Dr. Chandra was in the cafeteria, the place to which he habitually retreated after an on-call humiliation. There was no consolation in pudding, but he still stuffed himself with it every time something went wrong, every time he tangled himself in something really unfortunate, or tripped at exactly the worst time, falling into another mother and squeezing at her boob for purchase. You do that more than twice and people think you are feigning clumsiness for the sake of the grope, but he thought boobs the unloveliest things in the world; he'd cross the street to avoid a particularly large, stern pair. Every time he wrote the wrong dosage for a drug, and every time he got caught only pretending to hear a murmur or making up a laboratory value he'd failed to memorize, he'd come down to the cafeteria, always to the same table if it was available, stuck in a glass alcove, windows that looked over the memorial butterfly garden. You didn't have to be a dead child to get a butterfly there, but that was mostly what they represented, preemies who never made it out of the nursery or toddlers who couldn't beat their brain tumor or teens who succumbed to leukemia. The pudding was cheap and filling. He ate it and ate it until he thought he could feel it squeezing from the pores of his nose.
"Is it in?" he had asked Emma, when he had tried to intubate the monstrous child.
"I don't fucking know," she said. "We're tubing a baby, not having sex." Then she bumped him out of the way and looked in the child's mouth. "In his brain, maybe," she said, yanking out the tube, then putting in another, all in about twenty seconds. "There you go," she said, patting Dr. Chandra on the shoulder. She walked off, and he noticed for the hundredth time how she had curls that really bounced. Natalie was shaking her head. The medical student was staring at the ceiling. When the respiratory therapist asked him for vent settings, Chandra just walked away.
I could just leave, he thought to himself in the cafeteria. It was a thought that had occurred to him before, to walk out of residency, out of the hospital, and out of the horrible half-life. He'd walked out of rotations before, but only as far as the Residency Director's office, to complain and to cry to the man who insisted they all call him Dad. Nothing ever came of it, and he always went back to work. Tonight it was raining too hard to walk out, though maybe that would be a better option than remaining—to leave the hospital and be swept away, out into the bay and through the Golden Gate, out to the Farrallons where he could live on puffins and baby seals, a better diet than humiliation and misery and vanilla pudding.
A noise took him away from the Farallons—a surge in the wind. Suddenly it blew so heavily he felt the hospital rock. The few other late-night diners looked up from their pizza or ice cream or pudding. Chandra rose and pressed his face against the window. Now the rain was falling so hard it totally obscured the garden. When the window went dark he thought it was because of the sheer volume of rain, until he saw his pale face reflected in the depths of the darkening glass, and saw that all the others were going to the windows to examine them, too. When he pressed his face against the glass, and cupped his hands at his temples to block out the light, he still couldn't see through. Staring and squinting, he saw a dim flash of light, as if at a great distance, and thought it must be lightning struggling to shine through the rain.
"What's going on?" he asked no one in particular. Nobody answered. The others in the cafeteria only tried like he had to see out the darkened windows. He turned back and was about to try again when he felt the first big lurch. They're all going to laugh at me, he thought as he fell, just after he knocked his head on the table. But before he felt himself pressed back flat against the floor, he had time to see that everyone else was falling, too.
Three floors up Emma was relaxing—as much as she ever did on call—in her luxurious call room. It was really an attending-level call room, but then she was nearly an attending, and had anyway been outthinking and outclassing most of the attendings since her first year of fellowship. But who needed a vanity in their call room, and to take a bath in the whirlpool tub was only asking to be called out wet and naked into the middle of a crisis. She lay in bed a little while, visiting in spirit every baby in the unit, holding them a minute in her expansive mind, considering their afflictions and trying to anticipate the dips and turns their hospital courses might take that night. There was nothing she could think of that she had not already warned Natalie to watch for, or that Natalie would not anticipate herself. You couldn't spell out everything for them, and she left more than usual unspoken with Natalie, who was smarter than the average third-year, or less dumb, at least. She did an imaginary survey of the PICU as well, since she was covering both units tonight. The regular PICU fellow was still trying to swim in.
Sirius Chandra passed briefly through her mind, tangled up and confused and goofy and already slightly smelly, she'd noticed standing close to him, though the night was hardly half-over. She thought of tracking him down in whatever hidey-hole he'd retired to, for the sort of talk a good and empathetic Fellow was supposed to deliver to a really dispirited Intern, but it seemed too late for tears and complaints and excuses. She turned on the television but it played only a moment—a glimpse of a girl and her horse who she managed to recognize as Pippi Longstocking before the station cut out, and then every station she tried was off the air. She turned it off, and sat down on the bed, and got a page, not from the unit just outside her door, but from her home.
"She's fine," her husband said as soon as he picked up the phone. Their daughter was five months old that week.
"Pretty late for a social call," she said.
"Such a storm," he said. "I couldn't sleep."
"Well, I might have been."
"Better to be woken by someone you love."
"Who says I don't love these people?"
"She's sleeping right through the thunder. Did you know she twitches when she sleeps?"
"Are you sitting there watching her again? No wonder you can't sleep. Were you checking her breathing? It's fine. It's always going to be fine, and even if it wasn't, you're not going to catch it by staring at her. You've just got to relax. Don't you think I'll tell you if there's something wrong with her? Paul? Paul?" She listened for him—sometimes he fell very silent and she could barely hear him breathing—and she thought the line was dead until a lady's voice spoke out of the phone.
"He is gone, my love. Gone forever, not to be seen again in this world. He is already drowned, but not you. You I will protect and preserve and love for all your allotted time."
"Who is this?" Emma demanded, so nervous all of a sudden that she was holding the phone in front of her face and shouting into it. "Is this the fucking operator?" She only got silence for an answer, and then she got the terrible heaviness that comes of being thrust up so impossibly high, so impossibly fast. Not even an angel wielding the sheltering grace of God could cushion her fully. She fell back, like all the rest.
