I know I should be listening, but once Juan Carlos walks into the nurse’s report room and sits next to me, his left leg jiggling against mine, all I can think about is his head between my legs, his long, black hair shanking into my blonde curls, and my nails digging into his back.
He jangles his flipping coins now, and everyone knows he’s getting some, and even though he’s had half the nurses in this room, I heat up, because for the last few months that some he’s getting is me.
“What’s it gonna be, Lily? Heads or tails?” He flicks his coin into the air.
I ignore him, even with his mile smile fixed on me. He grabs my hair, tugs for my attention, coaxes me to face him and when I do, I say, “Fuck you, Juan,” blowing the words into his face. I shake off his grip, but he knows I can’t shake the tingle from his touch. He pulls my hair like this when we’re together, his sway locked into mine. Says he loved my hair, from the minute he saw me, first and best. White like an angel’s.
I understand hair to be just like nails. Perpetual reminders of the seamless transformation of life into death, night into day, lucky into unlucky. Fallen companions to our living cells. Impervious to pain. Not like me, half-filled with hope, the other half dread, that tonight Juan will ask me to promise him forever.
The charge nurse, Patty, reads the nurse’s report aloud. She wears her Santa Claus hat, which is supposed to make us feel better about working in the ICU on Christmas Eve, but the hat makes me feel sad. Almost sad…because Juan is here. Patty rattles through the patients’ names, but enunciates their room numbers and diagnoses and lists the medications that drip into their veins. She tells us if they’ll open their eyes when we speak their names or squeeze their hands. None of the report can I keep straight. Lately, I don’t sleep, even after these deadening twelve-hour night shifts, even before Juan started messing up my sheets.
Patty tosses the report sheet aside. She fingers through a box of Christmas chocolates, pinching a couple to see what’s inside. “Our last patient is still in the OR. A redo heart bypass; he’ll be sicker than most. Who wants him?”
Juan’s up on his feet before anyone can speak. He flips his coin, calls it heads, dances his feet, and plays like he’s won. He shoots a sideways grin at me and says, “I’m taking that heart tonight. I feel lucky.”
Why would Juan want a heart so ruined? Sternum cracked open, ribs splayed wide, pumping made still in a pool of blood. Hours of surgical manipulation causes the heart to enlarge, and though it’s bigger the muscles weaken, and it doesn’t pump as well. The patient will arrive with his chest still open, his contracting chambers visible through transparent sheets of betadine-stained plastic. More vulnerable a pose than saying the words, “I love you.” But Juan doesn’t care how incurable a heart is. He’s still trying to save the one heart he couldn’t. His mother’s last cry, as she collapsed to the kitchen floor, “A Dios Mio,” like she was singing to the white-spackled ceiling with her red pot holder clutched to her chest. This is precisely my point eventually someone leaves, but I won’t say that to Juan.
Juan sits back down, serious now, and tucks his coin away. His eyes fix on mine, like he knows what I’m thinking, and maybe he does. He whispers, “Love can mend a damaged heart.”
In the breath of calm in the report room, familiar harmonies of Christmas music play, from where I can’t tell. Silent night, holy night, maybe for some, but here on 7-West, the report room erupts into chatter as the nurses begin to call out room numbers and diagnoses, jockeying for where and with whom they’ll spend their Christmas Eve. Shelly takes the thoracotomy in 7-12, and Joan wants the heart transplant in room 23. Merle asks for the pair of MI’s.
But all I’m thinking about is Juan and his coins. He thinks if he flips them often enough he can change the odds and make chance a friend or claim a wife he can count on until death do us part.
Almost immediately all except me have assignments, and now I know I should have been listening because Patty smirks and says, “Looks like you’re stuck with room 7-16.” Patty was Juan’s last girlfriend. She’s a veritable portrait by one of the Dutch Masters with her two hundred pounds bound in creamy white flesh and her “no-matter-what-I say” angelic smile. She’s out to make me suffer because Juan has made it clear—I’m the one he wants forever, however long forever is.
