The Possible World

by Liese O'Halloran Schwarz

  “Well, he’ll need a name,” I said.

  Leo looked up at me, surprised.

  “I don’t want him in the house,” I warned.

  “I promise,” said Leo.

  Two days later, I woke to tiny needling sensations on my calf. The little cat was curled up behind my leg. How had he gotten inside? I reached down, felt the chittering breath of his purr on my fingers, disengaged his claws from my skin, and brought him up to sleep in a ball near my chest with a sigh.

  During the daytime, the still-nameless kitten followed Leo and me from chore to chore, jumping to bat at the cabbage moths where they hovered over the cauliflower heads, or lying on the dirt and giving himself a bath in various odd positions—one hind leg stuck high in the air while he worked on the soft fur of his inner thigh—or simply curled on his side, watching us through half-closed eyes. Leo fed him table scraps. Before long, he was big enough to eat a mouse, and massacred them happily at night. More mornings than not, I woke with the furry bloody-mouthed lump of him on my bed and a ravaged carcass on my doorstep.

  He earned his keep, I told myself, stroking his silky back in the dark. And it wasn’t like I’d taken on a pet. Not really.

  * * *

  I DIDN’T HAVE any animals by the time I came to Oak Haven, but Gloria had had a bird, a parrot named Carlo, who’d been with her since her childhood. He’d been trained to sit on her shoulder, and she even took him to work with her sometimes. He chuckled into her ear as she typed, startling her colleagues by bursting into commentary from time to time like a raucous sidekick. Gloria swore his conversation was intelligent, not just mindless repetition. He had a long memory: once when she was in her forties, he suddenly sang out in a strong, clear voice, “Elbows off the table!” She recognized the voice of her great-aunt, who had lived with her family and helped raise the children, and who had been dead for more than twenty years.

  “It was a shock,” Gloria said when she told me the story. “I hadn’t heard that voice for so very long. The most amazing thing was, I did have my elbows on the table when he said it.”

  When Gloria couldn’t live on her own anymore, something had to be done about Carlo, whose life expectancy might be more than a century. We aren’t allowed pets at Oak Haven. A sensible rule: animals are a lot of work and noise and mess, and who would care for them after we die? Still, the message stings: it is not our choice anymore. It is that shrinkage of a life that truly makes a person feel old, the pruning of all the small branches of possibility until one is left with just the nubbin of what is, and no more of what might be.

  Gloria belonged to a parrot-fanciers’ group on the Internet; before she came here one of them offered to take Carlo. The stranger drove from two states away to collect him while Gloria was still recovering from her latest coronary event, and by the time she was out of critical care, Carlo was gone.

  Carlo’s new mistress emails updates from time to time. Apparently he is still up to his old tricks, bellowing out the ABCs at dawn and murmuring nursery rhymes in Portuguese. Gloria loves to receive these messages, but they also pain her.

  “She’s asking What does Florzinha mean? Carlo says it all the time.” Gloria taps a response and presses Send. “It was my family nickname, Little Flower. No one knows me by that name now but Carlo.” Despite the tears in her eyes, there is a smile touching her mouth.

  My own nickname, chou-fleur, had been overheard by my Providence schoolmates and immediately corrupted in translation. Perhaps there is another very old lady even now, somewhere in Rhode Island, whose muddled memories include an adolescent shadow, that gangly, bookish Shoofly? And I have to wonder what kind of world it is that we live in when the only souls who know your true name are too far away for you to hear them if they choose to speak it.

  CHAPTER TWENTY-EIGHT

  * * *

  Lucy

  BY 3 A.M. MONDAY, THE urgent patients have been taken care of, the Tank is full and snoozing, and the chart rack is nearly empty. I’m jotting the procedure note after a shoulder reduction, my own shoulders aching pleasantly from the task. Some nights are busy all through, without a moment’s pause. But tonight has been more typical, a storm that has thrashed itself out by the wee hours. The pitch of the evening is behind us; the night shift is sloping toward dawn.

  “It’s so quiet,” says a tech.

