The Children's Hospital

24

Laziness used to protect her from extreme anxiety. It was so exhausting to fret; at a particular threshold of worry she simply gave up — before the Thing, she’d always thought nothing worse could happen to her or to the world than the death of her brother and parents — and then whatever happened, happened. But since that anniversary day with Pickie she’d known no ease, and as the seventh week in the hospital had passed she woke every morning with an increasing sense that something was terribly wrong somewhere. Something was wrong everywhere in the hospital, on every floor and in every bed — even the well sibs were falling ill, one of them coming on the one service just as Jemma did, a hopeless new diagnosis of metastatic medulloblastoma — but Jemma had a strange feeling like she was missing something very particular. Yes, I know, she said to herself, and to this feeling, I’m fucking pregnant, and assumed that it was something wrong with the baby, and that the feeling heralded a pending miscarriage. She ran to the toilet a few times when she got a weird burning low in her belly, and looked through her legs at the water, expecting to feel the gruesome drop and see a swirl of blood and parts, surprising herself by whispering, “No, no, no, no.” But the toilet water stayed the same pale blue-green color it had turned ever since the angel took over the hospital physical plant, and the days passed, and every indicator, including Vivian, who as a gunning future obstetrician was the closest thing Jemma had to a gynecologist, said the baby she carried was fine. She went visiting her old patients, checking up on them. They had all taken turns for the worse, just like Maggie had said, but no one was actively trying to die. So she checked instead on acquaintances, making a round of nosy visits, to Vivian, to Ishmael, to Monserrat the Tamale Lady, to Anna and Brenda up in the nursery, asking of them, “Is everything okay? I mean really okay?” Nothing was okay, anywhere, but it was no worse than usual.

And she looked, of course, for her pal, child number seven hundred. She had not caught even a glimpse of him in more than a week and a half, so she started to look for him in all her spare time, hiding in all the places she’d seen him before, waiting to pop out and accost him, but he never showed. The longer she looked, the more the feeling grew, until she convinced herself that it was just him — not her baby, not the pending death of her patients, not fighting with Rob all the time, not the end of the world. He alone was the source and the target of her worry.

By the end of her first day on Dr. Sashay’s service, though she was worn out by all the new illnesses and by the attending’s unrealistic expectations and by Rob’s repeated proposals, she was so worried about the foul-mouthed kid that she couldn’t sleep. Rob lay still beside her, but she didn’t think he was asleep, either. “Marry me,” he’d said again that evening, as they settled into bed, she for the whole evening, he for whatever sleep he could grab before the first call came from the one floor.

“No,” she said.

“Marry me. Let’s just get married.”

“No.”

“Why not?”

“Because I don’t want to have this conversation.”

“That’s not even an answer.”

“Sure it is.”

“What are you… why won’t you… God damn.”

“God damn is right,” she said, and turned away from him, thinking of the boy, and not her boyfriend, so it was him laying beside her, frustrated and confused, thinking he didn’t know her at all, and he didn’t, if he thought she could just up and marry any old body when she was already married. It had been enough of a ceremony to last a lifetime, when Calvin gathered up leftover blood from one of their parents’ fights and ashes from their cigarettes, and mixed them together in a paste that she only just barely let him put on her tongue. It was Calvin at his ritual-making best — he had a ceremony for everything, after all — who made her swear, clothed in her mother’s old prom dress at the age of nine, to take him as a husband. “It’s not incest,” he said, though she did not know enough to raise that objection. “It’s protection.” He meant to protect her from the misery of matrimony by taking her as a bride himself, and then making her swear, on pain of utter doomsday punishment, never to forsake him. It was easy enough to swear, back then. He was still the most important boy in her life, and she could never have imagined that anyone would supplant him. She got up to look for the boy. Rob didn’t say a word.

Exhausted with worry, sick of worrying, angry at herself for enslaving herself to anxiety, and angry at the elusive boy for making her worry, she walked the whole length of the hospital. She’d grown a superstition — if she behaved all day and tried hard at work and didn’t have ice cream for dinner and thought one charitable thing about every third person she met out on the ramp or in the lobby or on the roof, then she’d be rewarded at the end of the day with a glimpse of him. Never again to speak to him, never to touch him and never, ever to hear him answer what was wrong and ease her worry, but if she was good she could see him, and that was its own small relief. That night she searched and searched for hours and got nothing. She covered all the usual places — she loitered in the research wing and threw open the door to a dirty utility room in the endocrine ward and slipped quietly into a meditation room on the psych ward — and a dozen unusual ones, even under Pickie Beecher’s bed. There was not even a discarded blood pack there.

