The Children's Hospital

19

Jemma conducted a census of her own, not of numbers but of types. Others, thinking, like everybody did, of the precedent, asked themselves, where were the animals? They looked out the windows into the empty ocean and some asked the angel, What was the crime of the panda, that it should be eradicated? All she would say was that they were preserved, leading to speculation that this meant they were preserved in the mind of God, or that they were preserved in a deep, airtight cave under the ocean, or that somewhere out there on the sea another hospital was floating, twin to this one in every way except that it was stuffed full of ailing and well pandas. The precedent was in Jemma’s mind also, though not because it brought to mind the innumerable animals drowning in innocent pairs. She found herself thinking in twos as she looked at her fellow survivors. Among the children it was obvious that of even the most obscure illnesses two had been preserved — there were a pair of Pfeiffer syndromes, a pair of intestinal lymphangiectasias, a pair of lymphocyte-adhesion deficiencies; only Brenda, it seemed, was totally unique in her affliction. That this should happen in a place that had a whole ward devoted solely to the problem of hypoglycemia was not entirely strange. But Jemma looked further to see other pairs: a stylish nurse, the one with the great big ass, who inhabited the sixth floor had a twin in the PICU who wore the very same pair of rhinestone-encrusted granny glasses. There was a civilian Dr. Snood, father to one of the NICU babies; both men had the same blue eyes, looked down the same proud nose at people in the very same way, had the same leathery skin and the same awful hair. There was a pale girl in the cafeteria, a little big, with bleached hair and large brown eyes who could have been twin to Jemma before she died her hair red. These cases were superficial and obvious, and probably, Jemma thought, meant nothing. She wanted deeper pairings; not necessarily romantic, but fateful. Like would will to like and execute a destiny together.

Those pairs were harder to find. She liked to think, sometimes, that she and Rob made one, and that Vivian and Ishmael might soon represent another, and that Dr. Snood and Dr. Tiller were somehow yin and yang and fuss and budget to each other, and when they came together would make something perfect and prim and utterly unbearable, and that Father Jane and John Grampus could do great things together, despite their mutual disdain for the opposite sex and the fact that Grampus was sort of dating the angel. But the angel seemed to be dating everybody, and lately Jemma had seen John Grampus wearing a new hangdog look.

The hospital was organizing itself, anyway, in ways not formally declared by the Committee or by a principle of pairs. There were the old distinctions and the old hierarchy of ascending power and descending subservience: student, intern, resident, fellow, attending. There was a greater chain, harder to describe, and a little more fluid — Zini could make Dr. Chandra lick her shoe but Dr. Snood could probably make her grovel if he tried hard enough. A lab tech was superior, somehow, to a janitor, and the man from the physical plant was owed deference from the cafeteria workers. Volunteers were for anybody to order around, provided they spoke to them respectfully, mindful of their age and their altruism; nursing assistants were treated like dirty whores — no job was too low for them. Only the tamale lady seemed to soar free of classification, empowered, Jemma thought, by her itinerant status and the fact that she was not an official employee, and by the supreme deliciousness of her tamales — they were a sort of power, and the angel could not reproduce their subtleties of flavor. Even the parents were bound, only the most difficult ones resisting treatments now, with almost every child sicker than they’d ever been before. You could argue these distinctions, or declare them overturned in Committee meetings convened in a spirit of overwhelming generosity, but as long as the children were sick and the hospital was a hospital, they held.

Every attending had their own demesne, determined by geography and specialty. Dr. Walnut, the only surviving surgeon, reigned on the second floor with Dr. Wood, the anesthesia attending. Dr. Snood ruled the sixth floor. Dr. Pudding held court in the dim chambers of radiology on the third floor, splitting his territory with Dr. Sundae, who, as the last pathologist in the world, had assumed control of the clinical lab. Dr. Grouse, the master of the NICU, was famously laid-back, but he had Emma, a lady whose soft bouncy curls belied her no-nonsense attitude, to be his terrible enforcer. The seventh-floor subspecialty units were under the command of Dr. Topper, a touchy nephrologist. Dr. Sashay, the oncology attending, ruled on the eighth. Dr. Mim, the ER attending, deprived of subjects when the last of her patients were transferred upstairs the day after the storm, went up to the ninth floor, where she oversaw management of the increasingly acute issues developing in the rehab patients when she wasn’t splitting call in the PICU with Dr. Tiller, who was queen there. Nine of them altogether, they each had their fellows — except for Dr. Grouse and Dr. Tiller, who had to share Emma — and a team of residents and interns and students to cater to their every professional whim.

