The Children's Hospital

23

Jemma pre-rounded with her usual sense of dread, hand always pausing before knocking on the door, and it took a hefty effort of will to move her wrist. This was the part she hated most about switching services, the introductions. Hello, she must say. I am your new medical student. It’s true: about your illness and your life I am as well informed as a doughnut, and I am as qualified as a doughnut to manage your problems and move you toward the recovery of your health, if such a thing is even possible. Turn yourself to me, trust in my ignorance, let me be your own special moron; I’ll do my weary, confused best not to hurt you.

At least she had escaped Dr. Snood. The Committee had decided that the end of the world was no reason not to torture the medical students; they must continue to rotate within the hospital. Now that Jemma finally felt like she knew her patients and their problems, she would give them up for an entirely different set. On the fifty-second day she went to the heme-onc team with Rob, and Vivian went to the NICU/PICU team.

Dr. Sashay, an oncologist who’d come in the night of the flood to preside over a patient death, ran the service along with the fellow, Cotton Chun. “Yes,” she said, sizing Jemma up during an orientation the night before she came on the service. “You’re a bit of a fatty, aren’t you? Isn’t she, Cotton?”

“I wouldn’t know, ma’am,” he said, not looking up from his computer. Dr. Sashay put out her hand and smiled while she said this, and seemed genuinely friendly. Some people said she had once been a very tactful person, until she had her accident — she was run over by a jet ski while lagging far behind the crowd in a triathlon swim — but that afterward, though her extraordinary genius was not the least bit dimmed, and her generous spirit not soured, she habitually insulted her inferiors. “Somehow you don’t hold it against her,” said Rob, who already knew her from the PICU, where she consulted on three of his patients.

“I’m having a baby,” Jemma said flatly to Dr. Sashay, making Rob choke on one of the fancy danishes — orange and starfruit and papaya arranged as intricately as a mandala in the bun — that Cotton had called out of the replicator for them. Then she laughed — more advice from Dr. Chandra: “Whenever she says something that makes you want to kick her in the face, just laugh. She likes that. I was one of her favorites, and everybody fucking hates me.”

Dr. Sashay laughed back, a crescendo, decrescendo cackle. Strange, Jemma thought, to hear an insult not spoken in malice, but it seemed that was what it was. Dr. Sashay smiled wider, and Jemma wanted to say, You look kind of like a bag lady, don’t you? because she dressed in wrinkled droopy skirts and blouses, and her hair looked like she styled it by rubbing a cat on her head, but Jemma knew she wouldn’t be able to invest her insult with the same sort of friendliness, and left it unspoken.

“But you are going to have a baby, my chunky bunny. You’re going to have five or six of them, sicker than you can imagine, and you are going to learn to poison them like an angel. We’re going to get them better, all of us together — don’t think you’re not as much a part of the team as me or Cotton. We need you, so you need to learn your shit. When you’re not here, you’ll still be here, reading and learning. Sepsis, fever and neutropenia, typhlitis — you’ll be able to do them in your sleep — or should I say my sleep? — long before I’m done with you. We’re going to have adventures! These kids are full of surprises — you never can guess what crazy miserable shit they’re going to pull on you next. All I ask of you is that you do everything I say, read my mind, and give me what I want before I ask for it. I’m kidding! But not really.” She gave everybody a welcoming hug, then, and reminded them all that her name was pronounced with the accent on the first syllable.

Jemma’s first patient was Magnolia Watson, a fifteen-year-old girl with sickle-cell disease admitted for a pain crisis and acute chest syndrome. There was no answer to Jemma’s soft knock on her door. The hair was the first thing Jemma noticed in the darkened room. She stood and stared, not even all the way out of the door, and within a minute she’d developed a relationship with it — she admired it, then fell in love with it, then wanted it for herself. Magnolia lay back asleep on her pillows, her characteristic pose, with her impossibly thick hair piled up above her head. It was such an incredible mass, Jemma was sure she could hide a toaster in it, or perhaps even a toaster oven. It was coarse and herbaceous, and she would discover that whether freshly washed or days into a sweaty bout of pain, it gave forth a wholesome aroma, like bread or cookies. That first morning it was raised into two great hills, parted into a deep valley that ran perfectly straight along the top of her head. On the overheated actresses of the fifties, and on the men pretending to be those women, Jemma had seen the same style look like what it actually was, a big booby-head, but on Magnolia it looked stately.

