The Queen of Hearts

by Kimmery Martin

  “I’m so sorry. I didn’t see—” Hannah started. She was interrupted by Rolfe from the front seat, who was raising and lowering both arms in a Settle down. I’ve got this gesture.

  “Sorry about that, Bald Truck Dude,” he began.

  “Say what?” sputtered Bald Truck Dude, who did not appear to appreciate his new moniker.

  “Perhaps if your farm vehicle were a brighter color. Oh my. Are those overalls?”

  The man was now opening the truck door, gripping something in his right hand.

  “Go, go, go, Hannah,” Georgia screamed. In one fluid motion, Hannah threw the car into first and gunned it, burning rubber down the alley behind James’s apartment in Cherokee Park.

  “Roffff. Were you trying to get us killed? That guy weigh two-fiddy and had tire iron,” Landley slurred.

  “Whew,” Hannah said shakily. “Has anybody ever wondered who Sam Hill was, anyway?”

  Rolfe: “There were several famous Sam Hills. An early-nineteenth-century businessman whose establishments carried a wide array of odd inventory; a road builder in the Pacific Northwest who was thought to represent impossible projects; and my fav, Samuel Ewing Hill, an emissary of the governor of Kentucky, who was sent to intervene with the Hatfields and McCoys in 1887.”

  Dead silence.

  Then, from Georgia: “What the hell, Rolfe? Did you just eat an encyclopedia?”

  “My IQ is stratospheric. Please try to keep up.”

  “Your IQ is about the same as your penis circumference, jackass.”

  “Exactly.” Rolfe smirked. “Thank you for acknowledging that, Georgia. Oh, here it is, Hannah.”

  We wandered in. The party appeared to be full-blast, which is to say the guests ran the gamut from sweet and well-dressed wives who would fit in nicely at a Wednesday evening Bible study, to a bunch of barbaric drunks. The med student wives were clustered in the Sober Kitchen, having an occasional sip of white wine, blond coifs gleaming. The drunks were scattered, but we located a conglomeration of them outside near the keg.

  The party took place in a rambling old townhome from the early part of the nineteenth century, with soaring ceilings and ornate crown moldings, along with unusable, drafty fireplaces and Stone Age plumbing. With extensive renovation it could have been spectacular, but as it was, it languished in a row of ghettoized student housing. Nearly every house on the street sported crumbling trim and rickety back fire escapes, along with the requisite bedsheets in the windows—the universal denotation of student decorating budgets.

  Ignoring the revelry, I plunked myself down on a hideous purple futon just off the kitchen, wrapping my arms around my knees. Suddenly my head felt unbearably heavy, the gargantuan weight of my thoughts squashing my neck straight down into my chest. I moaned a little and toppled onto my side.

  “Whoa, Zadie! How wasted are you?” I felt the impact of a large body crashing down next to mine.

  “I’m not drunk,” I protested feebly.

  “Yeah, well, you look like you’re trying to cling to that couch to keep from falling off the earth.”

  Blearily, I opened one eye: Graham. He wore a flannel button-down and cargo shorts, and his wavy brown hair was rumpled endearingly. His cheeks were flushed.

  “I am very drunk,” he said happily.

  “Yes,” I agreed. “You are.”

  “Yes.”

  I waited, but nothing more came. Since the conversation appeared to have stalled, I closed my eyes and returned to my pit of misery. All the endorphins generated at Nick’s apartment a couple days ago had fled, leaving me stuck in an endless feedback loop of the bad thought. I kept replaying it in my mind: I’d messed up. I’d done something very bad, something catastrophic, and I couldn’t undo it. I moaned again.

  “Zadie? Zadie? You okay?”

  This time I opened both eyes, to find Graham’s face an inch or two from mine, his brow furrowed in alarm. Gently, he hooked his arms under my armpits and heaved me into a sitting position. One of his hands wiggled out from my armpit and began patting my back in a rhythmic thump. The thumping was a little too vigorous, but also nice, like I was a baby or something. I hiccupped.

  “Is it bad?” His voice was soft. “Whatever’s bothering you?”

  “Oh,” I said. I hiccupped again, which then turned into a full-blown sob. I covered my face.

