The Children's Hospital

28

After rounds, Jemma hid in the PICU staff bathroom rubbing on her eyes, a measure usually sufficient to drive a headache away, but one that looked so alarming to people who saw her driving the heel of her hand into her orbit, and who heard the curious, wet noises that her eyeball made when she did it, that it required privacy. She sighed, pressing harder with both hands, and saw floating bits of color in the dark behind her eyelids, here and there an emerald sparkle among them. She saw her brother’s face flash unbidden in the same darkness, pale and dead, how she imagined that his open-casket funeral face would have looked — the face a natural death would have given him. She did not understand why she was suddenly so angry; Maggie had been annoying her and countless others for years, and had never before evoked much from Jemma besides horror and pity. For a moment the spirit of her brother threatened to possess her, his face loomed larger before her closed eyes, his mouth opening to show a deeper blackness, and she knew if she fell into it she would lose her temper in a way that would make her his imperfect avatar, as angry as him but expressing it in a hissy fit rather than sublime fury. He faded away before he touched her.

“It was horrible!” Maggie had said, slurring a little, after waking from her extended postictal snooze just as they were rounding on her. “She made this nasty sound, and horrible green sparkles shot out of her eyes, and then I couldn’t move, and then I was seizing, and I knew I was but I couldn’t do anything about it!”

“Sometimes people hallucinate before their seizures,” said Emma. “You had a lot of activity in your temporal lobes, even on the pentobarb. Want to see your EEG?” The whole team was gathered around the bed, Drs. Tiller and Grouse and Chandra and Jordan Sasscock and Emma, everybody staring at the patient with expressions of fixed beneficence. Jemma was smiling even as she was being slandered.

“I want my brain back. She damaged it — I can feel the damage. How many deletions are there in alpha-thai minor? I don’t think I know any more. That part of my brain was damaged. I want to stop her before she does it again. I want justice, is what I want.” Jemma had dashed off to replicate a batch of festive cupcakes when she heard that Maggie was awake and extubated. Now she put them down on the trash can and backed out of the room. Maggie kept talking, her soft hoarse voice at odds with the fury in her words. “You’re on the list!” she called after Jemma.

“I’m giving you a little ativan,” Emma said. “One, two, three … relax!”

Jemma sat down at one of the station desks and tried to calm herself by going through one of her patients’ charts, trying to figure out how many days her platelet girl had been on each of her eight different antibiotics. “Septra number forty-seven,” she muttered. “Ceftaz number ten; vane number fifteen; tobra number seventeen; ampho number five.” But instead of becoming calm she just got more agitated.

Hour twenty-six, hour twenty-eight, hour thirty — the endless day went on and on. Rob came in and out of it, checking in on her in the morning to see how she’d done her first night in the unit. Recognizing her bad mood, he returned again and again, trying to cheer her up, bringing a succession of gifts: a bit of unusual candy from the gift shop; some ice cream; a cold salad-bar plum; a little song about Maggie, new words set to the tune of “I Got No Strings” (I got no chin to shape my jaw, nor sweetness in my soul!); a shoulder rub, then a back rub, then a thigh rub, and finally his face between her legs. They were paged before he could transform her — she was on officially until five o’clock, and he’d be on all through the night with the surgery team — though it would not have transformed her or the day unfolding with unpleasant surprises, even if he had made her sing. But it did provide a bit of shelter, to lie across the call-room bed, her hand resting on the back of his head, feeling the new sweat gathering atop his scalp, and feeling his gasping breath against her skin. Hand on the doorknob, he ruined it all just as they were leaving the room. “Marry me,” he said again.

“Not that again,” she said.

“Again and again,” he said. “Until you give me a good reason.”

“I wouldn’t marry you if you were the last man in the world, which you practically are. I wouldn’t do it with anybody. How many times do we have to have this stupid conversation?”

“As many as it takes,” he said, and stared at her, annoying fool, with his back against the door and his hand still on the knob.

“Can I go?” she asked. “I have antibiotic dosages to adjust. It’s very important. No one else can do it. No else has a calculator. No one else has the incredibly sophisticated grasp of arithmetic. They’re waiting for me, can I please get by?”

“We’re already a family,” he said. “I just want you to say it — I just want you to understand it, too.”

