“Compound Fractures” by Alice Hatcher
At eight years old, she already has a mastery of the orthopedic lexicon. She can name all 206 bones in the adult human body, from the distal phalanges at the tips of toes to the parietal bone crowning the skull. She has studied the architecture of interphalangeal joints that enable the flexion of fingers. She understands the differences between the tiny cracks of hairline fractures and the multiple breaks that characterize comminuted fractures. Her father is responsible. He doesn’t trust babysitters and, on weekends, takes her to St. Anne’s Hospital when he conducts rounds or responds to emergency calls. She brings drawing paper and scented markers but spends most of her time studying the anatomical charts hanging from the ceiling of the conference room in the hospital’s orthopedic wing, or poring over photographs in the medical journals and textbooks she pulls from towering shelves. She plays with plastic models of hinge and spheroid joints, maps the jagged sutures separating the bones of cross-sectioned skulls, and explores the processes in a vertebral column mounted on a slab of polished oak. When she draws, she uses as her model the wired human skeleton hanging from a steel hook in the corner. She can identify each point of articulation between its bones, but she is most confident in her understanding of misalignments and fractures.
* * *
At first, she doesn’t see the dog’s exposed bone, a broken radius, because her father has draped moist antiseptic gauze over the dog’s leg to prevent infection while he readies the kitchen, or what he calls the operating theater. Still, she grasps the situation in its entirety the moment she walks through the door in her plaid school jumper and sees the dog—in this case, a black and white beagle—lying on a plastic drop cloth on the kitchen table. Arrayed on a steel tray beside the dog are the instruments needed to set a fractured bone: bone forceps and hemostatic clamps, a retractor, bone screws and a steel plate, a roll of plaster bandages, and elastic wrap. Her father has already anesthetized the dog. A hypodermic syringe with a bead of clear liquid clinging to its needle rests beside the tray. Even unconscious, the dog seems to be in pain. The dog is drooling, and its purple tongue, edged with white foam, curls from its mouth. When she tries to touch the dog’s face, her father stays her hand and peels away the gauze to reveal, between two flaps of skin, a slick bone obliquely fractured and flecked with blood. It is hard to believe the dog is alive, but its chest is rising and falling. The dog’s ribs are slender enough to appear fragile, and she fears they might break in her father’s hands when he positions the dog for surgery.
* * *
She never tells her therapist that she sometimes looks in the mirror and sees her face as it would appear on an x-ray film, as a composite of shaded occipital ridges, zygomatic arches and temporal bones, a hinged mandible, and teeth fractured by incessant grinding—a fragile puzzle that might break apart at the slightest disturbance. She takes several vitamin supplements and drinks milk every day, even though she has read that high doses of vitamin D can cause nausea, and excess dairy has been linked to inflammation.
* * *
At her father’s funeral, a retired cardiologist offers his condolences. He stands so close to her that she can see the veined coffee stains on his teeth and the different shades of pink in the pale membranes edging his rheumy eyes. She smells the moldy cheese he had for lunch when he tells her he went to medical school with her father. Thinking, perhaps, that she doesn’t know much about her father as a young man, the cardiologist tells her that her father received a draft notice the day he graduated from medical school and, within six months, found himself treating casualties in a MASH unit at the height of the Tet Offensive. “Your father was one of the best trauma surgeons in Illinois,” the cardiologist remarks. “Vietnam was perfect training for him. Chicago’s West Side was like Vietnam in the 70s, and your father was the only doc who could deal with all the gunshot wounds. He was so calm.”
* * *
Her father impresses upon her the need for preparedness. He often wakes her at 3 a.m. and conducts a snap inspection of her room. If he finds a stray sock, an unshelved book, or a toy lying about, he empties the contents of her dresser and closet into black plastic garbage bags, strips her bed, and orders her to sleep on the wooden floor. “Someone could trip if there was a fire,” he explains. During surprise “bug outs,” he gives her minutes to pack her toothbrush and pajamas, and on the way to a motel, recounts the time he and three other docs dismantled the operating theater of their MASH unit and evacuated an area only three hours before the Viet Cong overran it. “They would have slaughtered all of us,” he states, picking at a callus on his thumb as he waits for a red light to change.
* * *
Symptoms of dissociative-depersonalization disorder include, but are not limited to: an ongoing or episodic sense of disconnection from one’s self (the feeling of being ‘outside’ of one’s self); the sense observing one’s thoughts and actions as though one were watching a movie; emotional detachment; the feeling of ‘being on autopilot’; and in some cases, the sense that one’s own body does not belong to one’s self. Individuals experiencing depersonalization sometimes injure themselves in order to feel ‘real.’
