The Children's Hospital

by Chris Adrian

  Dolores came into the room, followed shortly by Dr. Walnut. The two nurses attended to them simultaneously, and the way they postured and dipped their arms and hands and spun made it seem like they were dancing in synchrony, so Jemma expected them shortly to start into a doo-wop routine. They were the last two surgeons in the world, and representative of their kind, a meanie and a junior meanie. Jemma had imagined them mating, to replenish the species. It would be a sterile procedure, she was certain, involving betadine and steel. Dolores, the resident, would lay a clutch of eggs and make a nurse sit on them until they hatched, freeing an equal number of boys and girls, each the very image of their father or mother, each little mouth already turned down in a perpetual frown of annoyance.

  Dr. Walnut was a small man, a cardiac surgeon who’d been frequently slumming in the abdomen since the Thing. He had a pointy nose, and small ears, and round blue eyes. From the nose up he looked better suited to making cookies, or repairing shoes than cutting into children, but his thin white lips gave him away. Jemma thought they must once have been thick and red and luscious, but a professional lifetime of pressing his lips together impatiently had flattened and bleached them. Thin, curly wisps of white hair escaped from under the edges of his surgical cap. The cap was festive, covered with smiling, fat-tired school buses. Such silly little hats marked a person as a native of the OR. The hats were the only thing Jemma liked about most surgeons, and she wanted one for herself, but it was considered uppity for a medical student to wear one, so Jemma had always made do with the frowsy sheer bouffant caps that made everyone look like they were hiding their curlers.

  Dolores was as big as Dr. Walnut was small. She had probably been stately like Dr. Tiller, once, before she had decided to become a surgeon. Jemma had watched her make the typical transformation, across her intern year, one that was repeated over and over, through the decades represented in the surgical housestaff pictures that had hung down a dark hall of the medical school. The interns were all lean-faced and sharp-looking; the second-years were puffy and looked tired, the third-, fourth-, and fifth-years looked progressively weary and fat. Surgical interns entered the program healthy, ambitious, and beautiful, but the call and the toxic atmosphere wore on them; their souls shrank to nubbins while their asses bloomed into soft, marvelous pillows, and they became giant grub-like creatures that could perform a one-handed Kasai procedure, but when placed in the sun, made a mewling noise, and asked to be taken in, and to be fed fried food. Vivian said they were corrupt before they started, that the surgical muse called her slaves from among the evil dead, but Jemma disagreed, and had always thought it was sad, even in the most hellish days and nights of her surgery clerkship, even when a lady very like Dolores had ordered her to wear a truncated dunce cap during a pancreatectomy, how they were corrupted, how their bravery was corrupted to hubris, their genius corrupted to cleverness, their compassion corrupted to disdain, their patients corrupted to meat. Dolores’s cap was blaze orange. In the former world she’d been a huntress and an eater of game.

  “Well, kiddies,” said Dr. Walnut. “Let’s save this baby, shall we?” He rubbed his gloved hands together till they squeaked. He stepped up on a pedestal next to the table, and was suddenly almost as tall as Rob.

  “You’re in my place,” Dolores said to Jemma. Jemma moved, into the place of the scrub nurse, who moved her on. She thought there’d be no room for her, for all that she’d been invited. Dr. Walnut noticed her standing away from the table, and brought her over next to him, so it was Rob who had to step back. Dr. Walnut called for the music to begin—he listened to Ravel while he worked—and then put out his little hand for the scalpel.

  “Dr. Claflin,” he said, knife poised over the belly, “what are the layers of the abdominal wall? I forget them. I’d dearly like to know what they are, though, before I cut through them. I hate to cut in ignorance.” Jemma smothered an urge to put her face in her hands, and told him the information he already knew. It was a favorite question, one she’d been asked dozens of times in her clerkship, and always the surgeon pretended not to know the answer. Jemma rattled off the layers with minimum effort, aided by a mnemonic: surgeons climax if stimulated expertly in the rectum.

