J.C. and the Boys - The Beginning

It’s time for another story. In this one, an ICU nurse and a hospital chaplain fight the good fight against bureaucracy and incompetence.

The hospital was always cold.

                  Jeannie Christopher put on her summer habit—a dark blue lab jacket worn over a royal blue scrub suit—as she scurried to escape the heat of the parking lot into the air-conditioned chill of St. Mary Magdalene’s Hospital.

                  It was always cold.  And she was late.

                  She skipped the wait for the elevator and ran up the stairs. Paint peeled from the walls with geologic sloth. The disarray of the broken shards nagged at her sense of order. She had written a note for the hospital’s suggestion box, but no one had noticed.

                  The intensive care unit was on the third floor. Jeannie lunged breathlessly into the corridor that led from ICU to surgery and recovery, next to the surgical waiting room. Gus Charon sprang to his feet, in denial of his seventy-six years, and held the door open for her.

                  “Get on in there,” he said. “They need you. Things are happening.”

                  “Overslept,” Jeannie answered. She caught a pungent whiff of his after-shave as she passed him.

                  “I’ll collect later,” he called after her. Jeannie waved over her shoulder in acknowledgment, then tossed her purse and her lunch onto the counter. The alarm on a cardiac monitor was still sounding, a shrill electronic peal as piercing as a civil defense siren. She stopped at the nurse’s desk to turn it off. Relative silence descended upon the unit. She moved straight ahead toward the crash room at the end of the hall

                  “Thanks.” A grateful voice came from the crash room, where half the night shift and most of the nurses from days were gathered around the bed. The activity was purposeful, rapid, and calm.

                  The patient at the center of attention was trying to die, but the staff was working against him. Jeannie was glad to be out of it for once.  There were plenty of people around the bed—too many—but that was Vivian’s problem.

                  The contest drew spectators like carrion draws vultures. Even experienced staff members gathered in sight and hearing of the code, not to help, but to watch. Death was pornographic, forbidden, and fascinating. They watched with slack jaws and sweaty foreheads, glad to see, glad, too, to be on the live-side looking in. This time, at least, it was someone else.

                  Jeannie scanned the monitors of the other patients in the unit. The census was down from Saturday, the last day of her previous week. Mr. Wood was in room Six, right next door to all the commotion. His monitor showed a mild bradycardia, but since he was asleep, his slow heart rate was not abnormal.

                  As she leaned further to check Jonquil’s monitor, the accented voice of Dr. Rashad screeched from the crash room.

                  “Morphine, I called for!” he said. “Where is my morphine?”

                  “There isn’t any in the cart.” Prissy-Jo’s voice was panicky. “Hospital policy.” She was afraid of the Iranian physician.

                  “Go then, get me morphine,” Rashad snarled.

                  Prissy-Jo came out of the crash room, saw Jeannie, and tossed the keys of the narcotics cabinet across twenty feet. Jeannie snatched them out of the air and ran to the medication room behind the nursing station. She opened the locked cabinet and picked up a syringe pre-filled with a cardiac dose of morphine, stripping the wrapper as she walked quickly to Five to meet Prissy-Jo. The nurse’s face was blotched red and white with humiliation and expended effort. Sweat beaded her features and threatened the stability of a quarter-pound of makeup.

                  “Thanks, hon.”

                  Jeannie was left standing in the hall outside. Rather than return to the monitors, she walked down to Eight to check on the “Turnip.” Marie Jefferson had been hurt in a boating accident out on the lake. Jeannie entered her room and looked her over. She was hooked to a cerebral function monitor, a single-lead EEG, as well as to a cardiac monitor and ventilator. A wire drifted from her stubbled scalp to the brain-watcher. Regular waves skipped across the screen. The Turnip was still alive, if comatose. Jeannie shuddered. It was an unnerving sight even when she had all her wits about her. There was a faint gurgling sound from the woman. Jeannie suctioned mucus from Marie’s endotracheal tube, then, all well, she started to head for the next patient.

                  “What’s going on?” Jonquil whined from Eleven, around the corner of the nurse’s station. “I rang for help, but no one came.”

                  Jonquil Marie Hennessy was standing in the doorway of her room. She held onto the door frame with one hand; the other was wrapped around the stand for her intravenous medications. She was breathing deeply, rapidly. Jeannie took a second to grab a deep breath for herself before she strode purposefully toward Jonquil, wearing her I-know-what’s-best-for-you smile.

                  “You shouldn’t be out of bed, Mrs. Hennessy.” Wires skirled in disarray from the bed. Jonquil would have to be entirely put back together.

                  “But no one came when I called,” Jonquil complained. “And then there was all that noise out in the hallway.”

                  Jeannie moved the fifty-five year old woman back into her room while talking to her. “There’s a little problem down the hall, but it doesn’t concern you. Let’s get you back into bed.”

                  “Well, I heard all the commotion and I wanted to see. I mean, that’s what my room will look like if I have a ‘code,’ right? All those people tearing my clothes off and thumping on my bazooms and sticking me with needles and—”

                  “Settle down, Jonquil!” Jeannie commanded. “Be quiet. Get back in bed.”

                  “But—”

                  “I said, be quiet!”

                  Jonquil began to cry.

                  Jeannie had reached the bed with Jonquil, but there the woman’s knees locked, and she became as rigid as the bronze statue of the unvirgin Mary who guarded the hospital’s main entrance. Jeannie tried to ease her down, but the only result was more tears.

                  “Sit down and shut up!”

                  Jonquil’s eyes widened, but she sat on the edge of the bed.

                  “Lie down,” Jeannie ordered her.

                  Jonquil obeyed, her small frame quivering slightly with the effort of keeping quiet against the head of steam she had built up.

                  “Lie still,” Jeannie told her. “Relax.”

                  Jonquil nodded, her lower lip trembling. Jeannie forced herself to reject the temptation to apply cloth restraints to Jonquil’s wrists.

                  Jeannie cupped her stethoscope in her hand to warm the bell slightly while she took Jonquil’s pulse and watched her breathing. Ninety-seven and twenty, she noted mentally—not bad, considering.

                  “You have to settle down a little. Don’t let yourself get so worked up.”

                  “I can’t help it,” Jonquil sniffed. “I’m high-strung.”

                  “Sssh!” Jeannie put the stethoscope over the fifth intercostal space, feeling for the gap between the ribs, just to the left of Jonquil’s breast bone. She wanted to dose the woman with a tranquilizer, but she had been away for two days; the orders might have been changed. Jonquil’s heart sounded all right, though it was difficult to hear over the woman’s rapid breathing. It would have to do, for now.

                  Jeannie opened Jonquil’s pajama top, noting with relief that the conductive patches were still securely in place. At least Jonquil had not ripped the leads loose; she had carefully undone the wires so that she could move out into the hallway to snoop. Her so-called anxiety was premeditated.

                  Jeannie plugged Jonquil back into the monitor, glanced at the screen to see that everything was functioning normally, and buttoned up her silk collar pajama top, smoothing the collar into place.

                  “I’ll be back in a minute. Rest until I get here. Please.”

                  “I’ll be a good little girl,” Jonquil said. Jeannie doubted it.

                  The cardiac victim lives with the fear that at any moment her body might betray her and plunge her into pain and death. Each one reacted differently. Jonquil lived in a state of denial. Like a frustrated child, she wanted her way, no matter what was going on.

                  Stifling her own tendency toward a sharp retort, Jeannie turned and left the room. She had not gotten report on anyone in the unit; she needed to review their charts before she could do her patients any good.

                  As she exited, she glanced back to see if Jonquil was staying in bed—and crashed into Mr. Hennessy, Jonquil’s husband, on his way in to visit her before going to work. He caught and steadied her until she regained her balance.

                  From within the room, Jeannie heard Jonquil laugh. Her face flushed in embarrassment.

                  Henry Halliburton Hennessy was a hale fifty-seven year-old. Not much taller than Jeannie, he was dressed in a custom-made dark blue three-piece suit, the uniform of his insurance firm.

                  “I’m sorry,” he said. “I should have been watching where I was going. Are you all right?”

                  “It was my fault. Excuse me.” Jeannie tried to go around him, but his hands still held her.

                  “She’s too young for you, Henry,” Jonquil called out.

                  “Ignore her,” he said to Jeannie. “It’s the best way.” Still keeping a hand on her arm, he ushered her across the ten-foot-wide hall to the nurse’s station. “I’ll be there in a minute, hon,” he called to his wife. Then he grinned at Jeannie. “She makes you want to tie her up and gag her, doesn’t she?”

                  “We don’t do that,” she answered stiffly.

                  “Oh, I know,” Mr. Hennessy said, “but that doesn’t change the fact the Jonquil’s a real handful. Did she get out of bed again?”

                  Jeannie nodded.

                  “Then you did a good job to get her back in. I’ll go in there and let her complain at me for a while. You look as if you could use a cup of coffee. I’ll watch her.”

                  Thankfully, Jeannie watched him go into Jonquil’s room. The closing door did not quite cut off Jonquil’s welcoming complaint.

                  She glanced across the unit at Five; the code was still going on, but the slowing rhythm of activity told her that they had given up on Evan Jones. There was nothing she could add to the situation.

                  The narcotic keys jingled in her jacket pocket, a reminder. She entered the med room and relocked the narcotics cabinet.

                  What a day it was starting out to be, she thought. Then she reminded herself, as she did every day in ICU: they don’t call it intensive treatment; they call it intensive care. This is what you signed on for.

                  The reminder was losing its power.

                  She went down the short hall by the staff bathrooms to the break room, where there was a sink, a microwave, and, she hoped, a full pot of coffee.

                  Her prayer was answered. She poured a cup and took it up front to drink while she went over the charts. God alone knew when they would ever get to report.

                  Wanda Sue Beaufort, the ward clerk, was leaving Five as Jeannie, balancing her too-full mug, re-entered the nurse’s station. Wanda Sue undulated across the wide corridor and took the seat Jeannie was heading for, next to the chart rack.

                  “What were you doing in Five?”

                  “Don’t get your panties all knotted up now,” Wanda Sue drawled. “Vivian told me to come in and lean over him. Didn’t do no good, though. That old boy is deader than an armadillo with tire tracks. They’re just moppin’ up after him now.”

                  Wanda Sue’s figure was a legend at St. Maggie’s. Jeannie had seen the EKG’s of critically ill men of all ages jump when Wanda Sue entered their rooms. The twenty-one-year-old girl’s blonde hair, blue eyes, round hips, and anatomically unlikely breasts were, by themselves, enough to capture the eyes of most men. But Wanda Sue also wore a perfume that, Jeannie swore, was made entirely of pheromones taken from the urine of a cat in heat. Any man who walked by her desk, which was saturated with her scent, sprang to attention, without quite knowing why. Vivian, the head nurse, would not let Wanda Sue enter a male patient’s room.

                  The most attractive feature of Wanda Sue’s emotional makeup was her stubbornness. Once she took hold of an idea, there was no shaking her loose from it. She was a single mother, who got pregnant on the night of the senior prom and gave birth a few months after high-school graduation. Once a month for the past three years, she visited the local district attorney’s office to file charges of non-support against the baby’s father. When the clerks saw her coming, they just put the forms on the counter for her. She had never received a penny, but she kept trying with lunar regularity.

                  “Boy howdy, you shoulda heard Vivian make that sawed-off little runt get his behind up here,” Wanda Sue said. “She paged him when the guy started to turn bad. When Rashad answered the page, he was down in X-ray, and he said he was too busy and for her to get someone else and then hung up on her. You don’t do that to our Viv. So she got onto the P.A. and started saying just what it was he could do with his precious x-rays. Well, the next thing, he came stormin’ through the door, all five foot two of him, smoke blowin’ through his ears, and he run smack into a hundred and fifty pounds of pissed-off black woman who is not about to listen to him chew her ass. She chased him into Five. He took one look at the guy lyin’ there turnin’ blue and got to work. I near to laughed my head off.”

                  At that moment, Vivian stormed out of the crash room, trailing the Rashad in her wake. He was firing heavily-accented English at her like a machine gun. She stopped in the middle of the hallway; he nearly collided with her.

                  “If you had called me earlier, this patient might have been saved, Mrs. Hayes. You nurses take entirely too much responsibility on yourself. If there is ever any doubt on your mind, you should immediately contact a competent person to make the decision. My report will so state.”

