The Care of Strangers
Copyright © Ellen Michaelson, 2020
All rights reserved
First Melville House Printing: November 2020
Melville House Publishing
46 John Street and
Brooklyn, NY 11201
and
Suite 2000
16/18 Woodford Rd.
London E7 0HA
mhpbooks.com
@melvillehouse
ISBN 9781612198682
Ebook ISBN 9781612198699
Library of Congress Control Number: 2020943551
Book design by Beste M. Doğan, adapted for ebook
A catalog record for this book is available from the Library of Congress
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This story is dedicated to the patients of Kings County Hospital whose worldly wiles and audaciousness in the face of illness, poverty, and racism inspired me with their humanity and shaped me as a young doctor and still to this day.
“A novel is not a summary of its plot but a collection of instances, of luminous specific details that take us in the direction of the unsaid and the unseen.”
—CHARLES BAXTER, THE ART OF SUBTEXT
Contents
Cover
Title Page
Copyright
Dedication
Epigraph
Part One
1. Four Fs
2. Prosta
3. Prison Ward
4. Hair
5. Tea for Two
6. Fever Workup
7. Identity Displacement Syndrome
8. This and That
9. Post-Call Positive
Part Two
10. Train Wrecks
11. Brooklyn–Battery Tunnel
12. Death Note
13. No Mangoes for Mindy
14. Visiting Hours
15. Family Photos
16. Four H
Part Three
17. Finding the Pain
18. Case Review
19. Hurry Up and Wait
20. Heart Valve
21. Gurney Ride
22. Bridges
23. Museum Beads
Acknowledgments
About the Author
Part One
1
Four Fs
Sima pushed a large woman in a wheelchair to the A71 Nurses’ Station to catch a bit of breeze. The blackened steel fan was as tall as Sima and stood to the left of a double-wide doorway like an armless guard, stiff and steadfast, the whir and whoosh of its blades a metronome for breathing. Sima lifted her curls to cool the sweat on her neck while she scanned the open ward: beds down one side and up the other, heads to the wall, dark ankles, only a few of them sheet-covered, stuck into the middle of the room, bed after bed, twenty of them. The draft was a relief from the heat but it couldn’t clear the smell of roach killer. Smrod her mother called it whenever the exterminator made rounds in their building. The reek of smierdzacy foot odor and siki. Sima preferred the sound of the words for “stink” and “stinky” and “piss” in Polish. She breathed through her mouth.
From behind the Nurses’ Station, Nurse Armstrong snapped her fingers. “Stop your daydreaming, young lady.”
Sima pulled the chart from the pocket at the back of the wheelchair.
“Bed’s ready. On the right, two down from the window.”
“Do patients ever ask to be by the window?” “Window” was barely out of Sima’s mouth before she realized—what a ridiculous question. Look out the window at what? Beer cans and McDonald’s wrappers dug out of trash cans by the bums on Nostrand Avenue in the middle of Brooklyn? “Never mind,” she said before Nurse Armstrong had a chance to respond.
She maneuvered her charge through the crowded, smierdzacy ward. And then the woman in the wheelchair farted. Female, fat, fertile, flatulent. The four Fs of gallbladder disease—Sima could recite them, as she’d heard the medical students do. It had been nearly three years since Chief Resident Danielson invited Sima to join them on rounds after Nurse Armstrong discovered her asleep in the House Staff Library with an anatomy book. Sima had started working double shifts so she could take college courses during the day. She stopped the wheelchair alongside the only empty bed on the ward.
Bella, a nurse’s aide, was bent over the bed, folding hospital corners. “Where you been?” A packet of Pall Malls bulged from the pocket of her blue hospital-issue short-sleeved shirt. “I ain’t got all night.”
“I’m right here,” Sima said. She set the squeaky brakes on the wheelchair.
She looked up to see Bella tapping the floor with one foot, staring at her, the same way she’d done on Sima’s first day at the County. She hadn’t known what to say back then. You’re an expendable nobody, same as me—that’s what she would tell her now, if she had the nerve. Bella knew how to push the weight of her years around. Same as everybody trying to be somebody at the County—the sprawl of twenty-six red brick buildings connected by a tunnel in East Flatbush. That first day Sima walked outside to go for lunch. A-building Medicine, seven stories high, hovered over the entrance of the campus. The windowed bars of the Prison Ward on A32 faced the entrance to the C-building ER, where ambulances drove in. Sima made her way past the defunct hospital sanatorium for tuberculosis, then crossed the driveway to R-building Psych, only two stories with bars on the second-floor windows where they once held the Son of Sam, to the squat cafeteria with its screechy, wooden screen doors. R-building to C-building to A-building: head nurses ordered around floor nurses, and floor nurses unloaded their dirty work on nurses’ aides like Bella. And because she didn’t have to run all over the hospital between buildings the way orderlies like Sima had to, the high and mighty Bella dumped on Sima whenever she could.
