The Care of Strangers

by Ellen Michaelson

  The girl was Dr. Kahn’s first admission for the night, and Sima’s first transport. Together they waited until the girl got a shot of Demerol and the nurses made it clear it was time to move her out. Dr. Kahn studied the chart. Sima pushed the gurney to the elevator. The girl’s pisk did not let up.

  Mr. Biggs, the night shift elevator man, held his door open until the gurney was in, Sima and Dr. Kahn squeezed alongside it. He tapped his foot to the sound of the girl’s screams the way he did when he wasn’t busy, listening to jazz from the boom box he kept under his chair. The girl raised her refrain an octave higher. Mr. Biggs kept tapping until the girl began to wave her arms and socked him with her IV pole.

  “Hey, young lady,” he said to the girl. He moved the IV arm back onto the gurney. The girl pulled against his grip. She opened her mouth wide like a baby crow, and out came an even louder cry. “Nurses forgot to restrain this one.”

  “Sima can hold her arm,” Dr. Kahn said.

  Newbie intern, Mr. Biggs mouthed silently. Sima nodded.

  “You the doctor.” He shook his bald head. “You be the one have to put in a new IV when she yanks this one out.” He rearranged the gold earring in his left ear and straightened the shiny chain around his neck. He reached for his boom box. “Maybe some tunes will help.”

  Sima placed a hold on the girl’s forearm. Her wrist was so skinny she could reach around it entirely. The ER should have sent her to Pediatrics but there were no beds. Busy, busy night, and it was barely dinnertime.

  Dr. Kahn stepped off the elevator first. Sima backed the gurney out and pushed it down the long hallway behind her. The girl had quieted. But as soon as they stopped at the Nurses’ Station, she began screaming again.

  The night nurse lifted her clipboard. “Five IVs out,” her musky voice boomed over the girl’s. “Bed nine, bed six, bed five. And eight and twelve from before.”

  Bad luck for the intern on call. There wasn’t enough staff to keep an eye on every patient’s arm. Replacing the IVs alone threatened to take up half of Dr. Kahn’s night since there was no IV team at the County, just as there was no blood drawing team. Sima had heard the medical interns snicker at Dr. Kahn’s talent for inserting lines, far below a passable flair for tough sticks. She wished she had this skill so she could help Dr. Kahn.

  “And bed eleven, your favorite, Miss Osborn. IV is ok but her temp’s 103. Still.”

  “Miss Osborn’s back?” Sima said.

  “Yes, ma’am.” The night nurse squinted over her spectacles.

  “Put the screamer next to the respirator.”

  Dr. Kahn had so many things to do. Sima could feel her hold on the side rails of the gurney as if a tight grasp would make the night move faster as they pushed to the empty bed alongside the noisy respirator with its bellows bellowing, past Alma Mae, who was also back again, and Miss Osborn. Together they lifted the girl off the gurney onto the bed. Her hospital gown slipped off her shoulders, over her clavicles, down her chest, exposing barely budding breasts. Sima resettled the gown over the girl’s torso and retied it around her neck. The girl began to squirm in the bed. She waved her IV arm in the air.

  “You don’t want to lose her IV, too,” Sima said.

  Dr. Kahn plugged into her stethoscope.

  “I want my mamma!” The pisk of a six-year-old.

  Sima got hold of the IV arm. The girl lay still a moment. Then she flailed the other arm.

  “She needs Demerol.” Sima pointed to the foot of the bed. “The nurse left a restraint.”

  Dr. Kahn cinched the ragged piece of white sheet around the girl’s wrist. She screamed louder. Dr. Kahn leaned in with her stethoscope, a futile exercise. She stopped making noise long enough to lunge forward and close her teeth on the psych intern’s thumb.

  “Damn it,” Dr. Kahn said. The girl wouldn’t let go.

  Sima placed both hands firmly on the girl’s chin and pried her jaw open.

  The night nurse appeared at the foot of the bed, a chart in one hand and a syringe in the other. “I need an order for that restraint.” She glanced at Dr. Kahn grasping her thumb. “And for the Demerol fifty, with twenty-five of Vistaril.”

