by Chris Adrian
Through hour thirty-one she sat at one of the nurses’ stations in the PICU wrestling with the antibiotic dosing on her septic teenaged friend while Dr. Chandra and Dr. Sasscock played hangman across the table from her, waiting for the afternoon labs to come back. The girl’s creatinine had been sky-high at the late-morning draw; her kidneys were failing and if Jemma didn’t lower her doses she risked knocking them out completely.
“You’re just going to have to do that again,” said Jordan. “You may as well wait for the evening labs.”
“I almost have it,” Jemma said, though once again her calculations were yielding doses more appropriate to large-animal medicine. “And the drugs are due soon.”
“An hour delay won’t matter,” he said.
“In an hour Tipper will be down here,” said Dr. Chandra. “He does that shit in his sleep. You obviously haven’t learned how to profit by a timely consult.”
“I pretty much have it,” Jemma said.
“You’re probably right,” said Dr. Chandra. “But he’ll do that thing, anyway, where he laughs like your incompetence is cute but really he’s furious because you’re so stupid, and he won’t look at you. He looks at your feet or at the ceiling or at your ear or at your crotch but you have to be the queen for him to look you in the eye. He’s part of the program. He was always part of the program.”
“Pick a letter,” said Dr. Sasscock.
“Y,” said Dr. Chandra, “as in why am I here anyway? There’s a whole hospital worth of misery out there, better wallowing than here. It was never going to be part of my life, taking care of kids with a piece of soggy fucking origami where their heart should be. Why do I have to deal with it now? What’s the point? What are we being trained for, anymore? What?” He was looking right at Jemma, and made a gesture at her, folding his hands together and shaking them over the table. “Why, why, why?”
“Can you dose tobra every twelve hours in someone with a creatinine of two?” she asked him.
“Go ask Dad,” he said. “We may as well ask Dad. You get the same goddamn answer, that zombie smile, whether he’s alive or dead, here or gone, and no matter that he’s dead and the whole world is gone with him, we’re all still in the program and we’re all still under his thumb.”
“Do q twenty-four,” Dr. Sasscock said to Jemma, and to Chandra, “Dude, shut the fuck up. Pick another letter and stop badmouthing Dad. The man was a saint.”
Dr. Chandra shook his head, but stopped complaining, and they played on in peace, leaving Jemma to her work, until the labs came back and sent them scurrying. Jemma got three new quasi-emergencies—a low k and a high k and a low phosphorus—but decided to ignore them for five more minutes until she got the damned dosages set. Dr. Tipper snuck up on her just as she was finishing and pointed out that she’d got it all wrong. He looked at her shoes and her left boob and her belly and each ear, and spoke his mocking chortle, and she became more furious and more depressed and more weary, and all she could do, when he flew through the calculations and wrote out the orders and hummed her a snatch of the Mikado, was sigh at him, and say “Thank you.”
At hour thirty-three she encountered Monserrat and her tamale wagon, making her afternoon snack rounds. “You look awful,” she told Jemma.
“Everyone keeps telling me that.”
“Are you hungry? Have you eaten?”
“I had some juice… earlier,” Jemma said, not able to remember when she had last eaten.
“Strange, strange girl,” she said. “How do you think you can keep going with no gas in your engine, with no hamster in your wheel? Come here to me.” She took Jemma by the hand. Her wagon had been souped-up by the angel—motorized and decked out with moon-rover tires and a folding table and inflatable chairs, and a cooler/replicator that only made supremely exotic horchatas.
“You need to take care of yourself,” she said. “A cat takes better care than you do. Look at you!”
“I know,” Jemma said, as Monserrat lifted a cold bottle of soda from the cooler. Instead of opening it for her she rolled it back and forth across her face. “I should keep going,” she said. “I have some bad labs to fix… That’s nice.”
“First the cold, then the hot,” she said, guiding Jemma’s face over the steamer and stepping on the pedal to generate a blast that lifted her hair and left drops of water condensing on her nose. She nearly fell asleep while the lady massaged her face with a corn husk.
