The Possible World

by Liese O'Halloran Schwarz

  The aides stay in Gloria’s room much longer than they need to, longer than they ever do in Mr. McHenry’s room on my other side. Since his stroke, Mr. McHenry doesn’t speak well; it can take him a long time to find each word. His bedtime ritual is much quieter, the aides talking to each other as they work together to get him tucked into bed, treating him like I am so often treated, as if he isn’t even there. They’re in and out of his room in an eyeblink, giving him no time to eke out a sentence. Their trilled Do you need anything else? is followed immediately by the door clicking closed. The aides never wake me by joking with Mr. McHenry.

  When more laughter erupts next door, I knock on the wall. Three raps. The voices stop abruptly.

  “Oops,” says one of the aides. “Shhh.”

  Activity resumes more quietly amid whispers. A giggle—maybe they are laughing at me, maybe just another story. More pills, more murmured conversation. Then the voices stop and the door closes.

  A full minute. I can hear her breathing, and I recall the long ritual of pills. For such a relatively young woman, she really must not be well.

  “I do know where I am,” says Gloria clearly. “I suppose I was indulging in a bit of denial. You’re right, that couldn’t last. Nothing does.” Her voice is calm. I hear a click of the bedside lamp. “Good night.”

  * * *

  AN HOUR LATER, I am still wide awake, my right hand lying over the area where a fragment of my history makes its secret beside my heart. The overlying scar is ragged, like a half-spoonful of pink jam smeared across my skin, numb in the center but sensitive at the edges. My fingertips move over the painless, painful place, that survivor’s wound.

  Nothing lasts. Though I lie here breathing, remembering, though I have existed and still exist, there is no proof of any of it. The years have poured through me; I am a vessel, nothing left of all I have known and felt except a photograph I won’t claim and this sediment of memory; soon that too will be gone. And what after? No matter what the nuns promised, I fear that this is the only world there is. I am aware of how generous my lifespan has already been, yet I am galled at how ephemeral is all our suffering, all our loving and our hope. Nothing, nothing comes of it; nothing that won’t be snuffed out in an instant by death, leaving no trace.

  The nuns would be horrified at these thoughts; so would my mother. They would tell me hush, they would remind me of Heaven’s glory, and of the miracle that saved me, once upon a time. God has His reasons, they would say. There was a time when I would have believed this too. But that was a long time ago, and now I see it differently. To me, it seems more than possible that not all miracles come from God.

  CHAPTER FOUR

  * * *

  Leo

  NOBODY GETS ANGRY HERE. NOT the lady with the fluffy sweater and the half glasses, not the police officers. They don’t even raise their voices. Everyone does a lot of crouching and looking me in the eyes, and their voices are soft, soft, like I am sick and they’re really sorry.

  They give me cookies, four in a packet that crumble into sweet dust in my mouth and make me cough; they give me grape juice in a plastic tub with the foil peeled up on one side, and they don’t get upset when I spill. The first night, one nurse washed me for a long time, bringing a chair right into the shower and letting me sit down and close my eyes while she scrubbed and scrubbed at my hair. They give me a pair of yellow pajamas with trucks all over and metal snaps up the front, and in the morning they bring a big brown tray and lift off the top, releasing a plasticky smell from compartments filled with scrambled eggs, two short tubes of sausage, two sweaty triangles of buttered toast, a tub of orange juice, and a carton of milk. A lady opens the milk and cuts up the sausage for me and then lays the fork down on the tray and says eat up.

  The questions begin after breakfast. There are a lot of them and a lot of different people asking. They want to know how I’m feeling, they want to know if anything hurts, they want to know anything—just anything you remember. My mind is empty, a big shiny bowl holding nothing.

  They show me pictures, black-and-white photos of faces on a piece of cardboard, six of them. Do you recognize any of these guys? Just point if you’ve seen one of them before. The men are wide-eyed, like they’re surprised to be photographed. Look again, just take your time and look carefully. I don’t know any of them. I can tell the policemen are frustrated. The old one with the hair on the rims of his ears pushes his gray eyebrows together every time I shake my head.

