In this haunting true story, a dark secret threatens the career of an enigmatic brain surgeon called Ruth.

Ruth was a small British woman with close-cropped blonde hair and a tiny white triangular scar that lifted the corner of her upper lip just enough to make her look secretly amused. She was the new attending neurosurgeon, already in her early forties, though you wouldn’t know it to look at her, with her smooth fair skin, her quick exact movements.

Usually she was calm and polite, but you could never tell what would set her off. Her face would grow still, she would step up close, white-lipped, and empty her flat gray eyes into yours. It didn’t matter if her tone was mild, or even if her anger was reasonable, you felt as if a door to a room you did not want to enter had opened, and then closed again.

She was technically skilled, there was no question. She was quick and accurate, and could pop a pressure monitor into the brain in her sleep, her small hands deft on the instruments. But by the end of the year the wards were full of rumors, and she was gone.

Once, in the middle of the night, I brought her a CAT scan to read. She was alone with the scrub nurse in the OR, the anesthetist invisible behind the drapes. Music was playing – chants, a vaguely Cajun rhythm – and I saw, looking in the hollow where her neck rose out of the gown, that she was wearing a black, tie-dyed t-shirt under her scrubs.

A man lay on the table, his head wrapped in sterile plastic. Through a little round hole in the center of his skull, I could see the dura, the thin connective tissue that covers the brain. The dura was a vague blue, bulging. under pressure, and hair, shorn from the man’s scalp, lay in brown clumps on the floor by Ruth’s feet.

‘Thank you, Dr. Huyler,’ she said, as I came into the room and clipped the scan onto the luminous board. She craned her neck reading it. ‘Good. The ventricles are open.’

I turned to go, but she stopped me. ‘Dr. Huyler,’ she said. ‘Come here. I want to show you something.’ I stepped up behind her, careful not to violate the sterile field, and looked over her shoulder at the wound.

‘Have you ever seen the movie Alien?’ She was smiling a little.

‘I have.’

‘Are you familiar with the scene where the alien bursts from the man’s chest? On the spaceship?’


‘Watch.’ And she touched the top of the scalpel to the dura, as delicate as a brushstroke.

At first nothing happened. Then, slowly, a little blue-red worm of drying blood began twisting from the slit like toothpaste, and suddenly the clot spurted out of the man’s head like a plum, dripped down past his ear to the drapes.

‘That,’ Ruth said, ‘is how you take out a subdural hematoma.’


When I was a boy my family lived in Brazil, and during those months, as Ruth revealed herself to us, it kept coming back to me – festival night, down by the lake. Ash Wednesday and Africa combined, macumba, or santería, or voodoo, call it what you will. The poor gathered there by the hundred after dark. It was luck they were after, good fortune for the coming year. They stood in the shallows at the water’s edge with tiny boats they had made. On the boats were candles, photographs of dead loved ones and saints, offerings: bananas, small pieces of meat, feathers. They said prayers, then pushed the boats into the darkness. If the boats continued out in the water it meant the offerings were accepted. If they returned to shore it meant an indifferent future.

And so nothing was left to chance. The boats were wired, with small electric motors and batteries – expensive in the slums – and they continued, for hundreds of yards, until it was a lake of candles, a small constellation of human need.

A thousand miles to the east, the scene repeated itself on a massive scale, as enormous crowds gathered at the beaches of Rio and Bahia, and the boats went into the open sea. But the people here were too poor to travel, and so they made do with what they had: a small lake, with garbage on the shore, on the outskirts of the inland city. That night, in the dark, it seemed sufficient, beautiful, and the lake vast, without visible edges, full of candles entering the distance until they burned out.

A few yards offshore, hip-deep in the lake in a long line, stood the frogmen of the military police. They stood quietly, their black scuba tanks and wetsuits glittering in the lights off the beach, careful to let the boats pass untouched between them.


One night in the ER, as the faint siren of the ambulance grew nearer, I sat with Angela at the doctors’ station. She was a surgery resident who had just rotated off the neurosurgery service, and we talked about Ruth. It wasn’t my case, I didn’t have to go into the trauma room this time, and I felt calm, even content, as I watched. Ruth stood just outside the trauma room, and she was angry again – I could see it in her stiffness as she waited for the ambulance. Someone had called her too soon, before the patient had arrived.

