DEAD GIRLS by Andrew Peery

“When did this start?” Stephen asked, settling himself deeper into his side of the sofa. The morphine warmth was spread through his arms and legs, almost an itch, and he could not remember the last time he had felt it. The doctors did not use much morphine in this hospital. It was outmoded, replaced by narcotics like fentanyl and hydromorphone with more rapid onset and better side effect profiles. Sometimes a new intern would write for morphine, half asleep, barely out of medical school, unable to remember even the names of the other drugs she might choose.

Stephen was half asleep in the semi-dark of the windowless call room. The only light came from the green and white screen of a television that hung on the far wall. It was a scene from a seventies movie, something he had once thought was funny. A man and woman were walking onto a tennis court. In the green-white tennis court light, he could not see if Claire had responded to his question with her usual shrug, or if she was awake. The room smelled of Claire sleeping, a shampoo smell of impossible flowers. It was two a.m., and he was squinting at the bright light of television sky, wishing the actors would go inside so the screen would be dimmer. He looked away from the television to the ceiling tiles and the dull white walls of his room, away from those to the heavy metal door he kept closed and locked. The door was scratched and dented, painted canary yellow like every other door in the building. In every room on this hall, he could open a yellow door and see the same vinyl chairs, the same footworn brown carpet and black-splattered linoleum. An IV pole stood between him and Claire, a bag of clear fluid for each of them. His left arm was cold from the steady trickle of crystalloid into his vein. A plastic dropper chamber hung between the bag and the tubing, the drops rounding and falling, inverting the sky and tennis court, the famous actor. Air conditioning hummed in the ceiling above him. He wrapped his stiff blanket tighter around his shoulders, the smell of hospital soap deep in the fibers. He always got cold at this time of the morning, proof that he was supposed to be home in bed.

“Claire?”

“I don’t know,” she said. She turned herself slightly, pushing up with both arms to help her shift the weight of her belly. She was thirty-two weeks pregnant, still thin at her hips and ankles. The baby had altered only this one line of her body, a long curve from ribs to pelvis, her belly button protruding beneath the thin grey fabric of her T-shirt. She turned her eyes up and gave him a sleepy smile, the angle of her jaw overlaid with the grid-like impression of her blanket. Stephen grinned back reflexively. Sometimes a television commercial caught an actress just right and he would find himself grinning foolishly at the screen, tricked by an aspiring starlet’s enthusiasm for mouthwash or bubble gum. It was more embarrassing to smile that way now, with Claire struggling to get herself upright. She reached an arm toward the table in front of them, looking for leverage.

“Glass,” he warned her, watching as her knuckles and nails came to rest. The table top was dusted with small flecks and ampules, a series of clear glass vials with jagged-edged tops. She pulled her hand back and examined her fingers, looking for small cuts she would need to bandage. She brushed one hand across the other, a soft, practiced motion that would clean away the curved shivers without driving them into the skin.

“OK?” he asked, but he was reaching for his IV tubing. A cold sweat traced an aching line from his forehead through the stacked bones of his spine to his stomach. The swelling nausea defined an illogical anatomy, a mix of gut and bone and skin that were never connected in any medical book he had seen. As the sensation leapt impossibly from his feet to the back of his neck, he realized that he had not been paying attention; he had lost track of time while half asleep and almost warm under the blankets, his feet brushing hers at the midline of the cushions. Now it was obvious that he had wanted to vomit for at least the last hour. Claire nodded yes to the question he had already forgotten. She looked up from her hands to watch him, knitting her eyebrows over a sympathetic pout.

“You look miserable,” she said. “How’s your friend down the hall?”

“She’s still sick.”

“Intensive care sick? Sick enough for a tube down her throat?”

“Sick enough to say no. She doesn’t want it.”

“Should we go see her?”

“The nurses will just tell us what we should be doing.” He was still fumbling with the IV, his hands mostly steady, and the column of fluid glowed blue-white as the tubing slipped between his fingers. Claire took his hand in hers, folded the fingers into her fist, then pulled the fist beneath her chin. She found the wheel for him, opened up the IV. Halfway down the line, a syringe hung out at right angles, and her hand slid to it, their last milliliters of the ondansetron and morphine they had stolen from a patient. His arm turned colder from the rush of the fluid. “How sick do you feel, Stephen?”

“I don’t think I’ll throw up.”

“Just lay your head down,” she said, pulling him over, laying his head into her lap. “We’ll go see her in a minute.”

“OK.”

“We’ll go see her before they page us again.”

* * *

The girl, the patient, was bone thin and pale. She sat leaning forward, her legs crossed beneath the sheets of her hospital bed, breathing fast. With her left hand, she held back a handful of dirty blond hair to keep it clear of her mouth. She would not let anything get near her mouth, and she distrusted even the oxygen mask on the bed beside her, hissing as it ran. She clutched it with her other hand, pushing it into the mattress, afraid they would try to put it on her face again. The exam lights above her shadowed the hard edge of her jawbone, the sweat forming in the creases of her forehead. Her short white T-shirt hung damply across the bony points of her shoulders. It rose and fell, flat across the space where breasts should lift. She was eighteen but looked to be thirteen, like many cystic fibrosis patients. Stephen moved his stethoscope across her chest, searching for the sound of whatever threatened her. Her lungs crackled between her ribs, a sound like boots in dry leaves. Claire watched from the doorway, the IV in her arm capped off now, hidden under the sleeves of the same white coat that he wore. The nurses would stop to see her, smiling, always touching her abdomen in a way that seemed unpleasantly intimate.

