“It’s a good decision,” she said hopefully, as if trying to convince herself. “It’s the only thing we could do.”
And while Elsa knew her mother was right, she couldn’t escape her gnawing guilt.
When the day came and went, Elsa found she couldn’t just let Diana go. So twice a week, she boarded a train and then a bus, and made the long trip to visit her niece at St. John’s.
“Hello, Diana,” she said each time, her teenager’s voice all but singing when she spied the little girl in her tiny wheelchair. She leaned over to stroke Diana’s cheek and plant a kiss, but Diana didn’t move. Elsa hoisted her out of the chair and sat holding her tight, but there was no response, not a smile or even a blink, nothing to indicate Diana was in there.
Elsa watched as the nurses and therapists massaged Diana’s tight little muscles and bent and stretched her extremities to keep them limber so that they wouldn’t become distorted, as Elsa had seen with some of the other children.
One afternoon, as Elsa sat next to Diana, the young girl stiffened and fell into a seizure. Her eyes rolled back in her head, blood and spittle dripped from her mouth, a stain of urine spread out around her, and she fell to the floor in a writhing heap. Jumping up, Elsa ran into the hallway.
“Help!” she screamed. “It’s Diana, help! Hurry, please!” She was quickly surrounded by the nurses, who pushed her aside to enter the room.
Someone called an ambulance and the paramedics arrived to take over. They bundled Diana onto a gurney and lifted her into the ambulance, motioning for Elsa to sit in the front. The wail of the siren echoed in Elsa’s head as the ambulance snaked through the crowded Boston streets. She struggled to hear what was going on in the back, where Diana lay, but the screaming siren blocked out all other sound.
When the ambulance screeched to a halt in front of the Boston City Hospital, Elsa fled from the front seat. “I want to see Diana,” she said. But her soft words were lost in the urgency that surrounded her and instead she was ushered to a dingy waiting area where the smell of vomit hung in the air. She sat on the edge of an orange plastic chair, chewing her nails and picking at a loose thread on her coat.
Tears pooled in the corners of her eyes and streamed down her cheeks, mixing with the snot that ran from her nose. She drew a sleeve across her face. The door to the hallway squeaked as it opened, and her mother appeared beside her.
“Oh, Jesus, Mary, and Joseph,” Margaret sniffled. “They called me from St. John’s. What happened?”
“Oh, Ma,” Elsa cried, reaching for Margaret. Through her tears, Elsa recounted the afternoon’s events. “I don’t know where Diana is. They just left me here.” Her sobs started anew.
Margaret sighed, gathered herself, and held Elsa close. They sat together in silence, the room already feeling like a little tomb. There was nothing to say. They’d put Diana in a home, and this was what had come of it.
A bespectacled young doctor, fidgeting with a metal clipboard, entered the little room ahead of a portly nurse, who was busily tucking her brown hair behind her ears. They took seats on either side of Margaret and Elsa. The doctor removed his eyeglasses, wiping them clean as he spoke.
“I am sorry to give you the news, Mrs. Murphy,” he said, speaking gently to Margaret. “But your daughter has died. We did everything we could, but we just couldn’t save her.”
He paused, and Elsa gulped back her sobs. The nurse put an arm around her as the doctor continued.
“I’ve seen her records,” he said, holding the clipboard up for emphasis. “This was a very long time coming, I’m afraid.” He stood to go and tried awkwardly to offer some reassurance. “She’s not suffering anymore. Nevertheless, I am sorry for your loss,” he said as he moved toward the door.
The nurse stayed, her ample body spilling over the seat and onto Elsa’s chair. She held out some tissues.
“Can I call anyone for you?” she asked quietly. Margaret shook her head no. The nurse paused, then spoke again. “My name’s Maureen, and if you have any questions later, please come back to see me or give me a call.” She rubbed Elsa’s back and she looked right into her eyes. “I lost my little sister when I was about your age. I know how you feel.”
“But—” Elsa started to explain that Diana wasn’t her sister, but she decided to let it go. Instead, she looked at the floor, her tears falling onto the front of her coat.
“Do you want to see her before you leave?” the nurse asked.
“Diana? We can see her?” Elsa sat up straight and wiped her nose.
“Of course you can. Sometimes it helps to say good-bye.”
