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By dee_ayy
February 1, 2000
Disclaimer: The characters depicted within this story belong to 1013 Productions and 20th Century Fox Film Corporation, that company foolish enough to suggest there could possibly be “The X-Files” without Mulder. (Take it from us, you bean-counters. It won’t work!)
Spoilers: Uh huh. For the 7th season episode “Signs and Wonders.” Be warned.
Rating: PG-13 for Medical grossness
Category: MT, A, fill-in
Feedback: Makes it all seem worthwhile. dee_ayy@yahoo.com
Archive: Sure, just leave name and email attached. Tell me where and I'll be sure to visit!
Thanks: To those who wrote me asking “So, where’s the MT fill-in?” This one’s for all of you. And to Vickie, Keryn, and Peggy G, who helped along the way.
Author’s Note: Any similarities to Vickie Moseley’s fill-in, “Only the Righteous,” are nothing more than a freaky coincidence. And she’ll back me up on that.
Summary: Scully faces the severity of Mulder’s
injuries, as well as the inexplicable aspects of their case and his recovery.
Fill-in for "Signs and Wonders.”
_____________________________
God and Antivenin
By dee_ayy
I am a child of the suburbs; and as the daughter of a Navy man, the coastal suburbs at that. My experience with snakes was limited to those tiny brown/green creatures that slithered out of the garden unexpectedly when we were posted somewhere long enough to actually plant a garden. They startled, and were gone. In all my years in medical school and residency I never saw a snake bite. Never saw their assault on tissues and organ systems; never saw the pain they caused their victims.
I wish that were still so.
When I found him on the floor, I knew he’d been bitten. I saw the blood on his stark white shirt, and I knew. But I didn’t know what to do for him, except call 911. I am a medical doctor, and I didn’t have a clue. Had I read about snake bites in school? If I had, that information was lost to me now. I didn’t know what to do short of taking an inventory. So I looked, and I counted. Two on the upper right arm and shoulder. One on the left hand; that's three. One mid-chest; four. One on the right cheek near his hairline; five. One in the crook of his neck, where it meets the left shoulder, six. And I hadn’t even looked at his legs. Fang marks, each bleeding, all over my partner’s body.
Of course I dialed 911. Of course I called for help. And then I stared at him, completely unsure what to do.
“He got bites on his arms?” O’Connor had pulled himself from the floor and was standing in the doorway. I looked at him, unwilling to believe that the man who moments ago had tried to keep me from helping Mulder was now going to offer advice. Nevertheless, I nodded.
“Take off his watch. Shoes, too. And belt. Unbutton his pants. Swelling, you know.”
The advice was sound, so I did not bother to try and divine his motives. And I should have known enough to do that automatically. I did what he said.
At first Mulder was unconscious, it seemed. He would moan and writhe and twitch from time to time, especially when my hands approached one of the bites, but that was all. His eyes would open, but they were unseeing. I was glad. I didn’t think he’d want to be awake for this, so I made no effort to rouse him.
But it only lasted a short time. His eyes suddenly shot open, and he screamed and tried to get up. He flailed his arms, and I was sure he was trying to get away from the snakes that he believed were still near.
I did my best to calm him, to assure him that the snakes were gone. At least I hoped they were gone. I’d seen the one go out the door, but there had to have been more than one to cause this much damage. I felt my own heartbeat quicken as I furtively looked around, trying to assure myself that I wasn’t lying to my partner when I said they were gone. But I saw none. They were gone.
“He’s panicking,” O’Connor offered. I didn’t even bother to look at him, the statement was so obvious. Of course he was panicking. So was I.
Mulder kept saying Mackey’s name over and over. I don’t know why, but I did wonder where he was. This was his church, after all.
“He knows,” O’Connor said cryptically. “He understands now. He knows what side he’s on.”
I didn’t have time for that now. I could hear the ambulance.
+ + + + +
Was it possible that I hadn’t noticed? I’d sat by his side for all those minutes, and hadn’t noticed? When I brought the paramedic to Mulder’s side, I could barely recognize him. His neck, his face, his hand, his arm, his chest-- all covered with horrible discolored welts. His left ankle, where I hadn't even looked for bites, was almost twice its normal size. How had I not noticed?