Moving restlessly around the patient, Stephen and the intern from the floor wore yellow paper gowns and masks. He could not remember why they wore the gowns. It might have been that the patient had an infection. It might have been that they were protecting the girl from an infection. The thin paper of the gowns fluttered about them as they moved. The intern had a narrow face, round glasses beneath dark hair, three months since his last haircut, stubble on a chin so narrow Stephen suspected it would collapse from the weight of a beard. The intern wanted this patient to leave his floor, to go to an ICU so that he could stop watching her die. The ICU doctors would not take her – there was nothing to offer – they felt she would die anyway. Now the intern looked to Stephen and Claire, the team from anesthesia. If he could convince them to intubate the girl, she would have to leave the floor and go to an ICU. The other doctors would have to take her and put her on a ventilator. The intern would be able to leave this room. He would be able to go to a call room like their call room, to lay down on a couch or a bed, to know there was nothing else he should do. Stephen understood. “Will you let me put the tube down into your lungs? You’ll be able to breathe better.” The girl shook her head no.

The intern whispered to the girl, encouraged her to put the mask back on. Stephen knew it did not matter. He looked at her, wishing he could remember why he had to wear the gown. He wished he could remember every fact about her, every medication she took, every surgery she had ever had. It would make no difference if he could.

Out in the hall, he tore the paper gown in half and pulled it off the sleeves of his white coat. Claire was gone. There were thirty other rooms, other patients. It was three in the morning. The nurses had turned the lights down, and in the darkened hallway he felt more tired than he did with the girl, under the heat of the exam lights. The door was closed between them, and the yellow light glowed in the space between the door and the floor. There was more light from the nurses’ station down the hall. Some of the nurses were laughing. Outside the walls of the hospital, it was a warm August night, a full moon and clear sky.

* * *

At night, on call, the nurses would make time for Claire. The other female residents complained about the nurses, describing pettiness and backstabbing, a delay in following orders that was never seen with the male residents, a half second of hesitation, statements read back in questioning tones. The nurses, in turn, would complain about the condescension of these young women who did not respect their experience, their years of patient care which had given them, if not the knowledge of doctors, a strong sense of how things had always been done, the ways that patients had always died before.

Things were different with Claire. It was her situation they loved. She was the conversation that was ending just as he entered the fluorescent yellow workroom that smelled of microwaved leftovers. “Yes, doctor?” they said, forks paused over greasy plastic containers. He stammered out something about respiratory therapy for the girl, and they gave him a look that said they would call when they were ready. They waited for him to leave, so they could get back to discussing the father. Stephen stepped out to a computer in the hall, mounted to the wall beside the door, still within earshot.

“She is so nice.”

“There’s a sweetness to her. You see it in her smile.”

“And a pretty girl too, but she never acts like it.”

“I know, I know.” A sigh. “I wish I could look . . .”

“You see the way the thin one looks at her.”

“Creepy little man. Just that tight smile, and those blue eyes that are too close together. Skin and bones under that coat.”

“Have you called respiratory?” one said, giving her voice a nasal reediness in what Stephen hoped was a poor imitation. The two women started laughing.

“That one ain’t the father.”

* * *

“Here,” Claire said. “Come here.” Back in the call room, they watched commercials. She tapped a syringe of fentanyl against the table, coaxing air bubbles to the top so that she could push them out without wasting the drug. The bubbles were so small they did not matter. She could inject the entire syringe of air and it would not matter. It would diffuse out into his body in a precise way – there was math that proved it, research from a study decades old. Sometime, he thought back in the 1970s, there was a movie where a character was killed by injecting air into his veins. Now Stephen has to reassure his patients any time they see air in an intravenous line. He tells them about the study, the math, the elegant injection of increasing quantities of air into people who have been dead for decades. None of them died in the experiment, he tells them. Claire tapped the syringe so that the bubbles rose to the tip. This was pointless in adults, although there was a risk in children, a structural difference in their hearts that occurs in fifty-five percent of them at two to six months of age. On the television, six out of ten housewives preferred something. A mop? A floor cleaner?

“Here,” Claire said, “you get the last.”

“OK.” He slid his arm free of the coat. The pink hub of the IV floated on the skin of his arm, sealed beneath clear plastic and precise folds of tape. His skin was pale and freckled, decorated with a lacework of wide veins, all usable, none ruined yet. She reconnected the tubing from the IV bag he had left behind. “Hold still,” she said.

“I’m trying.”

On the TV screen there was a field of waving grass, the pink and white box of a drug used for weight loss, sixty-seven percent effective in trials, side effects of loose stools. He took a deep breath, then let it out. The first thing to go was always the nausea. The announcer was still talking. Claire was still talking.

“God, I hate those cows. Did they ever call for respiratory?”

He was trying to look at her, but his eyes were trying to roll back into his head.

“It’s orange scrubs I hate the most. She smells like curry.”

