Survivor Song

by Paul Tremblay

  Having the single entrance is an attempt to control the traffic of infected patients and reduce the risk of their spreading the infection to the other hospital populations. Ramola knows better but she is desperate to avoid the crowd, so she shows one of the officers her medical badge and asks to be let into the hospital here. She fumbles through explaining she is reporting for duty, is a part of the second tertiary support, in addition to her tending to Natalie’s emergency medical needs, a thirty-eight-weeks-pregnant woman who shouldn’t be made to stand and be tossed about by the gathering mob. The man shakes his head the entire time she talks, eventually cutting her off. He points to the left, to a group of blue Zumro tents more than one hundred paces away, erected in front of the emergency-room entrance. He says if either of them has been exposed they must go through triage and screening. As she protests further the man ignores her, and he loudly repeats the instructions and points at the tents for the oncoming stream of people behind them.

  Natalie says, “Fuck this, come on, Rams,” and walks toward the tents.

  Ramola is left openmouthed for a moment, holding her badge out toward the indifferent officer. She says, “Wanker,” and then sprints to catch up to Natalie.

  They approach the edges of a ring of humanity, ten to twenty rows deep, expanding out from the tents. There are four of them, ten feet in height, each the approximate width of a two-car garage and at least thirty feet long. They are stacked, side by side. Ramola cannot see through the crowd or over the tents to the emergency entrance’s sliding glass doors. This morning Ramola gave a cursory read to the hospital’s seventy-four-page Emergency Response Plan thinking she would read and reread it more thoroughly later in the evening. The tents are where they’ve set up triage and where everyone will be screened prior to entering the hospital. Medical personnel and service ambassadors in white coats, gloves, hair caps, N95 respirators, and green scrubs (decidedly not Hazmat gear) carry clipboards and flit from person to person like hummingbirds, serving as pre-screeners. They could be informing patients waiting to be seen for issues not related to the viral outbreak that they are to use a different entrance or perhaps they are being turned away; it’s likely that non-epidemic-related services have been suspended.

  The crowd grows and presses forward heedlessly. Arguments rage over who is first in the formless line. Everyone is shouting. Bullhorns and police radios crackle with static bursts and unintelligible commands. Off-campus, sirens cry and cars stuck on Broadway and Washington continue to blat their horns. As unnervingly apocalyptic as the desolate, empty lanes of I-95 were earlier, this scene confirms Ramola’s worst fears.

  “Is everyone here sick?” Natalie asks.

  “I don’t know.” Is it possible this number of locals have already been infected? As Ramola scans the crowd she does not see anyone presenting the most obvious and worst symptoms of rabies.

  “What are we—”

  Ramola grabs Natalie’s right hand. “We’re going in.”

  Natalie’s eyes are wide, the skin around her eyes is swollen and so deeply red as to be almost purple. She looks beat-up. She looks sick. Natalie says, “Don’t lose me.”

  “I won’t.”

  Ramola has given up on approaching a police officer or security guard for help, and she does not want to waste precious time in chasing down one of the frazzled medical staff, all of whom have seemingly disappeared. She walks directly into the crowd, sternly projecting in her best schoolmarm voice, an impressive one both in tone and volume. It is a voice Natalie has only been exposed to once, back during their sophomore year when Ramola accepted a late-night bribe (free pizza) to excoriate, anonymously via the telephone, a too-noisy-for-finals-week room on the dormitory floor above theirs.

  “Excuse us! Let us through, please. Doctor coming through. I’m here to help but we must be let through. Let us by. Doctor coming through. Thank you. Let us through, please . . .” Ramola steps between people if they aren’t paying attention. She taps arms and shoulders of others and if they turn to face her, she doesn’t break eye contact until after they step aside. She leverages the bags slung over her shoulders to force a wider opening for Natalie. Stink-eyes and annoyed looks from the crowd soften, some turning to fear, at the sight of clearly pregnant Natalie gamely trailing behind, wounded and wrapped arm held against her chest like a bird might hold a broken wing. There are murmurs and complaints but those come from behind, from people who are not directly in their path.