“How long ago was he bitten?” The paramedic seemed completely nonplussed.
I looked at my watch. Twenty minutes ago at most.
“Shit,” the man muttered upon hearing my answer. He deftly cut Mulder’s clothes, exposing his extremities, and I caught myself having the ridiculous thought that it was a shame, because I knew those pants were new.
Amazing what you have time to think when you can't actually _do_ anything.
At first, with everything that the medic did, I knew what he was doing and why. I didn’t have to ask. He administered oxygen--standard procedure. He started an IV in the back of Mulder’s right hand. The right forearm was swelling from the bite on the upper arm, and the left hand was severely swollen with another bite. He marked the edges of the edema--the swelling--with a pen, to chart its progression.
He looked at the bites and for a moment considered using a venom extractor. He counted how many of these devices he had in his box of supplies. Three. Mulder had eight bites at least. Eight that I could see, with the addition of the two on the left ankle. He didn’t bother using any, and I don’t know why. I marveled for a moment that he even carried three extractors, but considering what goes on here, I suppose it’s not surprising. The man wanted another IV, but the only extremity not swollen was Mulder’s right leg, so he started it in his foot. That was not standard. I did not know why it was so important to start two lines instead of just one. After all, he wasn’t rapidly losing any fluids.
But although I no longer was sure of the medical reasoning behind his actions, I was paralyzed into inaction. I didn't ask, didn't question. I just stood there and watched.
The bite near Mulder’s neck on the left side clearly concerned him, I could tell. He was worried about Mulder’s airway; that the swelling would close off his trachea. So was I.
He spoke to Mulder, tried to keep him awake and talking. My partner tried to oblige, but it was an effort--all he wanted to do was moan in agony, and I heard him complain that “it burns” more than once. The man tried to get Mulder to tell him what kind of snakes they were. When Mulder couldn’t or didn’t answer, he turned to me.
Eight bites, and I only saw one rattler. That’s what I told him; the man nodded.
Mulder said one thing clearly, and with a confidence that sent a shiver of fear and dread running down my spine. “I’m going to die,” he said. And though the paramedic assured him that no, he was not going to die, my voice betrayed me still, and I was mute.
+ + + + +
The ride to the hospital was a horror. They didn’t want me riding in the ambulance, but I insisted. I flashed my badge and asserted my will--Mulder calls it “doing my thing”--and they relented. Two patients, one paramedic, and me, all crammed in the back of the ambulance. Only one of us had no business back there, I knew, but it’s habit by now. And after what Mulder had just said, I was afraid to leave him.
Mulder’s pulse was racing, his eyes were darting all over the place frantically. They only stopped for a moment when they met Enoch O’Connor’s. O’Connor nodded at him slightly. “Now you know, boy,” is all he said, and my partner closed his eyes and looked away.
I knew I should have questioned O’Connor, should have found out then and there what the hell he was talking about. But I didn’t. I’m not sure now if I didn’t because I was too concerned for Mulder, or because I didn’t want to hear what this man had to say.
The paramedic marked the progression of the swelling one more time as the ambulance was arriving at the hospital. It had spread even more, and was becoming purple and angry-looking.
I realized when I stepped out that we were not at the big medical center in Athens, Tennessee, the place they had taken O’Connor from the lockup there. Rather we were at Woods Memorial, a smaller hospital closer to the church. I wanted Mulder taken to the biggest and best medical facility in the area. But the medic looked me squarely in the eye and told me that they have lots of experience with snake bites right here in Etowah.
Of course they do.
“If he’s a righteous man, God will heal him,” O’Connor told me before he was taken away.
God and antivenin, perhaps.
+ + + + +
“Is your partner allergic to horses?” I knew that antivenin is produced in horses, that it is potentially fatal to people with an allergy. But when I let my mind race through the seven years we have known each other, I realized that I had never seen Mulder anywhere near a horse; never heard him even mention the creatures.
I told them I didn’t know. My voice was as weak and powerless as I felt at the moment.
But the decision was made. The envenomation was obviously too severe to wait for a skin sensitivity test. They went ahead, pretreating with Benadryl and adrenaline, just in case. Twenty vials to start, the doctor ordered. It sounded like a lot to me.
