Phase Six

by Jim Shepard

  She’d always been one of those girls good at finding her own space and even better at doing what she wanted to do. In grammar school she’d been such a wool-gatherer that her teachers had decided it was never a good idea to send her on anything more than a two-step errand, and she’d spent a lot of her recess time reading, inside or out. Her hand was up so often in class that she supported one arm with the other, and by eighth grade it had gotten so bad that when she raised a hand her classmates lowered their foreheads to their desks.

  She’d preferred neatness and order and girls at her table who didn’t scream, and had been the school science whiz, an interest that when people asked she traced back to a homemade diorama of a Precambrian landscape that her father had found her in a junk shop. He had died when she was in ninth grade and she’d taken her biology final three days after the funeral and had gotten the highest grade in the class. Her mother had taken her father’s death even harder than Val or her sister had, and while she had stayed funny and loving she had developed a smile like a shut door. They’d spent a lot of time afterward at her rich grandmother’s house, which was so high on a hill they could watch storms passing by way off in the distance and never hear them, and there Val developed the kind of self-sufficiency that anyone left alone for long stretches in a big house would.

  She’d become such a grind that all of those ordinary workaholics who passed up their one Sunday morning home with their kids to work out at the gym or take their weekly bike ride around Rochester had teased her about the way she was always looking to organize her dead time. When her current boyfriend had first informed her that he loved her, he’d registered her response and then had laughed and said, “Don’t take it so hard.” She’d always settled on guys like him, except for one night in med school when she’d off-roaded with a woman from her hematology class who’d stopped by for some notes and on her way out had taken Val’s earlobe in her fingers and drawn her into a kiss. Val’s current boyfriend told everyone who would listen that he’d immediately known he was crazy about her, and she always responded in those situations that she’d immediately known that she was fine with that. During her internship she’d hung around with a gaggle of wiseasses, especially one woman in pediatric oncology and another in gynecology who said she’d been pregnant during her residency and that the first noise her baby had recognized was the sound of her pager. So when Val’s sister half-ironically texted things like I feel like you’re so distant from me, Val texted back responses like Who is this?

  Incoming

  At the handover both shifts gathered with their coffees and whoever was senior gave the rundown on each patient, spending a little more time on the new arrivals, and, if there were no other questions, at some point checked his or her watch and told everyone to get moving. On Val’s way out of the meeting a nurse found her and told her that EMS had called into Emergency an hour ago with some incoming: two boys, nineteen and twenty, one six feet 160, another six-two 184, both with high fevers, both with severe respiratory distress, and those boys were being moved to ICU. They’d been stabilized and a few things had been eliminated but no one was sure about the diagnosis. Whatever it was could be viral or bacterial or some kind of toxin but all the tests weren’t back yet. And then bam the fire doors opened and the two rolling stretchers came rattling through, nurses scattering out of their way, and the ER resident caught Val up on everything that had been worked up so far and what they were still waiting on. At one point it sounded like he was seeing if he could speak only in abbreviations. The boys were Kenny Lee and Aaron Friedman and they’d been found in Aaron’s parents’ basement. One set of parents was here and the other was on the way. They hadn’t found a wallet on Aaron but they had found a student meal card in his iPhone sleeve.

  The nurses supervised the transfer to the beds and then ran lines and started up the monitors. Val checked Aaron’s pulse, which panicked her a little, and even after the intubation he was breathing like he had a plastic bag over his head. Their temperatures came in at 104 and 104.5. Their lips were blue and their blood oxygen levels life-threateningly low, and the ABGs confirmed the oximeters. There was weird white stuff around the endotracheal tubes. The boys were further sedated and hooked to ventilators and rolled into prone positions, and the folders from Radiology that arrived displayed a rain forest of infiltrates in their lungs. Val’s interns stood around looking baffled. They were on their two-week ICU rotation and had feared weird dire shit just like this. Val and the senior resident and the attending physician on call had just started talking about diuretics to deal with some of the fluid when first Aaron and then Kenny crashed. People went running to one bed and then when the alarms went off had to go running to the other. Everyone pitched in when it came to resuscitation, and Val was vaguely aware of frantic parents being herded away, and no one wanted to call it for either boy, but they tried everything, and nothing worked, and finally the senior resident who’d been running the code called it for Aaron and then moved over to help out at the other bed for a few more minutes before the attending called it for Kenny. After all the noise, there was a sudden relative quiet, and everyone stood around both beds and the chaos of the room and the tangle of the equipment, looking at one another in shock.

  “Have we ever lost two people within a few minutes of one another before?” one of Val’s internists, Ronnie, a string bean from Oklahoma, asked. One of the monitors kept beeping until someone shut it off, and nobody answered him.

  The Family Room

  Val dealt with Aaron’s parents and the senior resident dealt with Kenny’s. Val didn’t do this very often, but when she had to, sometimes she took the loved ones into the Family Room and sometimes into her office. In this case the Family Room was closer, and the longer walk down the hallway before they heard the news seemed too sadistic.