With coffee cups in hand and stethoscopes around their necks, the other nurses jostle through the swinging double doors and onto the cardiac unit. The sooner we start, the sooner we finish. We fight our circadian rhythms; we maneuver in opposition to the rotating sun, trying to stay a step ahead of it all. Before the thickness of 2, then 3, then 4 a.m. pins us down. Before the sugar and the caffeine stop working.
And just before Juan slips out of the report room, he says, “What about you, my sweet Lily. Lucky or unlucky tonight.”
It’s not a question, but he wants an answer. I pretend I don’t know what he means. “Tell me about room 7-16,” I say. “Then I’ll know if I’m lucky or not.”
Juan wraps his arms around my waist. “Let me take you away from all this, Lily. To a place where white snow falls.” He gazes over my shoulder, looking to where I’m not.
Juan’s making promises he knows he can’t keep. He’s leaving Tucson next month for med school in Iowa, a state whose borders I can’t even picture on a map. Even if I go with him, I can’t stop working.
I tell him, “I’ve kicked up dust on these desert roads and wandered through cactus fields my entire life. I’ve never owned a pair of gloves.”
He steps back and throws up his hands, deflecting my put-off. Then he becomes absorbed in picking through that box of chocolates, looking for the caramel he can’t seem to find. A quiver jags through the straight of his jaw.
“Patty’s pissed I’ve fallen for you. 7-16’s dying. I don’t know if you’ll think that’s lucky or not. They put her on a levophed drip.”
Why do I say the things I do? But questions like this demand too much of me with my patient dying and eleven and a half hours to go.
He turns to leave, then turns again, “I’ll stop by to help you. I might have to wait all night for that heart.”
Merle lags behind in the report room, jabbering her native Vietnamese to her husband on her cell. Perpetually exhausted with three kids at home, she presses end and lazes her half-lidded eyes up at me.
“Merle, give me report on room 7-16,” I say, though I already know more than enough. Levophed is a precursor to a body bag, hung as a courtesy to give families time to contemplate forgiveness and mumble their last goodbyes.
She scans her notes, and then quickly reads, “Twenty-eight years old. Got a staph infection from a dirty manicure. Septic now. Blown up like a balloon. Intubated yesterday, on Levophed this morning.” The rest she doesn’t need to read. “Her husband came in earlier today, a girlfriend on his arm. The day shift borrowed the ring cutter from the ER. Her husband asked us to snip the ring…” She wiggles her fourth finger on her left hand, searching her English for the right word.
“Engagement?” I offer.
“It was a big diamond, I’m told. He took the ring with him. A girlfriend on his arm. He’s not a nice guy. This husband tells the news. She made us promise before she was tubed not to forget to put him on—11 p.m., Channel 4.”
Outside room 7-16, I don my yellow gown and gloves from the red isolation cart. I twist my hair into a blue bonnet. Behind the heavy glass doors, my patient lies sequestered. Her staphylococcus has mutated into a sophisticated hybrid antibiotics can’t kill. Through an unnoticed scrape, a scratch, a snipped cuticle in her case, this commonplace bacteria that lives on the skin, can sneak into the blood. Dividing and multiplying, overcoming each organ one by one. The heart succumbs last.
I enter the room, automatically switching from nose to mouth breathing, to escape the stench I know awaits me. My sense of smell has always been fierce. Not only scents, but also insincerity, trouble, and lies. Death carries an aroma too, rolls out slowly with sepsis, sometimes takes days to grab hold. Loosens the brain first, then the bowels. Slipping the patient into a coma, before she’s shitting herself, is God’s great mercy. If God’s not in the mood for mercy, we induce the coma with drugs. Morphine’s my favorite, tried it once or twice myself. A couple of milligrams from a forgotten syringe, I didn’t even feel the prick in my thigh.