                  He paused to gulp air, still wrought into a tight, if short, ball of tension, winded from the exertion of compressing the dead patient’s chest. His hair was plastered to his forehead with sweat, his pupils dilated with anger. Stopping to breathe, though, was a mistake.

                  “I called you three times before you finally got your sorry self up here,” Vivian said. “When you get around to writing your report, you might want to read mine. Now, there’s nothing left for you to do here, so get out of my unit.”

                  “I have the freedom of the hospital,” Rashad answered. “I can go where I please.”

                  “Then please yourself somewhere else, before I turn you upside down and mop the floor with you.

                  Jeannie caught a glimpse of Mr. Hennessy as he closed the door to Eleven. She went to Vivian’s side. The head nurse was still fuming.

                  “Where the hell have you been?”

                  “Will you two go somewhere else for your fight?” Jeannie said. “I just got Jonquil calmed down.”

                  Vivian opened her mouth then shut it abruptly. “Right.” She turned back to Rashad. “Follow me.” The head nurse and the doctor stalked into Vivian’s private office and shut the door.

                  “Don’t worry,” Wanda Sue said. She was suddenly close to Jeannie, and her perfume was nauseating the nurse. Jeannie moved around her, back to the chart rack, but Wanda Sue followed. “She ain’t mad at you—not really. She’ll forget all about it once she’s through with him.”

                  “I’ll bet you have some work to do,” Jeannie said, swallowing hard and feeling drops of cold sweat pop out on her forehead.

                  “Well, all right. Try to help a person and see what happens to you.” Wanda Sue went back to her corner of the counter, muttering. “Just trying to be friendly. Didn’t do nothin’ wrong. Give somebody a couple of letters after her name and watch her walk all over a person.....”

                  The voice got fainter as she moved away; so did the odor. Jeannie found it safe to breathe again as the air-conditioning swept Wanda Sue’s scent away from her. She promised herself never to complain about the temperature again.

                  She checked the census, to see if she had missed anyone. There was Jonquil, Mr. Wood, Evan Jones who had just died, and the Turnip. With only three patients, one or more of the nurses would be pulled to the floor. After the one-on-one care she was used to giving in ICU, Jeannie disliked working on the regular nursing units. Here in ICU she would take care of one or two patients. On a med-surg floor, she might be responsible, with the help of a couple of aides and an LVN, for fifteen or twenty.

                  Nursing was, originally, intimate. Florence Nightingale’s nurses cleaned their patients, fed them, did whatever was necessary to help them back to health, when they were able. In ICU, that was still the case. But down on the floors—nursing shorthand for a non-specialized unit—the patient-to-nurse ratio was so high that little time was available for intimacy.

                  Nurses—the good ones—need to care. It is no accident that the same word means taking care of sick people and breast-feeding a baby.

                  Jeannie reached for Jonquil’s chart. If she ever took report today, it was going to be some time yet. Evan Jones’ body needed to be cleaned up, the code report written.

                  The human body, after a failed code, is an ugly distortion of what the person had been in life. Advanced cardiac life support nearly turns a human being inside out. In the controlled frenzy of a code, the team had no time for niceties. Blood, vomit, phlegm, saliva, urine, and feces are the by-products of the last-ditch attempt to keep the human alive, and in the course of the attempt, no thought is given to the person’s appearance. He is stripped naked, to give the team full access to his body. A plastic tube, if the patient is not already intubated, is passed though his mouth into his trachea. If his heartbeat is disturbed, he often comes out of the code, dead or alive, with burns across his chest where the paddle-like electrodes have been placed to shock his heart out of its hysteria, as one slaps a person to break through the self-destructive feedback loop of emotional hysteria. In the reflexes of death, the body relaxes its control over the sphincter muscles. Shock makes a person sweaty—or, as it is called in medicine, diaphoretic—and all patients in this situation are in deep shock. After all, they are dying.

                  After death is pronounced by the physician in charge, the next task of the nurses is the restoration of dignity to the remains of the person, before those who loved him are allowed to see him. This task fell to the day-shift nurses.

                  The night-time people who were still in Jones’ room were writing up the history of the code, for the record. They put together from memory and scraps of written notes the sequence of events—what actions were taken, what drugs give, when and by whom.

                  The crash cart—a red Sears and Roebuck wheeled tool box filled with drugs, syringes, IV setups, airway tubes in various sizes, bandages, antiseptics, scalpels, and all the other weapons used to drive death away from the stricken patient—had to be restocked. Death might be planning another assault, his appetite whetted by the struggle just finished. The nurse responsible for recording the code had two hours of paperwork ahead of her. She would be short on sleep when she came in for her next shift that night.

                  When she had a weekend off, Jeannie tried to forget everything about her work. She read Jonquil’s chart from the beginning.

                  Jonquil Marie Hennessy entered the hospital as a direct ICU admission four days previously, suffering from angina pectoris, literally a pain in the chest. Angina is not a disease: it is a signal, a warning, a symptom, of a compromised blood supply to the muscles of the heart. The cardiac arteries, narrowed by minute deposits of fat, constrict temporarily, and the victim—in this case a woman of fifty-five, slightly overweight, a smoker, with a moderately serious heart murmur—feels intense pain during the attacks. They come seemingly at random. Jonquil had awakened from a sound sleep five nights ago screaming in pain and unable to catch her breath. Her husband Henry (Jeannie made a mental note to see if he was still in her room; she would catch hell from one of the doctors if it were known that Henry had stayed in the unit during a code) had called the rescue squad. By the time they had brought her to the emergency room, Jonquil was complaining that she had not had a chance to fix her hair or her makeup and did not want to be seen by anyone, let alone her cardiologist, who was a friend of the family. Angina was that way.

                  On arrival in the emergency room, Jonquil’s blood pressure was 170 over 110. She was otherwise asymptomatic, but because of her high pressure, the ER doc called Dr. Hezekiah Walters, who admitted Jonquil directly to the ICU. Jeannie had been home, asleep, when Jonquil wheeled into the unit, but stories had begun to circulate around the hospital almost immediately. By the time Jeannie arrived for work on the morning after Jonquil’s admission, the woman had already become a minor legend. She had sent her husband home before she was even in her bed, refusing to dress in the hospital gown, demanding that he bring her silk lounging pajamas. Jonquil was the only patient in the unit to be fully dressed in street clothes, until Henry came back, with her pajamas and robe. She refused to be treated by a male nurse, because her hair and makeup were in disarray. At 5:00 a.m., the nurses took her telephone away, because she refused to rest. Her call button broke down: one of the nurses found it ripped from its connection in the wall. When confronted with the fact, Jonquil accused the nurses of ignoring her pleas for help. By 5:30 three calls to Hezekiah Walters had been made to ask for verbal orders for tranquilization. By the beginning of the day shift, Jonquil was already the stuff of which legends are made. At 10:00, the beginning of visiting hours, Jonquil had her first visitors, but Henry was not among them. The favored two were her hairdresser and manicurist. Jeannie remembered explaining to Jonquil that it would be better if her nails were not painted. The coloring of the nail beds is a good indicator of the efficiency of the circulation of the blood.

                  “I’m not here for your convenience, honey,” Jonquil had said. “You can either take care of me or not—I don’t give a damn. But I’m not going to sit here and take orders from a child like you.” The manicurist had, as ordered, painted Jonquil’s nails a bright crimson, the color of her lipstick. Because of Jonquil’s vanity, the nurses had lost two means of keeping track of her condition.

                  Jonquil had not cared. “You’ve got me hooked up to machines and tubes to tell you how I’m doing. Besides, you don’t come in here often enough to keep an eye on me.”

                  When the nurses complained to Hezekiah “Preacher” Walters during his rounds on the day following Jonquil’s admission, his reply was brusque.

                  “It’s her life. Just keep an eye on her.”

                  Of course, the chart did not read that way; the chart was not half as human as Jeannie’s recollections. The chart was a legal document, the official record of the course of the patient’s treatment, admissible as evidence in court as proof of what had happened to the patient while in the care of the nurses and physicians. Every medication, every test, every action taken by any of the hospital’s people concerning Jonquil Marie Hennessy was, supposedly, contained therein. It was enclosed in an aluminum clipboard, hinged at the top, and guarded from casual view. Jonquil did not own her chart; it belonged to St. Mary Magdalene. After Jonquil left the hospital, it would, without its metal covers, be taken to the business office, from whence it would descend into the lower bowels of the hospital, to Medical Records, where it would join thousands upon thousands of others, to be kept far longer than the possibility of lawsuit might exist.

                  Jeannie checked the orders on Jonquil over the last three days—transdermal nitroglycerin pads to control her angina, with sublingual nitro in case of attack; a single daily dose of 25 milligrams of Ismelin for hypertension; oral Valium, five milligrams q.i.d. PRN for anxiety. Jonquil was unlikely to accept the tranquilizer, and the dosage was so small that it would probably not make any real difference in her behavior.

                  “Since you’ve been reading Jonquil’s chart, she can be yours for today,” Vivian broke in on Jeannie’s reading. The head nurse was standing behind her.

                  “Thanks a lot,” Jeannie said.

                  There was the usual crash of the food cart, up from the kitchen. “Breakfast is served!” Gus appeared along with the cart, wizened and hunched but moving with practiced ease as he distributed the trays to the patients.

                  “What about Jones?” he called.

                  “He won’t be eating breakfast,” Vivian said.

                  “He won’t be eating anything. He’s dead,” Gus answered. “What I want to know is can I have his?”

                  “Go ahead,” Vivian said. “Take it outside.”

                  “Jonquil hasn’t had her meds yet. She was up walking around.” Jeannie rose and started in the direction of the medication room.

                  “Don’t bother,” Vivian warned. “Pharmacy is late again this morning.”

                  Jeannie stopped. “What’s their excuse this time? Jonquil supposesd to have her meds with meals. Preacher will have a fit.”

                  “They’re understaffed.” Vivian shrugged, grinning. “So what else is new? Go ahead and call them.”

                  “Who else are you giving me?” Jeannie asked.

                  “Lucky for you, I’ll make it easy—Mr. Wood. Prissy-Jo can handle the Turnip by herself. Hoss and Maureen are getting pulled to work 3-East, as soon as they finish up with Mr. Jones.”

                  Vivian Marie Hayes, head nurse of the intensive care unit, was a stocky five-feet, six-inches tall, and seemingly of pure African background, for she wore the darkest skin that Jeannie, in her limited experience, had ever seen. Under its surface of deep brown, it glowed with a sheen of midnight blue. She wore her hair tightly-kinked, with no concession to hair-straighteners or other attempts to disguise who she was.

                  Her eyes, though, were her most striking feature. They were larger than usual and liquid brown. They seemed in constant movement, except when they fixed on the object of her legendary wrath. Dr. Rashad had felt their effect earlier. Jeannie believed that Vivian’s eyes penetrated whatever shields of falsehood or rationalization her victim might erect in self-defense. Around the eyes, the shadows of crow’s feet gleamed even blacker than her skin.

                  “Who has the first admission?” Jeannie asked.

                  “Prissy-Jo,” Vivian said, “but help her out if you can.” Vivian entered her office, which lay across the hall from room twelve. Jeannie caught a glimpse of the awful pile of paper on her desk, paper that needed sorting and signatures, the detritus of the night past’s crises and interventions. She heard Vivian sigh in resignation as the door closed behind her; or perhaps it was the pneumatic hinge.

                  Jeannie moved out of the nurse’s station to the food cart. Gus had vanished with Mr. Jones’ tray. She checked to make sure she took the right breakfast with her and entered Six, forcing her facial muscles into a semblance of a pleasant smile. No one knew, except the nurses, how much acting was involved in the profession.

                  “Good morning, Mr. Wood.”

                  “Call me Joe,” he said. “I got no time to be formal, Jeannie-with-the-light-brown-hair.” In spite of her mood, Joe’s greeting penetrated her gloom, and her grimace slipped into a real grin.  “Got a cigarette?”

                  “I don’t smoke, Mr. Wood—”

                  “Joe.”

                  “—Mr. Wood, and neither do you, unless you want to blow the place up. Take an extra drag of your oxygen.” She set the tray on the bed table and whipped the stainless steel cover off the plate, revealing breakfast with the élan of a maitre’d.

