by Chris Adrian
Out on the floor she’d thought she’d come to know how rounds were perpetual, but at least out there was always a chance to sit down, at some point during the long day. In the units she was in near constant motion, circling from room to room, bay to bay, and even from floor to floor, going constantly from patient to patient, because there was always something acutely wrong with them—if she collapsed at a table in some hidden corner of the PICU her pager sounded immediately. Rob had told her about the circling; on him it had a calming effect. “Sometimes at night,” he said, “if I’ve been going long enough, it feels like I’m everywhere at once, in every bay, upstairs and downstairs, and it’s like I can almost hold the whole place in my head, and all the collective fucked-upness of the kids becomes very individual and distinct, and it’s like I know everything about them, and can almost predict who’s going to code next.” Jemma said that sounded like a pretty bad trip to her.
But she felt it too, or something like it, that very first night. She was ostensibly covering both units, and even though it was largely a sort of pretending—Emma took care of most everything, or advised Jemma over the phone about even the smallest points of management—it was as overwhelming as it was exhilarating. Emma moved in her own circles, and Dr. Tiller was attending. Jemma succeeded spectacularly at avoiding her, and developed, before Rob’s sensor of fucked-upness, a Dr. Tiller proximity alarm that steered her away from particular bays just in time; a bit of dread in the air would push her away, or she’d see the distinctive shadow of Dr. Tiller’s headdress stretching around the corner on the wall or floor. Moving away from Dr. Tiller, or in search of Emma to get a question answered, she started, after she had accomplished a few dozen circumnavigations, to feel something akin to what Rob described: the place started to seem whole in her mind, yet the children became more distinct from each other. She could visit the bays and rooms and shape an imaginary child in her head before she arrived there in person, even if she could never distinguish the unique anatomic pathologies of the cardiac patients—she mixed up tetralogies and tricuspid atresias and simple VSDs in a way that seemed ill-fitting for the daughter of a cardiac surgeon. But beyond what Rob had described, there was something else, a sense that, though she was perpetually in motion, she was floating in the still center of the hospital. True, it was in the character of the intensivists to consider themselves the most important doctors in the hospital, and to consider the drama of the rest of the hospital inferior to that of the unit. But also, since the Thing, the patients, instead of striving to leave the hospital, seemed to strive to enter the PICU, and every time a child improved enough to move out of the unit another came immediately to take its place. Jemma, fatigued by hour twenty-three of wakefulness into a pretty trippy state of mind, thought she could feel the great lines of attraction, grooves in the unbodied essence of the hospital, along which critically ill children moved as certainly as the stars in their courses.
It was a very different sort of rounding than she’d become used to, and the novelty of it helped to propel her through the dawn despite her exhaustion. She slowed, as the sun rose, pausing longer and longer at each bedside. She was surprised to miss the conversation with her patients out on the ward, even when she had been just their talking doughnut. It was much harder to socialize with the comatose, even with Maggie, who, deep in her pentobarb coma, had reached a personal apogee of pleasantness. The barbecue boy twitching and crying in his troubled sleep; the spoiled-platelet girl flapping her hands gently in her restraints; the little hypoplast with the recently reopened chest, an opaque window of antiseptic tape fluttering over her heart; Marcus lying still in his bed, staring blindly at the ceiling, dead alive while his blood slid around the room through the crazy-straw architecture of the LVAD: at every bed Jemma looked at the numbers and did a brief exam, and then stood watching over them with increasing solemnity, until, as she stood over Jarvis, it was almost as if she was visiting his grave. She watched him, feeling something catch in herself every time his respirator gave him a breath. She counted them, eighteen a minute. He did not breathe over that rate, nor did he move a muscle in his body, though he wasn’t paralyzed, like other patients on the ventilator. His pupils, when she pried open his lids to look in his eyes, were fixed. When she pinched his fingertip, as hard as a bite, he did not draw away. On the second day after Jemma had carried him out of his nest he’d developed cerebral edema and herniated, though Dr. Tiller raged powerfully against his decline.