Whoever said death comes in threes was wrong. It barrels down on you in fours, and fives, and sixes, sometimes twice in a night. Lately, I’ve had a run—a trip to the morgue every time I’m here. I’d like to blame Patty’s assignments, but some of these patients were stable.
I’ve yet to grow accustomed to these smells, but at least now, I recognize the difference between the smell of life and the smell of death, and my Juan smells of life. Whether he shocks his patient with a few hundred joules or kisses my lips electric, he’s showing me how to coax pale hearts to crimson red.
Juan says it’s time to meet my parents. Says all mothers want their daughters to marry doctors, don’t you think? What I think, I don’t say. After my daddy left, my mom married a doctor, and it’s true, his MD skills came in handy. First he split her lip, then he stitched her lip. I learned the thinnest sutures could conceal some scars. But after everything she cooked, that kitchen smelled of her blood.
Now, in room 7-16, my eyes lose focus as they glide over my very still patient. From underneath her crisp tucked sheet, tubes from every orifice connect to a bag or machine narrating the story of an organ’s demise. Amber urine drains into a catheter bag. The ventilator’s blue tube coils from her mouth. A lingering scent of feces mixed with acrid IV drugs eddies in the air.
I lift her restrained wrist and study the type on her band. She’s not much older than me. I softly read her name—Elizabeth—and exhale the curl of letters into my mask, a warm whisper along my cheeks.
“Elizabeth,” I repeat, this time louder with my mouth to her ear. Four empty piercings dot her cartilage curve. Did her husband take her earrings, too? I squeeze her limp hand in mine. Beneath her lids, her eyeballs stutter. I really don’t want to wake her and have her open her dying eyes. They’ll beg for something, I never know what, but whatever it is I don’t have it to give. I crank up her morphine drip a notch.
Half of her meds keep her almost alive, the other half almost dead. Don’t we all tip-toe on that shredding tightrope strung between lucky and unlucky, while we wait for a celestial puff to blow us to one side or the other? Elizabeth won’t need to wait much longer.
It’s nearly 11:00 when Juan raps on the door, a candy cane dangling from his mouth. When he shapes with his lips to say “I love you,” the candy shatters to the floor.
Elizabeth’s ventilator hisses a mechanical sigh of surrender, reminding me to tighten her restraints. The tube that keeps her silent is the one she’ll try to pull out first. I wonder what her voice sounds like. Would she ask for her husband? Does she know he took her ring?
Standing outside the room, Juan kisses me right through my mask. His Nikes grind the red and white peppermint shards into the floor. He kneels on one knee and scoops up the broken bits, tosses them into the trash. I resist stroking the top of his head, pulling him into me. Juan’s been threatening a ring for some time, had Lily tattooed in a band around his finger. I don’t know what I’ll say if he asks.
He’s still on one knee when he looks up and takes my hands in his.
“I’ve got to get back in there. I’ve cleaned her three times already tonight.”
Juan pinches his forehead to frowns and rises to his feet. He leads me into her room.
Juan squints at Elizabeth’s monitor. Nothing seems to have changed. I know as he stares at the numbers, he’s hoping his hope can change them. Hours spent hoping are hours wasted. Her life seeps from her.
“Look,” I say in defense of my apathy, my exhaustion, too, “she’s going to die. Her husband clipped her ring. She loves that prick. How unlucky is that?”
I start recording her 11 o’clock vital signs, her hourly ins and outs and ups and downs, numbers on her flow sheet, her hours numbered by these numbers.
“She’s so young,” Juan whispers.
Her age is too close for comfort. Reminds me how unlucky some people can be. Statistics assure one thing, but those statistics get skewed, when that one in a hundred thousand is dying, and you’re wondering why it’s her, not you.
Juan turns on the TV before we clean her. I remember. “Put on Channel 4. She made us promise. She likes to watch him.”