Sometimes Jemma daydreamed of traveling to other teams like she used to daydream of traveling to other countries, so she thought her days might pass more pleasantly in the NICU like she used to think she would be prettier in Paris, or that people might have been more tolerant of her generous thighs in Quito or Buenos Aires. But she was stuck fast under Dr. Snood’s thumb, and rounds seemed perpetual. She had had the sense before the Thing, in the middle of her long, early mornings, that she had always been doing this, trudging from room to room gathering bad news, and that she would always be doing it. But she would go home, eventually, and look back and forward into that purgatory with the feeling that she was suspended between eternities. Now, though, in a hospital in the middle of the ocean, a place that every available clue indicated was the extent of the extant world, what before had only seemed, now actually was. Jemma would never go home. The children would never go home. Forever and forever Dr. Snood would roll his eyes at her from under his eternal caterpillar brows.

At least some of her patients were finally getting a little better. Ella Thims was off her hypertensive patch and tolerating three whole milliliters an hour of formula feeding through her little gastric button. Cindy Flemm had not vomited for five days, and had actually been seen out of bed, walking hand in hand around the sixth floor with Wayne, the boy who looked too fat to have CF. Kidney’s constipation had resolved and only the eldest sister, Jesus, seemed to resent Jemma’s early-morning visits anymore. Pickie Beecher was unchanged, however, his affect still flat, his mind still crazed, his shit still black. She knew he must still be sipping from blood packs, though no one had caught him again with one, and Thelma swore there was no way he could be leaving the floor to snack at the blood bank. “Your poop betrays you,” she said to him when he swore that he drank only juices.

“Good morning!” he said from under his bed, when Jemma had rounded on him that morning. “Happy anniversary!”

“Come out from under there immediately,” she said firmly. She’d instituted a policy with him, or thought she had. She was not intimidated anymore by his hiding under the bed, or the strange hissing, deflating noise he sometimes made, or his hanging from the ceiling, or standing on his head in the window. It was Thelma who showed her the way. “You show him who’s boss,” she told her. “Have you ever ridden a horse? It’s just like horses. He can smell your fear, and if you give him an inch he’ll be all over you. All over you!” And she had slapped Jemma gently all over her back and belly, as if Jemma needed help understanding what was meant by all over a body.

“Good morning,” she said to him, once he was sitting on his bed. “What’s the anniversary?”

“You visited me forty days ago exactly.”

“I thought you hardly noticed the passing of days.”

“Mostly not,” he said. “But sometimes.”

“Shirt up,” she said. He exposed his thin pale chest for her to auscultate. His exam was as normal as it always was. “Perfectly clear,” she said. She always made sure to tell him how healthy he was in his body.

“Will you walk with me to the window?” he asked her.

“All that way?” He stood up and raised his hand to her. He walked her slowly around the bed to the window, placing his steps as carefully as a drunk. The sun wasn’t up yet, but a gray light was on the perfectly calm water. Pickie pointed up into the blank gray sky and said, “My brother is absent from there, and from there, and from there.” He pointed at the horizon, and down at the water.

“Mine too,” Jemma said, and tried again to get him to talk more specifically about his brother, in her flailing, junior-junior-psychiatrist way, thinking that it might be a first step toward his recovery, since the antipsychotics and antidepressants and alpha-agonists and anxiolytics seemed not to make any difference at all in how he acted, to get him to talk in real terms about his lost brother. She was always imagining the scene: Pickie witnessing the drive-by, or the lingering toxic death from leukemia, or his crazy mother beating his older brother with a sack full of oranges, or even Pickie himself, carelessly playing with a loaded pistol, staring at his brother’s brains after he’d sprayed them all over the wall, and losing his mind in an instant. It was crude, and probably stupid, to think that she could break him open and let all the poison and craziness in him leak out, but no one else had any other ideas. Dr. Snood kept insisting they try new and different combinations of medications — he had taken it upon himself to try to fill the shoes of the lost psychiatrists, poring over the literature preserved in the hospital computer, ruled by the hour by some new study he transiently admired. Pickie and the anorexics and the three other psych patients took every new intervention calmly, but still ate their blood or found secret places to vomit — all of them, Jemma suspected, assisted by the angel in perpetuating their sickness. It had become obvious that she would help anybody do anything, as long as it didn’t directly harm another person. She was the sort of personality who said you were her favorite, or her best friend, and then went and said that to everybody she knew.