  Navigating becomes more difficult the closer they get to the tents, and some people attempt to engage Ramola, detailing symptoms, pleading with her to examine a loved one. Ramola apologizes and tells them they will be helped soon, and she does so without lingering but not without twinges of guilt. She and Natalie continue to push their way through until they come up against another set of the waist-high, steel crowd barriers that cordon off the tents.

  A young police officer, as tall as a folktale, stands over an entry gap between steel barriers. Instead of asking for permission or instruction, Ramola points at the officer, then points at her badge. She shouts, not to him but at him, “We’re coming through.” The officer shrinks under her glare and dutifully drags one end of a barrier back, opening a gap for their passage.

  Pausing briefly beneath the wide arch of the tent’s entrance, Ramola looks at her watch. It’s 12:17 P.M. If one hour post-exposure is indeed how long it takes this virus to travel up the nervous system and pass through the brain barrier, they don’t have much time left.

  Natalie is breathing heavily and looking back at the boiling pot of people behind them. “Are they going to be able to help everyone?”

  Ramola says, “Yes,” although she doesn’t believe it.

  They step into the tent’s spacious interior. The whir of heated air blowers drone; the air itself oscillates between warm and cold. A lane splitting the tent down the middle is being kept clear for passage and foot traffic. Eight white, square-shaped nylon curtains hang from ceiling beams and partition spaces along both side walls, creating ten patient triage/screening cubicles. Each space has an overhead lamp clipped to a wall joist, a small medical treatment table, and a rolling cart with two shelves loaded with assorted supplies. All the cubicles, as far as Ramola can see, appear to be occupied with patients. Ramola doesn’t recognize any of the medical staff in the tent, as she and her coworkers from the pediatric clinic aren’t supposed to report for duty until tomorrow.

  A skinny, middle-aged white woman with thinning hair, wearing yoga pants and a light, high-end jogger’s jacket, emerges from a screening area with her foppish husband in tow. An orderly herds them out of the rear of the tent and toward the hospital proper. Judging by his puffiness, he’s gowned to within an inch of his life (a joke from her residency days Ramola can’t help but recall, though it was clearly more endearing and humorous in non-outbreak circumstances), sporting at least two sets of scrubs and coats.

  The woman’s right hand is wrapped in gauze and her face covered in a white mask. She yells to her husband, but purposefully loud enough to be heard by anyone within earshot. “We have to wait three days for the next shot? Can you believe that shit? Three days. Three drops of blood. No room service. Bedpans and lookie-loos, my ass hanging out of a johnny. I don’t want to go in there. I want to go home and die.” The rhythm of her sentences is off, landing somewhere in an aural uncanny valley populated by the first iterations of computer text-to-speech programs.

  A police officer emerges to aid the orderly in escorting the couple into the hospital.

  A short, stocky woman pulling on new gloves steps out from the same screening area and walks toward them. She squints at Ramola’s ID badge and says, “Hello, Doctor? Are you just getting here? Have you checked in with the Command Center yet? It’s inside, check in at the emergency waiting area—”

  “My friend needs help first.”

  As Natalie walks into the recently vacated cubicle and sits at the edge of the lowered treatment table, Ramola quickly introduces herself t
o Dr. Laurie Bilezerian (her name is written in script directly on her lab coat as well as the phrase “family medicine”), and the doctor introduces herself to Natalie, insisting she call her Laurie.

  Ramola explains that Natalie was bitten by an infected man approximately fifty minutes ago and she’s thirty-eight weeks pregnant.

  “Okay. Dr. Sherman, can you glove up and unwrap Natalie’s arm?” Dr. Bilezerian places the long, tapered temperature probe, which is tethered to her hand-sized electronic thermometer, in Natalie’s mouth. “Please hold this under your tongue and keep your mouth closed.”

  Ramola puts on one glove and then freezes in place as she can’t help but watch Natalie and the doctor watch each other as they wait for the temperature reading. Dr. Bilezerian’s white mask presses tightly against her cheeks, indenting the bridge of her nose. A tuft of black hair leaks from under her cap, graffitiing her wide forehead. Natalie holds her breath without being asked to. All three women are motionless. Chaos churns outside the tent.

  The thermometer beeps three times.

  Dr. Bilezerian removes the probe and reads the digital screen, “Ninety-nine point two.” Her voice clipped, sharp. She turns away and disposes of the probe’s plastic cover.

