a percutaneous gastrostomy


THE BATHTUB HAS BEEN POLISHED so that whatever ambient light dances around the midnight sky above Glacier Drive is captured and amplified in its oblong parabolic. It looks like it is glowing from inside as it now rests on the driveway beside Ian’s truck. It becomes momentarily brighter in the headlights of Elaine’s car as it pulls into the driveway, parks and goes dark. She steps out of the sedan. Drowning out the usual nighttime neighborhood sounds is the continued banging and splintering of the remodel going on inside. Just a day ago this would have been frightening to her. She walks to the door and knocks.

Inside the McDaniel home her knock cannot compete with the percussion of removing the wall between the bathroom that Ian has since destroyed, and the great room. Debris is everywhere and drywall dust hangs in the air suspended in the bright light cast by a pair of portable work lamps on the floor. Random holes have been pounded through walls and cabinets and cupboards. This has gone awry some time ago.

She waits outside the front door for a break in banging but it is unrelenting. She tries the doorknob to find it unlocked and she walks in making her way to where the concussions are coming from. She reaches the middle of the great room and the banging stops, a large tool hits the floor in the bathroom startling her along with Ian as he exits the space turning down the hall to the master bedroom without noticing the intruder. She steps beyond the work lights on the floor, casting her shadow on what is left of the rear wall of the great room, its studs dappling her shadow into the recesses of Ian’s demolition, down the hallway and into the master bedroom. The breakers for the east part of the house are off and she is standing in one of two of the only sources of light. On his way back from the master bedroom with a large hammer in his hand he is startled by this little eclipse and stops. He looks at her, wipes his mouth with his bare arm. His wife-beater is saturated and soiled, his breathing still trying to catch up to his upper body muscles’ demand for oxygen, post meltdown.

“I want you to take me to Gray,” she says. There is no room for negotiation in her tone. Ian looks at her hard, discerning for longer than what most nerves would endure and then he drops the hammer, turns and retreats back into the dusty darkness of the back of the house and disappears.

“You’ve got nothing on me,” she calls out after him. “I told her, I told Pam about us. I don’t care.”

Ian emerges from the back of the house with a shirt on and keys in his hand. “We need to stop by the store first,” he says.

ELAINE’S RED SEDAN pulls into the parking stalls of the 7-Eleven on Corby Avenue. Ian and Elaine get out of the car and go in. He scans the beverage coolers and finds Gatorade, bottled water, chocolate milk and Red Bull. She is putting the pieces together. She has been here before. Ian makes the transaction at the register and the two leave the convenience store, walk past her parked car, through the gas pump islands to the intersection. He presses the call button for the walk signal and waits. She stares at him. He has clearly turned a corner, operating at a cadence and fervor that ignores any consideration of one’s self and she would be duly frightened by him if she had not found what she prayed was not misplaced trust. The signal goes green and the walk sign chirps and they cross the street.

They go down another block past office buildings and just beyond their parking structures on the other side of a retaining wall is a self-serve car wash. Ian leaves the sidewalk and cuts diagonally across the tarmac with islands of vacuums and carpet shampooers, through a car wash bay and out the back. Elaine follows having to double-step to keep up. The two go left out of the bay along a cinder block barrier that leads them to a long steel gate that rolls on a track. Ian steps up to a keypad on the other side and enters a code. Elaine stands on the asphalt in the middle of the entrance, looking through the bars of the gate as it makes it slow retreat to allow them entry. She realizes she was just here earlier today.

Ian leads her through to the first alley where they go up, every unit looking the same except for the regression of the odd numbers painted on each door. Ian stops at a unit and fishes in his pocket for keys. Elaine arrives at this side. And then he sees it.

There is a second lock on the door’s bolt, a silver disk lock clamped adjacent the lock Ian affixed to the door. He grabs the disk and yanks it around. “Fuck!”

As this obscenity reverberates down the alley, Elaine hears a muffled growl from inside the unit. She presses her head against the rolling door and it raps along its chassis waving up and down from her force against it. There’s another growl, low and barely human. Her eyes go to Ian.

“Is that Gray?”

Ian doesn’t confirm, he’s gone in panicked thought. She turns her face to the door and speaks into it, louder.

“Gray?!” She pounds on the door.

“Give me your keys.” Ian says.

“What?” she says in more dismay.

“Give me your car keys!”

She hesitates, trying to make any sense of what’s going on. She pulls her car keys from her bag and that momentary silence breaks with a muffled roar from inside the unit, in two syllables, repeating three times, louder until Elaine interrupts.