The ER was full, as always, and a man was yelling nearby, his voice heavy and incoherent, that they were hurting him. ‘It wouldn’t hurt if you didn’t fight us,’ a nurse said, breathing hard, as they struggled to hold the man down on the gurney, buckling the leather straps to his wrists and ankles. He was wild, drunk, full of half-formed words, watched by the patients who sat waiting around us.

‘I don’t know how you work down here,’ Angela said. The man heaved and bucked on the gurney, and nurses converged, a knot of dark blue scrubs bending over him, until he was quiet. I shrugged my shoulders, and we turned back to Ruth.

Of all of us, Angela knew Ruth the best. By coincidence they had come from the same hospital in Miami, Ruth as a new attending, Angela to complete the last year of her surgery residency. But there was no loyalty between them. ‘She got really friendly in Miami a couple of years ago,’ she said, nodding to where Ruth stood down the hall, ‘ when she found out I was from Panama. She said they have some powerful magic down there. It was weird. She invited me over for dinner once and then we went out drinking. Now she acts like she doesn’t know who I am.’

‘She is good, though,’ she added. ‘She knows what she’s doing.’ And she was. I remembered, that night before the harvest, the liver transplant, how the pressure monitor had seemed to flow into the young woman’s head through Ruth’s hands, deep into the ventricle of the brain. And as the numbers climbed on the screen – 40, 50, 60 – Ruth had shaken her head.

‘She’ll die,’ she’d said. ‘Her intercranial pressure is far too high this early.’ And then she’d gone off to find the family.


The frogmen were there for a reason; there had been drownings in the past. Earlier, as I stood in the crowd with my father and mother, watching the boats, I had noticed the women, dressed in white, their black arms dipped in flour. A dozen or so, and even at first they had seemed odd, a strange look in their eyes as they stood near the water. Slowly, one by one, they began to rock, back and forth, murmuring at first, letting it build up in them. Then it would start, the speaking in tongues, the jerking of their bodies as the crowd gathered around them, the convulsing on the ground, and finally, the rush for the lake. They would flip and heave into the shallows, driven out from the beach, soaked dressed clinging to their backs, to their breasts and legs, trying for deeper water. And then the frogmen would converge. It was the moment they had been waiting for, grabbing the women in their arms, picking them up, and dragging them back to the beach. Then the line of divers would re-form, and the women would lie back, spent, in the blankets of the crowd until it came on again. It was the force of order, of military rule, against the spirit world: soldiers, with women in their arms, carrying them to the safety of dry ground.


‘Ruth keeps a complete fetal skeleton in a jar in her bedroom,’ Angela said. ‘She took it out and showed it to me. I couldn’t believe it. She told me it reminds her of why she’s a surgeon.’ Angela looked uneasily away, but after a bit she continued, as if talking to herself alone. ‘Do you know what she did every chance she got when we were in Miami?’ I said nothing.

‘She’d go to raves. She talks like someone in Masterpiece Theatre, and she was a regular rave-queen. She’d go when she was on call. She’d carry her beeper, and whenever there was a bad head she’d come in smelling of incense. Everyone knew it.’

‘When we went out that one time she got pretty drunk. We were sitting there in this bar, and this middle-aged woman walked by. Ruth was staring at her, I mean, just staring. And then she turns to me. ‘Angela,’ she says, ‘there’s something I want to tell you.’ ‘What,’ I say. And then she looks at me, and she whispers, so quiet I can barely hear her. ‘I’ll fuck anything.’ That was what she said. ‘I’ll fuck anything.’ I’m telling you, I went home pretty quick.’


The woman called 911, and told the paramedics, very clearly, that she wished to be transported to University Hospital, where her lover was a doctor.

She was big and black, with silver studs running up the arc of her left ear, and she was crying. Her face was a mass of bruises, a split lip, one eye swollen shut, with scratches on her neck.

‘Ruth did this to me,’ the woman said clearly, to anyone who would listen. ‘Ruth. Ruth did this. This is what she does to me.’