“Marjorie. That one’s Marjorie.”

“Don’t you love her pockmarks? Don’t they have acne medicine in the Philippines?”

“Thailand, actually.”

“That floor is nauseating enough. It always smells like someone took a shit in the middle of the hall.”

He was not quite awake anymore. His head was in her lap when her pager went off, a jarring sound that he tried to ignore. He pretended to be sleeping. Her fingertips were on his arm, tracing the blue curves of vein beneath the skin as she talked on the phone. Then he was not in her lap, just on a pillow. She was walking around, the smile getting brighter on her face. As she hung up, she laughed. “New patient,” she said, loudly enough that he knew he should just sit up. He pressed his hands to his eyes, swung his feet around to the floor. He would go to the pharmacy to check out more narcotics.

* * *

In the hallways of the operating rooms, the floor wavered in the distance, like heat on the black tar roadways of the outer counties. Whenever he was this tired, even before he started using, the floor wavered. The first time it happened, he thought it was from inattention, a trick of peripheral vision and a distracted mind. He had stopped himself in the hall. He had concentrated on the grid of scratched white linoleum, reminding himself that it could not be moving, that he had to make himself see what he knew was actually there. He had stared for three minutes, waiting. Then he went back to work in a building that seemed to be melting.

Outside, the nighttime heat of August made everything motionless except for the road. The green trees and Carolina farmland ran for a hundred miles in any direction, uninterrupted by mountains or ocean. The high floors of the hospital gave a view of the horizon, but the horizon was no different from the nearby miles. An hour’s drive took you to the same place you had left – same trees, same towns.

Three blocks from the hospital, he kept a mattress and a couch, a television and ten boxes of unpacked books. The apartment was in an old tobacco warehouse, renovated with hardwood floors and a silver refrigerator he could barely keep stocked with Coke. High glass windows looked out on the downtown. There were no tall buildings, just four- to five-story brick, interspersed with parking lots, labeled with the names of bank and insurance companies that had not existed for decades. The glass windows of the warehouse would pivot at the center, half outside and half inside the building, held on balance with a chain notched into the window. His first night in the apartment he watched a fight at the bus station two blocks away. Under the towering white lamps of the parking lot, two men beat a third man unconscious. He called the police and waited for someone to come. Then he called an ambulance and waited for someone to come. A blue truck arrived, loose PVC pipe and a rattle of tools in the back. He watched two men help the injured man into the cab.

He went to the animal shelter and found a grey and white cat that seemed to like him. They would sit on the floor and watch a television he perched on the boxes of books, the cat willing to curl in his lap. He was home one day in the early morning, the air still cool from the night before. The warehouses two blocks away were making cigarettes, the last factory working in the city. He could smell fresh tobacco coming through the window. It was a sweet smell, honeyed, like something delicious. He fell asleep to it, strangely happy, and when he woke up the cat was gone. There was no sign of her in the courtyard three stories below. There was no sign of her up the fire escape to the roof, no sign of paw prints in the flat tar that stuck to his shoes. In the distance, a line of passengers waited to board a bus, clutching bags and suitcases.

* * *

There were no shadows in the operating rooms. The fluorescents shone down in all directions, into every corner. A few wheeled machines maintained dimmer spaces beneath them. The floor was a tangle of electrical cords. Stephen looked down with each step, moving carefully at the head of the black-mattressed operating table as he prepared for his anesthetic. He checked the anesthesia machine, an ungainly cluster of monitor screens and cylindrical devices larger than anything else in the room. A few streaks of blood traced arcs across the surfaces, left over from the last surgery or the surgery before that. He prepared a laryngoscope, a curving metal blade hollowed through with a fiberoptic light. This would lift away the patient’s jaw, enabling him to see the vocal cords as he inserted a breathing tube.

Metal trays of surgical instruments rattled as the nurses around him unpacked them. The nurses were men, Filipino, Rick and Bobby, both shorter than him. “Hello,” they said. Stephen said hello back. He had worked with them many times. He knew that Rick was from a village on the coast and Bobby from a larger city. He knew that only one of them sent money home, and that the other had dated a series of women who could be charitably described as questionable. He knew that Rick’s mother was sick, and that he was trying to get time off to go home to see her, and he knew that some of the other nurses complained that Rick had a large family, and that someone was always sick, and that they were tired of taking extra shifts. He did not know what Rick looked like. He had never seen him without a surgical mask and scrub hat. Some people can recognize other people from the eyes alone, but Stephen was never good at that. He had seen Bobby’s whole face only once, at the grocery store. He had walked past him, intent on getting milk. He turned around when he heard the familiar, slightly offended voice that followed him up the aisle. He was surprised to see a man in a grey suit and pale blue tie. “What,” Stephen said, “are you a banker in your off hours?”

“It’s Sunday,” Bobby had said.

Setting up the OR, Stephen worked silently. He drew up syringes – medicines to go to sleep, medicines to wake up, medicines to encourage the inadequate contractions of the heart. He took glass vials with colored labels from a wheeled drug cart at the back of the room, more than ten of them. He listened to eighties songs on the radio station the nurses liked, every word of the lyrics remembered from childhood. One of the men hummed softly while he laid out a hundred instruments with handles like scissors. “I’m going to see the patient,” Stephen said. He lifted a fistful of syringes off the stainless steel counter of the machine, putting them in the chest pocket of his scrubs.