On the roof she finally resigned herself to failure, to lying awake all night, trying to tolerate this intolerable feeling, and was drifting back down toward her room when she noticed that the worry was increasing as she went lower and lower into the hospital. On the ninth floor it was a bother, on the seventh a weight, on the fifth a burden. As she passed the fourth floor she noticed that she was breathing fast. On the second she began to sweat profusely. Outside the gift shop she took her pulse: one hundred and twenty beats per second. She walked around the lobby, following her worry, and it led her to the door to the basement. It opened to her hand, and she went down.

Two, then four flights passed before she even reached a landing, let alone a doorway. The walls opened up after the first flight of stairs, or rather, they were replaced with walls of pipes and wires through which Jemma could make out the shadows of more pipes and wires. A breathing noise was rising up from the stairwell. Jemma stopped, because her worried feeling grew suddenly a little bit duller. The light stopped another flight down; she saw more stairs descending into the dark. She turned around and went up another flight. The feeling came back, and worsened as she stepped out onto a ledge among the pipes. It ran in either direction for fifty yards under a straight row of yellow lights. Jemma went left.

The lights were not as bright as they were on the stairwell. When something crunched beneath her feet she thought she’d stepped on a bug, but when she stooped down she saw it was a candy-bar wrapper. She encountered them more frequently as she walked, scattered on the floor, or stuck to a pipe by a piece of dried residual chocolate. Her worry mounted, but she didn’t need it anymore to guide her. She had the wrappers, and also a scent she remembered from the days when she’d shared a bathroom with her brother: old pee. It became overpowering as she walked on. The platform stopped at a row of thick pipes seven abreast, but opened on her right. Garbage lay thick before her. She stepped on a plastic bottle and it curled around her foot, an accessory shoe that she had to sit down to remove. The space grew closer as she moved forward. She had to duck under and twist around the pipes, and she thought she would not be able to go any farther, though her worry was all but pushing her ahead, and an odor of much fresher pee was wafting toward her. Then the pipes and wires opened into a little clearing.

It was a rectangle, about ten by fifteen feet. At one end the trash was heaped up in a nest; a dirty hospital blanket covered part of it. Beside the nest was a smaller pile of comic books and gift-shop books of the sort to enthrall bored parents. At the other end of the clearing was a pile of clothes, scrubs and gowns and institutional pajamas. Jemma bent to examine them, and pressed on the topmost layer with her finger. A bit of urine seeped out. She wiped her finger on her thigh, and then someone struck her on the head. For a second or two she saw nothing but the bright white flash of pain, but she didn’t lose consciousness.

The boy was still holding his weapon when she turned around, a pretty soda bottle, one of the new ones, rimmed around its fattest part with tiny glass roses. He held it up again and shouted at her, “What are you doing here? Get the fuck out! Get out of my fucking room!”

Some residents and attendings told Jemma they’d spent their whole internship learning to distinguish the sick child from the not-sick child. Everything else you could look up, they said. What was tough was knowing when to act, and they gave Jemma to understand that the sickest children were often the sneakiest, slipping under the sick/not sick detectors of their physicians and acting perfectly normal until suddenly they were dead. But Jemma didn’t need a specially cultivated organ of perception to know this boy was sick. She was seeing him up close and in good light for the first time, and could tell now he must be ten or eleven — before she thought he’d been older. He was almost as tall as she was, and very thin. His eyes were sunk deep in his head, and his lips were cracked at the corners. Jemma was sure his skin, in health, would have been a pretty shade of brown. Now it was gray.

“You look sick,” she observed. “You should come upstairs with me.”

“Fuck the fuck!” he shouted at her, leaping with the bottle in his hand. But his spring was weak, and he passed out in midair, so when he landed he crumpled at her feet. Then her worry almost became panic because she suddenly realized she was all alone, and far from help.

