Patterns

by Michael Hanson

Patterns

I’ve had this image in my head where I’m standing in a well-lit room holding my cousin Patrick’s brain. Light fixtures flicker and the air smells like embalming solvents and I’m there alone holding Patrick’s brain, the edges of the room with that warped look you see in stainless steel, like there’s water on everything, and I’m standing there looking at folds and valleys and the last word that comes to mind is unremarkable.

This is what happens when you dig up an autopsy. Twenty bucks to the county court for a little peace of mind. Piece of mind. People say that, say they’re gonna give you a piece of their mind. They don’t mean it that way, hands cupped around a thalamus, an offering.

Patrick’s brain weighed 1,350 grams. The things the government knows about you. The autopsy is five pages long and set with stocky black font with headings and subheadings and dates and page numbers. Reading through it, I can trace the hand of one Victor V. Froloff, Assistant Medical Examiner at the Ramsey County Medical Center in St. Paul, Minnesota.

Victor V. Froloff has a long and loopy signature, and I’m jealous he knows my cousin Patrick in such an intimate way. I think about this man with his strange Slavic name, imagining the scent of his freshly scrubbed hand, that cheap doctor-soap smell, that tinge of latex from the surgical glove he would have pulled off before pinching his fingers around a fat, ballpoint pen to ink his long and loopy signature below the words: mixed drug toxicity (heroin, amphetamine).

A few things happen when you overdose on heroin. The central nervous system shuts down, that is, your pupils shrink to the size of pinheads, your breathing slows and slows, what doctors call acute pulmonary edema. Your mouth goes the way of sandpaper, tongue discolored, skin discolored, often bluish gray. You’re likely to have stomach cramps or spasms, to piss yourself, to shit yourself. You go from drowsy to delirious to comatose, and if you keep going, well…

They found Patrick in the basement wrapped in a blanket. May is supposed to be a happy time in the Midwest, when the ground thaws and flowers bloom, but there was Patrick wrapped up like a lamb—Patrick, who, five years my senior, was my closest male relative besides my brother, whose body shared likenesses with all the men on my father’s side, from the slant of our jawlines to the stocky build of our shoulders, our bulging bellies, our smaller than normal feet.

Victor V. Froloff sees my cousin’s body in a different way. He does not see it as one in a network of bodies—bodies with connections beyond ligaments and bone structures. Still, Victor and I are after the same thing—in this case a story. This story isn’t just about my cousin Patrick, either. It isn’t about one man in my family, but a series of men: Patrick and myself, my father and grandfather.

Every family has things they don’t talk about, but stories have a way of getting out. Families are just collections of stories when you think about it. You might view a family member one way, and then you hear something about them that changes everything. Childlike heroism evaporates. Villainy becomes a matter of complication. I’ve heard stories from family members at Thanksgivings and Christmases, stories of infidelities, of neuroticisms, of anger and resentment and, in some cases, forgiveness.

Growing up in Minnesota, I heard less about my dad’s side of the family. I knew from stories my father told me that my grandparents met at nursing school in St. Paul, then moved to the eastern side of Wisconsin to a town called Fort Atkinson, where they both worked in the same hospital. My grandfather was a nurse anesthetist, making good money bringing people to that place they go during surgery (I’ve had this image in my head). One time my dad took our family to Fort Atkinson and showed us the house he grew up in, a big Victorian on the edge of town. He told me about a neighbor that pointed a shotgun at him for walking through his property, even told me about a young boy who’d been butchered in a barn nearby by some local psychopath. People in the Midwest tell lots of stories like that, but the way my father told it, he couldn’t help emphasizing how close I was to that boy in age, like the story wasn’t about me, but damn-well could be.

I’ve had this other image in my head. There’s the one where I’m holding Patrick’s brain, but there’s also one of my grandfather, his face like my father’s, like my own face, and he’s standing over me with a knife in his hand. It’s a clear summer day and we’re in the mouth of this big brown barn, and the sky is blue and there’s wind in the trees and my grandfather has his knee on my chest, arms pinned behind my back, and he’s got this knife to my throat. I don’t think that I am choking but he keeps telling me to hold on, that the air is coming soon, and I begin to wonder if I am choking, and his weight presses on my chest (I can feel it in my veins), then the world goes blank and I am me again.

There are other images, too, some which I’ve invented: my grandfather in a white padded room, him on a steel table with a pair of electrodes protruding from his temples, his body convulsing, then going limp.