By the time Jemma left him the shrunken sun was disappearing into a bank of clouds, and the day had turned sufficiently that her pager quieted and she was no longer on call. Tousled, wrinkly Dr. Chandra found her to get signout on his patients.
“Are they all alive?” he asked her.
“Oh yes,” Jemma said. “Everybody did okay. Let’s see. Bed 1 had a k of 2.0—I bolused. Her pressure was in the eighties after she got some fen-tanyl—so I gave albumin. She spiked, I cultured. She had a film this morning, but I haven’t seen it yet.”
“I hate this place,” he said, stretching and yawning. It was a very different morning than yesterday’s. All that bright sunshine seemed a year ago now to Jemma. The sea was the color of bile and the sky slate-gray. “Don’t you hate it?” he asked her.
“It was only my first night,” she said.
“That’s enough to know. The places are like people, and first impressions count for a lot. I liked the one ward better. They’re nicer up there. I don’t know what it is—the kids are almost as sick upstairs, but down here everyone’s always in a bad mood.”
“They’re not exactly hanging leis up there, either.”
“It’s like they hate me down here. They all think I’m stupid.”
“Nobody thinks you’re stupid,” Jemma said, though she had heard it said of him that he could not diagnose his way out of a wet paper bag.
“They think I’m stupid upstairs, too, but they’re nicer. They’re just nicer people.”
“You know more than me,” Jemma offered.
“You’re a student,” he said simply. “Sort of. I guess there aren’t any students any more. We’re all in the program now, caught in its clutches. The program—I’d been counting down the days left in residency and now it’s going to last forever. It’s not that different than before. You never get to leave and there’s no life outside, and everybody’s horribly depressed because nothing good ever happens here, and it’s the ugly truth about the program that they pretend to care about you eating and sleeping and learning and not wanting to die every minute of your work day, but really they care about you only as far as they can kick you or as deeply as they can fuck you, and nobody pretended more lamely or cared more superficially than our director. How are you? he’d say, and stare at you with his zombie eyes. Call me Dad. We’re all one family—what a horribly unfunny joke. I used to be so jealous, sometimes, watching all the regular people outside—I’d sit in the park and even the homeless people seemed as happy and free as fat little hobbits. But now”—he clapped his hands together, startling Jemma, who always had trouble staying awake around hour twenty-four, and was starting to drift—“just like that, the hospital ate the whole fucking world, and now nobody will ever get out or go home. Do you ever wonder if it would be more pleasant around here if Dr. Tiller were dead? It’s probably a sin to think like that. The angel says it’s okay, but I don’t believe her.”
Jemma wasn’t sure if she should continue with the signout, so she said, “The angel’s a good listener.”
“Yeah,” he said. “What about Bed 3?” She told him the night’s story on that patient, and on the others he was responsible for, 5 and 8 and 13 and 17 and 18, and then his ten babies upstairs. She became lost in her notes, not sure who had thrown up and who hadn’t, or who had spiked, or which baby got the weird purpuric blotch that was shaped just like lost Australia. Chandra was sympathetic. “They’re all kind of the same, anyway,” he said.
When they were finished she went upstairs to start her officia
l morning rounds before Dr. Sasscock could find her—she had carried some of his patients overnight, too. Brenda was lounging in her isolette, looking quite relaxed and even, in her own way, rather healthy. Sound asleep, she nonetheless lifted an arm to point as soon as Jemma stepped up on the dais.