“Don’t say that word,” she said, shouldering past him, aware that he was staring at her as she walked away down the hall. She stopped on a set of preemie prints and shook her ass, meaning the gesture to be somehow conciliatory. Maybe it was her bad mood that made it feel taunting and cruel, but sometimes a boy should know when to just be quiet.

She’d had so many bad days, before and after the Thing. Why this day should seem like the culmination of every bad day, she did not know, unless it was on account of the pregnancy. At eleven weeks she was almost always nauseated, though the really horrible gut-twisting retching only came at night — it was such a horrible sound, something that started out deep in her rectum and spurned the easy way out, making the long journey up to her mouth, gathering volume and a truly ass-nasty assortment of tastes to fill her mouth and vapors for her to spray around the bathroom. She knew it was the single most unattractive thing she’d ever done. She ran every faucet while she performed, and had the angel play loud music, and flushed and flushed and flushed the toilet, all to keep Rob from hearing, and she would never let him in with her, though he wanted to hold her hand while she did it. She could deal with it. Vivian swore up and down that it would pass, and Jemma didn’t mind being tired all the time, or how some foods — asparagus and potatoes and apple juice — were suddenly unpalatable, but the agitation, if it continued at such a pitch, would surely wear her down. She’d met a string of pregnant ladies who all seemed perched on the brink of a particular type of madness. “I just want to rip off my own leg and then beat everybody around me to death with it!” was how one patient described the feeling to Jemma. “Yes,” Jemma had said, drawing on a store of vaguely remembered and possibly made-up information, “I think it can be quite normal to feel that way.” It was as if the little hurt which Maggie had done her in the morning had marked her equanimity in just the right place to weaken it fatally, so all the subsequent wrongs of the day were exacerbated.

Through hour thirty-one she sat at one of the nurses’ stations in the PICU wrestling with the antibiotic dosing on her septic teenaged friend while Dr. Chandra and Dr. Sasscock played hangman across the table from her, waiting for the afternoon labs to come back. The girl’s creatinine had been sky-high at the late-morning draw; her kidneys were failing and if Jemma didn’t lower her doses she risked knocking them out completely.

“You’re just going to have to do that again,” said Jordan. “You may as well wait for the evening labs.”

“I almost have it,” Jemma said, though once again her calculations were yielding doses more appropriate to large-animal medicine. “And the drugs are due soon.”

“An hour delay won’t matter,” he said.

“In an hour Tipper will be down here,” said Dr. Chandra. “He does that shit in his sleep. You obviously haven’t learned how to profit by a timely consult.”

“I pretty much have it,” Jemma said.

“You’re probably right,” said Dr. Chandra. “But he’ll do that thing, anyway, where he laughs like your incompetence is cute but really he’s furious because you’re so stupid, and he won’t look at you. He looks at your feet or at the ceiling or at your ear or at your crotch but you have to be the queen for him to look you in the eye. He’s part of the program. He was always part of the program.”

“Pick a letter,” said Dr. Sasscock.

“Y,” said Dr. Chandra, “as in why am I here anyway? There’s a whole hospital worth of misery out there, better wallowing than here. It was never going to be part of my life, taking care of kids with a piece of soggy fucking origami where their heart should be. Why do I have to deal with it now? What’s the point? What are we being trained for, anymore? What?” He was looking right at Jemma, and made a gesture at her, folding his hands together and shaking them over the table. “Why, why, why?”

“Can you dose tobra every twelve hours in someone with a creatinine of two?” she asked him.

“Go ask Dad,” he said. “We may as well ask Dad. You get the same goddamn answer, that zombie smile, whether he’s alive or dead, here or gone, and no matter that he’s dead and the whole world is gone with him, we’re all still in the program and we’re all still under his thumb.”

“Do q twenty-four,” Dr. Sasscock said to Jemma, and to Chandra, “Dude, shut the fuck up. Pick another letter and stop badmouthing Dad. The man was a saint.”

Dr. Chandra shook his head, but stopped complaining, and they played on in peace, leaving Jemma to her work, until the labs came back and sent them scurrying. Jemma got three new quasi-emergencies — a low k and a high k and a low phosphorus — but decided to ignore them for five more minutes until she got the damned dosages set. Dr. Tipper snuck up on her just as she was finishing and pointed out that she’d got it all wrong. He looked at her shoes and her left boob and her belly and each ear, and spoke his mocking chortle, and she became more furious and more depressed and more weary, and all she could do, when he flew through the calculations and wrote out the orders and hummed her a snatch of the Mikado, was sigh at him, and say “Thank you.”

