Sima listened to the fan in the back corner pushing stuffy air around and around. Elevator lady air, orderly air, dead man air. There was nothing like the smell of dead man air. Or the vision of a dead man dressed for the morgue. Birth and death: always draped in white.
The fan was stuck in one position. The air blew straight at the bundled chart, moved one corner of the top page and then lifted them all. Page after page, one edge and then the whole sheaf up in the air. Mars Peabody’s last days flew off his crotch. One page hit the back wall of the elevator, another lapped against the handrail, one grazed Miss Lawrence’s elbow.
“Damn fan,” Miss Lawrence said.
Sima got down on her knees to gather the pages.
“Hope he went fast,” Miss Lawrence said. “Ain’t no good death but a fast one.”
“In the end it was,” Sima said. She collected Mars’s days, page by page, and placed them back in order, from the face sheet to the ER admission to the daily progress notes, lab tests, order sheets, and consultations by half the specialists at the County.
The elevator door opened to the tunnel.
“There you go, Sima,” Miss Lawrence said.
Mars was dead. He was a dead father, like Mindy’s father, and Sima’s own. And Mr. Shtrom.
* * *
—
PAST THE MUMMY PIPES, HISS and steam, the buzz of fluorescence. The giants bowling overhead. The bumping and screeching that meant life.
The yellow light in the tunnel usually made everything blurry, and tonight it was worse. Sima was crying. No more elevator rides. No more gurneys to push. Mars, Mr. Shtrom, Mindy’s father. Her baby brother. No more dead bodies. She had been the one to find her father dead but then her mother said she was too young to go the funeral.
She heard Tunnel Guy before she saw him coming down the long hallway, a dark face, a spiky dark head bopping up and down, the sound of the radio blasting out through his headphones.
Tunnel Guy stopped at the foot end of the gurney.
“I’ve got a dead man here,” Sima said.
“You got a lumpy gurney covered with a white sheet,” Tunnel Guy said, his curly head still moving with the beat.
“Show a little respect,” Sima said.
“That’s a black man’s line,” he said, opened his eyes wide. “You ain’t no black man.”
“This is a black man,” Sima said. “A dead black man.”
“Once you’re dead, you’re dead,” Tunnel Guy said.
Sima was close enough this time but she still didn’t see a name tag on this ghoul. “You’re maintenance. You’re not the one who delivers them to the morgue.”
“Morgue is that way,” he said. He pointed to the hallway behind her. Then he strutted past the gurney in the direction he had been pointing. He disappeared into the cloud of mummy pipe steam.
* * *
—
THE DEATH CERTIFICATE OFFICE DIDN’T know Mars was dead yet. They hadn’t called Mindy down to sign the death certificate. Mars hadn’t listed anyone as next of kin; he hadn’t even known his son was alive until he got a letter from Bug Man. Mindy now had to face a relative she had never met before, with the patient already dead. Mindy asked Sima to be there with her.
Late May, almost June, and not yet summer in Brooklyn, late afternoon. Mindy and Sima stopped in the middle of the hallway. They let a gurney go by and then made their way to the wall of chairs across from the Nurses’ Station on A71.
An older black man with gray-white kinky hair sat at the close end. A much younger male, a lanky teenager with dark brown wavy hair and lighter skin, was posted nearer to the hallway, watching all the traffic: patients being pushed in wheelchairs and on gurneys, interns and residents walking back and forth from the Nurses’ Station, writing orders and answering pages, heading off into the big ward or disappearing into the charting area.
Sima and Mindy approached. The older man stood up.
“I’m Dr. Kahn,” Mindy said to the teenager she assumed to be Derek, “your father’s doctor.” She held her hand out toward him.
The older man put an arm around the younger. “This here’s my buddy’s son, Derek. I’m Bruno Bailey, but they call me the Bug Man,” he said. He nudged Derek. “Shake hands with the doctor, son.”
Mindy reached out again.
“Go on,” Bug Man said.
Derek barely lifted he eyes. He stretched an arm toward Mindy, and the two shook hands.