“Please, yes. I want to see her.” Elsa sniffled and stood, eager to escape the mustiness of the old room.
Margaret sighed and looked at the floor.
“Not me, thank you,” she said. “I’ve had enough of these places to last a lifetime. Go on. I’ll wait here for you.”
Maureen led Elsa down a brightly lit hallway to the room where Diana lay. A nurse scurried about, clearing the equipment, switching off the monitors and pumps. The floor was littered with empty syringes, rubber tubes, streams of paper, and discarded latex gloves. In the midst of the clutter stood a gleaming steel stretcher. Diana looked so tiny and so… so comfortable. Gone was the pain of her brittle bones and tight muscles, and her mouth seemed fixed in a slight smile.
Elsa took her hand and stroked Diana’s forehead. She seemed so peaceful that Elsa turned to Maureen.
“Are you sure she’s…?”
Maureen nodded. “We’re sure.”
Tears streamed down Elsa’s face.
“Diana, you know we’ll always love you.” She leaned over and kissed Diana’s cheek, then turned and started for the door.
“Thank you,” she said in a whisper to Maureen as Maureen hugged her.
They walked back down the hall to the waiting room.
“Are ya ready then?” Margaret asked as they entered the room. “Come on, let’s go home.”
Maureen took Margaret’s hand and gave Elsa’s shoulder a squeeze.
“Call me if you need to talk,” she said again. She handed her card to Elsa, who tucked it into her pocket before Margaret could snatch it away. They walked to the exit and stepped into the crisp fall air.
On the way home, Margaret said over and over that Diana’s death was for the best, that it was God’s will. Elsa suspected that she was trying to convince herself.
Life went back to normal, but Elsa was more lonely than ever. Even her twice-weekly visits to St. John’s were gone now. She wanted to talk with someone, but Margaret had never been much for conversation, and Elsa’s duties at home and school kept her from making close friends. Her shoulders sagged with the weight of everything, and one night she bundled herself into her coat and headed out into the cold night for a walk. She pulled her coat tighter and shoved her hands deep into her pockets, where her fingers curled around a small card. She pulled it out. Maureen Hill, RN was inscribed there along with the telephone number of Boston City’s emergency room. Elsa fingered the raised letters, tucked it back into her pocket, and turned for home.
The following day, she turned up at the ER registration desk and asked for Maureen. The clerk smiled.
“Who can I say wants her?” she asked.
“Elsa Murphy,” she answered. The clerk disappeared, and after a few uncomfortable minutes she returned with a smiling Maureen. Her brown hair was pulled back in a tight bun and she pushed the stray tendrils away from her face as she neared the desk. As she got closer, Elsa noticed the tiny freckles that sprinkled Maureen’s pale skin. It was hard to guess her age but she was old, Elsa thought—at least forty.
“Oh, Elsa, come on in. I’m so glad to see you.” Her voice was warm and soft, like a gentle touch. She guided Elsa to the staff lounge, where she pulled up two chairs so they could sit.
“How are you, honey?” She said it in such a soothing way that Elsa started to reply, but her stomach knotted up and she began to cry. A soft whimper
rapidly turned to gasping sobs.
In fits and starts, she sobbed out her story. She told Maureen all about Diana and Janice and her mother.
“Poor Diana never had a chance in this family,” she finished.
“Honey, you did the best you could for Diana. She was a very sick little girl. I’ve seen patients like her before, and you and your mom keeping her at home as long as you did was an act of great love.”
Maureen leaned forward and spoke softly.
“My own sister was born when I was fifteen years old. I remember how excited I was that a baby was coming—until she was born and we saw how deformed she was. I was heartbroken. She never even came home with us. She died in the hospital without ever sleeping in her fancy new crib or wearing the clothes we bought her.” She touched Elsa’s hand.
“When she died, I knew I’d be a nurse. So, you see, I do know how sad it can be and I know it’s much worse for you than it was for me. You knew Diana; she was a part of your life for a long time. She was lucky to have had you and your mom to love her.” Maureen smiled and squeezed Elsa’s hand.
Elsa sniffled.
“I’m not so sure that Diana was lucky to have us. We’re nothing special. No one’s ever graduated from high school in my family, and I don’t even have any real friends.”
