The Children's Hospital

by Chris Adrian

  “Didn’t these used to open out?” Jemma asked. Rob was too distracted by the chaos in the unit to answer her. Nurses and doctors and assistants were running every which way. Jemma thought they were in a panic for the same reason that she wanted to be in one; they knew it, too, that something awful had happened, something to which the only proper reaction was to run around like this, from room to room, shouting and barking at each other. But it was the more ordinary pandemonium of a unit in uproar. Rob had told her about these patients, little unformed people so sensitive to disturbance that a raised voice or an unpleasant inflection or an ugly face could make them sick. It was said of them that they were trying to die, when they decided that the noise or your bad mood or the vibrations in the ether were too much to bear, and they stopped breathing and dropped their heart rate, turning blue or purple. Turn away from the light! the nurses would shout at them, half-joking. All the doors to all the bays were open, and Jemma could see through them that there was hardly a single isolette or crib that didn’t have a person or two administering to the patient. It looked as if every last one of them was trying to die.

  As they entered the first bay, a swiftly passing nurse caught Jemma’s shoulder, pulling her a few steps before she stopped. Fat, middle-aged, with smart hair and stylish glasses, she looked just like countless other nurses. Jemma knew her the way she knew a lot of the nurses in the unit and the nursery—she’d been yelled at by her for touching a baby or not touching a baby or not washing her hands correctly or breathing wrong around the babies. Her name was Judy or Julie or Jolene.

  “You, what are you?” she asked.

  “A med student.”

  “Useless! Useless! Have you ever given bicarb before?”

  “Not exactly,” Jemma said, meaning never at all.

  “Well, time to learn!” She shoved a nursing manual and a little phial of bicarbonate into Jemma’s hands, pointed at the nearest isolette, and then she was off, swift as before, shouting the dose back over her shoulder. Jemma turned to Rob to ask about the particulars of correcting a metabolic acidosis, but he was gone, collared by an attending to assist with intubating a plum-colored baby down the way. Jemma could look things up as well as anyone, and probably quicker than most. Facts leaked out of her brain within days of being stuffed in, but she had excelled in school all her life because she always knew the most direct route to the information she required. She had the heaviest white coat in her class, full of books and laminated tables, and she wore at her hip the most advanced data-storage device she could find. She read the entry on bicarb in the nursing manual pretty quickly. For the next five minutes she would know as much as anyone about how to give it, and then the information would be gone. She thought she was doing a good job, and was feigning confidence as she drew up the medication and flicked bubbles out of the syringe. Still, the flapping harpy who had assigned Jemma the task made another pass by her just in time to catch her wrist and shriek at her, “It’s not going to do much good in her bladder. That’s the foley, you moron!” It was just one of many pasta-thin tubes disappearing into a tangle beside the little body before emerging to plunge into various natural and unnatural orifices. Jemma had thought she’d traced out the line pretty carefully. Judy—Jemma got a sustained look at her dangling name tag as she was shrieking at her—pushed her out of the way, into the orbit of another nurse, who pressed her into service trying to get IV access on a fat, seizing one-month-old. He was huge and veinless, and had just the appearance of a red beachball, the way he bounced in his bed. “He hasn’t seized in a week!” said the new nurse. “We just pulled the broviac yesterday, for God’s sake, and the IM ativan isn’t working for shit. Are you any good at these?”

  “I’m okay,” Jemma said, though she’d never in her life gotten an IV on anyone except Rob, whose veins were as great and obvious as highways. She took a foot while the nurse took a hand, and they both began to stab blindly into the soft red skin. Jemma got a flash of blood once, but when she tried to thread the catheter the little vein blew. “Try again,” the nurse told her, and Jemma did, failing three more times before the nurse got one. By then the baby’s battery had run down. It was only twitching once or twice a minute.

  “Should we still give the drug?” asked the nurse.

  “I guess,” Jemma said, looking around for a real doctor. Rob was in this bay, doing compressions four isolettes away. She decided not to bother him with the question. The nurse pushed the tranquilizer and they both bent over the isolette to watch its eyes glaze.