It was immediately apparent that Mulder did have a sensitivity. His breathing became labored; he lost consciousness. If not for the antihistamines, he would have gone into full-fledged anaphylactic shock.
I stood and watched. More antihistamines. More adrenaline. Steroids. They couldn’t not give him the antidote; they had no choice. They just had to play this game, administering the cure, and the drugs to make sure the cure did not kill him. It was a roller coaster of sorts, the hills and valleys wreaking havoc on my partner’s system.
I almost preferred when the allergic reaction had the upper hand. At least then Mulder was quiet, wasn’t crying out in agony.
I finally found my voice, and asked them to treat his pain.
The concern for his airway, from the bite on his neck and from the shock, led the doctor to hold off on providing relief from the pain, I was told. If they sedated him, when he still wasn’t stable, it was more than likely they would end up intubating him; putting him on a respirator.
So much of medicine is a gamble, decisions made on nothing more than faith that you are doing the right thing. This doctor felt it better that Mulder be in pain and breathing for himself than comfortable and on a machine. I was glad I didn’t have to make such a judgment call. I don’t think I would have been able to ignore my partner’s pleas for relief.
It took over an hour to administer the 20 vials. In the mean time Mulder’s initial lab work came back. I didn’t know then what I know now; didn’t know that venom is made up of several complex enzymes that each provide invaluable aid in the snake’s effort to catch, kill, and digest his prey.
So I didn’t know what to expect from the studies of Mulder’s blood and urine. Didn’t understand why the doctor ordered immediate hyperhydration with saline. Didn’t understand that the venom breaks down muscle tissue, causing potentially dangerous buildups of myoglobin, calcium, and phosophorus in the kidneys. Didn’t understand that complete renal failure was a real possibility; one the doctor was hoping to head off by flooding Mulder’s body with fluids, diluting the toxic waste accumulating in his kidneys, to be followed by a diuretic to flush it all out. They would do this over and over, as long as it took.
I understand it all now.
The antivenin had a noticeable and positive effect on the bites on Mulder’s upper body. The swelling stopped, and even began to recede--the tide was beginning to turn back. This was an especially welcome sight on his neck. Concern for his airway lessened, and I knew this meant that Mulder’s torture would soon end with the aid of morphine.
But the bites on his hand and leg continued to swell. Too much venom for the amount of antivenin, leaving the bites located furthest from the point where the antidote entered his body, the bites located where veins are small and blood-flow more easily restricted, to worsen unchecked.
This meant more antivenin, more allergic reaction. More time on the roller coaster.
+ + + + +
But first they’d moved him to the ICU, where I now sit, where I have sat for the past three days.
They ended up giving him a total of 50 vials of antivenin over those first two days. Thirty initially, then 10 more 12 hours later when the edema and ecchymosis in his ankle refused to respond. Then five more six hours after that, and five more still six hours after that. If this had happened in DC--anywhere but here, most likely--the hospital would not have had anywhere near that much antivenin on-hand. But this place seems to have an endless supply.
His hand came around, and started to improve, after the first day. The ankle remains a concern. It is swollen to the point of unrecognizability, the skin pulled so taut it is shiny and hot to the touch. But it has not worsened, so they have stopped the antivenin. And so far the tissue remains alive; the venom, with its ability to destroy tissue to the point where necrosis sets in, has not gotten the upper hand. But it could happen at any time.
That’s the amazing thing about venom. It hangs around, keeps trying to accomplish its goal. Keeps trying to kill its victim any way it can.
It anticoagulates the blood, so the prey will bleed to death quickly. You would think it would not be able to have much effect on something as large as a man, but you’d be wrong--it just takes longer. Mulder’s blood counts fluctuate wildly from one test to the next. His hemoglobin level hovers around the area where a transfusion would be ordered, then recovers slightly--his body fighting the invader itself, and winning the battle, at least temporarily. I’ve been warned that his blood work could be abnormal for weeks after this. But each time a nurse takes a blood sample, I pray for the news that his levels have returned to normal. But it hasn’t happened.