“I’ll go with you,” Rick said.

“You go first, then,” Stephen said. “I’ll go check in with my senior.”

“It’s Claire tonight?” Bobby said. Stephen nodded.

“We like her,” Rick said.

“So friendly,” Bobby said.

* * *

“Did you think it would be like this?” Stephen asked.

“Being pregnant?”

“Being a doctor.”

“My dad was a doctor. He didn’t sleep much.” Claire shrugged.

“That’s why you went to med school?”

“He didn’t think I was smart enough.”

“Oh?” Stephen said.

She took the new syringe from his pocket and screwed it down onto her IV. “He wasn’t paying attention.”

“I think there’s something wrong with me,” Stephen said.

“Oh?” she said.

“I’m seeing things, I feel dizzy all the time. You think it’s too much midazolam?”

She laughed, a wide bright smile. “That’s why you started. Don’t you remember telling me?”

“Not really. I thought it was something about being nervous.”

“Nervous? What are you afraid of?”

“Making a mistake. Killing people.”

“Maybe you should talk about that with someone.” She pushed the syringe down, 4 cc’s, 5 cc’s.

“Are you available?” he said. She let out a long slow breath as the medicine started to reach her. “Not really,” she said. Even in the dim light of the call room, he could see that her pupils were shrinking. “Call your best friend from college. Call your Mom.”

“I’m sure that’ll work.”

“Call someone who knows you.”

“This is the only place anyone knows me.”

“Talk to the nurses, then.”

“Hmm.”

“Befriend a patient. A sick patient. A really sick patient.”

“Hmm.”

“Trick someone into knowing you.”

“I tried that.”

She shrugs. “It’s not like you’re sleeping with me.”

“No,” he said. “It isn’t.”

“Knowing someone isn’t all it’s cracked up to be.”

“I know what you mean.”

“I knew somebody. Calls after work. Trips out to dinner.”

“Somebody knew you.”

“Unfortunately.”

“Talk to them lately?”

“Try reading my email.”

“My eyes are too blurry.”

“Well, that’s what you get for cutting back on the midazolam.”

“Did you start this, or was it me?”

“We started in the bathroom, next to pre-op, on a lunch break.”

“Why did we start?”

“Because we were bored.”

“I was bored?”

“You were tired. I was bored.”

“I put a needle in my arm because I was tired?”

“You were curious.”

“Were you curious?”

“We were curious. We had syringes of narcotics. We shoved them into other people every day. We wanted to know what it felt like. I wanted to know. You’d remember all this if we hadn’t used the midazolam.”

“I might have wanted to know . . .”

“I smiled at you.”

“Why?”

“I even kissed you, after.”

“Nothing more?”

“The belly’s not yours.”

“Why did you kiss me?”

“Because you always smile back.”

“Will that ever happen again?”

“Not just now.” She closed her eyes, and he got up to go see the patient. Hands on the door handle, he clenched his jaw shut, trying to stop himself from talking. “Claire,” he said, “we’re friends at least, right?”

The eyes opened again, slowly, and he saw the familiar angles of teeth. “Of course we are, sweetie.” He was smiling right back as he shut the door between them.

* * *

Stephen walked through a set of double doors, into the holding area. There were two long rows of beds with curtains between them, the lights in each space dark except at the end, the last of them, a sharp white that guided him the length of the room. The curtains came half way out between each bed – he could not see his patient’s face, only feet beneath a white blanket. A black woman sat in a chair, holding the plastic bag they give to patients to hold their own clothes. Muffled in the tire-like down rings of a pink ankle-length coat, her small frame was taut and agitated. She spoke at a high pitch, the sound of shouting barely controlled for a public space. With each gesture of her hands, a single white feather threatened to shake loose from the threadbare fabric of her sleeve. “I’m not saying that,” she said.

“What then?”

“Why don’t you listen?”

Stephen smiled as he came into view.

“Hello, I’m Doctor Addison.”

A tired black man looked up from beneath a twisted hospital gown. A few wires scattered across his bony chest and arms connected him to a monitor behind him. The red and yellow numbers – heart rate and blood pressure, oxygen saturation – all were reasonable enough. His right arm rested uselessly beside him, up on a pillow, twice the size of the other, the skin stretched shiny red tight. The man drummed sausage-sized fingers in a stiff, awkward way, continually surprised by the strange, tingling numbness.

“Why can’t I have this surgery tomorrow?” the man asked. The woman shook her head.

“I told him, doctor.”

“Did he ask you what you said?”

“Your arm is infected.”

“Infected how?”

“In the ER they said infected from you putting needles into it.”

“Baby, you know I don’t do that anymore.”

“Who am I going to believe, you or the doctor?”

“I think you should believe me.”

“Doctor never lied to me.”

“I stopped that.”

“That doctor NEVER, NEVER lied to me.”

“You seen him before?”

She shook her head, long curls of hair whipping across her face.

“You gonna believe me, baby?”

She got up, tucking the bag underneath her arm. “You best think about where you’re staying when this is over.”

“Bull shit.”

An old woman in scrubs looked out from behind a door. “Don’t you speak that way in this room.”

