Solstice poetry editor Robbie Gamble’s essay, “Exit Wound,” was honored as a Notable Essay in The Best American Essays 2020. “Exit Wound” originally appeared in the Fall 2019 Issue of Solstice, which was a print-only edition. To honor Robbie’s achievement, we’ve reprinted it below.
Robbie worked for twenty years as a nurse practitioner with Boston Health Care for the Homeless Program. He has also worked with No More Deaths, a humanitarian organization in Arizona working to serve migrants, experiences he recounts in his recently released chapbook, A Can of Pinto Beans.
Exit Wound
I barely noticed the police helicopter hovering overhead as I biked home from graduate nursing classes, pedaling down Main Street past the Bunker Hill Mall on a leaden November afternoon. I did register the four or five cop cars, lights flashing but sirens off, swerving through the parking lot to set up a perimeter in front of the 99 Restaurant & Pub, a middle-of–the-road steakhouse that served as the main watering hole at the center of the drab mall. But I didn’t pay them much mind; Charlestown in the mid-1990’s was one of those tribal, insular Boston neighborhoods where a lot of ugly stuff—turf wars, drug deals gone bad—went down, and no one ever talked about it. Charlestown is notorious for its Code of Silence; nobody who grew up there ever saw, or heard, anything criminal taking place. Suffolk County prosecutors complained bitterly about the absence of eyewitnesses willing to come forward, even for the most blatant crimes. I didn’t expect to hear any more about this particular flurry of police activity as I pedaled on to Somerville and home, to help my wife get dinner together and bathe our three boys, read them bedtime stories and then hit the nursing textbooks.
So I was surprised to learn next morning that I had ridden past a mass shooting in progress: five North End mob types preparing to tuck into an early dinner, gunned down by two assailants, leaving four dead and one badly wounded. The Boston Globe headline read “Steak Tips to Die For,” followed by an account of the action that unfolded in front of scores of patrons, including two off-duty cops a couple of booths over, who radioed for all the backup I saw screeching in as I passed by, the gunmen bursting out the door at just about that moment, to be tackled on foot in the parking lot, cuffed, and apprehended. This time, there were plenty of eyewitnesses for the prosecution to pick over, as it was pretty hard for nearby diners to ignore the five wiseguys slumped in their entrees. The gunmen, a father and son, were sentenced to life, ending a particular spasm of violence between rival Mafia families in Boston. Locals joked that the 99 Restaurant should be renamed “The 95” to account for the lost patrons. That’s how folks deal with trauma in Charlestown.
It’s a short steep walk uphill from the mall to the Bunker Hill Monument, a compact National Park commemorating the first major battle of the American Revolutionary War. The monument is a simple granite obelisk rising high out of a grassy square, and my boys loved to climb the 295 spiral steps inside, counting as they huffed their way up to the chamber at the top and the four windows that opened onto a panoramic view of the Boston skyline and harbor, the three-masted profile of “Old Ironsides” riding at anchor, and closer by, Charlestown’s densely packed square mile of housing projects and townhouses sprawling over what had once been the open slopes of the battlefield. If we timed it right, we would descend in time for the musket demonstration, where a park ranger, dressed in authentic colonial militia garb, would march out to present a well-burnished flintlock rifle to the gathered knot of visitors. My oldest son, Joseph, was particularly fascinated by the weapon: the heavy brass fittings, the painstaking ritual of cleaning, priming, and loading the piece. The ranger would fire off a blank round in the direction of downtown, a deep-throated roar which echoed off the gentrified brick townhouses on the perimeter of the monument square, sending all the neighborhood pigeons up in startled flocks. The boys were always enthralled.
From a military standpoint, the Battle of Bunker Hill was a British victory, as the colonial forces had to retreat to Cambridge when they ran out of ammunition. But they inflicted terrible casualties on the British and proved that they could hold their own against the most powerful military force in the world. The war dragged on for eight more years, but the initial successes of colonial militiamen in their skirmishes at Concord and Lexington, and then holding their ground at the barricades on Bunker Hill, helped give rise to the narrative of a body of skilled marksmen who could keep tyranny at bay. When the dust of the war settled, the idea of “a well-regulated militia,” and with it the uninfringed right to keep and bear arms, was enshrined in the Second Amendment of the Bill of Rights.
I passed my nurse practitioner boards, and I went to work for a group called Boston Health Care for the Homeless Program, an organization that delivered healthcare to homeless adults and families in the greater Boston area, meeting with people in the streets, in shelters, in hospital clinics, in seedy motels, in safe houses for battered women, in temporary family housing sites. I worked for the family team, making what were essentially house calls to mostly single moms and young kids living in transient shelters, waiting to be eligible for a permanent place to live. I saw a lot of moms with PTSD and depression, kids with asthma and scabies and behavioral issues as a result of being bounced around from shelter to shelter while waiting for a housing application to come open.
