The Resurrectionist.

A Novel.

Matthew Guinn.

For two who kept this one alive:.

JOE HICKMAN.

and BRAIDEN GUINN.

resurrectionist n. (a) Hist. A body-s.n.a.t.c.her; a resurrection man; (b) gen. a person who resurrects something (lit. & fig.); (c) a believer in resurrection.

fernyear n. & adv. (a) Obsc. A past year, olden times.

Epigraph.

In whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrongdoing and harm, especially from abusing the bodies of man or woman, bond or free. And whatsoever I shall see or hear in the course of my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets. Now if I carry out this oath, and break it not, may I gain forever reputation among all men for my life and for my art; but if I transgress it and forswear myself, may the opposite befall me.

-HIPPOCRATES.

Educational inst.i.tutions . . . are peculiarly sensitive to outside criticism, and particularly to any statement of the circ.u.mstances of their own conduct or equipment which seems to them unfavorable. . . . As a rule, the only knowledge which the public has concerning an inst.i.tution of learning is derived from the statements given out by the inst.i.tution itself.

-ABRAHAM FLEXNER (1910).

Monday.

DOG DAYS AND THE FRESH BODIES are arriving once again. Always, Jacob feels the old stir of antic.i.p.ation when the baked stillness of August is broken by their return to campus, these young people crackling with energy in the last sullen days of summer. The first-year students are always the first to arrive, fresh-faced and with eyes narrowed toward the bright future, intent on the four years ahead of them in laboratory, cla.s.sroom, and clinic; painfully earnest, the n.o.ble words of Hippocrates echoing in their minds. They come from every corner of the state and the nation and from eighteen foreign countries, even Kazakhstan this year. He'd had to pull down the globe to find that one, working late in this drafty office last winter, poring over the registrar's report. Each of them from the top tier of their college cla.s.ses, a crowd of overachievers prepped, tested, vetted, screened, admitted, and financed. And each of them consumed with a single, burning goal: to leave this South Carolina campus a doctor.

The view from the top floor of the old administration building offers a vision straight from a recruiting brochure: serene live oaks dropping shade over the rich green of the Bermuda gra.s.s, the campus walks bricked in stately order. Every inch of the old campus meticulously maintained, a fit and proper welcome to the incoming cla.s.s, this one hundred and fortieth group of doctors to be graduated by the South Carolina Medical College. All that history, he thinks, renewing itself annually. A long tide of beneficent humanity ushered forth to heal the rest. And generation after generation of venerated MDs defeated, ultimately, by the immutable fact that human life is still a terminal sentence.

But today is no time for morbid thoughts; there is too much to be done. At the base of the building, just within Jacob's line of sight, Dean Jim McMichaels stands before a group of reporters and photographers doing what he does best: pressing the flesh of anyone within his reach. Or, as the dean puts it behind closed doors, shooting the s.h.i.t. He excels at it. In the year that Jacob has served as the school's public relations director, McMichaels has made his job almost too easy; the dean himself is the real PR man.

The dean is dressed for the role, in a white hard hat and Wellington boots no less, the boot leather caked with red clay from the exposed walls of the building's foundation, threatening to soil the cuffs of his Brooks Brothers pants. He gestures and points as though he were the foreman of the crew, and Jacob can easily imagine the spiel he is laying out for the press. No doubt a good deal of play on the metaphor of foundations, from the antebellum brick of this old building under renovation to the role of the Medical College in the state's past and future. "Foundations for the Future" is the catchphrase the dean happily announced for this year's campaign, and Jim McMichaels having said it, it was so. The newspapermen are probably jotting it down in their notebooks now.

McMichaels takes hold of a gold shovel and gazes at it significantly. Jacob knows the shovel. He bought it and the metallic spray paint that now coats it yesterday, at Five Points Hardware. There are traces of gold back at his condominium, on the concrete patio where the paint drifted past the newspapers he'd set out before spraying it.

There is the sound of applause as the dean takes aim at the ground with his golden spade. He settles the shovel on the school's hallowed ground and gives it a hearty kick with a Wellington heel, grinning to beat the band while the cameras flash.

Grinning himself, Jacob settles at his desk and begins to leaf through the morning's paperwork, a small stack of press releases to be cleared for the university's website. Most of them are pro forma, this year's versions of news of the Cla.s.s of 1999 rewritten from last year's texts. An agenda for the white-coat ceremony to be held in the Chapel Clinic that afternoon, another for the opening-of-year gala at the Dean's Mansion Friday night. No edits except for the first of the external releases, announcing Dr. Austin Malloy's promotion within Admissions. Jacob strikes the phrase "will a.s.sume the position of a.s.sociate dean" from the text, though he knows the school's alumni will have Malloy grabbing his ankles soon enough.