  Natalie says, “I’m fine. That’s not a fever. I tend to run hot.”

  “It’s within the range of normal,” Ramola says, and puts on her second glove.

  Dr. Bilezarian nods, says a solemn, “Yes, it is,” and returns the thermometer apparatus to the supply cart and prepares a needle.

  Natalie shivers as Ramola unwraps her arm. They lock eyes and Natalie offers a preemptive explanation. “It’s cold out. I’m cold. I only have this thin, damp shirt-dress on.”

  “I’m sorry, I should’ve given you my sweatshirt earlier.”

  “Don’t be sorry. You don’t have to say sorry to me for anything ever again after today.” Natalie wipes tears. She flinches and grimaces as the last of the towel is pulled away from her arm.

  Ramola says, “Laurie, prior to wrapping the wound I cleaned with water and hand soap. It should be cleaned again with Povidone.”

  From her spot hunched over the supply cart, Dr. Bilezerian says, “We’ll get you all cleaned up and tended to, Natalie. Have you ever been previously vaccinated for rabies, pre- or post-exposure?”

  Natalie shakes her head and says, “No, never.” Her right leg bounces up and down nervously, right foot tapping on the stepstool below the examination table.

  “Roll up her sleeve, expose her shoulder for me, please, Doctor. Okay, Natalie, this first shot is human rabies immune globulin; it slows the virus down, keeps it from attaching to the nervous system until the vaccine can get in there and help your body make its own antibodies. Both the globulin and the vaccine are safe for you and your baby.”

  “Oh, good. Great. I’m . . . Thank you, Doctor. Sorry, um, Laurie.” Natalie looks at Ramola and then away, and away from her belly, down at her jittery leg. Ramola assumes she’s feeling guilty for what she said earlier about not caring if the vaccine was safe for the baby. Ramola wants to shout, No! and hold Natalie and tell her that she is the one who doesn’t have to apologize, doesn’t have to feel sorry for anything, not after all that’s happened to her.

  In a screening area across from theirs, a medical staff member has a needle in her hand while another grapples with a small, late-middle-aged man. His tan oxford shirt is dotted with blood, so too the mottled skin of his neck. He shouts, “No!” and as he loses the wrestling match, his shouts become mewling cries. Whether it’s intuition or that dastardly enemy, fear, taking the reins again, Ramola believes, for the first time today, that it is too late for Natalie, they won’t be able to help her, and in a matter of hours, she’ll be gone.

  Dr. Bilezerian says, “This is going to hurt, I’m sorry, but it’s most effective when administered in and around the wound. Try to keep your arm as relaxed as you can.”

  Laurie swabs the puncture wounds, most of which have already scabbed over, with iodine, staining Natalie’s forearm a coppery brown. Ramola offers Natalie the crook of her arm instead of her gloved hand. Natalie takes it. She turns her head and looks away as the doctor inserts the needle and injects globulin at three sites. Natalie squeezes Ramola’s arm with each stab of the needle, but otherwise doesn’t react until it’s over, and then she releases a large, wavering exhalation.

  The doctor covers the wound with a gauze pad. “We’re all done with that. You’re doing great, Natalie.”

  Natalie releases Ramola’s arm, pats her belly, and exhales deeply again.

  Dr. Bilezerian swabs Natalie’s shoulder with an alcohol wipe and holds up a second needle. “Next is a shot of vaccine. This won’t hurt as badly. I promise. It feels more like a flu shot.”

  “Ooh, those are my favorite.” Natalie half laughs and half cries, and her mischievous smile remains. Natalie already appears less vacant, less hopeless. Ramola has never felt more proud of her friend, or more bone-crushingly sad for her.

  “Right? You could do this all day,” the doctor says as she injects the vaccine. “And we’re done.”

  Ramola swaps spots with Laurie and sets to affixing the pad and wrapping Natalie’s forearm with more gauze. She considers asking the doctor what the efficacy of this treatment has been during the outbreak. Have they had many or any successes in preventing exposed patients from succumbing to the viral infection? She doesn’t want to ask in front of Natalie, not yet anyway. Ramola has always believed physicians should be forthright in sharing information with the patient, or in the case of her charges, their parents, no matter how dire the prognosis or uncomfortable the conversation. As Ramola’s sinking, hopeless feeling can be measured in fathoms, perhaps it’s not Natalie she’s protecting from hearing potentially devastating news.