One day I was making my way down a long dank corridor of cramped motel rooms, knocking on every door to see if anybody needed Tylenol, a blood pressure check, a new prescription for their psych meds, maybe just another adult voice to talk with, and a beaming young man opened the door to his room and invited me in. He told me he was recovering from being shot seven times, a drive-by at his son’s seventh birthday party, and that, incredibly, he had just been grazed by each shot: in his shoulders, both buttocks, his torso, a thigh, a calf. He still had a couple of dressings, which I checked, and his wounds were indeed healing well. “All he got was meat!” he grinned, “The guy was packing a .22—just pussy bullets, I tell you, pussy bullets.” And he was one of the happiest people I ever saw in those dreary motels. I couldn’t say if he had always been that way, or if coming through a fusillade of metal with all of his organs intact had given him a joyous new grip on the world.
We moved from Somerville, on the northern fringe of the city, to Jamaica Plain, one of the few Boston neighborhoods that managed to maintain some degree of socioeconomic diversity, with elaborate Victorian homes hard up against generic subsidized housing blocks, and a bustling commercial core of independent businesses running down Centre Street. The neighborhood curled around the serene body of Jamaica Pond, a beloved public greenspace with community boating, grassy slopes and shade trees shared by tweedy dogwalkers, picnicking Dominican families, fishermen, lesbian couples, aging hippies, hard-driving hipsters, and wizened Chinese seniors practicing Tai Chi on the shore. Our boys fell in with the knot of neighborhood kids, biking and rollerblading endless figure-eights at the quiet end of our street, rushing out when the snow fell to go sledding in the Sugarbowl, a steep natural depression in the rolling slopes beside the pond.
After nine years of knocking on motel room and family shelter doors for the family team, I shifted to the organization’s respite care program, a 100-bed facility where homeless people could stay and receive care when they were too ill or injured to stay in shelters or out on the streets, but didn’t need all the services of round-the-clock hospital care. My patients came for management of their diabetes and asthma, some had broken bones from assaults or being hit by passing cars, others had pneumonia, frostbite, cirrhosis, or HIV, and many were also withdrawing from drugs and alcohol. We helped them to heal, connected them with primary care and substance abuse treatment programs, and sent them back out again. About this time, my marriage frayed, and my wife and I decided it would be best for the boys if we eased our daily tensions by separating. I moved out into an apartment a few blocks from our Jamaica Plain home.
One crisp November night I was biking home from work, and I saw a large cluster of flashing blue lights blocking off Centre Street, just a few blocks past my apartment. Not an unusual sight in the neighborhood, but the next day I learned there had been a fistfight among three young men eating slices at the Same Old Place pizza parlor. The fight escalated, a couple of the men drew weapons, and in moments all three were dead: two shot, one stabbed, and a woman passing by was grazed in the leg by a bullet. The next day the owners cleaned up the mayhem inside, replaced the plate glass storefront that had been shot out, and put up a picture frame on the wall around several bullet holes left there, as a reminder of the incident. Once the police tapes came down, the neighborhood bustle and flow resumed as it had been before. As far as I know, there were no criminal proceedings after the incident, as everyone involved in the fight was dead.
When I think about this violent night, as well as the gangland slaying I biked past in Charlestown years earlier, both events unfolding within 100 yards of my daily routine, I’m surprised at how little they affected me. I didn’t feel particularly traumatized or unsafe because of what happened. Maybe it’s because I grew up during the Cold War, under the ever-present threat of nuclear annihilation, and my psyche is deeply imprinted with the idea that if your number is up, well then, it’s up. Maybe it’s because I dealt with traumas all day long in my work: battered women, neglected kids, guys spiraling hopelessly down in their addiction, and the experience of being somewhere near a shootout didn’t seem any more traumatic than the parade of human suffering I witnessed most every day. I don’t think often about those seven human beings who died, or the families they might have left behind. Maybe it’s because they were all men with violent backgrounds, I mean they weren’t schoolchildren or tourists or parishioners, and some part of me makes that self-righteous calculation that, well, maybe they got what was coming to them. Or maybe I’ve gotten so used to violence, and particularly this American brand of let’s-take-matters-into-our-own-hands gun violence, in the daily news feeds, in movies and music, all the popular culture, that the fact some wiseguys got popped over dinner isn’t terribly surprising, doesn’t shake me at all.