“Gray?” Her face is back to the door and she pounds on it. “It’s okay, we’ll get you out of there.”

Ian is already running down the alley and around the corner. He breaks the beam of the gate’s exit sensor and it opens too slowly for his state of panic. He squeezes through with widening space, runs through the car wash to Corby Avenue and crosses through rolling traffic to the 7-Eleven parking lot. He is in her car, starting, slamming it into drive and peeling out of the parking lot onto the four-lane thoroughfare of Corby.

Elaine is crouched in front of the door on the balls of her feet to keep her legs from shaking. Gray has gone quiet and all that can be heard is the ambient traffic noise of the evening. And then the clang of the front gate’s drive chain and the squeak from its steel wheels rolling across the steel beam that keeps the gate centered, and then the sound of a slowly accelerating vehicle. Elaine is watching in the direction of the noise. The feeding lane’s asphalt has a glow of light as she hears the vehicle move and she races in her mind of what possible excuse she could have to be seen there by herself at Fort Knox crouching by a storage unit that late in the evening.

The exhaust noise of a detuned V8 engine becomes more pronounced the closer it gets and as its light starts wrap around the corner down the alley from Elaine, she rises from her position, her knees cracking along the way, and as she does an old oxidized pickup truck makes the corner. It is burdened by its load of storage fodder and lists to the driver’s side as it comes around. Its headlights slowly pan across the alley, eventually catching her standing there at unit 435. She has no clue what to do.

The truck ambles along jostled by the rut of the drainage ditch and the stepped escalation of the alley’s grade. Its springs squeak and frame creeks and the engine’s idle increases under a little more throttle to pull its load up the alley. The driver looks at Elaine as his truck passes her. He’d stop and ask if she were alright if he spoke her language. He watches her watch him in his passenger-side mirror before he makes a turn up another alley.

Elaine exhales, unaware she had been holding her breath that whole time. She is in a rare position standing outside that storage unit. She is stranded, helpless, second-guessing everything that has brought her to this point. Just as her emotional response to this brims her ability to control it, she sees a tiny bit of light coming through a small hole in the door at the level of her eye. She steps close to the door and puts her right eye to the light holding on to the roll-up door with both hands, fingers curled into the tops of the slats and her thumbs gripping beneath them. She sees the interior of the unit, the low wattage light suspended above and just ahead of what looks like a man seated in a patio chair who appears to be facing the rear wall of the unit, silhouetted against it. The wall is covered with paper and photographs, large x-rays and MRIs, and charts and telemetry readouts.

“Gray?” she whispers and taps against the door, but the man in the chair doesn’t move.

IAN HAS BEAT LOWE’S CLOSING for the night. He grabs a red shopping basket and runs through the big box store to the hardware aisle. He stops at rows of padlocks on merchandising hooks and finds the silver hockey pucks, Contractor Grade No. 40 padlocks. Their position on the rack forces him to his knees as he reads the product numbers on each plastic-bubble package. One by one he throws them in the basket. Once he has gathered all the product numbers he can find he is back on his feet. He hefts the loaded heavy plastic basket and runs to the checkout queues, none of which are illuminated. He detours to the self-checkout section and begins scanning the packages. An automated female voice begins to announce, “Twelve dollars, forty-eight cents” and repeats eight times, each announcement sounding louder to Ian, beckoning the attention of any Lowe’s associate within the vicinity, but even the kiosk where the associate monitors activity in the self-checkout area is vacant.

“Please select payment method.”

Ian has triple-bagged the packaged locks and on his way out has placed them on a demagnetizer at a vacant register, triggering a faint pulse that deactivates any security tags that may be inside the packaging.

THE SOUND OF YET ANOTHER VEHICLE captures Elaine’s attention. Before she can prepare for another encounter she sees her own sedan round the corner and come up the alley, stopping short of hitting her. Ian gets out of the car toting the plastic bags holding the locks.

“Take the car out of here. Park it by the car wash.”

Elaine gets in her car and closes the door, but Ian stops her before she drives on.

“Do you have a pen?”

She searches her bag and finds one and hands it to Ian who clicks it, grabs her hand and writes a four-digit number on her palm.

“This is the code for the gate to get back in,” a brave or stupid assumption on Ian’s part. She’s had a bit of time to think while he has been shopping – a new resolve, a better plan. It’s written all over her face. Ian still has her by her wrist.

“Did you touch that door?”

“I looked at him through that hole. Yeah, I touched the door.”

