by Chris Adrian
Already it was six thirty, and Jemma had four more patients to see, one of them a psychiatric case, who surely counted for two or three patients all by himself, as it always took longer to round on psych patients, both because there were more (and nosier) questions to ask them, and because they tended to babble like the lunatics they were, or stare wordlessly at her, like snakes. She was supposed to meet with her senior resident at seven thirty, and then with the whole team at eight o’clock. She might do it, if she suddenly became more efficient than she’d ever been before in her life.
The Thing—she was not sure what else to call it, and there was as of yet, one week out from it, no consensus on a name among the survivors—had greatly expanded her duties. Attrition promoted her to intern status, though the interns, sorest afflicted with call, had survived better as a group than any other among the physicians. Three-fourths of the class was present in the hospital the night of the storm, compared with one fourth of the second-years, a handful of the third-years, a single chief resident, and a sprinkling of attendings. The attrition made for a nightmare of cross-cover, a call night that went on forever. New, unwieldy services were declared. Jemma was bumped from the nursery service when it merged with the NICU/PICU service, and landed on the Neuro/General/GI team, which later absorbed the dispossessed psychiatry patients. There was another student—her friend Vivian, Dr. Chandra, the intern, a second-year resident named Anika who acted as the senior, and one precious attending, a haughty gastroenterologist summoned in the night of the storm to do an endoscopy that proved too challenging for Timmy, the fellow on call.
Jemma took the stairs—the elevators were working but she avoided them because the angel-lady was always singing in them—to the ninth floor, home to the psychiatric and rehab units. In every hospital she’d ever worked in, the psych unit was always located on the top floor, as if to maximize the patients’ chances of a successful suicide when they inevitably defenestrated. As she pushed through the door off the staircase, she imagined the inhabitants of the ward, mostly brittle anorexics and the under-ten oppositional-defiant set, running down the long halls toward the bright windows, only to bounce off the glass or shatter into a fluff of papery skin and bone. The floor was divided half and half between rehab and psych. The rehab side was done up in a space motif, with dark blue walls and black ceilings set with tiny electric lights, seven-toed green alien footprints on the carpets, spaceship wagons, and, in the playroom, the star chamber that John Grampus had bragged about, a scale model of the solar system hung from the ceiling—before the Thing it had been made of styrofoam and plastic, but when the doors opened afterward the children discovered that the styrofoam planets were now made of glass, and that they hung in space without any visible support, and the stars in the ceiling, formerly just glow-in-the-dark stickers of the sort Jemma had in her bedroom as a child, now shined deeply from a dark sky, brightening and dimming in synchrony with the stars above the roof. The psych side was not decorated except with the pastels thought soothing to the eyes and minds of the young insane. Vivian, who carried three of the four psych patients, thought it was too drab, and wanted giant mushrooms in every room, and bodiless cat-smiles painted on the walls, and deforming mirrors to confirm the worst delusions of the anorexics.
The ward had capacity for fifteen, and was the only ward in the hospital not full or over-full on the night of the storm. Now in addition to the four psych patients it housed boarders from the ER, children whose croup or asthma or innocent viral syndrome had resolved and left them well. A single nurse presided there, a serene Samoan lady named Thelma who was in the habit of gathering the children up once a day for a group hug, even the anorexics, who struggled against her, or cursed at the touch of her great fat body against theirs. “Here to see my babies?” she said to Jemma through the intercom, when Jemma waved through the glass to be let in.
“Just one,” Jemma said. She saw her patient’s initials on the board behind Thelma: P.B. A round lavender magnet denoted his location; the rooms on the ward were not numbered but colored, lavender, rose, moss, sage, lemon, rust, peach, cucumber, sienna, sea-foam, caramel, saffron, cornflower, tangerine, periwinkle.
“If he bites or scratches just scream for me,” Thelma said as Jemma approached the desk. “I know how to handle him. You want me to come with you? He can be rough on first-timers.”
