“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 orders, 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.