Jex pauses for a moment as if about to resist, then lifts the folded envelope to Ms. Tubman, who takes it and quickly pockets it under the folds of her dress.
“Very good, Ms. Blackwell. Have a good day.”
“Thanks, Ms. Tubman. Have a good day.”
Ms. Tubman walks through the library stacks and up to the administrative offices on the first floor, past the statue of Degas; and the coffee table books by National Geographic; and the little store in the front where they sell old books and cheap knick-knacks. Before she gets to her office, she passes Charlie, an assistant who has been in the library for years. “Charlie,” she says, “can you make sure this gets in today’s post, walk it over to the post office yourself? I’d much appreciate it.” She holds out Jex’s envelope.
“Sure, Ms. Tubman. Not a problem.” He takes the envelope.
“Thank you, Charlie, you’re a dear.”
“Not a problem! Have a great day,” Charlie replies as he walks down the hallway in a near skip. Ms. Tubman watches Charlie and the envelope walk away. She does not hesitate. She just shrugs to herself, smiles a half smile out of the side of her mouth and continues to her office.
* * *
Jex stands on the corner of Hill and 5th Street, not exactly sure where to go, what to do. The wind is cool on her face. She looks left and then right and then left again. She walks to the bus stop and stands there a while, as though waiting for something, but she doesn’t know what she is waiting for. She picks at her fingernail and lights a cigarette. Puffing on the smoke, she looks up and sees a bus driving down the street, headed to the bus stop just a few feet from Jex. It seems familiar and safe to her.
She doesn’t feel like driving herself today, anyways. The bus arrives and she gets on, Line 62. She tells herself that she is just going to ride around for a while, listening to music and thinking. Let someone else do the driving for once. But deep down, she knows. Johnny Hobo screams away at her through her ear pods, and she knows. She is going to Reseda.
* * *
Little Toy Saxophone
The challenge is clear in Dr. Stephens’s voice. “So, Ms. Blackwell,” she says with a determined smile. “What are your thoughts on Ms. Awad’s condition?”
Dr. Stephens and Jex have returned to the examination room. Ms. Awad is fully dressed and sits on the exam table. Mr. Awad has taken the seat next to her. They all look at Jex expectantly.
Jex doesn’t hesitate. Her chin is up. Her voice is firm and full of confidence. “Well, for the ankle, it seems pretty clear that there is some post-traumatic osteoarthritis, I think secondary to moderate osteoporosis in the ankle and related joints.”
Dr. Stephens nods her head slightly approvingly. Mr. and Mrs. Amad listen intently as Jex continues.
“There are a few probable root causes, I suspect, mostly the injury she suffered last year where she fractured the ankle. It has been healing slowly, I think, and maybe you are not moving around as much as you used to?” Jex asks this to Ms. Awad, who reluctantly nods her head in agreement.
“And, I don’t want to be too personal, but the charts show you have gained a few pounds in the last year or so.”
“Yes,” Ms. Awad says quietly. She seems to almost blush under her veil.
“We both have gained a few pounds recently,” says Mr. Awad, his back straight and rigid, but his tone polite and respectful. “And you are correct, we have not been as active as we used to be.”
“I’m not judging,” Jex assures them. “You can speak with Dr. Stephens about that stuff later if you want. I’m just breaking down some of the likely causes so that you can have the information and might want to change your lifestyle a little, if you want.”
Mr. Awad nods. “Thank you, Ms. Blackwell,” he says quietly but firmly. “We appreciate your observations.”
“My dear,” Ms. Awad retorts, with a sing song in her voice that betrays the smile under her veil. “I do believe Ms. Blackwell is calling us a couple of old lazy bones. We’ve heard that before, haven’t we?”
“No,” Jex interrupts quickly, her face turning red. “I’m just setting out the factors, so you know. I would never say that.”
“Yes, dear,” Mr. Awad says through a thin, knowing smile, as though the two are sharing an intimate private joke to which Jex is not quite privy. “I feel like we have heard that one before. Though perhaps not always so politely.” His eyes twinkle but Jex can’t help but notice a streak of sadness in them, something that is suddenly clear to Jex has been in his eyes since he entered the room. Jex just sees it now, as he continues. “Well,” Mr. Awad smiles, “perhaps it is time we finally take the doctor’s orders.”