                  “We have for you this morning, sir, at Saint Mary Magdalene’s hotel and youth hostel—”

                  “Why are the youth so hostile?” Joe asked.

                  “—a meal prepared for you personally by trolls working in our hellish kitchens, under the whip of a diabolical dietitian, sweating in the light from the flames of the vast dietary ovens—oatmeal! Salt-free, cholesterol-free, flavor-free. That’s not steam you see rising from your breakfast, sir, it’s the effluvium of the last bit of dry ice, especially added to your meal to ensure that it arrives in your room with the temperature and consistency of week-old banana-raspberry jello! Fall to, O honored guest in our humble house.” Jeannie curtsied, her head bent low. Joe applauded her performance and began to eat.

                  “Comfortable night?” Jeannie asked.

                  “It was all right, until the ruckus started next door. It kept me up. I’m glad he finally got away.”

                  “Who?”

                  “Jones. He came in and talked to me.”

                  “Oh?” she said. Joe had been asleep when Jones died.

                  “Don’t look at me that way,” Joe answered through his gummy oatmeal. “He did. It was about five-thirty this morning. He sat on the edge of the bed and we had quite a little chat. They were working on him in the next room, and he found it irritating and uncomfortable, so he came over here until it was over with.”

                  “It must have been a dream,” Jeannie said, trying to keep her voice light. Joe Wood had been an easy patient, undemanding, cooperative, pleasant to be with. She hoped that he would come back to normal.

                  “No,” Joe went on, “it wasn’t. All the noise woke me up. I know when I’m asleep and when I’m not.”

                  There was a syndrome Jeannie was beginning to worry about. Some patients in ICU developed a situational response to the stress of being in the unit, with all the tension and strangeness of the procedures carried out there. Usually it was the ventilator patients who fell into the “ICU psychosis.” Doctors—especially the shrinks from the inpatient psychiatric unit upstairs—pooh-poohed the idea. It did not appear in their APA list of mental problems, so it did not exist, as far as they were concerned. But, if a person woke up with chest pain, with a machine doing his breathing for him, unable to swallow or to talk, guarded by strangers, with lines attached to his arms and legs, restrained in a strange bed, with machinery groaning, blinking, and whirring all around him, he would have to be crazy not to go crazy. Joe was not hooked up to anything but a heart monitor, nasopharyngeal O₂ and a single IV line. But he did not sound quite right to Jeannie.

                  “How long have you been in here, Joe?” she asked. “Three days? Sometimes this place can be pretty scary. It scares the hell out of me, and I get to leave when I want to.”

                  “I’m not scared, Jeannie-with-the-light-brown-hair. I’m just trying to tell you what happened. Let those people know that they didn’t fail Jones. He wanted them to stop, and when they did, he was… relieved.” He pushed the bed table away. “Now can I have a cigarette?”

                  “No,” Jeannie said automatically. “Are you sure you weren’t having one of your spells?”

                  Joe Wood, besides having a sick heart, also suffered from bilateral transient ischemic attacks, or TIA’s. Deposits of fat had so narrowed the carotid arteries in his neck that sometimes the blood flow was reduced to the point where his brain was not getting enough oxygen to keep him fully awake and aware. Some spells lasted only an instant, others up to several hours, depending on how long the artery remained blocked. When Joe experienced one of his spells, the neurological deficits were focal: parts of his brain quit working. Since there was, as the doctors like to say, involvement of both the left and right carotid arteries, the symptoms would shift depending on which side became ischemic.

                  It was one of Jeannie’s pet peeves in nursing school that a physician would use a five-dollar word to say something basically simple—“ischemic,” for instance, when he meant not getting enough oxygen. But over the three years she had worked in ICU, she had settled into the terminology herself and used it without thinking. When she caught herself talking to a patient’s family and using the long Latin words, she tried to drop back into comprehensibility. But it was a losing struggle. The words meant what the words meant, with more precision than simple English could provide.

                  Joe might be trying to explain something he really experienced, but no matter what he said, it could be explained away by the existence of his TIA’s, without resorting to the ICU psychosis. Joe’s illness was sufficient unto itself to explain some neurological failing. Combine that with the confusion experienced on waking and low morning blood sugar, and you had a reasonable rationalization for almost anything.

                  And yet, patients did sometimes know more than they should about what was going on around them and within them. More than once, Jeannie had heard a patient say something that should have been said in a seance. If one of her charges insisted that he was going to die, Jeannie had learned the hard way to call in the family. Sometimes the patient knew more than the doctors and nurses. Someone with a normal EKG, who seemed not to be in danger, announced—usually calmly—that they would die at, say, 4:30 in the afternoon, and did.

                  But not always. Sometimes it was real; sometimes it was delusion. There was no good way to tell.

                  Joe’s TIA’s could give him any number of symptoms. If a blockage occurred on the left side, the effect was on the left brain, which controlled the right half of his body and speech (Joe was right-handed). If it happened on the right, the left side of the body would be affected. The effects could range from a mild, brief disturbance of consciousness, on the order of a fainting spell or even just a moment of dizziness. If the attack were prolonged, Joe might, in a left-side attack, temporarily lose the ability to speak. Hallucinations were not impossible. In essence, a TIA is a mini-stroke, and bears the same relation to a major stroke as angina does to a full-scale heart attack.

                  The treatment for recurrent TIA’s is surgical—open up the patient’s neck and mechanically ream out the deposits from the carotid artery. It is also dangerous: a little embolism may break loose and float downstream in the blood to a point where the arteries have narrowed so much that it can not pass. The little glob of plaque can then completely block the flow of blood to a section of the brain and cause the stroke that the surgery was designed to prevent.

                  Joe became a patient at Saint Maggie’s by having his heart attack while visiting one of his customers in the hospital. Jeannie had been called out to the code on the floor. As an ICU nurse, she responded to medical emergencies anywhere in the hospital, in much the same way as an EMT jumps into his ambulance when someone is injured out in the world. When she arrived in the room where Joe was collapsed into the visitor’s chair, she saw the gray, sweaty skin of the victim of myocardial infarction.

                  Joe’s heart stopped as Jeannie burst into the room, followed by another nurse, an aide, and a physician who was making rounds on the same floor. But the physician was an orthopedist, who had not worked a code in years. He had enough sense to defer to Jeannie’s superior knowledge.

                  Together, they yanked Joe from the chair into a supine position on the floor. As they did so, Jeannie saw an aide wheel the crash cart into the room.

                  “Get them out of here,” she ordered the aide, who shepherded the patient and his other visitor out into the hallway. The second nurse pulled the bed out of the way.

                  “You bag him,” she told the doctor, who tilted Joe’s head back to open his throat so that air could get into his lungs. She tossed him the black ambu-bag, and he began by giving Joe four quick breaths before Jeannie started compressing Joe’s chest.

                  Jeannie was small. She had to straddle Joe’s belly to get into a position where she would have enough leverage to depress his chest enough to force blood through his heart to keep his brain alive.

                  Jeannie’s practiced hands felt for the xyphoid process, the little piece of cartilage protruding from the notch of Joe’s breastbone. She traced it up to the notch, moved her hand two finger widths above it, placed the heel of her right hand on Joe’s sternum, and put her left hand on top of her right, interlacing the fingers. This ritual may have taken as much as two seconds—possibly less.

                  Straightening her arms, she began to lean forward forcibly, pushing down hard on Joe’s chest, then releasing the pressure, over and over again, counting as she went: one-one-thousand, two-one-thousand, three-one-thousand, aiming for a steady rhythm of sixty beats per minute. The work was exhausting, especially with a man of Joe’s size. After a dozen compressions, Jeannie was drenched with sweat, her face flushed with the exertion, her breathing deep and fast. After every thirty compressions, the doctor squeezed the ambu-bag, forcing air into Joe’s lungs.  The guidelines kept changing year to year. It was a crapshoot anyway.

                  This time, it worked. Jeannie and the orthopedist forced Joe to live. They kept blood flowing from heart to lung to heart to brain. Joe started breathing spontaneously after a few minutes of CPR. Breathing heavily herself from the exertion, Jeannie checked his pulse: it was rapid and thready, but it was enough. He was alive again. She got off him and stepped back, leaning against the wall, as Jeff Walters, a cardiologist, bent over him and another nurse stood by with the drugs and equipment from the crash cart ready to hand.

                  There had been much more that happened to Joe Wood that day, three days before, but Jeannie had been only a peripheral part of it. After Joe was stabilized, right there on the floor of his friend’s hospital room, he had been lifted onto a gurney and taken to ICU right at the time for shift change. Jeannie last saw him that day when she peeked into his room while leaving the unit to go home; Joe had been unconscious, unaware of what had just happened to him.

                  “Y’know,” he said, forcing her back into the present, “I know what you did for me.”

                  “You already thanked me,” Jeannie said.

                  “I know. But that’s not what I’m talking about.” Joe’s face was so serious that Jeannie was afraid he was about to announce his imminent demise, and she wanted to run from his room. His expression disturbed her at some level that she could not quite identify.

                  “I have to get Mrs. Hennessy her breakfast.”

                  “All right,” Joe said, “but come back. You’ve been gone for two days, and I need to tell someone this. I’ve been sitting on it since I woke up in here. I have to talk to someone, and you were there.”

                  Jeannie edged toward the door. “I’ll be back as soon as I can. I have to get back to work.” She fled Joe’s room.

                  Once outside, she leaned against the wall, her breathing almost as deep and rough as if she had just finished the CPR that had forced life through Joe’s heart and lungs three days earlier.

                 

Chapter 2

                 

                  Hoping that no one had seen her panicky exit from Joe’s room, Jeannie forced herself to walk to the food trolley for Jonquil’s tray. She had spent too much time with Joe; she was worried that Jonquil would pout over having to wait so long for her breakfast. Just as she entered Eleven, she remembered the Ismelin order.

                  “Henry’s gone, Christopher, so you don’t have to smile,” Jonquil said as Jeannie came in. “What kind of slop have they got for me this time?”

                  Jeannie set the breakfast tray on the bed table and wheeled it into position so that Jonquil could eat. “Hospital food is pretty bad, isn’t it?” she said, as neutrally as she could. Jeannie hated to depend on the techniques of the shrinks, but sometimes there was nothing else to fall back on. Respond to the complaint to let her know you’ve heard it, then try to get her to comply in spite of her attitude. “But you need to eat, even if you’re sick. I’ll be right back.”

                  Jeannie escaped Eleven before Jonquil could frame a reply, returned to the nurse’s station, and called the pharmacy. After a long wait, the phone was answered.

                  “Pharmacy, Colleen here.”

                  “Jeannie Christopher, ICU. I need P.O. meds for Mrs. Jonquil Hennessy, to be taken with breakfast—Ismelin, twenty-five milligrams, Valium five milligrams.”

                  “We’ll get to it as soon as we can,” the voice said. “We’re short today.”

                  Jeannie took a deep breath to dispel her flash of anger.

                  “Maybe I didn’t explain correctly. Mrs. Hennessy is at this moment staring into a tray of St. Maggie’s best efforts and getting slowly sick to her stomach. Preacher Walters ordered that she have her meds with meals. Shall I call him up and tell him that you’re too busy to comply with his orders?”

                  “All right, for chrissake,” Colleen said. “I’ll send it up.”

                  Jeannie knew that it would be quicker for her to get it herself, although it meant leaving the unit. Then she caught a glimpse of Wanda Sue, who was fixing her fingernails.

                  “Never mind, I’ll send someone down after it.” She hung up on Colleen, one more person antagonized.

                  Wanda Sue bridled when Jeannie made her request; her nails were still wet, she complained. But she went.

                  Almost simultaneously, Preacher Walters walked into the unit, dragging a train of followers along behind him like ducklings trailing behind their mother on the way to the pond.

                  Unlike his older brother Jeff, Hezekiah “Preacher” Walters enjoyed the rituals that went with the exercise of his profession. His attendants included a handful of younger doctors, residents mostly, intent on snatching up any morsels of wisdom that fell from their leader’s lips, along with his recommendation for staff status; his office nurse, who took his notes and, in his absence, sometimes gave orders in his place; and Horst Appleby, Saint Maggie’s assistant administrator, who accepted from Preacher the large donations that the hospital needed in order to function.

