The Children's Hospital

by Chris Adrian

  The boy was still holding his weapon when she turned around, a pretty soda bottle, one of the new ones, rimmed around its fattest part with tiny glass roses. He held it up again and shouted at her, “What are you doing here? Get the fuck out! Get out of my fucking room!”

  Some residents and attendings told Jemma they’d spent their whole internship learning to distinguish the sick child from the not-sick child. Everything else you could look up, they said. What was tough was knowing when to act, and they gave Jemma to understand that the sickest children were often the sneakiest, slipping under the sick/not sick detectors of their physicians and acting perfectly normal until suddenly they were dead. But Jemma didn’t need a specially cultivated organ of perception to know this boy was sick. She was seeing him up close and in good light for the first time, and could tell now he must be ten or eleven—before she thought he’d been older. He was almost as tall as she was, and very thin. His eyes were sunk deep in his head, and his lips were cracked at the corners. Jemma was sure his skin, in health, would have been a pretty shade of brown. Now it was gray.

  “You look sick,” she observed. “You should come upstairs with me.”

  “Fuck the fuck!” he shouted at her, leaping with the bottle in his hand. But his spring was weak, and he passed out in midair, so when he landed he crumpled at her feet. Then her worry almost became panic because she suddenly realized she was all alone, and far from help.

  “ABCs,” she muttered. It was the mantra of the panicked and the inexperienced: keep them breathing until someone who knows what they’re doing arrives. She bent to listen at his mouth. When she put her hand on his chest she felt a jolt, and thought she must have kicked up some static by wading through all those candy wrappers. He sat up like a horror-movie murderer and struck her again with the bottle, this time on the cheek. Again the glass failed to break.

  “Stop that!” she said sharply, tears springing in her eyes. They blurred her vision as she groped for him. She touched his face and his shoulder, and he fell forward over her. She remembered his weight from when he stepped on her in the gift shop; she had never before met such dense flesh. She took a moment before she rolled him off of her to understand how much her head and her cheek hurt and make sure she was still thinking straight. Still unconscious, he peed on her.

  She took him, very slowly—dragging and hauling and resting as infrequently as she could bear, and laying him down every minute to check his breathing—to the ER. The PICU might have been better, but seemed too far away. The ER had been mothballed shortly after the Thing: no one was expecting any more admissions. It even seemed to have shrunk a little, to most observers. A few people slept down there, every so often, and it was rumored to have become a trysting ground for the lonely and not-very-well acquainted, but mostly it was deserted.

  It was entirely empty and dark when Jemma struggled in with the boy. She took him into a trauma room because it was closest to the door she’d come through. As soon as she put him on the gurney she reached past his head to the wall and slapped the code button. No red lights flashed. No voice cried out, Code blue! It was just a chime, and it sounded more to Jemma like the call of an ice-cream truck than the announcement of a pending death, but she knew it was ringing in the PICU, too, and that to the people who knew what it meant, it sounded as horrible as any screeching klaxon. After a few seconds of it she heard the angel speak, too. “A child is dying,” she said finally.

  “Call somebody,” Jemma said. “Get Emma down here. This kid’s tanking.”

  “Name me, I will serve. I have preserved you all these days, but I cannot help you without a name.”

  “Just do it,” Jemma said. She had resisted all these weeks, forfeiting fancy pancakes and silk-weave scrubs and fleecy socks—Rob had to do all the making and the shopping and Jemma could only get food by herself at the cafeteria.

  “Only name me, and I will serve,” the angel said again.

  “Just do it, you stupid fucking bitch!” Jemma said.

  “I am named. O, listen creatures, again I am named! Again I serve!” Then she was quiet.

  “Did you do it?” Jemma asked. “Are they coming?” There was no answer.