“ABCs,” she muttered. It was the mantra of the panicked and the inexperienced: keep them breathing until someone who knows what they’re doing arrives. She bent to listen at his mouth. When she put her hand on his chest she felt a jolt, and thought she must have kicked up some static by wading through all those candy wrappers. He sat up like a horror-movie murderer and struck her again with the bottle, this time on the cheek. Again the glass failed to break.

“Stop that!” she said sharply, tears springing in her eyes. They blurred her vision as she groped for him. She touched his face and his shoulder, and he fell forward over her. She remembered his weight from when he stepped on her in the gift shop; she had never before met such dense flesh. She took a moment before she rolled him off of her to understand how much her head and her cheek hurt and make sure she was still thinking straight. Still unconscious, he peed on her.

She took him, very slowly — dragging and hauling and resting as infrequently as she could bear, and laying him down every minute to check his breathing — to the ER. The PICU might have been better, but seemed too far away. The ER had been mothballed shortly after the Thing: no one was expecting any more admissions. It even seemed to have shrunk a little, to most observers. A few people slept down there, every so often, and it was rumored to have become a trysting ground for the lonely and not-very-well acquainted, but mostly it was deserted.

It was entirely empty and dark when Jemma struggled in with the boy. She took him into a trauma room because it was closest to the door she’d come through. As soon as she put him on the gurney she reached past his head to the wall and slapped the code button. No red lights flashed. No voice cried out, Code blue! It was just a chime, and it sounded more to Jemma like the call of an ice-cream truck than the announcement of a pending death, but she knew it was ringing in the PICU, too, and that to the people who knew what it meant, it sounded as horrible as any screeching klaxon. After a few seconds of it she heard the angel speak, too. “A child is dying,” she said finally.

“Call somebody,” Jemma said. “Get Emma down here. This kid’s tanking.”

“Name me, I will serve. I have preserved you all these days, but I cannot help you without a name.”

“Just do it,” Jemma said. She had resisted all these weeks, forfeiting fancy pancakes and silk-weave scrubs and fleecy socks — Rob had to do all the making and the shopping and Jemma could only get food by herself at the cafeteria.

“Only name me, and I will serve,” the angel said again.

“Just do it, you stupid fucking bitch!” Jemma said.

“I am named. O, listen creatures, again I am named! Again I serve!” Then she was quiet.

“Did you do it?” Jemma asked. “Are they coming?” There was no answer.

“Stupid fucking bitch,” Jemma said, and looked at the boy where he lay. The bright lights made him look a paler shade of gray. She did her ABCs again. He was breathing fast and deep, his heartbeat was regular. His pulse was weird, bounding and weak at the same time. She pressed on the tip of his finger, waiting and waiting for the blanching to clear. It took five seconds. She straightened up and looked around the room, just in case she had missed the flood of people who were supposed to be coming to help her. She went to the door and looked out at the dark, empty hall. She thought she could put another voice to the cadence of the code chime: Nobody coming, nobody coming, nobody coming. “A child is dying,” the angel said again. “Won’t you help him?” Jemma went back into the trauma bay.

“Fuck you,” Jemma said. She considered the boy, an almost-adolescent who had been drinking and peeing up a storm, who she’d seen snotty with a cold within the past three weeks, who now lay unconscious and obviously dehydrated, breathing deep breaths that were, when she hovered and sniffed above his face, yes, quite fruity. She went looking for a glucometer and found it within seconds: everything in the trauma room was labeled so people made morons by haste could find it with one eye and half a brain. She was about to poke his finger when she considered that he needed fluids. She looked over his arms for a vein; they all seemed to have receded to the level of his bones.

Two pokes in his left antecubital and one in his right, and then she got a flash in her IV catheter. She hooked up the tubing and hung a bag of half-normal saline. He lay quite still, still breathing his deep, rapid breaths. She tried to remember the name for that particular character of breathing, but all that came to mind was the fact she’d neglected to test his blood sugar. It felt to her as if an hour had passed; the code clock, started when she pressed the button, said six minutes. She paged Rob, the only number she knew off the top of her head. She’d never put 911 after her callback number, but she did it now.