  She’d always been told that she needed to work on her bedside manner, but even having reminded herself, she couldn’t stop wincing when she gave the parents the news. They had to be told twice. The mother, when she heard, stalled, like she’d been unplugged by the shock. The father turned and started walking along two walls of the room before ending up back in front of Val again. They demanded to know what had happened, and Val repeated to them that at this point what had killed Aaron wasn’t clear, and the doctors were trying their best to figure that out, though they had ruled out some things. The father asked if it had been some new strain of coronavirus and Val said she didn’t think so. The mother started keening and her husband pitched over to her and they grabbed each other in an end-of-the-world embrace.

  Val gave them some time to themselves and washed her face and got some coffee. Then the mother came and found her and said she wanted to see the body. When they got to the room, the nurse who had just removed the tubes and lines slipped out. The mother put her mouth down by her boy’s ear and told him that she was here with him, that he’d be okay, that she wasn’t going anywhere. The father stood behind her. Val half turned away, moved, and was never clear on what to do with herself in such situations. The mother hung on to the bed rail and asked for a chair, and Val pulled one over for her and she sat, with a look on her face like she might recede to the end of the earth.

  They all listened to the carts rolling back and forth down the hall. A distant wailing started that was probably the other mother. The father asked about Andrew and Abraham, and Val watched the mother realize that they still hadn’t told Aaron’s brothers, who turned out to be waiting in the lobby with a woman Val assumed was an aunt. The whole group gathered again in the Family Room, the youngest brother clearly already frightened by what he’d heard happening around the ward. The parents looked to Val to do the talking, and before she finished, the aunt cried out and the youngest brother stood up and walked out into the hall in a version of his father’s response. The older brother put his hands on his ears with his elbows out like he was trying to muffle something deafening. Val gave them more time alone, and che
cked in with the attending, and then came back and stayed with them in a way that she hoped was supportive but unobtrusive, unpleasantly aware that she was about to add to their pain with questions.

  The mother did most of the answering. It turned out that the boys had come back from their travels with the flu, and had planned to take it easy, but they’d gotten worse and worse and she’d found them both in front of the TV and called an ambulance. Where had they been? Prague, and Vienna, and maybe somewhere else; they’d talked about some side trips. She could check. Her husband handed her a Kleenex. And Val noticed that the mother’s nose wasn’t just running from her tears. Whatever he had, he gave it to us, the mother told her, making a face and pointing at the older brother.

  Next Up

  The head critical care nurse informed her that Emergency had sent over another boy presenting with all the same symptoms, and though she was one of those nurses who was always putting her fists on her hips and acting like she alone was going to be able to handle whatever was hitting the fan, she looked as alarmed as Val at the news. Down the hall through the windows in the fire doors they could see a distraught man and woman flanking the reception desk. The nurse headed over to them to see what she could find out and Val took a breath and stuck her head into the room that was already a traffic jam of carts and people.

  The new arrival turned out to be also nineteen, also tall, also in bad shape, and named Barry, and one internist asked him, “How’re we doing, Barry?” though Barry was clearly in no shape to answer, and when the other internist hooking up the ventilator said about the white stuff surrounding the intubation “It’s sticky,” both internists looked to Val as the resident, and Val shrugged.

  “Have you ever seen that before?” Ronnie asked.

  “Not before today,” Val told him.

  Ronnie washed off his gloved hands like they were radioactive. This kid’s numbers were a little better than the others’ had been, and he seemed to be breathing a little more regularly, but given what had just happened the attending was going over him from head to toe, so Val backed off and figured she’d go do what she could for the parents.

  They saw her coming through the double doors and took each other’s hands. She tried to be lucid and to the point without being brutal: their son’s condition was very serious, it wasn’t clear what was causing it, and Val and her colleagues were doing all that they could. The mother looked at her like Val had kicked her in the face. She said that her Barry was a rare blood type; did they know that? Val thanked her for the information and asked if Barry was friends with a boy named Aaron Friedman or Kenny Lee, and the mother’s face changed and she said yes, why? Barry had just seen those boys a few days ago.

  By the time Val got back to Barry’s room, the attending wasn’t liking the way the boy’s numbers were trending, and when she told him what she’d just heard, he said they had better call the infectious disease attending, and then asked if they even had an infectious disease attending. The one they’d had had taken a job elsewhere, and the attending hadn’t heard whether he’d been replaced. They asked around, and the head critical care nurse said that the university had an infectious disease attending, and they made some calls and eventually heard that the guy had been pulled off the golf course and was on his way.

  In the meantime he had told them that they should initiate the hospital’s infectious disease protocols, and it turned out that there were three different sets that didn’t completely agree. After some squabbling over that, the attending finally said, “C’mon, people, let’s do what we can do, you know the drill,” and everyone tied on masks and donned goggles and signs were made and hung outside Barry’s room. Those who’d been in the room changed gloves and gowns.