“We’ve heard a lot about you,” Sima said to Bug Man. Then she turned to Derek. “Your father showed us a picture of you when you were a little boy.”
Sima saw Mars’s big white teeth in the mouth of the teenager. When Derek stopped smiling, she noticed he was fidgeting with a button on his shirt. The button was hanging by a thread, about to fall off.
“Can I see my father?”
“Let’s sit down a minute,” Mindy said. She led them back to the row of chairs. She stood until they sat down, and then she sat next to Derek. Sima remained standing.
Mindy pulled patient note cards out of her coat’s breast pocket, tapped the cards against her knee. Then she put the cards into a side pocket. She cleared her throat, closed her eyes for a second, and then opened them.
“I don’t know what your father wrote in his letter,” Mindy said. She folded her hands in her lap. “Sima here helped him write it.”
Sima smiled though she wanted to cry. Mars had done lots of bad things. But she had stayed late one night to read the final version of the letter. She’d bought a stamp for the envelope and the letter went out in the hospital mail the next day.
“He sent the letter to me,” Bug Man said. “He wrote that he had a really good doctor. A Jewish lady doctor from Boston. Must be you he was talking about.” He smiled at Mindy.
“He had a bad infection in his heart from using drugs,” Mindy said. “Did you know about that, Derek?”
Derek turned to Bug Man. “You said he quit drugs.”
Bug Man’s eyes went wide. “That’s what got him into the hospital,” he said. “He got clean after he was here.”
“The infection wasn’t going away,” Mindy said. “It damaged one of his heart valves.”
Derek yanked at the loose button on his shirt and the button made a tiny sound as it landed on the floor.
Mindy picked the button up and placed it in Derek’s hand. “Your father was very sick.”
Derek turned to Bug Man. “Can I see him now?”
Mindy put a hand on Derek’s shoulder. He shrugged away from her touch.
“I came all the way from Virginia to see my father,” he said. “I want to see my father.”
Mindy kept her eyes on Derek. “Your father’s heart gave out last night,” she said. “We did everything we could. But his mitral valve tore. His lungs filled with blood. He couldn’t breathe, and then his heart stopped. I’m so sorry to tell you this. He died last night.”
“Mars is dead?” Bug Man said.
“My father died?” Derek said.
“We did everything we could,” Mindy said. “The infection in his heart was very bad.”
Derek pulled further away from Mindy and stood up. He walked back and forth in front of the chairs, and then he stepped toward the Nurses’ Station a few feet away. A young nurse was delivering an elderly woman in a wheelchair to the ward. The old woman looked at Derek and smiled. Derek raised his arms over his head, then covered his face with his hands.
“But I got here, Bruno brought me here,” Derek cried. “He said I had to come.”
Mindy moved closer to the tall young man. She rested a gentle hand on his arm again.
In his face, Sima glimpsed the five-year-old boy from Mars’s photo.
“He really wanted to see you again,” Mindy said.
22
Bridges
Sima lik
ed to think about how bridges kept one side of a city away from its other side. How they separated the hills from the flats, the old parts from the new. Kept big buildings away from little buildings, business buildings away from those where people lived. San Francisco, San Diego, St. Louis, Tampa–St. Petersburg. Portland, Oregon. Paris, France. New York, New York.
But what separated people was more than geography. East Side, West Side, Uptown, Downtown, the Lower East Side, the Upper West Side. History. It was not just where your parents were born but where they went to college, if they had the opportunity to go to college at all. If English was their native language. Vegetarian or meat eater, couch potato or marathon runner, walker or Rollerblader or cyclist vying for road space in Central Park on Saturday and Sunday mornings when the weather was dry and not too cold.
Many who lived in the City would never consider riding a bike any more than others would ever consider eating at McDonald’s. The rich and the middle class lived here in New York City, in Manhattan, the center of the universe. And everyone else lived where they could. All anyone had to do to tell the difference was to stand on a busy street corner and notice who was driving the cabs and the buses, selling the newspapers, or sitting on a curb with a hand out, trying not to get stepped on.