Years rolled by, Martha and I tried to work our conflicts through in couples therapy, and then we didn’t, and eventually we got divorced, on amicable terms. One by one the boys wound their way through high school, got driver’s licenses, started peeling off to college. One day at work I was eating my lunch while typing up notes on the patients I had seen that morning, when the admissions nurse flew by, chirping “Your afternoon admission will be here soon,” and she dropped a sheaf of faxed documents onto the desk. They were from a nearby rehab hospital, a collection of histories, progress notes, lab results, and med lists, from which I could piece together the story of the patient I would be admitting to respite care. I finished my sandwich as I started to leaf through them, and I realized I was going to be in for a long afternoon.
What I gathered from the dry narrative in front of me was that the patient was a man in his early twenties, who I’ll call Mikey, a heroin addict. He was from Charlestown of all places, a scrappy street kid, a knucklehead. Several months before, he had been involved in a drug deal that went ugly, and someone shot him in the face. The bullet entered just to the right of the bridge of his nose, travelled diagonally through his brain, and blew out the left rear of his skull. He survived the attack somehow, and neurosurgeons were able to keep him alive by removing a big portion of the damaged bone and brain tissue around the exit wound at his left parietal lobe. He had gone through several reconstructive surgeries, but still was missing a big section of his skull.
Amazingly, for all of the brain matter that had been removed, Mikey was still able to speak coherently, and walk with a limp, his right side now being weaker than his left. The damage had left him subject to sudden mood swings, with poor impulse control, and the staff at the rehab hospital noted frequent behavioral problems. The biggest thing was that he had intractable pain in his head, and conventional medicines, even fairly high-dose narcotics, barely touched it. He believed that the only thing to help his pain was heroin, and apparently he had left the rehab hospital a couple of times, gone out and gotten high. He said he felt better, at least for a little while, when he returned. His rehab doctors were concerned about the relapses, that because of his lack of impulse control, he could easily overdose, and die. They were also concerned about the huge hole in his skull, covered over only by a slack layer of scalp tissue. If he were to fall on his head, or start a fight and get hit in that open area, he could suffer further brain damage, and die. He needed further surgery to attach a titanium dome over the unprotected part of his skull, but the neurosurgeons were reluctant to perform the procedure if he were still using narcotics of any kind, prescribed or illicit. They were sending him to our respite facility because of our experience in handling homeless folks with complicated addiction issues, and the plan was, if he could stay with us for thirty days, clean and sober, they would go ahead with the surgery.
The admission nurse brought Mikey up on to the floor and introduced him to me as we headed for the exam room. He was a skinny young man with watery-blue eyes, wearing jeans and a hoodie, who shuffled down the hall listing slightly to the right, and he seemed kind of jittery as he shook my hand, trying to scope me out. His greeting was a little slurred, but intelligible, and he was able to put together complete sentences. The plastic surgeons had done a tremendous job reconstructing his face, leaving only a small puckered scar beside his nose. But when he turned around, there was a grapefruit-sized concave space scooped out of the back of his shaved head, his scalp hanging loosely into the void left by the surgeries. I asked him if he understood why he was coming to stay with us, and he said that he did, that he needed to be somewhere he could stay clean and get ready for the next surgery. He was very earnest, trying to make a good impression: “I get it, Rob, I know I gotta get this surgery done. I know I gotta be clean, but it’s hard, man. My head hurts so much, you don’t know, it’s all the time, and what can you do for my pain?” He wanted Percocets, and I explained to him, for the first of many times, as I am sure the rehab docs did before me, that we couldn’t give him narcotics now, that the surgeons needed him to be opiate-free; we could give him Tylenol and Motrin, and hot packs, and extra pillows, and anything else we could think of. He nodded, “Yeah, yeah, Rob, I get it, I know you’re trying to do the best thing for me, Tylenol doesn’t do shit, but I know what you’re trying to do, and I’ll do my best too, but the pain is bad, I’ll try, I really will.” And he seemed to mean it, but every five minutes he would circle back to the pain, and could he have a Percocet, just to start out, and we could take it from there? And I would re-explain the surgeons’ plan, and he would agree, and I did a brief physical exam while we circled around and around.
He was in surprisingly good shape, given his severe injury, just the right-sided weakness and some limited vision, and of course the monstrous crater in his skull. Finally, I was able to finish up, and I showed him to his room, his bed and his locker, where to get the elevator to go downstairs for meals, explaining everything several times over to make sure he got it clear. He seemed really grateful, and he shook my hand, “Thanks, Rob!” as I headed back to my desk to type up his admission note.
