The Possible World

by Liese O'Halloran Schwarz

  This CT shows the exact opposite of a lobotomy: the posterior, not the anterior, frontal lobes are destroyed. The posterior lobes are the home of conscience, decorum, shame. Without their inhibitory function, the impulsivity in the anterior lobes can run unchecked, setting the darker, angry side of the person free.

  The bullet rests innocently just behind the ear, an irregular chunk of dense white, like a comet with a tail of destruction behind it. Smaller than my fingertip.

  “I heard the yelling.” I turn. It’s Giles, the psych resident on call. He looks at the monitor. “Yikes.”

  He’s doing a wise resident’s preemptive strike, trolling the ED for potential consults before he’s called, in the hopes of getting the paperwork done early so that he can get some sleep tonight.

  “Am I terrible to be relieved that she’s not coming to me?” he asks.

  Giles and I met as interns and jumped straight into a light chumminess from the moment he’d looked at my ID badge. “We both have the names of British children in postwar children’s books,” he’d said. “Riding railways and carrying rucksacks and forever telling each other to keep our chins up.” His mother is Chinese; he’d lived in Hong Kong until he was nine. In that first conversation, I learned his biggest regret (being brought to America just young enough to lose his accent), his biggest grudge (against his parents for same), his short-term goal (a hot boyfriend), and his long-term goal (a hot husband). He’s funny and sharp-witted, the kind of person who knows every phlebotomist and tech and housekeeper in the hospital by name. When I’d told him about Joe, for once the sparkle had dimmed, and he’d hugged me. Chin up, Lucy, he’d murmured, and it had been unexpectedly bracing.

  “When are you done with nights?” he asks. “We should get a drink.” A surprising invitation—we’ve always been strictly hospital friends.

  “April.”

  He winces. “Brutal. Well.” He taps the counter, two brisk knocks. “Maybe we can have an early dinner before then.” He grins and is gone.

  * * *

  A HISPANIC MAN in a windbreaker is there when I get back to Trauma 2 after reading the CT. I see that the chart now has a name: Ortiz.

  “Rosa,” the man is saying, bent over the stretcher. He has one of her limp hands in his. “Abre los ojos. Mirame.” He sees me. “What’s wrong with her?”

  “It looks like she was shot.”

  “She was shot?” His accent gets thicker suddenly: chot. “Where?”

  “In the head,” I say as gently as I can. How could anyone say that gently?

  “Pedazo de mierda,” murmurs Rosa. Mr. Ortiz looks shocked.

  “I think we’re ready for more Haldol,” says Sheila. I nod and mouth five.

  “Vete a la verga,” Rosa says, pulling her hand out of her husband’s grasp; lightning-quick, she slaps him across the face.

  “She’s not herself right now,” Sheila tells him, sneaking the Haldol into the IV port.

  “Vete,” Rosa says, slapping the air as he backs away. “Asshole.”

  “Rosa,” says Mr. Ortiz, staring at his wife, his hand still over his cheek. He turns to me. “She’s—you know? Callada. Reservada. She makes, you know, pictures with sewing. We have children, five and seven years. She’s always tranquila, you know, she never yell.”

  “Are your children okay?”

  He nods. “They were sleeping. They didn’t wake up.” The tears come into his eyes. “I was at my cousin’s house.” I can smell the cousin’s beer on him. “I should have been home.”

  You’d be shot too, I want to say. You’d be in Trauma 3.

  “She need surgery”—miming, an open hand moving vaguely around his head—“to take it out?”

  “Maybe. It depends on what the neurosurgeon recommends.”

  “When she is going to be better?”

  He means when will she be back to normal. How can I say never?

  “It’s not clear how she’ll heal,” I say, sidestepping. “There’s damage to the part of her brain that has to do with personality.” I’m not sure how much he understands, but he’s nodding and I press on. “She’ll need to stay in the hospital for at least a few days. Then she’ll probably go to a different hospital for a while, in case she has trouble with things like walking.”

  There are antibiotics to prevent infection, anticonvulsants to prevent seizure, the ICU and then the rehab facility where Rosa can be nursed back to health. And odds are good that she will heal, every part of her except the shattered brain tissue.