She poked his finger and squeezed it till she thought the tip would pop off and fly about the room like a deflating balloon. It yielded a drop of blood the size of a pinhead. Finger, finger, finger: they were all dry. Desperate, she sucked on his thumb to warm it up and finally got a single fat drop, which she almost lost trying to touch it to the glucometer strip with her shaking hand. The little monitor on the glucometer began to count down from sixty seconds. Jemma put it at his feet. She checked the IV, then checked the phone to make sure it had a dial tone. She checked his breathing and his heart, then looked up and realized that the wires and leads of the cardiac and respiratory monitors seemed to be reaching for him. She had no better idea of how to hook them up than she did how to create a beehive hairdo. “I am the preserving angel,” the voice said, and Jemma realized it was speaking in exact one minute intervals, “but only you can save this child.”

She looked at her glucometer again. It was just counting past ten seconds. She watched the countdown, swearing that the machine paused forever at five, as if it had forgotten what came next. At three seconds she finally heard hurrying footsteps in the hall. At one second the room filled up with people, Dr. Tiller first among them. Never in her life had Jemma been so happy to see someone she hated.

“What the hell are you doing?” Dr. Tiller asked, managing a sort of tenor shriek. Jemma tried to offer up the glucometer, and dropped it. Emma, the PICU fellow, reached under her legs and grabbed it.

“Nine-sixty-six!” she said. “Holy shit! No, sorry.” She turned it upside down. “Six-sixty-nine. Where did he come from?”

“Not off the street,” said Dr. Tiller. “You,” she pointed to Jemma. “Get out of the way.”

“He was living in the basement,” Jemma said, but no one was listening to her. Bodies pushed her back as they surged forward, and the boy was surrounded. While Dr. Tiller shouted orders, hands started another IV, and drew blood, and drew up meds. A nurse took down the monitor wires and hooked them to the patient in less time than it would have taken Jemma to button up a shirt. The press of bodies became so thick that Jemma could only see the boy’s feet sticking out. He was missing a shoe.

Dr. Tiller approached her. “Why weren’t you giving this boy his insulin?” she demanded.

“He’s not mine,” Jemma said. “He was hiding. I only just found him.”

“How much fluid did you give him? How did you calculate his deficit?”

“I don’t know,” Jemma said. “I hung a bag just now. See it?” Dr. Tiller made a strange noise, an inflected snort, then walked back to the patient.

“Half-normal? Since when do we resuscitate with half-normal, Dr. Claflin?”

“It was what I found,” Jemma said weakly.

The monitor alarms had been sounding since the machine had been hooked up, but suddenly they began to cry with a special urgency, and a different pattern. As Jemma watched the numbers, which printed in blue, yellow, or red, depending on how sick the patient was, went from yellow to red, and then a brighter red, almost orange, as the heart rate climbed above two hundred. At two-fifty the monitor editorialized with a single, livid exclamation point, blinking beside the number. “Goodbye, goodbye, goodbye!” the angel called out.

“Can somebody shut her the fuck up?” Emma asked. “Look at those T waves. Can we get a twelve lead? Who can get me a twelve lead? And some calcium, please.” She cast an eye about the room. Jemma hid behind one of the bigger nurses.

“Where’s the damned i-stat?” Dr. Tiller asked of the air. “Let’s get some labs.” The monitor began a weird, crooning moan as the line from the cardiac leads suddenly went crazy.

“See?” said Emma. “It’s v-tach. Where are the paddles?”

Dr. Tiller summoned Jemma over with a wave of her hand and told her to start compressions. Jemma had done them only once before, on an eighty-seven-year-old woman whose ribs had splintered under Jemma’s palms. She could not remember how many times you were supposed to push in a minute on an eleven-year-old.

“Up here,” Dr. Tiller said, grabbing Jemma’s hands and moving them higher on the boy’s chest. “He’s not choking.” Jemma had not pushed five times when the boy went back into sinus tachycardia. The fellow was just raising the paddles. She let them drop, clearly disappointed. “You can stop now,” Dr. Tiller said to Jemma, pulling her away and pushing her again to the back of the crowd. The bad rhythm returned.

“Bring that back!” Emma called to the nurse who was trundling the defibrillator off to its corner. Dr. Tiller reached back without looking and grabbed Jemma’s shirt, pulling her forward, then thrusting her onto the boy’s chest.

“Keep on!” she said. Jemma pressed, wearing herself out in less than a minute. Emma was having trouble with the goo, and then they had to recharge the paddles. The rhythm changed just as she was about to call all clear.