  Everyone looks up: the secretary, the nurses. Even I stop writing.

  “I need a doctor here!” The shout comes from bed 8, a curtained cubicle on the opposite side of the big room.

  “You see what you did?” the charge nurse calls to the tech while running toward the source of the outcry. I follow, and by the time we get there, I’ve mentally ratcheted through the possibilities and settled on the most likely: a patient actively seizing, and at bedside a panicked family member.

  But when I pull back the cubicle curtain, it reveals not a family member but Alice the intern, and the patient is not seizing but dead. The monitor hanging above the stretcher shows a quivering line where the spikes and notches of heart rhythm should be.

  “He just stopped talking.” Alice’s voice is high.

  “Get him to Trauma,” I say, and a small crowd of nurses and techs surges around us, popping the monitor leads off the patient’s chest, twisting the oxygen tubing from the wall, pulling the stretcher away and shooting with it in a tight cluster through the doors to Trauma Alley.

  In Trauma 2, I yank the patient’s trousers down and put a gloved left hand to the groin, feeling for a pulse. This ignominious stance is the command post of a Code. Stand here, hand here, watch the monitor, give the orders.

  No pulse, not breathing.

  “Bag him.” The mask is already over his face, a nurse squeezing breaths from the Ambu bag, and a respiratory therapist is lubricating the endotracheal tube for me and snapping the laryngoscope together, testing the light. “Chest compressions. Get him on the monitor.” A tech hauls himself up to stand on the bottom stretcher rail and begins CPR. Hands snake around his, pressing monitor lines onto the leads mapped across the patient’s chest wall. “Hold CPR.” The tech pulls his clasped hands up; all eyes look toward the monitor, where an undulating line of static appears: V-fib, ventricular fibrillation. Inside his chest, his heart is at a quivering standstill, the electrical impulses moving chaotically through the muscle. “Charge to two hundred. Alice, get ready to shock.” The defibrillator whines, the paddles are pressed into Alice’s trembling hands, the sound tops out, and she says, “Clear.”

  We all take our hands off and lean away, and the body on the stretcher convulses slightly, never the enormous jump that one sees on television, then we all rush back toward him and take up our positions again.

  No change on the monitor.

  “Charge to three hundred,” and the process is repeated. This time, success: the thin orderly pattern of sinus rhythm peeps happily across the monitor screen.

  And we’re swarming again, but it’s different now, the room awash in cheer: another one pulled from the brink. The nurse hangs a bag of heparin and the respiratory therapist dials in settings on the ventilator while I slide the endotracheal tube into the dark diamond of space between the vocal cords at the back of the patient’s throat.

  “Aspirin and morphine and beta-blockers,” I tell Dennis. “Call the Cardiology fellow for admit to CCU.”

  All is calm efficiency in Trauma 2 now, the patient’s chest rising and falling with ventilator breaths, the IV pump ticking the heparin in. A tech undresses him, shakes out a hospital gown over his naked body, folds his clothing into a bag. I tap orders into the computer and read the chart Alice had started. Thirty-eight years old, no cardiac history. He’d gotten a clean bill of health from his primary doctor just last week. He’d come in complaining of indigestion.

  “Let’s get a postcode ECG; he may need stat angioplasty. How’s his heart rate?” I turn to check the monitor again, and see the patient’s arm move. “He’s waking up. We need to restrain him.”

 
Too late: he is already sitting, eyes open. His hand comes up, reaching for the tube in his throat. A tech pulls his hand down, pins it; a nurse catches the other hand. He shakes them off.

  “Sedate him,” I say, but in that blink he is standing, literally standing upright on the stretcher stark naked, the hospital gown sliding down his arms and puddling at his wrists. He has the endotracheal tube in one hand and the IV tubing, squirting a clear stream of heparined saline, in the other. He roars at the wide-eyed staff.

  Just a beat with him balanced there; then we all leap toward him.

