All in a Day

All In a Day

8:00 AM

My job is to not get in people’s way. Only ask the questions on the checklist. Process patients, no decisions of consequence. Each question is a screen to assess symptoms. But what ends up happening is the interview becomes a last grasp for comfort. I hear people tell me stories they wouldn’t bear to tell their husbands or wives. And I have to urge them to answer the medical question directly and move on to the next. Like people on a reverse assembly line, deconstructed to their most minute parts. At the end of the session, people usually shake my hand and leave without saying much. As a fourth year medical student, I can’t legally provide a diagnosis. They look at me waiting for some closure. All I can do is reference them to someone higher on the totem pole. But a patient doesn’t come to the hospital expecting good news anyway.

An announcement pierces the air. “Paging Dr. Sinclair,” the loudspeaker says.

Hospitals have different codes to say over the loudspeaker as to not cause alarm. Code Blue is the most common. It means that a patient is in need of resuscitation. Code Grey means there is a patient with a stroke. We also use doctor codenames as well. “Dr. Stork” means a woman is in labor and needs immediate help. “Dr. Sinclair” means there is a dangerous situation. I’ll have to take the back elevator to get to the cafeteria later.

In the examination room, the chief resident is telling his patient that he should cease chemotherapy treatment. That realistically, he should focus on her quality of life with the little time he has left. He can’t say this out loud, but the doctor wants him to go out with some dignity. Be able to say goodbye to his family without worrying about vomiting everywhere. With some hair left. Able to stand up on his own. I hear his patient warmly say thanks. His voice has a gentle rasp but no waver. I can hear his wife softly sob. She begs him to reconsider. To give it one more shot. He says “I’m tired, and I’m ready.”

Five patients into my day. I look over my lengthy notes. My hands write everything my patient have to say because I don’t know what is actually important for my seniors to know. During my daily reports, what are called “sign-outs,” the chief resident’s eyes always glaze over. When I see his notes on a patient, they’re about a quarter of the length. The bare essentials. I straighten out my pristine white jacket and welcome whoever is up on the queue.

The next patient walks in alone. She looks young but has grown distinct crow’s feet around her eyes. She’s dressed well, but her clothes are unnaturally baggy. I can see her collarbone jut out. She has prominent, attractive cheekbones, but her cheeks have hollowed. I assess her basic information. Age, height, weight, race. She is only thirty-five years old. Five foot five. I try not to avert my eyes when I hear her weight. Usually patients understate their weight out of self-consciousness. She says she’s 150 pounds, and she probably was. I ask her about her family to break the ice.

She says, “I had a son.” The clock ticks loudly, reverberating through my silence. I ask the first question verbatim, and she gives me a short response. After a few questions, her phone goes off with the standard xylophone ring tone. She turns it off without looking.

“You can take that call. I don’t mind.”

She says, “Don’t worry, I don’t need to. It’s just my mom.”

The interview lasts ten minutes. She thanks me and reaches out. Her hand is soft and cold. She holds on and lets the heat of my hand radiate. I have to pull back and usher her out politely.

4:00 AM

I am required to come at five in the morning, but I always come earlier to do my rounds. I check the updated notes, the overnight nurse’s report on each patient in the ward. Most of the patients are still asleep.

This morning, one patient tried to sneak to the bathroom with a cup. His IV bag stand trailed behind. His catheter hung limply between his legs. I had to tell him he couldn’t drink any water or eat anything before surgery.

He kept repeating, “But I’m so thirsty.”

I said, “You can’t drink when the doctors intubate for surgery there is a reduced/no risk for aspiration which could lead to pneumonia, a big complication post surgery.” He stared at me blankly.

“They have to stick a tube down your throat and if you drink, your throat could swell and you could get really sick.”

He said, “But I’m thirsty, can’t you please let me have a cup of water? Just one?” I pressed the call button for the nurse.

She walked in and asked what the problem was.

He said, “I’m so thirsty and the doctor won’t let me drink.”

The nurse said, “Mr. Rodriguez, you have a busy day today and you need your rest. Come back to bed and lie down. Let me get you some candy to suck on. What flavor would you like?”

“Lemon has always been my favorite.”

“You’re in luck. I always carry some candy around, and the last piece is only for you.”

“Thanks, Lisa. You’re my favorite.”

“How about I adjust your bed. