The Children's Hospital

by Chris Adrian

  Well, enjoy it while it lasts, I say.

  I know when something is going to last forever, he says. I heard them talking down there. Nothing’s going to save me from dying. Maybe I’m not going to Heaven, but I’m not going back there.

  Miracles have been known to happen.

  Ha! he says, making it an ancient and ageless sound.

  So here we are, I say, because we are on the roof.

  So what? I’ve seen it. It looks the same.

  It is the same. But you, for now, are different. I am the recording angel; you are just a boy. You can’t wander around all day prying into people’s business: you’ve got to have diversions. So here is one.

  I bring him to the edge of the roof, our hands still joined, but when I say what we are going to do, he pulls away.

  I can’t swim, he says,

  You can now.

  I’m not wearing my bathing suit.

  You’re not wearing anything. And he notices that this is true.

  Shit! I’m naked. You’re naked. You fag! He turns and is about to run, but I am quicker than any wandering undead soul could ever be. I take his hand and leap off the roof, dragging him after me, weighting my wings with memories of sadness and rage. Jarvis is shrieking all the way. We go down, past the long root of the hospital, and the bright globe at the bottom where my sister keeps her spirit, and further, feeling the pressure but not the wetness of the water, falling faster into the lightless cold abyss, but the cold doesn’t bother and we don’t need light for our eyes.

  My rubber band, fastened securely to Jemma, is stretching, and Jarvis wears one that is similar, though like every other child there he is attached, soul and body, to the hospital, until they reach the new world. He is reaching next to me, stretching his hands and his fingers because he can tell we are nearing the bottom. We are drawn back before he can touch it.

  We shoot out of the water, up into the air, down onto the roof. I have been alighting all my new life on bedposts and leafless trees and flagpole tops and live wires—Jarvis has only done it this one time. I land on my feet; he lands on his ass, but is up again immediately. I think I saw bones! he says, and then, Can I do it again?

  Vivian was working on her list. She worked on it every day—she only had to look out any window to be reminded about it—but still it felt like a chronically neglected task. There was so much other work to do. She was working as hard as any resident-and-a-half in the old world, and she had never learned so much or had so much responsibility for patients, as she had now, and here and there she had made, in the absence of the one fellow and attending, a decision that truly was life and death. Nonetheless every now and then she had the feeling that all the exhausting and vitally important work she was doing on the ward was easy, and ultimately of no consequence, compared to the list.

  If anyone else was making one, she did not know. Jemma had lost interest almost immediately, and the great Why that had occupied their initial days and weeks had lately been neglected. People were just doing the work, after all, and all their spare time was spent grieving or trying to snatch a few minutes of normalcy from out of their extraordinary situation. People were dating, and making friends, and having bitter, comfortless sex, and learning to love better the children in their care, but lamentation had given way to a sort of dull voiceless grief, and thoughtful reflection, never fully established in any but a handful of the populace, was giving way to an exhausted sort of acceptance.

  And she was as bad as any of them. Tonight she had been sitting for an hour already with nothing to show for it but a slew of generalities (rudeness… intolerance… war) and a few mild particulars (novels about shoes… grade-school beauty pageants… closeted politicians). Two weeks ago she’d have had ten major and twenty minor categories already delineated in that time, arranged neatly in two columns, and she’d have started to arrange them in ranks and associations. Tonight they were all over the page, clustered like flying insects around a drawing of Ishmael’s back. “Nothing bad about that,” she said, looking at the drawing, and thinking of him. She had put him aside for her work, and now she wished she had not. “I understand,” he said, and went off to do more of his own private work, reading and research, trolling for some personal affinity or flash or recognition that would suggest to him what he had used to do, and who he had been, in the old world.

  That was what he said he would do, but in fact he was with Thelma, the big nurse who den-mothered the kids on the psych ward. It wasn’t exactly a date. He had gone up to talk to her, and brought her some fancy candy that the angel had designed for him. He had no idea why he was attracted to her. He did not think large women in their fifties were his type, but he was always being surprised by affinities—mobbed all of a sudden by a violent attraction to some nurse or doctor or patient or piece of furniture. He did not understand the feelings. They were different from what he felt for Vivian—they were not tender, and he knew he did not love these people, for all that he wanted to shove himself, body and soul, into their bodies, or draw them into him until they disappeared. At the height of his lust he wanted to enter them only so he could tear them apart when he exited—he imagined standing and stretching to his full height, and throwing them off him in strips of flying flesh.

  No more of that, he told himself every time he did it. And yet he kept doing it again and again, knowing that it was inferior to what he was pursuing with Vivian, and knowing that it would hurt her, and knowing he must keep it secret from her. And what made him saddest about the whole business was that his skill at it, and his familiarity with bodies, and the sense as he raged upon the man or woman in his grip that this was all so familiar, made him think that this was what he had done in the old world. But what kind of job was that, and what sort of person did it? “Do you know,” he said to Thelma, pushing her great hammock-sized bra up off of her breasts, “it is my first time.”

  “Mine too, baby,” she said. “Ha ha ha!”

  The Committee proclaimed the end of another rotation, and Jemma got to visit Jarvis in an official capacity when she switched onto the NICU/PICU team. Rob joined the surgeons, Vivian took Jemma’s place on the heme-onc service, and Maggie, the pale, chinless goat of their class, came onto the intensive-care service with Jemma. “At last,” she said, “some really sick kids,” actually rubbing her hands together, while she and Jemma were waiting for their orientation lecture from Emma. Maggie had not planned, before the Thing, to work with children much more than was necessary to graduate. Kids creeped her out and big-headed googly-eyed kids creeped her out especially. Her brother and sister, senior residents at one of the most prestigious and toxic internal medicine programs of the Northeast, had a place reserved for her to come suffer and thrive and fulfill her bright, evil promise. She’d only been in the children’s hospital that night because she was doing a rotation in pediatric anesthesia, seeking to learn procedures made more challenging by tiny airways and veins, and she still lusted shamelessly after every sort of insertional intervention. She had a little six-word song she kept singing, and kept trying to get Jemma to sing with her. “I just can’t wait,” it went, “to intubate!”

  Jemma could wait. Though there had been, before, a certain amount of junior professional pride that came with successfully completing a procedure, she was already sick of them. She never wanted to see another epiglottis again, but she and Maggie had not been in the unit an hour when she was presented with one. Emma stood in a PICU conference room and gave them their orientation lecture, a plain exhortation to do good work and not be overwhelmed by how complex the patients were, modified for the new days with a coda in which she told them the unit was the best place to be at a time like this, because when you’re doing chest compressions and such you really don’t have time to worry about all the really horrible shit. Already exhausted not an hour into her day, Jemma still had thirty-five hours of call before her. It didn’t matter that what Emma was saying was vitally interesting—past a certain threshold of exhaustion all lectures
were soporific. Jemma stared out the window at the sea, and another beautiful morning—the sun was behind them, so the PICU looked out into the ice-cream-cone-shaped shadow of the hospital.

  “It was always important,” Emma was saying when they were interrupted, “to keep them, to save them, though there was a point where you always said, after this it’s more suffering than living. Maybe that shouldn’t have changed, but it has. Now there’s a new rule: never let them go, never ever, because we can’t lose one more. Not even one. This was never an easy place to be, and now it’s even harder—they’re all sicker, they really are—so listen: I’m always here, if you see something that makes you want to chew off your fingers and you need someone to stop you. Just ask the angel to call me, or page me yourself the old-fashioned way: 719-0058.” She made them recite her pager number, and did not smile, but her face softened a little under its cap of curls. Maggie raised her hand, but before Emma could acknowledge her they were interrupted by the soft tinkling of the code bell, and the angel’s calm alarum: “A child is dying.” Emma was off in an instant, Maggie and Jemma followed close behind.

  They didn’t have far to go. A child had collapsed just a few yards from the conference room, the brother to a boy in the unit, an eight-year-old who’d arrested during soccer practice. He’d spent four days on bypass, and emerged ruined from the interventions of the intensivists, alive but unable to move or speak or probably even think. The cardiologists had fallen swiftly upon the whole family, but come up with no answers. The boy whose code inaugurated Jemma’s unit experience, the youngest child, had been put on an antiarrythmic despite a normal EKG, but had, it turned out, been cheeking and spitting the little yellow pills since the great storm.

  “Marcus, my friend,” Emma said to him as she felt in his neck and groin for a pulse. “What do you think you’re doing?” When she couldn’t find the pulse she told Maggie to start chest compressions.

  Not again! Jemma thought, because she was still having nightmares about Jarvis, who lay intubated a few beds down. He followed her around on her sleepless peregrinations or they were living out a married life in his basement nest or she was crack whore to his stylish pimp and he called her “motherfucker” or “stupid bitch” and kicked the shit out of her all night long. But she didn’t say it out loud. And she didn’t run away, like she wanted to do.

  She hated to bag, but Emma made her do it. She’d never managed to force the mask tight enough against the face for a good seal, and always worried, even with big people, that she’d squeeze so much air into them that she’d pop their lungs.

  “Shouldn’t I intubate?” Maggie asked. Emma ignored her. Dr. Tiller arrived at the head of a mob of nurses.

  “What’s this?” she asked Emma.

  “Pretty much what it looks like,” she said. She pressed a pair of defibrillator paddles against the boy’s chest and looked briefly at the rhythm. “V-fib.”

  Emma announced the all clear. Jemma, too intent on the bagging, didn’t hear. “That means you, especially,” Emma said, nudging her with her knee. “There now,” she said, as she delivered a shock and the child went back into a normal rhythm. By the time they’d moved him to a bed, though, he’d become pulseless again.

  There was something dreamlike about the time that followed, maybe because the deep, sighing breaths Jemma was putting into the boy were breaths in the cadence of sleep, and they cast a dreamy pall over her, and even over the activity in the room, which was as graceful as it was frenetic. Jemma considered, as she breathed, how every actor in the room, except the patient, was a female, and wondered if that had anything to do with the exquisite coordination that was taking place. Dr. Tiller stood at the head of the bed, ataraxic and remote, arms folded across her chest. Emma got access, and the nurses pushed the code drugs barely a half minute after Dr. Tiller called for them. Emma called for some atropine and handed the laryngoscope to Jemma, though Maggie, still laboring at compressions, made a swipe at it as it was passed off. Jemma had the irrational feeling, as she beheld the thing, that the boy’s epiglottis was somehow indicting her as a procedure thief. She missed it twice but Emma would not take it from her. “There’s no hurry,” she said. “We’ve got him right where we want him, he’s not going anywhere. I’ll just bag a little while you think of something peaceful.”

  “I never get these,” Jemma whispered. “It’s okay.”

  “Mountain streams. Or just mountains, never mind the water. Dry mountains—they’re green on the bottom and white on top. You’re going to get this one.” Maggie was twisting in place like she had to pee, and derailed Jemma’s thoughts—she was trying to envisage a calm green mountain pasture—so she could only see a beautiful bathroom in her mind’s eye, a fancy-toilet-catalog bathroom. Maggie sat on a toilet of amber and gold and alabaster, peeing serenely. “Now here you go,” Emma said, stepping away, and Jemma finally got it. She hooked up the bag to the tube, and breathed in time with him, and found herself developing strange feelings for the dying boy. It wasn’t enough, just to squeeze the bag. She wanted to squeeze him in a big hug, or put her naked hands around his twitching heart and squeeze that, too. She yearned toward him—toward his pretty white lungs, his smooth red liver, his fat purple spleen. She was leaning a little over him, almost about to lay herself on top of him—she wanted him so badly all of a sudden, and that was the way to have him, pressing herself close against him, skin to skin—when Maggie pushed her roughly on the shoulder between compressions. “Watch it,” she said. Jemma blinked, shook her head, and blushed.

  The dream ended not long after the tube went in. The boy could not stay out of the bad rhythm. After fifteen minutes Dr. Tiller called the makeshift bypass team—Dr. Walnut and Dolores. When they arrived someone else took over the bagging from Jemma, and Maggie, her hair in a sweaty flip, was excused from the chest when she started to drip on the sterile field. A couple of words slipped out of the corner of Emma’s mouth as they passed her where she stood, arms folded over her chest, in the doorway: “Good job.” She handed them each a list with their respective patients circled, and told them to spend the rest of the afternoon getting to know them.

