Chapter 35
“First of all,” Dr. Easton starts. “Get the fucking pads on.”
The ER nurse standing beside Annie is a small mouse with straightened platinum hair that swings uniformly around her face.
Her badge reads AMBER with no last name. She must be new.
Dr. Justine Easton’s badge reads DR. EASTON in bold. She’s the chief of emergency and has been since Annie was a medical student.
Her greying hair is pulled back haphazardly in a magenta scrunchie. She’s only forty-five-ish but has a sphinx-like, reincarnated
presence. Her crow’s feet already extend the length of her cheeks. She paces in arcs at the end of the hospital bed, a snake
charmed by the song of the tele-metry machine.
It’s 8:02 a.m. on the wall clock.
Amber is frantically searching the bottom drawer of the crash cart. She pushes aside packages of catheters, intubation tubes,
bite blocks, and a few fall onto the floor. At 8:03 a.m., she still hasn’t found the pacing pads.
Annie leans over to retrieve them from the top drawer. She places them discreetly into Amber’s hands.
“Thanks, Dr. MacLeod,” she says. But once the adhesive backing is off, Amber misplaces the pads on the man’s chest.
“What’s going on?” The elderly patient groans underneath her.
He tries to sit up. The back of his grey hair is sticking up at the top.
His gown is not tied, revealing his sun-spotted skin and spindly legs.
MR. VAN DER ZEE is scrawled on the whiteboard over his bed in hasty handwriting.
Details from another patient are only partially rubbed off; the chain of old vitals linger in the bottom right corner.
“Your heart rhythm is irregular, Mr. Van der Zee. We’re going to fix it,” Annie says. “Then we’ll get you breakfast.”
Annie peels off the pads and corrects their placement. “Listen. The pads go on the diagonal, Amber. Imagine the heart needs
to be between the two pads so the voltage can run through.”
“I’m glad someone here can teach elementary school,” Easton says. “And where the fuck is RT?”
The telemetry machine wails, then regurgitates a roll of white paper covered in erratic tracings. Annie turns and taps the
buttons in quick succession. The alarm stops.
Mr. Van der Zee groans again and clutches at his chest.
Amber is now a wide-eyed statue. Annie turns to the defibrillator and sets the sync and voltage herself.
“Let’s just get this over with and cardiovert him.” Easton tightens her scrunchie.
Annie had been charting in the hallway before all of this.
It used to be paper and pen. She loved the simplicity: the firm hand required for triplicate pages, shaping the letters correctly.
Lining up the vital signs in sequential boxes. With an actual chart in her hands, everything about the patient was organized
onto one or two pages, like a story. It felt permanent.
Now she has to chart on a skinny computer tower.
She drags it around room to room while the hard drive rattles like it’s dying.
The wheels stick or spin in the wrong direction.
Her AI scribe suggests notes in advance and tries to finish her sentences.
She can never find the right tab and each task takes a dozen clicks.
Her colleagues rarely look at the patients anymore; they type and scroll forever, glued to the screen and its demands, attached to it like an umbilical cord.
Annie has already seen two patients this morning. First: a septic-looking man in bed 8, hypotensive and tachypneic. His lips
were flaky dry. When Annie pressed her stethoscope to his back, she heard crackles in both lung bases. Second: a cranky toddler
burning with fever. She saw a flaming eardrum through the viewfinder on the otoscope. His third ear infection this year, his
parents said. He’d need more antibiotics. The prescription pad was in her hand but she couldn’t find a pen.
In the middle of charting both patients, Annie heard Easton bark: “Bring the crash cart.”
8:04 a.m.
It’s well past the end of Easton’s night shift. She looks even more tired than usual. Her eye sockets are shadows; her eyes
thin slits. Apparently Justine Easton chops an obscene amount of wood in her backyard after each shift and loves to sharpen
her collection of axes, or so Annie’s heard. Justine hosts all the work parties and serves red wine with cuts of rare steak
off an industrial-sized barbecue on her deck.
Annie never goes. They’ve stopped asking why. They’ve stopped inviting her altogether.
“Page RT again,” Easton says.
On cue, Jason from respiratory therapy jogs into the room. He works out. He likes to mention this to Annie often. His neck
is ropy with muscle, nearly the same diameter as his head. He has a fresh crew cut.
“I’d like some breakfast,” Mr. Van der Zee says.
“He’s full code?” Jason asks.
“No intubation. Have the Airvo ready on your side in case. We’re short on ketamine. He’s gonna tank when I give him this propofol.
MacLeod, get a central. Nurses can’t find a peripheral and he’ll probably need a pressor. Work your fucking magic.”
Easton swears a lot.
Annie mostly ignores her. After prepping the area for a line, she tears two hot-pink chlorhexidine sponges from their sterile
foil packaging and paints it on. She doesn’t need the ultrasound to find the vein, even if everyone else uses it. Anatomical
marking has always worked for her. The vasculature is a map she can trace, the pulse of it in her ears, under her fingertips.
“Just a pinprick, Mr. Van der Zee,” Annie says as she infiltrates the area with lidocaine.
8:06 a.m.
“You don’t want the vascular probe?” Revived, Amber has the ultrasound cart at her hip.
“Can you ask Maura to run my orders for bed eight,” Annie says as she palpates the skin with gloved fingers.
“She’s a machine,” Jason says. “Just watch.”
“He needs a gram of ceftriaxone and two IVs. Two litres of saline,” Annie says. She enjoys being a machine, the relief of
her brain fully occupying itself; no nooks and crannies for grief or sadness or questioning.