  “You’re a little shaky,” said the nurse, when the baby had grown quite still. “You want some of this?” She shook the syringe at her.

  “No thanks,” Jemma said.

  “I’m Anna,” the nurse said cheerily, sticking out her hand. “And I’m kidding! Nice try with those pokes, though—seriously.” Jemma took her hand weakly and stared at her, not sure what struck her as so strange about the woman, and she thought for a moment it was her chicken neck or her oversized turquoise earrings that gave her the air of a trailer-park queen, until she realized it was the cheery tone, so out of place in this carnival of crises, and in the context of the great crisis. Jemma suddenly understood that she hadn’t been thinking about that, about what the broadcast lady was saying—you have all been saved from the water. “Is it real?” she asked Anna.

  “One hundred percent genuine prime delicious benzo!” she said, sniffing lovingly at the syringe. “I’m kidding!”

  Judy grabbed Jemma’s arm and dragged her down the bay, not even speaking to her but delivering her to another access nightmare and then hurrying away again. Jemma picked up a syringe and started poking; the baby’s nurse didn’t even look up. Jemma failed three times on this one, three on the next one, and two on the next, a post-op cardiac train wreck whose central access stopped working just as the unit went all to hell, and whose irritable heart was wanting its antiarrhythmic. Jemma tried three times and got the fourth, a scalp vein just in the place you’d put a bow on the head of a normal baby girl. Then she got two in a row, both on the first try, but just when she thought she might actually be developing some skill or attracting some luck at inserting IVs, someone wanted her to intubate. She was three bays away from where she started, faced with a former twenty-seven-weeker who, now a month old, and five days off his ventilator, had abruptly decided to stop breathing.

  “How many of these have you done before?” the nurse asked her. Jemma said three, which was technically true, but she did not volunteer that none of those attempts had been successful. She knew the procedure well enough, knew how to put a rolled washcloth under the little neck and tilt the head back, how to pry open the toothless mouth with her pinkie and sweep the tongue aside with the edge of the laryngoscope blade. She put her tube in the first hole she saw. “Esophagus,” said the nurse, listening over the belly with a stethoscope as Jemma puffed a few bursts of air through the tube with a bag. “Did it again,” she said, after Jemma’s second try. “Did you say you’d done this before?” Jemma didn’t answer, only rolled the head back again and poised her arm for another swoop. She saw it again, the single pink wet hole, and understood how it wasn’t the anatomy she sought. She wondered how a trachea could be so thoroughly hidden in a neck the diameter of a shot glass. The nurse was shouting out the baby’s heart rate, which fell further and further as Jemma failed to remove the foreign body from its throat. “One ten!” she shrieked. “Ninety! Sixty!” Jemma took out the scope, straightened her back, and took a step back right into Rob.

  “What are you doing?” he asked.

  “Intubating this little boy.”

  “Trying, anyway,” the nurse said. Rob took the bag and mask from her and ventilated by hand. When Jemma went in again he looked over her shoulder, his cheek pressed to hers. He was covered in sweat. His clothes were soaked through, and Jemma wondered if other people had noticed how he reeked of sex.

  “Ah, just pull back a little,” he said, tugging gently at her wrist. The vocal cords
popped into view and Jemma went through them with the tube. Rob’s fingers clutched the tube over hers, pinning it against the kicking baby’s lips.

  “You’re in, finally,” the nurse said to Jemma.

  “Don’t let go till the tube is secure,” said Rob, and then he hurried away. Jemma could not figure how much time had passed since she saw him last, and she quickly lost track again after he was gone. She intubated two more babies, put in another IV, assisted with a chest tube, bag-ventilated for a half hour under the intermittent tutelage of a pierced-up respiratory therapist, and finally changed a diaper, and then she could not find another emergency. Jemma was in the third bay, the middle bay, when it all stopped; she sat down on the floor and leaned back against the wall. She saw Dr. Chandra standing in the middle of the bay, a silver laryngoscope in his hand, looking forlorn and confused. Natalie and Emma were standing very tall on either side of an isolette three babies down from where Jemma sat, with their heads held high and their noses elevated, so they looked to be sniffing for the next crisis, but it never came. Dr. Grouse, the attending, was standing with his arms folded, seeming to be staring intently at a monitor, but his eyes were closed. The silence of alarms seemed heavy and oppressive, and the noise of a loosely connected piece of oxygen tubing near Jemma’s head was rather soothing. She closed her eyes and fell asleep, but only for a few minutes, waking to discover the nurse Anna shaking formula on her from a bottle.

