home when he was drunk. Finally, I identified his place as the one with the cut screen.

I called Sarah, a number I knew by heart, and this time she answered immediately, and when I told her everything that had happened, she insisted on coming straight down. I said she didn’t have to, I told her, “There’s nothing you can do here. He’s in the ICU now. Nobody can see him. They kicked me out an hour ago.”

“It doesn’t matter.”

“Why don’t you come down after he’s released—that’s when he’ll really need you. He’s okay right now.” I thought for a moment. “But I don’t know how long they’re going to take care of him. You should be here for him when he gets out.”

“And if he doesn’t?”

“Doesn’t what?”

“What if he doesn’t make it?”

‘‘He’ll make it. He’s stable now.” Which wasn’t really true; that’s why they put him in the ICU.

“I’ll meet you this afternoon,” she said, then she hung up.

Next, I called the dean at UNEMC, but I could only leave a message with his secretary. Then, I cleaned up Daniel’s apartment before Sarah could see it. I kept looking for some evidence of our past, some link back to the people we once were together, even the smallest thing—a book, some music, a picture. But Daniel’s apartment could have been anyone’s—there was nothing of Daniel in it at all, no sign of the person he used to be, no sign of the person he was now. It was hard to believe he’d lived there for years. His home was like a hotel room, but without the cleaning staff. What I still don’t understand is why Daniel would settle down into that isolation, that place with no one so far from home. The refugee. Washed up like debris in a strange sterile land.

I spent the rest of the afternoon waiting for Sarah. And as the day dragged on, it occurred to me that’s all I’d ever done, I’d waited far too long where Sarah was concerned, I’d waited until it was too late. For years, I’d thought of her as a sister, and once, she seemed like my lover. But then she announced she would marry, and I suddenly felt a future I’d never considered before forever closed to me. And with that closure came a comprehension I didn’t want, and a longing that would grow all through the winter and the spring. An emptiness would form that would somehow be connected to the loss of Daniel, but would include and then become the loss of Sarah herself.

It was late in the evening when the cab brought Sarah to Daniel’s condominium. We went out for dinner, but neither of us really ate anything. That night, Sarah slept in Daniel’s bed. I slept on the couch in the living room, and I had bad dreams there. Daniel’s dreams, dreams of the refugee. A tunnel without lights. Black loneliness and despair.

Early the next morning, we went to see Daniel, and learned he’d been moved out of the ICU. We went up to the detox unit, and they let us onto that ward almost without caring. When the ambulance brought him in yesterday, nothing I could say could get me past the front desk—not that I was Daniel’s friend, or that I rode in with him, or was his brother (which was almost true). When I told a nurse I was a medical student at UNEMC, she laughed.

We walked down a broad hallway separating private rooms. The place was overrun with staff, the orderlies and nurses and aides almost all men. The patients were mostly men too, various ages; they all looked old. I glimpsed one man in heavy restraint sobbing before his door was closed from within. There was one woman I heard screaming through a closed door, just inarticulate terror. People in mauve and teal went in and out of her room, but they couldn’t make her stop. In Daniel’s room, a heavy screen covered a narrow window that looked down several stories onto a parking lot and a golf course beyond. There was a television and some magazines, two copies of impressionist paintings, and a rope net surrounding the bed, thick nylon strung between sturdy tracks bolted to the ceiling and the bedframe. Daniel’s skin was wet and pasty. He groaned and turned away.

“Jesus,” I said. I looked at Sarah. Her eyes were wet, but her mouth was grim. I got an orderly to unlock the net and slide it back against the wall. “Daniel,” I said. I touched his shoulder. “It’s me, Richard. And Sarah.”

Daniel blinked his eyes. His face looked swollen and thick, and I wished Sarah hadn’t come. She sat on the edge of the bed and took Daniel’s hand in hers. I couldn’t think of anything to say.

Daniel coughed and motioned for water, and I got him some. “Thanks,” he said finally. His voice was wooden.

“How are you feeling?” I asked. He shook his head and closed his eyes.

“Do you remember yesterday?”

But Daniel didn’t answer. We sat in silence for a long time. Eventually, a nurse came in and told us we should go and let Daniel get some rest. She gave him some pills and said we had about five more minutes. Daniel looked ashen against the white bedclothes. His breathing was gentle and regular. He didn’t stir when Sarah let go of his hand. She rose from the bed and went to the bathroom to wash her face. I was about to leave myself when Daniel slowly opened his eyes, focused on me with an effort, and said, “Do you remember the first time?” He looked like he was going to cry. “You took care of me.” I squeezed his hand. “It was like magic,” he said. “Then it was gone.” He closed his eyes again. “Magic,” he murmured. Then, he was asleep.

I’m not sure what they gave him, but for the first time, Daniel looked peaceful, and I was thankful for that, whatever the pharmacology was. In his sleep, he was smiling now, and I wished him a long rest, untroubled by dreams. Who needs dreams anyway? Daniel had his memories. Let him write his own history, create his own past. We all make up the truths we need to survive.

“Magic,” the nurse sniffed behind me. I swung around, scowling, but she just stared right back, that purulent look I’d been noticing recently, disdain for doctors seeping out everywhere. She was right though, and she knew it; finally, I was the one who had to look away. It wasn’t magic Daniel remembered—it was just shape-shifting, transient as smoke, not real at all. I turned back to the bed.

This was real. This gray boy—man on the white sheets, the twilight half-life that brought him here. You took care of me Richard. But I couldn’t remember that. In my whole life, I don’t think I ever took care of Daniel—it was always the other way around. His was the older brother’s role.