  “Culera,” mutters Rosa. Her voice is slurred, the Haldol booster beginning to take effect. “Vete a la chingada.”

  He blanches, takes another step back.

  “My wife is a Christian,” he says. “She doesn’t even know those words.”

  His meaning is clear: this is not my wife. He’s right. The quiet, religious needlepointer is no more. This profane, irascible woman has replaced her.

  Who could blame him if he leaves her after this, in a month or a year or a decade? When she goes home, if she is ever able to go home, her children will not know her. The younger one may grow up without any memory at all of the person she was before. This injury has already taken Rosa from her family; in the years to come, it will take them from her too, driving away everyone who has known and loved her before tonight.

  When I pass the room a while later, I see a spare tableau: Rosa lying back with eyes closed and a middle-aged woman standing alone at the side of the stretcher, holding her hand.

  I have often thought that if you’re going to have a child, have a daughter. She’ll be the one by your bedside in the ER and in the ICU waiting room, sleeping on the hard chairs around the clock to be allowed in to see you for fifteen minutes every four hours. She’ll be the one arguing with your doctors about your medicines or your diet, talking to you in your coma, encouraging you through physical therapy. Looking at Rosa, I can see that the child is only half of the equation. In the end, there might be only one person by Rosa’s side, one person who will still see the baby, the girl, the Rosa-ness in the coarse, vituperative stranger. It will take more than this to drive a mother away.

  * * *

  NO ONE KNOWS the hospital like an ER resident. We rotate through every specialty and become familiar with every unit and floor. That knowledge has come in handy recently, every morning when my shift is over and I’ve needed a place to sleep. Of course, I could just go home, but each day I consider it briefly and decide no.

  The internal medicine call rooms scattered around the building are off-limits; they’re strictly assigned. I could easily find an empty pallet in one of the surgical bunkers filled with the breath of unwashed napping interns. But I know a secret, so I get into the elevator and press the button for eight. The doors slide closed and eight levels above they slide open again on Obstetrics.

  I badge into the doctors’ lounge, empty now, everyone at rounds or in the OR, and go past the espresso machine, past the comfy armchairs and flat-screen TV. Push through the door at the back, and there it is: the OB call suite. Six clean quiet rooms snuggled into the corner of the building. No bunk beds here; these call rooms are plush. One room each for an attending, resident, intern, and student still leaves two unoccupied; I’ve staked one of them out with a toiletry bag on the nightstand and a jacket over the desk chair. Knowing no one will challenge it—who would sleep here voluntarily if she could be home?

  As I’m falling asleep, entering that delicious interval of loosening, my joints and spine melting into the mattress, my brain disengaging and wheeling free before the plummet into unconsciousness, I suddenly see Karen. Laughing, shaking her head. Life is too damned short. The way she says it, it’s a quip, the end of a funny anecdote, not a prophecy. Her face bright with amusement, just another afternoon of another day in the long domino series of days we’re all so foolishly sure we have ahead of us. Is it memory or dream? Impossible to tell.

  CHAPTER SIX

  * * *

  Clare

  WHEN I FIN
ALLY NOTICE THE new pill in my morning cup of medicines I wonder how long I’ve been taking it. I’ve gotten into a lazy habit of swallowing the pills without inspecting them. Nearly twenty years in this place means I’ve seen a lot of changes. The waxed, gaily patterned Dixie cup has shrunk into a soft fluted paper thimble; the colors and sizes of the pills themselves have varied too, as one medicine goes generic, or as another stops being manufactured. A new one gets added for a while twice or three times a day to treat a minor infection; then that one goes away and it’s back to the familiar quartet: vitamin pill, calcium pill, stomach pill, laxative.

  “What’s this pill?” I ask the nursing assistant, pointing to the cup.

  “Which one?”

  I turn the cup over into my palm and poke my finger into the pile of tablets, chasing the green oval one away from the others.

  “That one. I’ve never seen that one before.”

  “I think that’s antacid,” she says, but not with any conviction.