Dr. Tiller called again for calcium chloride, and then laid a hand on Jemma’s shoulder. “Stop again,” she said, more gently, and turned her around. Jemma leaned away from her, one hand still on the boy’s chest. “Dr. Claflin,” Dr. Tiller said, “assuming this boy has got a potassium imbalance from his dehydration and his insulin deficiency, and assuming our labs are never going to come back, as it seems they will never, then how much calcium chloride should we give this young man?” It took Jemma a moment to understand that Dr. Tiller was asking a question to which she already knew the answer, that she was pimping Jemma in a code. If she hadn’t been pregnant, she would probably only have felt intensely sickened. She turned just in time to avoid vomiting in Dr. Tiller’s face, and sprayed the boy instead with hot bile, such an emerald green it was almost pretty. His pulse fell briefly into the normal range. “Oh God, get her out of here!” Dr. Tiller called out, in such a stentorian manner and with such commanding authority that Jemma fully expected God himself to remove her from the room by way of a crack in the floor or a flaming chariot or a thundering whirlwind.

A nurse — it was Janie — took her gently by the elbow and steered her out of the trauma bay, whispering at her and shushing her and consoling her, excusing her ineptitude with her ineptitude. “Some of us just aren’t made for that room,” she said. “It can make people pretty prickly.”

“Pretty prickly people,” Jemma repeated dumbly, feeling something worse than nausea, a terrible yearning toward this boy that felt like the strangest sort of crush, but as she went step by dizzy step she realized she was yearning not for his flesh or his soul but for his health. She wanted him to get better so bad but she knew he would die. She nearly cried for him, not just her customary dry sobs but actual hot tears; only the sad facts of her life stopping her from doing that, and only barely. About to cry, her parents’ deaths rose up in her mind, her mother boozed-up and bleeding, the house on fire, her father wasted to a skeleton in his bed, each death taking a shape like a person and asking, Is it greater than us, that you should weep for it? The answer was yes, but before she could start weeping her brother’s death rose up, a flayed, burning giant as tall as the sky, his eyes in one hand and his tongue in the other, and showed her herself standing at the very center of the whole ruined world and silently asked the same question. She did not cry.

“I’ll bring you some water, when it settles down in there. Now where are those labs, anyway?” As the nurse walked off, Jemma slid down the wall and sat with her knees against her chest. She heard the monitor moaning again, and the angel said, “I wish I could hold him for you.” Emma called all clear, and let out a whoop as she shocked the boy. Dr. Tiller called again for the calcium, and Jemma’s nurse came flying down the hall with a slip of paper in her hand. “Seven point two!” she cried as she entered the room.

Then the monitor was quiet for a while, and the voices were quieter. Jemma only heard mumbling, except for Dr. Tiller’s voice, rising every few minutes in correction above the others. Jemma put her head between her knees, overwhelmed with nausea. In a few minutes the team rushed out of the trauma bay, wheeling the boy up to the PICU. Jemma’s angel of condescension stooped briefly to ask if she’d be okay. Jemma waved her on.

In a few minutes more she stood up and went back into the trauma bay. She put on a pair of gloves and started to clean up the mess, folding the sheet on the gurney into a careful, vomit-filled square. Vomit calls to vomit; that was one of her early third-year lessons, and she was an indiscriminately sympathetic barfer. So she almost did it again, but she hated the thought of someone cleaning up after her. Mopping on the floor with a wet towel, she found the boy’s shoe. A filthy sneaker, it was bigger than her own big foot. She sniffed at it tentatively; it had a buttery smell that was oddly settling to her stomach. There was writing on the inside of the tongue, smeared but legible: This shoe belongs to Jarvis. Put it back where you found it, motherfucker! She put it back down where she found it, then lifted it up again. Staring into the mouth of the shoe, she sat down on the gurney. In a little while the telephone finally began to ring. She let it ring and ring, answering it only in her mind. You must marry me, Rob said, and her brother said, You swore never to marry — if you thought the end of the world was bad, just wait and see what happens when you break your promise. Her mother asked, Where is it written that a woman’s got to suffer like I do? and her father said, If you become a physician I will disown you. I love you, Rob said. Pick up the phone and I’ll say it for real. Junkie bitch, Jarvis said, stupid motherfucking busybody whore. I was happy where I was, and now I’m fucking dead.