At hour thirty-three she encountered Monserrat and her tamale wagon, making her afternoon snack rounds. “You look awful,” she told Jemma.

“Everyone keeps telling me that.”

“Are you hungry? Have you eaten?”

“I had some juice… earlier,” Jemma said, not able to remember when she had last eaten.

“Strange, strange girl,” she said. “How do you think you can keep going with no gas in your engine, with no hamster in your wheel? Come here to me.” She took Jemma by the hand. Her wagon had been souped-up by the angel — motorized and decked out with moon-rover tires and a folding table and inflatable chairs, and a cooler/replicator that only made supremely exotic horchatas.

“You need to take care of yourself,” she said. “A cat takes better care than you do. Look at you!”

“I know,” Jemma said, as Monserrat lifted a cold bottle of soda from the cooler. Instead of opening it for her she rolled it back and forth across her face. “I should keep going,” she said. “I have some bad labs to fix… That’s nice.”

“First the cold, then the hot,” she said, guiding Jemma’s face over the steamer and stepping on the pedal to generate a blast that lifted her hair and left drops of water condensing on her nose. She nearly fell asleep while the lady massaged her face with a corn husk.

“It’s been a good day,” Monserrat said, while Jemma started to eat, hushing her every time she tried to say something. “Not so pleasant outside, and ugly days used to never turn out well, but already today I’ve captured five others just like you, dragging their big bottoms and looking like they’re about to cry. I do an intervention and it goes a little better. I like the word — intervention. My son did one for my high salt and my blood pressure. It was swift and cruel — he threw it all away and I wanted to wander into the woods like a deer and lick rocks, but he was right, and I am right. How do you feel? Would you like another?”

“Tired,” Jemma said. “And late. And thanks. I’ve got to go.”

The lady put another warm tamale down Jemma’s pants, catching it in the band of her scrubs and adjusting it so it settled in the small of her back while Jemma just stood there, reflexes slowed by fatigue so that by the time she jumped away it was already done. “If you don’t eat it then give it to someone you love,” said Monserrat, and pressed the button that folded up the table and deflated the chairs. She walked off behind the wagon, steering it nimbly with a little black joystick.

Hour thirty-four she spent with Vivian, who came down to do a consult — her second day on the service and she was already trusted with them — on a Down’s syndrome baby in the NICU who’d been persistently throwing blasts on his smears for the last three days. “You look awful,” she said to Jemma, pausing in the middle of her note.

“I know,” she said. “Everyone’s told me. Really, everyone. Somebody wrote it in the bathroom up here. Jemma Claflin is one hideous bitch.”

“Sorry,” Vivian said. “You just look tired. A little worse than post-call. Was it a bad night?” Jemma shrugged and put her head down on her arms. “Don’t go to sleep. You’ve got another two hours yet. Tiller’s going to page you, you know, for her own fucked-up signout. What did you learn, Dr. Bennett, from the trials of the night? It’s like rounding all over again, but for absolutely no reason at all.” She sighed.

“Are you all right?” she asked, continuing the note — Jemma heard the nib of her fountain pen scratching across the page — but reaching with her non-writing hand to massage Jemma’s scalp. Jemma nodded. “I was worried about you, last night. I should have come to visit. I meant to. But the list was pressing. It’s so strange — it leaves me alone for a couple days and then it’s like, of course! How could I have missed that one! I have to work on it, and every item has a related item, every paragraph a subparagraph — within and within and within, but I never seem to get to the heart of anything. And then the next day I look at it and it all seems so petty and stupid and totally not worth it. Not worth even thinking about. It’s like I was drunk, but I haven’t been drunk, much, and I haven’t been shrooming since way back, honest.”

“Everything’s strange,” Jemma said. “At least you’re not throwing up all the time.”

“That’ll pass, and even if it doesn’t, I’ve got some plans. That reminds me, we should check an hCG. What if it’s a mole? Wouldn’t that be disgusting?”

“Three moles are walking in a tunnel, single file, on their way to raid a farmer’s kitchen,” Jemma said, though she could see the other kind of mole, the one that Vivian was talking about, a placenta corrupted to the point of malignancy.

“We’ll do a sono if it’s high,” Vivian said. “I was up all night with the list, even though I knew I was on call today and should sleep, and the boy wasn’t snoring for once, and we had this incredible session before bed. I should have been exhausted.”