* * *
When her father tells her to “fetch a second roll of plaster bandages for the dog’s cast,” she knows what to do. She routinely inventories the contents of the hallway closet and knows the bandages are on the middle shelf, with the cotton pads and mesh strips, a nylon tourniquet, antiseptic swabs, stainless steel sutures, aluminum splints, rolls of silk surgical tape, foil packets of collagen dressings, syringes sealed in clear plastic pouches, two cardboard boxes stuffed with latex gloves and surgical masks, a wooden case filled with scalpels, and a scuffed leather medical bag containing a set of bone forceps, seven hemostatic clamps, a coiled stethoscope, and a string of wooden rosary beads.
* * *
By her forty-eighth birthday, the hoarseness of her voice and her difficulty swallowing have become impossible to ignore. She suspects, from the location of the lump, that the growth is on her thyroid gland. With a great deal of reluctance, she makes an appointment to see an endocrinologist, who performs a needle biopsy and refers her to a surgeon. The surgeon, only fifty years old, is a highly decorated Brigadier General retired from the military after four tours of duty in Afghanistan. She learns this from a nurse—whose hurried intake involves waving a digital wand near her forehead to take her temperature and slipping a padded blood-pressure clip onto her index finger—and the framed newspaper articles, photographs, and presidential letters of commendation mounted on the walls of the examination room. Waiting for the surgeon, she experiences tingling in her hands and feet, and alternating waves of anticipation and dread only partly related to her impending surgery and the tumor nursing on the soft tissue of her neck.
* * *
As an adult, she tells her therapist she “felt intensely numb” looking at the dog. “The beagle,” she clarifies, adding, “there was always a dog in the house.” When she notes the paradox contained within the phrase “felt intensely numb,” her therapist suggests she is intellectualizing her pain. She nods and starts talking about the intensity of the reading lamp her father used in the kitchen operating theater.
* * *
After college, she briefly considers applying to medical schools, but convinces herself she is not stable enough to be trusted with the health of others, and too broken inside to withstand the pressures medical school would certainly impose. She abandons plans to attend medical school for the same reasons she never has children.
* * *
“One of the primary considerations in any operating theater is the prevention of infection,” her father says, stepping up to the porcelain sink where her mother once rinsed cups of iceberg lettuce. He pushes against the faucet with the back of his wrist to start the flow of water. He slowly washes his hands, methodically massaging a bar of soap between his palms and lacing his fingers together beneath scalding water until his skin glows bright pink. As an added precaution, he stretches powdered latex gloves over his hands, even though, he remarks, they are “only setting a dog’s leg.” He returns to the kitchen table, smooths a crease in the drop cloth, and tells her to wash her hands because he will need her to hold a flap of skin with the retractor while he sets the bone. Its breathing has slowed, but the dog is stable.
* * *
Sometimes she pulls the stethoscope from her father’s medical bag and slips its chest piece beneath her school uniform shirt. As the diaphragm’s metal ring warms to her skin, she closes her eyes and listens for a heartbeat beyond the amplified sounds of rubber tubing brushing her plaid jumper. She never finds a heartbeat. She hypothesizes that she is dead, citing as one premise her sense of invisibility, and finding in the absence of a heartbeat her final proof.
* * *
Even after studying a photograph of the surgeon accepting a medal for distinguished military service, she is unsettled by something familiar in the surgeon’s expression when he enters the examination room and extends the hand that will guide a scalpel into her neck. She isn’t thinking about a scalpel, or even her tumor, when he sits down on a stool and palpates her neck with his warm fingertips. Drawn to the sharp intelligence in his soft grey eyes, she resists an impulse to touch his wrist. She wants to ask him if he has a wife or children, what part of town he lives in, and what sorts of books he reads. She desperately wants him to understand something about her, and in her desperation, she feels afraid, and deeply ashamed. When he releases her neck, he considers her expression and assures her that he has done thousands of thyroid lobectomies, and that she has nothing to fear. For a fleeting moment, she believes him.