And his kidneys. Daily they have performed the hyperperfusion treatment, pushing so much saline into his blood it’s no wonder to me that it won’t clot. But no sooner do they dilute the fluids in his body to a ridiculous degree then they administer Mannitol, which flushes it all out at an alarming rate; through his kidneys, keeping them safe and functioning.
+ + + + +
As for Mulder, he sleeps. He sleeps almost all the time, except when awakened by nurses to take the medications that must be given orally. Most of the time when he is awake he has no energy to speak. He only looks at me, tired and unsure. His eyes are slightly unfocussed, like his attention is not on the world outside. He seems aware of the battle that is waging within his own body. But each time he wakes the drugs and the illness quickly pull him back under.
And as a result I have had time. Time to do research and quiz Mulder’s doctor on the etiology of rattlesnake bites. The man has been at this hospital less than a year, but he told me wryly that he considered himself “somewhat of an expert” on the bites. And I believe him. His care of my partner has been thorough, and administered confidently and competently. My big-city snobbery about quality of care in small rural hospitals has taken a hit, but then this is an abnormal situation.
And I’ve had time to think about that, too--the situation. Time to try and decide what exactly happened here. And how. And who was the “good guy” and who was the “bad”--if there was such a thing. And where all this fits in with my own beliefs, and how I can reconcile the two. It’s not things I want to consider, not with Mulder lying there like he is.
I wonder what he thinks happened. I wonder what he will tell me when he is up to it. I wonder what Enoch O’Connor was talking about when he said Mulder now knew what side he was on. The answer might be found a few doors down the hall, in O’Connor’s room, but for some reason I can’t make myself go in there. The man scares me. It’s not the snakes, though Lord knows I hate them. His zealotry scares me. His conviction scares me. His certainty scares me. I have conviction in my beliefs. I know I do, and I am comfortable with them. But that is what it is--comfort. O’Connor feels so much more. What would that be like, to feel faith and belief coursing through your veins, hot and passionate and powerful, like the venom of a snake? Is my “comfortable” enough?
And I wonder about Mackey. I wonder where he went, why no one has been able to find him. I wonder how we could have been so completely fooled by him. Was it his collar and his outward demeanor that fooled me? He looked like a man of the cloth, so we automatically saw him as trustworthy? We took his every word as, well, as gospel. But he violated Gracie. He very likely killed Jarrod Chirp and is responsible for the attack on Mulder. But I know I never doubted him, never suspected him. Because he looked the part.
So many questions, and no answers.
Mulder stirs, and I jump from my chair. Each time he wakes I need to see him. Need to look in his eyes and gauge his condition, look for insight into the level of his suffering. That he has barely said a word to me in three days tells me volumes already. I wait for him to engage with the world again. Wait for his internal journey toward recovery to reach its destination. The doctor tells me he is doing as well as can be expected, but he doesn’t know Mulder, and his recuperative powers. I know he is heavily medicated. But that has never stopped him before.
His eyes meet mine, and I know instantly that this time he is back, so I bid him good morning.
He blinks, and his eyes narrow. “Morning? When?” he asks.
He really is back; that’s always his first question. “Three days, Mulder,” I tell him. “You’ve been here three days. How do you feel?” The familiarity of the scenario playing out between us comforts me.
“Terrible.”
“Are you in pain?”
“My foot is killing me.”
“It’s still terribly swollen, Mulder. You were badly bitten on the ankle.”
The mention of the word “bitten” makes him visibly shudder. I can’t imagine what it must have been like. That is something I purposefully did not allow myself to think about these past days. He looks around his bed, and takes inventory of the paraphernalia surrounding it. There is nothing special, nothing he hasn’t seen before. Only the multitude of bags of IV solution hanging over his head are different. With the reduction of swelling in his left hand, the second IV was moved from his foot to his left arm, so he has them in both arms now. But he doesn’t ask. He will eventually, but for now he has other things on his mind.
“Mackey?” he asks me.
“Disappeared,” I tell him. He nods, as if he knew that already. “What happened, Mulder? Can you tell me?”
He closes his eyes--whether to try and remember, or try and forget, I cannot tell. “Snakes,” he says. “Everywhere.”
“Mackey had snakes too?” I ask him. He shakes his head.