“Hello, little thing,” Jemma said. “I get to visit you every morning now, you know, and be your own special moron. Your very own moron, to do a little dance for you when you’re sad, to lie down at your feet when you need to lord it over somebody, and when you are hungry you can say, Hey, moron, peel me a grape!” The baby dropped her arm, but continued to stare while Jemma felt her head and listened to her chest and belly. She had grown—now she was a thirty-six-weeker, almost big enough to be born, and almost big enough to have gone home, in the old world. Jemma had pictures of her in her new camera, and stored on the computer in the call room, documenting her many visits. Day by day and week by week she looked more human, though never much like a normal baby, with her toaster-shaped head and her train-wreck face and her many-fingered hands, not to mention the tubes that grew as certainly as her more natural appendages. There was still not much body to cover, and not much work involved in a full exam, even as her improving health allowed more detailed probing and firmer poking. But Jemma, when she was done with her exam, felt suddenly tired. It often happened this way. The first twelve hours of call were all right. Fifteen was a logy hour, but sixteen through twenty were fine. Zombie time started at hour twenty-four, and the big crash came in the morning of the next day, at hour twenty-five, when she could hardly remember her name and might fall asleep on her feet if she stopped moving for too long. She felt the crash impending now; to ward it off she closed up the isolette and put her head down on top of the box, meaning to keep it there ever so briefly—sometimes three minutes of sleep could keep you going for another hour. She fell asleep immediately, her hands relaxing where they hung at her sides, and her mouth opening a little, so her breath clouded the plastic.
There now; goodnight, Jemma. Sleep well, for you’ll not sleep long, and since I am not a preserving angel I’ll not be able to catch you when the drop attacks come during walk-rounds, the creeping sleepiness that you feel coming more completely over you as the endless seconds pass and Emma tries to make you understand the differences between the three types of total anomalous pulmonary venous return. The big velvet sheet drops down over you, somehow managing to cover your feet and legs and belly and chest and shoulders before it covers your head and your eyes, and then you’ll be on the floor, awake already as soon as you’ve hit, all the insensitivists peering at you, disappointed at the already dissipated scent of a likely intubation. Sleep on, hard and deep. The customary morning bustle of the NICU will proceed around you, and the nurses will pay you, for the most part, only cursory attention. Nobody bears you any ill will, though one or two of them understand that you must have a pile of work to do, and yet they do not wake you because the prospect of your suffering pleases them just a little. Anna, arrived to feed the baby, doesn’t wake you, either, but her motives are pure: she thinks you need your rest, thinks you look worn out and a little ugly, and while she is waiting for the formula to run down through the tube, does your hair for you, and you will wake in half an hour with none of your morning work done but with a hairdo, three braids coiled on top of your head in a pattern that seems to your fuzzed-up mind as complex as the worst congenital heart lesion, that makes you, in your blue-green scrubs and dancing clogs and canary-colored robe, the very picture of post-call glamour.
After rounds, Jemma hid in the PICU staff bathroom rubbing on her eyes, a measure usually sufficient to drive a headache away, but one that looked so alarming to people who saw her driving the heel of her hand into her orbit, and who heard the curious, wet noises that her eyeball made when she did it, that it required privacy. She sighed, pressing harder with both hands, and saw floating bits of color in the dark behind her eyelids, here and there an emerald sparkle among them. She saw her brother’s face flash unbidden in the same darkness, pale and dead, how she imagined that his open-casket funeral face would have looked—the face a natural death would have given him. She did not understand why she was suddenly so angry; Maggie had been annoying her and countless others for years, and had never before evoked much from Jemma besides horror and pity. For a moment the spirit of her brother threatened to possess her, his face loomed larger before her closed eyes, his mouth opening to show a deeper blackness, and she knew if she fell into it she would lose her temper in a way that would make her his imperfect avatar, as angry as him but expressing it in a hissy fit rather than sublime fury. He faded away before he touched her.
“It was horrible!” Maggie had said, slurring a little, after waking from her extended postictal snooze just as they were rounding on her. “She made this nasty sound, and horrible green sparkles shot out of her eyes, and then I couldn’t move, and then I was seizing, and I knew I was but I couldn’t do anything about it!”
“Sometimes people hallucinate before their seizures,” said Emma. “You had a lot of activity in your temporal lobes, even on the pentobarb. Want to see your EEG?” The whole team was gathered around the bed, Drs. Tiller and Grouse and Chandra and Jordan Sasscock and Emma, everybody staring at the patient with expressions of fixed beneficence. Jemma was smiling even as she was being slandered.
