Sima saw the blue sofa against the back wall of the living room and the matching blue shag rug on which a police officer stood, her hat in her hands. “Are you the daughter?” she said.
“Where’s my father?” Dr. Kahn said.
“I’m sorry,” the police office said. “Your mother called us.”
“She’s not my mother.” Dr. Kahn pushed between them into the hallway that led to the bedroom. Bits of snow flaked off her coat onto the blue shag rug.
There was a mezuzah on the bedroom doorpost, silver with bits of blue stone. Sima raised her hand toward Dr. Kahn’s snow-flecked shoulder. Dr. Kahn fingered the mezuzah and stepped over the threshold. The tails of her scarf made a wavy shadow against the door. Sima followed. The room smelled of piss and shit. There was a triangle of light coming in through the open door, just enough to see skin: the soles of two feet sticking out from under the sheets and blanket.
Dr. Kahn reached back toward Sima now, catching her hand and squeezing it. With her other hand she touched the heel of her father’s foot. She lifted the corner of the sheet and placed it back down carefully on top of his ankles.
“Sheets make my father’s feet hurt, he never covers them,” Dr. Kahn said. His face was turned to one side, away from them, so quiet.
Her own father’s face—Sima had seen it, on its side. His eyes were closed. Sima had found him, on the floor of his study. Thick black-gray eyebrow scrunched up above his eye, the one she could see. His mouth, his blue lips. Sima hardly remembered more than her father’s face and the way he lay there, the silence. She remembered the whole room as Dr. Kahn now would, the almost-closed wooden blinds, the light coming through the doorway, illuminating her father’s naked feet.
12
Death Note
Sima pushed an empty stretcher into the Cardiac Care Unit. She had never seen Miss Armstrong work in the CCU but there she was that night, her hand on the wrist of a white man sitting up in the bed closest to the Nurses’ Station. He was barrel-chested and hairy—a semicircle of white hair a crown on his balding head, curlicues of it out the neck of his hospital gown and down his arms. In her four years as an orderly at the sprawling Brooklyn hospital and the only immigrant there who didn’t hail from a Caribbean island, Sima had never seen such a patient at the County. Alongside Miss Armstrong’s Jamaican black, the man looked as if all the blood and pigment had been drained out of him.
“Give a hand here, Sima.”
With her left hip, Sima lodged her stretcher up against the wall nearest the door to the CCU and set the brake, all the time with her eyes on the pale man. She approached the nearest side of the bed, opposite Miss Armstrong.
This patient may have been different than their usual, but they had stood alongside hospital bedrails more times than either of them could count. They steadied their hands and forearms under the large man’s upper arms. On the count of three, they tried to maneuver his body up against the raised pillow behind him. Eyes wide and bloodshot, the old man stared straight ahead. He grabbed the rails as though he were in a boat about to tip. He shook the rails and wouldn’t let go.
“He’s sure to pull out that IV,” Miss Armstrong huffed. She lifted the IV bag off its pole to untwist the tubing and then hung it back on its perch.
Sima eyed the name on the man’s wrist band.
“Siedziec prosto,” she said to him in Polish, her native language. Sit up.
Miss Armstrong nudged Sima. “One of your people?”
Sima searched for and found an Eastern Orthodox cross around the man’s neck. Slavic, Ukrainian. She felt for the gold six-pointed Jewish star under the edge of her scrubs shirt. Not one of her people. Her ears got hot. Here in America, in New York, New York, a simple, uneducated Polish Jewish peasant immigrant could become someone with the upper hand, someone this man could never harm, and a Caribbean woman’s touch held his life on the line.
The man grunted. He let go of the bed rails and wrapped his arms around his barrel chest. “Tell him he’ll more comfortable if he sits against the pillow,” Miss Armstrong said.
“Siedziec prosto,” Sima said again. “Bedziesz bardziej wygodne.” Sit up. You’ll be more comfortable.
Sima’s face was now inches from the man’s, close to the deep folds that led from his nose to the corners of his mouth. His lips were gray-blue. Sima understood that such a dusky color meant a problem with blood flow, with a patient’s heart. She’d asked Chief Resident Danielson about dark lips and cool hands and feet on patients when she made rounds with him and the interns.
