This resident possesses a dangerous combination of optimism and inexperience. She is one of the few people around Tess to imagine the child’s future — or, more accurately, to redesign it, for each of the caretakers imagines it. But the resident — she has plans. Knowing that Tess’s neurological deficits are multiple and tangled, the determined little doctor reads history after case history. She thinks about what she reads. She is thinking now while supposedly snatching a much-needed nap in the on-call room. Elbows on the desk, slender brown fingers probing her dense hair, she thinks about clever neurons taking over from failed ones.
I LIKE THAT SLOW TRAIN. It goes from town to town, and at the first three stations you can still see the ocean. Then the train runs behind pines like the ones in Maine. I was born in Maine. It runs past factories. It stops in the city.
I got off there, in the city.
I was scared, but I didn’t turn back.
THE RESIDENT THINKS about synapses creating themselves; and she remembers that there are areas of Tess’s damaged brain that have not yet been fully scanned; and she says to herself that until Tess reaches some plateau — and she’s not there yet, she’s still climbing — why, no cap can be put on her progress.
The older doctors are less sanguine. Neurological deficiencies united with gut deficiencies make a grim prognosis. These physicians doggedly do their jobs. The neurology attending follows the case. He may write a paper; no name has yet been attached to Tess’s particular agglomeration of troubles. The surgical attending replaces the feeding tube when necessary. She works with speed and grace. The tube is Tess’s lifeline: she will never have use of her upper digestive tract, never be able to employ her mouth for eating or drinking, never bite or chew. Nonetheless — the dental attending reminds the nursing staff, his pale eyes intense — the twelve teeth Tess has already sprung must be brushed frequently with a little stick tipped with foam rubber, for despite the inutility of the tiny incisors they are subject to decay. (Also they enhance her smile.) The infectious-disease attending — who at this moment is scowling at another child’s lab report floating from the printer — prescribes for Tess’s frequent infections. He is a Bengali trained first at home and then here. Even as he battles the microbes that invade Tess, he wonders, as if from afar, which one will carry her off. Already there are antibiotics that, for her, might as well be barley water. “She is a fly in our web,” he said once to a nurse, surprising her not only with the thought but with his clipped voicing of it. He is usually so silent.
The case of Tess is discussed periodically by the staff, with at least one of the weary attendings present. When immediate concerns about Tess’s condition have been voiced—“Her cranial circumference is not enlarging,” the resident reported yesterday; “Hmmm,” said the neurology attending — the talk turns to her near future, to her disposition, to her removal from the unit, from the single-crib room containing Tess-specific toys, mobiles, and that padded stroller; containing, also, amenities common to all patients’ rooms: giraffes prancing on a frieze; a window looking out on other hospitals; television, sink, wastebasket; hamper for dirty linen; bin for dangerous waste; and, attached to the wall above the crib, a box of rubber gloves. There’s a bathroom for the use of parents and guests. Tess’s bathroom is entered by the cleaning person every morning, and by her mother, who visits once or twice a month these days, though in the beginning she came more often.
IN THE CITY I waited for the subway. I lit up, and a black girl in a uniform told me I couldn’t, but she was nice, she let me finish the butt. The subway came. It was after rush hour but still crowded, so I hung on a strap in front of a woman and her two children. They were cute, Mexican maybe, such big eyes, and I made funny faces at them so they’d laugh. But the mother went stiff, so I stopped. I looked at myself in the black window. Round head, round glasses, buzz cut. Maybe Billie thinks I look like a girl that’s still in school but I think I look like a boy that’s turned eighty without ever growing up. There’s a disease like that. I read about it once.
I always liked to make funny faces at kids.
EXCEPT FOR THE CLEANING PERSON and Tess’s mother, no one uses the gleaming bathroom. Tess’s father, who had no fixed address at the time of Tess’s conception, had left the state altogether by the time of her birth. The cost of the child’s residence here, the cost of her care, the cost of Tess — this is presently borne by the hospital. The cost is one of those enormous figures flung by newspapers at a horrified public. To the accounting department Tess is an impressive statistic. To the hospital counsel she is always a worry. And today she is a task.
What else can I do? the counsel asks aloud, partway through his draft. Alone in his office, he directs his question to Tess, seven floors above. The Utilization Committee is breathing down my neck. Two years. Those pricks can count.
There have been efforts to move Tess into a facility. A facility is certainly her destination if she continues to live. The Sisters of Evangelista would take her, would love to take her, would love to love her; but they are not a hospital, and their medical services are unequal to the demanding body of this tyke. The bags hanging from Tess’s pole must be continually replaced; the cylinder of nutrients attached to the feeding tube likewise. And the places where she’s pierced must be kept uncontaminated; and physical therapy must be performed; and visual stimulation … Tess needs expert servitors. Loved by the Sisters, she’d be dead in a week.
So how lucky Tess is, thinks one of the nurses, who is Tess’s primary today, and is gently swabbing the area around her feeding tube … how lucky Tess is to make her home in the unit, with its trained staff. Here she sees dozens of smiling faces. (Tess now smiles at the primary.) Here the practiced hands who tend her do so unresentfully, for they tend not only Tess but also patients who howl, who hurl little fists, who fiercely suck bottles and pacifiers; who vomit and hiss and grow quite red in the face; whose harelips get fixed and whose stomata get repaired and whose bacterial infections succumb to medications and whose viruses succumb to the passage of time; who often get better; who at last leave, though they may be back. (Tess scowls.)
I TOOK THE ESCALATOR up from the subway. The wall there got decorated by kids from some art school. They used bottle caps and other junk they found. I always touch it. My friend the wall.
When I got off the escalator the bus to the hospital was just rolling up.
I didn’t turn back then, either.
Billie says you can always count on me.
CLOWNS SASHAY INTO THE UNIT on Tuesdays and Fridays, and every day there are volunteers to wheel the child into the activity room so she can look at other children. Other children look at her. They find comfort in her placid refusal to make noise, in her willingness to share toys — that is, to have a toy snatched from her tray and replaced by a different toy. One thing is as good as the next to this little girl who has never grabbed; who has never sucked; who will never — thinks the fashion-minded nursing student with sudden envy — feel envy; who will never — the exhausted resident may be forced to conclude — discriminate between Tess and non-Tess.