“It’s been a good day,” Monserrat said, while Jemma started to eat, hushing her every time she tried to say something. “Not so pleasant outside, and ugly days used to never turn out well, but already today I’ve captured five others just like you, dragging their big bottoms and looking like they’re about to cry. I do an intervention and it goes a little better. I like the word—intervention. My son did one for my high salt and my blood pressure. It was swift and cruel—he threw it all away and I wanted to wander into the woods like a deer and lick rocks, but he was right, and I am right. How do you feel? Would you like another?”
“Tired,” Jemma said. “And late. And thanks. I’ve got to go.”
The lady put another warm tamale down Jemma’s pants, catching it in the band of her scrubs and adjusting it so it settled in the small of her back while Jemma just stood there, reflexes slowed by fatigue so that by the time she jumped away it was already done. “If you don’t eat it then give it to someone you love,” said Monserrat, and pressed the button that folded up the table and deflated the chairs. She walked off behind the wagon, steering it nimbly with a little black joystick.
Hour thirty-four she spent with Vivian, who came down to do a consult—her second day on the service and she was already trusted with them—on a Down’s syndrome baby in the NICU who’d been persistently throwing blasts on his smears for the last three days. “You look awful,” she said to Jemma, pausing in the middle of her note.
“I know,” she said. “Everyone’s told me. Really, everyone. Somebody wrote it in the bathroom up here. Jemma Claflin is one hideous bitch.”
“Sorry,” Vivian said. “You just look tired. A little worse than post-call. Was it a bad night?” Jemma shrugged and put her head down on her arms. “Don’t go to sleep. You’ve got another two hours yet. Tiller’s going to page you, you know, for her own fucked-up signout. What did you learn, Dr. Bennett, from the trials of the night? It’s like rounding all over again, but for absolutely no reason at all.” She sighed.
“Are you all right?” she asked, continuing the note—Jemma heard the nib of her fountain pen scratching across the page—but reaching with her non-writing hand to massage Jemma’s scalp. Jemma nodded. “I was worried about you, last night. I should have come to visit. I meant to. But the list was pressing. It’s so strange—it leaves me alone for a couple days and then it’s like, of course! How could I have missed that one! I have to work on it, and every item has a related item, every paragraph a subparagraph—within and within and within, but I never seem to get to the heart of anything. And then the next day I look at it and it all seems so petty and stupid and totally not worth it. Not worth even thinking about. It’s like I was drunk, but I haven’t been drunk, much, and I haven’t been shrooming since way back, honest.”
“Everything’s strange,” Jemma said. “At least you’re not throwing up all the time.”
“That’ll pass, and even if it doesn’t, I’ve got some plans. That reminds me, we should check an hCG. What if it’s a mole? Wouldn’t that be disgusting?”
“Three moles are walking in a tunnel, single file, on their way to raid a farmer’s kitchen,” Jemma said, though she could see the other kind of mole, the one that Vivian was talking about, a placenta corrupted to the point of malignancy.
“We’ll do a sono if it’s high,” Vivian said. “I was up all night with the list, even though I knew I was on call today and should sleep, and the boy wasn’t snoring for once, and we had this incredible session before bed. I should have been exhausted.”
“‘I smell swe
et candied carrots!’ said the first mole.”
“I actually was exhausted, but it came to me. Local news. How could I have missed it? It was always so awful, no matter where you went, but worse than that was how it demeaned everything it touched. Part the bad hair and there it is, a thoroughly belittling but tireless regard. Even when they tried to praise something, they condemned it.”
“‘I smell apple pie!’ said the second mole,” Jemma said, trying not to think about the extensive coverage, or see it replayed across the white static behind her eyes—a shot of Calvin’s blood on the ice, a burned hand reaching out from beneath a tarp, the string of idiot commentators speculating on the nature of the devil-cult that supervised the black ceremony. There was her house burning and the wreck of Martin’s car wrapped around an impervious tree. It all conflated into one supremely horrible story about which the now slack-jawed bimbo had nothing to say.