  “Lie down,” I plead as I grip his calf with both hands. “Please lie down.” His brows are drawn together into a mask of incomprehension and rage as he stares down at me. I try to make my voice calm and professional, commanding. “Sir, you need to lie down or you’ll fall.” For an instant his gaze unclouds and I think he’s understood, but then he kicks out, almost jerking me off my feet. I grab again, my hands slipping on his sweat-slick skin, and end up winding both arms around his leg in a kind of hug. I reach around myself, clutch the fabric on the back of my white coat, and hold tight. “Someone get some Valium.” My cheek is pressed so hard against one hairy thigh that the words cause me to bite the inside of my cheek.

  The stretcher bucks against its wheel brake as we struggle to bring him down. The monitor leads spring free and flail, and the tube in his hand whips, spraying heparin into the air. Blood streams from his open IV site. I can feel the taptaptap of drops on my scalp and a warm trickle through my hair.

  “Is someone getting Valium?” I yell. “Goddamn it.”

  My fingers are losing their purchase on the fistfuls of fabric, my nails making little ripping noises on the cloth as they slide, when suddenly the seething knot of humanity on the stretcher comes loose and the patient drops.

  Breathless, my fingers numb, I lean across his inert body, fumble for the monitor wires and snap them back into place, look at the screen: a straight, lifeless line. We swing into a second code, all of us still panting. I slip another endotracheal tube into position in his throat, squirt epinephrine into it, and bag it in while Dennis places another IV line. Then back to the groin, new gloves squeaked over my damp hands. Giving orders: continue chest compressions and more epi, again and again, the ampoules twinkling in midair as they are passed from nurse to nurse toward the stretcher and depressed steadily into the new IV in his arm. Nothing on the monitor except the coarse, unpretty waves of CPR.

  “Change the lead,” I say, but the second lead shows the same.

  We’re grim now, no talking except the essentials, my orders and the brisk answering of the nurse pushing meds, epi in. Every few minutes the CPR provider changes, a new person stepping up as the one before steps down.

  It might be twenty minutes, it could be an hour. I push it through round after round of meds, changing leads again and again, but never get anything on the monitor except that flat green unshockable line. Gradually I become aware that the tech stepping up to take over CPR is not on his first, or second, or even his third turn: large stains show under the armpits of his scrubs as he locks his arms together to begin chest compressions.

  “Doppler,” I say, and it’s in my hand. “Hold CPR.”

  I squiggle gel over groin and neck, run the transducer over the femoral artery, then the carotid. Nothing but white noise. I dial up the volume, straining to hear any syncopation of pulse. Finally, I take the transducer away from the cooling skin and switch it off, quieting the ocean rush. The room is absolutely still. I look at the big clock on the wall.

  “Time of death zero three fifty-one.”

  The respiratory therapist disconnects the oxygen bag. Someone clicks the monitor off. The sweating tech steps down from the stretcher, pulling his CPR-locked arms apart. They all stream out into Trauma Alley, leaving only me and the charge nurse in the room.

  I write his death note. Code: V-fib successfully converted to sinus with 300 joules; patient reverted to asystole. Second code, ACLS protocol followed, unsuccessful. The words hold nothing of the Frankenstein moments between the codes, the patient standing on the stretcher with hospital personnel hanging from his limbs. Cause of death probable myocardial infarction. Discharge to morgue.

  No CCU now, no stat angioplasty or cardiologist. Instead, calls to the medical examiner and the primary doctor. And to the family: another chance for me to plow that unwelcome divide between before and after into a stranger’s life.

  “Did he get three rounds of epi or four?” Dennis asks without looking up from the chart where he is documenting.

  “Five,” I say from the scrub sink. “I think.” I wash my hands, then wet a handful of paper towels and wash my face, crouching a little to look at my reflection in the paper towel dispenser.

  “Can bed eleven have more morphine?” Maureen, one of the urgent area nurses, puts her head around the trauma room curtain. “He says his pain’s eight out of ten.” She looks at the naked, blood-slicked body on the stretcher, the sprays and smears of red on the floor. “Yikes.”

  “Bed eleven.” Mr. Blythe, kidney stone. “Yeah. Give him another six. Thanks. How is it out there?”