She sniffled again and wiped her nose.
“I don’t want to live in Dorchester forever. I want to be somebody. I want to go to school and, well, just get out there and do something. When I really start feeling sorry for myself, I think about how much worse it could be.” She paused and then told Maureen about the magazine article and its terrible photographs. “Have you seen those stories? It’s just awful. Those people need help. It makes me ashamed to be so selfish.”
“Oh, honey,” Maureen said as she folded Elsa into her arms. “You’re not selfish. It’s human nature to want something better for yourself. You know, I went to nursing school so I could help those poor babies who never go home, and here I am in the ER. The best thing you could do is watch out for yourself and make something of yourself. Then you’ll be able to help people all you want.”
It was almost as though Maureen had read her mind.
“Do you think I could be a nurse? I used to watch the nurses at St. John’s, and it seemed like, well, maybe as a nurse I could make a difference. It seems like nurses do things that matter. I couldn’t help Diana and I can’t help the refugees, but as a nurse, I could help. I know I could.” As she said it, her tears stopped and her sadness lifted a little.
“I’m glad to hear that,” Maureen said. “God knows we need more nurses. If you’d like, you can bring in a list of your high school courses and we can make sure you’re taking the right ones for a nursing career. We can start looking at scholarship applications, too.”
Maureen’s kindness made Elsa feel weepy again.
“Thank you,” she whispered.
Elsa returned the next day, and Maureen helped her to choose the courses she’d need for nursing school.
Over the next few months, Elsa found herself in the ER several times a week hoping to just be around Maureen, whose encouragement helped Elsa forget her own misery. After a while, the reception clerk even knew her by name. “Have a seat, Elsa. I’ll page Maureen,” she’d say. When it seemed clear that Elsa would continue to be a frequent visitor, Maureen arranged for her to volunteer at the hospital, running errands and helping the patients and visitors.
Elsa felt alive in the emergency room, where everything was a matter of life and death. There in the ER, her own sadness seemed swallowed up and somehow faded. She mattered there—at least to Maureen, who always made Elsa feel needed.
She still worked at the library and even increased her hours so that she could help out with the bills that plagued her mother. Margaret continued to work from dawn till dusk and had little time left over for Elsa, who turned to her books and studies in earnest.
With her newfound resolve, Elsa kept on top of her grades more than ever. As graduation approached, Maureen wrote letters of recommendation and said she wasn’t surprised when Elsa was accepted to Boston College’s nursing program on a full scholarship.
She was going to be a nurse. Even Margaret smiled at the news.
“A nurse,” she said. “My own daughter, a nurse.”
3
For Elsa, four years of school passed quickly, and in the spring of 2000 she graduated from Boston College. Almost immediately the nursing boards loomed, and she passed the rigid test with flying colors. She was pronounced an RN—a registered nurse—at last. And with Maureen’s help, she was hired in Boston City’s ER. She celebrated her new position with a fresh supply of lipsticks—soft pinks and muted beiges, quiet, wholesome colors, fitting for a nurse.
Finally able to contribute a real salary to her small household, Elsa wanted her mother to retire. Maybe they could even buy a cozy house somewhere nearby. Anywhere but Dorchester.
But Margaret frowned at the offer.
“Oh, Elsa, you’re a good girl, but I’d go batty if I was home every day. No, honey, I’ll keep working, but a new couch would be nice, or maybe a TV that actually works.” Margaret smiled. “You know, for a kid who never had a break, you turned out all right. I’m really proud of you.” She leaned over and gave Elsa a quick peck on the cheek. “I love you, Elsa.”
Her mother had never been much for affection, and her words caught Elsa off guard. But Margaret was up from her chair and out the door before Elsa could respond and say that she loved her, too.
* * *
A week later, Margaret didn’t appear for her morning coffee. Certain that she had overslept, Elsa went into her mother’s bedroom and found her still in bed with the covers pulled up high to her neck and her eyes closed.
“C’mon, Ma, your coffee’s getting cold.”
She moved closer and saw that Margaret wasn’t breathing and had a bluish cast to her skin. Panicking, Elsa threw off the covers and tried to breathe for her mother, but it was too late. Her mother’s skin was ice-cold.
Elsa cradled her mother’s limp form and wept.
“Oh, Mama, why now?”