Mr. Shtrom grunted again. He pursed his lips. Sima could hear his breathing, in and out, struggling to move air. He yanked his arm from her hold and the IV machine bleeped. She reached for the arm to save the IV from being pulled out, but his hand flailed toward her face. She ducked to avoid getting smacked. The old man coughed. His big hairy white hands gripped the side rails again.
“Go find the good doctor. She’s in the on-call room,” Miss Armstrong said.
* * *
—
THE ON-CALL ROOM SMELLED THE same as always, like dirty socks and running shoes. Sima found Dr. Kahn in fetal position on the bottom bunk. Working so many nights together that year, Sima watched her every move, trying to understand what it was like to be an intern. What it was like to be this insecure intern who struggled to get through each day and night. Dr. Kahn was just recently back from a week’s mourning leave after her father’s death. She rolled onto her back and stared at the rusty springs above her. Sima sat down on the edge of the bed.
“There’s a new patient for you in the CCU. Miss Armstrong wants you to know,” she said.
“I saw him in the ER,” Mindy said and turned to the wall, her back to Sima.
Sima nudged her on the top of her head. “Nurse Armstrong needs you.”
Somewhere between lunch in the Red Hat diner across the street from the hospital and the day they’d found Mindy’s father dead, she had decided that Dr. Kahn had become her mentor. She didn’t know exactly when this had happened but she admitted it now to herself: she wanted to be Mindy. And Mindy had invited Sima to call her by her first name.
Mindy’s pager rested on the floor by the bed. It beeped but she didn’t answer it. It beeped again. Why Chief Danielson didn’t see that Mindy wasn’t ready to be back taking care of cardiac patients Sima couldn’t understand. Mindy’s father had died of a heart attack.
Sima read the numbers flashing on the pager as it beeped again. She shook Mindy’s shoulders with both hands. “Miss Armstrong needs you.”
Sima wanted urgently to be needed right now. She got an A in biology, in all her courses. Still, she’d put off taking English composition another semester once again.
Mindy moved closer to the wall behind the bed, pulled her knees tight into her chest.
The numbers on the pager flashed a second time. Sima turned to leave the on-call room.
* * *
—
IN THE CCU, MR. SHTROM STILL held tight to the bed rails. His hospital gown hung off his shoulders. He started to rock in the bed.
“Now, now,” Miss Armstrong clicked her tongue. “All this fuss will get you nowhere.”
“Where’s Dr. Kahn?” she asked. “His heart rate is racing.” Miss Armstrong looked up at the monitor as it bleeped rapidly above her patient’s bed. “He signed out against medical advice from some tiny hospital in New Jersey. Bad heart attack. I need the doctor.”
“She’s coming.” Sima could only hope this was true. She tried to straighten the hospital gown on the old man’s shoulders.
Mr. Shtrom rustled the arm with the IV again and the IV machine chirped. He pursed his lips harder. Suddenly his face got blue, then bluer.
“Get the bottle of nitro,” Miss Armstrong shouted. “Top shelf on the desk.”
The telephone was on the main desk in the CCU close to the d
oor. Sima grabbed the phone and dialed the number to the on-call room. Ring, ring. Pick up the phone. She didn’t want to imagine Mindy still lying there on her side, face to the wall.
“Hurry up with the damn nitro,” Miss Armstrong’s voice was louder. “Then page Kahn.”
Sima dropped the phone and ran to the bed with the bottle of nitroglycerin pills.
“Under the tongue,” Miss Armstrong said to Mr. Shtrom, her words firm but gentle.
Sima took a tiny pill between her thumb and forefinger. She didn’t know the Ukrainian word for tongue so she tried the Polish one.
“Jezor,” she said.
She lifted her hand to her own tongue and tapped it with her forefinger, and as she leaned in, the Star of David fell out of her scrub shirt right in front of Mr. Shtrom. His breathing got faster, shallower. He grabbed at his chest and shook his head side to side.
He shoved Sima’s hand away. He grabbed the bed rails again. “Nah, Juden, nah!”