The last release gives him pause. From it, a black-and-white photo of a stunning young woman stares back at him. Her features are regal-aquiline nose and luminous eyes, black hair cascading around a face so perfectly featured that it might have been carved from stone. He reads her name and sees that this is the Presidential Scholar from the University of Virginia he has been hearing so much about.

Jacob had picked the young man from Kazakhstan as his diversity star for the cla.s.s profile this year, but now he has a bona fide poster girl. Daughter of an Egyptian diplomat, childhood in Cairo followed up by high school outside D.C. before her years at U. Va. and Oxford. A rare case: the academic record is as beautiful as her portrait. Yara Nasir, I will have to be careful not to overexpose you, he thinks as he places the release in his out-box, marked high priority.

His desk phone rings and he grabs it, is greeted by the voice of Elizabeth, the dean's secretary and the de facto receptionist for Administration; every call goes through the dean's office first.

"Kaye Siegel for you, line one," she says in her Charleston accent, the low-country cadences still p.r.o.nounced after twenty years in Columbia. "International call," she adds. He can picture her raising an eyebrow as she says it.

"Thanks, Elizabeth," he says, and presses the blinking red light on his phone. He speaks over the faint buzz of long-distance static. "Guten Tag, love."

Kaye laughs. "Closer to Guten Abend here, Jacob."

"How's Munich?"

"A German conference room bears a striking resemblance to a Columbia conference room, especially after the third straight day. At least the coffee's decent."

Jacob smiles into the phone. Kaye is, as his late father would have described her, a woman in a man's world. Bavarian Motor Works began courting her before she even graduated from international law at Carolina, and she has been with the company since, with the plant in Spartanburg running full steam now and talk of expansion all but constant. A woman in a man's world perhaps, but Jacob knows his father would have walked out of West Columbia Textiles midshift for the kind of job the German automaker has brought to South Carolina.

"And how are you?" she asks.

"Good. A little first-week mania, but it's seasonal."

"Pressure is pressure, Jacob. Are you handling it?"

He looks at the stack of press releases on his desk and cannot see how his day's work could be much less significant.

"Handling it fine. Even keel. Really."

There is a pause on the line. He knows that she is, by training, thinking of pursuing an alternative line of questioning. Instead she sighs.

"Even keel, huh?"

"Yep. Even. Keel."

"Keep it that way, all right? Look, they're starting the next meeting without me."

"How do you say 'wait' in German? Can you tell them to hold up a minute?"

Again she laughs. "You don't say 'wait' over here. Corporate policy. It's a four-letter word. Take care of yourself, Jacob. I'll see you Wednesday, okay?"

"Can't wait."

He would say more, but Kaye has already rung off. He places the receiver back in its cradle and thinks that he is grateful for her checking on him. But even more grateful, perhaps, that she did not say why. At least by name.

He steps to the window to monitor the dean's progress. No one is left on the lawn. Remarkable efficiency. Had Jacob joined the photo op, he would still be down there, b.u.t.tonholed by some bored metro writer telling one bad joke after another to forestall going back to the newsroom. But McMichaels has dispersed them like a cla.s.s at the end of a lecture. Even the shovel is gone.

Jacob checks his watch, looks over at the bookcase that lines one wall of his office. He scans the photographs propped on the shelves. Most are shots of himself with Kaye, interspersed with a couple of awkwardly posed Polaroids of his late parents. But it is another photograph there that catches his eye, and he pulls it down. Old sepia daguerreotype, faded, a portrait of the school's graduating cla.s.s of 1860. Men from the foundations, as McMichaels would say. Taken on the front steps of this building all those years ago. Two rows of stern-looking faces, all male, all white, staring the camera down in the moribund manner of the nineteenth century, this gathering of plantation gentlemen setting out to do what they could in the bleak era before penicillin, asepsis, or the X-ray. Their bearded faces seem to scowl at him. One dark smudge of an African face peers over a shoulder in the second row, probably caught there while running an errand into the building, trying to get out of the photographer's way.

Standing by the bookcase, he can just make out the graceful lines of the face of Yara Nasir, cla.s.s of '99, on his desk. Things are different now from what they used to be, thank G.o.d. More room at the inn.