  “Under control,” says Maureen. She’s been a nurse for twenty years; she knows better than to say quiet or calm.

  I toss the clump of towels into the bin. “I’m going to do a ramp check.” A bit of ED slang meaning I can’t be in this fluorescent box of hospital for one more second, I have to step outside and pretend I have the option to walk away. “Back in five.”

  “All righty,” says Dennis.

  The glass doors at the end of Trauma Alley sense my approach and whish open. For once, there are no ambulances chugging out carbon monoxide in the roofed space just beyond the sliding glass doors. We’ll have another deep snow or two before winter is done, but it’s just bearably chilly in my long-sleeve shirt under scrubs under white coat. I sit on the loading dock, take a deep lungful of the night air. Somewhere in this city, there are flowers; I can smell them.

  It was a good code: we did everything right. I could have given him sedation right after we got sinus rhythm back. Sometimes things go unexpectedly, some alchemy of circumstance, no one to blame. The morphine during the code hadn’t been enough, one good stiff dose just two minutes earlier might have made the difference. This one was young, only five years older than me; he’d come in walking and talking. Usually if they’re going to die, they’re more than halfway there when they get to us. I see his eyes again, confused and furious. There aren’t a whole lot of ER patients who look at you and then die; if they are well enough to look at you, they are usually well enough to save.

  In extremis, people do not resemble themselves. I’d coded him and pronounced him dead, but I wouldn’t recognize him now if his ghost were to walk up to me. His life had ended in a room crowded with strangers.

  One ER shift can swing from a beautiful satisfaction—a dramatic save, a neatly made diagnosis—to a dismal failure. Underneath the hubris that keeps us moving, always a churning river of worry: Could I have done that better? Strange that an impulse at eighteen—I think I’ll be a doctor—translates so many years later into this dark moment. I remember again that aphorism that’s been haunting me lately: it won’t love you back.

  I jump as a long shadow wavers on the ground beside me. I turn and blink up into the floodlight beam from the ambulance bay, see the bright orange hat. It’s the homeless frequent flyer with the worms in his knees.

  “Freddy, you scared the hell out of me.”

  “Sorry.” He stops walking. “What’re you doing out here? You’re supposed to be in there.”

  “Just taking a break.”

  “That’s okay, that’s okay,” he says, as if reassuring himself. He comes a little closer. “Is it all right if I smoke?”

  “Aw, Freddy. What am I supposed to say to that?”

  He sits on the other end of the loading dock, slides a crinkling packet from some hidden pocket in his camo vest, and scrapes out a small
flower of flame. He puts the cigarette to his lips and sucks in deeply.

  “You’ve got blood in your hair,” he says in a tight, breath-holding voice.

  “Yeah.” I remember the boy, Karen’s son, drenched in blood, his button eyes.

  “Somebody get shot?”

  “Heart attack.”

  “Right, right,” he says, nodding so hard that it rocks his body back and forth. “People die from those all the time.”

  They don’t, actually. Heart attacks are generally fixable.

  “Even if you do everything right, you still die,” says Freddy on a long exhaled plume.

  A flash of screaming for Valium with my face squashed against the naked haunch of the man whose name I didn’t even know, his genitals bobbing inches away from my ear. It had been a disaster. What will I tell his wife? Platitudes I can’t truthfully rely on this time: he wasn’t in any pain and he died instantly. What is left to say? Only I’m very sorry.

  “My heart’s good,” says Freddy. He coughs.

  During the day this street throbs with traffic and the sidewalks are thronged with people walking urgently, talking into cell phones. At night the population evacuates to the nicer neighborhoods and homes, leaving shuttered storefronts and abandoned houses. I look at the yellow oblong of a fourth-floor window in the research lab building opposite, wonder who is toiling there so late, and why.

  Freddy turns his face up to the sky. “Look at all the stars,” he says.

  I look up.

  “Where?” The patches of sky between the buildings are too light, the glow of the city besting the universe. “I can’t see them.”