She listened to his breathing, more labored as his eyes bulged at the Star of David dangling between them. David. Davey. Her brother, her father’s. At that moment, she wanted him to know who she was. And that she held the pill that could ease his pain.
She didn’t hide the star. What kind of doctor would do that?
Then he hit his chest with both hands. His nostrils puffed out. “Nah, nah.”
Mindy shuffled in through the door. And the next second, Mr. Shtrom was down. He fell back onto the pillow. His arms limp, his mouth wide open. Mindy stood there by the bed, not moving. She just stood there so still Sima could barely stand it. Was Mindy going to do something, call someone, breathe, talk, anything? For a moment, she didn’t care.
“Page the code team,” Mindy finally ordered. “Now!” And then Sima ran to the phone.
Mindy shoved down the side rails of the bed and got up on the mattress. Her knees were along one side of Mr. Shtrom’s chest. She leaned over him, the heels of her hands balanced on his bare torso, and she started to pump on his heart. “Get him breathing,” she said to Miss Armstrong.
Miss Armstrong placed the mouthpiece of the Ambu bag over the patient’s blue lips. Sima watched Mr. Shtrom’s chest move in and out, in and out. The overhead announced the code, and then came the squeak, squeak of running shoes into the room. The on-call doctors from all the medical wards in the hospital stampeded through the door into the CCU and surrounded the patient’s bed.
The senior resident stood center stage. He looked up at the EKG monitor above the heads of everyone in the room. “Check the IV line,” he called out.
One intern fingered the IV site, another one turned up the flow on the tubing.
“Push an amp of epi,” the senior ordered. Miss Armstrong handed a syringe to the intern by the IV site. “Epi’s in.”
“Keep pumping,” the senior ordered.
Mindy was still up on the side of the bed, on her knees alongside Mr. Shtrom. No one from the code team had taken over for her. Her forehead was wet with sweat and wrinkled with concentration. She leaned her hands onto the man’s chest again and again as if her life depended on every compression.
One hand over the other, Sima pushed down on the air as if she were pumping in place of Mindy. Would she have taken over, given Mindy a break, if the room hadn’t been filled with interns? She’d witnessed almost as many codes as they had. For a moment, she was satisfied there was no role for an orderly in this drama, other than to deliver a sample to the stat lab, or to go find a box of gauze pads.
“Where’s anesthesia? We need to tube him,” the senior shouted. “We can’t wait. Miss Armstrong, an ET tube, a large one.” He had Mr. Shtrom’s head in his hands, extending his chin up and his neck back to the correct angle for inserting the endotracheal tube.
Sima stood at the far end of the bed now, away from the action of the code team. Her feet were covered with the torn paper wrappings of discarded 4 x 4 gauze pads, used alcohol swabs. The white bedsheets were specked with blood. Mr. Shtrom’s feet stuck out of the sheets.
Then the senior resident suddenly called out, “Everyone, stand back.” Mindy stopped pumping and got off the bed. The senior held up the paddles and then gave Mr. Shtrom a shock. The old man’s body flailed for a second. “Resume pumping.” And Mindy was back at her station.
“Does he have a pulse?” the senior asked. Mindy shook her head no.
“Stand back.” He gave the patient a second shock, and a third.
“Everyone stop,” he ordered, Mindy still pumping. He said it again, “Everyone stop.”
Mindy, Miss Armstrong, the other interns, and Sima stood still so the team could assess the patient’s response. Everyone watched the EKG monitor above the bed.
Flatline.
“Dr. Kahn?” the senior said.
Mindy looked at the clock on the wall by the door. “Time of death: 5:45 a.m.”
* * *
—
AT 7:00 A.M., SIMA FOUND Mindy on the bottom of the bunk bed in the on-call room, Mr. Shtrom’s chart open in her lap. Her white jacket was in a ball on the pillow. She was still in scrubs. She hadn’t taken a shower yet.
“The nurses need the chart,” Sima said.
Mindy didn’t look up. “I have to write the death note,” she said blankly.