  Dr. Bilezerian removes her gloves, picks up a two-way radio, and asks for an available orderly to bring a wheelchair.

  Natalie says, “I don’t need that. I can walk.”

  “I think you’ve walked enough. You need to rest, get some fluids, and think healthy thoughts.” She hands Natalie a piece of paper. “This lists rare but potential side effects you might experience. It’s marked with the date and time, and that barcode sticker corresponds to both the globulin and vaccine you received. You’ll be given a bracelet inside, too, with the same information but you definitely should hold on to this as a backup. I’m sure you noticed things are a little hectic out there. If all goes well, which I’m confident it will”—at this her voice increases in volume, she turns to look at both Natalie and Ramola, and she places a hand on Natalie’s shoulder; with the mask covering all but her eyes, it’s impossible to tell if she’s smiling or frowning or any one of a thousand complicated expressions in between—“you’ll be back here or be assigned to go to another treatment center for the follow-up vaccine booster in three days. You cannot get one before then, okay? Getting the second shot too soon will compromise the immune response. Now, you may need that paper to ensure you get the second shot. They’ll explain this process to you again inside. Do you understand? Good. And while we wait I need to take down some information as well.”

  Natalie gives her name, address, date of birth, cell phone number. When asked for an emergency contact she says, “I don’t—my husband, Paul, was killed. He died less than an hour ago.”

  The doctor pauses typing on her medical tablet computer. “Oh my God, I’m so sorry.”

  Natalie shakes her head, silently saying no to everything. She points at Ramola and sputters through a flash flood of tears. “She’s my emergency contact.”

  Dr. Bilezerian asks what their relationship is.

  “Friend,” Natalie says.

  As Ramola digs through her overnight bag, hunting for her yellow zip-up hooded sweatshirt, she recites her cell phone number.

  “Is there anyone else you’d like to list as an emergency contact? Any immediate family or—” Dr. Bilezerian peters out as though coming to the too-late realization that there is no
good or happy answer to her queries.

  Natalie shivers and gingerly flexes her left arm. “I don’t know if any of this, any of what we’re doing, even matters. I’ll pretend it does.”

  Ramola says, “It very much matters, and we’re going to keep you healthy. And the baby, of course.” She stumbles over herself to include the nameless child.

  Natalie says, “I’ll add my parents as contacts. They are in Florida. They sit in their condo all day and watch Fox News and complain about the humidity when they’re not arguing or forgetting to eat.”

  Dr. Bilezerian asks for their names and information and Natalie obliges.

  Ramola drapes the sweatshirt across Natalie’s back and over her shoulders. “You can take that damp jumper off once we’re inside.”

  Natalie says, “I don’t think I can squeeze into this.”

  “It’s surprisingly roomy. I swim in it.”

  “Yellow, huh?” Natalie laughs.

  “Well, it’s my—”

  “I know yellow is your favorite, but this is really fucking yellow. If I zipped this up I’d look like a pregnant banana.”

  “Only if you wore matching bottoms. I’d say you look more like a lemon.”

  “Don’t argue with the pregnant banana.”

  An orderly appears in the cubicle with the wheelchair, and without missing a beat, says, “I’m here to help a, um, pregnant banana get in out of the cold.”

  Natalie says, “All right, I’m the only one who can call me that.” She slides off the table and settles into the chair.

  Dr. Bilezerian helps Natalie put on a white respirator mask, explaining that exposed patients are wearing them out of an abundance of caution. She reminds Ramola where the Command Center is, instructs the orderly to take good care of her patient. She says, “Goodbye, Natalie,” and wades back into the tent’s bustling concourse.

  The orderly says, “It’s ugly out here. Think they’ll let me stay inside with you ladies?”

  As they wheel Natalie from the screening area Ramola notices the middle-aged man in the cubicle across from them is gone and has been replaced by an older one, pointing at the back of his hand. She overhears the doctor—who un-gloves and crosses his arms—saying, “I don’t see any broken skin. I know—but you’re the one who told me she’s an indoor cat. . . .”