Bullied growing up in Poland on her walk to elementary school by children of anti-Semitic Catholics and communists, Sima didn’t care to push anyone around. Even after four years at the County, and never fitting in. The only white girl orderly. She didn’t dance to reggae or calypso like the nurses and aides from Jamaica and Trinidad and Tobago. She’d been invited to join them at the end of Saturday night shifts, but the one time she went, she left after an hour. Her Polish-speaking mother would worry. Nights Sima waited for Mama to fall asleep in the living room to crackly recordings of dead Yiddish singers so that she could retreat to her bedroom to study without scrutiny.
Sima watched as Bella finished with the bedsheets. She waited as her patient sat forward in her seat. What an effort it was for the hefty woman to lift herself out of the wheelchair and onto the bed. Even with two hospital gowns tied together, she exposed a belly covered with stretch marks.
Sima stared at the half-moon scar in Miss Osborn’s right upper quadrant. “Right upper quadrant”—the medical term for the right side of the abdomen under the rib cage where the liver and gallbladder sit, RUQ. She’d taken Anatomy I and Anatomy II on top of all the pre-med courses Chief Danielson suggested. He made it no secret he would write her a letter of recommendation if she kept her grade point average up. She rarely got less than an A-minus. The scar in the RUQ meant the patient had already had her gallbladder removed. Something else was wrong.
Once situated on the bed, Miss Osborn lifted her tied-together gowns to air her cornstarch-dusted breasts.
Bella coughed. “You eating all that cornstarch?”
From behind Bella, a tiny voice creaked from the next bed over. “Beer and pork rinds. That’s what her kind e
ats.”
Sima smiled. She didn’t have to see Alma Mae to recognize the words of the eighty-five-pound asthmatic, Miss Osborn’s body opposite, one gown wrapped around her twice and tied in the middle. Repeat patients admitted for days or weeks were treated like royalty. Especially ones who spoke their minds to nurses and aides and sometimes even to the doctors. Alma Mae was in and out of the hospital with asthma every few months. She was tiny but had an opinion about everything and everybody. That cruel comment on Miss Osborn’s diet aside, Sima looked forward to hearing what Alma Mae had to say.
Bella elbowed Sima. “Intern wrote orders in the ER to get three stool samples from this one. And you, missy, is going to help me lift old fart face here.”
Miss Osborn closed her eyes and sighed the way she had in the elevator.
Alma Mae piped in, “Person stinks of smokes like you ought to know when to keep her mouth shut.”
“Sorry,” Bella said.
Miss Osborn opened her eyes and looked down at the bedsheets. She didn’t say a word.
Sima knew Bella was not sorry, but that piece of knowledge would get her nowhere.
Alma Mae tugged the gray-white ends of her hair into the air. “Leastwise, I got something the doctors know how to treat.” Sima pushed her up from the ER every two months it seemed, wheezing and talking and coughing, like she was doing now.
Alma Mae coughed and wheezed again. She couldn’t seem to catch her breath.
Bella lifted the oxygen tubing off her pillow. Alma Mae flapped her arms.
“I want Sima,” she said. “She’s got bedside manner. And she reads anatomy books.”
Bella dropped the tubing around the old lady’s neck. “We all know how smart Sima is.” She smirked and stood back from the bed. “She’s all yours, Dr. Sima.”
Alma Mae winked. “Sima reads more than books, which is more than I can say for some.”
Sima untangled the snake of tubing behind Alma Mae’s head. She hid her face behind it so she wouldn’t have to respond to Bella’s smirk or Alma Mae’s wink.
Through the curves of thick plastic, she scanned the ward again. All the beds laid out, a respirator bleeping across the aisle, an IV bag dripping yellow vitamins into Johnson, the alcoholic two beds down, admitted for the second time that summer, the food cart in the middle of the room with half-eaten piles of mashed potatoes and the same brown mystery meat they served in the cafeteria. Nurse Armstrong was making her vital-sign rounds now, demanding patients open their mouths for her thermometer.
Sima placed the oxygen prongs into Alma Mae’s nostrils and secured the tubing behind her wrinkled ears. The skin of Alma Mae’s neck was as sweaty as Sima’s own. A hospital with no air conditioning. Twenty beds to a ward. She’d read it wasn’t legal to have huge, open wards anymore, even in inner-city hospitals in the 1980s. Sima often hated this place—the disrespectful patients, the staff talking behind the doctors’ backs, the level of illness that was everyday business, the shabby street clothes bagged until discharge. Alma had no teeth. And then every other double shift, Sima loved it.
It was life, right-in-your-face life, every ugly and beautiful fragmented bit of it. New York, New York, where people came from every corner of the world. She loved trying to make sense of it. She hated it. She loved it. Deep in the center of Flatbush, the only white member of the ancillary staff. An invisible immigrant. Hardly anyone noticed her slight accent. Her grammar was good enough to pass as American. She was an American.
“Sima,” Bella said. “Get your skinny white ass over here.”
Sima scurried to the foot of Miss Osborn’s bed. She patted the sheet over the woman’s feet, and as she moved closer, the smrod hit. The woman was sitting in a pool of brown, her face covered by her hands.
“It’s OK, Miss Osborn,” Sima said.
The ward clerk shouted into the room. “Sima, they want you in X-ray.”
“Missy, you ain’t going nowhere,” Bella said.