“They’re getting him ready for the morgue,” Sima said. “They paged me to take him down.” Trips to the morgue were the worst part of being an orderly, even when she didn’t know the patient. But this patient, this Ukrainian patient. She had held the tiny nitroglycerin pill and she’d let him push it away. She tried to imagine if she’d been his doctor.
The door to the on-call room opened. Chief Resident Danielson stepped in. He sat down quietly on the other side of Mindy. He wasn’t known to come into the hospital this early, and he rarely made appearances in the on-call room. Sima didn’t think his presence, quiet as it seemed to be that moment, was a good sign.
“Sima, I need to speak with Dr. Kahn,” he said.
Sima paused in the hall at the partly opened door. She heard Chief Danielson ask for the chart. She heard him flipping pages.
“He was in big trouble the minute he walked in the door,” he said.
Silence. Then she heard Mindy say, in monotone, “I should have done another EKG.”
“This guy was a goner before he got here,” Chief Danielson stated as if it were fact. “But yes, you should have done another EKG. It wouldn’t have made any difference, but that’s what you should have done when Miss Armstrong paged you.”
Sima was grateful Chief Danielson invited her on rounds with the interns, but she could tell he liked to see them squirm when he asked questions. She wasn’t sure she wanted to be an intern on his watch. He should have known Mindy wouldn’t do well in the CCU so soon. He could have assigned her to a regular medical ward. Or Neuro. Nothing big ever happened on Neuro. He had taught Sima a lot, he’d offered to write her a letter of recommendation. What would he think if he’d seen her with Mr. Shtrom?
She put her head into the room. “The nurses need the chart,” she said.
Chief Danielson put his hands into the pockets of his long chief resident coat. “Please write the note and notify the family, Dr. Kahn.”
“They probably don’t speak English,” Sima said.
“Dr. Kahn can handle it,” Chief Danielson said.
Sima didn’t understand how he could be so sure.
Chief Danielson didn’t make eye contact with either of them. He straightened his coat and stepped out.
* * *
—
MINDY STARED DOWN AT THE pink progress note pages, her hands glued to the blue plastic chart. She sat motionless, like a statue of herself.
Sima waited by the door.
Mindy spoke. “Patient died. The end.”
“That’s not what you’re supposed to write,
” Sima said.
“You answered the page, you were there when I wasn’t. You write the note.”
Mindy’s pen slid off the chart onto the floor. She kicked it across the room and it disappeared under the opposite bunk. The chart slipped off her lap onto the floor.
Sima picked up the pen. “Maybe the senior could write the note.” She sat down next to Mindy, both of them now cross-legged on the floor. She picked up the chart and held it out to her. When Mindy made no eye contact, Sima lowered the chart onto her own lap. She opened it to the next clean page. And then she began to write. She read out loud what she wrote.
“Death note: Called to see patient having chest pain at 5:15 a.m. He was in cardiac arrest.”
Mindy closed her eyes and didn’t say anything. Sima continued to write and read.
“The code team was called. Three rounds of cardiac medications were given and three shocks with no response. The patient had signed out AMA from another hospital the second day after a massive anterior wall MI. The patient was pronounced dead at 5:45 a.m. Family will be notified.”
Sima placed the chart in Mindy’s lap. Mindy opened her eyes and stared at the note.
“Nothing here is inaccurate,” Sima said and handed Mindy her pen.
* * *
—
THE SHTROM FAMILY HUDDLED IN the corridor outside the double doors to the CCU: a clan of people pacing and mumbling to each other, short and not-so-short, skinny and round, some with curly brown hair and some blond, two or three wearing glasses and hats, the babushkas clutching purses to their chests. That was all Sima could see at first of these of Old Country people Aunt Miriam left Poland to get away from. They sounded like an unruly school brood at recess. When she was little, the children of these people threw rotten tomatoes at her, spit at her. Kike, dirty Jew. She didn’t pull out her Star of David and wave it in their faces. But at that very moment she wanted them to feel what she had seen in her own father’s eyes when a Ukrainian doctor said he couldn’t do anything for the son of a Jew, and her baby brother died and her father was never the same again. Her mother couldn’t forgive her father. And Sima’s life was never the same again.
The Care of Strangers Page 7