The Dissection of Dignity (First Chapters)

[AubreyRLeClair]

Just before she leaps from the ledge.

 

When the light is such that the street below remains a half answered question.

She presses her toes together so that the blood drains and the tips become white against the rich colored bricks.

Then, without breath. Without hesitation.

She goes barefoot.

Out into the radiating darkness.

Her hair floats soundlessly above her and her shirt luffs against her body. 

It is 5.9 seconds from the cloudless sky to the earth. Just longer than it takes to blow out a birthday candle.

There is a mathematical equation to represent the force exerted by the pavement upon her body.

 

It's easier that way. To think of things as numbers. To quantify the impact. Rather than the number of days or hours

that might have been.

 

The only person who sees her fall, sees without seeing.

A bird, a bag, a figment.

Something large and unusual. But in the still and lambent air, it is hard to tell what has fallen.

The morning sun rises above her, reflecting pale lapis light off her skin. And Her Still Warm Body, lays with legs twisted and arms flung open, as if to welcome a close friend.

 

The light swings westward on its axis, passing increments of gold. It does not pause to announce her passing. It does not halt the day. Cabs swing around the corner, cumbrous and lazy in their arc. Oblivious to her tragic form.

 

Nearly thirty minutes pass before the light is sufficient for the slowly waking city to recognize that she is not a bird or a bag, but a body. A human.

 

The first person to see her for what she really is, is a businessman on his way to work. He slows his stride reluctantly, wipes the sweat from his brow and walks over to check on her.

 

And only after he realizes,

truly understands, only then, with muttered guttural exclamation, hurries to the front desk to confer with the doorman.

 

What should they do?

 

They stand together as one humming body, closer to one another than is normally appropriate. The heat collects under their collars and the businessman removes his suit jacket. A large circle of sweat stains his back.

They call emergency services. 

They step back to examine the situation. Should they cover her? Nervously, they drag a large quilted blanket over to the parking lot, the kind that are used to pad the moving carts. And standing for a long time, the doorman finally nods his head. With troubled hands, they drape the blanket over her. The businessman moves a dirty mask away from her body.  Her arm sticks out from under the blanket, and her fingers are pale despite the heat.

 

As an irrepressible reflex, the businessman bends over to move her hand under the blanket. A crumb of peace or a semblance of stillness. But the doorman catches his arm and shakes his head. They should not move her.

The police come and cover her in tarpaulin, the edges of which curl upwards in the heat.

Under the tarp, her muscles contract. Expanding. Releasing.

 

One Year Earlier 

Day 40

Good morning fuckers, how many did we get overnight? 

Six admissions, we're capped.

Anybody trying to die on us?

  One emergency that got dumped on us and another trying to bottom out on us, but everyone else looks pretty good.

Eve leans in intently. Her notes are filled with the names of her patients. The morning vitals and labs are outlined by color, red for high, blue for low, everything else gray. The tension wracks her shoulders. Her right leg is permanently tensed as if ready to spring out of the chair at any moment. Her hair is plastered to the side of her face, trapped by her mask. She sits at the computer with her shoulders hunched, hands shaking more from adrenaline than nervousness.

There is a certain hollow calm. The rooms are windowless, gray clad and flickered phosphorescent bulbs. Impossible to tell whether the light is dawning or fading, receding or rushing to meet the rusted bricks of the city buildings.

She starts writing, typing too fast,

 88 yo male- no wrong, wrong, backspace.

78 yo male patient w/ congestive heart failure, COPD, coronary bypass, atrial fibrillation admitted w/ severe septic shock secondary to influenza and superimposed pneumonia.

The phone rings and Eve picks it up before the first ring is finished. 

Hi, this is medicine... Yes, I'm sorry. We just had a code. I'll do it now.

 She continues writing. Admitted to the floor. Shortly after admission, labs returned Lactate 5, WBC 23, Bands 7%.

The beeper rings out in its methodical, persistent tone.

Eve checks the pager and calls back. 

Yes, I know she is waiting for discharge, I'll be done as soon as possible

Don't forget about the morphine. The nurse, Eric, replies.  

Yes, I'll put it in as soon as possible. Go ahead and give her two of Morphine. I'll put it in now.