Juan jiggles the coins in his pocket, while he flips to Channel 4. “Unless her husband’s the Pope, she might not get her wish.”
On Channel 4, the news is pre-empted by the Vatican’s Mass. The old holy man waves his robed arms and orchestrates thousands of prayers. Not a word of Latin do I understand; still this ancient language thrills me. Could life’s answers be encrypted in the syllables that drop from his holy wagging tongue?
“Do you think she’s wishing she’d die? If she knows her husband took her ring?”
The Pope pauses, and on cue the choir begins. Their hymns suffuse the empty space between Elizabeth’s ventilated breaths. Ten breaths per minute, one breath every six seconds. I catch myself breathing in harmony with the vent’s metronomic beat.
Juan runs his gloved hand across her forehead, tucks back her hair. “Have you tried to see if she can breathe on her own?”
“Why bother? You know where this is going.” Or maybe he doesn’t. Maybe he needs to flip his coin. Inevitability doesn’t stop his desire to change this woman’s odds.
He disconnects her ET tube, and I count, “One… two…three…” waiting to prove she’s dying and for the vent’s disconnect alarm to sound.
“Come on, girl, breathe,” Juan begs and rubs his knuckle on her sternum between her breasts.
Before the alarm rings at six seconds, Juan thumbs the red silence tab. He waits another six-second cycle. The building pressure in her lungs doesn’t make her gasp for air. This I could have told him, but there’s no telling Juan what he doesn’t care to know.
“That’s enough. Put her back on the vent,” I say.
“All right.” He sighs. “Let’s get this done. My heart should be up from the OR soon.”
I swirl the washcloths in soapy water, as Juan lifts off her gown.
“What’s her name?” he asks.
“Elizabeth,” I say.
“Pretty,” he says.
He’s right about that. Even with the bloat and the berry bruises on her trunk, her arms and legs, her belly’s still tan and smooth, her breasts uniformly golden—an exotic beach with Mr. Channel 4? Juan glances to the waxed triangle of skin at the Y of her legs. He covers her breasts with a clean towel. He averts his eyes as I wash her.
A Brazilian wax Juan wants of me; says the pleasure would all be mine. I say it isn’t love if there’s pain involved. You’ve got a lot to learn about love, he replied. He hasn’t mentioned the wax since, but I wonder if he’s thinking about it now.
“My father’s expecting you for Christmas dinner. My sister made a cake.”
Lately when Juan’s father looks at me, he thanks Jesus and his dead wife that Juan is settling down. I don’t know what he’s has told his dad. He can be selective with the truth.
“Can we see how this night goes? I already can’t even stand on my feet.”
Last January, a few months before we got together, Juan went away for awhile. He’d gotten hooked on the speed he was dealing to save money for medical school and never bothered to tell his father that the “internship” was actually rehab. His father already calls him “Doctor Juan Carlos” as if his MD is guaranteed.
“You ready to turn her?” Juan asks.
Juan likes to talk of our future together, but talk beyond this moment makes me squirm. Doesn’t Juan see the future doesn’t count? Where is that golden promise that at one time was soldered in Elizabeth’s ring?
“Did you know Elizabeth’s husband came in today with a girlfriend on his arm? He cut her engagement ring right off her finger.”
I wiggle my left hand’s fourth finger at him. He gives me a look like he’s trying to decide if I’m worth it, and honestly I’m not sure I am. I mix the past with the present and don’t see a future. He told me he wants to ask my stepdad for my hand in marriage. I told him that the man was dead, but Juan knew I was lying.
“Not every husband is an asshole,” he says. Underneath my mask I smile, not because I believe him, but because he clearly believes this to be true.
Still, at the end of this shift, I hope Juan will grab a fistful of my hair, right down to the roots, and hold me while I shudder this night away.
From the TV, Christmas bells start ringing and the Pope parades out of St. Peter’s, anointing thousands with a message of hope. Almost midnight. Almost Christmas. I bought Juan some going-away presents—a scarf and some warm wooly gloves. Maybe he’s got a fur coat for me.