  Once when the fluffy-sweater lady leaves for a minute, the two policemen are alone with me and I think uh-oh. The hairy-ear man comes forward, and I get ready.

  “Kid, give us a break, okay?” he says.

  The tall blond man behind him starts to say something, and the old one puts up a hand, just shows him the back of it, like stop.

  “We want to get the bad guy who hurt your mom,” he says. “Don’t you want to help us get the bad guy?”

  A flicker of something in the emptiness. “You mean Clyde?”

  “You see,” says the old guy to the blond one. “Clyde who? What’s his last name?”

  “Did Clyde hurt Mama?” Mama. The word comes naturally, but brings nothing with it: no face, no feeling.

  “That’s what we’re asking you. This is very important.” His face is really close now. “You must have seen the guy who hurt Mrs. Wasserman and your mom. You were right there. Just tell us.” He brings out the cardboard with the photo faces again. “Is it any of these guys? Don’t be afraid, he can’t hurt you now.”

  I don’t know the faces on the cardboard. I don’t know Mrs. Wasserman. I do know Clyde. It’s fleeting and flapping around the corner of my memory, a blue shirt on a wash line, a pair of black boots inside the door. A bad feeling licking up around the sight of the boots—he’s home—but then draining away just like that, out of my mind. I hold my breath and try to coax it to me—the boots, the boots—but then the lady comes back and she shoos the cops out.

  When everyone’s gone and it’s quiet, I hold my breath and the flickering expands into snatches of thought: Clyde would have backhanded me for talking too little or talking too much; Brother Timothy’s face would have pinched up with disgust and I would have to hold out my hand, or both hands, if he’d had enough of your insolence, young man. So the shiny bowl isn’t totally empty after all; there’s Clyde, and Brother Timothy. But they’re mere flecks swimming around, and if I try to look directly at them they swirl away, leaving just the peaceful emptiness, like a blanket of new snow over a landscape.

  I know it’s a hospital but I don’t feel sick. They haven’t told me what’s wrong with me, but I guess it’s bad because everyone’s very, very sorry. They’re sorry to move me, to wake me, to ask me questions. The sorrow is in the cookies, the juice, the rough towel they dry me with after the bath, but mostly in their eyes, all of their eyes that don’t look right at me. It’s as though I’m the sun, too painful to look at, I am something too hugely sad to behold.

  CHAPTER FIVE

  * * *

  Lucy

  WHAT WAS THE NAME OF that pasta we liked

  How is he able to do this every time? His texts carry so much with them, like tiny digital icebergs, and seem impossible to answer. Is he reminiscing about the early days of our courtship, or planning dinner with his new girlfriend? Does he presume that six weeks is far enough past the immediate turmoil of breakup to chitchat and share recipes, or is this a way of reaching out? It feels like a test.

  Which one

  There, put the ball back in his court, matching his lack of affect and punctuation. Make him explain himself. The answer comes quickly.

  The one with the capers

  The memory telescopes out from his words, taking my breath with it. Like a punch in the chest. Of course he’d meant that one. The one he’d labored over for my birthday our first year together, settling me with a book and a glass of wine and barring me from the kitchen for hours while he cooked, that little apartment filling with aromas: gar
lic, browning butter, rosemary. Finally leading me to the table, making me keep my eyes closed until the big reveal. The first thing I saw when I opened my eyes was the heap of dirty pots and pans in the sink behind him, before seeing his huge smile and then, looking down, the plate of linguine. He must mean that pasta. So what should I reply?

  The one you made when we lived on Mott Street? No, that sounded sentimental. How about I don’t remember? Too obviously disingenuous. I could say Ugh, that one—I hate capers. Although true, that would be just nasty to tell him now, after all the years of pretending that it was a delicious meal instead of one cherished primarily for the love and the effort. It seems very much in keeping with what I am beginning to understand about him that he remembers the pasta, but not the rest.

  Why

  The single word throbs on the screen like an accusation. Don’t ask a question unless you’re prepared for the answer. Don’t I remember that from some television courtroom drama? He might say Making dinner for new girlfriend or Missing you. I’m not prepared for either of those. I tap the Delete key three times, leave the screen blank, drop my phone back into my pocket.