Eve wipes some sweat from her brow and absentmindedly adjusts her mask before realizing her mistake. She carefully pumps hand sanitizer all over her hands and arms and rubs it in until it is dry before going back to the computer. Her fingers hover over the keyboard, tapping lightly in preparation as she glances at her checklist.

She notices an abnormal level - the PTT blood level.

The level to make sure you don't bleed from every possible orifice- bleeding internally, coughing up blood, shitting out blood. Yes, that level. Check that level. Too high then lower the level. Too low then raise the level. Monitor. Control. Don't mess it up. She moves her mouse over and puts in the morphine order. 

She double checks the PTT- too high. Leaning back she nearly falls out of her chair. She grabs the phone and calls the  nurse to let them know. 

She continues typing, Called to bedside by RN, respiratory rate 36. Emergency response team called, chest x-ray… The pager beeps again in its steady methodical tone. Followed by another page. Another page. Another page. Another page. Incessant, unending. 

Shit! What's going on over there Eve? Bishal asks. 

Just my lucky day. Eve responds. She picks up the phone and dials back the first number.

 Kent wing, please hold. She hears on the other end of the phone. 

Tucking the phone handle in her neck, she reaches across the table and pulls a different phone towards her. The phone wires criss-cross. She dials the second number on the pager. 

Medicine, returning a page. She says into the second receiver.

Oh good you called back. The nurse says. I've been trying to get through, we're about to call an emergency response team on your patient in 25b and I just wanted to let you know before it happens. Hypoxic respiratory distress. Do you want me to put on a nebulizer? The nurse asks, panting slightly. 

Hold on, let me tell my seniors. Eve turns around. 

Bishal, they're calling an emergency response on Ms. Bell, South 25B. Eve points to the board. 

Ok, tell them to go all the way up the oxygen. I’m sure they did already. Bishal nods and starts collecting his papers. 

Turning back to the phone, Eve responds. Just go all the way up on the oxygen, we're on our way. 

She untangles the phone cords before hanging up. The other phone in her hand suddenly stops playing music, 

Hello. She hears through the receiver.

Hello? Eve responds.

This is Eric the nurse for room 203a, he's asking for Tylenol for headache.

Ok, I'll put it in. Eve drapes her stethoscope hastily around her neck and shoves two pens in her pockets.

Hey Ellie, can you do me a favor and please put in Tylenol for 223a? Eve runs out before she hears the answer, because Tylenol isn’t as important as a crashing patient.

Oh shit, Eve runs back into the room and grabs her pager off the desk. Sorry, did you hear me?

It's already in. Ellie says, flashing a bright smile. 

Thanks! Eve calls back, walking quickly down the hall.

  No running! The nurse manager sings out in a chirpy voice. No running! She trills again as Eve rounds the corner. 

Eve takes the corner fast and runs straight into an EMT. Oh god, sorry. 

She glances up and sees the name tag: Steve. 

Sorry Steve! Eve calls out, pivoting away.  

He looks unflustered and simply shrugs. 

She doesn’t stop.  

Eve grabs the stairs, and takes them two at a time. The elevators are too slow. Halfway up the stairs she pauses for a moment, winded. The stairs dim, the stairwell tilts. The smell of urine washes up. Stale and suffocating. She notices two cigarettes collected in the corner. Keep up. She rallies and continues up the stairs two and two, one and one, texting her senior Sarah as she climbs. 

Eve bursts out onto the 7th floor and sees Bishal disappearing into the patient's room. She looks around furtively, walk-running the rest of the way, slowing down a few steps before the room to collect herself. 

Where have you been? Sarah asks.

Sorry, I ran as fast as I could. Eve says panting.

It's fine, don’t run. We don’t run.

The attending, Dr. Wong, steps into the room. 

Who has this patient?

Eve organizes her papers, I do. 

She folds the paper so the one-liner shows on the top.

 Ms. Bell: 67 yo woman with pulmonary hypertension, heart failure, COPD and end stage renal disease on hemodialysis Tuesday, Thursday, Saturday who presented in fluid overload secondary to missed dialysis, status post emergent hemodialysis for hyperkalemia, now euvolemic. Our team was called by the nurse a few minutes ago for increased respiratory effort. I just got here so I need to listen to her lungs. Eve reports. 