She’d had a rocky course since her admission — Jemma had read the chart the night before. She came in with both her knees hot and swollen big as softballs, with saturations in the low eighties and a whited-out chest film. The water came in the second week of her hospitalization, by which time she had improved on IV antibiotics and pain medications and an exchange transfusion. But her pain became intractable after the Thing, a phenomenon probably not unrelated to the loss of her family, who had failed to visit her on the day of the storm, like they had on most every other day.

Jemma was looking at the vitals sheet, trying to add up all the PCA hits when Magnolia spoke. “Where’s the bitch?”

“I’m Jemma. I’m your new student doctor.”

“Where’s the bitch?”

“Which bitch?”

“You know. White coat. Mean little eyes. Teeth like a rat. The bitch. Like you, but a bitch.”

“If you mean Maggie, she got transferred. They like to switch us around, because we’re learning.”

“Transferred into a little boat? Set her floating like Captain Bly. Goodbye, bitch. Enjoy your fucking breadfruit. It’s a movie, you know. You can watch it any way you want. The old one or the new one — she remembers all of them. Or one with my brother as Mr. Christian and Uncle Poo as the Captain. Poor Uncle Poo. He was a different kind of bitch, like the ones that get slapped around. He was everybody’s bitch, but she made him so big inside he just yelled and yelled and in the end he had his day and Mr. Christian was stuck on this island without his pants. A girl shouldn’t see her brother’s thingie flapping in the wind, not when he’s all grown up. She’ll change the endings if you want, or even if you don’t.”

“How are you feeling?” Jemma asked, hugging her clipboard and trying to look friendly. She thought that first impressions counted for a lot with teenagers. She beamed the thought at the girl in the bed: I’m not a bitch I’m not a bitch I’m not a bitch.

“Same old deal,” said Magnolia, drawing up her long legs next to her, turning to her side and pushing her blanket off. She raised her slim arm and pointed with one long finger at five joints in succession, rating the pain in each one: left elbow, right elbow, left knee, right knee, right hip. “Seven,” she said, “eight, eight, seven, six.”

“May I touch?”

“Gentle,” she said, so Jemma hardly pressed at all as she felt the joints. Still, Magnolia gasped and moaned, but yawned once in the middle of a moan. Maggie, in truth an anxious and stingy personality, had warned Jemma at length about the wily medication-seeking behaviors of sicklers. She had five separate ways of deciding if pain was real or not, before she gave painkillers. “You got to look at the blood pressure,” she said. “You got to look at the pulse. You got to look at the pupils. You got to kick the bed — if they’re really hurting then they won’t even notice.” Jemma had stared out the window at the dark, empty water while Maggie talked. Every so often someone would think they saw a light in the dark, but tonight Jemma saw nothing but her own face and Maggie’s chinless reflection. “It’s always real,” she had said, not caring to hear the fifth method.

“Sorry,” Jemma said. Magnolia gave her PCA button a push.

“Are we done here?”

“Almost,” Jemma said, listening to her chest and her belly, and catching a glimpse of her My Little Pony panties, a revelation, as she ranged her hips. How stupid, to think you could know anything about anybody in five minutes, even if you were pawing at them like a confused, horny monkey. But even if it was all pretend, it was nice to know, in that moment, that Magnolia was no hollow-eyed demerol fiend of the sort who are hated and pitied for their need, ER ghouls who pass from hospital to hospital, generating huge charts and huge ill will. With her menagerie of stuffed animals, and shelf of middle school romance novels as wholesome as the odor of her hair, and her innocent panties, she was suddenly one of the youngest fifteen-year-olds Jemma had ever met. It was something Vivian had taught her about adolescent girls, that an old twelve was older by far than a young fifteen or sixteen, and that the quickest, if most cursory way, to gauge this true age was by looking under their skirts, not for the Tanner stage but for the panties of innocence or experience.