Pickie would only talk of his brother’s thousand eyes and hundred hands. “But what was his name?” Jemma asked, a question she’d asked many times before.

“He was my brother,” Pickie said, the same old answer. “Now he is dead, and there is no good in anything, and I must live on forever to witness all the wrongness. Every wrong thing arises from the death of brothers, and every wrong thing has come from my brother’s death. Oh! Oh! Oh!”

He knocked his head against the glass. Jemma said nothing — that week they were trying to extinguish all his bad behaviors by ignoring them — but she reached and patted him dexterously on the head, knowing it might be interpreted as an encouragement, but unable to just leave him alone banging his head, though he wasn’t doing it very hard, more a vigorous tap than a really hard bang. She patted him until he stopped, but refused to sing him a song, when he asked, because she was getting late already, and her next patient was a time sucker.

She went down to room 636, occupied by an eleven-year-old boy with cerebral palsy and developmental delay named Tiresias Dufresne. Gorked on the surface, unable to walk, or speak, he nevertheless had a lot going on inside his head. He had a special headset, lost in the flood, that had allowed him to communicate by fixing his eyes on letters and words on a computer screen. Attempts to replicate it had not satisfied him. His vocoder had never said a bad word about anybody, but his mother, popularly known on the ward as “that fucking bitch,” six feet tall and weighing as much as three average-sized medical students, was the apotheosis of the hospital mom. In the first weeks of her pediatric rotation Jemma had observed another hierarchy: spineless parents with noodle-supple wills were “sweeties”; parents who wanted everything explained in detail before consenting to a procedure or intervention were “a little difficult”; those who actually refused procedures or interventions became frankly “difficult”; those who habitually refused interventions or dictated treatment based on their own past experience entered the continuum of “crazy,” at whose far end Ms. Dufresne reigned unquestioned.

“Just do whatever she tells you to do,” was the advice Dr. Chandra gave Jemma when she met Ms. Dufresne for the first time. “If she starts getting angry, it’s okay to run away. And don’t cry in front of her; it just makes her more mad.”

“Good morning!” Jemma called as she entered the room. Ms. Dufresne was an armoire-sized shadow in her chair at the window. Tir was moving restlessly in his bed, flexing and extending his arms and legs as if he were trying to swim within the space confined by the blue mesh tent that hooked to his bedrails and kept him from falling to the floor.

“Hello dear,” said Ms. Dufresne quietly. Jemma had gotten along with her pretty well so far, but she had already learned how fine was the line between “dear” and “motherfucker.” Still, she was used to being abused, and somehow she preferred the motherly rage of Ms. Dufresne to the exquisite smarminess of Dr. Snood. It helped, somehow, to think that it was fierce love for her gorky, twitchy boy that made Ms. Dufresne thunder, and stomp her feet, and wave her fists in the air just before your face, and threaten to pull your tongue out through your ass.

“How is he?” Jemma asked, aware of her mistake as she made it.

“Why don’t you ask him? You know he can talk to you.” Ms. Dufresne’s breathing became a little heavier. She didn’t like to interpret for lazy motherfuckers who couldn’t be bothered to make the effort to speak to her son.

“Sorry!” Jemma said brightly. “Tir, how are you today? Do you feel better than yesterday?” He stopped his breast-stroking for a few seconds and turned his eyes to the windows. “That’s yes, isn’t it?”

“Same as it was yesterday. Same as it was the day before. Same as it was always.” Ms. Dufresne began to huff. She was not a well woman; her grocery list of illnesses included diabetes, hypertension, coronary artery disease, and congestive heart failure.

“Are you feeling okay?” Jemma asked Tir. He was in the hospital for an attack of cyclic vomiting. He’d thrown up everything that had passed his lips or his button for the three days before he’d been admitted, and was still being fed through his veins now, six weeks later. He looked to the window again, at the gray banks of clouds floating over the silver water. “Great!” she squeaked, unzipping his bed with a broad sweep of her hand and arm. “I’m just going to listen, okay?” He continued to swim as she listened on his chest and back. Tir was always smiling, even when he was in horrible pain, or in mid-barf. His smile was involuntary and useless for the purpose of gauging his mood, but his big hazel eyes were richly expressive.