  * * *

  I’M A WEEK into a Nights Month, the twice-yearly dreaded block of night shifts. Also known to the residents who suffer it as Death Month. Each shift starts at 11 p.m. and ends at 7 a.m., officially a mere eight hours but always bleeding well over the finish line. In a Death Month, I go to bed midmorning and rise again after sundown, the day swallowed by unconsciousness, and life is made into a speeding night train, all the color and sound flashing by the window in segments: one night, two nights, three. Hold your breath and count them, six in a row and then a day off; after four weeks of this, the disconnection from society will feel like a mild psychosis.

  Tonight, judging from the waiting room, things are under control. Scattered patients waiting, no one moaning or crying or vomiting. A child leans into its mother, neither of them visibly ill, both of them training their eyes on the television suspended near the ceiling. But who knows what is behind the locked doors to the urgent area? Sliding my ID badge through the security scanner, I steel myself for the first glimpse of what kind of night it might be. The double doors chunk open to an almost-empty triage area—only one patient there, a man on an ambulance stretcher. At bedside, the charge nurse, Sheila, and the intern, Alice; at the foot of the gurney, the two paramedics who brought him in.

  “Hiya, Doc,” says one of the paramedics.

  “Hey, Bill.”

  Big Bill must work nearly every day. Tall and bowling pin shaped, he reminds me of one of those inflatable clowns with sand in the base that my cousins and I used to punch when we were kids. The first time I heard the gravelly shout of his voice I laughed out loud, thinking it was a joke.

  “Found Down,” Sheila tells me, pumping the rubber bulb to take his blood pressure. The patient lies still, eyes closed, no response as the cuff tightens around his biceps.

  “Just layin’ there in the middle of the sidewalk,” says Bill.

  “We’re trying to figure out if he needs a trauma room,” says Alice.

  Sheila thumbs the wheel on the bulb, hissing the air out, and takes the stethoscope out of her ears.

  “Normal vitals,” she says.

  “Did he respond when you put the IV in?” I ask Bill.

  “Nope.”

  He doesn’t look like the usual Found Down. Clean clothing, neatly dressed. He’s maybe forty, just a few strands of gray in the hair that’s cropped to a tidy level above his ears. I lean forward: no eau de street comes up from him, no alcohol, urine, vomit, or ripe sweat; instead, a faint whiff of aftershave. Apart from the scissored sleeve of his jacket and shirt, where EMS has gotten IV access, he looks as though he could be peacefully asleep on his sofa at home.

  “Maybe it’s a whaddyacallit, designer drug,” brays Bill.

  “Dextrostick was ninety-six,” says Bill’s partner. Not diabetic coma then. “No track marks, so we didn’t give Narcan.” His tone a bit anxious, seeking approval.

  “Makes sense,” I say. It still could be heroin—no need for needle marks, it’s easy to snort an overdose—but nothing about this guy looks like heroin. It was wise not to give Narcan if there’s not actually an overdose; the medicine’s effect is highly unpleasant with a reaction that often includes violent vomiting, and unconscious patient plus vomit equals aspiration and possible death.

  They all stand there looking at me.

  “Well, by definition he’s comatose,” I say. Coma: unresponsive with eyes closed. “I guess he needs to go to Trauma.”

  “Can I help?” Alice asks. I nod. As an intern, she works urgent care in the Big Room only; she won’t get to Trauma Alley until next year, when she’ll junior on critical cases. In two years, Alice will groan at the sound of a trauma call over the PA, and play Not-It with her colleagues; but for now, she is excited by the prospect of caring for one of the sicker patients.

  “Trauma One,” directs Sheila, and we roll him there while Bill and his partner stay in the triage area to write out their paperwork.

  In the trauma room, we get to it. Sheila brakes the stretcher and goes to retrieve the neat coil of wires looped over the monitor on the wall, flips off the plastic tabs and adheres the leads to his chest, while Alice cuts his clothes off and I listen to his lungs. Both sides clear. The pulse oximeter clamped to his index finger reads 100 percent.