“Are you all right?” Magnolia asked, because Jemma had paused with her hand on the girl’s neck, palpating and palpating and swaying a little bit. “I don’t hurt there. I never hurt there.”

“All done,” Jemma said, feeling herself blush. “Thanks for being patient.” She’d been having a daydream — prancing panty-ponies had shown her that Magnolia’s joints were glowing blue under the skin and she felt very certain that the cartilage was… depressed. It only needed an infusion of vigorous hope to bring the pain down to zeros all across the board. Was it a symptom of pregnancy, she’d asked Vivian, to lose control of your imagination? Stories kept creeping uninvited into her head — Ella and the thousand Arabian ostomy bags, Kidney and the Giant — and illnesses took on colors and shapes and causalities ridiculous and fantastic and plainly stupid. Cindy’s gut had been nibbled short by the worm of dissatisfaction; Jeri’s liver was shot through with veins of coal; Tir had a mouse in his head, nibbling the connections between hand and mind. “Schizophrenia, maybe,” said Vivian. “Pregnancy, no.”

“Thanks for not being the bitch,” Magnolia said. “Can we turn up the PCA?”

“I’ll talk to the team.”

“That would be a no, then,” she said, and turned over again, drawing the blanket up over her head. She wouldn’t say another word, though Jemma stayed another five minutes trying to draw her out. The only answer she got was the happy chirp of the PCA when Magnolia pressed her button.

Juan Fraggle was next, a boy who had failed despite great effort to die on the night of the storm. Harsh, unremitting AML chemo had decimated his immune system, and made him host to a nasty fungus which Dr. Sashay and others had only managed to tickle with the antibiotics they’d chosen. “Mucor,” she said of the fungus. “It even sounds like a fucking monster, doesn’t it? I could hear it snapping its fingers at me.” She tended to personify aspects of any illness, and then take personally their assaults, so this fungus was sassy, and that mutated cell was crazy, just as the ocean was critical, or the thunder was full of wrath. She’d hurried in that night through the storm, with saving him in mind. But when she consulted with Cotton and the resident on call and saw the boy, who on cursory inspection already appeared quite dead, she’d had the conversation with his parents — this is the time we’ve been talking about all these months, and now you must say goodbye. His family stood around his bed in a circle, eyes closed and heads bowed, some of them not understanding Dr. Sashay’s words but all of them appreciating her earnestness. They prayed for him, hands together until the hospital rose and they all fell down.

In their first hours afloat, the eighth floor behaved no differently than the rest of the hospital. The children there, like those in NICU, all tried to die. Blood pressures bottomed out, blood was vomited or defecated by the pint, lungs blew out as suddenly as a tire on a quiet highway drive. Dr. Sashay and Cotton and all the nurses were distracted from Juan by these other emergencies; they had to tend to them themselves, since every child in the PICU was behaving similarly. Even some of his family went out to help — his two oldest sisters were premed and one of his brothers was a nurse. Juan slept, oblivious to the change in the world. His fever broke. His blood pressure climbed out of the toilet. His cold, purple hands and feet and his black lips all lapsed pink. His sassy fungus had retired from its deadly mischief. No one noticed until the next morning, when he woke and asked his grandmother to go across the street to fetch him a cheeseburger, sending her into hysterical sobs.

That morning he was surrounded by his family in his very crowded room. His incipient death had called every available relative to him — his mother and grandmother were with him, his three sisters, his brother and brother-in-law, his twin eight-year-old cousins, and his aunt and his uncle. Only his father was missing, stuck in Bolivia, from whence he had been trying to come since his son had been diagnosed three months previous. So there were bodies everywhere in the room, though since the Thing the hospital had grown enough new rooms that everyone could have moved out. They lay on the floor or in the window seat, in cots and reclining chairs. One of the little cousins was stretched out beside the patient, the other one was curled at his feet.