“No, Scully. He was a. . . .” He stops. Thinks for a moment. “It was him, Scully,” is all he can say before we are interrupted by the arrival of a nurse, who is clearly delighted to see how alert her patient is. Our conversation must wait.
+ + + + +
The doctor quizzes Mulder at great length about how he feels, what he is feeling, where it hurts. He delivers the news about his condition, from the blood work to the kidneys to the swelling and bruising, in a clear, concise, understandable fashion. For some reason Mulder does not seem surprised by the incredible damage done by the bites.
But the most attention is reserved for his foot. Mulder complains that it burns terribly, which the doctor tells him is to be expected. When asked to wiggle his toes, Mulder tries his best, but the swollen digits barely move. Trying to move his ankle is just too excruciating. Even touching it causes Mulder to cry out in agony. Even the weight of the sheet, my partner claims, is too much to bear. So it is left exposed, misshapen and discolored, for all to see. I keep catching myself looking at it, though I try not to.
The doctor decides that enough is enough, and calls in a surgeon. He determines that the swelling has to be compromising the blood flow in the foot to the point where tissue death is imminent. Something must be done, surgically, to relieve the pressure beneath the skin.
It’s called a fasciotomy, and the idea is to cut the skin open, relieving the pressure beneath. The skin is left open until the swelling goes down, when it is then closed. If it works, Mulder will be left with a large jagged scar snaking from mid-calf around his ankle and across his foot. A permanent visual reminder of this ordeal.
If it does not work--if the swelling does not abate, or infection sets in--he could lose his foot. Mulder and I both nod numbly as the surgeon takes his leave.
I chase after him, to ask him the hard questions that I don’t want to ask in Mulder’s presence. I want to know what he thinks the chances are of saving Mulder’s leg. He is appropriately evasive, of course. Tells me that he has seen the procedure work more often than it has not. But to be honest he has had to perform his share of amputations.
Everyone here has experience with the complications associated with snakebites, I realize. What kind of place is this?
+ + + + +
As I return to Mulder’s room, I see Enoch O’Connor coming out. He moves quickly, in the opposite direction, so I do not speak to him. Just as well; I will find out from Mulder what he wanted.
But when I enter my partner’s room, he is deeply asleep. It seems impossible that he could have fallen asleep so quickly after O’Connor’s departure, so I assume the two men did not speak at all. That is just as well, too, I think. I settle myself into my chair again to wait until they come to take him to surgery.
After a few moments Mulder starts to writhe in his sleep. I am sure he is having a dream, so I move to wake him before he hurts himself, or upsets the lines in his arms. But when I stand his foot catches my attention as it always does.
It’s oozing. There is a whitish substance oozing from the two bite wounds. If it is infection, not only could he lose his leg, it could kill him. I rush to the nurse’s station to call for help, leaving my partner to thrash around in his sleep.
+ + + + +
No fever. White blood cell count within the limits of normal. None of the systemic signs of infection are present. And yet everyone saw the substance oozing out of his ankle. The surgeon says this is an indication that they should proceed with the surgery without delay. The medical doctor isn’t so sure and orders a culture taken of the substance.
I am completely confused.
The two men actually air their disagreement in the room, in the presence of the patient, who is now awake. I assume Mulder is not listening, and I have no opinion to add to the fray, so I stay by his side and just listen to them argue. The surgeon doesn’t even want to wait for the results of the culture. If it is a local infection, he says, every minute will count. He’s right about that.
Suddenly Mulder’s voice draws my attention back to him.
“It doesn’t burn,” he says quietly.
I look at him quizzically, and he says it again. “My ankle. The burning’s gone.”
That’s enough for me. I stand up and interrupt the doctors to give them this piece of information. The doctor gets out his tape measure, and the swelling has gone down 2 centimeters in the hour since the oozing started. He looks at the surgeon with a sense of smug righteousness, as if something he did was responsible for this sudden improvement. We all know that isn’t the case.
But what was responsible? I don’t really care, as long as the swelling continues to go away.
+ + + + +
With at least a temporary end to the latest medical crisis, Mulder and I have time to talk again. There is so much we could talk about, but I wonder if we will. I will leave it up to him, and simply remind him that hours earlier he had been in the middle of telling me something about Reverend Mackey.