“‘I smell sweet candied carrots!’ said the first mole.”

“I actually was exhausted, but it came to me. Local news. How could I have missed it? It was always so awful, no matter where you went, but worse than that was how it demeaned everything it touched. Part the bad hair and there it is, a thoroughly belittling but tireless regard. Even when they tried to praise something, they condemned it.”

“‘I smell apple pie!’ said the second mole,” Jemma said, trying not to think about the extensive coverage, or see it replayed across the white static behind her eyes — a shot of Calvin’s blood on the ice, a burned hand reaching out from beneath a tarp, the string of idiot commentators speculating on the nature of the devil-cult that supervised the black ceremony. There was her house burning and the wreck of Martin’s car wrapped around an impervious tree. It all conflated into one supremely horrible story about which the now slack-jawed bimbo had nothing to say.

“It’s not even the extreme lameness, how lame they look or how obscenely they fondle things. Here’s the within: it’s temporary. It’s the rage of every story — I was never even meant to be told but now you have forgotten me. Why did you disturb my rest? Why did you wake my curse? You never even really cared. Something like that — all that pathetic lame shit banding together and praying for vengeance.”

“‘I smell mole asses!’ said the third mole.” Jemma saw empty white static again. She sat up and started to rub her eyes.

“Now it seems stupid already, like I said. Don’t do that, you’ll detach your retina and anyway it’s disgusting.” She wrote a few more sentences while Jemma kept rubbing, then shut the chart. “Heme-one is fun,” she said. “My guess is leukemoid reaction, but it’s a little late. She’s so Downsie, though. AML? That would suck. Anyway, I’ll talk to Sashay about a bone marrow and set it up with Wood tomorrow morning after rounds if it’s a go. Are you even listening to me?”

“AML,” Jemma said. “Sashay. Bone marrow tomorrow.”

Vivian looked at her watch. “Two more hours — hang in there. Just picture Tiller blowing Snood if she tries to make you cry.”

“I never cry,” Jemma said, “and don’t spread rumors.” She took the chart back just as her pager sounded. Jarvis was bradying and desatting. She had no idea what to do about that, and the rest of the hour passed before she and Emma figured out together that his ET tube was too low.

The sun came out at hour thirty-four, and as hour thirty-five closed Jemma paused many times by the windows, wanting to get out of the hospital, looking at the green water and wondering what it would be like to go floating in a dinghy. Trailing behind the hospital would not be the same as being inside it, and she wondered if it would give her the same relief as she’d get after being inside for a thirty-six-hour run of suffering back in her surgery rotation, when she’d leave the hospital, blinking in the sun like a newly sprung prisoner, and walked very lightly for all her exhaustion, because her steps were buoyed by that I’m-not-in-the-hospital feeling. It would fade, even before she got home, even before she sat down at her computer to look at applications for cosmetology school or garbage-man school, replaced by the dread of certain return. At a window on the stern side of the NICU, she watched herself, standing upright in the dinghy, clothed quite dramatically in a winding, flaring hospital sheet, or a dress sequined in colors exactly matching the sunset-sea, or wearing the most gigantic fruit hat ever. She receded, hand up in benediction, swallowed by the horizon.

“Hey baby,” Anna said, stepping up next to her at the window. “I need you to come look at the baby. See something good out there?”

“Just… water,” Jemma said. She let Anna take her hand and lead her to Brenda’s isolette.

“All of a sudden she just looks like shit. Don’t you think? And she was having such a good day. She tolerated the feed advance and weaned her oxygen again and she sat out with the volunteer for twenty minutes listening to a story. It was all fine until all of a sudden.” Jemma looked down at the mottled child, who tried to lift her arm to point but only succeeded in extending her wrist a little. She reached her hand into the isolette to feel the belly, because it looked a little rounder than usual. It was as smooth and stiff as the surface of a bowling ball.

“Oh fuck,” Jemma said.

Every time she went into a surgery, Jemma suffered forebodings of doom; she knew something awful was going to happen. She’d never seen anybody die on the table; she hadn’t even seen a particularly nasty complication. She’d seen no exsanguinations, no confused amputations of the wrong limb, no mad surgeons carving their initials on the patient’s hide, no beheadings. Still, she believed that something awful did happen in every surgery; someone would be flayed open, a stranger would be rummaging about in their innards. Someone would suffer an assault no less violent for how slow it was, or how practiced, cool, and methodical.