“Sima’s an orderly,” Alma Mae piped up. “Call one of them housekeeping folk.”
Sima pulled her shoulders back. Alma Mae smiled at her, motioned her toward the door.
She was about to walk away when two interns appeared, stethoscopes flung around their necks. The male, in short sleeves with a royal blue tie, was barking orders at the female, the pockets of her short white intern jacket stuffed with test tubes, rubber gloves, and note cards.
“Sima, they need you now,” the ward clerk said. “Oh, my Lord, this ward stinks.” She stepped toward Miss Osborn’s bed and pointed to the brown mess on the floor. And suddenly, the male intern was at the bedside with sterile containers ready to catch his stool samples.
Miss Osborn, now the center of attention, peeked through her fingers at the handsome, eager intern scrambling to remove a red lid on each of his three containers. Bella was on one side of the bed and Sima, still on the other, placed a hand on Miss Osborn’s elbow, her skin hot from fever but dry and velvety, the bone a small knob. Sima could only imagine what it was like to lie in a bed with a swarm of nurses and aides and orderlies constantly prodding, doctors young enough to be your own children focused on your oozing stool. She could feel Miss Osborn’s arm shake, her whole body.
“It’s OK, Miss Osborn,” Sima said. “Everything’s going to be all right.”
Sima didn’t know everything was going to be all right. She’d seen how doctors could so easily take hope away. If she’d learned nothing else at the County, she’d come to know that the one thing patients wanted to hold onto was hope. She wasn’t sure how much she had for herself in this life, if she’d ever do more than push poor people through the dark hospital hallways on their next desperate trudge. But maybe hope was something.
2
Prosta
Sima set her registration form in front of the clerk at Brooklyn College. The woman raised her right arm, a run of silvery bangles sliding against her white skin, not a hint of tan even though it was still summer. She removed a red pencil from behind her ear. She flicked it between her thumb and forefinger, bangles clanking with each flip of her wrist. PJ Brown, Brooklyn College: her ID didn’t identify what she got paid to do.
Sima imagined PJ on the R train, strong-handing a pole by the door so she’d be the first one out at her stop. Big-haired, Brooklyn-born, brassy, New York, New York, from head to toe. Long, shiny fingernails painted twice as red as her day-job pencil. She could see her sauntering out of a bar in spiked heels laughing with loud girlfriends when Sima’d be heading home in sweaty scrubs and sneakers after a night shift. She couldn’t picture for herself the kind of American life she conjured for PJ. The woman was no college grad. She boasted to everyone she’d worked the registration desk since the week after she’d given birth. She didn’t wear a ring.
But for almost two years now, alongside the official Brooklyn College stamp PJ used on all forms, she kept a photograph: her daughter in cap and gown.
“You see my Sara?” PJ said.
“Of course.” Sima needed only one course to graduate. She dreaded seeing the smiling Sara, hugging her diploma.
PJ waved the photograph. “This will be you soon. Make your mother proud.”
Sima’s mother was prosta—simple. “Simple people aren’t proud,” her mother told her in Polish. Sima should be content, a Jew safe in America. How many times had Sima heard this. Her mother with a sixth-grade education only wished her daughter to have “a more better job.” Her widowed, single mother didn’t want to know her only living child needed to be somebody. She didn’t know Sima could soon be a college graduate. Sima was afraid to tell her.
Sima erased English composition from her registration form. But then she didn’t put the pencil down. She wrote the course in again. She was not prosta. She erased it, she wrote it in.
Tap, tap, tap. PJ rapped on the counter.
“Time’s up, dear.” PJ took possession.
“Deadline was five minutes ago.”
Sima watched as PJ placed a firm red check mark in the right upper corner of her form, raised the official Brooklyn College stamp, and pressed it hard over the mark.
“You can change your mind,” PJ said. “Drop a course, add another. It doesn’t matter.” She tossed the form into a box.
Bangles clanked, the window closed.
Sima couldn’t remember which courses she’d finally listed, or how many.
The clock overhead said 2:35 p.m.
Only twenty-five minutes until her next shift. She ran down the stairs, out to the Flatbush Avenue subway entrance on Nostrand. Four stops to the County. Four years as an orderly. Four years, four stops. Must be something special about that number. She lived with her mother on the fourth floor in their building. Her mother survived the Holocaust and she wanted four children. She had two miscarriages after the war—four years before Sima was born and four years after. Her mother waited another year, until Sima was five, to have her brother. If her brother had lived, and her father too, they would have been four: Sima, her brother, her father, her mother.
3
Prison Ward
The door to the Prison Ward slammed behind her and she was in a cage without windows. No telephone on the wall, no doorknobs, no way in, no way out. She felt small, an expendable nobody, foreign born, not a gentile. Sima braced herself the moment the second rusty metal door closed her in, before the third one opened and shut, and she was as deep as anyone could be, locked inside the County.
There was a knuckle-shaped dent in the middle of the third door. Above the dent was a small window at the level of her chin. A broad-chested guard with a gun in a holster sat high up behind the window. Black-bean eyes and a tip of pink tongue stuck out between dark lips. His fingers gripped the silvery neck of a microphone.
“Hospital ID,” he said.
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