  With all that done, there was just the beeping of the monitors. The head critical care nurse said, “Do you think we need to think about a quarantine?” and the attending said that he’d just been considering that step, and then said that certainly anybody who’d been working with Barry shouldn’t go anywhere. And one of the interns said, “What about his family?” And Val said, “What about everyone who worked on Aaron Friedman and Kenny Lee?”

  Neither question seemed to be a popular one. Nurses fanned out in various directions, maybe looking for something that might be useful in a situation like this.

  Val spotted a kid standing on tiptoe to see through one of the windows on the fire doors, just a pair of eyes and some messy hair, and said that for the time being they’d also better stop anyone from coming or going from the lobby as well, and the attending agreed, so Val picked up the phone at the nurses’ station and told the front desk. The kid’s eyes disappeared from the window.

  She headed over to the window and looked through. Barry’s mother was in a chair by the potted plant near the front doors, staring at her hands like they held the solution to her son’s situation. Her husband had his hands in his pockets, and Val watched them both recognize Aaron’s parents, still wrecked, who drifted over to them and hugged them. Barry’s mother said something and then Aaron’s mother said something back, and Barry’s mother put her hand over her mouth.

  The attending asked if anyone had an updated ETA on the infectious disease guy’s arrival and a nurse said that he’d texted from the highway and by now he was probably only twenty minutes out. People were looking at their phones, and one of Val’s interns kept asking if anyone had a signal. Outside, a thunderstorm had hit, and with every lightning flash in the darkness, it looked like the parking lot with its berms and trees reappeared and then vanished.

  Val had two texts on her phone, one a GIF from her sister and one in which her mother complained that if she was catching another cold she was going to kill herself. She texted both of them, Another slow day in the ICU, and texted her boyfriend, Might be stuck here a while after my shift, and then ignored his immediate What’s going on?

  A half hour after that, the infectious disease guy still hadn’t arrived and Barry crashed, and they couldn’t save him. Coming out of Barry’s room, the attending didn’t look overwhelmed, but he didn’t look composed, either, and given that he was usually all about calm, whenever he seemed anything else everyone tended to get petrified. He maintained a we-got-this expression on his face that even in its inauthenticity was probably more persuasive than Val’s. The infectious disease attending strode in and said, “Where’s the patient?,” and then saw everybody’s faces and immediately sobered up. He spent some time in Barry’s room, and when he came out he conferred with Val and the attending, and then examined Aaron and Kenny. When he finished that, he started making calls.

  “Any ideas?” the attending asked, and the infectious disease guy, holding the phone, said, “Not yet,” and then changed his voice when he got through to whoever he was calling, and gave a rundown of what might be going on, including a potential need to initiate a lockdown on the ICU.

  One of the interns still didn’t believe what was possibly unfolding. Val could see it in her eyes: it was like when you passed a highway accident and then spotted all of those oncoming cars still heading toward it, unaware.

  The thunderstorm, meanwhile, was still going. Val found her snack in the fridge and slid her mask off and sat for a minute, eating pita wedges and celery from a baggie, and tried to get ahold of herself.

  Her courage was starting to feel slippery, like something she needed to pin down, and between deep breaths it felt like she’d startled an animal in her rib cage. She told herself with impatience that it was time to be what she’d been pretending to be, and she slid her mask back on and stood up to get back into the game.

  The infectious disease guy was asking for a list of anyone who’d had any contact at all with any of the three boys, or who’d had contact with someone who’d had contact with them, and Val’s intern from Oklahoma said, “Well, that’s pretty much everybody,” and Val smiled at him, like, Well, you’ve got us there. And then to get
herself going, she poked her head into one of the other rooms, where a forgotten patient sat wet-eyed and silent, and she asked if he was all right, and then when he didn’t answer she told him to sit tight, that someone else would be by before too long.

  IV

  The Wolf Keeps the Caribou Strong

  At Danice’s shriek the kid bolted, and Jeannine and Danice just stood there, staring, but Olsen took off after him. He slipped on the plastic bag the kid had dropped in the doorway and did what looked like a painful split, but by the time Jeannine and Danice got themselves outside he was just a few feet behind the kid, and at a turn near a little bridge over a brook he took him down. A few dogs still chained nearby scattered and barked.

  The kid fought and kicked and Olsen’s eyewear and mask were knocked askew but he righted them and then heaved himself on top of the kid’s legs and back and pinned him into some spongy grasses and thistle. The dogs yelped and gyrated on their chains and one broke free and charged at them and then dodged away.

  The plastic bag had some cheese and an egg in it. Jeannine held it open for Danice and then they both hustled over to Olsen and the kid. Olsen was talking to him in Danish and the kid had stopped struggling. He lay there, quiet, and they all waited until he finally answered, and when he was finished talking, Olsen reported that his name was Aleq, and that he didn’t think he was sick, and that he also didn’t think that anyone else was still alive.