I first heard of my grandfather’s schizophrenia from Patrick. I must have been twelve at the time. Patrick was staying the week at my parent’s house in Minnesota and we were playing videogames in the basement when he said, “you know grandpa was crazy, right? You know they put him in a mental institution, that they had to move across the state for what he did?”

Back then I had no idea what an emergency tracheostomy was. It’s when your windpipe gets blocked or swollen so bad that they have to cut a little hole in your neck so you can breathe through a tube. It happens to cancer patients or people with severe neck injuries. So imagine my twelve-year-old horror when Patrick told me that my grandfather, a practicing nurse, lost it one day and thought my aunt Sue’s friend was choking, then proceeded to pin her to the ground, this innocent preteen girl, and give her an improvised tracheostomy she did not need.

This is a story my father does not tell, will not tell. I’ve brought it up a few times, usually while drinking, and he just sighs and shakes his head, a habit I’ve inherited when asked about things that bother me. And though I don’t like to talk, I do like to tell stories, like this one of Patrick’s lifeless body splayed out on a cold steel slab, a shadowy medical examiner standing over him with a ruler in hand. The autopsy table looks like a slanted steel tray with raised edges to keep fluids from flowing onto the floor. And here we have Victor, his shoes covered in blue polypropylene sacks. He works his fingers over Patrick’s body, still cold from the thirty-six-degree mortuary chamber he’d been stored in. Victor The Traveler, readying himself to go into my cousin in ways I never could, recording his findings in that cold medical language that creates distance, but still has a strange poetry to it. He writes: 

The body is that of a well-developed Caucasian male appearing to be consistent with recorded age of 32 years old. The body weighs 172 pounds and measures 5 feet 7 inches in length.

The body is cold to touch and postmortem rigidity is present in the jaw, but absent in all large and small groups of muscles. Postmortem lividity is dark purple, non-fixed, but present over posterior aspects of the body except in areas exposed to pressure, over the face and the anterior neck area.

The head is normocephalic. The scalp is unremarkable. The scalp hair is brown, short and measures approximately 4 cm in length at the vertex. The forehead is atraumatic. The eyebrows are well-trimmed.

Patrick was thirty-two years old, the age I am now. Cousins play a funny role in the family unit, genetic mutations of the self, like siblings from an alternate timeline, an answer to the question: what if things were different? Patrick lived in River Falls, Wisconsin, a small farming town about an hour outside the Twin Cities where my father’s family moved after my grandpa’s incident. It’s the kind of town where main street still serves as the primary infrastructure, a straight road framed by false-front facades like something a cowboy once rode down. There’s a pizza joint and a dive bar and a theater marquee wreathed in lightbulbs. There’s a church and a university and people who walk and drive to each, people who, like many Midwesterners of Nordic heritage and sentiment, find it impolite to talk about themselves in public, much worse to talk about their families.

That doesn’t mean your family isn’t talked about, especially if the story is good enough. People talk over rosebushes in yards, over tablecloths at church luncheons. They talk at schoolboard meetings, talk about the nut down the street who fancied himself a surgeon, how they brought him here from the loony bin, how they got him medicated now, how he shouldn’t be a threat anymore but should still be watched with suspicion. Count your blessings, they say. You never know when it will happen to you.

The irises are gray. The pupils equal and round measuring to 0.4 cm in diameter. The corneas are translucent. The sclera and conjunctiva display no petechial hemorrhages.

Examination of the nose reveals no external trauma. Palpation reveals no fractures. The ears are formed and situated normally.

The lips are unremarkable and the oral cavity displays an edentulous mouth. There is a beard and mustache present with hair length approximately 1 cm. The cheek and chin are unremarkable. The tongue lies anteriorly along the floor of the mouth in the midline.

You don’t know how much the teeth keep a face in form until they are gone. Patrick lost them smoking meth, but when he was young, he had a sharp face, a trickster’s face. Some of my first memories of him are from the trailer park he lived in growing up. There was a field nearby with these massive cross-sections of concrete plumbing fixtures, water mains big enough to halfpipe in. There was this hill where we’d tuck our little bodies into tires and roll ourselves down—laughing, getting sick, laughing again.

Patrick’s mom, my Aunt Molly, was the party type, and for the longest time, my favorite Aunt. She had sandy blonde hair and smoked Marb Lights and ran a pawn shop in town with her husband Bill. They always had cool stuff around: the black box for stealing cable, drawer after drawer of N64 cartridges. At one point Patrick was really into Pogs, those circular cardboard cutouts with dragons and eight balls on them. Then it was every type of football or wrestling videogame he could find. We used to play-wrestle, too. Since he was so much bigger than me, we would practice doing suplexes and powerbombs on the bed. Again, I would tell him, flying through the air. Again, again, again.