“You sound hungry. Are you hungry?” He looked at the door: no. “Well, how about if we try and creep the feeds up some? Let’s go up to ten cc’s an hour.” His feeds were presently running at seven cc’s an hour.

“Eight would be better,” said his mother.

“Eight would be okay, but ten would be superb! We’d like to get you off the sauce, Tir.” She smacked his hanging bag of parenteral nutrition. Every day Dr. Snood asked for the precise number of milliliters of nutrition solution delivered into the boy’s veins. “Shouldn’t we reduce that, Dr. Claflin?” he’d ask her. “Don’t you think his liver would thank you? Wouldn’t his liver rejoice?”

Ms. Dufresne stood up. “Sure, it would be great. Every time it’s like this. Ten would be great, you say, and you rush him, and then the vomiting starts again. So let it be ten. What do you care? You won’t be here when he vomits. It’ll be me covered in it, trying to keep him from choking on it. But I’ll call you, when he does it. I’ll put you in his bed and he can vomit on you. How will you like that? I’ll put your face in it and you can eat it, like a dog. Like a fucking dog!” She had come to the other side of the bed, and was twisting the blue mesh in her giant hands, huffing like a cartoon locomotive. Tir swam on blithely.

“Eight it is!” Jemma said. “I’ll just go tell the nurse now. Have a good morning, Tir,” she added, and, “Have a good day everybody!” She had never fled from the room, but she often walked out backward like she did now, in case an object should fly at her head.

Down the hall from Tir’s room was another room she hated to enter. A CF boy named Sylvester Sullivan lived there with his mother. Sylvester was sweet, five years old but stuck at the developmental level of a two-year-old for reasons that were never determined because his mother disallowed portions of the workup, insisting that there was nothing wrong with her son. He knew a few words, but most of his utterance was excited, endearing, cheerful babbling. Most of his mother’s utterance was babbling, too, of the anxious rather than cheerful sort. It endeared her to no one.

Jemma couldn’t stand being around her, let alone talking to her, so she had worked out a system with the sympathetic nurses, who passed responsibility for that room among each other like a snake, so none of them had to deal with Mrs. Sullivan for more than one day out of the week. Jemma had to see Sylvester every day, but she waited for a signal from the nurses to go into the room. When his mother left to go to the bathroom, or take a shower, or to get her son a graham cracker, then Jemma, who had mastered a three hundred and sixty second exam, would dart in and look at Sylvester and his vitals sheet. She was telling Carla/Snarla about the change in Tir’s feeds when the signal came, a page on the overhead system, “Line six for Jemma Claflin.” There were only five lines on the sixth-floor phones.

“Off you go,” said Carla, whose Snarla aspect, Jemma had discovered, was quite isolated from her regular personality — offend her in the slightest and she’d threaten to fuck you up with a mop handle, but she never held a grudge, and they’d been getting along very nicely for a whole week. Jemma ran down the hall and into the room. Sylvester was bouncing in his bed and watching a videotape, aping a bouncing blue dog on the television. When he saw Jemma he waved and said, “Bloopee!”

“Bloopee to you, too,” Jemma said, flying serenely through the exam until she crashed in his lungs. He had a finding, an area of decreased sounds over the left lower lobe, and maybe a crackle or two. His lungs had been entirely clear the day before. They’d been clear for weeks, and he’d finished his tuning-up course of antibiotics three days earlier. Jemma percussed awkwardly on his back with her fingers, and thought he was perhaps a little dull over the left lower lobe. He turned around and tapped on her, too, crying bloopee all the while.

“There you are,” said his mother as she came through the door. Jemma’s heart sank as she turned around to look at her. She had a mass of curly poodle hair on her head that hung down just far enough to obscure her eyes, which like her son’s were a lovely shade of blue-gray, but, dog-like, she seemed to see just fine through the hair. From underneath that bushy mass her nose stuck out, pointy as a weapon over her pale, full lips. “I was just getting Sylvester some crackers. Would you like one?” Jemma shook her head. “Well, how does he sound? Is he crystal clear? Is he soft as a pillow? I think he’s so much better. Don’t you think he’s better? I haven’t seen you lately. Do you still come to see him? Do you think you should still come and see him? I think you should still come to see him. I’m not the doctor, I know. And you’re not the doctor, either. I just wonder, you know. Cracker?” She poked a graham cracker in Jemma’s face, so it scraped above her lip and filled her nose with the odor of cinnamon.