“It’s not even the extreme lameness, how lame they look or how obscenely they fondle things. Here’s the within: it’s temporary. It’s the rage of every story—I was never even meant to be told but now you have forgotten me. Why did you disturb my rest? Why did you wake my curse? You never even really cared. Something like that—all that pathetic lame shit banding together and praying for vengeance.”
“‘I smell mole asses!’ said the third mole.” Jemma saw empty white static again. She sat up and started to rub her eyes.
“Now it seems stupid already, like I said. Don’t do that, you’ll detach your retina and anyway it’s disgusting.” She wrote a few more sentences while Jemma kept rubbing, then shut the chart. “Heme-one is fun,” she said. “My guess is leukemoid reaction, but it’s a little late. She’s so Downsie, though. AML? That would suck. Anyway, I’ll talk to Sashay about a bone marrow and set it up with Wood tomorrow morning after rounds if it’s a go. Are you even listening to me?”
“AML,” Jemma said. “Sashay. Bone marrow tomorrow.”
Vivian looked at her watch. “Two more hours—hang in there. Just picture Tiller blowing Snood if she tries to make you cry.”
“I never cry,” Jemma said, “and don’t spread rumors.” She took the chart back just as her pager sounded. Jarvis was bradying and desatting. She had no idea what to do about that, and the rest of the hour passed before she and Emma figured out together that his ET tube was too low.
The sun came out at hour thirty-four, and as hour thirty-five closed Jemma paused many times by the windows, wanting to get out of the hospital, looking at the green water and wondering what it would be like to go floating in a dinghy. Trailing behind the hospital would not be the same as being inside it, and she wondered if it would give her the same relief as she’d get after being inside for a thirty-six-hour run of suffering back in her surgery rotation, when she’d leave the hospital, blinking in the sun like a newly sprung prisoner, and walked very lightly for all her exhaustion, because her steps were buoyed by that I’m-not-in-the-hospital feeling. It would fade, even before she got home, even before she sat down at her computer to look at applications for cosmetology school or garbage-man school, replaced by the dread of certain return. At a window on the stern side of the NICU, she watched herself, standing upright in the dinghy, clothed quite dramatically in a winding, flaring hospital sheet, or a dress sequined in colors exactly matching the sunset-sea, or wearing the most gigantic fruit hat ever. She receded, hand up in benediction, swallowed by the horizon.
“Hey baby,” Anna said, stepping up next to her at the window. “I need you to come look at the baby. See something good out there?”
“Just… water,” Jemma said. She let Anna take her hand and lead her to Brenda’s isolette.
“All of a sudden she just looks like shit. Don’t you think? And she was having such a good day. She tolerated the feed advance and weaned her oxygen again and she sat out with the volunteer for twenty minutes listening to a story. It was all fine until all of a sudden.” Jemma looked down at the mottled child, who tried to lift her arm to point but only succeeded in extending her wrist a little. She reached her hand into the isolette to feel the belly, because it looked a little rounder than usual. It was as smooth and stiff as the surface of a bowling ball.
“Oh fuck,” Jemma said.
Every time she went into a surgery, Jemma suffered forebodings of doom; she knew something awful was going to happen. She’d never seen anybody die on the table; she hadn’t even seen a particularly nasty complication. She’d seen no exsanguinations, no confused amputations of the wrong limb, no mad surgeons carving their initials on the patient’s hide, no beheadings. Still, she believed that something awful did happen in every surgery; someone would be flayed open, a stranger would be rummaging about in their innards. Someone would suffer an assault no less violent for how slow it was, or how practiced, cool, and methodical.