The chest is symmetrical and is well developed with a normal A-P dimension. The nipples are male and unremarkable. The abdomen is slightly protuberant and displays numerous striae inferiority.

When I was little, Patrick gave me one of my first lessons in death when he took my brother and I down to the local river to fish, where we’d stuff firecrackers in their mouths and watch their guts splatter on the river stones. Bunch of little killers painting the river red. I don’t remember feeling sorry for the fish as much as not wanting to handle them. The way they wriggled in my hand, slimy scales on warm, soft skin.

The first time I began to view death as a real, permanent thing was when our grandfather died. I remember the leaves on the ground at his funeral, the strange white casket they put him in, my seven-year-old self wondering why they put him in a casket like that just to lower him into a shadow. What I most remember of my grandfather are his hands, how they’d wrap around me and pull me into his arms. He had a booming voice, too, and he’d sit in his favorite green chair with a wide smile and thick eyeglasses and press me tight against his chest so I could feel his heart beating. Then one day his heart stopped, sitting in that same green chair, standing up one last time, falling down again. His funeral was the first time I saw my father cry.

Then Patrick got Leukemia a few years later and I thought he was going to die, too. I remember his pale bald head, going to the hospital with all the machines beeping. He was in good spirits when we saw him, but I know there were times he thought he was going to die. Make-A-Wish even sent him to the Pro-Bowl in Honolulu. Nothing like shaking Brett Favre’s hand to make you feel you’ve lived a meaningful life. 

The upper extremities are well-developed and all fingers are present. The fingernails are long and soiled by dirt. No injection marks are identified.

When we got to be teenagers, Patrick and I switched from fake wrestling to drinking and smoking bowls. Patrick’s family had moved into my grandma’s house by then. The kitchen was narrow and always smelled of dinner rolls. There was a backyard we never went in because the deck behind the house had collapsed. Portraits lined the walls: my father’s permed hair at his wedding, a black and white photo of my grandfather. A glass cabinet held strange porcelain sculptures. Carpet covered the bathroom floor.

One time Aunt Molly bought all these tanning beds because she wanted to open a tanning salon. She stashed them in the basement, and I remember the prickly feeling I got seeing her use one once, like looking into a sarcophagus. She had lots of hustles like that, lots of ways to game the system. Everyone was always sick in that house, diabetes or back issues, blood disease, heart disease. She taught Patrick early on how to file for disability after his Leukemia. She taught him which medications could be used for recreation, which could be sold, even. If you have to work, work for cash so you don’t have to report it to the feds. Pawn shops, tanning salons, maybe a drug deal here and there.

The lower extremities are well-developed. All toes are present and the toenails are very long and deformed. The skin below the right kneecap displays an ellipsoid area of scarring measuring 3cm in greatest dimension. No fractures of the long bones are identified.

         My dad came to resent my Aunt Molly for the way she raised her kids, bunch of layabouts looking for the next scam, giving them free reign to do whatever they wanted, like the time Patrick lit his leg on fire fucking around with gasoline in the driveway, just pouring it out and lighting it up. Had to get a skin graph and everything.Everyone smoked in that house, too. Asses plopped in camp chairs in the garage, sucking down Marbs and Mountain Dew. I always had to hide my smoking from my parents, but it never mattered when I was at Patrick’s. Patrick really liked to snort things. That’s how he took the heroin that killed him. That’s how I took pills with him, too. He was always a step ahead of whatever phase I happened to be in growing up, so when I first started stealing beer from my dad’s fridge, Patrick was there. When I first started smoking weed, Patrick was there. Sometimes he’d hand me morphine pills in the car on the way to Christmas mass. Then, when Aunt Molly died from lung cancer, Patrick started going to mass a lot. He started taking pills a lot, too.

The external genitalia are those of a normal adult circumcised male. Both testicles are present into the scrotum.

There were times growing up my dad would explode with anger. He’d cut people off on the freeway or stand alone at the far end of the rink when I played hockey, hands in his pockets, screaming at the refs whenever they made a bad call. I used to find it funny, my dad getting kicked out of games like that, and then I got older and started to wonder what his anger was actually about. The truth never came out when he was throwing things in the garage or ranting about my mother or taking a belt to my ass whenever I acted up some. To this day, my father has a tendency to shut himself away, especially at holidays, where he’ll sit alone in his room watching TV when the rest of the family drinks and eats finger food. When I moved out for college, my dad built a bar in our basement, and a few times I’ve come home to find him asleep on a stool, his high school yearbook spread out in front of him, old photos from the place he grew up. Deep down, my father is a tender man, but when I ask him about his regrets, about the things that have pained him, he seems incapable of speaking such things. As I’ve gotten older, I’ve also adopted this habit, shutting out the world and wanting to hide.