But there was only silence in the tiny apartment.
Elsa, a few neighbors, and Maureen attended the funeral services. Annie, with a small baby in tow, showed up toward the end but left after giving Elsa a quick embrace.
Elsa was on her own.
She was grateful when Maureen asked her if she wanted company, but right then she needed to be alone. She went home and climbed the narrow staircase past the yellowed, flaking wallpaper and inhaled the familiar scent of grease and stale cigarettes. The Murphy apartment was hers now, and its emptiness echoed her life.
She was alone.
And though it had been the way she’d lived, more or less, for all of her life, it wasn’t enough. She didn’t want to end up like her mother, with no one to attend her funeral, her death barely noticed.
Then Elsa remembered the magazine. It was still in her bedroom, tucked into the drawer of the nightstand, filled with the stark portraits of sad-eyed Rwandan refugees. She pulled out the magazine and looked at the pictures that had riveted her so long ago, and she found that once again, she was consumed by the unremitting misery in the images. Surely, all these years later, these people were dead.
But what if a nurse had gone and helped?
She inhaled deeply, and as she did, a calmness settled over her, and she knew—she would go. Somehow she would help, she would make a difference; however small, in whatever small corner of the world that needed her, she would help. She sat straighter and exhaled slowly. These people needed her—and she needed them.
A few days later, she approached Maureen in the hospital cafeteria.
“Maureen, do you remember the conversation we had years ago, about the refugees from Rwanda? The ones in that magazine I told you about?”
“Of course, honey. That’s what got you started on the road to nursing school.” She paused for a moment, sta
ring into space. “It seems as if there are always refugees in the news, doesn’t it? One sad story after another. Today it’s Sudan and the Balkans. Tomorrow it’ll be someplace else. Yet most of us forget the tragedies as soon as the stories fade from our television screens. You have a good heart, Elsa, to still be thinking about them.” Maureen sighed and gazed at her generous lunch. “Makes me feel guilty to have so much and do so little.”
“I didn’t mean to make you feel guilty, and you do a lot for people who come through the ER. Look at everything you’ve done for me. It’s just that now seems like a good time for me to do something. With Mama gone, and no one waiting for me at home, I think I’d like to volunteer with one of the aid groups, if they’ll have me.” She paused for a moment, then continued. “I wanted to make sure it was okay with you. It’ll take me away from the hospital, after all.”
“Oh, honey, of course it’s okay with me. You go right ahead, and let me know if there’s anything I can do to help. I’d be so proud of you, doing something like that. Hell, we’d all be proud of you.”
Elsa knew she’d need experience to apply, so with Maureen’s guidance, she threw herself into her work with a renewed sense of purpose and saw patients and families much like her own, devastated by drugs and alcohol and tragedy. She focused on learning the ropes in the constantly bustling maze of the ER, and her days became a frenzied blur of misery, gunshot wounds, and overdoses. Yet she tackled it all with unbridled energy, more determined than ever to make a difference, treating every day as if it was a starting point for getting where she wanted to be.
Somehow, in the grim haze of that chaotic apprenticeship, Elsa learned how to save lives and how to recognize when someone couldn’t be saved. Those were the hardest ones. They reminded her of Diana. But in order to do her job, she needed to learn to deal with her emotions and do what needed to be done.
Elsa soon settled into the routine of the ER, but even the routine wasn’t so routine. There were new hazards every day, and though she learned to break into a sprint when she heard the overhead intercom buzz out, “Arrest team to Trauma One,” her heart quaked as she ran. The announcement usually meant that a gunshot or stab wound victim was arriving, and she was expected to assist. It wasn’t long before she knew where to stand, and how to pass equipment when the surgeon decided to open someone’s chest and perform heart surgery right then and there. Early on, the senior trauma surgeon had even directed her to hold a heart in her hands while he repaired a deadly wound. Terrified, she’d held it tenderly as though holding a fragile piece of glass, but the wounded heart was slippery, and she was sure it would slide from her hands. Her own heart beat faster, and beads of sweat collected under her face mask, clouding her vision. She could hear the chaos at the edges of the trauma room, people shouting about blood and the operating room, but there in the center, it was almost calm, except for her own hidden panic. Oh, God, she thought, don’t let me faint.
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