“Those files you gave me, they’re in there with him. Your fingerprints are on them and now they’re on the door. You don’t want to go anywhere, go calling anybody. You’re an accomplice now.” He watches the expression on her face change.

“Hurry back here. I need your help.”

Elaine drives away. Ian tears into the bags, pulls out a package and rips into the plastic bubble clamshell. He pulls the keys out from under the lock and tries one of them in the tumbler of the lock on the door. No good. He opens another package, pulls out another key. No good. He grabs the remaining six packages out of the bags and runs up to a better illuminated spot in the alley flooded in amber light by a sodium vapor street lamp above. All six packages are laid out on the tarmac, two rows of three, in systematic order of product key code numbers. He sees that three of them are the same. He splits open one of the three packages and retrieves the keys and runs back to the door.

A key goes in the lock and the bolt slides. Elaine returns around the corner and runs up to the unit.

“Grab those,” Ian says pointing to the packaged locks left under the amber light. She does so and meets him back at the door. He unlocks the remaining padlock, slides the bolt on the door freeing it from the jamb and slowly raises it up. The light coming from the suspended bulb climbs Elaine’s body and finds her face. Without the frame of a three-eighths inch hole the scene before her is amplified in its depth and breadth. Gray struggles to turn his head, trying to see who is there behind him, but the duct tape is unrelenting, keeping the tissue of his forehead and face in place while his skull tries to rotate in the sack of his head.

“What have you done to him?”

Ian presses on the small of her back, pushing her forward while he brings the rolling door down to close.

Elaine’s senses are overwhelmed and as most brains do, hers tends first to what she sees – the wall, the documents and artifacts from the files she gave Ian, the suction machine, the pale, clammy thighs of the hostage void of any tone or definition spreading flat over the sea-foam green slats of the seat of the adirondack. She is lead by what she sees around to the front of the the chair. The doctor confirms what he thought he had heard earlier, the sound of a familiar voice, and yet he is still stunned by Elaine’s presence.

The sight of him makes her take her breath and hold it. The damage to his face, his soiled diaper, the NG tube up his nose, the patina of vomit, blood and expectorate meshed into the knit of his Izod are a lot to take in against how she last saw him. She lets her breath go and draws another and along with it the stench of a man held for two days against his will, covered in the decay of his own physiological responses. Despite it all she reaches out to his face, more of a habit than compassion and wipes away sweat from his brow.

Gray has changed, though, not the man she last saw. What there was about him she loved is gone. His eyes bore into her, cut at the tops of their irises by his partially closed upper lids. He frightens her. Revealed in the context of his secrets, his greed, his lies, and now his contempt, Elaine finally sees him for the devil she denied he was all along.

“My God, Ian.” She turns to Ian to find him occupied rummaging through a box marked “Virginia” in black ink.

“I’m not getting enough calories in him. That’s a pediatric NG tube and it doesn’t allow the volume he needs.”

“Just let him eat.”

“He can’t eat. His jaw is broken, his palate is crushed and he’s missing teeth.”

Elaine resists the urge to cover her mouth. “What happened?”

“I hit him.”

“You did this?” She was right to be afraid of Ian.

“It was a reflex.” Ian pulls a packaged catheter out of the box along with gauze dressing and medical tape. “Hold this.” He says, and searches deeper in the box and finds a 2cc screw-tip syringe and a packet of individually wrapped alcohol swabs, all of which he hands to Elaine. From a small sheath on his belt he pulls out the Leatherman. He unfolds the tool and from within it  pulls out a two-inch leather punch.

“What are you doing?” she asks. Ian takes an alcohol swab packet from her hands, removes the swab and rubs the leather punch and the handles with it.

“Look at him,” he says while he is sterilizing the instrument. Ian grabs skin on Gray’s arm between his thumb and forefinger and pinches it. When he releases his hold, the tissue on Gray’s arm retains the shape for a few moments.

“He’s dehydrated and starving because I can’t get enough fluid in him.”

“Then just stop doing this,” she says, escalating in her dismay of what’s unfolding before her. “Let’s get him to a hospital.”

“No, we can do this. He’ll be okay.” Ian grabs a cath-tip syringe and connects it to the NG tube and draws the plunger back. Nothing comes up in the tube form Gray’s stomach. “It’s empty.” Ian slides the folding chair over positioning it behind the adirondack and then he pushes the chair along with its patient to lean back and rest on the back of the folding one.

“Ian, what are you doing?”