  The nurse lifted the hospital gown, cooed to the girl, and jabbed her in the buttocks. The girl’s eyes were wide, wet with tears. With her hands tied, she couldn’t wipe them. She rolled to her side and settled in, a veteran. Her legs were splayed as though she were running in place. One of her tied arms trailed behind her.

  Sima pulled the gown over the girl’s exposed skin. She unfolded the light summer blanket at the foot of the bed and spread it over the sick child.

  “You’ll need a shot of Keflex for that thumb,” the night nurse said. She unwrapped a gauze pad and handed it to Dr. Kahn. “Not every night a nurse gets to jab an intern.” She chuckled and placed the open chart on the corner of the bed. “Don’t forget to sign the order for the restraint and the Demerol, doctor. And for the antibiotic. I’ll have it for you up front.”

  Sima stood at the head of the bed. Dr. Kahn leaned against the wall to one side, cradling her injured thumb. They watched the girl breathe, eyes closed, her skinny limbs askew under the blanket, one dark foot uncovered.

  “Have you noticed how little hair black people have on their bodies?” Sima said.

  “Koreans have even less.” Dr. Kahn snugged the gauze on her thumb. “I’m doing my own study. Men and hair: where they have it and where they don’t.”

  “Yeah?” Sima grinned.

  “Now that I’m in New York, I get to go out with lots of different ethnic types.”

  “You have time to date?”

  “Not really,” Dr. Kahn said. “But I met a Korean guy this summer. He had the thickest hair on his head but hardly any on his legs. Or anywhere else for that matter.”

  Classmates at Brooklyn College joked about how hairy Jewish men were. Sima didn’t date. Her father had hairy knuckles but she couldn’t recall much more about his looks than what she’d seen in the black-and-white photographs her mother kept hidden in a drawer in the dining room.

  “Jewish men are hairy,” Sima said.

  “I dated a tennis pro in college,” Dr. Kahn said. “He was surprisingly hairy. Fourth-generation American. Someone in his family fought in the Civil War.”

  “I’ve never met anyone more than second-generation American.”

  “Like I said, you’ve got to get out of New York.”

  * * *

  —

  ON HER WAY OFF THE ward, Sima stopped at Alma Mae’s bed to reposition her oxygen tubing. One bed over, Dr. Kahn sat in a chair, stretching an extra-long tourniquet, supplies set up for three sets of blood cultures.

  “Please make a fist, Miss Osborn,” Dr. Kahn said.

  “Sima, you better help that new doctor,” Alma Mae said.

  Miss Osborn smiled at Sima. “I seen you before. You good.”

  “Interns draw blood, not orderlies,” Dr. Kahn stated. A dubious County honor.

  Alma Mae ignored Dr. Kahn’s remark. “Honey,” she said to Miss Osborn, “she’s as good as any of them doctors. She’s going to be one herself soon enough.”

  Sima was startled. “I’m only an orderly,” she said. “I have to graduate college first.”

  “You make rounds with them doctors,” Alma Mae said. “I seen you.”

  “The Chief Resident is just being nice.” Sima didn’t want Dr. Kahn to hear.

  “You only got to finish that English class,” Alma Mae said. “That’s what you told me.” Alma Mae had a way of making it easy for Sima to confide, and never forgot a word. This tiny woman knew more about her than her own mother.

  Dr. Kahn seemed preoccupied. She tied the tourniquet snugly. “Please keep making a fist, Miss Osborn.” She slapped at the bulging skin to plump the big vein there. She released the tourniquet, moved it, and retied it. Miss Osborn
pulled her arm away.

  “My fingers turning blue.” Miss Osborn slapped Dr. Kahn’s hand as she loosened the tourniquet another time. “I want Sima.”

  Dr. Kahn shoved the tourniquet into a pocket, collected her supplies and stepped away.

  “Hey,” Miss Osborn sat taller against her pillow. “You going to take care of me?”

  Dr. Kahn turned back to her. “You have a fever. We’re trying to find out why.”

  “They took my shit to the lab,” she said. “Didn’t that tell what’s wrong?”

  “I wish it did. For both our sakes,” Dr. Kahn said. “We need to get blood. Sometimes it’s hard to see veins under black skin.”

  “I don’t see nobody here who’s not black. You sure you a doctor?”

  Dr. Kahn’s face went blank. She hadn’t done any psych rotations yet, but Sima expected her to think more carefully before she spoke. She’d handled herself better on the Prison Ward.