But despite all the talk Ruth was the same. She continued, distant and controlled, just as she had been, nodding politely to me in the hall when we passed, a small woman, with small quick steps. They drove her hard, beyond herself. All of us were used to call, to being up thirty-six hours or longer, but as a junior attending Ruth was on call every night, at home with her beeper. On a bad string, if events aligned, she could go for the better part of a week with only scraps of sleep, so tired she could barely stand, until the heads lay shaved beneath her fingers, and she had to do it again.

And then there was that curious phrase, that I heard only once, under her breath, when things were going badly one night: ‘Esmeralda’s going to die tonight.’


When Angela finally turned Ruth in, the chairman of surgery came into the clinic with a nurse, and they took Ruth with them into the bathroom. As the chairman waited outside, Ruth did what they asked, went into the stall, urinated into the plastic cup while the nurse stood and watched. Of course she knew then that she was finished, but she went back to the clinic anyway, the nurse said, and kept seeing patients as if nothing had happened.

Her urine lit up. Fentanyl. Cocaine. Valium. Marijuana. The drugs of the hospital and the street, and she was gone, the very next day, the headlines – BRAIN SURGEON SHOOTING UP BETWEEN OPERATIONS – suppressed from the city papers. They handled it well – rehabilitation, a special program in another state, paid for by the hospital. No talk. The next plane out.


Three months later, the rolled the man in, and this time it was mine, this time I couldn’t watch from a distance. He was in his fifties, in a suit, ejected from the car, intubated already by the paramedics, and his head, the bones of his skull, felt loose, like gravel and warm bread.

‘Call neurosurgery,’ I said to the nurse, then continued, listening to his chest, feeling his belly, watching the scissors go through the suit cloth as we stripped him.

And then Ruth walked through the door like a ghost. She was done with rehab, and they’d let her come back. ‘What do you have for me, Dr. Huyler?’ she asked, looking down at the dying man. I stared at her, unable to answer for a few seconds.

‘Um, unstable skull fractures. And he’s posturing.’ As I spoke, the man’s arms curled again up to his chest, his wrists twisting outward in the darkest of involuntary reflexes. A bad head. His arms had their own intention, their own power, and the nurses struggled to keep the IVs in place.

‘OK’ Ruth said. ‘Paralyze him.’ So I gave the order, the drugs flowed, and he went slack like a dead man.

Ruth has changed, it was as if life had gone from her. She looked tremulous, frail, her skin wrinkled and dry. She looked her true age, she looked uncovered, with none of the strength I was used to, the well I had seen her call on again and again. She was a husk, and as we waited for the CAT scan I tried to make small talk. ‘Good to have you back,’ I said, watching her closely. Even then I knew it was a taunt, a match held up to the birdcage, where the hawk sat on a stick.

She looked back at me over the man’s still figure, her eyes glittering, and inclined her head. It was the last time I saw her. A few days later they caught her again, and fired her for good.

‘She’d been through rehab before,’ Angela said, ‘back in Miami, only nobody out here knew about it. Why would it work this time?’ I wondered if Angela was afraid now. She showed no sign of it, but she had reason. Ruth’s career was over, all those years of work, and she had Angela to blame. ‘I felt bad about telling on her until her girlfriend called me up. She thanked me for turning Ruth in.’

‘She thanked you?’

Angela nodded. ‘She told me a lot about Ruth. How every morning she’d drink a cup of black coffee and do two lines of coke. Every morning. How when she’d had a really bad day she’s go to the farmers’ market and buy a live chicken. She’d take it home and light candles and put on music and cut the chicken’s throat with a straight razor.’

Esmeralda’s going to die tonight.


But the months passed, and Ruth was well and truly gone. No one knew where. Probably she left the city, drifted to New Orleans of LA, where no one would know who she was. But I’m not certain, and half of me expects to see her again, there in the doorway as I stand by the gurney.

‘What do you have for me, Dr. Huyler?’ she’ll ask, full of prayers and cocaine, smelling like candles. And I’ll answer her.

‘Gunshot wound,’ I’ll say. ‘To the head.’

This short story is taken from the collection The Blood of Strangers by Frank Huyler, available now from 4th Estate.

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