  “It’s okay. It’s okay,” he said. “Shhh, Zadie, it’s going to be okay. Do you want to talk about it?”

  It came flooding back: the knifelike awareness that had struck me as Edict’s intubation had changed from exciting to terrible. One minute, I was blithe and confident; the next minute, a rush of shame and fear engulfed me in a clanging drumbeat. Don’t keep trying for longer than you can hold your own breath, Nick told me. Without the tube to breathe for her, she would suffocate to death in a matter of moments. I’d felt my lungs screaming for air and still all I could see was a featureless landscape of homogenous pink in her airway; there was no sign of the vertically slanted whitish vocal cords, which were the structures I had to locate in order to get the tube into her trachea. Nick had taken over as soon as it was clear that disaster loomed, and we bagged her, but her oxygen levels had not risen. After an eternal agony of time, Nick had managed to get her reintubated. But by then crucial minutes had passed without oxygen.

  She was twenty-seven. She was pregnant.

  Again, I felt the nausea rise as I thought of my carelessness in preparing for the intubation. “I do and I don’t,” I said to Graham in a tiny voice.

  “It’s okay if you want to tell somebody,” he said. “I think it’s making you sick.”

  My tears surged up, little balloons of shame against my closed lids. An indeterminate choking noise escaped me.

  I felt Graham slide over, and then his big arms were around me. “What I did, it’s unforgivable,” I told him, my tears wetting the front of his soft flannel shirt. He was quiet, patting my hair gently from time to time until I got ahold of myself. I could hear his heartbeat, a steady, distant, reassuring thud.

  “Nothing’s unforgivable, Zadie,” he whispered.

  I shuddered and closed my eyes. We sat like that, lost in our separate reflections, until my voice was steady enough to talk. Graham listened silently to my account, his face hardening as I talked.

  “How could Dr. X—” he began.

  “What’s wrong with Zadie?”

  We both looked up, startled. I scooted out of Graham’s arms. Emma peered down at us, undoing her pinned-up knot of hair, releasing a buttery flow of silk. With her pink cheeks and swimming-pool-clear blue eyes, she looked like an arctic beauty queen.

  Graham gestured to the futon. Emma sat down beside me, primly perched at the edge, her head half-cocked. “Are you okay?” she asked.

  I shook my head, knowing if I tried to speak, I’d start wailing again. I glanced helplessly at Graham.

  He leaned around me toward Emma and, in a low tone I could barely hear, filled her in. She listened, quietly at first, and then with increasing incredulousness.

  “Zadie, none of that is your fault!” Emma sounded appalled. “Where were the respiratory therapists when this happened?”

  “He asked me if I had everything ready, and I said yes.” I shut my eyes, remembering. “It was just the two of us; there weren’t any RTs there. Ni— Dr. X knows all about ventilators; he gave us the lecture on ventilator management, remember? We paged them, but he got tired of waiting and told me to go ahead. So I did.”

  Emma jumped up. “Dr. X holds one hundred percent of the responsibility there. He never should have attempted a complicated intubation in a pregnant trauma patient without the respiratory techs present, let alone tell an absolutely ignorant third-year medical student to ‘get everything set up.’ And the truth is, that girl was never going to survive anyway.”

  “You don’t know that,” I sa
id miserably. “I kept pestering him to let me do it. I thought I knew what I was doing, and I didn’t. And he probably only let me do it because . . .” My voice trailed off. I didn’t have to say what we were all thinking. Nick had let me do the procedure without adequate preparation because I was sleeping with him.

  “Anyway, the short version is, I messed it up. I failed that patient.” I spoke quietly. I thought of the suction I hadn’t hooked up, the disconnected oxygen. “It turned out her airway was swollen. I couldn’t see anything at all when I looked with the laryngoscope. Her lungs were already trashed, so she didn’t have any reserve. He finally did it somehow, but . . . she died a few hours later, when her family decided to pull the plug.”

  I hesitated and then gave voice to the thought I’d been trying to suppress:

  “I don’t think I can be a doctor now.”

  Graham and Emma began speaking at once; Graham’s voice was steady and quiet, Emma’s higher-pitched and insistent. Graham deferred to her and went silent, both of us absorbed by her vehemence. She swung in my direction.

