CHAPTER 3 #2
Midazolam. Five milligrams per milliliter, two-milliliter vials, foam tray of twenty slots in four rows of five. I work by rows. Row one, five. Row two, five. Row three, five. Row four — four. The fourth slot is empty. The slot at the far right.
I check again.
Nineteen.
The ledger says twenty.
I stand for a beat with my right thumb on the foam at the edge of the empty slot.
The fluorescent overhead hums. The missing vial could still be administrative — drawn and not initialed; pulled for a code and never logged — or it could be the kind of missing vial I have been trained to write up.
I check a third time. Nineteen. I flip the ledger to today's sheet. I read the last three entries.
Two pulls in the last forty-eight hours, both for OR-5 cases, both initialed by the on-shift pharmacist and witnessed by the float nurse on Tuesday — a name I have never seen. The math should give me twenty. The math gives me nineteen.
I lift the foam.
Nothing under it.
I write the discrepancy in the ledger margin in my own hand: Midazolam working stock 19 of 20 at 11:14 Wed Oct 15, witnessed E.
Rossi RN, awaiting pharmacist reconciliation.
I sign my initials. I date it. I lock the cabinet and walk to the pharmacist's window and tell her, low and clean: "Midazolam working stock is short one vial. "
She looks up over her reading glasses.
"Ay dios."
"Write it. I'll pull the dispensing audit. Don't say anything to the floor yet."
"Already written. I'll be in the residents' workroom. Page me."
She nods. She is on it. She will run the audit.
I will not learn for another nineteen days what the audit will show — the audit will show nothing, which is the kind of nothing that is a thing, and that knowledge belongs to a future version of me.
Somewhere in this building a hand has been moving vials past a ledger for longer than I have been transferred to this service.
Today I know only that the count was off by one and that I wrote it down.
I am walking out of the pharmacy when Stefan comes in.
He is in the hunter-green scrubs the cardiothoracic attendings wear, the white coat unbuttoned, the cord at his left wrist just visible at the cuff.
He is carrying a clipboard he does not need, which makes the clipboard an instrument rather than a tool.
He is looking at the pharmacist's window over my shoulder before he is looking at me.
I have learned three things about Stefan Mikhailov this week: he counts in fours, he leaves Earl Grey on trays without writing notes, and he registers a room before he registers a person.
He registers me.
His face holds; his mouth shifts by maybe a millimeter, and his hand goes to the cord at his left wrist and then back to the clipboard. The word lands exactly where he meant it. He says, low, with a man's care for a word saved for the right corridor: "Doll."
He walks past me.
He lets the sentence stand and goes to the pharmacist's window.
I keep walking. The word follows me for the length of the corridor.
Doll. He has been laying it on me all week — the cafeteria, the tea bags, the small white index card in the library yesterday — and I had been calling it ambient, a register the way Beatriz says mija.
Now it has an address. He said it to me.
He said it once, deliberately, with the care of a man giving a word to its intended person on its intended morning, and the warmth rises under my hairline unasked and stays unrefused, and I have no shelf in me for it yet.
I walk to the residents' workroom.
The room is half-full. Two third-years arguing about lap durations.
The broken-nose resident at the Keurig pouring coffee that has been sitting since six.
A whiteboard along the far wall with the chief's red-marker handwriting still readable in the corner — three lines about pediatric medication dosing, my answer paraphrased and initialed NR.
I sit at my workstation. I open the chart.
I begin to chart the OR-1 case in the language nurses learn to chart in — clean, declarative, ten percent of what I noticed and one hundred percent of what is true.
Somewhere in another room a cap-click goes off.
I hear it through the wall.
The wall is the partition between this workroom and the small office at the end of the corridor where the senior attendings file.
The walls are thin in this building. The cap-click is the same one — the dense brass click of an expensive fountain pen being capped and uncapped — and it is happening, I take inventory, four times in the next eleven seconds.
He is in the corner office. He is writing notes. He is alone.
My ear has learned the sound. A nurse's ear learns the chamber-cycle whistle of the autoclaves as surely as it learns the cardiac monitor's V-tach alarm — a single sound, repeated, becomes a piece of my equipment without my consent. Hayes's pen is in my ear now and I have not asked it to be there.
I chart.
Gabriel passes the corridor and my head stays down.
I catch him through the workroom's glass partition with my eyes only — the white research-wing coat heavier and longer than the surgical coats, the black hair tied back at the nape with an elastic, the height of him taking up the doorway as he walks across the corridor toward the freight elevator.
He is moving slowly. He has just come up from Sub-basement 2 with a sealed folder in his right hand. He passes the workroom door.
He turns his head one degree — the shift of attention an animal does at a sound — and I think he is going to look at me, and his gaze stays on the elevator panel, and the not-looking is more than a look would have been.
My eyes stay on my chart. They will tomorrow find his.
He passes. The elevator pings at the corridor's end. He is gone.
I keep charting.
My phone vibrates at my hip.
Sister Mary Catherine. Missed call number three.
The second one is still sitting unreturned at the bottom of my log.
I had told myself last night, at the kitchen counter, the medallion warming in the V of my own hand, that I would call her tomorrow evening when I could keep my voice clean.
So far the voice is still too thin. I will call her tomorrow.
I tell my phone this, silently, the way one tells a piece of equipment a thing it cannot hear.
The screen goes dark in my palm. The voicemail icon stays where it is.
At fifteen-twenty Beatriz pages me to the chief's corridor.
I close the chart.