  “Squeeze my hand,” Sima said, “while Dr. Kahn puts the tourniquet on again.”

  Miss Osborn sighed. She let her arm go loose and gripped Sima’s hand.

  Dr. Kahn set her supplies back on the bed and sat down slowly. She didn’t look up as she retrieved the tourniquet from her pocket and cinched it tight. She pressed her fingers on the patient’s skin. Her eyes, her white coat, her nose, every part of her doctor-self appeared aimed at the target. “It’s sometimes hard to find a vein in a large arm.”

  “I’m sure there’s one in there,” Miss Osborn said.

  Sima marveled at the way County patients mustered their reserves. Doctors too.

  Dr. Kahn removed the tourniquet. She walked around the bed and tied off Miss Osborn’s other arm and palpated for a vein there. She freed that arm, and walked off the ward. She returned a few minutes later with additional supplies: more 4 x 4s, more gloves, half a dozen large twenty-cc syringes, and the longest needles she could fine.

  “Maybe you should page the senior,” Sima said.

  “This is intern’s work,” Dr. Kahn said.

  “You’re a psych rotator,” Sima said. “No one cares if you can’t do everything.” Sima knew Dr. Kahn was aware of how much her survival on the medical wards depended on being competent at these menial tasks that made a County intern’s life hell, especially the nights. But sometimes being competent meant asking for help. “It’s ok to ask for help.”

  The night nurse stationed herself at the foot of bed with an update. “Fever Bed 1, temp 101. IV’s out, too.”

  Dr. Kahn didn’t respond. She took off her white jacket and hung it over the back of the chair. “Please lie back,” she said to Miss Osborn. The nurse headed off to other tasks.

  Dr. Kahn stepped to the head of the bed. She cranked it down until Miss Osborn was lying flat. She opened a clean pair of sterile gloves and stretched them on. She moved one hand deep into the folds of flesh between the patient’s pendulous abdomen and her wide thigh.

  “Nerve, artery, vein,” Dr. Kahn mumbled under her breath the mnemonic Sima heard medical students recite. Dr. Kahn was feeling for the artery that pulsed alongside the vein.

  During emergencies, doctors drew blood from the groin to check a blood sugar or hemoglobin. But interns were taught to avoid getting samples for blood cultures from dirty sites, places on the body where it was impossible to sterilize the skin. The groin was one of those sites. Bacteria in the area often contaminated the cultures, making the results useless.

  “You should page the senior resident,” Sima said. Drawing blood from a dirty site for a fever work was worse than not even trying to do the dreaded task on the on-call intern’s endless list of scut work. The night was growing longer. And Sima had her own work to do.

  7

  Identity Displacement Syndrome

  The first Monday of every month, Sima worked days, and her shift started in Psychiatry. The stairwell in R-building was grimy linoleum and bits of fossilized gum, the smrod of urine instead of stool. Sima breathed through her mouth one flight up to the Psych ER. Behind a curtained-off space, a patient who called himself JJ lay stretched out on a gurney, his bony knees poking up out of baggy shorts. His ankles descended into American Flyer high-tops.

  “I’m training to be a Jew,” JJ said. “Are you a Jew?”

  Fever beads, sweat rosary of the sick, covered his forehead. His admission papers read: “Fever, rash, Identity Displacement. r/o meningitis (Puerto Rican street kid wants to be a Jew).”

  “Like my yarmulke?” JJ tapped the red-and-black beanie pinned to his mop of kinky, dyed, red-brown hair. Sima had hid her own hair under a cap for two months after trying to become a blonde without Aunt Miriam’s help. The tint turned her locks green in the pool at the Y. She finally convinced her mother, after two weeks that wearing the cap to bed was part of a school assignment.

  “I got a Jewish nose, don’t you think?” JJ said. He turned his head sideways. “Just like Sammy.”

  “Sammy?” Sima said.

  “Sammy Davis, Jr.,” JJ said.

  “So you want to be a singer?” Sima said.

  “I want to be rich and famous,” JJ said.

  “Most Jews aren’t rich and famous.” None Sima knew. “And they don’t like their noses.”

  She felt JJ’s shiver through the edge of the bed. She tapped the shoulder of an aide.