Ms. Awad agrees and murmurs, “Time to take the doctor’s orders.”
“Remember,” Jex emphasizes. “I’m just a hospital volunteer – not a doctor.”
“We know,” Mr. Awad assures Jex, his voice pensive but friendly. “It is just a little something someone used to say to us.”
Jex smiles. “Now,” she continues. “About that knee. As I said before, Dr. Stephens may re-conduct some or all of these exams and come to a different diagnosis, but for the knee, it seems clear to me that you have a torn, maybe partially torn, collateral ligament, and also a meniscal tear as a result of degenerative horizontal cleavage in the knee. This is most likely a degenerative thing that happened over time, but was probably, you know, exacerbated by your ankle injury.”
“Her knee injury was caused by her ankle injury?” Mr. Awad queries, his brows curled in curiosity.
“Well, not quite,” Jex clarifies. “I suspect that Ms. Awad favored her right leg when her left ankle was healing. That caused additional stresses on the leg, including the knee and the joint. This would hasten the degeneration, and could make it happen a lot more quickly than if the ankle hadn’t been broken.”
“Yes,” Ms. Awad says quietly. “I may remember Dr. Stephens warning us that if we don’t exercise more, my knees could suffer.” You can almost see Ms. Awad’s guilty expression as she looks over at Dr. Stephens, who smiles in a way that feigns frustration. Mr. Awad shakes his head slightly and lowers it in slight embarrassment.
Jex doesn’t comment, and instead focuses on the diagnosis. “Yeah, so, if you recall, there was a test where I had you lie face up on the exam table. You knee was fully flexed and I rotated your foot a little bit. I created what is called a varus stress at the knee. When I extended the knee, it hurt you a little, and you could hear a click right in the joint. That’s pretty solidly a characteristic of a medial meniscus tear. Right here,” Jex says as she points to her own knee.
“I see,” Ms. Awad says, clearly impressed.
“Yes,” Jex says, nodding, before she continues. “And also, I conducted a test where I pulled your tibia while I held my hand on your upper tibia.” She demonstrates on herself as the Awads nod in understanding. “I saw significant movement there, especially compared to the other leg, which didn’t have any of that movement. In your left leg, the movement was in excess of one and a half centimeters. That indicates an anterior cruciate ligament rupture.”
“Oh,” Ms. Awad responds. “That doesn’t sound good.”
“Well,” Jex says with assurance. “It’s really good that you came to the hospital and saw Dr. Stephens. If there’s anybody who can make sure you get the best treatment in the world for your condition, it’s Dr. Stephens.”
“Thank you, Ms. Blackwell,” says Mr. Awad, his eyes still glimmering with that twinkle that lies somewhere between pride and sadness. “We do appreciate your time and your advice.”
“Thank you both for giving me this opportunity. I really appreciate it and I know you are going to do great in your recovery, Ms. Awad.”
“Thank you, Ms. Blackwell,” says Ms. Awad, her voice somehow mirroring the sad, prideful look in Mr. Awad’s eyes. “I believe that you are correct in that observation. This time, I believe it is time to recover.”
“Thanks, Jex,” say Dr. Stephens. “Now,” she says, turn
ing to the Awads. “Perhaps it’s time to talk a little about next steps.”
* * *
An hour later, Jex is sitting alone in the hospital cafeteria, drawing perfect renditions of anatomical joints and ankles in her sketch pad. Steam rises from the cup of tea sitting on the table in front of her. She has ear pods in, listening to “Frank Capra” by Advance Base. There is no place she would rather be, and nothing else she would rather do.
A fan hums above her. The blades clack away in a way that is almost like a pair of maracas knocking. It doesn’t seem to bother Jex and she doesn’t look up at all. She just sketches away, ligaments and tendons and such. Remarkable accuracy. Her consciousness disappears into the pad and she is disappeared. Disappeared until a finger taps on her shoulder. Jex doesn’t jump or flinch at all. She just looks up and behind her to see Dr. Stephens standing there, smiling and with a cup of coffee in her hand. Jex takes off her ear pods and looks up at the doctor.
“Hi, Doctor,” she says.