AT EIGHT-THIRTY ON this August morning the Chapel Clinic glows like an emerald, its bright gla.s.s facade giving back the morning sunshine to the city around it, casting the greenish light refracted from its mirrored windows on the palmettos and the concrete, bathing everything in underwater hues. But Jacob hardly notices; he is going to be late for his monthly meeting with Kirstin Reithoffer, his sponsor from the Physicians' Task Force, and Reithoffer is a doctor for whom all trains run on time.

He double-times it past the great fountain toward the building's front entrance. In lean-budget years the fountain is shut off to save on electricity and maintenance, but lately, with the economy booming, it sprays forth its two-story-high jets of water almost exuberantly, just as the famous architect envisioned it: a perfect counterpoint to the clinic's gla.s.s walls. Patients pa.s.sing the last minutes before their appointments sit on the concrete walls that frame the fountain's pool, some of them staring vacantly at the traffic, most of them smoking. A black man in the school's physical plant uniform walks the edges of the pool with a net, skimming out the cigarette b.u.t.ts tossed in the water.

At the entrance Jacob takes his place in line as the doors are opened for the busy day. It is a bad spot to be in a hurry. Nearly all the patients filing into the building are disabled in one way or another, a crowd of the sick and lame moving into the clinic through clouds of smoke from their discarded cigarettes. Jacob steps aside to let a woman with a walker go in front of him in a slow, shuffling gait. The woman is easily fifty pounds overweight, and is escorted by her husband, a thin man with skin weathered like old leather, wearing a feed cap with the logo of a local co-op embroidered on its front. Country osmosis, he has always called it: this strange process by which the women of the rural South seem to take on the weight lost by their men in hard labor. When the walker creaks past the granite walls of the foyer and into the open atrium, Jacob is free, and slips past the patients creeping toward the elevators. He moves to the escalators instead, where he takes the moving steps two at a time.

He spies an old face from his intern days coming toward him on the down escalator. Parker Hauser, a real hotshot back then and a rich kid, probably heading down from the parking deck to the dermatology clinic on the first floor, where he now runs one of the most coveted practices in the clinic. Jacob remembers him as the first person he'd known to own a cellular phone. Jacob had kicked it once, accidentally, where it sat on the floor of the interns' lounge, and Parker had exploded. "Do you know how much a bag phone costs, d.i.c.khead?" he'd shouted, and one of the nurses had burst into laughter. Jacob smiles and says h.e.l.lo to him as they pa.s.s on the moving stairs, but Hauser, caught up in intense conversation with one of his residents, seems not to have noticed him.

At the vascular surgery clinic on the third floor Jacob is ushered back to Reithoffer's office by the administrative a.s.sistant, who shuts the door behind him. She is the new one; Reithoffer replaced the entire staff within six months of coming south to Columbia, claiming they were too inefficient for a first-rate clinic. None of the new people are local.

Reithoffer is on the phone, but she nods at Jacob and motions for him to take a seat. While the surgeon talks, Jacob looks around the office, taking in the framed diplomas and citations. Though her residency brought her stateside, Reithoffer's other accolades are international: certificates from surgical a.s.sociations in Germany and the Netherlands, a commendation from the University of Edinburgh for lifetime achievement. How she finds time for her committee service to the school has always mystified him.

"So, how are the cravings, Jacob?"

Jacob looks down from the walls and into Reithoffer's pale blue eyes. He has not heard the doctor finish her phone call; he has been reading a framed proclamation from the American Academy of Surgeons, trying to make out all the fine type. He clears his throat.

"Fine, thanks. Except that there isn't much doctoring in Administration. I'm ready to get back into practice."

"Of course you are. But the cravings?"

"Nearly gone."

"Nearly?"

"There are times . . ." Jacob says, his voice trailing off. "There are times when I think about it. That freedom from anxiety."

Reithoffer nods. "Understandable. But you fully realize that this freedom is illusory?"

"Yes."

"That is the key to avoiding relapse, you know. And the craving is the key danger of Xanax, why every course of medication should be carefully monitored." Reithoffer waves one hand in the air, the gesture casually European. "Only in America would we imagine life without the bother of anxiety. And that is why these tranquilizers are so completely overprescribed here."

There is an awkward silence; they both know that Jacob never got his tranquilizers from a prescription. As if to break the tension, Reithoffer begins flipping pages in the chart spread out on her desk. "How about alcohol?" she asks.