* * *
One night, after drinking a bottle of wine, she opens a hinged leather case containing a handwritten note and the silver star her father received in 1968 for “valor in combat.” Two weeks before his death, her father mailed her the medal, a dull grey star affixed to a tricolor ribbon. Though her father kept it in a locked safe in his study, she has always known about the medal. At the age of six, she listened to her mother tell the story of her father and another doctor performing surgery in a jungle. “Your father never heard the bullet. He just realized Dave was no longer kneeling beside him,” her mother told her. “Your father tried to give him CPR, but when he opened his mouth, he saw the back of his head had been blown away.” For years, Dave’s parents would send her father dozens of letters (which she discovers cleaning out her father’s study) describing the closed casket shipped from Vietnam and asking whether there might have been some mistake, and if their son might still be alive. She doesn’t know if her father replied to any of the letters, but if he did, she imagines he would have written in a steady hand that “there was no hope,” and that he would have intended this truth as a mercy.
* * *
Her father points out the paired bones running the length of the beagle’s lower front leg and explains that the skeletal structure of a dog’s leg is not entirely unlike that of a human’s leg. “The paired bones spanning the human elbow and wrist are called the radius and ulna, just like the dog’s bones,” he tells her. Similarly, he notes, “The bones in the dog’s hind legs are called the tibia and fibula, names that correspond to the bones running from the knee to the ankle in the human body.” Later, as the dog sleeps off the anesthetic, her father opens his copy of Grant’s Atlas of Anatomy to show her a diagram of a human hand, noting the points of articulation between the radius and the carpal bones of the wrist, the locations of ligaments, and the similarities between a human arm and a dog’s leg. “These similarities,” he observes, “are taken by some as evidence of gradual evolution from a common ancestor, and by others as proof of God’s grand design.”
* * *
As an adult, she often thinks of the beagle when she hears the word “bitch.”
* * *
After five years in therapy, she begins to discuss fractures in vaguely metaphorical terms. She refers obliquely to hairline fractures caused by repeated insults and relentless stress (fractures not always revealed by imaging or psychotherapy); pathological fractures of bones weakened by underlying conditions such as osteoporosis, unrelieved insomnia, and masochism; greenstick fractures in bones damaged only on one side, so that, viewed from a certain angle, the bone’s opposite side can still go out in public, to grocery stores and even cocktail parties; comminuted fractures of bones shattered in multiple places, resulting in an abrupt withdrawal from social engagements and prolonged pain management; spiral fractures to bones twisted in opposite directions by cruelty and compassion; torus, or buckle, fractures in bones deformed (and ashamed) but not cracked; compound fractures that cause bones to break through skin, so the unsightly trauma resulting is both physical (to the bone and dermis) and psychic (even to those who observe, rather than directly experience, the injury). Still, she is hesitant to relinquish the precision of textbook definitions, the restraint of the scientific register, or the legibility of the anatomical lexicon. There is too much ambiguity, and too much ambivalence, to bear when one abandons clear referents in speech.
* * *
The brief note folded into the leather case containing her father’s silver star is undated, unaddressed, and unsigned. “I’m sorry for everything,” it reads. Her father denies any wrongdoing, and any recollection of writing the note, when she calls him days before his death to confront him with certain facts about her childhood. She realizes, weeks later, that her father might have been thinking of her mother, or Dave, when he wrote the note.
* * *
She wonders if conversations about psychic pain are counterproductive, insofar as they often elevate rather than alleviate suffering. She tells her therapist an old joke. Patient: “Doctor, it hurts when I go like this.” Doctor: “Then don’t do that.” Her therapist suggests she is undermining their work together by avoiding prolonged conversations about her father. “Possibly,” she says, before lapsing into an uncomfortable silence.
* * *
The fact is, she still loves her father, though she isn’t sure why. Her love, she thinks, is idiopathic.
* * *
She decides the man she has been dating needs to know about her childhood if they are going to be in a serious relationship. He grows pale and tenses as she talks about the dog and so many other things. “It doesn’t matter what your father went through,” he insists, shifting on his end of the couch. “There was no excuse for what he did.” She feels guilty, wondering if she misrepresented certain facts or miscast her father. She rises abruptly, saying she doesn’t feel well and needs to get ready for bed. The fact is, she doesn’t feel well.
* * *
If her mother had still been living in the house, she might have lied and told her daughter the dog slid into the stairwell while chasing one of its toys across the kitchen tiles. Her father, though, eschews imprecision of any kind. After stabilizing the dog’s leg, he emphasizes the importance of assembling every fact pertinent to an injury during an intake. (He will retire with many complaints about how medicine has changed.) The circumstances leading to a fracture, he explains, can inform the best approaches to treatment and post-operative rehabilitation, and the prophylactic measures most likely to prevent aggravation of the injury. From the phrase “prophylactic measures,” she knows her father kicked the dog down the steps. “The dog was chewing on the couch and needed to learn a lesson,” he states. “It left marks on the back leg and tore a hole in the skirting.” He then explains the precise nature of the dog’s injuries, pointing to the fractured radius, the exposed marrow, the serous fluid edging a flap of torn skin.