  “Wake up, sweetie,” she said. “You can’t sleep there.”

  “Stop that,” Jemma said.

  “It’s not too hot, is it?” Anna asked, shaking out a few drops onto her arm.

  “What time is it?” Jemma asked.

  “I haven’t looked. Will you move, or should I roll you out of the way?”

  Jemma stood. “What happened?”

  “You were here. You saw. They all crumped at once. The whole damn unit, except her.” She pointed to an isolette in the middle of the room. It was set upon a dais that Jemma was quite sure hadn’t been there the day before. “She auto-extubated an hour ago. How about that? Now they want me to try to feed her. That seems a little hasty, don’t you think?”

  “I mean outside. What happened outside?”

  Anna shrugged. “Ask somebody who’s thinking about it,” she said, and turned to feed her patient. Jemma walked away from her, to the isolette on the dais. Standing on her toes, she could look inside to see the King’s Daughter, sucking on her hand with her rabbity mouth. She turned her head to look serenely at Jemma. It was unbearable, not for the ugliness of her face, but for the peace of her eyes. “Brenda,” Anna said. “Isn’t that an awful name? She needs a sleeveless tee shirt and bad hair, to go along with that name.”

  “I have to go,” Jemma said—she had a view into all the bays but didn’t see Rob anywhere that she looked. She hurried right out of the unit, past the little flocks of people three or four strong, who were finally turning on the televisions set high in the corners of every bay, seeking answers about the state of the world but finding only lambent static.

  It takes four angels to oversee an apocalypse: a recorder to make the book that would be scripture in the new world; a preserver to comfort and to save those selected to be the first generation; an accuser to remind them why they suffer; and a destroyer to revoke the promise of survival and redemption, and to teach them the awful truth about furious sheltering grace. And I am the least of these, for though I alone know the whole story of the call that asked for the end of the world and the flood that answered it, and though it falls to me to write the Book of Calvin and the Acts of Jemma and the Book of the King’s Daughter, I already know that in the new world no one will read scripture, and they will not labor under the sort of covenant that can be written down in words.

  Now we are only two, but two others are coming, our brother and our brother. We are a family, but only in the way every angel is related to every other angel, and nothing but duty binds us. I do not love or hate the angel in the walls of the hospital, who all these stunned survivors are getting to know by name, since they must capture some small part of her bright essence with a name before she can serve them. Ancient and ageless, she never lived or died. I was a special case. Only Metatron was like me, mortal before he was angel. But he went on to be the right hand of God, and I am the imaginary friend Jemma has never even known that she has. Still, he is not really my brother either, though if I ever met him I would call him such, and I was mightier, in my way, than he ever was, or is.

  * * *

  On their first day at sea I am obligated to dance above the hospital and praise them all, the high and the low, the damned and the elect. I remember lust, and it is like that, to be taken by the urge to dance and praise. I would have railed against it, in my old days, and schemed against it, and destroyed it. Not anymore. It is a joy to submit.

  My sister sings with me, though she is trapped in the substance of the hospital, and cannot leave it to dance with me. If she did, it would sink like a stone. I spin in a spiral that echoes the form of the hospital below. Blue sky above and blue sea below and the hospital a white mote between them.

  Praise their ignorance, my sister sings.

  Praise their fear, I sing.

  Praise their hatred.

  Praise their envy.

  Praise their bitter grief.

  Praise them and put them aside.

  They are eating the last tainted bread of the earth.