Down the hall, in another call room, Rob was speaking.
"Something awful has happened," he said to Jemma, and she was reminded of her mother, who had spoken those very same words, in the same sort of frightened, croaking whisper, when Jemma came home on the night of her brother's death. She was reminded, too, of the feeling she'd had as soon as she came in the house—she had known that something was horribly wrong before she saw anyone, before anyone delivered the news. She and Rob dressed hurriedly, pulling on each other's scrubs by mistake, so Jemma's shirt hung on her and Rob's clung tight across his shoulders. Neither of them remembered to put their socks on. Jemma opened the door, after they'd both hesitated a while, listening. The hall outside was empty. The red preemie footprints wandered along the carpet, same as they had when the two of them had gone into the call room. It all seemed quite normal, until a great wail, not a child's, came washing along the walls. The telephone lady's voice spoke as if in response. "Be comforted, my darlings."
They followed the little footprints back toward the NICU. The call room was placed so that a person should be able to run from bed to the unit or the delivery rooms in less than two minutes, but they creeped along so carefully that it took a whole five minutes just to come to the door to the glass bridge, or rather the place where that door had been. What previously had been a glass door was now a great circle of darkened glass, opaque and slate gray like the window in the call room, reflective only of flesh-colored shadows. Jemma put her hand against it and drew it back immediately. The glass was so cold her fingers stuck a little as she pulled her hand away. "What's happening?" she asked.
"Something awful," said Rob. "Come on." He took her hand and drew her along, past the pictures of children at play and past the giant newspaper articles. These all looked the same to Jemma's eye. Outside the unit, though, there was something new. Just beyond the doors, where she was sure a water fountain had stood earlier in the evening, there was now a little recess set waist-high in the wall, surrounded on three sides with flat squares of colored glass. Just above the recess was a greater light than all the others, an amber square the size of an adult hand. Rob reached past her to press his palm against it.
"What is it?" Jemma asked.
"A door handle, I think."
"Name me, I will keep you," said the woman's voice, seeming to speak from within the hole in the wall.
"Just open the door. Open the damn door."
"Until I am named, I cannot keep you, I cannot preserve you, I cannot make the thing you desire. John Robert Dickens, I have named you, now you must name me."
"What the fuck?" Rob said, taking his hand away. "How do you know my name? Who the fuck are you?"
"I am the preserving angel," she said again. Jemma walked past him and swiped her badge through the old reader that still sat next to the door. The double doors were quiet a moment, as if considering whether or not she should be admitted, then suddenly swung in.
"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.
"What are you doing?" he asked.
"Intubating this little boy."
"Trying, anyway," the nurse said. Rob took the bag and mask from her and ventilated by hand. When Jemma went in again he looked over her shoulder, his cheek pressed to hers. He was covered in sweat. His clothes were soaked through, and Jemma wondered if other people had noticed how he reeked of sex.
"Ah, just pull back a little," he said, tugging gently at her wrist. The vocal cords popped into view and Jemma went through them with the tube. Rob's fingers clutched the tube over hers, pinning it against the kicking baby's lips.
"You're in, finally," the nurse said to Jemma.
"Don't let go till the tube is secure," said Rob, and then he hurried away. Jemma could not figure how much time had passed since she saw him last, and she quickly lost track again after he was gone. She intubated two more babies, put in another IV, assisted with a chest tube, bag-ventilated for a half hour under the intermittent tutelage of a pierced-up respiratory therapist, and finally changed a diaper, and then she could not find another emergency. Jemma was in the third bay, the middle bay, when it all stopped; she sat down on the floor and leaned back against the wall. She saw Dr. Chandra standing in the middle of the bay, a silver laryngoscope in his hand, looking forlorn and confused. Natalie and Emma were standing very tall on either side of an isolette three babies down from where Jemma sat, with their heads held high and their noses elevated, so they looked to be sniffing for the next crisis, but it never came. Dr. Grouse, the attending, was standing with his arms folded, seeming to be staring intently at a monitor, but his eyes were closed. The silence of alarms seemed heavy and oppressive, and the noise of a loosely connected piece of oxygen tubing near Jemma's head was rather soothing. She closed her eyes and fell asleep, but only for a few minutes, waking to discover the nurse Anna shaking formula on her from a bottle.
"Wake up, sweetie," she said. "You can't sleep there."
"Stop that," Jemma said.
"It's not too hot, is it?" Anna asked, shaking out a few drops onto her arm.
"What time is it?" Jemma asked.
"I haven't looked. Will you move, or should I roll you out of the way?"
Jemma stood. "What happened?"
"You were here. You saw. They all crumped at once. The whole damn unit, except her." She pointed to an isolette in the middle of the room. It was set upon a dais that Jemma was quite sure hadn't been there the day before. "She auto-extubated an hour ago. How about that? Now they want me to try to feed her. That seems a little hasty, don't you think?"
"I mean outside. What happened outside?"
Anna shrugged. "Ask somebody who's thinking about it," she said, and turned to feed her patient. Jemma walked away from her, to the isolette on the dais. Standing on her toes, she could look inside to see the King's Daughter, sucking on her hand with her rabbity mouth. She turned her head to look serenely at Jemma. It was unbearable, not for the ugliness of her face, but for the peace of her eyes. "Brenda," Anna said. "Isn't that an awful name? She needs a sleeveless tee shirt and bad hair, to go along with that name."
"I have to go," Jemma said—she had a view into all the bays but didn't see Rob anywhere that she looked. She hurried right out of the unit, past the little flocks of people three or four strong, who were finally turning on the televisions set high in the corners of every bay, seeking answers about the state of the world but finding only lambent static.