Later in the afternoon I picked up Mikey’s chart, a heavy three-ring binder with all of his documentation now collated inside, to return it to the rack of charts in the nurses’ station. There was an open slot on the top shelf, and I slid it in, right at eye level. As I did, I glanced at the label on the spine of the chart, with the patient’s room number, name, and date of birth, and I suddenly felt weak at the knees, almost dropped to the floor. The date of birth printed on the label was 8/5/1989. August fifth, nineteen-eighty-nine. The same day that my eldest son was born. The two of them, Mikey and my son Joseph, had come into the world on the very same day.
I was immediately carried back into the intensity of that morning. The baby had been two weeks overdue, and we were squirrely with anticipation. Martha’s waters broke some time after breakfast, and the waves of contractions began, subtly at first, but picking up quickly like a sudden storm rolling in off the ocean, and we drove to the hospital where she was set up in a room and the waves crashed higher and harder as Martha folded into herself drawing on mysterious strengths to bring this baby out of her, and I was awed by her determination and I felt helpless standing at the bedside in the presence of her thunderous waves of pain. I had to step out of the room for a moment to catch my breath and composure, and when I returned she was ready to push, filled with a primal ferocity. And then there he was, all new and human and breathing, and we said his name is Joseph, and they laid him on her belly and he looked out at us with those solemn, grey, newborn baby eyes that seemed to hold all the deep wisdom of the entire unfolding universe he had just been born into.
Then I thought about Mikey, and the arc of his life, so different from Joseph, who was now a young man studying studio arts at a bucolic college campus. What obstacle had dropped on Mikey to make his path veer off from all the privileges my son enjoyed? Was it the meanness of poverty, or some crippling family dysfunction? Was it crappy schools, or growing up in a neighborhood saturated with drugs and violence? Was it just shit-bad luck, like the chance meeting that ended with him getting a bullet in the face?
And what had his birth been like? Was it at the very same time as Joseph’s, late afternoon? Did his mother labor hard for him, hold him close when he was born, did she love him? Was his father there? What vision did he hold in his wise newborn eyes? Could he have imagined he would end up like this?
Mikey struggled through the next several days. The pain in his head was unrelenting, and all of our puny measures didn’t do shit for him. He would ask for a Percocet, and when we reminded him of the surgeons’ plan he would blow up, then feel sorry and apologize, try to cope for a while. He would obsess about heroin, “I tell you it works, Rob, like nothing else. The pain just goes. I’m having wicked urges to use right now, please, I don’t want to book out of here, can I just have a Percocet, a Vicodan, hey, even just some Codeine to get me through?” We circled around again and again. The only thing that distracted him from the pounding ache was to engage with staff, to have someone’s complete attention, and he would shuffle doggedly after me as I moved around the floor, trying to meet the needs of my twelve other patients. He was so earnest, trying so hard to hang in moment by moment. It must have been unbelievably difficult to live within that damaged brain, with that level of impulsivity, but we were all exhausted by his neediness, the effort required to keep his focus on staying clean. I was having a hard time imagining how we would be able to get him to keep it together for a whole month.
The fourth day after Mikey’s admission, I looked up late morning, and realized it was unusually quiet on the floor. “Where’s Mikey?” I asked the charge nurse. “Oh, he’s downstairs in the lobby with a visitor. I think it’s his mother. I’ll check on him in a little while.” I was thrilled with this bit of news, glad that his mother was in his life, glad for the break while she took on the task of giving him complete attention, and I hustled on to spend time with my other patients.
An hour later the charge nurse pulled me aside, looking disgusted. “You’re not going to believe this. The lobby security guard just phoned up, said he had been watching Mikey and his mother, sitting and chatting in the lobby. All of a sudden, they both seemed to get kind of anxious, and his mother looked around and then slipped him a little package. The guard went over to check if it was some kind of contraband, and Mikey freaked out. He just jumped up, dropped the package, and ran out of the building and down the street. It was a bag of heroin, and a hypodermic kit. His mother brought him heroin.” She snorted. “His own mother!”
I looked out the window into the low bank of overcast clouds that seemed to be trying to flatten the city. Mikey was gone, gone for sure. And I thought about the lengths we parents will go to, in order to protect our children from suffering, and that feeling of weakness welled up in my knees again. I tried to shake it off as I stepped back out onto the unit floor, to check on how my other patients were doing.
I made it through the rest of the shift, biked back home to my quiet Jamaica Plain apartment, pulled some dinner together from leftovers. After I ate, I called Joseph at his college dorm, three hours drive away in upstate New York. He didn’t pick up, he almost never did right away, and although I knew he would call me back later, I stayed on the line to listen to his recorded message all the way through.
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