  “It’s not. This one is the antacid.” I chase a different pill to the rim of the bowl my cupped palm makes. When did my hands become so hollow?

  She looks at the two pills balanced on the edge of my hand. “Maybe a water pill?” she guesses. Her phone buzzes and lights up her pocket; she darts a glance down. She’ll be in trouble if any of the nurses notice. Phones are supposed to be off during a shift.

  “I don’t need a water pill,” I tell her. “I have never needed a water pill.”

  “Maybe the doctor added one.” She looks down again into her pocket, straining to read the message there. “Almost everyone here takes a water pill.” She adds in a stage whisper: “Mrs. Pereira takes three different water pills.” Really, this one should be fired.

  “The doctor didn’t talk about a new medicine the last time he visited. Surely he would have said something.” Her expression tells me how bizarre that statement seems to her: Who would bother discussing medical decisions with doddering, ancient me? One doesn’t inform the shrub when it’s being pruned. “Well, he should have said something. Anyway, nothing about me has changed, so why would my medicines need to change?”

  “I don’t know,” she says, her impatience no longer subtle. She holds out the cup of water. “Here you go.”

  “You expect me to take a mystery pill without any explanation?”

  Still holding out the cup of water: “Miss Clare. You need to take your medicines.”

  “Or what.” I close my hand over all the pills.

  She’s not looking; she’s scooped her phone from her pocket with her free hand and she’s frowning at it, tapping at the screen with one thumb.

  The arrogance! It reminds me of my former neighbor Ellie Schlosser’s story from the Anschluss—the booted Nazi tossing a command at her as she was walking out of Vienna. Go back, he said, without even stopping. He didn’t even look to make sure I obeyed. He just presumed I would obey; he presumed we were all that beaten. She didn’t obey. She didn’t go back; she kept walking and she escaped, and lived until ninety-seven and died surrounded by generations of descendants, just next door here at Oak Haven, in the room Gloria has now.

  “Are you kidding me.” The aide has noticed at last that I have not taken the water from her. “You will not win this,” she declares. “I have a toddler at home.”

  She drops her phone back into her pocket and shifts her weight to her other hip, and we stay like that for a while, her holding the water out, me with my geriatric fist clutching the pills. Her eyes are focused in the middle distance, over my head.

  “I have other residents waiting,” she says finally, breaking the standoff.

  “Don’t let me keep you.”

  She mutters something, sets the cup of water down on the bedside table, and leaves the room. I rest my hand on my knee.

  Now I’m thinking about Ellie. She’d been the subject of an oral history project; a student had come every day with her recording equipment, and for some weeks snatches of monologue, in Ellie’s deeply accented English, floated out from her room. I had to choose between my husband und my mother. My mother made me go. Her voice matter-of-fact about everything else but her mother and the peremptory Nazi. She returned to him again and again. The arrogance! The arrogance of that man! The outrage lancinating across the decades, fresh for a few seconds before her narrative subsided again into a composed recitation of fact.

  Belinda, the heavyset Liberian nurse who’s been at Oak Haven about as long as I have, comes into the room.

  “Belinda,” I say, shaking away the ghost of Ellie. “That girl is trying to kill me.”

  “No one is trying to kill you, Miss Clare. My goodness. What’s the trouble?”

  “She’s giving me someone else’s medicines.” I open my fist to show her, the pills rattling in the valley of my palm. My skin so dry that the pills aren’t sticky, not even a little bit. How could I need a pill to rid my body of water?

  Belinda gives me a long, hard look.

  “Why do you treat people like that?” she says. “You know her name.”

  “Her name doesn’t matter. She’ll move on in a year.”

  “Everyone’s name matters,” says Belinda. “She knows your name.”

  “Well, she’s paid to,” I say. “And it’s written on my door.”

  She waits.

  “Tanya then,” I say. “Tanya is giving me the wrong medicine.” I hold my hand out higher. “That’s not my pill.”

  “It’s Mariah,” she says. “Not Tanya. And you knew that.”

  She squints through her reading glasses at the pills. I touch each one with my forefinger.