                  Jeannie sprang to her feet in spite of her resolution not to kowtow to any of the doctors. The reflexes programmed into her in nursing school died hard. Even now, she felt the tug of past indoctrination, and, involuntarily, she responded. Before she realized, she was holding the door to Jonquil’s room open for Preacher and his entourage, proffering the chart to Preacher’s nurse, a witless woman with big tits and vacant eyes.

                  The nurse was first through the open door. Jonquil’s tray flew, and the oatmeal smacked into her face and cascaded down onto her bosom, from which it dripped with a series of heavy, gummy thuds. The nurse was too stunned even to wipe her face. She stood rigid with shock, unable to believe she had been attacked wantonly, without reason.

                  Jeannie nearly hurt herself trying to stifle her laughter. The nurse made strangled gasping noises. No one moved but Jonquil, who, seeing whom she had hit, lay back on the bed and giggled. To hide her smile, Jeannie bent over and picked up the scattered plastic dishes and loaded them on the tray. Horst Appleby tried to lead the weeping nurse from the room without touching her coating of cold oatmeal. The rest of the entourage kept silence, waiting to take their cue from Preacher. Stepping over Jeannie, he came to the bedside, ignoring the whole mess.

                  The others gathered at the foot of the bed. Jeannie, still cleaning up, saw his polished wing-tip squish into the cold, gelatinous oatmeal.

                  “Morning vital signs!” Preacher called.

                  Jeannie balanced the tray and the chart as she stood up. “Ninety-seven and twenty, patient agitated and out of bed.”

                  “Temperature?”

                  “Normal.” Jeannie hedged. There just had not been time to fall into the routine.

                  “Doctor,” Jonquil smiled, “I don’t want to be a tattle-tale, but no one took my temperature this morning.”

                  Knowing looks passed among the ducklings. Preacher turned his craggy, Old Testament face to focus on Jeannie.

                  “Did you, or did you not take this patient’s temperature?” Jeannie felt the heat rush up her neck and bloom all over her face. She had lied—harmlessly, she thought; now she had been caught.

                  “I came onto the unit—there was a code in progress in Five. Jonquil, I mean Mrs. Hennessy, was out in the hall, watching. I put her back into bed, then the Nursing Supervisor pulled half our people to work in Three-East, then the trays showed up and—”

                  “Never mind your excuses,” Preacher said.

                  “But she had no business watching!”

                  Jeannie surprised herself with her exclamation. Everyone’s eyes were already on her. She wanted more than anything else to flee the room, flee the pressure of the eyes. She wanted to be as tall as Dr. Walters, so she could meet him evenly, eye to eye, without having to look up to someone she did not look up to. None of the eyes left her. Jonquil’s were glittering with pleasure.

                  “Mrs. Hennessy was endangering herself and violating the privacy of another patient. It was my job to return her to her room and re-attach her monitor lead.”

                  “Is this true?” Preacher turned to Jonquil and released Jeannie from his gaze.

                  “I—I was afraid,” Jonquil whispered. In the instant that it had taken the physician to turn away from Jeannie, Jonquil’s expression had shifted from triumph to contrition.

                  “I heard all the noise, and I couldn’t help but think that if anything happened to me, they would be doing all those . . . things to me, too, and I was afraid. I wanted to see, but I didn’t want to see. I just kept thinking that soon it would be me....” Her voice fell away into silence: a single tear coursed down her cheek, blazing a trail through pancake makeup.

                  Preacher held out his hand peremptorily. “Let me see her chart.” Jeannie handed it over. Preacher flipped through the document.

                  “Mrs. Hennessy has not had her morning medications.” The question was implied in the statement. “I’m sure you have a reason for that, too.”

                  Jeannie felt the flush blooming again. She forced herself to answer factually, holding her emotions in check as well as she was able.

                  “Pharmacy hasn’t delivered the morning meds yet. I sent the ward clerk down for Mrs. Hennessy’s. She hasn’t come back yet.” Where was Wanda Sue? “Besides, the orders called for the medication to be given with meals. Mrs. Hennessy has not eaten her breakfast. Do you want to change the order?”

                  Preacher saw the reaction of his clique and realized that he could lose control of the situation momentarily. “Get your supervisor. I’ll meet you both in her office in five minutes.”

                  Jeannie left the room. She dumped the breakfast tray onto the cart with a crash. Prissy-Jo looked up from the counter, where she was transcribing her notes on the code into Mr. Jones’ chart.

                  “Who peed in your corn flakes, honey?”

                  Jeannie growled a wordless reply and went into Vivian’s office. The head nurse looked up, curious, from her paperwork.

                  “I’ve gotten into trouble again,” Jeannie said. “Preacher’s pissed.”

                  “Jonquil?”

                  “Yeah. He wants to talk to you about me. Probably my attitude. I talked back to him. He’ll be in here in a couple of minutes.”

                  “Sit down,” Vivian said. “Coffee? Might as well relax for a minute or two before the fight begins.”

                  “It’s too late for that,” Jeannie said. “I think I’ve already fired a couple of volleys.”

                  “Here he comes.” Vivian gestured through the windows of her office to the nurse’s station. Hezekiah Walters was moving angrily, looking for a pen to amend his medication orders for Jonquil. “He looks pissed,” Vivian said. “But he almost always looks pissed.”

                  Jeannie tried to calm herself before the confrontation. She wanted to maintain her self-control, so that she could explain why she had taken the actions she did. Dr. Walters did not understand that kind of chaos that she had walked in on that morning. Nothing bad had happened. But he magnified every little error. She knew that she should have taken Jonquil’s temp but there just hadn’t been a chance: the entire morning routine had been disrupted by the code on Five. Still, she did not want to act defensive. She would admit her mistake. If only he wouldn’t try to make her cry

                  The phone on Vivian’s desk rang. The head nurse picked it up. “ICU, this is Vivian.”

                  She grabbed a pen and began making notes. “How bad?”

                  More notes.

                  The pen stopped moving.

                  “You’re kidding.” Vivian covered the receiver with her hand. “You take this one. I’m pulling you off Jonquil for now. Get Prissy-Jo to help you clear Five. They’re sending us a trauma, head injury, a Jane Doe.”

                  “But Dr. Wal—”

                  “Move it!” Vivian ordered. “Preacher can wait if he wants to. We’ve got work to do.”

                  Jeannie sped from the office. “Is Five cleaned up?” she asked Prissy-Jo.

                  “Just about. It needs linens.”

                  “Then get on it. Head trauma coming in hot.” Prissy-Jo left the open chart on the counter. Preacher Walters watched open-mouthed as the two nurses ignored him and went about their business.

                  Prissy-Jo began by getting fresh linens on the bed formerly occupied by Mr. Jones, who was safely on his way to the morgue, buried in the hospital’s sub-basement. One of the housekeeping workers had already cleaned the room, and all the evidence of previous occupancy was removed.

                  Jeannie circled around the rear of the nurse’s station to the supply and equipment room. Head trauma scared her: events could happen too quickly, uncontrollably. She gathered everything she could think of that might be needed. Her list included a grab bag of stuff, an electroencephalograph (EEG); a kit for assessing neurologic status, including a reflex hammer and a collection of smells, tastes, and touches; an otoscope for looking deep into the ear; and an opthalmoscope to see into the eye and even beyond, to the optic nerve, an extension of the brain itself. She hated neurological assessment: it was too much like peering through a person’s skull into the stuff that made them a person. She felt as if she were violating something more than private, something hidden and sacred, when she used these instruments. A hurt heart was one thing: it was a pump, a mechanism, that could be dissociated from the person it belonged to. A person could even be given a new heart, and no essential part of the person changed.

                  But a brain did not exist in the sort of anatomical isolation of an organ like the heart or kidney. The brain was the seat of identity. The brain was were the “I” lived, or even more, it was, perhaps, the “I” itself. Amputate a limb: transplant a liver: resect a bowel: bypass an artery—the patient was still identifiable. But damage a brain—

                  Jeannie forced herself to stop the train of thought and do her job. She wheeled the equipment to Five and busied herself setting it up. The patient would arrive from ER already with an intravenous line in place, and possibly intubated, depending on what was wrong with her.

                  After glancing over her work to see that everything she had done so far was ready, she went to the medication room. The standard drugs for controlling seizures—Valium, Dilantin, and phenobarbital in injectable form—might be needed. She also grabbed thiopental sodium and paraldehyde. They were not often used, but, if needed, would be needed quickly.

                  Jeannie reminded herself that Dilantin had to be injected with great care through the IV line, and only into a saline solution. It could combine with dextrose or glucose, both sugars, to form a precipitate of solid granules that would then flow into the vein and from there into the heart and lungs. The others could be injected safely enough.

                  As she selected the likely drugs, she reviewed the probable dosages. The physician would order what was, in his judgment, called for. But if she could anticipate what he might want, she could save precious moments. And if he ordered an incorrect dosage, she could try to correct him before he did any harm. Usually the physician was right—but not always.

                  She heard the doors bang open on the east corridor, which ran from the elevators, surgery, and the lab. The gurney on which Jane Doe was carried announced her arrival with a squeaky wheel. The west corridor was for public access to the unit. Thus, critically ill patients could be moved without too great an exposure to the visitors and staff that normally wandered the halls of the hospital. It was a good piece of planning on the part of the architects who had designed the facility. Enough violations of the patient’s privacy took place in their treatment that whatever dignity could be saved, should be. At least they could travel through the building for treatment without being exposed to the stares of strangers.

                  Jeannie met the gurney with a handful of meds and accompanied Jane Doe into Five. Both the orderly and the ER nurse wore surgical masks over their faces. The patient was lying on a backboard, her head held steady with a cervical collar. As Jeannie had expected, an IV was already hung.

                  The woman on the gurney was old, easily in her seventies. She lay unconscious, but now and then her facial muscles twitched slightly, as if in the beginnings of a smile or a grimace: the movements never came to conclusions, only to beginnings, then her face relaxed. She was a bird-woman, all her bones pointing this way and that under her leathery brown skin.

                  She stank.

                  Jeannie involuntarily wrinkled her nose at the woman’s odor. It went beyond the smell of a sick and unwashed person. There was something malevolent, almost evil, about the stench that rose in waves from her body. It was acrid, nearly sulfuric; it made the back of Jeannie’s throat itch unmercifully. Her lungs felt as if she were out of shape and running a long race. Cold sweat broke out on her forehead and upper lip.

                  Georgia, the ER nurse, chuckled behind her mask. “Don’t laugh,” Jeannie managed to say, “or I’ll get even. What’s the story on this one?”

                  “Let’s get her into bed first,” Georgia said. “We can talk in the hallway.”

                  The three of them lifted the old woman on the backboard into the bed. Georgia transferred the IV bag from the rod rising from the gurney to a bedside IV pump. The rectangular blue box stood at the patient’s eye level on its own stand. Orange LED readouts told of the rate of flow of fluid into the patient’s vein. Georgia set the pump to a reading of eighty milliliters per hour while Jeannie gathered the papers from the gurney. The papers formed the beginning of this woman’s chart. She began to flip through them when another wave of nausea struck her. The orderly laughed out loud.

                  “Get out of here,” Jeannie said, “and take that stretcher with you.”

                  As the orderly obeyed, Georgia said, “Let’s us get out of here, too. I can’t take much more of her smell.” Outside in the hallway, Jeannie waited until Georgia had removed her mask. “I don’t care how badly she stinks, she might be able to hear you.”

                  “She won’t hear anything—we got her zonked out good.”

                  “On what—no, wait,” Jeannie said. “Just give me report on her.”

                  “You got some coffee up here?” Georgia asked. “I swear, I can still taste that woman’s smell.”

                  “In the conference room.”

                  Jeannie picked up her own cup from the counter where she had left it, but it was gone cold. She followed Georgia to the coffee pot.

                  “This Doe came in about an hour ago, with a whole raft of Mexicans carrying her in. There must have been a dozen of them,” Georgia said. “They said they found her unconscious in her house.”

                  “So why is she a Jane Doe?” Jeannie asked. “They must know her name.”

                  “They do, but they were all afraid to tell us. She’s one of those healing women, a curandera. That’s all they would say. Why they brought her here, I don’t know, if she’s such a healer.”

                  “What’s the matter with her?”