“No thank you,” Jemma said, batting at the cracker. “I come by every day, just like always. I just keep missing you.”

“Oh. Of course. I didn’t mean it as anything. I was just wondering. I didn’t mean to accuse, you know.” But she was still pointing at her with the cracker, as if to say, with this graham cracker I accuse thee.

“He’s got a little noise. I’d like to check an x-ray.”

“In his lung. He’s got a little noise in his lung?”

“Yes.”

“In his lung?”

“Yes, like I just said, in his lung.”

“Oh God, do you think it’s the pneumonia? Do you think it’s the pseudomonas? Do you think it’s a fungus? His poop is all floaty again. This morning it floated like crazy. It popped right up so fast I thought it was going to fly through the air. I thought it was going to follow us back to the room. It’s always like that, it always gets floaty just before he gets sick. Do you think it’s related? Do you think he needs more enzymes? I think he needs more enzymes. Will you get him some more enzymes?”

Jemma had been opening her mouth to speak, once and twice and three times. “I think he’ll be fine. We’ll just check to make sure there’s nothing new happening.”

“Is that your final opinion? Is that your professional opinion? Have you got a professional opinion yet? You’re just a little student. I don’t mean anything by it. But it’s hard, you know. It’s just hard, to see him like this. I mean look at him.” Jemma looked. The child was bouncing again in his bed and shouting “bloopee” at the television in a spray of graham cracker.

“He looks okay,” Jemma said.

“Is Dr. Snood here? Is Dr. Snood coming? Has he come already? Will you tell him I’m waiting for him? Did I tell you the poop is smelly again? You should smell it, it’s awful. He went three hours ago but it still smells like it in the bathroom, if you want to come. I thought I was going to die. It even seemed to bother him, and it never bothers him, not unless it’s really, really bad. And it’s really floaty. My hair still smells like it. You should smell it. Smell my hair, then you’ll know.” Jemma’s pager sounded just as the lady was pushing her head toward her.

“Oh boy,” Jemma said, “it’s an emergency!” She flashed the number on the display and said, “I’ve got to go.” As she fled the room, she called back that she’d return after the x-ray was done.

“Bring Dr. Snood!” said Ms. Sullivan. She started to pursue Jemma down the hall, but Jemma had learned that if you actually ran from her she wouldn’t follow. If you walked she’d follow you for up to twenty minutes, even into the bathroom. “It’s really quite floaty!” she called out

“I believe you!” Jemma called back. She ran to the nurses’ station, slowing down as soon as she was out of Ms. Sullivan’s line of sight. She filled out the x-ray requisition and dropped it off with the clerk, then continued around the desk and down the hall to the next room and the next child. Jeri Vega had already had a liver transplant, but was waiting for another. She was one of two children on the liver transplant service, part of the GI service and therefore on Jemma’s team. Dr. Snood was not a transplant doctor, and paid little attention to Jeri. Her problems were chronic, not acute, and she’d been hospitalized more to move her up the transplant list than for her chronic rejection and liver failure. “It’s a sea full of livers,” her mother had said, standing at the window and looking over the water. Her daughter had a unique metabolic defect that had poisoned her first liver. She was the only girl in the world with it, the product of a mutation so rare, shy, and retiring that it required cosan-guinity to bring it out: Jeri’s father was also her great-uncle.

Jeri was a very hairy five-year-old, partly on account of her immune suppressants, and partly on account of her extraction. With her bushy black head of curls, thick synophrys, downy mustache, and hairy cheeks, she looked like a Sicilian Annie. Today Jemma thought she looked a little more yellow than usual. Her mother said it was just the light. Jemma listened to her chest, heart and belly, and felt her big, useless liver. When Jemma tickled her she didn’t laugh, but only gave Jemma a bored look.

“She’s tired today,” her mother said matter-of-factly. “Maybe she’s got an infection.”

“We could look at some blood.”

She shrugged. “Let’s watch her.”

“We’ll talk about it on rounds. Her vitals have been fine.” Jeri’s mother shrugged again. She was another mom reputed to be difficult, but she’d always been nice to Jemma, and her management plans, when Jemma passed them on to the team, only rarely drew ridicule from Dr. Snood. Jemma would have liked her more if she did not have a tendency to lurk in the corners of the room, squatting in the darkest shadow, seeming to size you up.

“Have any more bodies floated up?”

“No. No more.”

