Critical Conditions

I ate a banana and some toast and peanut butter, and poured a cup of coffee for the road. Emily’s dish had plenty of fresh water.

I have found every intensive care unit I have ever visited to be an eerie place. Almost by definition, ICUs are hallowed temples of tragedy or triumph. The final results of the labors there are binary, either a zero or a one. The practitioners are either heroes or they are failures. The mood in the space, in the area that exists between the linoleum tiles and the ceiling tiles, is subdued, as though the players-the doctors, the nurses, the therapists-don’t even pause to acknowledge the immense stakes that are always on the table.

I greeted the ward clerk in the Community Hospital ICU, identified myself, and asked where I could find the new transfer from the ER. Without looking up from a duty roster, he asked, “Which one?”

“Adolescent OD. Female. Don’t have a name. I’m Dr. Gregory, for a psych consult.”

He raised his head and gestured toward the far corner and said, “Ms. Doe. She’s in bed four.” As I walked past him he said, “Good luck.” In the vernacular, I assumed he meant that for her more than me. A dividing curtain was partially pulled in front of the bed in the distance, so from the nursing station I couldn’t see much more than the footrail.

I asked, “Is her chart here?”

“No, her nurse has it out there.”

On the far side of the bed a stocky woman with red hair wearing a brilliant chartreuse top was adjusting the controls on an infusion pump. I wondered where Adrie

I turned back to the ward clerk and asked, “Is Dr. Arvin here?”

“Is he the attending?”

“No. She’s the urologist.”

“The little one?”

“Yes.”

“She’s over there, I think, with the patient. Was a few minutes ago, at least. I haven’t seen her come back out, but I was in the john for a minute.”

A glass wall separated the nursing station from the eight ICU beds. The moment I was through the glass door into the unit I was confronted with the familiar but disconcerting smells and sounds of last-chance medicine. My breathing grew more shallow.

I found Adrie

Way too low.

She was holding her new patient’s limp hand.

Adrie

Adrie

I said, “Okay,” and touched Adrie

Staring at the bright red numbers on the monitor, I stated the obvious as I gestured at the pale figure on the bed. “She’ll be on a ventilator soon, won’t she?”

Adrie

On masking tape at the endrail of the bed someone had written, DOE, M. in bold capital letters.

M. Doe was a tall girl. In unconsciousness, she seemed to stretch out over the length of the hospital bed. Monitor wires snaked from the upper end of her torso, which was immodestly covered by a pastel hospital gown that had seen about fifty too many washings before it had been pulled over her thin frame.

“Do you mind covering her up a little better please, Ren?” I asked.

The nurse turned and said, “I’ll do it.”

I thanked her and introduced myself. She smiled at me with a patronizing face that said, “We have a lot of work to do before you’re going to do any good.”

An automated blood pressure cuff began to inflate on the girl’s upper arm, a drain gurgled, and the infusion pump measured another dose of fluid into her IV tubing. A nice little ICU symphony.

Adrie

My first thought was that in these circumstances, no one was lovely. But I said, “Yes, she is,” trying to imagine what M. Doe looked like twenty-four hours earlier, and what events, what pain, had brought her here.

The child moaned and rolled her head to the side. She coughed once, a tiny cough, an infant’s cough, before her eyes opened slowly and froze on me. Her eyes were puzzlingly clear, the same luminescent purple as my ex-wife’s. And like Merideth’s always had, this girl’s eyes pierced me instantly in a way that compromised my balance.

“Hello,” I said, moving forward half a step.

She blinked once before her eyes closed again.

Adrie

“Is she responsive to pain?”

“Was earlier, now only minimally to deep pressure. But I haven’t played any Barry Manilow CDs yet. That might get a scream out of her.”

I smiled.

Behind us we heard the squeak and drone of rubber wheels on linoleum. I turned and saw Marty Klein accompanied by a scrub-suited doc whom I didn’t know. Behind them, a respiratory therapist was pushing a ventilator and a treatment cart our way. I said, “Hello, Marty.”

He nodded. In other circumstances, I knew we would end up talking about bicycles, my passion, and golf, his. Not this time. He said, “Hi, Alan, thanks for coming, sorry she’s not too talkative. We’re here to get her on the vent. Step out a minute, please. Okay?”

“Of course.” I had no desire to watch what he was about to do. None.

Adrie

“No, Adrie

“You have my home phone?”

“It’s on the chart, right?”

“Yes. I want to talk with the parents, too. When you find them.”

“I’ll find you, don’t worry. Get out of here. Go play catch with your son or something,” he said as he pulled the curtain farther around the bed.

I began to follow Adrie

“You have a pen?”

She gave me one. I used it to sign onto the case and then scribbled a brief progress note that reported an apparent overdose, an unconscious patient, absent family, and no progress. On the order sheet, I wrote, “When patient attains consciousness: Suicide precautions should be in place, including 1:1 staffing × 24 hrs.” I also left instructions that I be called immediately when the parents were located or the patient became oriented.

Adrie

“She may not be done trying to kill herself, Ren.”

“I know that. I’m just giving you a hard time. With Lauren out of town, somebody needs to, right? You heard from her?”

“Not this morning, no.”

“You’ll let me know?”

“Of course, thanks.”

I turned back to the admissions data. The data field was mostly blank. But the first line read, “Doe, Merritt.”

Out loud, I said, “Her name is Merritt.”