                  “Head injury of some sort.” Georgia paused to sip her coffee. “This stuff’s terrible. Anyway, bruises on the left side of her head suggest a lateral concussion, maybe contusion. She hasn’t had any difficulty breathing, so whatever’s wrong with her probably isn’t in the mid or lower brain. But her temporal lobes must have taken a helluva smack. Vital signs are stable. They loaded her with Valium downstairs, in case of seizure. The only weird thing is that she keeps grinning. Her eyes are rolled back: she’s really out. But her mouth keeps twitching. And she stinks.”

                  There was a sudden, loud cry from the public corridor. “¿Donde ’stá mi madre, viejo? Dígame!”

                  The screamer was female, angry, and contralto. “What’s all this noise?” a male voice shouted outside the double swinging doors that opened out to the lobby. “Don’t you know that this is a hospital?”

                  Jeannie and Georgia stepped from the conference room around the corner, to intercept the disturbance before it reached the patient area. But they were too late. Vivian had already come out of her office and was standing arms folded, waiting.

                  “¡Díme, hijo de puta! ¿Dónde está mi madre?” The screaming woman burst into the corridor trailing Gus Charon, who grimly—and appreciatively—held on to her as she dragged him on one arm and Dr. Caine on the other. Their weight didn’t slow her down in the least.

                  The woman looked about thirty-five years old. She had straight dark hair to her waist. Her skin was the color of fresh coffee with cream, her eyes so dark a brown that they seemed to be black. She was tall, nearly six feet, and strong enough to pull the two men along effortlessly, in spite of their attempts to restrain her. She stopped in front of Vivian and shook the doctor and the gatekeeper from her the way a dog shakes herself dry.

                  Both men tried to grab her again. She took a step back, then her eyes dared them to approach her once more. Gus knew when he was outmanned, but Dr. Caine thought that his professional dignity would protect him. Once he had learned—painfully—that it would not, he, too, backed away.

                  The woman approached Vivian.

                  “Let me see my mother.”

                  Vivian did not move. “Visiting hours begin at ten-thirty. You may see her then, if you are a relative.”

                  “She is my mother.” The woman’s English was unaccented, her voice steady, demanding.

                  Vivian seemed to fill the hallway. “What is your name?”

                  “I do not have to tell you.”

                  “No, you don’t,” Vivian said. “Nor do I have to let you into my unit. Until you can behave yourself, you don’t get one step further inside.”

                  “I have the right—”

                  “I have the right to have you arrested here and now if you keep disturbing my patients,” Vivian said. “Don’t think I won’t do it. Gus, call security to ICU.”

                  He hesitated, his eyes wary. “Do you want a Code Green?” He would have to move around the screaming woman.

                  “No,” Vivian said. “Just get one of them.” Gus edged past the stranger, against the wall, and out the double doors to his desk. In the silence that followed, each heard the faint sounds of Gus’s telephone.

                  “All right,” the woman said, her voice now quiet and modulated. “I will leave. But I will come back at ten-thirty to see my mother.”

                  “Fine,” Vivian said. The two eyed each other for another long moment. Then the woman turned and left the unit. Vivian gave her time to get out of earshot, then walked to the double doors and stuck her head out.

                  “Cancel the call, Gus,” she said.

                  “But—”

                  “Cancel it. All I need now is those yahoos tramping around the unit in their uniforms, frightening my patients.”

                  “Yes, ma’am,” Gus could be heard through the doors. “I see your point.”

                  Vivian turned to the watchers.

                  “There are patients here to be cared for, aren’t there?” she asked. “And they’re all wondering just what in blue hell is going on out here. Get to work.”

                  “Well, I guess I’ll be getting back,” Georgia said.

                  “Not yet,” Vivian ordered. “We haven’t accepted your patient. You can go back when we do.”

                  “But I have—”

                  “Look, the nursing supervisor pulled half my staff to work on the floor. Just stay with that Jane Doe until we get things under control. Show Dr. Caine where we’ve put her.”

                  Caine was the staff neurologist, fresh out of residency and struggling to establish a private practice. He was at times unsure of himself, but instead of becoming more autocratic when he did not quite know what he was doing, he tended to solicit the nurses’ judgment.

                  It was a delicate game. He could not appear to be asking a nurse what to do; nor could she overtly give the orders. But she could—and Jeannie had done so—speak to the air around him, serving up ideas like ping-pong balls. Caine would return the ones he thought good with a gentle backhanded compliment. Those he found inappropriate got lost, or tangled in the network of words that stretched across the patient between doctor and nurse.

                  No one acknowledged that the game existed. But with the right nurse, Dr. Abraham Caine was a virtuoso player.

                  Georgia was the wrong nurse. She had no talent for the game, refused even to serve.

                  Jeannie had checked on Jonquil by simply observing her monitor: the patient was quiet, her heart in sinus rhythm. Joe Wood she stopped in to see briefly.

                  “Quite a ruckus,” he said.

                  “Testy relative,” Jeannie answered. “How are you doing?”

                  “Fine,” Joe said. “Problem solved?”

                  “Problem put off until later, I’m afraid.” Joe’s color was good, his breathing regular. Jeannie always looked, while appearing only to stop in for small talk. It made the routine checks a little easier on the patient. Then she hurried to Five to relieve Georgia.

                  On the way, she saw Preacher Walters’ profile through the glass door to Vivian’s office. He was gesticulating. Most men simply gestured, but Preacher was putting on a performance for the head nurse. It looked to Jeannie like a silent movie.

                  Dr. Caine and Georgia were silently standing on opposite sides of the old woman’s bed. Caine’s brow was furrowed in concentration, as he watched the twitches play across the woman’s face. Without even realizing she did it, Jeannie counted the patient’s respirations to herself.

                  “Georgia, you can take off now.”

                  The ER nurse slipped quickly out of the room. “What are you smiling about?” Caine asked.

                  “Nothing,” Jeannie said. “Just something I saw.”

                  “Hell of a family, isn’t it?” Caine nodded toward the woman on the bed. “There must have been a dozen people who brought her in, all jabbering away in Spanish at about a hundred miles an hour. It took forever to find someone to translate.”

                  “History?” Jeannie said.

                  “Not much. No prior neurological problems that I could find out about. Never been in the hospital before. In fact, the relatives seemed to be having quite an argument about whether or not to let me treat her. Half of them wanted to take her back home: the other half wanted to explain to the admitting clerk that it was time for them to come into the twenty-first century. They were all scared silly that she might die. We managed to find out that she’s a curandera, one of those Mexican healing women. Delivers babies, removes and puts on curses, treats you with herbs and ground up bones and incantations.” He wrinkled his nose. “And she stinks.”

                  “I see why they couldn’t make up their minds,” Jeannie said.

                  “One of them must have called the wild woman who came in here,” Caine said. “Her daughter.” He showed Jeannie the bruise on the curandera’s temple. “Here, on the left side of her head is a bruise. We ran a skull series: there’s no fracture, but she has been unconscious for hours. Unless there’s a concussion or contusion, I can’t find anything really wrong with her. But the way her face is moving bothers me. I gave her some Valium to try to stop it, but it hasn’t even slowed down.”

                  Jeannie leaned closer to the wizened face. The muscles of the La Curandera’s face—she had to call the woman something—the muscles seemed to have independent lives of their own, apart from the rest of the body, which was quiescent under the influence of the diazepam, a muscle relaxant and tranquilizer. She heard a faint series of clicks. It shouldn’t have been this way, but the proof was in front of her eyes.

                  “Was her face like this when you first saw her?” she asked.

                  “The same. The Valium had no effect.”

                  The puzzle tantalized Jeannie. It was outside her experience to see a single part of the body acting out of concert with the rest. The body was a whole: what happened to the heart, for instance, affected the blood vessels, the kidneys, the brain itself. If she were not seeing it, she would have declared it medically impossible.

                  Yet there was pattern to the movement. She saw it, leaned forward, a catch of excitement in her throat. Pulses of muscular action—not disorganized, random activity, but regular—teemed across La Curandera’s face, from left to right. Then they were gone.

                  “What?” Caine said.

                  “I thought—” Jeannie snapped her open jaw shut with a click of her own teeth.

                  “Thought what?”

                  “I thought I saw—something,” she said. “But it’s gone, now. Maybe I was wrong.”

                  “What did it look like?”

                  Jeannie did not want to put a name to it. But Caine’s eyes were boring into her. He was frustrated by this patient. Maybe she had seen something.

                  “Those tics looked for a minute like your eyelids look when you’re dreaming—like REM sleep.”

                  “That’s it,” Caine said. “Not REM—it’s a facial tic.” He bent over the woman’s face and opened her eyelid. “Cotton.” Jeannie tore a small wisp from a cotton ball and handed it to him. He dragged the cotton lightly across the cornea, the outer surface of the eyeball. La Curandera gave no response to the irritation: her eye remained still.

                  “That’s it,” Caine said. “And that’s why it looks like rapid eye movement under the skin of her face. Fifth cranial nerve damage. C-5 doesn’t handle facial muscles: they’re not moving. But the muscles of the jaw, the ones used in chewing, are under its control. I’ll bet if this goes on while she’s awake, it hurts like hell.”

                  “So she has cranial nerve damage?” Jeannie asked.

                  “Could be,” the neurologist said. “We’ll know better when she wakes up. Get an EEG. And check her vitals every half-hour.”

                  Jeannie wrote down the physician’s orders. “Anything else?”

                  “Yeah, give her about 10 mg of Valium IM in an hour or so, then every four hours. Let’s see if we can get this tic under control. Standard orders for seizure activity—if any shows up, call me. And keep your eyes open for any signs of increased intracranial pressure. I don’t really expect it, but she wasn’t hurt badly enough to have fifth nerve damage, so who knows what the hell is going on? Watch her like a hawk. I’m going to go find some breakfast.”

                  He paused at the door. “And get her cleaned up: she smells.” Caine left Jeannie to carry out his orders. She opened the gown to reveal La Curandera’s bony chest. Her breasts were small, nearly atrophied. Her ribs made a ladder under the skin of her chest. The stench rose in waves from the uncovered skin. Jeannie stepped into the room’s lavatory and ran the water into the patient’s plastic wash basin until it was warm enough to do some good, and grabbed a bar of soap and a washcloth.

                  When she emerged from the bathroom, the tic had again begun to stream across La Curandera’s face. Jeannie watched closely and could see that there was a slighter movement in the neck, below the spot where the jaw was hinged to the skull.

                  The movement fascinated her. It seemed purposeful, almost as if it were in some sort of code. And Dr. Caine was right—the facial muscles themselves were not involved. Only the masseter and temporal muscles on each side were moving. Jeannie’s hand went to her own face, just forward of the hinge of the lower jaw: she clenched her teeth and felt the muscle bulge. She moved her hand to a spot in front of her ear, still clenching and unclenching her jaws, and felt the temporal muscle contract and relax. There was minute movement of La Curandera’s jaw, but the tic spread up both sides of her face along the path of the masseter and temporal muscles, as if a wave of innervation spread along them only to disappear somewhere in her scalp.

                  Then, while Jeannie was watching, the movement and the faint clicking stopped. Jeannie noted the time for the chart, then proceeded with the bath.

                  Some sort of ointment covered virtually every square inch of La Curandera’s skin. Jeannie was afraid to scrub too hard, but she did her best to remove the sticky stuff. She had to empty the basin half a dozen times before she finished the routine of soaping up the skin, scrubbing gently, wiping, rinsing, and going over each part of the body again. The washwater turned gray with the residue of the ointment and dirt. When she finished, La Curandera’s skin was a healthy pink—probably for the first time in a long time.

                  With the skin clean, Jeannie set about attaching the three leads of the heart monitor. All ICU patients were routinely monitored: it was part of the intensive care. A full EKG measured twelve leads. The monitor commonly used in ICU measured the heart’s activity on only one circuit, called Lead II. Jeannie tore open the sterile package containing the monitoring kit. She placed the ground electrode first, on the left chest, just below the collarbone. The negative lead went in the same position on La Curandera’s right. The positive electrode she stuck on the woman’s skin on the left side of her chest, on the lowest rib she could palpate with her fingers, in line with the nipple of the atrophied breast. Then she wheeled the monitor to the bed, checked to make sure that it was turned off, and connected the color-coded wires. Before turning the machine on, Jeannie checked her connections for tightness and correctness. It was a practiced routine, but she never trusted herself to perform it unthinkingly. She always double-checked.