“And the one, is it still alive?”

“Ishmael was just fine when I saw him last.”

“And that was long ago? Was it days? Something could have happened, yes?”

“It was earlier this morning,” Jemma said. She’d seen him in the gift shop, when she’d gone by for her morning fistful of gummy bears. He’d taken a job as assistant to the volunteer while he waited to remember what he’d done before the Thing.

Ms. Vega stood up out of the corner, took Jeri from her bed, and stood her up by the window. Jeri leaned against her mother’s leg and looked back at Jemma with her huge black eyes. Her mother did a very professional imitation of someone casting a line out into the water. Jemma thought she must have some kind of mechanical apparatus in her mouth, so precisely did she make the noise of a winding reel. “Jeri!” she said excitedly. “What am I doing? I’m fishing for a liver. Oh, they’re biting!” She hauled mightily on her imaginary pole, then pretended to lose it. Then she fell on her daughter, tickling her maniacally. Jeri looked bored with it for a few moments before she burst out laughing. “There,” said her mother. “Now she’s better. You want to have a try?” Jemma approached slowly, and tickled cautiously at the still-hysterical child. As soon as she touched her Jeri calmed and glared at her.

“You’re a bad tickler,” said her mother.

Jemma had woken up with the sense that she was forgetting something, and the feeling worsened through the day. She thought Pickie must have given her something — a sense of unease for an anniversary present. She had obsessively checked her scut list, the row of tasks, each saddled with its own empty box to be checked off or filled in when the task was done. But by the midafternoon she’d done everything but look at Sylvester’s chest film. Down in the dim, cool reading room, looking at the film and waiting for Dr. Pudding to arrive, she felt nagged almost to exasperation by the feeling. It made her more nervous than usual when she tried to read the film. Dr. Pudding made her nervous anyway. He was ancient and fit, a sporty mummy who had run marathons and swum in the frigid bay and had won the national over-seventy wife-throwing championship three years before. There were attendings who wore their spite on their sleeve, like Dr. Tiller, the professional counterpart to raging Helena Dufresne. You could tell she hated you the moment she looked at you. Others, like Dr. Pudding, hid their disdain under a pleasant veneer, but it seemed to Jemma that these types hated no less, and no less passionately, and five minutes with Dr. Pudding almost made her long for Dr. Tiller’s honest fury, or a refreshing dose of Dr. Snood’s plain, old-timey smarm.

“Shadows,” he whispered, looking very dried out in the cold, weak light from the reading box. “Shadows on shadows, Dr. Claflin. Can you make sense of them?”

“I see a smudge,” Jemma said.

“A smudge? Do you mean a blob? Do you mean a smear? Or do you mean an infiltrate? Do you even know what you mean, Dr. Claflin?”

“I see an infiltrate,” Jemma said. “Right there, behind the heart.”

“Do you really?” he asked her.

“Yes,” she said confidently.

“Do you think it could be normal anatomy?”

“It’s too fuzzy.”

“Some of us are fuzzier than others. How many films have you read, that you know what’s fuzzy and what’s not? How many, Dr. Claflin?”

“I haven’t really been counting.”

“One, two, three,” he said, pointing at each of her toes and then her fingers and counting up to twenty. “More than this? How many times has piggy been to market?”

“Maybe a few dozen.”

“How many have I read, do you think?”

“Many more,” she said, looking back at the film.

“Thousands and thousands and thousands, Dr. Claflin. Now, what do you see in this film?”

“I guess it’s normal.”

“You guess? Is that what you’ll write in your report?” He picked up the dictaphone receiver and held it out at her. She could hear the tinny voice of the angel: “Name me, Jemma Claflin. Oh, give me a name and I will serve you.” Dr. Pudding frowned and hung it up.

“It’s normal,” Jemma said.

“Wrong,” said Dr. Pudding, clapping his hands in front of her face. “If you see it, never let anybody talk you out of it.” He smiled at her, his face in the dim light a tight ghastly friendly mask.

“Thanks,” Jemma said, realizing as she left the room that she had just thanked him for trying to humiliate her. But shame hardly distracted her from her anxiety; it got worse after the hurried lunch with Vivian and Ishmael, and persisted through the evening and the night.

“Are you awake?” she asked Rob, a few minutes after he had come in and collapsed next to her without undressing. He was clammy and smelly but she clung to him anyway, her anxiety palliated a little by the pressure of his bottom against her hips.

