The Children's Hospital

by Chris Adrian

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

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

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

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

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

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

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

  “You visited me forty days ago exactly.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  “Eight would be better,” said his mother.

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

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

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

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

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

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

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

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

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

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

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

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

  “Yes.”

  “In his lung?”

  “Yes, like I just said, in his lung.”

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

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