Hesitating to enter the operating room, she scrubbed longer than was necessary. The distinctive odor of the soap, and the noise of the water drumming in the steel sink, brought back memories of the long eight weeks she’d spent in her surgery clerkship, and the longer eight weeks she’d spent repeating the clerkship after she’d failed. The people who had tortured her so vigorously then were all dead now, but she felt no safer, for that, in this place. She could feel the hair at the nape of her neck standing stiffly erect, and she felt a nausea that was distinct from her morning sickness. The spirit of her father, the only kind surgeon she’d ever met, ought to protect her, she thought. But when she closed her eyes she only saw him shaking his finger at her.

Rob kicked a pedal to start an adjacent tap running and started to scrub without talking to her. They were still in a fight. He wet his hands and arms, and began to soap them up. Jemma ran the brush idly over her fingertips, and watched, liking how the water and foam caught in the hair on his forearms, how it matted and curled. Jemma watched the brush travel from the tip of his fingers up to a point halfway between his elbow and shoulder, then down again.

“Stop looking at me,” he said. Jemma continued to stare. Rob hurried his scrub, scooping his hands and arms under the water to rinse them. He sidled up next to her, arms held up in front of him, elbows dripping. “Don’t let Dr. Walnut beat you into the room,” he said, then backed through the door into the OR. It was a rule of surgery, that the most senior surgeon comes last into the OR like a king comes last into the chamber of state.

In her sixteen weeks of surgery, Jemma had perfected the post-scrubbing posture — it was the one thing she had gotten good at. She flexed her arms crisply at the elbow, and splayed her fingers gracefully before her face. She squelched her foreboding, backed into the door, and thrust it open with a commanding blow from her ass. She spun on the ball of her foot, careful not to fling any drops from her wet hands and arms, and gave the scrub nurse a look she hoped would be interpreted as proud — she had learned that scrub nurses tended to ignore you if you were earnest and kind. The nurse handed her a sterile towel. Jemma dried herself, finger to elbow, and tossed the towel to the floor in her best imitation of surgical haughtiness. The nurse helped her into the blue paper gown, and then into the gloves, stretching them at the mouth while Jemma reached her hand into them, the way you reached into a snake hole, or into a toilet. No matter how forcefully she shoved her hand into the glove, there was always a bit of empty finger at the tip that she’d spend the next five minutes worrying and pulling. Like always, it ruined her haughty-surgeon act. The nurse, her eyes made articulate by her mask, gave Jemma a look that said she’d seen right through her.

After the nurse had tied up her gown, Jemma walked over to Rob. He was helping to prepare the body; Brenda lay spread out, already unconscious and intubated, on the operating table, tied at ankles and wrists, arms above her head, so she made the shape of an X. After a nurse finished scrubbing the child’s belly and chest with betadine, Rob put the drape on her. He shook it out with a snap, and then it settled over her, obscuring her face, her neck and chest, her arms and legs. A window in the drape exposed an oval of stained belly five inches across its longest part. Underneath the skin her belly was rotting; she had an infection in the wall of her bowel, flagrant and obvious on the x-ray that Jemma had ordered. “Excellent work,” Dr. Walnut had said, after Jemma had been interrogated by the two surgeons. Jemma had already ordered all the tests that Dr. Walnut wanted by the time he came to see the child. He rewarded her by summoning her — at hour thirty-eight — to the surgery. Jemma would rather have had a kick in the face. Now she’d been awake for forty hours. It was a new record for her.

As Rob smoothed the drape, Dr. Wood raised his little screen, a length of sterile paper that was hoisted north of the shoulders but south of the chin, ostensibly to establish the upper border of the sterile field, but also, and more importantly, to divide the domain of the cranky, rude surgeon from that of the contented and fun-loving anesthesiologists. It was a different world, behind the blue curtain. On this side of it, surgeons scolded at sutures cut too long and too short, at fat retracted with insufficient or overzealous force, and dissected the ignorance of the common medical student, and when there was laughter, it was only cruel. On the other side the anesthesiologists reclined among their puffing machines, discussing films and art and restaurants and golf, and gossiping in quiet voices about the surgeons in the room. How often Jemma had wanted to go there, to the other side, during her sixteen weeks of hell. She wanted to go there now.