  Praise their unhappy fate.

  And praise their hours of joy.

  Praise their good work.

  And praise the sickness of children.

  Praise all the tumors.

  And praise the bad blood.

  Praise the tired livers.

  Praise the ailing spleens.

  And praise the high colonic ruin.

  Praise the drowning waters.

  And all the drowned beneath them.

  Praise our accusing brother.

  Let him rise from the depths.

  Praise our destroying brother.

  Hurry his ascendance.

  Praise Rob Dickens.

  May he lend Jemma his strength.

  Praise Jemma!

  Mother of all!

  Praise Jemma!

  To the edge of the new world!

  Praise Jemma!

  The most important girl!

  My dance is a blessing!

  Our song is a prophecy!

  Let her win!

  Let her triumph!

  The redeemer after the reformer!

  Praise her in her whole!

  And praise her in her parts!

  Praise them in their whole!

  And praise them in their parts!

  Praise them! we sing, a command to the sky, and to ourselves. And I wonder as I speak half the names of the survivors, oldest down to youngest, praising all the while with my heart as well as my voice, if I ever loved like this when I was still alive, when it was not, as it is now, an obligation of my nature, and a condition of my being. Then the song is over, and I lie on the still-forbidden roof in an attitude of sleep, exhausted by passion, feeling disappointed and empty, and wondering what I was so excited about.

  Like lust, I say, and do you see how it is true.

  Jemma’s best friend Vivian joined the crew, dressed in goggles and surgical overalls insulated with pillow stuffing and led by Jordan Sasscock, the PICU senior, that tried to break through the glass doors of the lobby with a bench. It was the sort of bench, built from heavy wrought iron and laminated wood, that would have been more at home in a park than in a lobby, but it nicely approximated a battering ram just when they needed one. While a big crowd watched from the railings of the atrium balconies, they lifted it all together and ran at the doors that weren’t doors any longer, but had become, while they were all distracted by the sudden lurch toward death taken by every last patient in their care, one flat panel of glass, as dark as slate and yet if you stood close and stared long enough into it, you saw
your own face deep within, not exactly reflected. When Vivian looked she thought of a girl swimming up from the depths of a cold mountain lake.

  She didn’t know what she expected to see, on the other side of the shattered glass. Maybe the city on fire, or all the buildings fallen down. Or maybe just a group of soggy policemen. “We’ve been knocking for hours,” they would say. Something had happened—that much she certainly believed. You could not feel that violent disjointment which had unsettled her off her feet, and unsettled the kids out of their tenuous grasp on health, and think otherwise. But a new ocean, and them in the hospital the only survivors? They were more likely experiencing some cruel experiment—black out the windows and blow in some aerosolized LSD and get Phyllis Diller to hide somewhere with a microphone and claim to be a sweet, creepy angel—than the end of the world.

  “I wouldn’t do that, if I were you,” said the voice, seeming to come from everywhere in the lobby, loud but not stern.

  “Fuck you!” said Maggie Formosa, one of Vivian’s classmates, and easily the worst person she knew. Jordan counted to three and they ran. She was thinking of her family as she ran, imagining, stupidly she knew, that they were all waiting on the other side of the glass, lined up with hundreds of others behind a police barrier that separated this strangely behaving hospital from the usual city.

  “You will live!” the voice shouted at them, and something about the tone of the voice betrayed it to Vivian as at once utterly compassionate and utterly deceitful, and in the scant moments before they collided with the glass it managed to convince her not that they were going to live but that the world had well and truly ended, and that they had been thrust beyond an ultimate pale into a strange and horrible new world.

  She alone of the six was prepared for the hard shock that assaulted their shoulders when they ran the bench into the unbreakable glass, but she fell back with all of them, and just like Maggie she nearly missed having her foot crushed by one of the legs of the bench. But while Maggie stomped her feet and shouted at the highest window, the black glass cap of the atrium, Vivian sat on the ground and drew her face to her knees and wept, just like anyone who believes all of a sudden in the proximity of angels, and the death of her family, and the end of the world.