* * *
She will never give away her father’s edition of Grant’s Atlas of Anatomy. Her father’s signature is inscribed on its yellowed cover page, impressed into the paper with the force of a heavy hand gripping a ballpoint pen. Sometimes she trails her fingers over the signature as if she were reading braille, as if she might glean something about her father from the flecks of ink filling the grooves of descending letters, only to realize that she can barely remember her father’s face. Then she closes the book and everything returns: the faint shrapnel scar in his forehead, the unruly hairs disrupting the soft arch of his eyebrows, the dark striae in his ice-blue irises.
* * *
For weeks, her father mixed morphine into the dog’s wet food. By the time he cut the dose, the dog was addicted. It suffered terrible withdrawal symptoms for days, and for the remainder of its life, showed little interest in playing with toys or other dogs. It cowered in the presence of adult white males between the ages of 30 and 60 and, unable to control its bladder, often urinated on the carpet, which always led her father to beat it with his belt. It seemed tormented by hunger, even when it had just eaten, and suffered constant tremors that prevented it from walking up and down stairs. Every afternoon, she searched the carpet for wet spots and sopped up urine before her father came home. She always carried the dog up and down the porch steps when she took it for walks.
* * *
She sees her mother eleven times during her adult life, each time during a short trip to Kansas City, where her mother lives with her second husband. She always meets her mother in a restaurant. One year after her father’s death, she sits at sidewalk café in Kansas City, gazing at a leaden river while her mother eats a croissant. “Before he went to Vietnam, was Dad,” she begins, turning to her mother. She trails off when she notices her mother’s fingertips trembling at the end of the croissant. “Was your father what?” The croissant’s crust is breaking apart between her mother’s fingers, shearing off, in pieces, onto a pat of butter. “Was he always violent?” Her mother is not expecting the question and looks like she has been slapped.
* * *
“Three days after my surgery, a friend from out of town slammed my hand in the door of her pickup,” she tells anyone who asks about the swelling and discoloration. “I was reaching into the cab for my fleece, and she didn’t see me standing behind her.” She recounts this story so many times that she needs to remind herself there was no truck, or fleece, or friend from out of town; in fact, she turned from a mirror reflection of her bandaged neck and slammed her hand into a doorjamb, just to interrupt her racing thoughts—to create a pause—and feel something. “Nothing’s broken,” she assures friends, recalling how calm and focused she felt sitting on the edge of her bathtub, curling and straightening her fingers to test her flexor and extensor tendons and the functioning of her MCP joints before swelling engulfed them. She recalls pushing against the sides of her fingers to test the integrity of her collateral ligaments. The pain, she thinks, was moderate to severe.
* * *
As the surgeon describes follicular carcinomas of the thyroid gland, she finds herself mapping the lines in his face and matching the color of his eyes to the close-cut hair at his temples. She is too consumed by longing, an almost physical craving, to care about the outcome of her surgery. It’s a sign, she knows, that she is not doing well. “My father was an Army surgeon in Vietnam,” she blurts, when the surgeon rises to leave. The surgeon’s face clouds. “My dad was in Vietnam, too,” he says. “But I never really knew him.”
* * *
One month after she punches the doorjamb, the bruises are fading, but the joint at the base of her middle finger appears enlarged, almost arthritic, and she fears that misaligned bone fragments are already knitting together. Her hand throbs when she types. It is difficult to uncap jars or use scissors. Whenever she panics, she massages her hand, watches bones shift beneath her skin as if she were studying an x-ray, and tells herself she only has a contusion or, at worst, a hairline fracture. When her therapist asks her why she won’t see a doctor, she waves the question away, insisting it’s sometimes best to let things heal on their own.