"Same as before. Just the social drink."

"Fine. But remember that it's all of a piece with addiction. Alcohol is the prime avenue of relapse for those in tranquilizer recovery. It's cheap. Easy to come by. Similar effects on the nervous system. Be careful."

"Right. I've got you."

Reithoffer rises and takes a blood-pressure cuff and stethoscope off the coat tree behind the office door. She sits on the edge of her desk and motions for Jacob to raise his arm.

"And the Klonopin? How long have we been off that?"

"Three months now. I started tapering it in March."

"Which you will remember I advised against."

Jacob nods. "I remember. But I'm not a junkie, Kirstin."

Reithoffer shoves the cuff up over Jacob's bicep and cinches the strap tight against his arm. "No. Not a junkie." She breathes through her nose as she arranges the strap to her satisfaction. "No junkie could have finished a residency here at Carolina. If one ever does, the school will have my resignation promptly." She smiles. "What you are-were-was a resident under great strain, working long hours. A resident who made a mistake. I am under strict confidentiality regulations from the Physicians' Task Force, but I can tell you that you are not the only one to make such a mistake."

"That's good to know."

Reithoffer slips the stethoscope under the cuff. It is steely cold against Jacob's skin. "Let's review it once more, the error. Tell me again why you broke your oath."

Jacob shifts in the chair, but Reithoffer grips his arm more tightly and begins pumping the bulb of the blood-pressure cuff. Her fingers are long, delicately tapered, but strong.

"Again? What's the point?"

"To know your weakness. To face down the wolf so he doesn't come again."

Jacob takes a deep breath. He knows that Reithoffer will take at least three readings of his blood pressure as he talks. There will be time.

"The last year was the hardest," Jacob begins. "I had a lot of debt, just piling up, and the moonlighting was the only way out of it. I was getting stretched too thin. I was getting tired."

Reithoffer studies the gauge of the cuff. Jacob can hear the starch in her white coat crackle when she moves. She nods for Jacob to continue.

Jacob takes a deep breath, closes his eyes, and remembers.

That third year of his residency, something had slipped, some cog in the turning wheels of his ambition had sprung loose. He'd been working like a dog at the little county hospital out in Newberry in between shifts at Memorial, trying to stay ahead of his rent and the enormous student loans. Some weeks that meant two to three days with no sleep, the seven-to-seven shift in Newberry sandwiched between his schedule at the university and his ancient Honda overheating on I-26 as he floored the pedal to make it from one ER to another. It had started out as hard as he could imagine. Then it had gotten harder.

It was especially bad in Newberry that fall. He lost three patients in November-two of them goners that he could have let go easily enough, but the third a woman of thirty-two whose breast cancer had metastasized at a rate beyond any even the oncologist could comprehend. Jacob had diagnosed the tumor and consulted with the oncologist throughout her treatment. Everyone knew it wasn't his fault and couldn't have been. But still there were her eyes, sinking into her skull in the last two weeks she was alive, which would never accuse him. And that, somehow, was the worst of it, the last indictment of his incompetence as her physician.

Her chemotherapy had been aggressive and it had taken its course on her body. A week before Thanksgiving he had stuck his head in a door on rounds and apologized to the woman in the bed.

"Wrong room," he said. "Sorry."

"No, right room, Doctor Thacker," she said as he looked down to recheck the name on his chart. "Wrong life, I guess."

Jacob froze. He felt that he could never again look up from the clipboard, so great was his shame, his disgust with himself.

"It's all right," she said softly from the bed. "It's okay."

When he looked up, she was smiling. Her weary face wore an open expression, already past this latest indignity. Not as though she were antic.i.p.ating some long-shot good news from this visit, but simply that she was glad to see him. Her expression was simply, impossibly human.

He understood then that she knew this Friday afternoon to be her last, and tomorrow's Sat.u.r.day afternoon to be her last. He sat down on her bed and they did not talk about the cancer or her regimen but simply talked. Yet her approaching death was in every unspoken word, fusing the conversation and charging it with meaning, with a new significance of the mundane. Later it would strike him that it was something like grace in the room, but then he could see it only as death, a thing she had somehow transcended while it crippled her healer.

After that it was as though his horizon had shifted, then dimmed. The bright goal was still there but now with less l.u.s.ter. The woman died on Thanksgiving Day. Jacob was at the hospital, midway through his twelve-hour shift, when he heard. He had eaten a Thanksgiving meal of cold turkey and store-bought dressing without tasting any of it.