                  When she flicked the monitor’s switch, a normal sinus rhythm appeared on the screen.

                  The EEG was more difficult. Jeannie hated the procedure, simply because of the tangle of wires that had to be attached. But if she waited for a technician to appear, it would probably be hours before the test could be run.

                  Over twenty wires had to be connected. Each lead from the electroencephalograph terminated in a small suction cup. She used a tube of conduction gel to insure that the minute impulses from La Curandera’s brain would be transmitted to the machine. At each attachment point on the patient’s skull, Jeannie stuck a rubber cup, goopy with the gel, and attached the proper lead.

                  When she finally finished, she double-checked each wire and turned on the EEG. Alpha, beta, and theta waves tumbled from the pens onto the strip of recording paper. La Curandera was unconscious. There should have been no alpha rhythm. But there it was.

                  Jeannie raised the side rails on her patient’s bed. She checked that La Curandera was really unconscious, even to the point of applying a pain stimulus. The woman made no response. But the EEG continued to dump alpha waves. Jeannie was certain that she had connected the EEG properly. She pushed the self-test switch on the machine: it responded as it should. She was out of her depth. After taking a last look at the EEG, the EKG, and the patient, Jeannie left the room to call Dr. Caine.

                  Everything was all right, but nothing seemed right. Wanda Sue was back at her desk.

                  “Did you get the medicine for Mrs. Hennessy?” Jeannie asked.

                  “Yeah,” Wanda Sue drawled. “I gave it to Prissy-Jo.”

                  “What took so long?” Jeannie was punching in the code for the hospital’s PA system.

                  “Pharmacist had a heart attack just as I walked up.” Wanda Sue grinned up at Jeannie.

                  The paging circuit came on. Jeannie started to call Dr. Caine. At that instant, Joe Wood screamed across the hall, and the entire hospital heard his agony.

                  Jeannie dropped the phone and ran to Joe’s room. Wanda Sue was right behind her: Prissy-Jo and Vivian appeared a split second later. Joe was out of bed, huddled in a corner. His breathing was ragged with panic, his pulse pounding.

                  Somehow, his monitor leads were still attached and functioning. Jeannie and the others helped him back into bed. Joe trembled with fear, drooling a little but unaware of it. He had soiled himself. As they settled him in the bed he seemed to come back into the room with them. He wiped his mouth clear of saliva, sniffed the air, and blushed.

                  “Never mind,” Jeannie said. “We’ll get you cleaned up in a minute. Are you all right?”

                  Joe nodded, not trusting himself to speak. “Do you know what happened?”

                  He shook his head, eyes searching the room. His movements were still jerky.

                  Jeannie began to go through the litany of simple questions and tests to determine if Joe was oriented to time and place, trying to find out if he had had another TIA.

                  “What’s your name?”

                  “Joey. Joe. Joseph Wood.”

                  “Follow my finger.” She moved her index finger left and right, up and down, while she watched Joe’s eyes track the motion.

                  “Who’s president?”

                  “Who cares?”

                  “Grab my fingers.” She held her hands out to him, and he took them on his own. The test of comparative muscle strength was to give her a clue to any damage that might have been done to Joe’s brain. He closed his hands on hers and squeezed.

                  “Please,” he said. “Hold on to me. Please. Just hold on.”

                 

Chapter 3

                  Father Diego de la Vega, S.J., was lingering over a cup of hospital coffee when Jeannie’s call came in. He was in his office next to the chapel on the first floor of St. Maggie’s. In theory, this hour of the morning was his time for private prayer; in actuality it was his coffee break.

                  The name Diego de la Vega did not seem to fit the paunchy Cuban-Irish priest behind the chaplain’s desk. There was a trace neither of Errol Flynn nor of the masked and caped crusader about him. Unknown to him, everyone in the hospital called him Father Zorro behind his back.

                  Unknown to everyone in St. Maggie’s, Father Diego’s secret fantasy was to be Zorro, the fox.

                  When he was a child, Diego de la Vega watched all the movies and TV shows and listened to the radio programs about his alter ego. He dreamed of having the power to right all wrongs committed by those with power, those with authority. He still longed to search out corruption and evil, and, like an avenging angel clothed in black, to punish wrongdoing.

                  During his early adulthood, he more than once found himself planted in front of a television set, watching his hero heal the broken world neatly within the temporal confines of a thirty minute program. He longed for such effectiveness still.

                  No bishop can endure such an attitude in a parish priest, nor could the head of the American chapter of the Society of Jesus. Diego was put out to pasture as a hospital chaplain. He spent his days, and often his nights, among the sick and injured, giving, when he could, the sacraments, a priestly blessing, or simply a friendly talk to the separated brethren, the Protestants and other non-believers who seemed to him to be overpopulating his corner of the world.

                  He was a priest, a black-clad Jesuit, whose true identity was Zorro. But it had never become manifest. Every petition circulated, every rally attended, every mile marched had fallen, like Adam, into a chaos of complexity and mixed motivations. Nowhere in his life had Diego de la Vega, S.J., found an outlet for his dream of justice. He longed—had longed all his life—for one clear, uncontaminated battle with evil.

                  The telephone rang.

                  He spilled the dregs of his coffee across the unsatisfactory copy of the report he had been writing for his bishop. It was already two weeks late. It detailed his activities as chaplain for the past year—the number of patients visited, communions given, masses celebrated, advices offered, last rites performed over the dead and dying—the statistics of a priest’s work with the sick. Gathered together, it made an impressive pile of paper. The hospital was fertile ground, where the fear of God grew fruitfully.

                  “Damn it,” he said into the phone, feeling the stream of warm liquid spill across the papers into his lap.

                  “Father?” It was one of his favorite nurses, Jeannie Christopher from ICU. She seemed distracted, unsure of herself, which was unusual for the young nurse. He hung up the phone without identifying himself and stabbed his handkerchief at the wet spots on his trousers. The phone rang again.

                  “Chaplain’s office,” he answered, correctly this time. “What can I do for you?”

                  “Can you come up here?” Jeannie asked, after identifying herself.

                  “What is it?” He wanted to stay in his office until the coffee dried. Besides, he was afraid of intensive care. It was to him a torture chamber, a preview and a precursor to the torment of the unrepentant in hell. The instruments of plastic and chilled steel, always cold as they invaded the flesh, caused him to wince internally, in premonitory pain. If Dante had lived in this age, the circle of hell reserved for torturers would have been created from the tools of intensive care. He often prayed for a death rapid enough to save him from the ministrations of the ICU staff—a sudden, killing stroke, a tiny meteorite descending from the heavens aimed squarely at his skull.

                  “One of our patients, Mr. Wood,” Jeannie said. “He’s behaving a little—well, strangely, and he needs to talk to someone.”

                  “What do you mean?” Fr. Zorro dabbed with his handkerchief at the wetness of his trousers. He was delaying his obvious duty and knew it, but was unable to stop. He did not want the young nurse to see him like this.

                  Jeannie explained briefly. From her manner, Diego knew that she was hurried and needed to get back to her patients. He cursed his own delaying tactics. Was this the way a righter of wrongs should behave?

                  “I’ll be right up,” he said.

                  After hanging up the telephone, Diego paused, wondering if it were too early in the day for a nip. He was not a whiskey priest, he reminded himself. But he was going into the part of the hospital he feared most. A little liquid courage might help him do a better job of listening. He would not be distracted as much by his own fears.

                  Knowing that he was rationalizing, he opened the bottom drawer of his desk and found his bottle of bourbon. The level was down lower than he expected. Had the housekeeping staff found the bottle in his absence? It seemed plausible. He reached into another drawer and found a broad felt marker. After pouring himself a careful one and a half ounces, he marked the new level of whiskey in the bottle, capped it, and replaced it behind his current files.

                  He lifted the shot glass and toasted the Figure bound to the crucifix that hung on the eastern wall. Help me to face their suffering, he prayed, and tossed the bourbon against the back of his throat. Help me.

                  As usual, there was no answer. Father Diego slammed the shot glass down on the desk and started resolutely to the door. Halfway there, he stopped, went back to his desk, and replaced the glass in the drawer with the bottle. There was no sense in advertising his weakness.

                  The corridors were busy. His office was on the ground floor, in the administrative wing of the building. Although the hospital was run by the sisters of St. Mary Magdalene, most of the staff, medical and administrative, was lay. Diego wondered why there were not more nuns every time he wandered the hallways, which he did many times each day. Young girls fresh from high school and dried-up matrons, their lives entwined at a distance with the patients they never saw or touched, sat at desks and chattered the keys of their typewriters in every office he passed. Computer printers added their own higher-pitched, semi-electronic screeches to the cacophony, in which coffee was slurped, gum snapped, pencils electrically sharpened, pens clicked, and feet shuffled. Plastic covers were lifted and replaced with snicking sounds. Papers fell into place like autumn leaves settling to the ground after summer’s glory, dried and in their graves.

                  Greetings rose above the background sounds like fish jumping momentarily above the surface of a wind-ruffled lake. Some were fat splashes of whiskered catfish, like that of the few men, who were, even in these times, the supervisors of the sea of female clerks. Others were baby trout, the young Catholic girls who always looked up from under artificial eyelashes and smiled “Hello, Father,” as he passed, and to whom he handed out waves of the hand and grins of encouragement, like a parent at the door on Halloween. Here and there, the older women, working at a second job to keep their families solvent, darted nods like minnows, keeping their eyes on their work, darkly aware that the supervisors were always watching.

                  The administration was constantly looking for ways to hold down costs. Personnel was their fishing pool.

                  Finally, Diego passed through billing and medical records and admissions to the main lobby and its elevators. Here, he was in a public area of the hospital, and everything changed. The colors of the walls were even different. In Admin, the walls were a driving yellow, a color selected by the efficiency consultants to keep people active and working. In the lobby, the walls were a comfortably neutral beige, with off-white accents and a hint, here and there, of green. The effect was calming to the patients and their visitors as they entered. The employee entrance, from the back parking lot, he recalled, was a particularly alarming orange, to get the staff charged up for an energetic day’s work.

                  The gift shop lady, Mrs. Wagner, had to greet him and tell him all her troubles keeping the volunteers in line. Diego extricated himself as soon as he could, but it was a full five minutes before he got away from her. If he hurried past someone like Mrs. Wagner, he made an enemy. Not only would the old biddy complain to Horst Appleby, her son-in-law, but Diego would have lost a source of information. The regular sessions of complaining were the price he paid for the rich well of hospital gossip he picked up from her. Perhaps one session in ten gave him a vital bit of information. And he did not mind as much as he told himself he did; it delayed his arrival in ICU.

                  From Mrs. Wagner at the gift shop, he enclosed himself in the elevator with half a dozen visitors, apparently from two different families, one Mexican, one Anglo.

                  The four Hispanics greeted him cheerfully in English, then proceeded to chatter away in Spanish. The mother and eldest daughter were arguing over a boyfriend: he could not tell whether it was the mother’s or the daughter’s. The two younger children were of an age to belong to the daughter, a dusky girl of eighteen or twenty, but seemed to listen much more to the mother (or grandmother?), a heavy-set woman in her late forties, a precognitive vision of what the daughter would become in her own later years.

                  The Mexican group got off the elevator on the second floor. Diego found himself under the eyes of the Anglo couple, both thin-lipped and tight-faced, silently antagonistic and bristlingly Protestant as they shrank from his Roman presence against the vinyl-covered elevator wall. They made him want to cry out. He never had understood the discomfort some Protestants felt in the presence of his priesthood. It often looked like guilt to Diego, but he never knew its source. He was almost relieved to exit the elevator on the third floor, leaving the silent, rigid couple to continue their vertical journey untainted by his Catholic presence.

                  As the elevator doors hushed shut behind him, Fr. Diego metaphorically girded his loins. Physically, after checking that no one else was in sight, he pulled his trousers’ waistband up to the middle of his girth. He glanced at the crotch-level coffee stain, hoping that his priestly aura would prevent anyone’s eyes from dwelling on the clerical wet spot. He could not change; his only other trousers were at the cleaners.

                  He moved through the corridor to his right and turned the corner. His worst fears were realized—Gus Charon sat at the ICU reception desk.

                  “Good morning, Gus,” Diego boomed, trying to bull his way past the guardian without stopping. But Gus was not to be denied.