“But – ”

The nurse slapped her hand on the wall. “Don’t you speak that way. I will call security.” The woman was hurrying down the hall, kicking the tail of the coat upward with each step.

“So,” Stephen said.

“She’s got my money in that bag,” the man said.

“So, I’m Doctor Addison.”

“Do you got a phone, doc?”

“I’m going to be one of your anesthesia doctors.”

* * *

“Patients aren’t friends and patients aren’t family.” There was a white board in the residents’ lounge, and someone had written this up there his first week in the hospital. One of the senior physicians saw it and erased it, and they all got a lecture at weekly conference about the cynicism that passes as humor in hospitals. Every day after that, there was a new quote. “They’re dying, not you,” was the one he always remembered.

On the ward, the nurses would not let the girl close her door anymore. She was guarded by an overweight nurse with two chins and tight purple scrubs. The broad lines of her face flushed red as she scowled at the doctors who would not do something. On the counter beside the bed, a small monitor measured the amount of oxygen in the girl’s blood. It was constantly alarming, a piercing high-low alternation that reminded him of the sound of European police sirens, at least how they sounded on television. The purple nurse could stop the alarm for sixty seconds, but it was always back again, insistent, offended.

“Don’t you have somewhere else to be?” the thin girl asked.

“I’m avoiding that place.”

The girl asked how many times he had intubated her, spreading the sentence out over three breaths. “Two times,” he said. He sat on the bed beside her.

“It’s strange I don’t remember.”

“There were medicines,” he said. “And you were pretty confused to begin with.”

“I’m not confused now.”

“No.”

“Why not?”

“I don’t know.”

“Are you here to do it again?”

“Will you let me?”

“No,” she said. Looking down at the bed, he saw there were a few crumbs of potato chips in sheets. “Why do you come visit me so much?”

“Third floor, hall B. You’re just down the hall from my call room.”

“Maybe you think I’m cute.”

“You’re a very pretty girl.”

“I’m glad I get to die cute.”

“That’s not . . .”

“Are you afraid of me dying?”

“I’m afraid of making a mistake that makes things worse for you.”

She smiled, ragged breaths coming through her teeth, her lips dry and flaked with dead skin. “This isn’t your mistake.”

* * *

For the past three days, Stephen had woken up early to look for his missing cat. Early was four in the afternoon, when there was still bright sunlight to remind him of the day he lost asleep. He pulled on clean blue scrubs, or at least scrubs that were not obviously dirty. He brushed his teeth and ate a bowl of cereal that he left half-finished on the window, hoping the smell of milk would lure her back. Then he began looking.

He crawled along every wall of the apartment, searching for some missed passageway created by lazy carpenters during the renovation of the building, rapping the sheetrock with his knuckles like a movie star thief looking for a hidden panel. He emptied his cabinets, exposing the brown water-stained spaces beneath the elbow pipes of his sinks. He pulled the massive silver appliances away from earth-toned walls, revealing layers of dirt and dead insects and even hair from the missing cat, as though she had lived there for months and not days. He took the stairs to the basement, wandering through the chain-link fences that demarcated storage areas. He used his penlight to search above the scarred wooden beams that supported the floors of the lobby, each one wider than his body, the grey dust of old mortar failing to reveal any tracks across them. He wandered the streets around his building, brick paved roads that were cleaned by the management of the building to make the neighborhood seem safer, no broken bottles or trash cans or abandoned cars, the streets swept clean and hosed down by helpful Mexican dayworkers. They wore jumpsuits emblazoned with the logo of the complex, and, assuming the Spanish he learned in the hospital was accurate, none of them had seen the cat. He knelt on the damp brick of the freshly washed street and looked into storm drains, one hand to the metal grate, his penlight struggling to illuminate the spaces below.

He knew that he would not find her. He told himself that she had made her way back to whatever life she was living before the SPCA. He imagined an abandoned warehouse, deeper in the city, the cat hunting pigeons and eating from the dumpster of a restaurant whose entire menu was built around biscuits. He imagined a wooded neighborhood, where sun shimmered in the trees and over the lawns of small brick houses, and a friendly fat woman put out food and water for the grey and white cat who lived in the trees behind her house. The fat woman wore loose floral dresses, and had a back garden filled with bedding plants and flowering trees, song birds in the high branches, a jasmine smell in the air when the breeze blew through. When the cat was taken to the pound, she wondered what had happened. She sat on her porch steps, waiting in the sun, a blue saucer of white milk warming at her feet.

* * *

Claire was sleeping again. She was curled beneath two blankets, her face turned back into the couch, only her feet visible at the bottom end, toes tucked between the last cushion and the arm rest, pink socks worn thin at the heel. The television was off, and the lights were off except for the desk lamp beside the computer work station, a wood grain formica shelf that was bolted into the wall. Stephen had another twenty minutes until the nurses would be ready for the patient in the operating room – there was some necessary implement being sterilized at high heat in the depths of the hospital. They would page him when it was ready.

