Chris Adrian - The Children's Hospital

“Didn’t these used to open out?” Jemma asked. Rob was too distracted by the chaos in the unit to answer her. Nurses and doctors and assistants were running every which way. Jemma thought they were in a panic for the same reason that she wanted to be in one; they knew it, too, that something awful had happened, something to which the only proper reaction was to run around like this, from room to room, shouting and barking at each other. But it was the more ordinary pandemonium of a unit in uproar. Rob had told her about these patients, little unformed people so sensitive to disturbance that a raised voice or an unpleasant inflection or an ugly face could make them sick. It was said of them that they were trying to die, when they decided that the noise or your bad mood or the vibrations in the ether were too much to bear, and they stopped breathing and dropped their heart rate, turning blue or purple. Turn away from the light! the nurses would shout at them, half-joking. All the doors to all the bays were open, and Jemma could see through them that there was hardly a single isolette or crib that didn’t have a person or two administering to the patient. It looked as if every last one of them was trying to die.

As they entered the first bay, a swiftly passing nurse caught Jemma’s shoulder, pulling her a few steps before she stopped. Fat, middle-aged, with smart hair and stylish glasses, she looked just like countless other nurses. Jemma knew her the way she knew a lot of the nurses in the unit and the nursery — she’d been yelled at by her for touching a baby or not touching a baby or not washing her hands correctly or breathing wrong around the babies. Her name was Judy or Julie or Jolene.

“You, what are you?” she asked.

“A med student.”

“Useless! Useless! Have you ever given bicarb before?”

“Not exactly,” Jemma said, meaning never at all.

“Well, time to learn!” She shoved a nursing manual and a little phial of bicarbonate into Jemma’s hands, pointed at the nearest isolette, and then she was off, swift as before, shouting the dose back over her shoulder. Jemma turned to Rob to ask about the particulars of correcting a metabolic acidosis, but he was gone, collared by an attending to assist with intubating a plum-colored baby down the way. Jemma could look things up as well as anyone, and probably quicker than most. Facts leaked out of her brain within days of being stuffed in, but she had excelled in school all her life because she always knew the most direct route to the information she required. She had the heaviest white coat in her class, full of books and laminated tables, and she wore at her hip the most advanced data-storage device she could find. She read the entry on bicarb in the nursing manual pretty quickly. For the next five minutes she would know as much as anyone about how to give it, and then the information would be gone. She thought she was doing a good job, and was feigning confidence as she drew up the medication and flicked bubbles out of the syringe. Still, the flapping harpy who had assigned Jemma the task made another pass by her just in time to catch her wrist and shriek at her, “It’s not going to do much good in her bladder. That’s the foley , you moron!” It was just one of many pasta-thin tubes disappearing into a tangle beside the little body before emerging to plunge into various natural and unnatural orifices. Jemma had thought she’d traced out the line pretty carefully. Judy — Jemma got a sustained look at her dangling name tag as she was shrieking at her — pushed her out of the way, into the orbit of another nurse, who pressed her into service trying to get IV access on a fat, seizing one-month-old. He was huge and veinless, and had just the appearance of a red beachball, the way he bounced in his bed. “He hasn’t seized in a week!” said the new nurse. “We just pulled the broviac yesterday, for God’s sake, and the IM ativan isn’t working for shit. Are you any good at these?”

“I’m okay,” Jemma said, though she’d never in her life gotten an IV on anyone except Rob, whose veins were as great and obvious as highways. She took a foot while the nurse took a hand, and they both began to stab blindly into the soft red skin. Jemma got a flash of blood once, but when she tried to thread the catheter the little vein blew. “Try again,” the nurse told her, and Jemma did, failing three more times before the nurse got one. By then the baby’s battery had run down. It was only twitching once or twice a minute.

“Should we still give the drug?” asked the nurse.

“I guess,” Jemma said, looking around for a real doctor. Rob was in this bay, doing compressions four isolettes away. She decided not to bother him with the question. The nurse pushed the tranquilizer and they both bent over the isolette to watch its eyes glaze.

“You’re a little shaky,” said the nurse, when the baby had grown quite still. “You want some of this?” She shook the syringe at her.

“No thanks,” Jemma said.

“I’m Anna,” the nurse said cheerily, sticking out her hand. “And I’m kidding! Nice try with those pokes, though — seriously.” Jemma took her hand weakly and stared at her, not sure what struck her as so strange about the woman, and she thought for a moment it was her chicken neck or her oversized turquoise earrings that gave her the air of a trailer-park queen, until she realized it was the cheery tone, so out of place in this carnival of crises, and in the context of the great crisis. Jemma suddenly understood that she hadn’t been thinking about that, about what the broadcast lady was saying — you have all been saved from the water. “Is it real?” she asked Anna.

“One hundred percent genuine prime delicious benzo!” she said, sniffing lovingly at the syringe. “I’m kidding!”

Judy grabbed Jemma’s arm and dragged her down the bay, not even speaking to her but delivering her to another access nightmare and then hurrying away again. Jemma picked up a syringe and started poking; the baby’s nurse didn’t even look up. Jemma failed three times on this one, three on the next one, and two on the next, a post-op cardiac train wreck whose central access stopped working just as the unit went all to hell, and whose irritable heart was wanting its antiarrhythmic. Jemma tried three times and got the fourth, a scalp vein just in the place you’d put a bow on the head of a normal baby girl. Then she got two in a row, both on the first try, but just when she thought she might actually be developing some skill or attracting some luck at inserting IVs, someone wanted her to intubate. She was three bays away from where she started, faced with a former twenty-seven-weeker who, now a month old, and five days off his ventilator, had abruptly decided to stop breathing.

“How many of these have you done before?” the nurse asked her. Jemma said three, which was technically true, but she did not volunteer that none of those attempts had been successful. She knew the procedure well enough, knew how to put a rolled washcloth under the little neck and tilt the head back, how to pry open the toothless mouth with her pinkie and sweep the tongue aside with the edge of the laryngoscope blade. She put her tube in the first hole she saw. “Esophagus,” said the nurse, listening over the belly with a stethoscope as Jemma puffed a few bursts of air through the tube with a bag. “Did it again,” she said, after Jemma’s second try. “Did you say you’d done this before?” Jemma didn’t answer, only rolled the head back again and poised her arm for another swoop. She saw it again, the single pink wet hole, and understood how it wasn’t the anatomy she sought. She wondered how a trachea could be so thoroughly hidden in a neck the diameter of a shot glass. The nurse was shouting out the baby’s heart rate, which fell further and further as Jemma failed to remove the foreign body from its throat. “One ten!” she shrieked. “Ninety! Sixty!” Jemma took out the scope, straightened her back, and took a step back right into Rob.