  “Can we get this patient a blanket?”

  The aide’s baby-blue shirt was opened halfway down his hairy chest. “Go ask a nurse,” he said and rolled an empty wheelchair alongside the gurney. “We need the bed. Put him in this.”

  “He’s got a fever,” Sima said. JJ’s arm was as warm and sweaty as Miss Osborn’s. “He needs a blanket.”

  The aide grabbed a sheet from a pile on the counter and dumped it on the wheelchair.

  JJ lay on the gurney, blue-lipped. “Nobody can tell I wasn’t born a Jew. I got the proof. I got the nose.” He curled up like a baby and closed his eyes.

  Sima smoothed the sheet to his neck and got a close-up of the nose. There was a small bump in it but it didn’t compare. Sammy’s was squashed in from being smacked, Sima was sure of it. No big ugly hook at the end like the cartoons of Jewish noses in the Polish newspaper her father had insisted she clip every week for his file.

  The aide bumped the wheelchair into the gurney.

  JJ opened his eyes. “Nobody bumps Sammy Davis, Jr.” His arms were folded under the sheet, his eyes fixed on the line of fluorescent ceiling lights.

  “This ain’t no Vegas, Sammy,” the aide aid. “Give up the bed.”

  * * *

  —

  SIMA STEERED JJ INTO THE tunnel hallway, klaps-klaps, the slap-slap of her running shoes on the concrete floor, creating an echoing beat, the scrape of the wheelchair wheels making bad music. JJ, alternately shivering and sweating, hummed to the beat of the wheels.

  Heading toward them was the short, skinny guy with spiky hair and headphones plugged into a Walkman hanging from the waistband of green scrubs. He strutted to his music, cracking gum, and stared at Sima. Tunnel Guy: he moved so quickly she never saw a name tag, only the word MAINTENANCE in small black letters across the back of his shirt as he passed by. They never spoke. She only saw him in the tunnel. He reminded her of some leftover hazy childhood fear of wandering in dark, scary places on her own. There was something about the way he strutted, ghostlike, past the old cages that lined the tunnel under the Psych building. Rumors told they used to put the uncontrollable crazies in these cages before there were drugs to keep them quiet. She saw Tunnel Guy so infrequently that his presence haunted her, the way she imagined her father had been haunted by government officials after the Holocaust. Crazy JJ didn’t pay him any notice.

  JJ yawned like a cat. “My real name is Jose Iglesias Juarez,” he said. “But you can call me Sammy.”

  “Yeah,” Sima said. “And you can call
me Dave.”

  Dave, Davey—she could hear her father’s voice. His only son named after his only brother who died before his fifteenth birthday. And then her father lost the second Davey at less than two weeks old.

  Pipes lined the tunnel hallway, wrapped in white like mummies. Steam seeped from the seams the way it did from manholes on the streets. God of the ghetto gone underground, connecting the twenty-six buildings of the County under the sidewalks and the trees, coming out in hot puffs from pipes carrying water from A-building to C-building to R-building.

  JJ reached over the armrest of the wheelchair and grabbed for one of the pipes.

  “Don’t touch,” Sima said. “They’re hot. See the yellow danger sign?”

  “I like all this steam.” JJ sniffed the musty tunnel air and raised his arms overhead, palms up, as if pleading with his maker. “Looks like heaven.”

  “Jews don’t exactly believe in heaven,” Sima said.

  “So what makes a person a Jew?” JJ asked.

  God of the Puerto Ricans gone underground. God of the Jamaicans and God of the Haitians and God of the good people of Trinidad and Tobago. And then she heard herself say, “Jews are circumcised when they’re eight days old.”

  * * *

  —

  SIMA WAS FIVE WHEN DAVEY was born and they all climbed down the narrow steps to the under-the-ground where there were no windows, only the light of candles. Her mama and papa, and the seven Jewish men in their village remaining after the war, with their wives and children. There was no rabbi, there was no moyel, the man who circumcised Jewish baby boys. So her papa’s friend, Lesk, the bookbinder, opened his yellow-brown pages to the Hebrew words he read every time one of the wives gave birth to a chlopak and everyone came to the under-the-ground to announce the child’s name and watch Lesk make the cut in the pink, wrinkly skin to bring another Jewish boy’s soul into the world.