“No, thanks,” Jemma said, trying to look bored as she flipped through the chart, uncovering the particulars of the case. The boy was six years old and carried diagnoses of juvenile schizophrenia vs. bipolar disease, trichotillomania, and pica. He’d been found a year before nesting in an abandoned refrigerator at a dump, the apparent leader (though not the eldest) of seven filthy feral children. He had passed through eight different foster homes and was ejected from the last after eating their cat.
“Oh yes he did!” Thelma said when Jemma raised her head to ask the question, Did he really…? She closed the chart, sighed, and started down the hall. She did not care for psychiatry, though she had done well in her clerkship, the first of her third year. She’d felt she made no one really any better, nor even helped to make anyone better, and did not like it when she found herself in the position of junior warden to the prisoners. “But he’s still crazy,” she’d protested to one attending when they discharged yet another sloth-like depressive back onto the street over his dull, desperate protests. “We don’t use that word,” the attending had replied.
P.B.’s door was lavender, set in a lavender frame. Jemma knocked lightly and pushed it farther open. It was dark inside, but the blinds were drawn up and the sun was rising. “Hello!” Jemma said, trying to cast reassuring tones in her voice, but only succeeding, she thought, in making herself sound like a muppet. She put a hand up to shade her eyes against the first rays of the sun, just peeping, huge and red, over the distant blue horizon. She could see the bed, a flat dark shape with a lump in the middle, glinting red and silver along the safety rails. As she watched, the lump contracted and stretched, and then rose so very slowly, as if yoked to the sun rising behind it. “Is that you under there?” Jemma asked brightly, but the thing only continued silently to rise. She looked toward the feet, thinking it must be levitating now to be rising so high, but all she saw was a flash of silver when she looked down. I don’t have time for displays, she thought. Just then the child stretched to his limit, and threw back his blanket like a mincing vampire, blocking the glare. She saw a pale bald boy whose head seemed two sizes too big for his body.
“My name is Pickie Beecher,” he whispered. “I am a vegetarian.”
“Good for you. My name is Jemma. I’m a student doctor here in the hospital. I’ve come to talk to you. Is that okay?” He stared at her a moment, still in his vampire pose, then dropped his blanket and shrugged. Jemma came around the other side of the bed to escape the glare. The rising sun pinked him up and made his eyes shine like black buttons.
“It’s very bright today,” she said stupidly.
“It often is,” he said, sitting down again.
“How do you feel this morning?” she asked. He shrugged. “Do you feel better or worse than yesterday?”
“I hardly notice the passing of the days.”
“Okay. Well, if I asked you to rate your mood and give it a score between one bunny rabbit and ten bunny rabbits, with one bunny rabbit meaning you are very, very sad, and ten bunny rabbits meaning you are very, very happy, where would you put it? How many bunny rabbits?”
“Are you bleeding?”
“No. How many rabbits?”
“But I can smell your blood.”
“I really think I’d know if I were bleeding somewhere. But let’s concentrate on the bunny rabbits. How many do you think?” He cocked his head at her, closed his eyes, sniffed deeply, and smiled. “Five bunny rabbits? More? Seven? How about seven?”
“You have the best blood in you. Blood within blood, the newest blood, blood so new it is only the possibility of blood.”
“Seven bunny
rabbits. That’s how many I’ll put you down for.”
“For breakfast?” he said.
“No, for your mood. For how you’re feeling this morning, if you’re happy or sad.”
“It doesn’t matter. I am a vegetarian now.”
“But how are you feeling?” Jemma asked, somewhat harshly.
“We are beyond feeling now,” he said sadly. That was a statement Jemma was not prepared to argue with. She gave up on that question.
“Have you been hearing any voices that other people don’t hear, or seeing things other people can’t see?” He bit his lip and furrowed his brow, and kicked his little bare feet out toward the window a few times.
“The angel speaks to me. She says, Abomination, ageless of days, you too are a child. Even you will be saved. You will be washed clean and saved. I do not believe her.”