In high school, they called him Prince Daniel, after the time a girl stumbled out of the main entrance and fell down the front stairs. She was high as a kite, and she bounced on her ass all the way to the sidewalk, scattering her books and papers behind her and jamming her skirt way up past her hips. Then, she just sat there next to the buses, dazed and confused, stoned out of her mind, her legs spread wide, and anyone could see she wore no underwear. Everybody stood around laughing and staring. Except for Daniel. He ran over to help her, shaming the others to silence; he covered the girl with his jacket and made me gather her things. She was shaking hard as he helped her to her feet, and he had to support her by the waist as he walked her past the others to his car. Prince Daniel. But they never forgot the way he made them feel, and the name was always tinged with contempt.

Do you remember the first time? I remembered the bulletproof feeling clearly enough, and the way time started sliding around. Being late for school and leading Daniel up those same granite steps on a leash. How quiet it was inside at first, everyone already in class, the empty hallways stretching away on either side like dim and dusty tunnels. The school felt old to me as it never had before, ancient, almost archeological, and I wanted to linger there and understand that, but Mr. Pfnausch came roiling out of his office then, and he changed everything. Then, we were running, and some others started running, and by the time we ducked into the empty auditorium, five grown men were chasing us. Daniel opened an emergency door, and we ran across the parking lot and the football field; we ran all the way up the hill on the other side before we stopped to look back. The alarms going off and Daniel still on his leash.

I remembered how inviting my school looked from that perspective, the broad expanse of sunny brick long and low and warm, and how small Mr. Pfnausch seemed in the doorway. If only he’d been calmer. His distant shouts, the tiny figures at his side. They could have been us.

It was like magic. A perfect morning and a perfect escape, right out of the books. The sun-drenched hilltop in the clear spring light. Daniel pulled off his collar, saying, “Thanks. I won’t need this anymore.” I stood next to him with my arm around his shoulders. The day was just beginning, and life seemed limitless.

Of course, there was a following day, the appointment in Mr. Pfnausch’s office. There would always be following days. Mornings after. One tomorrow after another stacking up beyond belief, beyond endurance. I touched Daniel’s shoulder under the crisp white sheet, but it felt bony and cold.

You spent your whole life looking for magic, going back over and over, trying to find that place again, that hilltop in the sun, that moment before tomorrows when everything seemed perfect. And all the time your life kept moving forward, while you kept going back, until what you finally found was just yourself for a moment, lying at a crossroads, true and gray against bleached hospital sheets. Daniel.

Drinking was the great expansion, where all the rules were suspended, and nothing could ever go wrong. I came to believe it was like sex, always there just under the surface, silently organizing everything and everybody. The want that could not be satisfied, the voice that would not be stilled—whispering to you endlessly with its promise and its power. Promising everything, conscious and unconscious desire, waiting for you forever. But the promise was always the greatest part, and always disappointing in the end. No one could keep promises like that.

But more than broken promises, I think the tomorrows finally overwhelmed Daniel. The immensity of them stretching away. When I picture him now, I see him exhausted, I see him scared. Scared for a long time, a lifetime. I don’t think he was ever able to face his fears. Except maybe at the end—and maybe that’s what killed him. Perhaps he always knew it would—perhaps he spent a lifetime sobering up to terror. Self-loathing and defeat and the knowledge of his father’s death. The knowledge that this thing was his inheritance, his birthright, greater than he was, and maybe from the start he knew he was doomed. Maybe from the very beginning he could see all the way to the end, the dangling belt.

Here, we learn the most basic things—electron orbitals, positive and negative valences, the way atoms combine to form simple molecules. We proceed step by step biochemically—through sugars and fats to proteins and nucleic acids. Then, microscopically, histologically, anatomically—cells to tissues to organs to organ systems. Finally, we consider the human organism. It’s very thorough. 

But no one ever asks why. No one even remembers.

Here, we understand nothing. Not even simple physics, the second law of thermodynamics. We forget that chaos is the natural order of things. That ultimately everything comes apart. Life is futile beyond words, a puny holding action against the inexorable scraping of the universe.

We’re nothing but a collection of molecules, spinning through the void—atoms linked for a moment by shared electrons, seeking balance and stability. Driven by positive and negative forces, trying to equalize opposite charges, always looking for the perfect match. Is that the same as loneliness?

I think of Sarah a lot. I was the one who gave her away when she married last week. She asked me to walk up the aisle with her, and I couldn’t refuse—I took her father’s place, her brother’s place. But across this long spring, I’ve come to realize that I wanted to take the groom’s place, I wanted to be the one to walk down the aisle with her. I wanted to start a life with Sarah, not mark the end of one. There are too many endings here.

Once, Daniel was like a brother, showing me the way. But I’m not sure I want to continue anymore. Four more years here and residencies after that and anything that matters just sort of tacked on later as an afterthought. Love and marriage. Or not marriage. Eventual children. A friend’s suicide. What’s the point of going forward? I want to go back, start over, find the wrong turns and make the right ones.

My first mentor, Skip, tried to teach me to get used to the idea of dying, death. But personally, I don’t think you can ever do that. Sometimes I think hope is all we have, and the loss of that is unbearable. But hope is just ignorance; knowledge reveals that.

I wish for a return to simplicity. A hilltop in the sun. I’m sick of thinking. Remembering and dreaming. I want to find those memory links and break all the connections, clog the receptor sites, flood the synaptic spaces with some kind of useless analog. I want to forget.

I am so weary. ADP, ATP—there is no energy left. Tomorrow at eight, we start our two-year comps, the exams they use to determine who gets to continue. Right now, all I want to do is get drunk. It’s a desperate feeling. Scary. Where a phosphate ion ought to be binding with adenosine diphosphate, I just see ethyl alcohol. A much simpler molecule.