The only time my father talked about my grandfather’s schizophrenia, he said it wasn’t that at all, but that the anesthesiologist my grandfather worked under at the hospital was a terrible drunk, that he’d be hungover or buzzed during surgeries, and when my grandfather outed him, the guy walked into the hospital with a revolver, pointed it at my grandfather’s face, and pulled the trigger on an empty chamber. “How would you react?” my father asked me, forming his fingers into a pistol and pressing them to my temple. “You think you’d be fine if someone pulled a gun on you like that? You think you’d just go on like normal?”

A few years later I found my grandfather’s name in a newspaper clipping that said he was sentenced to Central State Hospital for the Criminally Insane in Waupun, Wisconsin. Patrick told me that’s where our grandfather received electro-shock. I looked at images of those stone outer walls. I could picture gothic psych wards, white linen bedsheets—leather and lights and cold, steel surfaces.

The back is unremarkable. The buttocks and anus are unremarkable.

This is the part in the autopsy where the external exam ends and the internal one begins. Oh, how I envy Victor now, so much that I can see what Victor sees, feel what Victor feels. We become one person, Victor and I, ears pinched tight by the strap of our surgical mask, eyes shielded by safety glasses in case something squirts. We stand beside a metal tray piled with scissors and chisels and forceps and bone saws. We run our hand over them, reaching for a scalpel the way a mechanic reaches for a socket wrench, holding it up to the light to check the sharpness of an edge, twirling between thumb and forefinger, then lowering it.

A rubber body block rests beneath Patrick’s back, thrusting the chest upward. We place our left hand below the neck and make three cuts, one from each shoulder toward the bottom of the breastbone, a third running down to the pubic area, deviating slightly to avoid the navel. Muscle and fat separate, blood running down the table towards a two-inch drainage hole between Patrick’s feet. Pulling back the skin is like peeling the pedals of a dead, human flower, the chest flap covering half of Patrick’s face (the way a blanket might).

A striker saw splits the chest plate. A special set of shears cracks the ribs (the sound of twigs breaking). Victor and I work a scalpel through connective tissue until the entire ribcage is removed from the rest of the skeleton. Patrick’s internal organs become visible, his lungs and his liver, his deep, red, heart.

The body is opened in the standard y-shaped incision. All abdominal and thoracic organs are present in their usual anatomic relationships. The thickness of the abdominal fat measures 2cm.

The heart weighs 370 grams… The thickness of the left ventricle measures 1.3 cm concentrically. The thickness of the right ventricle measures 0.3 cm concentrically. The septal defects are present. The endocardial surfaces are smooth and glistening.

For a while Patrick studied actuarial science at St. Thomas University, a fancy private college in St. Paul. Actuaries analyze risk for insurance companies, and working as one comes with a hefty salary. Patrick always had a brilliant mathematical mind, himself a counter and a quantifier. He liked to talk about fractals, these branching geometric patterns that repeat themselves into infinity and are identical at any scale. They occur everywhere in nature, from ferns to snowflakes, lightning bolts to tree branches. He told me the universe consists of a series of unique and infinitely multiplying sequences—daisies and pinecones and hurricanes all with the same self-replicating structures.

Human beings are fractal, too. We branch out, fold, split and branch again. Our lungs look like upside-down trees, nature’s most efficient pattern to carry out respiration. The surface area of both human lungs is the size of a tennis court, and the total length of the bronchial tubes running through them is 1,500 miles, about the distance from Miami to New Hampshire. We are larger than we possibly can know, and I think about this as Victor and I pull both lungs from Patrick’s chest and place them on a steel scale, one you might find in the produce section.

The right lung weighs 680 grams. The left lung weighs 730 grams. The pleural surfaces are smooth and glistening without adhesions. No significant pleural effusion is present. The upper airways are clear of debris and foreign material with normal appearing mucosal surfaces.