  “Ah yes,” said Dr. Walnut. “That’s it. Now we can proceed.” He lowered his knife. Dolores brought the suction up in what looked to Jemma like a quick salute, then she brought it down to hover just behind the knife blade. As Dr. Walnut cut she sucked up the blood behind him. The skin sprang apart under the knife, and tiny beads of blood collected in the mouth of the suction. After he’d opened the skin, Dr. Walnut cut the rest of the way with the electrocautery. It sang a shrieking, keening note as it cut, and sent up acrid twirls of smoke that Dolores sucked out of the air before they could reach and offend Dr. Walnut’s pointy nose. What wafted toward Jemma she let go, so Jemma got smoke in her eyes. In her clerkship she’d become overly familiar with it, because she was a klutz with the suction, and could never capture all the smoke from the air. Sometimes, when the patient was very fat, it was like standing at a barbecue, and Jemma once or twice nearly passed out from holding her breath, trying and failing not to be carried on the clouds of smoke back to Calvin’s burnt black body.

  “Retractors!” Dolores said imperiously. When the nurse handed them to her, she took one for herself and handed the other to Jemma. Jemma had never seen retractors so small before—these were about as big as chopsticks. Hooked on both ends, used to pull skin and muscle and fat out of the way of the surgeon’s hands, they were familiar to every medical student, as retracting was their primary duty, after being humiliated and before wielding the suction. Jemma had retracted for hours and hours before, so at the end of the surgery she was unable to feel her hands, and surgeries became contests of will between her and the fat. She’d fallen asleep once, during a four a.m. appendectomy, pulling back on a crowbar-sized retractor, in the attitude of a water-skier. The surgeon, when she noticed that Jemma was asleep, had used her greasy finger to flip the retractor out from under a shelf of fat, and Jemma had fallen straight down on her back. Jemma had woken to laughter, and the shadows of masked faces under the surgical lights, and had wanted so badly for it all to be a horrible nightmare. Now she shifted her weight back and forth from one foot to the other, trying to stay awake. Everywhere she looked she saw comfortable places to fall asleep: under the various carts, curled up in the corner, in the cabinets full of gloves and towels. She thought of all the places she’d found her father asleep, when she was a child. In his car, in the bushes, folded over the kitchen counter, on top of the dining-room table; he could fall asleep anywhere, and it had always made her feel very grown up and somehow indispensable, to settle a blanket over him, wherever she happened to find him. She stared longingly at the blanket warmer. Surely the angel could warm a blanket, too—lengths of warm blanket billowed in her head, pouring out of the replicator to cover her on her bed.

  “Too hard!” said Dolores, and then, “Too soft!” Jemma adjusted the pressure on her retractor, but Dolores continued to scold, like a fat, crabby, perpetually dissatisfied Goldilocks. Dr. Walnut was rummaging delicately in the belly of the baby, leaning over the surgical wound every few moments and exclaiming, “Smell that rot!” He walked along the intestines with his fingers, seeking out the dead gut. What his fingers passed over, he pulled out onto the drape, so as he walked deeper and deeper, neatly placed loops of bowel grew up in a pile on the sterile drape.

  “Eureka!” he said, finally. He held the sick bowel up for all of them to see; it was purple, except where it was mottled black, a stark contrast to the earthworm-pink healthy bowel. “Five, seven, fifteen centimeters, I think, and the valve, too. Ah, poor short-gut baby! Dr. Claflin, would you like to make the first cut?”

  “No thank you,” Jemma said politely. But Dr. Walnut insisted. He placed the clamps and directed the scissors, miming the cut with his two fingers.

  “But wait a moment, it’s too dark. Dr. Dickens, would you adjust the light?�
� Rob reached above them to move the surgical lights. There were six of them suspended by as many triple-jointed arms above their heads. For five minutes Rob made adjustments, but Dr. Walnut was hard to satisfy. “Well, that’s fine for the left side of the field, but look on the right. What’s that? Stygian gloom!” Another three or four minutes passed. Dr. Wood peeked over his curtain and asked if everything was all right. “Just fine,” Dr. Walnut said. “We just need a little more right here.” He pointed with his finger at a spot inside the child. Rob reached for the sixth light, the one that was furthest away from him, and brought it around. As he set it in position, and Dr. Walnut exclaimed, “Perfect!” there was a noise Jemma recognized from her childhood: a violin string breaking, a strong, refined ping. The perfect light vanished. She felt a rush of air at her back, like a bus had just zoomed by her, and heard another childhood noise, a pumpkin smashing. She turned just in time to see Rob stuck on the far wall. He hung there a moment, then peeled away, head, chest, belly and legs, leaving a silhouette of blood on the clean white paint in the shape of his head. He fell to the ground and lay like a sleeper, his hat in place, blood expanding in a wet stain on his mask, and blood pouring from his ear.

