Pain Management

Author : Christina Dalcher

You have to bid right in these things. Too low, you wake early; too high, your money is lost. No refunds, no exchanges, all sales are final. The first decisions are made on the outside, when the surgeon wears white and not green, when talk is of likelihoods and estimates. Not pain. Never pain.

Everyone bids low, thinking they can gut it out if it isn’t enough.

The next patient rolls from pre-op into surgery, her face covered in a caul of fear. She’s not old enough to remember the days before the medical free market, before modern medicine morphed into part Über marketing strategy, part game show. Not old enough to bankroll the bucks for add-ons and upgrades. The old woman next to you rattles something about an appendectomy, says she still feels the surgeon’s blade slicing through flesh and fat and nerve, hands pulling muscle apart, slow fingers stitching. You wonder if the body remembers pain; the woman’s eyes assure you it does.

The girl disappears behind the door.

When the first sobs seep into the ward, a dozen phones chime in unison, reminding you of the approximate duration of operations, paid minutes of sedation, deficits. A suit in the corner calls his bank. The old woman who used to have an appendix begins to weep, turning the invisible diamond on her finger, the one she pawned to pay for her half-hour of pentathol that won’t be enough, not for the procedure on her chart. A father bends over his small son, whispering apologies.

Last chance, offer expires in thirty seconds, upgrade now! warnings flood your phone, each accompanied by a cheerful tweet punctuating the screams from a room that can only be the deepest circle of hell.

Your deficit is at zero. A fine number—assuming no complications, no unforeseen glitches, no hemorrhaging, no organs punctured by unsteady hands. One finger hovers over the screen before tapping ‘No.’ A sole ping answers. Are you sure? One thousand dollars buys five more minutes of unawareness.

A howl, hoarse and hot, comes from the girl in the operating theater.

The suit yells into his phone, demanding another transfer. The father pleads for an emergency mortgage; his son is only ten, he says. He breaks down as a nurse announces an unexpected delay. The girl’s voice, thin as thread now, begs the surgeon to let her die. They want you to hear this, the anesthesiologists. They pipe the sounds in. Motivational Muzak for the miserly.

Pre-op explodes into a symphony of beeps and chimes and pings; suits and grandmothers and desperate fathers scrambling for last-minute purchases. The red circle appears on your phone: Price surge. Current rate: $500 per minute. Upgrade?

Images pop up, full-color reminders of surgical squick. Gigli saws severing limbs, Finocchietto retractors spreading ribs, curettes, cannulas. Bone drills and chisels and cutters. The Italians win for sheer creativity on how to wreak havoc on the body electric.

Ten seconds remaining.

The voice in the operating room silences, and the orderly calls your name.

Yes. Five thousand dollars; ten extra minutes. Ten thousand all in for a simple appendix removal. When you wake up, you’ll have to sell the car.

In the theatre, bright lights blind you as the mask covers your nose and mouth. Numbers are punched into the gas-passer’s machines. Voices, distant now, call a procedure from the wrong chart, a bypass. Six hours. Patient paid for one. Poor guy. The lights dim and the voices muffle.

We’ll be making the first incision now.

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