The computer screen was bright white with Claire’s email account. She had left herself logged in, open to a long correspondence with the obstetrician Stephen had always known was the father. Pages of text were cluttered and interrupted with time stamps and computer addresses, changes in font, awkward rearrangements of paragraphs, interjections of poorly translated symbols, a half page of pound signs. It was made even more confusing by the hurriedness of some of the replies. There were five spelling errors in a two-line message sent from a cell phone, fury and frustration expressed with caps lock and exclamation points. He sat down at the computer and scrolled through, listening for any movement behind him. He kept the cursor on the box to close the window, moving through the text with arrow keys, ready to close it all and claim he was looking up lab values.

Some of the details surprised him. They had been sleeping together a year, before it happened. Now the obstetrician was in Baltimore, back together with an old girlfriend. He had moved away before she even knew.

Stephen’s pager went off, a low buzz against his hip. Claire stayed asleep. He went over to wake her, his hand almost to her shoulder before he thought better of it.

* * *

The rule of law is ten hours. Stephen had to go home for ten hours between shifts, a sleepy car ride where he turned the air conditioning on high to blow away the smell of his own armpits and feet. When he was a medical student he thought the pungent, vaguely sweet odor was a smell of illness, but now he knew it was only the smell of people who cannot bathe. He walked at least five miles a night in the hospital. He climbed up and down the building in hidden concrete stairwells no patient or family ever saw. To keep himself presentable, he carried a small bottle of mouthwash in his white coat, but that was all he could do. By morning, brown hair hung in greasy clumps across his forehead. The lenses of his glasses were smudged with oil and flecks of dead skin. The red oiliness of his cheeks threatened still more of the pimples that had embarrassed him since the week he started his training. Overall, his face had the wrong look for a doctor. His skin was drawn tight over an awkward series of bones, his forehead too high, an inadequate chin starting the slow curve of his face up to an overly prominent nose. There was nothing lovely about him and there never would be. Most patients distrusted him. They preferred the older men who stayed home and slept through the night.

“I’m thirsty, doc,” the new patient said. Stephen was wheeling the man with the infected arm down a green-tiled hall that connected the holding area to the main ORs. The hallway was crowded with operating room equipment, leaving just enough space for stretchers to pass. Doctors moving the patients had to walk in front or behind, struggling to steer the aging wheeled beds as they passed hundred thousand dollar machines with only inches to spare. Two cautery machines were stacked to form a wobbly grey metal tower, leaned against the wall for support, green surgical towels wedged under the wheels of the bottom machine to keep it from rolling away. The four-foot arcing c arms of x-ray fluoroscopes intertwined with the articulated viewers of surgical microscopes. Every surface looked scratched and grey, impossibly worn for machines that were wiped clean after every use. The constant scrubbing made them look worse, something caustic in the solutions that never completely evaporated. The technicians had to wear gloves when they moved them. The smell of disinfectant made Stephen’s eyes water.

“Hey, doc, I said I’m thirsty.”

“I’m sorry. I can’t give you anything to drink now. You might throw up going off to sleep. It could kill you.” This was not completely true. He gave patients a sip of water with pills all the time. Just a sip was not a problem.

“I just want a sip.”

“I really can’t,” Stephen said. “You’ll be asleep in just a minute, and then you won’t care.”

Using his good arm, the man sat himself up in the stretcher, turning back to look at Stephen, the movement filling the air between them with an apocrine smell of body odor and bad breath. His hair was short, flecks of not dandruff but something, Stephen thought paint, scattered through it. Green eyes rested in a heavy face, wrinkles at the corners of his eyes. His thin lips were flecked with dried spit, and when he opened his mouth to talk Stephen could see that his tongue was dry, his cheeks clinging to carious teeth.

“I’ve been skin popping heroin for three days. I can’t remember the last time I ate or drank anything. I know you been giving me these IV fluids in my good arm, but I can’t remember the last time I pissed. I can’t remember what I was doing an hour ago. So maybe I won’t care in a minute, but I care right now. Can I please just have a sip of water?”

Stephen sighed. He did not have a cup. There were no cups in the hallway or in the OR. They would have to go back to pre-op. Stephen reached forward and opened up the man’s IV. “I think you need some more IV fluids. We’ll go back to pre-op holding to get you more ready for surgery. You can have a sip of water while you wait.” They made a right turn, Stephen palming the metal plate that opened a set of glass doors. The bed creaked and wobbled as they made their way through a long empty room, spaces for beds marked out on the floor in red tape, walls lined with monitors for patients recovering from surgery. The metal side rails of the stretcher rattled against the pins that held them in place. At the end of the room they came back into the fluorescent light of pre-op. The angry nurse looked up from her knitting, the tips of her needles pointed at both of them, equally.

“That was fast,” she said accusingly.

“He’s underresuscitated. Not safe for surgery. Let’s give another liter IV.”

“And a sip of water,” the man said, looking from one to the other.

She looked at her feet, swollen white stockings over scuffed white shoes. She shook her head sadly at the prospect of moving them. “Like you couldn’t have figured that out an hour ago.”