“Hi Jex,” Dr. Stephens says through her smile. “Mind if I have a seat?”
“Not at all,” Jex says, gesturing to the seat across from her, and Dr. Stephens sits down. She blows into her coffee and cautiously takes a sip.
“So, you did great today,” Dr. Stephens states bluntly. “I knew you would be confident and graceful, but you really exceeded expectations.”
Jex smiles in a way that is aw-shucks without being either intentional or juvenile. “Thanks,” she says. “And thanks for the opportunity. It was a really awesome experience.”
The two pause for a second, maybe a few seconds, before Dr. Stephens continues. “You look really good Jex, you do. You could stand to gain a few pounds but you look good.”
Jex shrugs back ambivalently. “Whatever.”
“You do,” Dr. Stephens insists. Then another pause, one of those comedic ones, for timing. “But, do you ever wear anything other than that gray sweatshirt and jeans?”
Jex laughs. “I also have a gray hoodie. Oh, and a black hoodie, too. And one pair of black trousers.”
“I guess make-up is out of the question.”
Jex looks down her nose at Dr. Stephens. “Really?”
Dr. Stephens chuckles. “Forget I said anything.”
“You really have a good relationship with the Awads,” Jex says. “That really impressed me.”
Dr. Stephens nods. “I’ve known them for a couple years. I started speaking with them when I had to tell them their son died.” She says in a lower tone, turning almost into a whisper. “I stayed in touch.”
“That must have been horrible.”
“It was truly terrible. I’m encouraged by the fact that they brought him up to you. They are really doing a lot better. For a long time, they couldn’t even talk about it. It really was tearing them apart.”
“It’s good, though, that you have been able to be around to support them. That’s a really important thing for a patient to get from a doctor, right?”
Dr. Stephens shrugs. “But how many patients do I do it for? Three? Four? The rest are just nameless and faceless, really. Not when I’m treating them, of course, we give them the best individualized treatment we can. But there’s so many patients, and so few doctors, the kind of continuing long-term attention that most of these patients need,” she shakes her head, “we just can’t give. It’s frustrating sometimes.”
“Yeah,” Jex says, nodding her head. “I can see that. That’s lame.”
“Yes,” Dr. Stephens says with a little chuckle. “It is pretty lame. I don’t know the solution. We are just trying to do the best we can.”
“Yeah,” Jex says again. “You were really amazing in there.”
“Jex,” Dr. Stephens says, her smile growing wider. “You were the amazing one in there, really. The Awads seem reserved, maybe, but you should see how they usually are. They warmed up to you immediately. That’s really very important for a doctor; you have to be able to establish a rapport. Some doctors are never able to do it. You really seem to be a natural.”
Jex shakes her head. “I don’t know. I was just being me. I feel like a stupid kid.”
“Jex, you’re anything but stupid. And, unfortunately for someone of your age, with what you’ve been through and what you’ve seen, you’re anything but a kid. You should spend some more time being a kid.”
Jex shrugs again and looks away. “I don’t know,” she murmurs.
“So, what’s next for you,” says Dr. Stephens, moving on, changing the subject a little bit. “Summer’s here, what’s the plan?”
“I’m not sure,” says Jex. “I’m just going to take it easy, hang out a little bit. Working at the library, working here. If you ever need anybody to observe or participate in patient exams, let me know,” saying the last words with a smile and twinkle in her eyes.
“Understood,” Dr. Stephens responds with a wink.
“Other than that, I really don’t know,” Jex continues. “Try to figure things out?”
“And college?” Dr. Stephens pokes cautiously.
Jex shrugs again. “I don’t know. Someday, probably. I just don’t know when.”
Dr. Stephens nods, but doesn’t say anything of substance. She drinks her coffee. Jex drinks her tea. They speak of matters inconsequential; of matters of this and that. Time passes. Conversation, small talk, is enjoyed.
* * *
Jex walks out of the hospital. The sun is bright and shines into her eyes. She pulls her green neon rimmed gas station sunglasses from her bag and puts them on. She walks purposefully to her car, opens the door, turns the key. The engine turns over quickly and roars to life. The light vibration of the wheel feels good in Jex’s hands. She smiles and looks out her windshield. The day is growing long but the sun is not quite ready to set. She takes a long swig of water out of a plastic bottle. The cold feels good in her mouth and throat. Even the memory of dryness seems painful. She can’t help but smile as the blue sky bleeds lines of pink and yellow and white.