“You can escape yourself,” is how her dad had explained doctoring, back when Annie was eighteen. They were resealing a leaky
gasket and tossing around ideas about what Annie might do with her life. Mara was still asleep below; it was not a subject
they discussed in her presence. “In the ER, it’s not about you. You don’t even have a body. You’re there to help,” he said.
“Why don’t you do it anymore?”
“Well . . . I met your mom.”
“And you love it out here.”
“I loved parts of that life, too. People can change. Take different roads.” He put the wrench down and made a snake-like motion
with his hand. “You’re not glued to one path.”
Annie places the needle precisely into the river of the internal jugular. She’s in on the first try. She threads the line, inserts the catheter, flushes the tubing with saline, and sutures it all in place.
8:09 a.m.
“It freaks me out,” Jason says. “Do you ever miss?”
“He needs a non-rebreather.” Annie peels off her gloves and throws them in the trash. She turns the oxygen on the wall to
100 percent.
“I’ve never seen you miss,” Jason says, handing over the mask.
Easton pushes a bolus of propofol sedation. After Mr. Van der Zee floats away, Annie double-checks the defibrillator settings.
“Clear,” Annie says.
They all move back a few inches.
Annie pushes the red button. The zing goes straight up her spine. It always feels a bit that way. But today, it jolts her
like a thunderclap.
She tries not to show it.
Mr. Van der Zee’s eyes flutter open and he pulls at the non-rebreather mask. His heart is back in a regular rhythm.
“I’ve got eleven handovers, MacLeod,” Easton says, already halfway out of the room. “And we’re bed-blocked. There are ten
admits in the department.”
They’re short-staffed with fifty patients in the waiting room.
Annie works a double shift because she wants to help, and she wants to keep escaping herself. It’s a long sixteen hours before
she gets home. The bedroom is dark and Evan is asleep on his side.
She pours herself water at the kitchen sink.
Flickers of the day return in sequence. 10:46 a.m.: a sixty-year-old woman knitting a yellow baby sweater.
Cancer all over her chest X-ray. Her needles fell from her hands when Annie told her, the yarn spooling out across the floor.
3:08 p.m.: a twenty-two-year-old man, suicidal and paranoid, glued to a metal chair in the triage bay.
When he wouldn’t stop screaming, security had to move him into an isolation room.
10:58 p.m.: A colicky newborn howling in the pediatric room, the parents unsure how to help her.
Annie picked the child up and shushed her over and over against her chest.
She takes a long sip from the glass and feels the cold water hit her empty stomach.
1:29 a.m.: She’d found herself in the medication room, the heavily insulated space at the far end of the department. A computerized
wall of tiny drawers, containing tablets and ampules and vials.
For a split second, in the quiet, Annie found a sliver of Walker’s sound. It came from nowhere and everywhere, vaporous; a
halo of moonlight. It made her soft in the knees.
But then a code blue rang overhead. The sound vanished and Annie went running again. Today, everyone had sixteen critical
questions for her at once, on top of reams of reports and results. The portable phone on her hip wouldn’t stop ringing.
In the dark of the living room, Annie sits down on the couch. A powdery feeling in the back of her throat makes her drink
more water. She places the empty glass on the table beside her, next to the TV remote. She careens to one side and closes
her eyes.
The next thing she knows, Evan is kneeling on the floor beside her. On her back, he draws the shape of a sea star, then a
whale with his fingertips.
“Why aren’t you coming to bed?” he asks.
“I’m sorry if I woke you.”
“What’s wrong?”
“Nothing’s wrong.”
He removes the elastic from her wrist and massages the indentation left in her skin. He takes the other elastic out of her
hair and loosens the braid.
“I can always tell when you’re lying.” Evan leans down and kisses her temple. His lips are soft and linger there.
“Have the last two days felt like two years?”
“God, yes,” says Evan.
“I smell like disinfectant.”
He nods. “You do.”
“And you have to get up in two hours.”
“Mmhm.”
She sits up and leans into his chest. “I gotta rinse this off of me.”
“I’ll run you a bath,” he says.
Annie slips into the tub.
The running water helps relax her, and it’s even better when she submerges her head. All the other noise disappears. But she
can’t convince herself if Walker’s sound is there or not. She shivers despite the hot water.
She needs to know if he’s still alive—-if hearing his sound, for the first time since the accident on the tug, might mean this. But,
equally, she wishes she could not think about him at all; that the cement box had remained sealed, instead of cracked back
open and dumped out into her life.
She and Evan are finally settled.
She stares at the nubs of the stuccoed ceiling and stays under until the water is cold and it’s nearly morning and she’s run
all the impossible permutations of Walker showing back up. The sky turns lavender then pink through the square window over
the toilet.
Evan knocks on the door to ask if she needs a rescue party.
She struggles out of the bath, dries herself, pulls on her bathrobe, and listens for sounds that make sense.
What she hears is Evan on the other side of the bathroom door. She opens it. His hair is shorter now than when they lived in Hale’s. He has new creases around his eyes, even if he smiles less than she remembers. His shoulders slope forward in a way they didn’t use to.
“Good morning.” She leans into him, ear on his chest, thump-thump-thump. She closes her eyes and feels the relief of him.
“You didn’t come to bed.”
She had not, but she doesn’t have a reasonable-sounding explanation for it. Instead: “I couldn’t stop thinking about work.”
He rests his chin on the top of her head. “You can get a couple hours’ sleep before you go back in.”
“It’s only a half shift to cover this afternoon. I’ll be fine.”
“What time do you finish?”
“Five.”
“Let’s go for a quick dinner, after? Decompress?” he asks. “Then early to bed.” He interlaces his fingers with hers, tethering
her for a moment.