* * *

The main elevators and bathrooms took up all the space in the center glass column of the hospital, with the bedtower wards radiating out to the sides like the spokes of a rimless wheel. Stephen stood in an alcove of eight elevators, none of them running at this time of night. A bench with stained green fabric occupied the middle of the small space, and beyond that was an unbroken curve of windows, floor to ceiling glass interrupted only by the hallways behind him. From the high floors of the hospital, he could see the lights of the university, a hundred gothic stone buildings lit with spotlights. There were lights on the ground and on the roofs, lights on buildings that pointed at other buildings. He wondered if the students in their dorms were issued blackout curtains for their windows. Beyond the campus lay the dark shapes of the buildings downtown, silhouettes against the starlight of the horizon, most lit only by the thin lights of the street lamps below. There was no sign of sunrise, but the day residents who relieved him came in before sunrise. His watch read five-thirty.

He was contemplating the gargoyled roofline of the university chapel when the alarms began to go off. It was a high-low alarm, like European ambulances on television, like the pulse oximetry alarm in the girl’s room, and the symmetry of all this made his heart race. Over the alternating tones was the preternaturally calm voice of a woman, announcing the specific problem and its location, but he had already run the length of two hallways before the words were even out – “Code blue, third floor, hall B.” She repeated them again, and at his velocity the words died out from one speaker as he came into the range of the next one. He slammed through the door of a stairwell, the weight of it driving the door handle into the cinderblock wall, excavating a few pieces of yellow painted concrete. He was running down the stairs three at a time, his hand sliding lightly over the length of the metal rail to give him balance, gripping it only at the landings to whipsaw himself around and continue what amounted to a form of controlled falling. He covered five floors this way, launching himself out another door onto the hallway where the girl, his patient, was dying.

There was no one there.

At any code in the hospital there was always a crowd. Nurses and physicians and therapists and medical students would press around the doorway, most with nothing to do, some there to learn and some there to watch. So many people would pack around the bedside that you could not move around the patient, you would simply ask the others to pass you whatever you might need – IV needles or syringes or the resuscitation mask with the football-sized blue plastic bag to squeeze air into the patient’s lungs. A policeman would come, there to maintain order in the event that some family member felt volubly overwhelmed by their grief and concern.

Outside the girl’s room, the hallway was empty. He pulled up at the doorway, arms to the frame on either side, and he and the girl stared at each other, equally out of breath. She smiled at him, lifting her oxygen mask from the bed and offering it forward in her hand. “Here,” she said.

“I just need a minute,” he said.

“Or two,” she said, giggling as his chest heaved up and down from the unaccustomed effort. “Do you need a tube down your throat?”

He smirked back at her. “I’m glad to see you’re OK.”

“I know,” she said brightly.

“Your sats are even better.”

“Ninety-three on no oxygen. My heart rate’s like a hundred and twenty. They keep giving me albuterol inhalers. I feel like I’ve had fifteen shots of espresso.”

He pulled himself upright, smoothing his white coat into a less twisted configuration. “The heart rate thing is just a side effect.”

“Thank you, doctor. I would have never known that if you hadn’t been here.”

“You’re welcome, patient.” He looked up and down the abandoned hallway, surprised the commotion of his arrival had not attracted some attention. “Where is everybody? Where’s nurse Barney?”

“Purple scrubs? Her name’s Leia, Dr. Stephen. She went running down the hall with the rest of them.”

He looked up and down the length of the hallway. From where he was standing, he had a view of the entire ward. “Running where?”

“I think through that door you use at the end of the hall. I’ve heard it slam closed like fifteen times.”

“Everything’s fifteen with you,” he said. Three people came rushing down the hall, their arms across their chests to control the bouncing of their stethoscopes around their necks. One of them was carrying a defibrillator. As they reached the door a nurse opened it from the inside, pointing farther down the hall. He tried to think of every other place that could be down that hall, every other room in the spaces beyond his call room.

“Can you stay fifteen minutes?”

“I have to go to the code.”

“Maybe you should sit down. You’re looking worse than you did when you got here.”

* * *

The crowd was clustered around the open door to the call room. The hallway of call rooms and offices was half the width of the patient hallways, a yard wide at best, with no need to accommodate wheeled stretchers or equipment. At least thirty responders were packed together, most unable to move in any direction, making it impossible for Stephen to get near the door. From inside the room, a voice he did not know was shouting for epinephrine and atropine – drugs that meant Claire was dead. At the end of the line, standing beside him, a thin Indian nurse worked hurriedly at a red metal cart, breaking open prepacked syringes and passing them toward the door. She shouted, “The cart needs to move closer! Some of you need to leave!” Many of the responders who were there clearly wanted to leave, but they could not fit through the space between the red cart and the wall. “We’ve got the tube in,” someone called from the room, the voice of another anesthesia resident who must have arrived for work early. Beside the red cart, a tall African man stood with a clipboard, a muscular man with ritual scars on his cheeks, noting the doses of drugs as they were given. He began shouting orders in a surprisingly high voice, “Move down the hall. There’s a stairwell at the end of the hall. Janice, move down. Vicki, go to the stairwell . . .”

A thin blond girl was standing beside Stephen, a sleepy looking resident rubbing blue eyes with her fists. She stared at him for a moment, then turned to the African, who was clearly in charge. “I think there’s a mistake. I got a page to come here, but I’m the resident on obstetrics.”