  “You,” Maggie said to Jemma, as soon as they were out in the hall. She jerked her thumb at the doorway to the conference room where Emma had spoken with them earlier. “In here now.” Jemma followed her in, and watched her, just for a few moments, as she stood with her hands on her hips, panting furiously, wet stains still growing on her scrub shirt. What was coming was obvious. Jemma gathered up her things and moved toward the door. “Oh, no, missy. You’ve got something to hear, first. That was my tube you took away. It belonged to me and don’t tell me, don’t you dare tell me that you didn’t see my name on it. I’ve got a list, and you don’t want to be on it.”

  “See you later,” Jemma said. Maggie, hands still on her hips, stepped quickly to the door, looking much more like a ballerina or an aerobics instructor than a raging crabby-ass.

  “How dare you! How dare you! You don’t even care about it. I heard you. I saw you. The whole thing was wasted on you.”

  “I just want to leave,” Jemma said. Maggie put her face closer to Jemma’s and tried to thrust out her chin, but only succeeded in pursing her lips. “You’re making me sick,” Jemma said, because an intense wave of nausea was rising up from her belly.

  “You make me sick, too!” Maggie said, and then her voice was drowned out by the noise of Jemma’s blood rushing in her ears. She felt dizzy; a strange green shade was drawn across her vision. For a moment she couldn’t see anything. She fell to her knees and vomited, her sight coming back only after her stomach was empty and she was retching miserably. She’d barfed on poor angry Maggie, who seemed to have thrown herself literally into a fit. Jemma adjusted her head and pushed some furniture out of the way to give her a safe space to seize in. Then she opened the door and screamed, “Emma!”

  It seemed like a violation, to pry open Maggie’s mouth and look into her throat, and it would have been unfor
givable, Jemma was sure, for her to intubate her classmate. It had to be done—it took a half hour to get her to stop seizing, and by that time she was so loaded with meds she was only breathing five times a minute. But she was so chinless that she proved difficult even for Emma to do. She got hooked up—the nurses descended on her, overcoming their distaste for adults—she was really only as big as a ten-year-old, anyway—to stick her for blood and an IV and hang her fluids and get her on the monitor. If you didn’t look at her face, her expression still impatient and dissatisfied even after eight milligrams of ativan, and two hundred each of phenobarbital and fosphenytoin, and another hundred of pentobarbital, she could have been a child in the fancy ICU bed, vacated just that morning by a CP/DD moaner-groaner with pneumonia who, kicked back to the ward, left behind one of his mobiles. A dozen winged monkeys floated over Maggie’s head. Emma wound up the mobile after Maggie was all tucked in, and, wings flapping, the monkeys circled and the box played a tinny version of “Yesterday.” Jemma watched her for a little while, imagining it was her in the bed, overcome with toxemia or hyperemesis or simple fatness or demon-baby syndrome, while tourists from other wards, drawn by the novelty of a sick adult, passed by the glass walls of the room and cast their eyes on the sleeper. Maggie was all covered up, but Jemma knew that when it was her a boob and a succession of dirty panties would be displayed to the passers-by, and, seeing her, they would all appreciate what a simple blessing it was to be awake and ambulatory and unintubated.

  “Don’t you have somewhere else to be?” the nurse asked her finally.

  “Feel better,” Jemma said to Maggie. She left the room and hesitantly embraced her new duties. Emma had done her the grueling honor of assigning her ten patients, five downstairs in the PICU, five upstairs in the NICU. Downstairs she had Jarvis, Marcus, and three others—a fifteen-month-old boy whose father had beaten his head against a barbecue, a fifteen-year-old girl who, undergoing treatment for leukemia, had gotten a bag of infected platelets infused into her veins the day before the flood and swan dived into septic shock and respiratory distress syndrome, and a post-op cardiac patient, a girl born a week before the storm with no left side to her heart. Upstairs she had three preemies, a three-month-old with leprechaunism, and little Brenda.