  “Stupid fucking bitch,” Jemma said, and looked at the boy where he lay. The bright lights made him look a paler shade of gray. She did her ABCs again. He was breathing fast and deep, his heartbeat was regular. His pulse was weird, bounding and weak at the same time. She pressed on the tip of his finger, waiting and waiting for the blanching to clear. It took five seconds. She straightened up and looked around the room, just in case she had missed the flood of people who were supposed to be coming to help her. She went to the door and looked out at the dark, empty hall. She thought she could put another voice to the cadence of the code chime: Nobody coming, nobody coming, nobody coming. “A child is dying,” the angel said again. “Won’t you help him?” Jemma went back into the trauma bay.

  “Fuck you,” Jemma said. She considered the boy, an almost-adolescent who had been drinking and peeing up a storm, who she’d seen snotty with a cold within the past three weeks, who now lay unconscious and obviously dehydrated, breathing deep breaths that were, when she hovered and sniffed above his face, yes, quite fruity. She went looking for a glucometer and found it within seconds: everything in the trauma room was labeled so people made morons by haste could find it with one eye and half a brain. She was about to poke his finger when she considered that he needed fluids. She looked over his arms for a vein; they all seemed to have receded to the level of his bones.

  Two pokes in his left antecubital and one in his right, and then she got a flash in her IV catheter. She hooked up the tubing and hung a bag of half-normal saline. He lay quite still, still breathing his deep, rapid breaths. She tried to remember the name for that particular character of breathing, but all that came to mind was the fact she’d neglected to test his blood sugar. It felt to her as if an hour had passed; the code clock, started when she pressed the button, said six minutes. She paged Rob, the only number she knew off the top of her head. She’d never put 911 after her callback number, but she did it now.

  She poked his finger and squeezed it till she thought the tip would pop off and fly about the room like a deflating balloon. It yielded a drop of blood the size of a pinhead. Finger, finger, finger: they were all dry. Desperate, she sucked on his thumb to warm it up and finally got a single fat drop, which she almost lost trying to touch it to the glucometer strip with her shaking hand. The little monitor on the glucometer began to count down from sixty seconds. Jemma put it at his feet. She checked the IV, then checked the phone to make sure it had a dial tone. She checked his breathing and his heart, then looked up and realized that the wires and leads of the cardiac and respiratory monitors seemed to be reaching for him. She had no better idea of how to hook them up than she did how to create a beehive hairdo. “I am the preserving angel,” the voice said, and Jemma realized it was speaking in exact one minute intervals, “but only you can save this child.”

  She looked at her glucometer again. It was just counting past ten seconds. She watched the countdown, swearing that the machine paused forever at five, as if it had forgotten what came next. At three seconds she finally heard hurrying footsteps in the hall. At one second the room filled up with people, Dr. Tiller first among them. Never in her life had Jemma been so happy to see someone she hated.

  “What the hell are you doing?” Dr. Tiller asked, managing a sort of tenor shriek. Jemma tried to offer up the glucometer, and dropped it. Emma, the PICU fellow, reached under her legs and grabbed it.

  “Nine-sixty-six!” she said. “Holy shit! No, sorry.” She turned it upside down. “Six-sixty-nine. Where did he come from?”

  “Not off the street,” said Dr. Tiller. “You,” she pointed to Jemma. “Get out of the way.”

  “He was living in the basement,” Jemma said, but no one was listening to her. Bodies pushed her back as they surged forward, and the boy was surrounded. While Dr. Tiller shouted o
rders, hands started another IV, and drew blood, and drew up meds. A nurse took down the monitor wires and hooked them to the patient in less time than it would have taken Jemma to button up a shirt. The press of bodies became so thick that Jemma could only see the boy’s feet sticking out. He was missing a shoe.

  Dr. Tiller approached her. “Why weren’t you giving this boy his insulin?” she demanded.

  “He’s not mine,” Jemma said. “He was hiding. I only just found him.”

  “How much fluid did you give him? How did you calculate his deficit?”

  “I don’t know,” Jemma said. “I hung a bag just now. See it?” Dr. Tiller made a strange noise, an inflected snort, then walked back to the patient.

  “Half-normal? Since when do we resuscitate with half-normal, Dr. Claflin?”

  “It was what I found,” Jemma said weakly.

