Chris Adrian - A Better Angel

He is here for a tune-up: Every so often the cystic fibrosis kids will get more tired than usual, or cough more, or cough differently, or a routine test of their lung function will be precipitously sucky, and they will come in for two weeks of IV antibiotics and aggressive chest physiotherapy. He is halfway through his course of tobramycin, and bored to death. We go down to the cafeteria and I watch him eat three stale doughnuts. I have some water and a sip of his tea. I’m never hungry when I’m on the sauce, and I am absorbing so poorly now that if I ate a steak tonight a whole cow would come leaping from my ass in the morning.

I do a little history on him, not certain why I am asking the questions, and less afraid as we talk that he’ll catch on that I’m playing intern. He doesn’t notice, and fesses up the particulars without protest or reservation as we review his systems.

“My snot is green,” he says. “Green like that.” He points to my green toenails. He tells me that he has twin cousins who also have CF, and when they are together at family gatherings he is required to wear a mask so as not to pass on his highly resistant mucoid strain of Pseudomonas. “That’s why there’s no camp for CF,” he said. “Camps for diabetes, for HIV, for kidney failure, for liver failure, but no CF camp. Because we’d infect each other.” He wiggles his eyebrows then, perhaps not intentionally. “Is there a camp for people like you?” he asks.

“Probably,” I say, though I know that there is, and would have gone this past summer if I had not been banned the year before for organizing a game where we rolled a couple of syndromic kids down a hill into a soccer goal. Almost everybody loved it, and nobody got hurt.

Over Wayne’s shoulder I see Dr. Chandra sit down two tables away. At the same time that Wayne lifts his last doughnut to his mouth, Dr. Chandra lifts a slice of pizza to his, but where Wayne nibbles like an invalid at his food, Dr. Chandra stuffs. He just pushes and pushes the pizza into his mouth. In less than a minute he’s finished it. Then he gets up and shuffles past us, sucking on a bottle of water, with bits of cheese in his beard. He doesn’t even notice me.

When Wayne has finished his doughnuts I take him upstairs, past the sixth floor to the seventh. “I’ve never been up here,” he says.

“Heme-onc,” I say.

“Are we going to visit someone?”

“I know a place.” It’s a call room. A couple of years back an intern left his code cards in my room, and there was a list of useful door combinations on one of them. Combinations change slowly in hospitals. “The intern’s never here,” I tell him as I open the door. “Heme-onc kids have a lot of problems at night.”

Inside are a single bed, a telephone, and a poster of a kitten in distress coupled to an encouraging motto. I think of my dream cat, moaning and crying.

“I’ve never been in a call room before,” Wayne says nervously.

“Relax,” I say, pushing him toward the bed. There’s barely room for both our IV poles, but after some doing we get arranged on the bed. He lies on his side at the head with his feet propped on the nightstand. I am curled up at the foot. There’s dim light from a little lamp on the nightstand, enough to make out the curve of his big lips and to read the sign above the door to the hall: Lasciate ogne speranza, voi ch’intrate .

“Can you read that?” he asks.

“It says, ‘I believe that children are our future.’ ”

“That’s pretty. It’d be nice if we had some candles.” He scoots a little closer toward me. I stretch and yawn. “Are you sleepy?”

“No.”

He’s quiet for a moment. He looks down at the floor, across the thin, torn bedspread. My IV starts to beep. I reprogram it. “Air in the line,” I say.

“Oh.” I have shifted a little closer to him in the bed while I fixed the IV. “Do you want to do something?” he asks, staring into his lap.

“Maybe,” I say. I walk my hand around the bed, like a five-legged spider, in a circle, over my own arm, across my thighs, up my belly, up to the top of my head to leap off back onto the blanket. He watches, smiling less and less as it walks up the bed, up his leg, and down his pants.

See the zebra? She has atrocious pancreas oh! Her belly hurts her terribly — sometimes it’s like frogs are crawling in her belly, and sometimes it’s like snakes are biting her inside just below her belly button, and sometimes it’s like centipedes dancing with cleats on every one of their little feet, and sometimes it’s a pain she can’t even describe, even though all she can do, on those days, is sit around and try to think of ways to describe the pain. She must rub her belly on very particular sorts of tree to make it feel better, though it never feels very much better. Big round scabs are growing on her tongue, and every time she sneezes another big piece of her mane falls out. Her stripes have begun to go all the wrong way, and sometimes her own poop follows her, crawling on the ground or floating in the air, and calls her cruel names .

Suffer, zebra, suffer!

Asleep in my own bed, I’m dreaming of the cat when I hear the team; the cat’s moan frays and splits, and the tones unravel from each other and become their voices. I am fully awake with my eyes closed. He lifts a mangy paw, saying goodbye.

“Dr. Chandra,” says a voice. I know it must belong to Dr. Snood, the GI attending. “Tell me the three classic findings on X-ray in necrotizing enterocolitis.” They are rounding outside my room, six or seven of them, the whole GI team: Dr. Snood and my intern and the fellow and the nurse practitioners and the poor little med students. Soon they’ll all come in and want to poke on my belly. Dr. Snood will talk for five minutes about shit: mine, and other people’s, and sometimes just the idea of shit, a platonic ideal not extant on this earth. I know he dreams of gorgeous, perfect shit the way I dream of the cat.

Chandra speaks. He answers free peritoneal air and pneumatosis in a snap but then he is silent. I can see him perfectly with my eyes still closed: his hair all ahoo; his beady eyes staring intently at his shoes; his stethoscope twisted crooked around his neck, crushing his collar. His feet turn in, so his toes are almost touching. Upstairs with Wayne I thought of him.

Dr. Snood, too supreme a fussbudget to settle for two out of three, begins to castigate him: A doctor at your level of training should know these things; children’s lives are in your two hands; you couldn’t diagnose your way out of a wet paper bag; your ignorance is deadly, your ignorance can kill . I get out of bed, propelled by rage, angry at haughty Dr. Snood, and at hapless Dr. Chandra, and angry at myself for being this angry. Clutching my IV pole like a staff, I kick open the door and scream, scaring every one of them: “Portal fucking air! Portal fucking air!” They are all silent, and some of them white-faced. I am panting, hanging now on my IV pole. I look over at Dr. Chandra. He is not panting, but his mouth has fallen open. Our eyes meet for three eternal seconds and then he looks away.

Later I take Ella Thims down to the playroom. The going is slow, because her sauce is running and my sauce is running, so it takes some coordination to push my pole and pull her wagon while keeping her own pole, which trails behind her wagon like a dinghy, from drifting too far left or right. She lies on her back with her legs in the air, grabbing and releasing her feet, and turning her head to say hello to everyone she sees. In the hall we pass nurses and med students and visitors and every species of doctor — attendings and fellows and residents and interns — but not my intern. Everyone smiles and waves at Ella, or stoops or squats to pet her or smile closer to her face. They nod at me, and don’t look at all at my face. I look back at her, knowing her fate. “Enjoy it while you have it, honey,” I say to her, because I know how quickly one exhausts one’s cuteness in a place like this.