“I want my brain back. She damaged it—I can feel the damage. How many deletions are there in alpha-thai minor? I don’t think I know any more. That part of my brain was damaged. I want to stop her before she does it again. I want justice, is what I want.” Jemma had dashed off to replicate a batch of festive cupcakes when she heard that Maggie was awake and extubated. Now she put them down on the trash can and backed out of the room. Maggie kept talking, her soft hoarse voice at odds with the fury in her words. “You’re on the list!” she called after Jemma.
“I’m giving you a little ativan,” Emma said. “One, two, three … relax!”
Jemma sat down at one of the station desks and tried to calm herself by going through one of her patients’ charts, trying to figure out how many days her platelet girl had been on each of her eight different antibiotics. “Septra number forty-seven,” she muttered. “Ceftaz number ten; vane number fifteen; tobra number seventeen; ampho number five.” But instead of becoming calm she just got more agitated.
Hour twenty-six, hour twenty-eight, hour thirty—the endless day went on and on. Rob came in and out of it, checking in on her in the morning to see how she’d done her first night in the unit. Recognizing her bad mood, he returned again and again, trying to cheer her up, bringing a succession of gifts: a bit of unusual candy from the gift shop; some ice cream; a cold salad-bar plum; a little song about Maggie, new words set to the tune of “I Got No Strings” (I got no chin to shape my jaw, nor sweetness in my soul!); a shoulder rub, then a back rub, then a thigh rub, and finally his face between her legs. They were paged before he could transform her—she was on officially until five o’clock, and he’d be on all through the night with the surgery team—though it would not have transformed her or the day unfolding with unpleasant surprises, even if he had made her sing. But it did provide a bit of shelter, to lie across the call-room bed, her hand resting on the back of his head, feeling the new sweat gathering atop his scalp, and feeling his gasping breath against her skin. Hand on the doorknob, he ruined it all just as they were leaving the room. “Marry me,” he said again.
“Not that again,” she said.
“Again and again,” he said. “Until you give me a good reason.”
“I wouldn’t marry you if you were the last man in the world, which you practically are. I wouldn’t do it with anybody. How many times do we have to have this stupid conversation?”
“As many as it takes,” he said, and stared at her, annoying fool, with his back against the door and his hand still on the knob.
“Can I go?” she asked. “I have antibiotic dosages to adjust. It’s very important. No one else can
do it. No else has a calculator. No one else has the incredibly sophisticated grasp of arithmetic. They’re waiting for me, can I please get by?”
“We’re already a family,” he said. “I just want you to say it—I just want you to understand it, too.”
“Don’t say that word,” she said, shouldering past him, aware that he was staring at her as she walked away down the hall. She stopped on a set of preemie prints and shook her ass, meaning the gesture to be somehow conciliatory. Maybe it was her bad mood that made it feel taunting and cruel, but sometimes a boy should know when to just be quiet.
She’d had so many bad days, before and after the Thing. Why this day should seem like the culmination of every bad day, she did not know, unless it was on account of the pregnancy. At eleven weeks she was almost always nauseated, though the really horrible gut-twisting retching only came at night—it was such a horrible sound, something that started out deep in her rectum and spurned the easy way out, making the long journey up to her mouth, gathering volume and a truly ass-nasty assortment of tastes to fill her mouth and vapors for her to spray around the bathroom. She knew it was the single most unattractive thing she’d ever done. She ran every faucet while she performed, and had the angel play loud music, and flushed and flushed and flushed the toilet, all to keep Rob from hearing, and she would never let him in with her, though he wanted to hold her hand while she did it. She could deal with it. Vivian swore up and down that it would pass, and Jemma didn’t mind being tired all the time, or how some foods—asparagus and potatoes and apple juice—were suddenly unpalatable, but the agitation, if it continued at such a pitch, would surely wear her down. She’d met a string of pregnant ladies who all seemed perched on the brink of a particular type of madness. “I just want to rip off my own leg and then beat everybody around me to death with it!” was how one patient described the feeling to Jemma. “Yes,” Jemma had said, drawing on a store of vaguely remembered and possibly made-up information, “I think it can be quite normal to feel that way.” It was as if the little hurt which Maggie had done her in the morning had marked her equanimity in just the right place to weaken it fatally, so all the subsequent wrongs of the day were exacerbated.