Jemma was not sure what to do with that. Did he mean a private angel, a voice like bread talking, or did he mean the chatty Kathy living in a computer core somewhere in one of the hospital’s new sub-sub-basements? That lady talked to everybody. To Jemma she said things like, “Be comforted, your brother did not die for nothing,” and “Name me, Jemma, and I will be your truest friend,” and “You are more beautiful than the open sky.”
“What do you know about my brother?” Jemma demanded of her, but she’d only breathe back, “Name me, oh please name me.” “Name yourself,” Jemma told her. Rob, the sucker, had already succumbed, and called her Betty, the first name he’d thought of. She wanted a different name from everybody, to seal a personal covenant, she said, and to invite and allow her preserving protection.
“How about if I take a listen to you?” Jemma asked Pickie, waving her stethoscope in a very friendly manner.
He raised his arms above his head. “Do what you will.”
His physical exam was perfectly normal—his heart beat at a regular rate in a regular rhythm, and she heard no extra sounds, no murmur, no rub, no gallop. His lungs were clear—she liked the clear rustling noise a pair of healthy lungs made. He did not complain when she listened a little too long at his back, and when she listened on his belly he giggled like an ordinary six-year-old. After she’d finished she tried and failed once more to elicit an official statement on his mood. She gave up on her other questions.
“Do you want me to close the blinds?” she asked, because now the sun, smaller but hotter, was shining full into the room. He didn’t answer her, so she left the window as she’d found it.
Just as she was closing the door he called out, “Doctor?”
“I’m not a doctor yet. You should call me Jemma.”
“Doctor Jemma?”
She sighed. “Yes, Pickie?”
“My brother is dead.”
She almost said, Lots of people are dead, Pickie, but it seemed too cruel to say that, even if it were so obvious and true. Instead she said, “I’m sorry,” and shut the door on him, his silver bed, and his lavender room.
Her next two patients were on the sixth floor, both of them languishing on the GI service. The first was a three-year-old girl named Ella Thims who had one of those terribly exclusive diseases, a syndrome of caudal regression that had left her incomplete in her bowels, and blank between her legs. The surgeons had feasted on her for many months, so that now she was a miraculous horror of reconstruction. Jemma had spent her time on her first visit to the girl trying to sort out her various ostomies and riddle the ocher contents of the bags, and she still was not sure she comprehended the Escheresque complexities of her urinary anatomy.
Jemma feared her. She’d seen her before, staked out at the nurses’ station on the sixth floor in a little red wagon, her bags hidden under flounces, blood or albumin or parenteral nutrition hanging above her from an IV pump. Twice a day volunteers would take her for a spin around the floor. She’d wave and call hello to anyone who’d meet her yellow eyes—years of TPN had done a number on her liver. On her bad days, when she was infected or oozing blood from her orifices, she’d still come out to the station, but not wave or call hello, or mischievously throw toys from her wagon, or slap her hands to her huge, Cushingoid cheeks over and over in a refined Oh No! gesture. She’d only lie on her back, her eyes staring but unfocused, and utter piercing shrieks on the quarter hour.
Today she was as well as she ever got. When Jemma came in she was standing in her crib naked but for her diaper, gripping the bars with her swollen fingers. She smiled when she saw Jemma, and called out, “Hello!”
“Good morning, Ella. How are you feeling today?”
“Hello!” She danced a little as she stood, drumming her feet then swinging her hips so her ostomy bags shook like hula skirts. Jemma reviewed her vitals on the three-foot-long record hanging at one end of the crib. Her blood pressure had shot up in the night, and was still high. The attending, Dr. Snood, had castigated Jemma the previous day for not knowing the range of normal blood pressures for a three-year-old, so she’d studied a card Rob gave her—all his knowledge was condensed on a stack of laminated cards six inches thick.
“Do you have a headache?” Jemma asked. “Is your vision blurry? Does your tummy hurt?” Ella put her lips together and blew a glistening spray at her that hung in the parallel shafts of light sliding through the blinds. Jemma held her breath as she passed through the cloud, approaching the child with her stethoscope held out before her. Ella thrust her chest out, as if to receive a dagger. She was a well-practiced patient, quiet for the cardiac exam, breathing deeply through her mouth for the lung exam. She insisted on listening to Jemma’s chest. She was very intent on it, though the earpieces were only half in her ear, and facing the wrong way. “Sick,” she pronounced, shaking her finger at Jemma, and shaking her head. “Sick, sick, sick!”
