“Good morning, Ella. How are you feeling today?”
“Hello!” She danced a little as she stood, drumming her feet then swinging her hips so her ostomy bags shook like hula skirts. Jemma reviewed her vitals on the three-foot-long record hanging at one end of the crib. Her blood pressure had shot up in the night, and was still high. The attending, Dr. Snood, had castigated Jemma the previous day for not knowing the range of normal blood pressures for a three-year-old, so she’d studied a card Rob gave her — all his knowledge was condensed on a stack of laminated cards six inches thick.
“Do you have a headache?” Jemma asked. “Is your vision blurry? Does your tummy hurt?” Ella put her lips together and blew a glistening spray at her that hung in the parallel shafts of light sliding through the blinds. Jemma held her breath as she passed through the cloud, approaching the child with her stethoscope held out before her. Ella thrust her chest out, as if to receive a dagger. She was a well-practiced patient, quiet for the cardiac exam, breathing deeply through her mouth for the lung exam. She insisted on listening to Jemma’s chest. She was very intent on it, though the earpieces were only half in her ear, and facing the wrong way. “Sick,” she pronounced, shaking her finger at Jemma, and shaking her head. “Sick, sick, sick!”
“I’m okay,” Jemma said. “You’re sick.”
“Sick!” she said, and pointed.
“You’re sick,” Jemma said. “You’re miserable. I’ve never seen a more miserable child in all my life!” Ella cackled and grabbed Jemma’s ears, and pulled her close for a kiss and a whiff of her toilet breath. “Sad little girl!” Jemma said.
“Dead lady,” Ella sang. “Dead ladeee!”
“Okay,” Jemma said, disentangling herself from the hands. Ella grabbed a piece of hair and would not let go, so Jemma lost a few strands as she pulled free. “You’re making me late,” she said gently. Ella tossed the strands in the air and pressed her face through the bars to watch them fall. “See you later,” Jemma said.
“Goodbye now,” Ella called. “Hello, later!”
Ella’s neighbor was another short-gut girl who had to be fed through her veins. She had been a miracle preemie sixteen years previous, a twenty-five-weeker who lived back when that was nearly beyond the limit of viability. When she was still kitten-sized she got a nasty infection that cost her most of her gut, but she’d done fine until she was fifteen. Then her weary, overworked little intestine had decided to retire, and left her with chronic nausea, constipation, pain, and a belly that swelled up grotesquely whenever she ate even the most bland and innocuous morsel. Her name was Cindy Flemm.
Jemma found her awake, sprawled in her bed with her hair matted against her wet pillow, a wet bar of sweat running down the back of her tank top — she favored short shorts and tank tops and belly shirts, clothing that showcased her thin limbs and swollen, scarred belly. She had the pale, drawn look of someone who had just vomited, and would soon vomit again. “You look awful,” Jemma told her.
“I feel awful,” she said. “I feel like shit — like the shit of shit. Like shit squared. I need my benadryl — it helps with the barfing. Carla was supposed to give it to me but she got distracted — she always gets distracted. The service here sucks ass. Will you give it to me? It’s right there by the sink. I’m too tired to reach or I’d just do it myself. I do everything else myself, I may as well do that. If I could just move.” Jemma looked on the counter and saw the capped syringe.
“I don’t think I’m allowed,” Jemma said.
“But I need it. And I’ll get in trouble if I give it to myself. You can do it, though. You have to do it. Please. Come on.”
“Well,” Jemma said, picking up the syringe and holding it up in the light. It was clearly labeled: ten milliliters of solution for fifty milligrams of drug. She looked again at her patient, and thought she noted a new green cast to her skin. “Okay, but let’s talk a little first. How was the night?”
“I need it now,” Cindy said. “Right now!” She opened her mouth wide and made a deep, urping noise at Jemma. “Here it comes,” she said. “I’m going to get your face.”
“Okay, okay,” Jemma said, uncapping the syringe and looking around for a port into the line. She made to inject the drug into a high one, but Cindy scolded her again, putting her clammy hand out and guiding Jemma to a lower port.
“Push it fast, or it won’t work at all.” Jemma did as she was told, wondering why it would matter where it went in the line, or how fast. Always seeking to avoid being yelled at, she cleaned the port thoroughly with an alcohol swab, then turned back to Cindy to finish the little interview and do an exam. She’d sunk down in her bed. Her mouth had fallen open, and her eyes were half lidded. The nurse came in. Carla was famous for her ill-temper — people called her Snarla behind her back.
“What the fuck are you doing?” she asked.
“She needed it,” Jemma said. “She was going to vomit.”
“What were you doing bringing benadryl in here?”
“It was already here,” Jemma said.
“That’s not the point. That’s not the point at all. Look at her, she’s addicted to the shit. Look at her! Why don’t you just run around hooking all the babies on fentanyl pops?”
“It’s benadryl,” Jemma said. “It’s an antihistamine.”
“So? You think that means you can’t get hooked on it? These GI kids get hooked on anything, you moron. And if you give another med on my floor I’ll have you thrown the fuck overboard. Got it, Mr. Goodbar?” Jemma blushed and opened her mouth. A few things her brother might have said ran through her head — Double fuck you, bitch; Step a little closer so I can kick in your fucking face; You are as small and puckered and ugly as an asshole — but she couldn’t bring herself to say them. She only stood there and blushed, and said, “Mr. who?”
“Just watch it,” Carla said, and huffed out of the room, the syringe clutched in her hand.
“Fuck you,” Jemma murmured, and imagined the phrase floating down the hall to settle in her ear, so she’d hear it echoing there all day. She turned back to Cindy — sound asleep now, and looking much more comfortable. “Cindy?” she said, but the girl didn’t even snore. Jemma listened to her heart and poked her once in the belly — she couldn’t bring herself to do much of an exam on a sleeping teenager — then went to see her next patient.
Five doors down, there was a four-year-old with hideous constipation. Not pooped in seven days, is what the consult-request note said. The child was in the hospital for endocrine issues — she and her eight siblings had all been admitted for rickets after Child Protective Services had discovered them living in a commune with their father and three mothers, fed on a strict diet of guava juice and spelt. They had names like States’-Rights and Valium and Shout and Shoe-Fly; Jemma’s patient, named Kidney, walked half the time on all fours because she was weak and her bones were hideously deformed. Jemma hated vitamin D; the structure was confusing and calcium metabolism had never made any sense to her. She’d reviewed it with Rob for an hour the night before, sure that the attending, an enthusiastic pimper, would test her knowledge.
The room was dark, and full of beds, two under the window and two stacked in bunks against each wall — it wasn’t legal but the children had flocked into the same room the night of the storm and refused to be separated again. It was full morning outside, but the blinds were drawn, and someone had thrown a blanket over the window. “Kidney?” Jemma said, and every shape in the bed stirred. They were sleeping double and triple, leaving one bed under the window empty. Pale faces came out from under the blankets. They were all blond. “Hi everybody,” Jemma said.