Eve stands next to the outline of Bishal hunched over the patient's bed, stethoscope to ear. He stands up. 

 It sounds worse than this morning. She seems dry though- they took off 6 liters. Bishal says. 

Eve notices how pale the patient is and that, despite her large frame, she appears small in the bed. She glances down at the woman’s hands that are pressed flat on the sheets and watches her abdomen suck in and out like large pallid bellows. Eve imagines what she must look like to Ms. Bell. A towering face with a green mask, dressed in a gown that looks like a hazmat suit. She doesn’t want her mask to be the last thing Ms. Bell sees. 

Did anyone order the chest XRay and EKG? Dr. Wong asks.

Already in. Sarah responds. 

Has she been tested for COVID?

Eve checks her notes, Yes, she’s been tested for COVID. Several times. All negative. 

Okay, let's get BiPap to the bedside. Dr. Wong orders.

When was the last time she was intubated? 

Two weeks prior, it's a 45 day admission. Eve responds. 


Does she have any family? 

A daughter, but she's at work. Eve says. 

Let's call her, let her know her mom might go to the ICU. 

Eve feels the attention in the room shift towards her. 

I’ll call her daughter,  Eve offers. 

No, no I’ll do it, Bishal says. 

Bishal steps out of the room and Eve’s pager starts ringing. 

 Should I answer it? she asks Sarah.
Yes, call back once and if they don’t answer quickly enough then come back in and give your pager to another intern. Sarah says, ushering Eve out of the room. 

Eve walks quickly to the nearest hallway phone and picks up the receiver, dialing the number that is on the pager. 

Returning a page. Eve says quickly into the phone receiver. 

Hi, this is Eric, the nurse from 5 north, can you please put in that order for the Morphine I asked for? I know you're busy but she's in a lot of pain. And nausea meds for Ms. Baker, she says she has gas.

I already did... the morphine I mean. And yes to the gas medicine but is it gas or abdominal pain? True nausea? Did you ask? Eve questions. 

I don't see the morphine. Eric responds. 

I definitely put it in when you last called. But I’ll double check. Sometimes the computers are glitchy. Eve says, fidgeting. The call feels like it is taking too long. She wonders whether Ms. Bell is okay.  She glances back into the room. Time folds in and contracts its’ mechanical iris. Blinks... twitched lids. 


Yea, It's not here. Eric says again. 

That's not good. Maybe it didn’t go through. I’ll check and put it in again. 


Then as if an echo is making its way down a long tunnel, Eve hears Sarah yelling from Ms. Bell’s bedside. 


Ms. Bell, Ms. Bell hello, wake up! Ms. Bell, hey, someone call a code. There’s no pulse, call a code. Sarah says loudly. 

You've got to be kidding me, what's going on today? Bishal exclaims. Hey intern! Get in here. 

Eve slams the receiver down clumsily, missing several times as she hears Eric’s voice in the distance, Hello, are you still there? Are you checking? 

Eve rushes back to the room and takes her place at the head of the bed. 

Eve notices that Dr. Stewart has arrived and is helping Dr. Wong. 

Bishal has already started compressions. Eve stands dutifully, ready to give rescue breaths. Counting the compressions in her head. 

Suddenly her back aches with a familiar dull cramping sensation. She feels a bright trickle on the inside of her leg. No, no, not now she thinks. No, not now.

But she can’t tell. It's too early. She counts to herself, Thursday, Friday, Saturday. No, that was two weeks ago. Two weeks, not four.

But the sensation is a spreading warmth that rivulets and seeps along cotton fibers and down follicles of soft hairs.

All the while, Eve manages to remain calm, with her hands spread flat on the bedsheets of this sweating, living- not living woman. She squeezes her legs shut to dam up the flow. 

“Breaths! Breaths!” Bishal waves impatiently. 

Eve presses the bag and gives a breath to Ms. Bell through the mask.

Clear, yells Dr. Wong. It's going to read the rhythm. Dr. Wong points to the machine. 

Before Eve can move, Dr. Stewart shoves her hands aside. 

For Christ's sake, they said clear. Dr. Stewart grabs the bag mask and physically pushes Eve aside. Eve steps sideways, her legs still pressed together almost crossed.

Help with the IV if you can't bag-valve correctly. Dr. Stewart snaps. Thinly veiled contempt hovering in the air.