Ian rips what’s left of Gray’s Izod right up the middle of Gray’s body exposing his bloated white and belly. He reaches for and pops open a Betadine package and takes the iodine soaked sponge with one hand while he palpitates the left side of Gray’s abdomen with two fingers from his other hand. Tap, tap, listen. He finds the spot and marks it with his index finger and brings the Betadine sponge in trailing dark, disinfecting iodine along its path to the indexing finger and traces a circle of bronze antiseptic around his digit. He works the sponge in a concentric circle working away from the center. Finished with the sterile area he lifts his finger from the middle and scrubs that point as well.

“Open the Foley catheter package so the valve and opening are exposed. Don’t touch the tip,” he tells her.

Elaine doesn’t comply. The two are locked by their eyes, his waiting, hers searching. Ian is gone, a decade ago, a dozen years, any of a number of times he had to replace Virginia’s feeding tube, not the nasal gastrostomy, the tube down her nose, but the one she had surgically inserted through her abdomen wall into her stomach when she was six months old.

“What are you doing?” She’s more forceful with panic on the threshold of her reaction.

“I’m putting in a G-tube. Get the catheter ready.”

A Foley catheter is a long surgical tube that has a central channel for fluids and a peripheral channel that is used to inflate a small balloon either with air or sterile water. The balloon is near the inserted tip of the catheter and once inflated inside a bladder, or in this case, Gray’s stomach, the balloon keeps the catheter from sliding out of its invaded organ. When used for a stomach G-tube, the site where the tube enters the abdomen, called an ostomy or stoma, needs to be dressed in a way that the tube is gently pulled so that the balloon seals the hole through which it is threaded from inside the stomach. Ian and Linda were taught to use a baby bottle nipple with the top cut off to match the diameter of the feeding tube and the side split so the nipple could be placed around the tube with the nipple base down against the dressing surrounding the stoma. The catheter is then gently pulled snug, the nipple pressed into the dressing and the stoma site and then taped secure. Depending on the surgical quality of the stoma, this dressing needs to be changed daily. If the stoma leaks, the dressing should be changed more often. Over the course of Virginia’s life, Ian and Linda have replaced G-tubes hundreds of times, catheters that either came out of Virginia’s tummy due to a failure of its balloon, or when Virginia pulled them out herself.

Ian has never done the actual surgical insertion of a G-tube, a percutaneous gastrostomy. It’s a surgical procedure that is done with an endoscope, a small camera on the end of a long tube that is inserted in the stomach to ensure placement of the tube. Ian doesn’t have an endoscope, just the leather punch on his Leatherman multi-tool.

Gray knows full well what a percutaneous gastrostomy is but has no energy nor ability to fight what Ian is about to do to him. Ian pushes the index and forefinger of his left hand hard into the left side of Gray’s abdomen dead center of the iodine circle, straddling the point he had previously marked. His right hand comes around to that point with the leather punch and begins a slow push into the flesh between Ian’s fingers.

“Are you out of your mind?!” Elaine pushes Ian back by his shoulders knocking the adirondack forward slamming back down to its front legs sending a shockwave of pain through Gray. She has Ian pinned against the wall with her hand on his right wrist trying to restrain his lunacy and the Leatherman.

“What’s your point here, Ian? Why are you doing this? To get even? Revenge for your daughter? Your wife?”

“Ginny had a G-tube since she was six months – she never ate by mouth – she couldn’t swallow. I want him to have this goddamn catheter sticking out of his side!”

She still has him pinned. She’s not much of a match for him, he could plow right through her, but she presses her body against him, fully, slides her other arm around his neck, her hand to the back of his head, her fingers through his hair and she pulls him forward onto her shoulder, his face into the curve of her neck.

And Ian just barely breaks.

It’s been years since Ian felt an embrace. The more he lets the tension subside, the deeper she penetrates him. He exhales, his eyes closed, his right arm coming down and she leans into him even more.

“You want vindication?” She whispers. He opens his eyes while his face is buried in her neck and he tilts his head up just enough to pull focus on Gray, naked save for an adult diaper, some duct tape and the remnants of a golf sweater. Gray meets Ian’s gaze with the stare of a sociopath.

She is still uncertain that if she pulled away from Ian, he’d either collapse to the floor or stab Gray, so she moves from him with a slow grace, her body leaving him in a peel instead of all at once. She reaches into her jacket pocket and pulls out Gray’s cell phone and with her other hand retrieves its battery from the other pocket. She snaps them together and powers up the phone. Its start-up ring tones are familiar to Gray and his eyes shift from Ian to the phone. Elaine opens the phone. She presses a button activating its speaker and then another that induces a connection.

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