  “Listen to me, Zadie.” Her eyes bored into mine. “I could go on and on about how none of us are perfect, how everyone makes mistakes, and all of that shit. It’s trite, but it’s true. And in your case, she was going to die anyway, and I don’t think the responsibility lies with you. But regardless, there’s good that will come from this terrible thing. And it’s not you giving up a career you’re going to be great at.”

  I dropped my eyes.

  Emma twisted until I looked at her again. “Maybe none of us can be truly gifted at medicine until we’ve grasped the consequences of what we do. In most jobs, most of the time, you can put in a half-assed effort and the world isn’t going to stop spinning. But in this case, the world did stop spinning, at least for one person—two people, actually. It’s not enough to understand intellectually that lives depend on you. You have to feel it; and maybe you have to experience the crushing weight of responsibility that comes with all the accolades and respect and financial comfort accompanying medicine. You’d be a brilliant physician and a caring one no matter what. Now you’ll be the most conscientious doctor you can be, because you know what it’s like to fall into the depths. Maybe it seems easier to quit at this point, but, Zadie, you owe it to her to keep going.”

  I tried not to cry again—all this crying was getting really old—but there was no stopping it. I recognized some truth in what Emma said. But even if there was a silver lining, the thought of benefiting from the grotesquerie of someone’s death in any way seemed monstrous. I thought of the way she’d looked—her delicate jaw, her dark hair fashioned in a pixie cut—and misery swamped me so thoroughly I wondered if it was possible to die from it. I cried, feeling as cut off and alone as it was possible to feel, spinning away in my own little joyless universe.

  Then, from somewhere in the void, I felt a hand clasp mine and squeeze briefly before letting go. “Oh, Zadie,” Emma murmured in a voice I’d never heard before. She hesitated and then drew me against her. She and Graham linked their hands behind my back and around my front, hugging me in the middle until I wasn’t sure where I ended and they began. To my surprise, Emma pressed her cheek against mine, letting my tears wet her face as the three of us clung to one another, rocking slightly back and forth, oblivious to the party raging all around us.

  Chapter Twenty

  A FORCE FIELD OF PAIN

  Emma, Present Day

  There were 147 steps between the pediatric ICU and the Family Conference Room. I knew because I counted as I walked, and when I reached the conference room, I turned and retraced my steps. This time the count was off by two: 149. I’d have to redo it, both ways.

  It took five minutes to confirm the total—147, correct the first time—but I added a third retracing to be sure. It didn’t help: no march to the gallows had ever been heralded by such dread. I reached the door of the family room for the third time, but I could not raise my hand to knock.

  After they’d finally dragged me from the Packard child’s bedside, I’d hurled the contents of my stomach into the nearest trash can. I could feel my mewling stomach now, acid eating away at the lining, consuming me from within. I tipped my head backward and began to count the rectangular ceiling tiles.

  Something no one knew: in med school, I began to have panic attacks. I didn’t know that’s what they were; I thought I suffered a form of hereditary insanity, my mind turning inward on itself in a cannibalistic fury. Black formless dread would seep over me like an unexpected immersion in a cave; I couldn’t catch my breath and sometimes I couldn’t feel my body. Gripped by sharp talons of terror, I’d have to hold on to the nearest object to keep from being swept away into the void.

  Eventually, I learned what was happening, and the doctor at the student clinic, an early practitioner of Eastern meditative medicine, taught me techniques to soothe myself back from the brink. What worked for her didn’t necessarily work for me, but I figured out I could calm myself by counting, or by physically arranging items into a logical progression by size, or sometimes by repeating a phrase in my mind until it became meaningless. And if I could, I’d run. Sometimes I ran for ten miles or more, the thudding repetition of my steps one more thing I could count.

  So there I stood: thirty-six years old, number one in my medical school class, the top choice of my acclaimed surgical residency, the recipient of a perfect score on Part 3 of the USMLE, a surgeon, a wife, a mother; there I stood, outside this bland beige door, my head tilted so far back it hurt, frantically counting and recounting the dingy speckled tiles of the hospital’s ceiling, the numbers churning and blurring in my mind, as I waited for a relief that I knew would never come.