The Brooklyn Bridge, the Manhattan Bridge, the Williamsburg Bridge, the Queensboro Bridge, the Triborough Bridge.
Puerto Ricans, Cubans, Koreans, Indians, West Indians, Pakistanis, Samoans, West Africans, WASPs, Hispanics, and Jews—Hasidic or not. Old Chinese bent from an ancient history of heavy loads.
Sima noticed there was something about having the choice to cross a body of water by car instead of by subway or bus that made a person’s accent change. At least in this city.
Mindy said Sima didn’t live in the City; she lived in Brooklyn. Sima had driven into Manhattan only once, through the Brooklyn–Battery Tunnel. Three o’clock in the morning, but there had been too much snow falling to for her to see the tall buildings lit up on the other end, the water along the docks. The Statue of Liberty in the harbor, her arm raised to the Big Apple sky. Sima thought it would be hard to die the way Mindy’s father had, all alone. It rarely happened that way at the County. All those white coats and running shoes.
* * *
—
AFTER ROUNDS WITH THE MEDICAL students one afternoon, Sima stood silently alongside Chief Danielson. She cleared her throat, cleared it again. Chief Danielson turned to Sima and waited.
“Why did you assign Dr. Kahn to the CCU right after her father died of a heart attack?” She blurted the words out, with that tone her mother hated so much. It was the only way to say what she had to say.
Chief Danielson put his hands in the pockets of his long white chief coat and rocked on his heels. He peered down at his shoes, then regarded Sima.
“That’s a good question,” he said. “An honest and a brave one. Thank you for asking it.”
* * *
—
ON HER DOUBLE SHIFT THE second week of June, Sima saw Mindy running to the lab, to the ER, to answer this page and that one. Mindy’s senior resident was busy helping four sub-interns, fourth-year medical students learning to do the work of interns. Every procedure the subs did had to be supervised, every order co-signed. That left Mindy pretty much on her own for the night. But by the end of the month, Mindy would become a resident herself, so she didn’t need much help anymore. She had survived the case review, she had made it through a year at the County as a psych rotator. Sima thought maybe Mindy would stay in Medicine.
Sima was called to A71 to transport Mindy’s admission for an X-ray the ER had forgotten to take. Mindy was carrying the code beeper for the senior resident while he escaped from his subs to take a quick shower. Sima scheduled all her double shifts when Mindy was on call now. They were friends again. Mindy had convinced Sima to sign up for English composition in summer school. She thought Sima should graduate for sure.
“Another night in the trenches,” Mindy said. “Good to have my personal orderly at my side.”
As Mindy helped Sima move the patient out of bed and into a wheelchair, the code beeper went off. A snippet of white sheet from the bed got caught in one wheel of the chair, and the sheet tugged hard on the patient’s leg. The woman moaned.
Sima released the sheet as gently as she could while Mindy looked down at the pager to see what ward the code was on.
Sima said, “Just go.”
Mindy ran.
At the end of the hallway, Mindy turned and called out, “Sima, come with me!”
Sima was supposed to take the patient to X-ray. Instead she was pushing the wheelchair to the side of the hallway and chasing Mindy down the hallway.
“Hey!” the patient yelled, but Sima didn’t look back.
Sima caught up with Mindy at the elevators. Mindy smashed hard on the red EMERGENCY button. When the elevator door didn’t open, Mindy headed to the stairwell, Sima at her heels.
No air. No light. Dried urine, running shoes sticking to the floor, three flights down.
Sima could barely keep Mindy in sight, Mindy’s feet were so fast. She didn’t falter as she pushed through the door to A41, three floors down from her usual ward.
“Where’s the code?” Mindy asked the head nurse there.
“The Isolation Room,” the nurse said.
Outside the room was a cart topped with a pile of rubber gloves and a box of blue paper masks. Mindy stuffed her arms into a gown, stretched a glove onto each hand. She grabbed two masks.
“Here.” Mindy handed a mask to Sima. “Grab a gown.” She gave Sima a pair of gloves.
“Where’s the rest of the team?” Sima said.
“I don’t know.” Mindy tied the mask around the back of her curly head and pushed the door into the Isolation Room. Sima followed.