  “Nice shoes,” I comment, tucking the socks inside them and dropping them into a plastic patient-belongings bag. They’re expensive-looking loafers, unscuffed, not your typical junkie footwear. Curiouser and curiouser.

  “Okay, what now?” asks Alice.

  “Airway’s good,” I say. “So—?”

  “Breathing circulation,” she finishes, pulling two gloves from the box on the wall and snapping them onto her hands. She puts her stethoscope against the skin of the patient’s axillae, left then right, and reaches under the gown to press two fingers over the femoral canal at the top of his leg. “Good pulses,” she says.

  “So he doesn’t need CPR,” I say. “Let’s finish the exam.”

  We go over him head to toe, looking for occult signs of trauma, checking the webs between his toes for injection marks, ending by rolling him to look at his back, doing a rectal exam while we’re there—normal tone, no blood.

  “Nothing,” says Alice when he’s supine again. “This is weird.”

  “Now a good coma exam. First, a noxious sensation.”

  I show her how to use a Q-tip to tickle his nose. Cruder options are nipple pinching or knuckles rubbed hard along the sternum. Nose tickling is just as effective, and a more elegant choice, one that doesn’t leave bruises. The cotton bulb twirled lightly around the inside of each nostril provokes no reaction: the patient doesn’t raise his hand or even grimace. I uncap a sterile needle and touch it lightly to the soft area between his first and second toe on each foot, then march the point up the spinal levels: the side of the foot, the calf, the outer thigh, inner thigh, and then up the torso left right left right, all the way to the collarbone. Zero response of any kind, at any level. But he’s not paralyzed: his reflexes at knee and ankle and biceps are normal.

  “What tests are you going to do?” I ask Alice.

  “Um,” she says. “Tox screen. Definitely head CT. ABG?”

  In reply, I take an arterial blood-gas kit from a drawer in the bank of cabinets that line the side of the room and hand it to her. This will kill two birds—not only the measurement of gases in his blood as a clue to metabolic or respiratory dysfunction, but the provision of a stronger pain stimulus than any other one thus far. An ABG is notoriously uncomfortable in doctorspeak.

  Alice sinks the needle into his right wrist. He’s still as a rock. As the bright arterial blood pulses up into the slender syringe barrel, Sheila pulls a bigger, darker sample from a vein in the other arm and then distributes that blood into various tubes for routine tests.

  “Should we intubate him?” Alice ask
s, pulling out the ABG needle and taping a pressure dressing over the puncture site.

  “No. He’s breathing fine, and there’s nothing to suggest cerebral edema.”

  We stand for a moment looking at the patient, who lies completely placid, naked under the thin cotton gown, no injuries or abnormalities evident except those that we have inflicted, the bandages from the blood draws and the tiny drops of crimson along the path of my needle. Sheila says what we are all thinking:

  “What the hell is wrong with this guy?”

  It’s been a good while since I’ve been completely flummoxed. Of course, at the beginning of my training, I was constantly baffled and overwhelmed, but at some point in the second year of residency, the ratio of unfamiliar to familiar dropped into a more manageable zone, and it’s continued dropping ever since. Human physiology and behavior can always surprise, but there are some axioms too, some deep consistencies so basic they are immutable, like the laws of physics. This patient is like something falling up: he simply does not make sense.

  He doesn’t smell like alcohol. His pupils are too big for an opioid OD. His breathing is normal: not fast to indicate metabolic acidosis, nor slow from carbon dioxide retention. His normal heart rate rules out almost all other overdose types. He could have a brain bleed, but that’s unlikely without neurologic deficits. I can’t shake the persistent impression that he is merely sleeping.

  “We still need the tox screen,” says Alice.

  “How’re you going to get that? It’s not like he’s going to pee in a cup for you.”

  “Oh, Foley, of course. I’ll do it.”

  A few minutes later, she’s poised with the catheter at the tiny pout of his urethra, her other hand gripping his penis at its base.

  “Okay. A little pressure now.” She’s nervous; although this might be one of the simplest medical procedures in existence, she hasn’t done it very many times yet.