  “I told you,” she said to his swollen purple face in the PICU. “I told you this would happen.” She spoke out loud, but really she was talking to herself, because she never had told him why she had run so halfheartedly from his courtship. When he asked why she had been so jittery, back at the beginning, she said not, “Because I was afraid something absolutely fucking awful would happen to you,” but instead, “I guess I have a hard time trusting people.” For the longest time she’d only told him she loved him in the throes of an orgasmic tizzy; she’d shout it in utter distraction and then wonder, during the after, if she could take it back. Then, after practicing on houseplants and the neighbors’ pets, and seeing how they came to no harm, she’d woken him one blue pre-morning to say it, premeditated and deliberate. “Don’t I know it?” he’d asked her sleepily, and drawn her to him. She’d folded into him, limb over limb, until she felt like a ball wedged against his belly and under his ribs. Now she imagined the roach, afloat at some far latitude, scraping its legs at her and broadcasting reproach on its antennae: I told you, didn’t I?

  She said it again, though—“I love you”—not able to help herself, or convince herself or fate or the furies or God that she had only been kidding, the whole time. She said it to the baby crying in his crib, and the boy weeping outside his house because he thought his family had moved away without him, and the adolescent weeping over the father he never met, and the man weeping for the drowned world. She was in love with every one of them, and she spoke the words to all of them like a fatal wedding vow.

  Dolores had proved herself a champ. “I’ll get it,” she’d said to Dr. Walnut, as if Rob were a ringing telephone, and not a dying body. Before Jemma had unfrozen out of her horror, she’d stabilized his neck, rolled him over, and caught the laryngoscope and ET tube tossed across the room by the anesthesiologist. Jemma by then had crossed the room, ignoring Dr. Walnut’s cry to come back, come back and retract. “I’ve got it,” Dolores said, looking deep into Rob Dickens’ throat. She tubed him on the first try and hooked up a bag. “Get back to the table,” she said. Jemma, her tongue already turning to stone, said softly, lamely, “He’s my fiancé.”

  News of his injury spread rapidly through the hospital, and in this place that could not tolerate new sadness, provoked a great lament—he was affable and handsome and only Jemma ever saw him in a bad mood, and for weeks he’d been cultivating new friendships about as eagerly and successfully as Jemma avoided them—not just because he was so well liked. Common opinion had it that everyone had suffered enough; added misfortune, even if it were relatively benign, was unbearable. And if just a broken nail or a bruised toe were bitter gall, then what was Rob Dickens, laid out in the PICU with diffuse axonal injury and a slowly expanding subdural hematoma? Jemma sat by his bed, not knowing or caring if she’d been excused from her duties, not moving even when the nurses came to roll him or give him mannitol or change his diaper, and not helping, either. Her stony feeling was such that she could barely move or speak. She thought of him as already dead.

  She leaned over in her chair, resting her cheek next to his arm, not ever asleep, but neither entirely awake, breathing in time with his respirator. She’d lift her head every now and then to look at his monitor, or look for as long as she could stand at his face, his swollen lips and eyes, and the horrible bolt that stuck out from his forehead—it looked like an industrial mishap, but had been put there on purpose by Dolores, a sensor to gauge intracranial pressure. Sometimes she thought his face belonged to someone else; with the slightest effort, a little twitch of imagination, she saw her first lover, or her mother or father, or her brother, laid out on their backs with the bolt standing up obscenely, like a handle, from above the left eye.

  People came and went all through the night and the following day—hours fifty through sixty. PICU people and visitors from all over the hospital, Jemma ignored most of them, unless they shook her hard. Synthesized flowers filled the room with their not-quite-right smell, and cards, crafted by children, appeared on the walls by the dozen, until there was no more wall to obscure, and then they began to darken the window. Vivian, Dr. Sashay, Ishmael, even Dr. Snood creeped solicitously into the room. “I’m fine,” Jemma mumbled at them, and would not talk anymore, no matter how they pestered. Sometimes she pretended to be asleep. Sometimes the voices did not register with Jemma until their speakers had left the room, but she always heard them:

  “Will he be okay?”