  Chapter Twenty-one

  NONE OF THEM HAS EVER BEEN HUNGRY

  Emma, Present Day

  “What did you just say?” I could hear other voices behind Zadie’s: a low-level buzzing, phones ringing, an outraged baby yelling. Of course: she worked on Thursday mornings. I should have called her before she got to work, but I’d spent the last few hours rocking back and forth in my call room, leaving Sanjay to mop up the other patients from last night. “Emma, what did you say?”

  “I need to see you,” I whispered. My throat felt broken.

  “I’m at w— Okay. Okay,” she repeated. Her voice changed. “I’ll see if Melanie can cover my morning patients. Are you at the hospital?”

  I forced myself to speak audibly. “Yes,” I said. “Call room.”

  “I’m on the way.”

  I hung up, glancing around dumbly as if seeing my surroundings for the first time: gray-beige walls, a twin bed fashioned from a chemical-emitting laminate, industrial maroon carpet. The call rooms were awful, but they were palatial compared to the rooms in which I’d been raised. Usually, I tried not to let myself dwell on the subject of my humble origins, but in my present circumstances, any topic would have been an improvement.

  It was one of the many ways I separated myself from others. The women who surrounded me now were urbane and sophisticated; they thought nothing of dropping two grand on a handbag; this was true even of many doctors where I worked. They bought art. They lived in beautiful homes. They were cerebral, including the stay-at-home moms. They read Man Booker winners and science journals; or at least they read the clever, intricate wordsmiths of Vanity Fair and the New Yorker. At dinner parties, they could discuss foreign policy and the corporate world, casting their polished voices with assurance. Their parents were doctors or CEOs; the older ones had shiny, beautiful children at Carolina or Duke or one of the Ivies; the younger ones had fair-haired cherubs in smocked clothing. They owned heirloom china and silver. They knew how to write a proper thank-you. They understood how to manage nannies and housekeepers. None of them has ever been hungry.

  On the exterior, I blended with them perfectly.

  I did now, anyway. When I first got to college, I thought I’d ou
tgrown my childhood: I read voraciously. I spoke correctly. I was careful not to betray my upbringing. But the things I didn’t know about a fine life were legion.

  Charlotte isn’t New York, but it’s glamorous enough. Every time I drove home from work, there was still enough of the rube in me to marvel at the life I had somehow landed. I pictured my childhood self, a blond, skinny, shy waif, sitting on the cinder-block steps of our three-room home drawing shapes in the dust, and I knew how she would gape if she could see through her future eyes. She’d glance down and note the luxury car logo emblazoned on the steering wheel, and although she might not give it conscious thought, the sound quality of the music coming through the top-notch speakers and the softness of the leather seats would register. She’d recognize the white coat she wore, and then she’d run her hands along the fine fabrics of her clothing: the slippery silk, the kitteny cashmere, the fine, soft flare of breathable cotton.

  And outside her car windows: Oh! Skyscrapers, silver sculptures the size of houses, streets like living creatures, awash with women in suits pulling wheeled cases and trim bankers waiting for the light-rail. A hospital complex so large it qualified as its own city. An alien world.

  Even Zadie, the child of vaguely hippieish college professors, had a childhood exponentially more cultured than mine. She might not have been rich, but her family prized literacy and craft, two qualities not exactly abundant in my upbringing. If you took a bird’s-eye view of the home where Zadie was raised—lofting yourself high above the line-drying quilts and the neat rows of butter beans and tomatoes—and you flew due east into the Appalachians, you’d eventually come to a county near the West Virginia border with only one stoplight. One stoplight and a scant row of crumbling two-story 1940s-era buildings lining the main drag, giving way within a few hundred yards to the likes of concrete-block gas stations and one-room churches. When some urban decadent from New York or LA needed a smug reference to a provincial glob of ignorance, this was the Kentucky they invoked (assuming for some reason Mississippi was unavailable, of course). From every vantage point, you could see the mountains: looming, dark monsters blocking the light, forcing the road to curve back on itself like a snake trying to eat its tail. The mountains of my childhood had once possessed a wild kind of beauty, but by the time I was born, this was gone. Now they resembled cancer survivors, their tops hacked off, trailing grime and silt, denuded of trees.