She notices a flyer on her windshield. It’s for a protest in downtown LA over the weekend. Anti-poverty, anti-homelessness. She pockets it and plops it into her mental calendar. She rummages in her glove compartment and pulls out a pack of Camel Crushs. She lights one and takes a puff.
The little red Focus with all the bumper stickers pulls out of the parking space and onto Seventh Street, and then turns off onto Grand. Jex taps her fingers on the steering wheel as her favorite Spoonboy song starts to play. The music fills the space around her as she turns onto the freeway and she sings hoarsely along. She is headed home.
Here comes the future and you can’t run from it.
Great mistake maker, chronic break taker, a risk taker.
Now it’s a year later and I feel the weight of it.
I’ve got some scars from it, but I don’t think on it.
And I’ve been doing fine.
* * *
Ana Gnorisis
Jex hears the resignation and irritation in the nurse’s voice and momentarily considers telling him just to fuck off and walk away. But this is triage and egos have to be left at the door. Jex is used to checking her ego. She grits her teeth and swallows deeply. After a moment, she begins to speak, in a clear, monotone, restrained tone that belies the fevered environment around her.
“Look,” she says, her eyes piercing spears right through the nurse. “I know the leg is bad, that’s obvious. That’s clear. But that’s all the triage team looked at. The original tourniquet was shit, but it was the right treatment for that leg, no doubt. But in all that commotion, they looked at the leg and they didn’t dig any deeper.”
“Yeah,” the nurse says, his words doused in sarcasm. “That’s what triage is. Hard to see anything that would lead to anything more urgent than the leg. And we have other injured people in this hospital that are more critical than this leg. “This tourniquet,” the nurse says, pointing at the careful knots and placement of Jex’s handy work, “will do for now, I don’t know what
the original one was like, but this one is fine.”
“Thanks,” Jex says without commenting further. “But you say that, but you don’t know. Here,” Jex says, and pulls Marcus’ t-shirt up to his chest, revealing the bruising that marks most of the circumference between Marcus’ last rib and upper thigh. She points at the bruising. “There,” she jabs with her finger accusingly at the blue and purple blobs speckling Marcus’ lower torso. “What about that?”
The nurse blinks and stares at the bruising, his mouth agape just a little bit. Jex continues. “And here,” Jex says, gently picking up Marcus’ left hand. “I’ll just be a second, Marcus,” she says to him as she does this. “I’m just going to squeeze your fingertips, just a little bit, ok?”
Marcus murmurs in a way that could not really be called assent, but was probably close enough to consent for the purpose at hand. She squeezes the fingertips. The tips turn white, but when Jex let’s go, they do not quickly return to red. In fact, they almost don’t turn back to red at all, just an off pink sort of color. “Delayed capillary refill,” Jex states with certainty in her voice. “Almost absent for that matter.”
“Hypovolemia,” the nurse says quietly, not yet reacting to his own diagnosis.
“Yes,” Jex says triumphantly. “Hypovelimic shock, for that matter. Stage 3, at least, maybe Stage 4. And that bruising, that’s Grey Turner’s sign, right?”
The nurse nods up and down in agreement. Jex does not hesitate. “There was a lot of blood on the ground where Marcus was lying, but not enough to take him past Stage 1 or Stage 2 of hypovolemia. But in all the chaos they forgot their basics and they have to remember ‘blood on the floor plus four’ – because of internal bleeding. When I tested his heart rate he was over a hundred beats a minute – looking at him now, it seems it’s only getting worse. Delayed or absent capillary refill; Grey Turner’s sign; sweating and confused. Probably in excess of thirty percent blood loss, maybe from retroperitoneal hemorrhage. Like an injury in the abdominal cavity, or something. Shit, why the hell do I keep talking and why are you not moving? There’s a real risk of necrosis, right? His organs could be dying right now! What else do I fucking need to convince you this is a high priority critical fucking patient?”
Jex Blackwell Saves the World Page 19