Dolores came into the room, followed shortly by Dr. Walnut. The two nurses attended to them simultaneously, and the way they postured and dipped their arms and hands and spun made it seem like they were dancing in synchrony, so Jemma expected them shortly to start into a doo-wop routine. They were the last two surgeons in the world, and representative of their kind, a meanie and a junior meanie. Jemma had imagined them mating, to replenish the species. It would be a sterile procedure, she was certain, involving betadine and steel. Dolores, the resident, would lay a clutch of eggs and make a nurse sit on them until they hatched, freeing an equal number of boys and girls, each the very image of their father or mother, each little mouth already turned down in a perpetual frown of annoyance.

Dr. Walnut was a small man, a cardiac surgeon who’d been frequently slumming in the abdomen since the Thing. He had a pointy nose, and small ears, and round blue eyes. From the nose up he looked better suited to making cookies, or repairing shoes than cutting into children, but his thin white lips gave him away. Jemma thought they must once have been thick and red and luscious, but a professional lifetime of pressing his lips together impatiently had flattened and bleached them. Thin, curly wisps of white hair escaped from under the edges of his surgical cap. The cap was festive, covered with smiling, fat-tired school buses. Such silly little hats marked a person as a native of the OR. The hats were the only thing Jemma liked about most surgeons, and she wanted one for herself, but it was considered uppity for a medical student to wear one, so Jemma had always made do with the frowsy sheer bouffant caps that made everyone look like they were hiding their curlers.

Dolores was as big as Dr. Walnut was small. She had probably been stately like Dr. Tiller, once, before she had decided to become a surgeon. Jemma had watched her make the typical transformation, across her intern year, one that was repeated over and over, through the decades represented in the surgical housestaff pictures that had hung down a dark hall of the medical school. The interns were all lean-faced and sharp-looking; the second-years were puffy and looked tired, the third-, fourth-, and fifth-years looked progressively weary and fat. Surgical interns entered the program healthy, ambitious, and beautiful, but the call and the toxic atmosphere wore on them; their souls shrank to nubbins while their asses bloomed into soft, marvelous pillows, and they became giant grub-like creatures that could perform a one-handed Kasai procedure, but when placed in the sun, made a mewling noise, and asked to be taken in, and to be fed fried food. Vivian said they were corrupt before they started, that the surgical muse called her slaves from among the evil dead, but Jemma disagreed, and had always thought it was sad, even in the most hellish days and nights of her surgery clerkship, even when a lady very like Dolores had ordered her to wear a truncated dunce cap during a pancreatectomy, how they were corrupted, how their bravery was corrupted to hubris, their genius corrupted to cleverness, their compassion corrupted to disdain, their patients corrupted to meat. Dolores’s cap was blaze orange. In the former world she’d been a huntress and an eater of game.

“Well, kiddies,” said Dr. Walnut. “Let’s save this baby, shall we?” He rubbed his gloved hands together till they squeaked. He stepped up on a pedestal next to the table, and was suddenly almost as tall as Rob.

“You’re in my place,” Dolores said to Jemma. Jemma moved, into the place of the scrub nurse, who moved her on. She thought there’d be no room for her, for all that she’d been invited. Dr. Walnut noticed her standing away from the table, and brought her over next to him, so it was Rob who had to step back. Dr. Walnut called for the music to begin — he listened to Ravel while he worked — and then put out his little hand for the scalpel.

“Dr. Claflin,” he said, knife poised over the belly, “what are the layers of the abdominal wall? I forget them. I’d dearly like to know what they are, though, before I cut through them. I hate to cut in ignorance.” Jemma smothered an urge to put her face in her hands, and told him the information he already knew. It was a favorite question, one she’d been asked dozens of times in her clerkship, and always the surgeon pretended not to know the answer. Jemma rattled off the layers with minimum effort, aided by a mnemonic: surgeons climax if stimulated expertly in the rectum.