“Move down!” the African said. He turned the red cart sidewise and used it like a bulldozer, forcing the complaining crowd down the length of the hall. “Move, move, move!” The OB resident walked along behind him, grabbing hold of the doorframe when it finally came within reach and pulling herself across the cart to get a view of the room. Then her whole body tensed, her mind now dealing with a problem that she knew and understood. “Call my attending! Get me a scalpel!” She climbed over the cart and disappeared into the room, hands and arms from inside lifting her up by the shoulders.

Stephen had not moved. With the crowd shifted down the hallway, he had a view into one of the offices. The police officer was there, a calm-looking man with short hair and tattoos on his forearms. He was talking to the janitor, Jimmy, a fifty-year-old man who emptied out the trash bags and vacuumed their call room first thing in the evening because he knew they did not like to be disturbed while they were working. He was a short man, five foot at best, with thin white hair and a white beard and mustache. He was sobbing. The policeman had one arm over Jimmy’s shoulder, his forearm tattooed with a mermaid sitting on a cannon.

Stephen could not stop looking at the policeman. “Aren’t you anesthesia?” one of the nurses asked. It was Leia. “Hey, anesthesia, don’t you need to get in there?” She grabbed his arm at the elbow, pressing the thick cloth of his coat into the capped off IV.

“She’s not my patient,” Stephen said. The officer looked up at him, a question forming in the wrinkles of his forehead. Stephen turned to walk down the hall. Behind him, the OB resident shouted for a suction canister and towels.

* * *

Stephen sat on the smooth white plaster of his own apartment window sill, a pillow at his back, his legs straight out. The black iron grid of the window was warm against the side of his leg, and the bricks beneath the plaster were warm, filled with the heat of the southern wall of the building. The bottom row of window panes were fixed to the wall, and he leaned himself against it, one hand over the panes onto the six-inch ledge outside. The middle half of the window was swung open above him, the sunlight focused in the seams of the old plate glass. He had been there for hours, and he could feel the first sting of sunburn across his forehead. The air outside smelled of warm brick and the tar of the roof, a fine dust of cement. The morning smell of tobacco had burned off.

His pager, dropped somewhere in the apartment when he had first stumbled home, chirped a solitary reminder every few minutes, new pages he had not yet examined. The old doctors, the great men and women who slept through the night and left the hospital to the residents, they were looking for him. There had been messages on the answering machine, a series of confused threats and entreaties from secretaries and nurses, once interrupted by an upbeat reminder of a haircut, his day off at noon, he should call if he needed to cancel. He ran his left hand through greasy, pasted-down hair, an inch longer than he had remembered, flattened by the scrub cap he had thrown away outside the hospital.

With each chirp of the pager he gave himself a bit more, the syringe resting on his right arm, all tubing gone, a single needle balanced at the angle of forearm and elbow. Any movement would send it clattering across the floor. He had waited for it, the awkward movement, the forgetful moment, but he found himself unusually precise on this day. Only the purple glow of the sun through his eyelids was keeping him awake. He took slow, deep breaths, long spaces between them. He stared down the length of street, past the long brick warehouses to the tall buildings downtown, the unnecessary street lights that stayed on in the daytime, the flat parking lots that never filled with cars, everyone gone to work somewhere else. A rainstorm was making its way over downtown, pulling each building into a dimmer, cooler light. With each chirp, he gave himself even more.

When the first drops of the rain arrived they were just out of reach. The edge of the roof hung over, a low ledge of brick perforated through by thick iron gutters, wider than his head. An iron drainpipe ran beside the window down to the courtyard below. The black, painted metal carried some sort of writing, but he was unable to focus his eyes to read it. The pipe was cracked, broken open on the backside – he could see a fist-sized hole, a few twigs and leaves there, a single feather. As the storm picked up, rainwater began to spill out, an orange stain on the ledge showing that this had happened before.

The chirp came again, then again, then constantly, a sad high wail of ten seconds that could not be the pager. He took his hand from the syringe and pressed it to his own mouth, certain that would stop it. From the inside of the pipe there was a rustle, the sound of an animal clawing against the metal. He stood up, the syringe falling away. His legs were weak underneath him, and he put both hands to the fixed part of the window, a trickle of blood making its way from his elbow to the tip of one finger. He leaned over to the pipe, the brick courtyard swaying three stories beneath him. Looking down, he could see the hole was larger than he thought, continuing below the window for another six inches. He could see more remnants of the bird’s nest, and below that, in the darkness of the pipe, he could see the grey and white face of his cat, the channeled rainwater pouring over her. She was struggling to claw her way out, but part of her was caught somewhere deeper in the pipe.

He tried to reach down. He could get his fingers just inside the hole, her claws leaving scratches on his hand. He stepped up onto the window sill, putting one leg on each side of the fixed panes of glass, his knee down onto the six-inch ledge. A wind had come with the storm, and now the heavy sheets of rain pushed themselves under the shelf of the window, wrapping themselves around him, a taste in his mouth that was sweeter than he remembered. He wrapped his arm in the cord of window shade, and the metal frame creaked somewhere above him. Looking down, he could see she was damming up the water, that it was rising to her face. “Don’t worry,” he told her. “Everything’s going to be fine.” He leaned over, far over, a violent creak from the shade above them, a snapping of plaster a hundred years old, and then he grabbed her by the ruff of her neck.

---

Andrew Peery’s work has appeared in The Gettysburg Review.