* * *
Fifteen wooden steps lead from the kitchen to the unfinished basement. In the absence of vertical risers, the staircase is not unlike a steep ladder with narrow treads instead of rungs. Thin, almost makeshift, plank handrails flank the steps. Her father often uses the corded phone mounted to the basement wall, and numbers and messages handwritten in ink cover the sloped wooden carriage supporting the steps. The broken threads of abandoned cobwebs dangle from the undersides of the highest treads. Above the lowest tread, a pull chain hangs from a mounted fixture holding a bare bulb. Once, cowering beneath the bare bulb and watching her father fold his leather belt into something resembling a strop, she urinates on the cement floor. As an adult, she can still see the quivering edge of the yellow puddle that formed between her feet. She can still recall the blue ink leeching into the carriage’s rough wood grain and the dark knots in each uneven step. She has always had a mind for detail. “A mind trained to classify and compartmentalize,” her father once said by way of a compliment.
* * *
During the First Iraq War, she cringes every time a CNN newscaster uses the term “surgical strikes” to describe the repeated bombings of Baghdad.
* * *
She imagines the report a radiology lab would send to an orthopedic (if she went in for an x-ray): “Patient: 48 y/o female. Findings: Significant swelling on the posterior right hand at the third metacarpophalangeal joint. There is no acute fracture. The bones are in normal anatomic alignment. The joint spaces are preserved. There is a prominence of the soft tissues at the level of the MCP joints on the lateral view which would correlate with the clinical description. Impression: There is no acute bone or joint abnormality.”
* * *
Her therapist asks if her teachers ever remarked on her bruises. Once, her fourth-grade teacher asked about her arms, she recalls, but it was Catholic school in the 1970s; teachers rarely intervened in playground fights, and bruises were unremarkable. This is true, but she knows, too, that her fourth-grade teacher never questioned her obvious lie about falling down a flight of stairs. He suffered a certain blindness, an inability to recognize the violence of an orthopedic surgeon who wore silk ties and drove a Cadillac with spoked hubcaps. As she explains, her teachers believed, maybe needed to believe, that the only people who beat their children were the jaundiced white men living in trailers down by the river, and black women living in housing projects on Chicago’s West Side. She uses the word “displacement,” hears the word “dislocation” echoing in her mind, and loses herself in looping thoughts of shredded cartilage and a femur’s head floating free of a pelvic bone. Her mind tends to wander in therapy.
* * *
The dog, the beagle, would limp for the rest of its life. Her father would often remark, with a great deal of pride, that the truly amazing thing was how well its leg had healed.
* * *
Three months after her surgery, she leans over her bathroom sink and examines the pale scar in the crease above her jugular notch. The surgeon did a great job, her friends often remark, and they are right. The scar is almost invisible, even if she sometimes feels hard tissue pulling taut, straining against her neck muscles when she turns her head. She recalls the surgeon’s warm hands palpating her neck and tries to cast herself back into the moment she looked into his eyes and felt safe. Failing, she looks at her swollen hand and feels bereft. She feels insatiable, nearly intolerable longing; she feels what others call grief.
* * *
Her father’s funeral is closed-casket. From the front pew, she considers the coffin’s polished walnut lid, brass pallbearers’ handles, and heavy clasp, knowing there is no such thing as closure. One week after the funeral, she uses part of her inheritance to pay the catastrophic cleaners who shampoo the rug and scour the walls in her father’s study. She donates another portion of her inheritance to an animal shelter. She considers sending money to a suicide prevention service but can’t steady her hand long enough to write the check.
* * *
Six months after she punches the doorjamb, there is vestigial joint stiffness and swelling at the site of the contusion. Her hand aches after strenuous activity, but the knot of tissue at the base of her knuckle itches. She takes the itch as evidence that her bones and tendons are still healing.
* * *
When her therapist asks her if she ever told anyone about the basement or the beagle or any of the other dogs, she says, “There were no words,” though she had all the words she needed, and she has all the words, now. She can still name every bone in the human body, and by extension, almost every bone in a canine skeleton. She just doesn’t know how to assemble the pieces of her father’s life, or by extension, her own, in a way that makes sense, though she knows the story’s overall structure, the points of articulation, and all the breaking points that can’t bear pressure, or scrutiny.
Alice Hatcher’s fiction, poetry, and essays have appeared in numerous journals, including Alaska Quarterly Review, Fourth Genre, The Beloit Fiction Journal, Lascaux Review, and Cagibi. Her novel The Wonder That Was Ours, long-listed for the Center for Fiction’s 2018 First Novel Prize, received recognitions from the Friends of American Writers and the Eric Hoffer Foundation. Her nonfiction received a special mention in the 2020 Pushcart Anthology. Hatcher currently lives in Tucson, Arizona. Her work can be found at www.alice-hatcher.com.