Hesitating to enter the operating room, she scrubbed longer than was necessary. The distinctive odor of the soap, and the noise of the water drumming in the steel sink, brought back memories of the long eight weeks she’d spent in her surgery clerkship, and the longer eight weeks she’d spent repeating the clerkship after she’d failed. The people who had tortured her so vigorously then were all dead now, but she felt no safer, for that, in this place. She could feel the hair at the nape of her neck standing stiffly erect, and she felt a nausea that was distinct from her morning sickness. The spirit of her father, the only kind surgeon she’d ever met, ought to protect her, she thought. But when she closed her eyes she only saw him shaking his finger at her.
Rob kicked a pedal to start an adjacent tap running and started to scrub without talking to her. They were still in a fight. He wet his hands and arms, and began to soap them up. Jemma ran the brush idly over her fingertips, and watched, liking how the water and foam caught in the hair on his forearms, how it matted and curled. Jemma watched the brush travel from the tip of his fingers up to a point halfway between his elbow and shoulder, then down again.
“Stop looking at me,” he said. Jemma continued to stare. Rob hurried his scrub, scooping his hands and arms under the water to rinse them. He sidled up next to her, arms held up in front of him, elbows dripping. “Don’t let Dr. Walnut beat you into the room,” he said, then backed through the door into the OR. It was a rule of surgery, that the most senior surgeon comes last into the OR like a king comes last into the chamber of state.
In her sixteen weeks of surgery, Jemma had perfected the post-scrubbing posture—it was the one thing she had gotten good at. She flexed her arms crisply at the elbow, and splayed her fingers gracefully before her face. She squelched her foreboding, backed into the door, and thrust it open with a commanding blow from her ass. She spun on the ball of her foot, careful not to fling any drops from her wet hands and arms, and gave the scrub nurse a look she hoped would be interpreted as proud—she had learned that scrub nurses tended to ignore you if you were earnest and kind. The nurse handed her a sterile towel. Jemma dried herself, finger to elbow, and tossed the towel to the floor in her best imitation of surgical haughtiness. The nurse helped her into the blue paper gown, and then into the gloves, stretching them at the mouth while Jemma reached her hand into them, the way you reached into a snake hole, or into a toilet. No matter how forcefully she shoved her hand into the glove, there was always a bit of empty finger at the tip that she’d spend the next five minutes worrying and pulling. Like always, it ruined her haughty-surgeon act. The nurse, her eyes made articulate by her mask, gave Jemma a look that said she’d seen right through her.
After the nurse had tied up her gown, Jemma walked over to Rob. He was helping to prepare the body; Brenda lay spread out, already unconscious and intubated, on the operating table, tied at ankles and wrists, arms above her head, so she made the shape of an X. After a nurse finished scrubbing the child’s belly and chest with betadine, Rob put the drape on her. He shook it out with a snap, and then it settled over her, obscuring her face, her neck and chest, her arms and legs. A window in the drape exposed an oval of stai
ned belly five inches across its longest part. Underneath the skin her belly was rotting; she had an infection in the wall of her bowel, flagrant and obvious on the x-ray that Jemma had ordered. “Excellent work,” Dr. Walnut had said, after Jemma had been interrogated by the two surgeons. Jemma had already ordered all the tests that Dr. Walnut wanted by the time he came to see the child. He rewarded her by summoning her—at hour thirty-eight—to the surgery. Jemma would rather have had a kick in the face. Now she’d been awake for forty hours. It was a new record for her.
As Rob smoothed the drape, Dr. Wood raised his little screen, a length of sterile paper that was hoisted north of the shoulders but south of the chin, ostensibly to establish the upper border of the sterile field, but also, and more importantly, to divide the domain of the cranky, rude surgeon from that of the contented and fun-loving anesthesiologists. It was a different world, behind the blue curtain. On this side of it, surgeons scolded at sutures cut too long and too short, at fat retracted with insufficient or overzealous force, and dissected the ignorance of the common medical student, and when there was laughter, it was only cruel. On the other side the anesthesiologists reclined among their puffing machines, discussing films and art and restaurants and golf, and gossiping in quiet voices about the surgeons in the room. How often Jemma had wanted to go there, to the other side, during her sixteen weeks of hell. She wanted to go there now.