And then it was slow motion.
Mindy in her wrinkled yellow gown, hair sticking out around the mask, stepped to the head of the bed, to the right side of a patient she had never seen before. She leaned down, put her face up close to the patient’s mouth listening, felt for a pulse at the neck.
“His pulse is weak. He’s not breathing,” she said. “We need to bag him.”
Mindy grabbed the Ambu bag from the crash cart. She lifted the patient’s chin out and up, and covered his mouth with the breathing bag to make a good seal.
“You bag him,” Mindy said to Sima. “I’ll pump.”
Slow motion. A few seconds felt like an hour.
Then Sima was at the head of the bed next to Mindy. It was just the two of them. She didn’t remember pulling her gloves on, but there they were, on her hands. Mindy’s gloved hands were there, over Sima’s showing her how to keep a good seal on the Ambu bag, how to squeeze air into the patient’s lungs. The patient’s chest moved up with each squeeze moving air in, then down as the air came back out.
Mindy felt again for a pulse. “No pulse.” And then Mindy made a fist and thumped the center of the patient’s chest. She laced her fingers together, the heel of one hand on top of the other. Mindy leaned hard into the patient’s chest with her whole weight.
“One-one thousand, two-one thousand, three-one thousand, four-one thousand, five-one thousand.” Mindy pumped and Sima squeezed. Again and again.
The door to the Isolation Room opened, and the intern from A41 pushed his way in.
“Hook him up to the EKG,” Mindy said, her voice loud, deep.
“Do we have a rhythm?” Mindy said, still pumping. Sima kept squeezing air.
“Yes,” the A41 intern said. “But it’s not sinus.”
“What is it?” Mindy asked, but A41 intern just stared at the EKG.
“You pump,” Mindy said to the intern.
The intern took Mindy’s place and started to pump. Mindy moved to the EKG machine.
One minute. Felt like ten.
; A race. In slow motion.
“It’s v-tach,” Mindy said. “We’ve got to shock him.” She picked up the paddles from the top of the Crash Cart. “Everybody stand back,” she said.
Sima and the A41 intern stood back from the bed. Mindy placed the paddles on the patient’s chest and pushed two red buttons. The patient’s whole body arched off the bed. “Keep pumping and bagging!” Mindy shouted.
“We’ve got a rhythm!” The head nurse was in the Isolation Room now, too.
Mindy turned to look at the EKG. “He’s in sinus,” she said. “Do we have a pulse?”
“Yes,” the A41 intern said.
“Stop pumping. We need to get a line into him,” Mindy said.
The A41 intern stopped pumping, grabbed an IV catheter, and got working on the line.
Mindy moved to the patient’s head. “I’m going to tube him,” she said. “He’s not breathing.”
“Shouldn’t we wait for anesthesia or the senior?” the A41 intern said.
Mindy took the laryngoscope from the top of the crash cart where the head nurse stood.
“Stop bagging him,” she said. Sima stepped back and Mindy leaned over the patient at the head of the bed. She rested the laryngoscope on the patient’s chest. Then with her left hand, she lifted the man’s chin higher in the air. She picked up the laryngoscope again in her right hand.
Then, as if she had been doing it her whole life, Mindy slipped the laryngoscope into the patient’s mouth and down into his throat. The head nurse handed her an endotracheal tube and she inserted the tube into the patient’s trachea. She removed the stylet, then the scope. She inflated the cuff on the side of the tube and attached the end of the tube to the Ambu bag as Sima had seen done so many times.
“Bag him,” Mindy said. Sima squeezed the bag and watched as Mindy fitted her stethoscope into her ears and placed the bell on the patient’s chest to listen for breath sounds.
“It’s in,” Mindy said. “Keep bagging.”
Then suddenly the patient coughed. He opened his eyes and coughed again. The muscles and veins in his neck bulged. He pushed the Ambu bag out of Sima’s hands, and then he grabbed the tube in his throat. One, two, three. He yanked the tube out of his throat and gave a huge cough.
The Care of Strangers Page 12