  “That’s my vitamin, and that’s my antacid, and that’s my calcium, and that’s the laxative. So what’s that one?” I push it to the rim of my hand again, bring the hand up closer to her face.

  “That’s a nerve pill,” Belinda pronounces.

  “What?”

  “Green oval with a D on it? Mmm-hmm, that’s an antidepressant.” She straightens up.

  I can’t make out the D, but it is green and it is oval.

  “I don’t take a nerve pill. That’s not my medicine. Someone mixed it up.”

  Belinda lifts the top page of the clipboard she’s carrying and scans the page below.

  “It’s your medicine all right,” she says. “Started on Monday. Dr. Evans’s orders.”

  “Why in the world,” I say, staring at the little green pill.

  “His note here—” She struggles to make out the handwriting. “He says Mandy’s reported you’re withdrawn.” She looks over her readers at me. “You do spend a lot of time on your own.”

  Mandy is the recreational therapist, whose spirited intrusions we all have to bear. She pops into my room each Monday and reads the offerings from the list clipped to her brightly stickered clipboard, lifting her voice at the end of each, so that she sounds like she is reciting a list of questions: Senior Jazzercise? Mall walking? Ceramics? She entreats me with a special vigor to join in, as I am more mobile than most, despite my near-centenarian status, and despite the titanium rod in my thighbone. When I demur, she makes a mock frown and puts an X on her list. Apparently she also confides in the doctor.

  “You are always reading,” continues Belinda. “Even when you’re in the dayroom, it’s always with a book. You don’t talk to people. You don’t come to Bingo.”

  I bend the index finger that’s been holding the green pill at the edge of my hand and flick the pill away, in a long arc across the room.

  “That’s what I think of Bingo,” I say.

  Belinda shakes her head. “You know I have to pick that up.”

  “I’m sorry,” I tell her, and I am. “But I don’t need a pill to make me go to Bingo.”

  “Dr. Evans is just trying to help you,” she says, squatting to look for the pill. “He thinks you’ll be happier if you socialize a little.” She goes down to her knees to sweep a hand under the dresser. “Miss Clare, you are naughty. Look what you are making me do.” Her voice
is a little squashed. Success—she gets the pill and lumbers to her feet. She slaps invisible dust from the thighs of her scrubs. “Mandy worries about you. We all do.”

  “I won’t take that pill,” I warn her.

  “I’ll write that down so the doctor knows,” she says, and hands me the cup of water, watches me chase the other pills down one by one. “Good girl,” she says, and from her somehow it’s tender, not condescending.

  When Mandy next visits, although I feel like I’m making hostage negotiations, I agree to a mall walk on Thursday. She puts a tick against my name on the list with real delight.

  * * *

  WHEN THURSDAY COMES and Mandy appears in the doorway of the breakfast room, I’m already regretting my decision. Wouldn’t the day be better spent the usual way, with a series of naps and a book? Maybe I should have opted for ceramics: the messy bad-child feeling of the clay might have been fun. But at least mall walking will be a chance to evade Gloria, who’s been persistent as a terrier, always at my table for dinner, rolling up to me in the dayroom and striking up a conversation about whatever book I’m reading. She’s read everything, it seems, and has an opinion about it all. It’s gotten so that the noise of her wheelchair starts a dull headache behind my eyes.

  We need to be ready by 8:30 a.m., Mandy reminded us all twice the day before. Breakfast is served at seven, so that shouldn’t be a problem, but there’s the meal itself and then the slow scramble of preparation, each one of us in our room fussing over dress, hair, handbag contents. The wheres ripple from room to room. Where are my glasses, where is my wallet, my lipstick, my tissues? And then the debate: Where to carry cash? A purse, a wallet, a pocket? In a purse, it can be zippered in safely. But then the whole bag might be so easily pulled from one’s grasp. Mr. Simonetti’s preference is for a front trouser pocket. Coat pockets are shallow, you see, no depth to them. Mr. Tuttle boasts about his jacket with snap pockets—no rough zipper teeth to cut the back of your hand. Mrs. O’Meara has a bag with a strong interior compartment that zips. There is no detail too trivial when you’re old.