                  “Howdy, Padre,” Gus said. The wizened old man moved with the speed that always took Diego by surprise. Someone that old should not have been as spry as a teenager. “Whatcha up to?”

                  “Just making rounds,” Diego lied.

                  “Not time for your rounds yet,” Gus averred. “You make rounds up here after lunch. By my calculations, you ought to be down in your office for another half-hour, then start on Med-Surg. That takes forty minutes, then lunch, then you hit Pediatrics before you come up here. So, whatcha up to?”

                  Gus had moved during his dissertation to block the entrance casually but effectively. Diego saw the futility of trying to talk his way past the gatekeeper.

                  “If you must know,” he said, “Miss Christopher called me and asked me to come up and talk to one of her patients.”

                  “Which one? The old Mexican broad?”

                  “I hardly think it’s any concern of yours.”

                  “It’s all a concern of mine,” Gus claimed. “I’m responsible for whoever goes in there.”

                  “But this is my job.” Diego said.

                  “Ain’t tryin’ to stop you doin’ your job,” Gus drawled. Whenever he was thwarted, he declined into the prairie dialect of his youth. Gus considered youth to extend from childhood to retirement. His own retirement had come at the age of seventy. He had worked as a cowboy until the prairie wind had made the winters too rough on his aching joints.

                  “Just tryin’ to broaden my education,” Gus continued. “Been tryin’ to pin down you Catholics on somethin’ for years. Never did get a straight answer. Been sittin’ here thinkin’ on it for the whole mornin’.”

                  Gus folded his arms, waiting. The two men stared at each other for a long moment, during which it became clear to Diego that unless he gave in and talked to Gus, he was not going through the door.

                  “It’s not a good morning for theology, Gus, but go ahead.”

                  “That’s the spirit,” Gus said. “Now, you’re a Catholic, I’m not. I mean, I go to church regular, but I’m a Baptist and we don’t hold with all the things you all say is right. Now, it came to me this morning that there’s a lot more Catholics than Baptists—not here in this town, but all over the world. So it makes a difference which one of us is right about certain things. That’s what I want to ask you about.”

                  With that, Gus stopped, waiting for an answer. But Diego did not know what the question was. He waited for it.

                  Finally, Gus said, “Well?”

                  “What do you want?” Diego asked.

                  “How do you all feel about that?”

                  “About what?”

                  “The differences,” Gus said. “If you all are right, then I’m goin’ to hell like it or not. If we’re the ones with the right ideas, then all of you Catholics are gonna be lookin’ up and wonderin’ where you went wrong. Seems to me it must make a difference.”

                  Diego was confused. “I’ll have to think about that one.”

                  “You do that,” Gus said. “Seems like an important kinda question to me.” He did not move from his position in front of the door. “I’ll wait.”

                  “Well, I can’t answer you now,” Diego said.

                  “In that case, it’ll cost you some silver.” Diego dug in his pocket for the few lonely coins he was allowed and produced a quarter. Gus held out his hand, and Diego tossed the money to him. Then Gus moved aside, allowing Diego access to ICU. In the doorway now, the priest turned back to the old guardian.

                  “Gus, just what do you do with the money you collect?”

                  “You answer my question,” the gatekeeper said, “and I’ll answer yours.”

                  Diego grunted and turned away.

                  “Padre?” Gus said.

                  “What now?”

                  “Good cleaner could do somethin’ about that accident you had.”

                  “What do you—?” Diego began. Then he realized what Gus meant. His face flushed red and he bashed through the door. It bounced back against the stop and hit him in the face. “Damn!” He struggled through the entrance, rubbing his nose, tears streaming from his eyes at the sudden agony. As the door swung shut behind him, he found that a blurred Jeannie Christopher was standing in front of him.

                  “It was you,” she said. “Are you all right?”

                  “I’m beginning to feel like Dago Red,” Diego said, wiping the tears from his eyes.

                  “Who?”

                  “Never mind—an allusion, that’s all.”

                  “Not you, too.”

                  “Not me too what?”

                  “You’re not having illusions, too, are you?”

                  “What are you talking about?” Diego asked, thoroughly confused by the direction—or directions—the conversation was taking.

                  “I’m not sure,” Jeannie admitted. “Is your nose all right?”

                  Father Diego wiggled the tip of his nose experimentally. “Seems to be,” he said. He sniffed, then found that, standing directly in front of this young nurse, he had to swallow. Embarrassment moved through his body. He could feel it as a distinct sense of warmth moving up his frame, to find its final location in his face and neck.

                  Jeannie, however, had turned away and was leading him along the corridor. Diego kept his gaze rigidly forward, willing himself not to look into the rooms. He found his eye coming to rest on Jeannie’s pertly rounded behind, visually muffled somewhat by the loose scrub pants that she wore, but by no means invisible under the fabric, which was guaranteed to inhibit sparks of static electricity because of the metal fibers woven into the cloth. Bothered by this reminder of his carnality, Diego turned his eyes away again, looking to his right—right into Jonquil Marie Hennessy’s eyes. She stared through the window of her room, seeming to will him to come in to give her what poor comfort he could. He found himself torn between his duty to counsel Joe Wood (and thus to please Jeannie Christopher) and the nakedness of Jonquil’s need.

                  “Father!” she called, in a voice he perceived as weak with pain.

                  Diego found himself at a full stop in front of her room, looking not so much at Jonquil as at the wires and tubes draped around and into her. Her monitor glowed greenly above her bed, signaling to him across the intervening space.

                  “Father?” Jeannie called. Her purposeful stride had taken her ahead of him. Not hearing his footsteps behind her, she had stopped and turned back to look for him. He was standing by Jonquil’s door, near the No Visitors sign.

                  “What about Mr. Wood?”

                  “I’ll just stop here for a moment,” Diego said. “I can make my afternoon rounds while I’m up here. Save a trip later.”

                  Jeannie seemed to poise on a point of indecision. “I really wish you’d see Mr. Wood—”

                  “I will, daughter,” Diego said. “I’ll visit everyone in the unit while I’m up here.”

                  “Well,” Jeannie said, “all right. Call if you need help.” Diego nodded, then tapped on Jonquil’s open door while he watched Jeannie return to her duties.

                  “Come in,” the breathy voice called.

                  Diego entered the room. There were three bouquets of flowers in the window sill: their scent nearly sickened him, but not so much as the sight of the pale woman stretched out on her bed, her face filled with fear.

                  Flowers were, in theory, not allowed in the patients’ rooms in ICU. Jonquil’s influence over Preacher Walters was such that an exception was made in her case. Besides, she complained loudly and unendingly when they were first shown to her, then removed.

                  “Can you help me, Father?”

                  “I’ll try.”

                  “Come in,” Jonquil said. “Sit down. Talk to me.”

                  Diego followed her instructions. “How are you feeling, Mrs. Hennessy?”

                  “‘About as well as can be expected,’ Father.” She inserted the quotation marks with her voice. “I hope to leave here, soon. As soon as they’ll let me go.”

                  Diego sat stiffly in the bedside chair. He had long ago realized that the furniture in the patients’ rooms in the hospital was for the convenience of the staff, not for that of the patients or their visitors. The chair fairly shouted at him to stand up and be on his way and leave its patient in peace.

                  “Someone must love you,” he conversed. “These flowers are beautiful.”

                  “It’s just Henry. No one else comes to see me.”

                  Diego smiled. “There is a sign on your door that says ‘No Visitors.’ It’s rather discouraging.”

                  “That’s just my problem,” Jonquil sighed. “I’m so lonely. You see, there’s really nothing wrong with my heart—not physically, I mean. I think it’s just broken.”

                  “Broken?” The priest in Diego automatically gave the encouraging therapeutic response. He had no idea what she was talking about.

                  “Yes, Father, broken.” Jonquil struggled to sit up straighter in her bed. Diego saw her glance into the mirror built into her bed table. Satisfied, she went on. “I am a prisoner here. They won’t even let me out of bed to go to the—the facilities. They accuse me of lying. They talk about me behind my back every day—at least three times. I’ve heard them, but even if I didn’t hear, I would know it. They sit in those offices over there, when they should be in our rooms, taking care of us, and they talk about us. And this morning, when that poor man died, I was so afraid of what was happening, I punched my call button, but no one came to see me for the longest time. And when they did, it was that Christopher woman. She hates me, I know she does, and she shouted at me.”

                  Diego shifted uncomfortably in his uncomfortable chair. “It can be very frightening in intensive care,” he said, while Jonquil paused for breath.

                  “That’s what they call it,” she continued, “but that’s not what it is! They hardly pay any attention to me at all. I mean, I don’t want to be a burden on anyone—far be it from me to make any of them overwork—”

                  Diego’s mind shifted into confessional mode. He listened with half an ear to the woman’s litany of complaint, but her chatter was more than he could bear to give his full attention. She rattled, her complaining sounding to his fatigued ear like dice bouncing in a backgammon cup, with about as much significance. Jonquil was self-centered, useless in the world, and knew it. She complained because she had no other purpose to give herself to. Diego had met many of her sort. He most often had seen them when he had worked among the poor in Central America, before the local authorities had demanded his removal from what they saw as “their” country. They were the wives of the rich landowners, the spouses of the leaders of the military junta. They had no voice in shaping their own lives and were consequently waspish and perpetually unsatisfied. Jonquil was one of them, a sister beneath the disguise of skin color and behind the barricade of language, privileged and unsatisfied.

                  To understand is to forgive was something Diego had once believed.

                  “Loneliness is a difficult thing,” he said into an unexpected and expectant silence.

                  “I wasn’t talking about loneliness,” Jonquil pointed out. For a moment the priest was flustered, but Diego was a veteran at dealing with self-pity and not about to be handled so easily.

                  “Are you certain?” he asked. “That is what you mentioned first when I came in.” Therapeutic confrontation, it was called. This must have been the ten-thousandth time he called on the technique. For the first seven or eight thousand, he had done it eagerly, trusting in the theories of his teachers which said that the mind in denial must confront that which it feared most before it could come to be healed. Never use it in anger, his teachers had warned. But thousands of these conversations ago, he had given in to his festering anger at the sick. The confrontations had worked all the better by being fueled by real feeling rather than a puny sense of therapeutic concern. He rationalized, some of the time, that the greatest gift he could give his patients was the gift of his true feelings. But more often his true feelings approached disgust. He hated to be manipulated.

                  “You feel that you are alone,” he said, “and it frightens you. It’s only natural. Have you ever thought that the reason you feel so alone may be that you make it difficult for people to get close to you?” Take that, bitch.

                  Jonquil reacted as if slapped. Her eyes filled with tears that flowed softly down her cheeks.

                  “Is that what you think of me?” she asked, softly.

                  Diego tried not to let his satisfaction show. “I can’t answer that for you.” He would not be deceived by her tears. He refused. The mission that had brought him into ICU still waited for him.

                  “Would you like to pray for divine help?” he asked her, standing. As far as he was concerned, the interview was at an end. “A blessing, perhaps?”

                  Jonquil’s tears vanished, as if miraculously. As far as Diego could tell, her face had never been wet. “You don’t give a shit,” she whispered. Diego was unaffected by her attempt to shock him. He waited for her answer.

                  “I was going to confess,” Jonquil said. “I’m not a Catholic, but I wanted to confess to you. But not now. Now I’ll die before I talk to you again. Get out of here.” She turned her face to the wall.

                  Diego realized what he had done, but it was too late to alter his actions. He muttered a few words, something between a curse and a blessing, and retreated from Jonquil’s room.

                  Jeannie Christopher was watching him from the nurse’s station, where she was writing in her patient’s chart. Diego walked around the corner and leaned heavily on the counter, looking across at the nurse.

                  “She get to you, too?”

                  “I shouldn’t let her,” Diego said. “I’m supposed to be able to deal with things like that.”

                  “You’re not the first,” she said. “She got me in trouble this morning, with Dr. Walters.”

                  “Preacher or Jeff?”

                  “Preacher,” Jeannie said. “Jeff’s OK.” Jeannie returned to her chart. Diego watched her work for a moment, then said, “Which room is Mr. Wood in?”

                  Jeannie finished making a note in the chart before answering. Father Diego had worked with her often enough to know that she was not being rude: it was her habit to concentrate so thoroughly on one task that she simply did not register what was said to her while performing it. He waited.

                  “He’s asleep right now,” she said, after writing the final words. “But he’ll wake up for lunch.”

