by Chris Adrian
“This is short for Ella. She’s got something wrong in every system.”
“I have three words for you: continue current management.”
“I’m not senior enough to write that,” she said, thinking, I have three words for you, too.
“Sure you are. You’re an intern now, remember?”
“Maybe you are,” she said. But for Ella’s second-to-last system she wrote, Continue current management, and for the last she wrote: OB-GYN: No ovaries, not pregnant! Rob didn’t notice. She shut the chart and filed it away with the others.
She went to pee and vomit, and then went to the roof. He’d told her to meet him by the sycamore tree, because he had something to show her. The moon was up, so the shivering leaves cast a shadow on the ground, and she could see pretty clearly beyond the shrubs and flowers that there was no one around anywhere. She was just about to pee again when she heard his voice.
“Up here,” he said. She went to him, climbing higher than she was used to going—he’d gone up to the highest branches that could support his weight. He struck a match as she climbed up next to him, and lit a circle of candles glued by their own wax in the ring of branches above their heads.
“You’ll set the tree on fire.”
“I’m watching them,” he said. But they soon distracted each other, smooching precariously, one hand on the branch and one on each other. They repositioned, and proceeded, Jemma wasting another opportunity to tell when he fiddled unnecessarily with a condom. As she lowered herself it occurred to her that she should not be up in a tree—she imagined the fall, and imagined a thousand girls falling down miles of stairs through the centuries—but that didn’t stop her. Her symptoms fled away while she moved. She imagined the collection of cells afloat inside of her, its peace disturbed by pleasure. “Hush,” she said to it.
“Hush yourself,” said Rob.
They sat for a while after they had finished. Two branches grew out close together about ten feet up the tree. He sat on them, with his back against the trunk, and she lay against him. The candles had burned down half their lengths before he spoke again. “It’s not strange. Strange is the wrong word. But it’s… something else. Part of me keeps saying that everything’s gone, and then part of me keeps asking, What’s left, and then noticing that there’s actually a lot. The hospital, the kids, the work, the water, the hope that we’ll get out of this, eventually, maybe to something else or even something better. And there’s you, but you’re the best of everything. The longer we go, the more I know that. I love you even more than before.”
She wasn’t a weeper. She never cried but did this other thing instead, a dry sob, and her face twisted up like someone who was crying but she never dropped a tear. She did it now. She’d met pregnant women who cried when they tried to decide on what shoes to wear in the morning. She hoped she wouldn’t become one of those. No matter why, though, she knew she must get away from Rob. She fell away from him, and swung down from branch to branch. He chased her, but she outdistanced him easily. In all her wandering she’d learned very well the new geography of the hospital, and he had to find his pants before he could follow her. Down the stairs, across the eighth floor, three spiraling circuits down the ramp, and down a more obscure staircase that only led from the fifth to the fourth floors, she ran hiding her twisted face from Dr. Snood, John Grampus, Dr. Sasscock—roadside witnesses whose stares she could feel, whose thoughts she could hear: There goes the crazy fat girl. Man, she can really move when she wants to.
She went to their room, no secret place. When he caught up with her she’d been doing her dry sobs, harder and harder, into a pillow for five minutes.
“What’s wrong with you?” he asked, angry and tender.
“What’s wrong with you? Why do you have to say shit like that?”
“Are you kidding? What do you want, then? I should say I hate you? I should say, I’d be all right, if it weren’t for you. You ruin everything. I can’t stand you. I can stand anything but you. All that”—he pointed at the window without looking at it—“is fucking fine, but you, you’re unbearable.”
“You know what I mean!”
“I have no clue,” he said, quiet but furious. “I have no clue what you mean, or what you want—why all the good stuff has to be bad. What would you prefer? You want a kick in the head instead of a kiss? I don’t get it, Jemma. I don’t get it at all…”
He had a fist raised, shaking it at her. She closed her eyes and put out her face, still sobbing, ready for a punch—she suddenly knew it was time for that. Go on! she thought, but didn’t say a word. The noise, when she heard it, was perfect, and perfectly remembered, a crack and a thud—her brother would have hit the wall harder, but Rob’s sigh was forceful and deep. She opened her eyes and saw him shaking his hand.
“Fuck,” he said, rubbing his knuckles and looking at the floor.
“It’s not that simple,” she said, trading her sobs for hiccups, and then coming to a loss for words. He didn’t know the half of it, she wanted to say. She herself didn’t know the half of it. She sat there hiccupping; he sat next to her rubbing his knuckles. When her hiccups had stopped, she reached under the bed and found the little kitty case. She took out a pencil, and the wrote the news on the wall behind the bed.
He had to lean close and squint to read her writing, which was even more cramped and scratchy than usual. It was like watching him get hit with an invisible pillow or pie. He looked back and forth from the wall to her face, then took the pencil and wrote his own message under hers. Jemma watched every letter as he laid it down: You must marry me.
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.
&
nbsp; 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.