  “Will she be okay?”

  “I hear that they’re trying to find someone willing to drill. Walnut’s scared he’d kill him. And he operates on hearts the size of jelly beans!”

  “Who else except him?”

  “Pudding? He’s IR, isn’t he?”

  “IR doesn’t drill in your fucking head.”

  “Dolores would do it. She’d think it’s fun.”

  “Can she hear us?”

  “I don’t think so. I think she’s sleeping.”

  “They were going to get married. Isn’t it cute? Isn’t it sad?”

  “Isn’t it enough already?”

  “Maybe it’s never enough.”

  “Maybe this is just the beginning. Maybe we’re all going to get it in the head.”

  “Times like these I want my Buffy. I want something besides what’s here, you know, because what’s here is so awful. But when I go looking for her, it’s still just static. I guess I could just ask for her, but I’m afraid I’d get something dirty. I don’t want to see Buffy doing something dirty, but what if I wanted it, you know, secretly. Deep down? The angel would see it and give it to me. She knows that sort of thing. She really does.”

  “That’s how all pornography happens. You ask her for one thing but she knows what you really want. Anyway, Buffy’s not coming back.”

  “I know it’s true. But it’s hard, hard.”

  “True things always are.”

  “Can you hear me?”

  “Jemma? Jemma? Jemma? Jemma?”

  “Can I get something for you, Dr. Claflin?”

  “She’s not a doctor yet. She’s not even a fourth year. Have you had to be with her at night? It’s a chore.”

  “She just sits there.”

  “I’ve peeped in once or twice and seen her move her head. Sometimes she whispers to him.”

  “It’s time to change him again. Is that poop in her hair?”

  “It’s blood. Jemma?”

  “When does she pee?”

  “She hasn’t been drinking.”

  “If we put her hand in warm water I bet she’ll pee all over the place.”

  “Such a handsome boy, even now. She’s a lucky girl. Was a lucky girl. You know what I mean, right?”

  “Exactly. Look at him!”

  “Dolores will drill. She just has to drill.” />
  “If you bring out what is inside of you, it will save him. If you do not bring out what is inside of you, you will kill him. In this hour, to not lift your hand is the same thing as to kill him.”

  Jemma opened her eyes. The two magpies were gone, and Pickie Beecher, whose voice she thought she’d just heard, was nowhere to be seen. Rob looked the same, eyes swollen, bolt in head, unmoving. She wiped some drool off his chin and pushed his hair away from the bolt and fluffed up his pillow and was smoothing his gown over his legs—it was always riding up—when the code alarm began to ring. She ignored it, at first. It wasn’t her problem, but it rang louder and louder in the room, and the angel wouldn’t shut up—“Save him save him O save him please.” She went to see what was happening. It was the first time she’d left since Rob had arrived.

  The bell was chiming for Marcus, the fat little five-year-old from the family with bad hearts. Emma and Dr. Tiller were already in the room, along with Dr. Chandra and a single nurse, Janie. The boy’s mother was standing in the door, calling out “Regresse Marcos, regresse mi amor!” Emma saw Jemma looking in.

  “Jemma,” she said. “We need you.”

  “Get someone else,” said Dr. Tiller.

  “She’ll be okay. Right, Jemma? Remember what I said?” Jemma walked up to the bed, climbed up on a stepping stool, and took over compressions from Dr. Chandra. But rather than distracting her from all the really horrible shit, the compressions brought it all more clearly to mind. So the child underneath her hands became Rob Dickens, and as she pushed on his chest it was from Rob’s mouth that bloody froth bloomed, higher and higher, a complex flower made of interlocking red bubbles.

  “More lidocaine?” Emma asked.

  “More lidocaine,” Dr. Tiller agreed. Janie pushed it. Jemma kept compressing, trying not to look at the face, but always coming back to it. It was Rob, then Pickie Beecher, then Josh Swift, then Cindy Flemm. It was Ella Thims and Magnolia and Juan Fraggle, but mostly it was Rob, and as she pushed and pushed it became his face not just because her obsessive imagination was able to draw the lineaments of his jaw and brow over the fat face of the doomed child, but because she saw it, as certain and as unreal, as she had seen her own mutated body bouncing in Ella Thims’s crib all those weeks ago.