“Ah yes,” said Dr. Walnut. “That’s it. Now we can proceed.” He lowered his knife. Dolores brought the suction up in what looked to Jemma like a quick salute, then she brought it down to hover just behind the knife blade. As Dr. Walnut cut she sucked up the blood behind him. The skin sprang apart under the knife, and tiny beads of blood collected in the mouth of the suction. After he’d opened the skin, Dr. Walnut cut the rest of the way with the electrocautery. It sang a shrieking, keening note as it cut, and sent up acrid twirls of smoke that Dolores sucked out of the air before they could reach and offend Dr. Walnut’s pointy nose. What wafted toward Jemma she let go, so Jemma got smoke in her eyes. In her clerkship she’d become overly familiar with it, because she was a klutz with the suction, and could never capture all the smoke from the air. Sometimes, when the patient was very fat, it was like standing at a barbecue, and Jemma once or twice nearly passed out from holding her breath, trying and failing not to be carried on the clouds of smoke back to Calvin’s burnt black body.

“Retractors!” Dolores said imperiously. When the nurse handed them to her, she took one for herself and handed the other to Jemma. Jemma had never seen retractors so small before — these were about as big as chopsticks. Hooked on both ends, used to pull skin and muscle and fat out of the way of the surgeon’s hands, they were familiar to every medical student, as retracting was their primary duty, after being humiliated and before wielding the suction. Jemma had retracted for hours and hours before, so at the end of the surgery she was unable to feel her hands, and surgeries became contests of will between her and the fat. She’d fallen asleep once, during a four a.m. appendectomy, pulling back on a crowbar-sized retractor, in the attitude of a water-skier. The surgeon, when she noticed that Jemma was asleep, had used her greasy finger to flip the retractor out from under a shelf of fat, and Jemma had fallen straight down on her back. Jemma had woken to laughter, and the shadows of masked faces under the surgical lights, and had wanted so badly for it all to be a horrible nightmare. Now she shifted her weight back and forth from one foot to the other, trying to stay awake. Everywhere she looked she saw comfortable places to fall asleep: under the various carts, curled up in the corner, in the cabinets full of gloves and towels. She thought of all the places she’d found her father asleep, when she was a child. In his car, in the bushes, folded over the kitchen counter, on top of the dining-room table; he could fall asleep anywhere, and it had always made her feel very grown up and somehow indispensable, to settle a blanket over him, wherever she happened to find him. She stared longingly at the blanket warmer. Surely the angel could warm a blanket, too — lengths of warm blanket billowed in her head, pouring out of the replicator to cover her on her bed.

“Too hard!” said Dolores, and then, “Too soft!” Jemma adjusted the pressure on her retractor, but Dolores continued to scold, like a fat, crabby, perpetually dissatisfied Goldilocks. Dr. Walnut was rummaging delicately in the belly of the baby, leaning over the surgical wound every few moments and exclaiming, “Smell that rot!” He walked along the intestines with his fingers, seeking out the dead gut. What his fingers passed over, he pulled out onto the drape, so as he walked deeper and deeper, neatly placed loops of bowel grew up in a pile on the sterile drape.

“Eureka!” he said, finally. He held the sick bowel up for all of them to see; it was purple, except where it was mottled black, a stark contrast to the earthworm-pink healthy bowel. “Five, seven, fifteen centimeters, I think, and the valve, too. Ah, poor short-gut baby! Dr. Claflin, would you like to make the first cut?”

“No thank you,” Jemma said politely. But Dr. Walnut insisted. He placed the clamps and directed the scissors, miming the cut with his two fingers.

“But wait a moment, it’s too dark. Dr. Dickens, would you adjust the light?” Rob reached above them to move the surgical lights. There were six of them suspended by as many triple-jointed arms above their heads. For five minutes Rob made adjustments, but Dr. Walnut was hard to satisfy. “Well, that’s fine for the left side of the field, but look on the right. What’s that? Stygian gloom!” Another three or four minutes passed. Dr. Wood peeked over his curtain and asked if everything was all right. “Just fine,” Dr. Walnut said. “We just need a little more right here.” He pointed with his finger at a spot inside the child. Rob reached for the sixth light, the one that was furthest away from him, and brought it around. As he set it in position, and Dr. Walnut exclaimed, “Perfect!” there was a noise Jemma recognized from her childhood: a violin string breaking, a strong, refined ping. The perfect light vanished. She felt a rush of air at her back, like a bus had just zoomed by her, and heard another childhood noise, a pumpkin smashing. She turned just in time to see Rob stuck on the far wall. He hung there a moment, then peeled away, head, chest, belly and legs, leaving a silhouette of blood on the clean white paint in the shape of his head. He fell to the ground and lay like a sleeper, his hat in place, blood expanding in a wet stain on his mask, and blood pouring from his ear.