Mulder looks up toward the ceiling for a moment, then goes to run his fingers through his hair. He picks up his left hand to do this, and stops short when he looks at the still-swollen fingers. He wiggles them.
“They look like sausages,” he says, clearly trying to lighten the mood, and perhaps even drop the subject. I will let him if he wants to; we have time. He drops the hand back to his lap.
“It’ll go away,” I tell him.
He nods but says nothing. After a moment he begins again. “Mackey was. . . . I don’t know what Mackey was, Scully. The devil. A demon. I don’t know what he was.”
“Mulder, that’s nonsense.” I firmly believe it is, too. “You’ve been through an incredible trauma,” I start, but he cuts me off.
“We were alone in that room, Scully, and suddenly it was full of snakes. He asked me if I was a righteous man, and then there were snakes everywhere. They were _in_ my clothes, Scully, how could that have happened?”
I don’t know. I don’t know how that could have happened, but I cannot believe what Mulder is suggesting. “Mulder, you don’t believe in the devil.”
He turns his head away from me, and mutters “Call it whatever you want, then Scully.”
+ + + + +
The radical and sudden improvement in Mulder’s condition allows me to leave for the night for the first time since he was bitten. When I return in the morning, I cannot believe the improvement. The treatment of his kidneys has been stopped--deemed no longer necessary--so he only has one IV now, moved to the back of his right hand since I last saw him. His left hand is barely swollen. The other bites on his upper body show nothing more than bruises. His foot, though still very swollen, is looking like a foot again. Mulder is awake and flipping TV channels, and looking bored.
“Any news on Mackey?” he asks as I enter.
I hadn’t even bothered to look into it, and I offer to go check. He tells me that I can do it later. When I ask how he is feeling, he says better.
But he’s still tired, and there is still pain, and his blood coagulation factors are still abnormal. He’s better, but far from well.
He’s quiet, pensive. He doesn’t speak to me, and he quells any attempts I make at small talk with brief answers that don’t facilitate conversation. Instead he continues to flip through the TV channels idly--not at the rapid-fire pace he usually uses when he is actually looking for something to watch. It’s just something to do. When he lands on the Discovery Channel, and we see that a documentary about snakes is on, he pauses long enough to smile ruefully at me before turning to the next channel.
When I ask him what is the matter, he tells me nothing. He says he’s just tired. I have no doubt that he is, but I also have known him too long. There’s something more, and I can only hope he will tell me in time.
I decide to go and check with the authorities about our suspect, and tell him I’ll be back with an update.
+ + + + +
When I return I am stopped by the doctor with the results of yesterday’s culture. The substance oozing from the bites on Mulder’s ankle was rattlesnake venom. He knows of no medical precedent for something like this, and there’s no plausible scientific explanation, either. The antivenin should have broken down any venom in Mulder’s body by now. He is at a loss to explain this, he says.
So am I.
I go to tell Mulder this amazing turn of events, but when I enter his room he has one thing on his mind.
“Mackey?” is all he says. I think he’s hoping for good news, but when I tell him we have nothing, that he has disappeared, he clearly isn’t surprised. He tells me we won’t find him.
“People think the devil has horns and a tail,” he tells me. So he’s back on this again. “They’re not used to looking for some kindly man who tells you what you want to hear.”
“He’s just a man, Mulder,” I tell him quickly. “Just like O’Connor.”
“Not like O’Connor,” he replies with conviction. Then he divulges what has been keeping him so quiet when he says “If this was some kind of test, looks like I failed.”
He couldn’t be more wrong. “I’d say if it was, you passed with flying colors,” I tell him. He’s looking at me questioningly, as if he doesn’t understand--and he doesn’t, not yet. “You’re alive, aren’t you?” I point out. Despite everything he went through, he’s alive, and whole. And medicine can’t entirely explain why.
“Proud and fancy free,” he says.
I don’t know what he means by that, but he grins so I smile back at him. And then I remember O’Connor promising me that if Mulder were a righteous man, God would heal him.
I have nothing but complete faith in the goodness
of my partner, so maybe that’s exactly what happened. Who am I to question
something like that.
<THE END>