I roll Elizabeth towards my side of the bed. With respect, he wipes her. Maybe even without a fur; Iowa’s winter won’t be that cold.
Patty shows up, raps on the glass, opens the door, and shouts, “Your heart is on his way up. Get out here.”
“Can you get along without me?” he asks, as he snaps off his gloves. I think he’d like it if I said no.
Outside room 7-16, I watch Juan stride away from me, hurrying to his heart. I won’t be able to keep him waiting forever. The coins in his pocket jingle-jangle down the hall.
By the time I finish cleaning Elizabeth, it’s past midnight. I write down her twelves. Her urine output is dropping; her respirations have slowed. The Channel 4 news is about to begin. I lay the call bell next to Elizabeth’s ear, and then turn up the television volume. I settle in a chair beside her bed. I look at her and I can’t deny the transcendent truth—a woman is inside that body. Her soul is getting ready to leave.
Her husband begins to speak and Elizabeth’s heart bleeps a few irregular beats. I hope his voice comforts her; maybe their marriage wasn’t so bad.
“Only good news tonight,” her husband announces. As he tells a story about a rescued litter of kittens, his eyes glisten with staged sympathy. Does it matter to him that his wife is dying? I can’t find a chink in his veneer.
“Merry Christmas,” I say to Elizabeth and dare to give her hand a squeeze. I’m hoping she’ll stay alive to the end of my shift. I could use a little luck tonight.
Wrapped in a blanket, sitting alongside Elizabeth, I slide into those fleeting between moments between awake and asleep. I imagine this sliver of peace to be that same shimmering crescent between night and day, life and death, lucky and unlucky. I believe some have called it “grace.”
In my dream, I know I’m dreaming, because Elizabeth is suddenly whole. We’re in the tropics somewhere, her eyes are closed, and her skin is that golden brown. I lean in to listen for what she might tell me about that state of grace. As if she can read my mind, she turns to face me, but when she opens her mouth, brightly colored plastic alphabet letters spew, undecipherable in their falling arrangement. This secret she keeps from me.
Then, one by one, she starts gagging the letters up. I struggle to catch them as if this might be the key.
Her eyes blaze open. I see no fear. Her coughing continues, lifts me out of the dream. She sitting up with her eyes fixated on her husband, gagging on her breathing tube. She’s desperate to speak to him.
The ventilator tube threatens to yank out of her throat and before I know it, I’ve got her pinned down, my weight pressing into her. Damn her flailing hand scratching my back. Damn Juan for forgetting to tighten her restraints. Or maybe I forgot. Instead of reaching for her breathing tube, which is what I expect, she reaches behind herself. She wants to clean her own body, save the humiliation of someone else wiping her ass.
“No,” I command, “it’s okay.” My mask conceals my lie. Her head whips from side to side. She grits her teeth so brutually into the tube, tears squeeze from her eyes. Her intention seems clear. With the door closed, there’s no help in sight, only I hear the vent’s singing alarm. I thrust my arm across her chest and with my free hand increase her morphine drip. Nothing to do now but hold and wait.
Tiny rainbow bubbles of saliva glisten on her teeth. Her flicking eyes come to rest on mine. Her fingers dig behind her. From the television, her husband wishes a Merry Christmas and a Happy New Year. This cracks me down the middle and makes me want to wail. “What do you think the New Year will bring? Should I go with Juan?”
Elizabeth squints her eyes into slits of hate and struggles to spit at me. I turn away and stare at the dripping morphine, twinkling like a precious gem in the light. I wish the drug would hurry and short circuit her brain. Finally, she surrenders, her body flaccid beneath mine.
Washcloth, warm water, basin, gloves.
Each of Elizabeth’s crevices, I wipe and wipe again. Her skin blanches white with every stroke. I roll her to her side. I change her sheets. I change her gown, but I haven’t changed a thing. Still, that smell of shit and death remains. What more can I do?