We remove the liver. 2,210 grams… smooth, glistening and intact. We remove the esophagus, stomach, intestines. The small and large bowels are unremarkable. The appendix is present and is unremarkable. The right kidney weighs 130 grams. The left kidney 115. The liver is also fractal in structure, main arteries branching into smaller arterioles. The calyses, pelves and ureters are without abnormalities. The urinary bladder contains 8cc of urine and the mucosa is grey-tan and smooth. Victor and I shift our weight; our feet are beginning to ache. We’ve been standing for several hours now, pulling things out, rinsing them, cutting away samples for tissue analysis. The prostate gland is of appropriate size with firm homogenous parenchyma. Both testes are descending into the scrotum.

For a moment I wonder how I got here, standing with Victor like this, breathing into this surgical mask, going into things in a way I never could by myself. Going into myself, really. So selfish, to see things that way, but it’s impossible not to recognize ourselves in those who haunt us. A body lay before me, lightning in its veins, shorelines in its soft tissues—rivers running and seashells whorling and storm systems developing and dissipating. Arteries twist like root systems and pulling out a lung is like transplanting a ficus and the veins around the heart are the color of peacock feathers and the intestines bulge like fat pink clouds and the kidneys look like they contain all the world’s secrets and I wonder which is more violent, the death or the aftermath. Which is more obscene, to accept things as they come, or to know precisely why?

Victor and I pull the rubber body block from beneath Patrick’s back and place it gently behind the neck, the way one might a pillow. We take a scalpel and cut from behind one ear, across the forehead and around the back of the head. We make another cut across the top of the crown and pull the skin away in two sections, like peeling half an orange.

Then comes the hum of the electric saw, that high pitch whine as blade meets bone, cutting the top of the skull until the cap can be lifted, exposing what Victor calls the cranial vault. The brain branches down into the spine, another tree-like structure, all easily severed with the pull of a blade until the most complex piece of matter in the known universe falls into my hands. Victor notes that the scalp and skull are without abnormalities or fractures. He talks about the dura and the leptomeninges and the clear grey matter of the cranial nerves. He does not discover ferns or fireflies, but that the brain stem and cerebellum are unremarkable, and I feel as if I might just lose myself.

One of the last times I saw Patrick was at our grandma’s house. I was moving out of the country for a while, so I went there to say goodbye. He had decided to quit college a few years prior, said he had a moral dilemma becoming an actuary, that he couldn’t bear to work in such a corrupt industry, all that corporate blood money. He’d been living off his disability checks and when I got there, his beard and hair were wild-looking, his teeth just starting to fall out.

He kept showing me YouTube videos of the fractals he loved so much—colorful geometric patterns unfolding over and over. He showed me pictures of galaxies, how they look like the neural networks in the human brain. “The universe resembles itself,” he told me. “Each piece contains all the information of the whole. That’s the design of it. That’s what God is.” I stepped back as he pointed at the monitor with gnarled fingernails, as if leaning closer might infect me with that madness. If what he said was true, then the parts of him I feared also lived in me, our family a fractal repeating itself through time: my grandfather in a white linen robe, my father alone in himself, now Patrick with body odor wafting from his sweatshirt, speaking of God and geometry and the shape of the human brain.

The human brain. So soft and delicate to hold, where every permutation is accounted for, every possibility produced. Whole realities exist here: some foggy realm where Patrick quits drugs instead of college, where he obtains his degree, finds a stable job, maybe has a family of his own. Where the anger falls from my father’s shoulders, where fear falls from mine. Somewhere in time and space, three generations of my family smile like they do in picture books, not a bruise or a blemish, not a secret to our name.

Victor and I place Patrick’s brain in a twenty percent solution of formalin and tuck every organ back where it was found, a puzzle of film and sinew. We pull the flesh away from the face before looping thread and needle through severed skin, lacing each suture until the belly looks like a baseball. Victor and I finally diverge, and just before Patrick is carted from the room, I bend down and kiss his cheek. “One day I’ll go into myself this way,” I whisper. “One day I’ll be strong enough to look at it.”

    

    

Author Michael Hansen is a Las Vegas based writer and journalist. In 2023, he earned a Master of Fine Arts in Creative Nonfiction from the University of Nevada, Las Vegas, where he received an International Award through the Black Mountain Institute. He writes for Nevada’s NPR Magazine, Desert Companion, focusing primarily on rural issues. In 2023, he was granted a Hawthornden Fellowship and in 2024, he was longlisted for the Disquiet Prize in creative nonfiction.

Artist Serge Lecomte was born in Belgium, spent his teens in Brooklyn. After graduation, he joined the Air Force. He earned Ph.D. from Vanderbilt University in Russian Literature. He worked as a language teacher at the University of Alaska, as a house builder, orderly, gardener, driller, bartender.