                  “Then I might as well see everyone now as after lunch. A little change in schedule never hurt. Who else do you have?”

                  Jeannie held up the chart she was writing in. “La Curandera.”

                  “La who?” Diego asked.

                  “Curandera,” Jeannie said. “She’s an old Mexican lady, a healing woman.”

                  “What’s wrong with her?” Diego was uncomfortable holding the metal-bound chart. He hated to read the notes inside. They seemed cold and inhuman to him. Pt. unresponsive to current therapy. New dx? Always Pt. Not even spelled out properly, let alone the name of a human being. He understood the reasons—efficiency, consistency, limited space to write, limited time to write—but it encouraged everyone towards the kind of thinking that was anathema to the humanity of the suffering person, the person that he was there to succor.

                  “We don’t know.” Jeannie took the chart back and replaced it in the rack overhead. “She came in hot this morning, in a coma.”

                  “Neurological?”

                  “Yeah, I guess. Want to see her?”

                  “Sure. If she can’t talk, at least I can pray over her.”

                  “It’ll probably do her more good than anything we can do. Come on. She’s in Five. I’m due to check on her anyway.”

                  They moved to the crash room, where La Curandera lay, her condition unchanged. Jeannie began her routine check of blood pressure, pulse rate, and the other variables that gave her some insight into what was happening in the old woman’s body. The heart monitor showed a steady sinus rhythm. The EEG that Jeannie had run earlier had been removed, and now the single lead of the cerebral function monitor trailed from the patient’s scalp down to the CFM. Everything was undisturbed. Jeannie touched the old woman’s forehead with the business end of a digital thermometer. The result—ninety-seven point eight —was close enough to normal. No fever.

                  Diego wished, for the n^th time, for a spiritual instrument that could let him see as deeply into La Curandera’s soul as Jeannie could look into her body. The skin, no matter what the texture, age, or color, was a barrier penetrable to the weapons of medicine, but sadly opaque to his own poor arsenal. As he followed the nurse into the room, he shied like a frightened horse. He pushed the fear from himself, thinking it was his customary reaction to the inquisitorial steel and plastic of the crash room.

                  But as he watched Jeannie perform the ritual check of vital signs, he sensed, somehow, that there was here an underlay of something older than modern science. something ancient, something pre-Columbian, bloody, and terrifying. The bed of La Curandera took on the smell of an Aztec altar. The tic that ran across her face with metronomic regularity, was like the tide of blood spurting from a violated chest.

                  He wanted to run from the room, back to his bounded office, the serenity of his tiny chapel. He could not understand how Jeannie could be immune from the miasma of evil that wafted about the patient. But she performed the treatment of her patient with a quiet competence undisturbed by fear or even perception that she was handling evil.

                  He forced himself to compose his mind for prayer. “God, he prayed silently, I ask your care for your child here, whose name I do not know. Help the doctors and nurses to discover what is wrong with this woman, and, if it is your will, to heal her of her suffering. In the name of your son our Lord, Jesus Christ. Amen.

                  He had half-expected his prayer to be interrupted, as in The Exorcist, but nothing happened—nothing at all.

                  Father Diego de la Vega was a believing priest. Doubt had failed in its assault on him during his early seminary years and had not threatened him since. His God, the Trinity of Father, Son, and Holy Spirit, was as real to him as the torch in the hands of a welder. He felt His weight, His heat, the trembling pressures in his hands, when he spoke to Him. It was not something he normally discussed with others, not even with other religious. The Presence of God was to Diego like the ocean to a fish—always with him, always nurturing, the environment through with he moved.

                  But not this time. He realized that the sense of evil he felt on entering La Curandera’s room was not a Presence, but an Absence.

                  He opened his eyes after the prayer, almost expecting to see the evil manifested. But the room was the same, the steady wave on the oscilloscope of the EKG, the tiny skritch of the pen of the cerebral function monitor, the unchanged tic that traveled across La Curandera’s face. Jeannie Christopher was waiting patiently for him to finish, so he lifted his right hand to make the sign of the cross over the woman on the bed. His arm felt heavy as he performed the final part of his rite, but he managed. Jeannie waited a moment longer, then raised her eyebrow, questioning whether or not he was finished. He nodded, uncertain of himself, and Jeannie led the way from the room.

                  Outside, he watched the young nurse for any sign that she might have felt something of his own experience, any hesitation or question. He again felt the warm Presence envelope him and welcome him back, and he cringed to think how alone he had been away from it. It was a wonder that he had not floundered like a gasping fish tossed by the waves onto the seashore.

                  Jeannie, apparently, felt nothing. He breathed a prayer of thanksgiving for his own return. The nurses must have some special armor, he thought, to protect them emotionally from the suffering they dealt with. To enter the presence of pain so often, many times to inflict it in the name of healing, and yet to maintain their compassion, they must have a special dispensation from God. To be touched, as he often felt himself to be, by so much pain, would be intolerable without divine help. How could an unprotected human being with any sense of comradeship with other persons spend half her waking life in the presence of intractable suffering and yet remain sane—more, even good tempered and cheerful? Yet Jeannie and most of the others did so, without even thinking about the process. They were the recipients of a special grace because of the work they did, without even realizing their blessed status. He knew there was pain in their work, that they could not perform it without a special vulnerability to the pain of others. It was not that they did not feel, but that they healed so quickly, minute by minute. They must heal: how else could they return day after day?

                  He felt inadequate in Jeannie’s presence. But she was speaking now, and he had not been listening. “—in Eight. You’ve already been in to see her. Prissy-Jo is with her right now, giving her the exercises, but she should be about finished.”

                  “I’m sorry, I was thinking about something,” Diego said. “What were you talking about?“

                  “Mrs. Jefferson, in Eight.”

                  Before her injury, Marie Jefferson was a successful and well regarded local musician. She played clarinet in a local jazz band, and taught piano part-time at the college, as well as playing for the symphony and for the small band that the community theatre used for its musicals.

                  No one knew what, if anything, went on inside her head. The boat wreck out on the lake gave her a severe depressed brain injury and nearly drowned her in the bargain. Between the two insults, she was permanently comatose.

                  Several of the doctors, though, who had heard her playing, were unwilling to remand her to purely custodial care. Because of their love for her music, Jeff Walters and Abraham Caine had led the effort to keep her in ICU, rather than in a nursing home, and her musician friends had contributed, too. It was not that she would ever recover: her injuries were too severe. The speedboat that had wrecked her own craft had crushed the parietal and occipital areas of her skull and damaged both the cerebral cortex and several of the underlying structures of the primitive animal brain as well. There was no chance of her awakening from her coma.

                  The nurses played music constantly in her room. Whoever had her care was responsible for keeping the jam box playing everything from classics to jazz to show tunes, softly, so as not to disturb the other patients, but loud enough that what remained of Marie Jefferson would, if it could, hear the beloved music.

                  Diego knew that Marie was sometimes called the Turnip, but he could not use the name himself. Totally unable to play music, he never chanted the mass, because he was almost tone-deaf. But he loved to listen, and he was an avid audience member, when his hospital duties would allow him the freedom to hear the symphony and Marie’s band. He had never spoken to her before the accident. But he had known her through her music, and he hated the thought of her lying comatose in her bed, without the benefit of death.

                  Prissy-Jo came out of Marie’s room, sweating from the exertion of performing the passive exercises. The passivity was all Marie’s. Prissy-Jo had just finished a workout designed to maintain tone in the comatose woman’s muscles. Without the exercises, Marie’s flesh would shrivel: her central nervous system was too much damaged even to maintain minimal tensions in the long muscles. She was reduced to autonomic behavior, and precious little of that.

                  Marie Jefferson was a lump of matter, whose heartbeat was one of the few functions still to work without intervention.

                  “All right, Father,” Prissy-Jo said, “you can go in now.” Jeannie was busy at the nurse’s station. Prissy-Jo walked into the lounge behind the station, and Diego heard her change falling into the Coke machine, the dull thunk of a can falling into the hard rubber of the access port.

                  “God, that takes a lot out of you,” Prissy-Jo said from the lounge, to no one in particular. Diego pushed open the door into Marie’s room.

                  After exercising Marie, Prissy-Jo had bathed her patient. Marie’s mouth hung slightly open, useless now for eating or breathing, because the tracheostomy tube had become the channel for her breath, which came wheezing from the ventilator by her bedside. The black rubber bellows moved up and down at a steady twelve breaths per minute: Marie’s chest mirrored its rhythm, with an unnatural mechanical regularity, and the white plastic tube that led from the ventilator to the tracheostomy tube pulsed in rhythm with the bellows and her chest, almost as if it, rather than she, were the locus of life in the room. The tube resembled nothing so much as a dryer vent hose, although it was smaller in diameter and translucent.

                  All the dressings had been changed, after the exercises and the bath. The initials “P.J.M.S.” and the date were written on the gauze tape that held each IV line in Marie’s veins. There was a plastic bag of D5W, a solution of five percent dextrose in water, full of antibiotics, hanging above Marie’s left side, its clear plastic tube snaking through a blue IV pump and into the antecubital vein in her elbow.

                  Marie was eating her lunch via an indwelling catheter that snaked from the subclavian vein under her collarbone into the superior vena cava, a short but wide vein through which all the blood from the upper half of her body traveled into her heart. The great volume of blood and the turbulence of its movement mixed the concentrated solution of sugar, proteins, vitamins, and minerals that Marie needed to maintain her life.

                  Diego felt almost as if her were violating Marie’s privacy, although he knew she could not care. But his gaze traveled to her head, still swathed in bandages, her hair shaved off a week ago for the surgery on her damaged brain. From the bandages, two probes protruded. One belonged to a cerebral function monitor to keep track of the electrical activity in her brain. The other monitored her internal cranial pressure—the amount of force caused by the swelling, or edema, of her brain tissue. It was the swelling, as much as the injury itself, which insulted Marie Jefferson.

                  The wires from her heart monitor primly trailed through the neck of her hospital gown and out the head of her bed to their connections.

                  Diego knew that on the midline of her back there were the small scars of three lumbar punctures. Spinal fluid was a useful diagnostic tool.

                  At Marie’s right arm, another IV was established. This further invasion, Diego knew, was for the infusion of anti-seizure drugs. Marie’s injuries had left her vulnerable to convulsions, along with all the other dangers that threatened her.

                  Although invisible under the bed coverings, a Foley catheter, with a small balloon on the tip to prevent it from slipping out, was inserted into Marie’s bladder to drain urine as soon as it was formed.

                  Each of these invasions, designed to keep Marie alive, was a potential source for the infection that would, eventually, develop. Each tube, catheter, needle, or probe could become a sliding board for bacteria to ride into the body. Each had a projecting tube or wire that could tangle or pull.

                  Diego touched the still, undreaming sleeper gingerly, aware of the potential for damage. He began the service of healing, which always included, for him, anyway, the touching of the sufferer. Especially for those who were unconscious, Diego believed in the importance of touch. It might be the only sense still active. He pronounced Marie Jefferson clean of all sin. She was unable to eat or drink the communion elements. Nevertheless, Diego moistened her lips with wine from his portable communion kit. One never knew: and the power of the rite worked mysteriously. Surely Marie Jefferson was in a better position than most to know the sacrifice of the cross.

                  He anointed her forehead with the chrism of healing, tracing a small cross on its unlined surface. The skin was flaccid under his moving thumb.

                  Perhaps Marie Jefferson was allergic to one of the ingredients in the chrism. Perhaps the health of her skin was beginning to break down because of her condition. Where Diego touched her forehead, a mild inflammation appeared in the shape of the cross. Diego saw it grow into being as he murmured the final words of the ritual. It was not a prominent marking, but its presence was undeniable. He had a few bad moments, wondering what he was seeing. He resisted the temptation to look at the palms of Marie’s hands for other markings. After a few moments of waiting, the inflammation went down, and the image of the cross was gone.

                  Diego hurried to pack up his kit and leave Marie Jefferson. He was being tossed back and forth between opposing forces: he just wanted to be left alone.

J.C. and the Boys by Alan David Justice is licensed under a 

Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

There's another story, The Communion of the Saint, here. 

And also here. 

And as a free audiobook here.

A Hanging Offense begins here. It's the story of the Peasants' Revolt in England in 1381, set in the town of Saint Albans.