I chart Elizabeth’s one o’clocks, though on the flow sheet’s output boxes there’s no place to mark her furious tears. Mine neither, so I blink them away, but I can’t blink away the contemptuous look she gave me.
It’s a Wonderful Life comes on after the news, and I consider myself lucky because Elizabeth is perfectly sedated, and there’s no better company Christmas morning than Jimmy Stewart and a drunken angel named Clarence.
Just about the time Jimmy’s running through the streets of Bedford Falls, elated that he’s alive, Juan steps inside the room. I want to pull him close to me but his words keep me where I stand.
“My patient’s not doing well. I don’t have a lot of time.”
He looks at the clock—a quarter to three. “I wanted to do this differently, but it seems like you’ve given me no other choice. Here, before I lose my nerve.”
He pulls down my mask and kisses me. Then he presses a piece of chocolate between my lips. “Merry Christmas, Lily. Merry me.”
Even before I can taste the chocolate, Juan’s out the door. The caramel center softens. My tongue feels something solid, so I tease it to my lips. I poke my tongue through the band, can feel the stone on my lower lip. A nurse never raises her gloved fingers to her lips, so I spit the ring out. It lands in the “V” between Elizabeth’s legs. The chocolate stains the white sheet.
“He wasn’t joking, was he, Elizabeth?” I say, staring at the ring. I sit down on the bed, next to her and hold the diamond to the light.
“Does a ring like this mean he’ll wait for me forever?” I hold Elizabeth’s hand in mine.
In the midnight blue outside this room, a fistful of stars have exploded. Contemplating Elizabeth’s hand more closely, I envision intricate clusters of the deadly bacteria woven into the diamonds of her skin. My tongue unfolds the word, staphylococcus. Unhinged from one another, the syllables fall from my mouth, each with an explanation of its own. “Staph”—what guided the shepherds to the star of salvation, “O”—the perpetual shape of an angel’s mouth, and “Coccus”—a twisting spherical cluster in the cosmos. There’s no explanation for the “y.”
With my gloved finger, I trace her blue veins. Her hands are as fragile as a white dove’s wings. Then I notice what escaped me earlier, crescent moons of shit beneath her nail beds. That’s what I call unlucky.
For this task, I take my time, each scrape done softly with the tip of a cotton swab. I massage lotion into her hands. “Merry Christmas,” I say when I’m done.
Yet something else seems required here. Her hands still don’t look right. So I slip the ring that’s meant for me on her finger. Though it won’t slide past her knuckle, the gesture seems to satisfy.
If she wakes again before she dies, let her think her husband loved her until death parted them. Let her think she was lucky and won her toss. Lucky or unlucky—doesn’t seem to matter which. Nothing lasts forever.
Just as the first slivers of light illume the sky, Elizabeth’s pressure begins to slip. It won’t be much longer now. As I dial her husband’s number, as requested when the end is near, I admire the ring now worn on my finger. I’m impressed by its perfect fit. Four, five, six rings, I count. I think about getting a manicure. There’s a place not too far from my house. When the voice mail finally answers, Elizabeth tells me to please have a nice day. So that’s what her voice sounds like. I’m glad I got to hear it. How long before her husband erases her message? I hang up, not knowing the words to say.
At the end of my shift, when I throw my mask, gown, and gloves into the trash, on top of the shattered candy cane pieces, I’m surprised to see Juan’s coins. I pick them out for him, one by one, in case he changes his mind.
Jean-Marie Saporito received her MFA from Vermont College of Fine Arts. Her writing has appeared in Numero Cinq and Hunger Mountain, and is forthcoming in the Bellevue Literary Journal. She is the recipient of the 2012 UNM Taos Resident Award, and her story which appears here, Lucky/Unlucky, was awarded the 2013 AWP WC&C scholarship.