“No,” he said.

“Something weird is happening,” she said.

“Understatement of the year. Understatement of all eternity.”

“I mean particularly. I think I caught something from Pickie.”

“Scabies?”

“Crazines. “

“You’re not crazy,” he said.

“You haven’t even heard my symptoms,” she said. “I have this feeling…”

“Like you want to drink some blood?”

“Like I’m forgetting something hugely important.”

“That’s an intern thing,” he said. “Did I dose that drug right? Did I make that kid NPO? Is the chest tube on suction or water seal? It’s just normal.”

“Something bigger,” she said. “Like something’s wrong and I’m not doing what I should do about it.”

“Exactly. It’s an intern thing,” he said. “Congratulations, Dr. Claflin. My little baby’s growing up.” He scooted closer against her and said it again, his voice trailing down as he spoke. “Welcome to the club… always worried… always about to die… it’s all you can do sometimes to not fuck them up worse…”

“That’s not it,” she said. She didn’t speak again, and within minutes he was snoring, but she asked herself over and over, What is it? A variety of problems presented themselves to her as she lay in the dark: Jeri was so very hairy; Sylvester’s pneumonia was sure to prove resistant to the single agent therapy upon which Dr. Snood had insisted; Dr. Chandra was still sleeping too late, and she had figured out that morning that he made up some of his lab results, but hadn’t told anyone of her discovery; her parents were dead and her lover was dead and were they waiting even now for her to join them?; she was not what she should be, she had not done what she was supposed to, this was obvious, inescapable fact; Calvin had a vision for her that she had never understood let alone fulfilled—don’t follow me but follow me your time will come behold my feast behold my offering behold the human grace but sister yours is the harder part; she was inferior to Rob, he loved her better than she loved him, purely, deeply, truly in ways that she had reserved for and lost with her dead, and he was a better doctor, like Vivian was a better student and a better doctor and a hotter mama, both of them were better because they cared more for the work, and subscribed with perfect honesty to the Committee ethic, they just did the work while Jemma just pretended and prevaricated, rounding with false vigor, presenting with false enthusiasm, caring with a false heart, no wonder Snood hated her, he saw right through her; Rob and Vivian were better friends anyway, and better people, open to receiving others into their circles of wonder and grief, sharing their hope and their fear over beer or tea or one of the strange new juices Vivian was always ordering up out of the replicator mist, while Jemma said nothing, they were already part of the project and she was a bystander because trusting is the first deadly sin, sharing is the second; the world had ended, after all, and wasn’t that a big enough problem, and wasn’t anxiety just punishment for a person who said, La la la, it was over already, for me, for a person who felt nothing and cared nothing for what was lost, and who, though she was on the boat, had still managed somehow to miss it? She submitted herself to all these problems in a spirit of open humility, yet nothing changed in her anxiety. These things might be true or not but none was the secret bother.

She sat up, exhausted but totally awake, lifting Rob’s arm to smell deeply of it, then let it drop. She could bite his ass (gently) and not wake him, but if she made the faintest peep of a pager-imitation he’d be up in an instant, reaching for the phone. She got out of bed, put on her shoes, and went looking again for her mystery boy. It had been a couple days since she’d searched.

But she felt the same if not worse after an hour of it, failing to catch even a glimpse of him. She had always had a hard time mustering sympathy for the victims of panic attacks, patients who slouched into the emergency room short of breath, with chest pain and tingling in their lips and fingers. You were supposed to ask them, Are you experiencing a crushing sense of doom? Now, with her hands and lips starting to tingle, and a bubbling sense of anxiety rising ever higher in her, she was better inclined toward them. She paused by the blood bank, examining a dirty sock abandoned in the hall. It was too small to belong to the child she sought.

She heard a scream and the noise of breaking glass. Maybe Pickie was conducting a raid — she ran to the blood-bank window. The teller was cleaning up a spill. “It’s all right,” she said to Jemma. “Just some clumsiness and a waste of some prime O neg.” When Jemma saw the blood gleaming against the linoleum two thoughts bloomed in her head: first she remembered blood on the green linoleum of her parents’ kitchen; then she realized her period was late.