Jemma examined him without waking him, something she did not like to do because it felt akin to molestation, pressing on a sleeping body’s belly, and slipping your hand under his shirt to guide your stethoscope over his heart. He looked just like a chemotherapy victim, puffed out with steroids, the same length of hair growing over his head and his chin. One arm was shoved down his pants, the other was thrown over his cousin’s neck. When Jemma whispered his name and shook him he would not respond. She had met teenagers before who feigned sleep no matter how hard you shook them, because they were tired of being woken at six in the morning to talk to a doughnut. She called his name once more, rather loudly, and a stirring passed from body to body all around the room, a shudder, as if the same nightmare creature had gone skipping from dream to dream to disquiet the sleepers. She took his vitals sheet and stepped carefully among the bodies and out of the room.

Josh Swift was next on her list. She had the chart story: sixteen-year-old boy with trisomy 223 who’d manifested every possible unfortunate association of that syndrome in his short life — duodenal atresia and an endocardial cushion defect and acute myelogenous leukemia — as well as a number of entirely separate afflictions, admitted this month for a big clot in his head. He’d complained of a headache to his primary-care doctor, a lady familiar enough with his disaster-prone protoplasm that she immediately scanned his head, and discovered a venous sinus thrombosis that extended all the way to his jugular. “He’s a freak,” was all Maggie had said about him, “a freak’s freak.”

But that description dismissed his complexity. He was, in clinical parlance, delayed, a term Jemma found a little curious, because it seemed to imply that the children so described would one day catch up with the normal children, yet they never would. But he had just enough insight into his condition to understand that fortune had treated him very badly — there was a note in his chart from a consulting psychiatrist who’d come by weeks before to evaluate him for depression. Jemma had always thought the extra twenty-first chromosome must code for an abundance of some protein responsible for contentment and sweetness, because all the Down’s syndrome children and adults she had met were smiley and gentle, or that on account of their diminished capacities all the existential sadness of the world passed harmlessly over their heads. Not so with Josh Swift; he knows there is something wrong with him, the psychiatrist had written, and he wants us to do something about it.

“How’s your head feel today?” Jemma asked him, after she had introduced herself. She found him awake, staring out at the sunrise with his blanket drawn up to his neck.

“Yuck,” he said, putting out his tongue so it hung over his chin.

“Worse than yesterday?”

“Much worse. Much, much worse.” When he frowned at her his big tongue made it look like he had three lips. Jemma hated headaches, especially in patients who had things happening inside their heads, because they made her feel compelled to do a complete neurological exam, the weakest part of her physical next to listening to hearts. She took out her penlight and approached him, ordering the cranial nerves in her head, trying to remember if the glossopharyngeal nerve was number nine, or twelve. She shined her light in his eyes and had him follow the beam as she swung it back and forth across his face. He wrinkled his forehead and smiled for her, stuck out his tongue again and said, “Ack!” She put a hand against his face and had him turn his head into her palm against the strength of her wrist, once on the left, then again on the right. When he did it on the right he touched her palm with his tongue. She thought this was an accident.

The last one she tested was number eleven, the shruggy nerve — she could never remember the proper name for it. She asked him to turn down his blanket so she could test his shoulder strength. She meant for him just to slip it down below his chest, but he threw it down to his belly, then gave two scissoring kicks to throw it to the floor.

Had Maggie told her he slept naked? Jemma didn’t think so. She stared at him for a moment, at the thumb-wide sternotomy scar that ran down his chest, and the mass of scars on his belly, and his little bitty penis, lost in a thatch of hair as thick and coarse as a mass of bean sprouts. It was as small and stiff as a pinkie.

“Put it in your mouth,” Josh told her matter-of-factly. Then he laughed, so his belly scars writhed like sporting worms. “You need to examine it,” he said, reaching toward her head, “with your mouth.” Jemma dodged his hand, and moved to retrieve the blanket. When she tossed it over him he started to cry, and said “You don’t like me. You don’t like me at all!” This was a true statement, but she didn’t tell him so. She just ran. The nurses giggled at her when she sat down at the station to recover. “You guys got a date?” one of them asked her. “When’s the wedding?” asked another. Jemma bent and vomited briefly in the garbage can beneath the desk. “Oh please,” said the first nurse. “He’s not that bad.” But the second nurse patted her back, and wouldn’t hear of it when Jemma offered to change the trash bag.