  The monitor alarms had been sounding since the machine had been hooked up, but suddenly they began to cry with a special urgency, and a different pattern. As Jemma watched the numbers, which printed in blue, yellow, or red, depending on how sick the patient was, went from yellow to red, and then a brighter red, almost orange, as the heart rate climbed above two hundred. At two-fifty the monitor editorialized with a single, livid exclamation point, blinking beside the number. “Goodbye, goodbye, goodbye!” the angel called out.

  “Can somebody shut her the fuck up?” Emma asked. “Look at those T waves. Can we get a twelve lead? Who can get me a twelve lead? And some calcium, please.” She cast an eye about the room. Jemma hid behind one of the bigger nurses.

  “Where’s the damned i-stat?” Dr. Tiller asked of the air. “Let’s get some labs.” The monitor began a weird, crooning moan as the line from the cardiac leads suddenly went crazy.

  “See?” said Emma. “It’s v-tach. Where are the paddles?”

  Dr. Tiller summoned Jemma over with a wave of her hand and told her to start compressions. Jemma had done them only once before, on an eighty-seven-year-old woman whose ribs had splintered under Jemma’s palms. She could not remember how many times you were supposed to push in a minute on an eleven-year-old.

  “Up here,” Dr. Tiller said, grabbing Jemma’s hands and moving them higher on the boy’s chest. “He’s not choking.” Jemma had not pushed five times when the boy went back into sinus tachycardia. The fellow was just raising the paddles. She let them drop, clearly disappointed. “You can stop now,” Dr. Tiller said to Jemma, pulling her away and pushing her again to the back of the crowd. The bad rhythm returned.

  “Bring that back!” Emma called to the nurse who was trundling the defibrillator off to its corner. Dr. Tiller reached back without looking and grabbed Jemma’s shirt, pulling her forward, then thrusting her onto the boy’s chest.

  “Keep on!” she said. Jemma pressed, wearing herself out in less than a minute. Emma was having trouble with the goo, and then they had to recharge the paddles. The rhythm changed just as she was about to call all clear.

  Dr. Tiller called again for calcium chloride, and then laid a hand on Jemma’s shoulder. “Stop again,” she said, more gently, and turned her around. Jemma leaned away from her, one hand still on the boy’s chest. “Dr. Claflin,” Dr. Tiller said, “assuming this boy has got a potassium imbalance from his dehydration and his insulin deficiency, and assuming our labs are never going to come back, as it seems they will never, then how much calcium chloride should we give this young man?” It took Jemma a moment to understand that Dr. Tiller was asking a question to which she already knew the answer, that she was pimping Jemma in a code. If she hadn’t been pregnant, she would probably only have felt intensely sickened. She turned just in time to avoid vomiting in Dr. Tiller’s face, and sprayed the boy instead with hot bile, such an emerald green it was almost pretty. His pulse fell briefly into the normal range. “Oh God, get her out of here!” Dr. Tiller called out, in such a stentorian manner and with such commanding authority that Jemma fully expected God himself to remove her from the room by way of a crack in the floor or a flaming chariot or a thundering whirlwind.

  A nurse—it was Janie—took her gently by the elbow and steered her out of the trauma bay, whispering at her and shushing her and consoling her, excusing her ineptitude with her ineptitude. “Some of us just aren’t made for that room,” she said. “It can make people pretty prickly.”

  “Pretty prickly people,” Jemma repeated dumbly, feeling something worse than nausea, a terrible yearning toward this boy that felt like the strangest sort of crush, but as she went step by dizzy step she realized she was yearning not for his flesh or his soul but for his health. She wanted him to get better so bad but she knew he would die. She nearly cried for him, not just her customary dry sobs but actual hot tears; only the sad facts of her life stopping her from doing that, and only barely. About to cry, her parents’ deaths rose up in her mind, her mother boozed-up and bleeding, the house on fire, her father wasted to a skeleton in his bed, each death taking a shape like a person and asking, Is it greater than us, that you should weep for it? The answer was yes, but before she could start weeping her brother’s death rose up, a flayed, burning giant as tall as the sky, his eyes in one hand and his tongue in the other, and showed her herself standing at the very center of the whole ruined world and silently asked the same question. She did not cry.