She felt equal parts “Aha!” and “Oh no!” Surely every moron with a functional uterus was able to keep track of these things, even the smallest-brained furry mammal knew when she was late. But Jemma had never been late before, and the only time it had ever been even a little different was a month before — the flow had been a little decreased, and the color a little changed. Now that made sense, too. She suffered from none of those entities whose names sounded like the names of evil Greek queens: dysmenorrhea, menorrhagia, menometrorrhagia, no horrible cramps, no bloatiness, no sourceless rages or crying spells. Since she was fourteen it had not ever demanded much attention from her.

And she was cautious: even during years of celibacy she stayed on her OCP, and dutifully replaced the condoms in her cabinet as they expired, and expired, and expired. Even at the first call-room encounter, she and Rob Dickens had used a condom. She always had one available, in her wallet, or her purse, or even, sometimes, in her shoe. Vivian had taught her well. She could lay out the rough shape of the years of her sex life in her mind: there was no spot of recklessness, in that regard, anywhere in it. Yes, witnessing a birth put her in the mood for sex, but she still had the most awful fear of pregnancy.

“You look a little pale,” said the teller. “Would you like some tea?” She worked alone all night long, in a lab that was isolated from the core lab, and was always trying to get people to sit down and talk when all they wanted was to take their blood and run.

“Tea!” Jemma said. “Oh, fuck!” She was thinking of Vivian’s mushroom tea, and the pictures of monsters she’d seen in her embryology class, and of limbless, eyeless babies floating out of teacups on beds of soft mushroom steam.

“What’s wrong with a little tea?” the teller asked. Jemma ran off without answering.

She’d made some acquaintances during her insomniac peregrinations of the hospital: nurses on various floors, ward clerks, the tamale lady, and techs in the core hematology and chemistry labs. Ten techs were working the night of the storm; now six worked by day, and four at night. She found the one doing urines, a woman named Sadie, and pretended to want to learn how to do a urinalysis so she could get close enough to the urine pregnancy tests to swipe two. Sadie was thorough, and had three urines batched already for testing. She went through each of them with Jemma, who had to pee furiously because of her question, and because of all the pee she was looking at, and because she had been drinking potent synthesized espressos all evening in an effort to flog her memory to give up what it was hiding.

When she got away from Sadie she went toward her room but veered away when she got to the door and she remembered Rob was still inside. She hurried to three other bathrooms, proceeding with the cautious but hurried steps of a girl about to wet her pants. None of them were empty: in two she found gossiping nurses, in another an anonymous person in red slippers with intestinal distress. She wanted and needed to be alone to do the test, so she picked up a flashlight from the sixth floor and went to the roof and peed on the dry ground beside a blueberry bush, taking ten milliliters from the middle in a plastic cup. She had done pregnancy tests before. Two weeks in a teen clinic and a procession of panicked fourteen-year-olds had made her an expert. It seemed like witchcraft, messing with your own pee among exotic foliage, under the light of a full moon, in the middle of the ocean. She sucked up a cc with her stolen pipette and applied a drop to the blank window, set the timer on her watch for three minutes, and turned on the flashlight. At first she kept the light on the test, and her eyes closed, but the monsters were still flashing in her head. She opened her eyes and turned off the light. The test, small and round, gleamed like a piece of fallen moon, but she couldn’t see what was happening in the window. “Bar, bar, bar,” she said. “Minus sign. Negative.” There were lots of reasons to miss your period besides being pregnant, and two days was not very late. Great stress was a reason. No one would fault a period for being late on account of the end of the world. She stood up and pulled down her pants to look at her spotless underwear, a gift from Vivian who was synthesizing her own line of lingerie. The timer sounded.

Jemma knelt again and raised the light, shining it down and blinking. Later she’d think her eye had tried to humor her, because at first she only saw the flat horizontal bar. But when she blinked again the window flickered and the vertical bar was there, dark, unbroken, blue, and undeniable. The image seemed to expand, the cross growing bigger and bigger, not in the air, but in her mind. She shut her eyes to block it out, but still it grew, as big as a mouse, a cat, a dog, a horse, a house, a hospital. It hung over her and cast her into deep, blue-black shadow.

She’d never been fainty, not as a child witnessing near brainings or facial deglovings, not at the news of death after death after death after death, not in gross lab, not during rectal disimpactions, not picking maggots from the feet of aged diabetics. But now she swooned like a helpless, petticoated weakling, falling back among the dusty rivulets of her pee with her pants around her thighs. The flashlight came to rest under the blueberry bush, lighting the underside of its leaves. Jemma, not awake and not asleep, watched the blue cross as it continued to rise and expand and triumph over her.