We can't get an IV. Says a junior nurse. 

Eve looks down at three plastic IV lines, which stick out of the patient's arms like little quills of a porcupine. The nurse manager, Mary Joy fiddles with the one that had a small amount of back flash blood in it.

So get an EJV. Dr. Stewart barks. 

We don’t do those. Mary Joy sings back admonishingly. 

So have the intern do it. Dr. Stewart replies.

Have you done an EJV before? Mary Joy asks, turning to Eve.

Eve had done many EJV’S in her emergency department rotations in Queens County. The heroin users with veins like dried vines which no longer produced fruit. Even their feet and ankles used up. She had slowly and methodically placed peripheral lines in their large pulsating neck veins- the only ones left. But this was different, she wasn't alone and it was an emergency.

Can you do it or not? Dr. Stewart asks loudly. 

I can. Eve says, moving forward slightly.

So do it.

Eve pulls back the woman’s neck vein, and feels for the carotid to make sure she won’t accidentally hit it. She talks out loud as she performs the movements.

I feel the carotid, this is clearly the vein. I’m getting ready to place it, please don't move her neck. I'm moving laterally to the vein.

Ms. Bell’s neck veins are engorged and tortuous. Eve pulls back the skin to straighten the vein and easily slides the IV in. 

Good job. Bishal says, looking pleasantly surprised with the ease of her movements. Okay, start the line.

It wasn't a particularly difficult procedure, but the proximity of the carotid made it dangerous if not done correctly. 

Good job says Dr. Stewart, Now move.

Eve presses her back against the wall as much as possible, trying to make herself invisible amongst the plastic tubing and oxygen spigots which catch on her collar and snag her hair. She tries to keep her legs pressed together. More droplets make their way down the insides of her legs, landing on her sneaker, feathering out. 

We have a pulse. Sarah says, triumphantly. 

Let's prepare her for intubation. Dr. Stewart says. 

Eve moves carefully, stepping over a visitor chair as she tries to extricate herself from the room without blocking the emergency cart. 

You can head back to the workroom, go finish your notes, I'll finish up here. Bishal tells Eve, clapping her on the back.

Eve pauses to make sure she isn't forgetting anything before heading out of the room. Reaching the nearest telephone on the wall, she thinks about the morphine and the three unanswered pages. She eyes the bathroom. 

She hasn't eaten since the day before and she isn’t sure when she last peed. Thirty minutes has elapsed since her last page. She answers the remaining two pages, puts the morphine order in again, and then shuffles carefully down the hall trying to minimize her movements, making it to the bathroom. 

The eighth floor staff bathroom has the oddest smell, is ten degrees warmer than the rest of the hospital and never seems clean despite the white smudged paper hanging on the back of the door with marks showing the hourly check-ins for cleaning. The yellow wallpaper is peeled off and cracked, and there are fliers plastered all over a tack board with signs that read, ‘clean hands make happy patients’ with a large smiley face and two big hands staring outwards. There are memos about nursing union meetings and reminders to clock your hours honestly. But, for Eve it is a chapel. An altar at which she can kneel to say her prayers. A sacred space, where no pager can penetrate. 

She strips off her paper gown and stuffs it into the trash, then carefully washes her hands before putting toilet paper down on the seat. It is a ritual that makes her feel sane. Some days, there are no bathroom breaks and it is 10pm before she realizes that she has not peed. 

 She assesses the damage and determines that the pants are not ruined. She soaks up the blood with toilet paper, small bits sticking to her underwear. Hopefully, there is a pad or a tampon in the call room. She makes a makeshift pad with toilet paper and carefully folds the paper in half. She hopes this will last until she can make it back to the call room. She looks around desperately, to see if  some thoughtful soul has left a box of tampons or pads in the bathroom. She sees a dried up oil diffuser, the residues of vanilla sugar coating the outside. Next to it is an empty box of tissues, the consistency of sandpaper. She sighs and resigns herself to the makeshift toilet paper pad.

An abrupt knock on the door startles her from her reprieve. 

Occupied! She shouts. 

She stands reluctantly to wash her hands. Her ritual over.

The cheerful smiley poster peers down on her with its two large hands reaching out from the poster approvingly.

[Natasha Williams]

Powerful opening.