“I’m okay,” Jemma said. “You’re sick.”
“Sick!” she said, and pointed.
“You’re sick,” Jemma said. “You’re miserable. I’ve never seen a more miserable child in all my life!” Ella cackled and grabbed Jemma’s ears, and pulled her close for a kiss and a whiff of her toilet breath. “Sad little girl!” Jemma said.
“Dead lady,” Ella sang. “Dead ladeee!”
“Okay,” Jemma said, disentangling herself from the hands. Ella grabbed a piece of hair and would not let go, so Jemma lost a few strands as she pulled free. “You’re making me late,” she said gently. Ella tossed the strands in the air and pressed her face through the bars to watch them fall. “See you later,” Jemma said.
“Goodbye now,” Ella called. “Hello, later!”
Ella’s neighbor was another short-gut girl who had to be fed through her veins. She had been a miracle preemie sixteen years previous, a twenty-five-weeker who lived back when that was nearly beyond the limit of viability. When she was still kitten-sized she got a nasty infection that cost her most of her gut, but she’d done fine until she was fifteen. Then her weary, overworked little intestine had decided to retire, and left her with chronic nausea, constipation, pain, and a belly that swelled up grotesquely whenever she ate even the most bland and innocuous morsel. Her name was Cindy Flemm.
Jemma found her awake, sprawled in her bed with her hair matted against her wet pillow, a wet bar of sweat running down the back of her tank top—she favored short shorts and tank tops and belly shirts, clothing that showcased her thin limbs and swollen, scarred belly. She had the pale, drawn look of someone who had just vomited, and would soon vomit again. “You look awful,” Jemma told her.
“I feel awful,” she said. “I feel like shit—like the shit of shit. Like shit squared. I need my benadryl—it helps with the barfing. Carla was supposed to give it to me but she got distracted—she always gets distracted. The service here sucks ass. Will you give it to me? It’s right there by the sink. I’m too tired to reach or I’d just do it myself. I do everything else myself, I may as well do that. If I could just move.” Jemma looked on the counter and saw the capped syringe.
“I don’t think I’m allowed,” Jemma said.
&n
bsp; “But I need it. And I’ll get in trouble if I give it to myself. You can do it, though. You have to do it. Please. Come on.”
“Well,” Jemma said, picking up the syringe and holding it up in the light. It was clearly labeled: ten milliliters of solution for fifty milligrams of drug. She looked again at her patient, and thought she noted a new green cast to her skin. “Okay, but let’s talk a little first. How was the night?”
“I need it now,” Cindy said. “Right now!” She opened her mouth wide and made a deep, urping noise at Jemma. “Here it comes,” she said. “I’m going to get your face.”
“Okay, okay,” Jemma said, uncapping the syringe and looking around for a port into the line. She made to inject the drug into a high one, but Cindy scolded her again, putting her clammy hand out and guiding Jemma to a lower port.
“Push it fast, or it won’t work at all.” Jemma did as she was told, wondering why it would matter where it went in the line, or how fast. Always seeking to avoid being yelled at, she cleaned the port thoroughly with an alcohol swab, then turned back to Cindy to finish the little interview and do an exam. She’d sunk down in her bed. Her mouth had fallen open, and her eyes were half lidded. The nurse came in. Carla was famous for her ill-temper—people called her Snarla behind her back.
“What the fuck are you doing?” she asked.
“She needed it,” Jemma said. “She was going to vomit.”
“What were you doing bringing benadryl in here?”
“It was already here,” Jemma said.
“That’s not the point. That’s not the point at all. Look at her, she’s addicted to the shit. Look at her! Why don’t you just run around hooking all the babies on fentanyl pops?”
“It’s benadryl,” Jemma said. “It’s an antihistamine.”