  “I’ll bring you some water, when it settles down in there. Now where are those labs, anyway?” As the nurse walked off, Jemma slid down the wall and sat with her knees against her chest. She heard the monitor moaning again, and the angel said, “I wish I could hold him for you.” Emma called all clear, and let out a whoop as she shocked the boy. Dr. Tiller called again for the calcium, and Jemma’s nurse came flying down the hall with a slip of paper in her hand. “Seven point two!” she cried as she entered the room.

  Then the monitor was quiet for a while, and the voices were quieter. Jemma only heard mumbling, except for Dr. Tiller’s voice, rising every few minutes in correction above the others. Jemma put her head between her knees, overwhelmed with nausea. In a few minutes the team rushed out of the trauma bay, wheeling the boy up to the PICU. Jemma’s angel of condescension stooped briefly to ask if she’d be okay. Jemma waved her on.

  In a few minutes more she stood up and went back into the trauma bay. She put on a pair of gloves and started to clean up the mess, folding the sheet on the gurney into a careful, vomit-filled square. Vomit calls to vomit; that was one of her early third-year lessons, and she was an indiscriminately sympathetic barfer. So she almost did it again, but she hated the thought of someone cleaning up after her. Mopping on the floor with a wet towel, she found the boy’s shoe. A filthy sneaker, it was bigger than her own big foot. She sniffed at it tentatively; it had a buttery smell that was oddly settling to her stomach. There was writing on the inside of the tongue, smeared but legible: This shoe belongs to Jarvis. Put it back where you found it, motherfucker! She put it back down where she found it, then lifted it up again. Staring into the mouth of the shoe, she sat down on the gurney. In a little while the telephone finally began to ring. She let it ring and ring, answering it only in her mind. You must marry me, Rob said, and her brother said, You swore never to marry—if you thought the end of the world was bad, just wait and see what happens when you break your promise. Her mother asked, Where is it written that a woman’s got to suffer like I do? and her father said, If you become a physician I will disown you. I love you, Rob said. Pick up the phone and I’ll say it for real. Junkie bitch, Jarvis said, stupid motherfucking busybody whore. I was happy where I was, and now I’m fucking dead.

  Are you taking me to Heaven? Jarvis asks me.

  No, I say. I am taking you to the roof.

  I can do that myself, he says, but he does not take his hand from mine, or curse me, or even frown, because he knows he wasn’t going anywhere before I fetched him out of the PICU. He was not enjoying his out-of-body experience. Free at last, he stood outside his prison door and hollered to be let back in. I was diminished, crammed in t
he corner of his room, watching him pace at the foot of his bed, and throw himself every so often upon his body. Face to face with himself he said, You fucker, wake up! He sat down on the floor, put his head in his hands, and cried. My sister was saying that he should take comfort, and that everything was all right, but he ignored her.

  I used to like the crying of children. I wished I could complain as profoundly as an infant, and I admired the way that toddlers sob against the world with their whole souls. I imagined an instrument of them, dozens of babies and toddlers arranged like the pipes on an organ, pedals to squeeze them and keys to poke them—I would play out a complaint to capture the ear of God, and in a whistling, snotty symphony of sobs and screams, articulate the thing that oppressed me, reason and remedy for my world-sized dissatisfaction.

  But now I cannot stand to hear it. I unfold myself out of the air and say, Look at me.

  Nobody looks any different, he said, staring at the passing faces. Even though I’m dead.

  You aren’t dead, I say. I am dead, but they look the same to me as always. Which was not entirely true: they are easier for me to look at now.

  Hey! he said as we passed the eighth floor. Hey! He tugged on my hand and my arm until I looked at him.

  What is it?

  I’m not so mad anymore. I feel fine and I just noticed it.

  Felicitations, I say. I am not so mad anymore either. You need a fleshy heart, to really feel things.

  All that time, all that shit! And all I needed to do was die. He walked on, leading me now.