Ethel Puffer, a fifteen-year-old girl with rhabdomyosarcoma, a malignant tumor of striated muscle that had popped up in her left thigh and nearly killed her, was more pleasant, if a little weirder than Josh. She went early to the doctor but came late to diagnosis; her pediatrician had thought it was the usual misery of adolescence somatasizing into limb pain. She had been a peppy and inspiring cancer victim, the sort to paint a smiley face on her bald head, bring homemade cookies for the nurses every time she came in for chemotherapy, and spend her time between retching spells boosting morale in the other kids on the floor by means of a rather sophisticated sock puppet show whose degree of obscenity depended on the age of her audience. Before her illness she had been a diver and a gymnast, and up until the Thing she could still be seen walking up and down the halls on her hands.

Now she was changed. She’d crashed the night of the storm; an occult bacteremia had made her septic, and she’d been nearly as sick as Juan Fraggle for a few days. When she recovered, and woke up again, and understood what had happened, she crashed again, differently. For a few days she would not speak or eat or drink, so Dr. Sashay put her on TPN and searched fruitlessly among the surviving staff for someone who could do a psych consult, coming closer every day to letting Dr. Snood inflict his amateur best on her patient. Then one night Ethel had rung her midnight nurse to ask for a bucket of black paint. He’d obliged her, thinking she was going to craft her way out of despair. When Maggie went in the next day she found that Ethel had blacked out all her windows, and painted a black skullcap on her bald head, and made herself the most incredible pair of raccoon eyes, and rinsed her mouth with paint so her tongue and her teeth were black. “Let me do you up,” she’d said to Maggie. “You’ll feel better.”

When Jemma went to see her, Ethel’s room was blacker than ever. Dr. Sashay would not restrict her access to black paint, so every day she added another layer to her windows. The sun was well above the water, but when Jemma went in at first she could hardly see her own hand in front of her face. It was fifteen minutes since her last trip to the bathroom, but once again she felt a terrible urge to pee. It occurred to her that she could squat in a corner of the room and wet the carpet and the patient would never know.

“Hello?” she said into the darkness. “Ethel?”

“I am here.”

“I’m Jemma. I’m your new student. Like Maggie, but not Maggie. How are you feeling this morning?”

“I am here.”

“Is your leg hurting at all?”

“I am here.”

“Okay,” Jemma said. She moved on to the exam. “She’s just working through it,” Dr. Sashay would say of Ethel. “Think of what she’s gone through, and what she’s lost. Think of what we’ve all gone through, what we’ve all.…” She’d turn to Jemma and put a hand on her shoulder. “Don’t you want to paint your head black?”

Ethel tolerated the exam. The longer Jemma was in the room, the better she could see her; there were places on the glass where the thick paint had cracked or flaked, so a few motes of light slipped in, and a few more from under the hall door. The way her painted skin blended with the dark, it looked like her face ended just above her eyebrows.

“Put your hand under my thigh,” Ethel said suddenly, just as Jemma was finished listening to her belly. Jemma hesitated, visions of Josh Swift still belly dancing in her head. “Please,” Ethel said. “Do it.” Jemma put her hand under the covers, and under a firm, muscular leg.

“Wrong thigh,” said Ethel. Ethel moved Jemma’s hand with her own until it rested under a hollow under the other leg. It sat there for a few moments, between the warm flesh and the damp sheets, before Ethel spoke again. “Do you feel it?”

“Feel what?” Jemma asked.

“My lump. Do you feel it? It’s what I’ve got. It’s my thing, what’s with me. It’s mine.”

“Yes,” Jemma said. She wasn’t sure if she did or she didn’t — it might have been a stringy muscle belly rolling between her thumb and her finger under the thin scar, but it was hard to suppress the reflex that made her, when asked Do you hear this murmur, Do you see that cotton wool spot, Do you feel my lump, say Yes, Dr. Snood, Yes Dr. Sashay, Yes Ethel Puffer. Ethel reached a strong claw around to clutch at the back of Jemma’s thigh.

“I feel yours, too.”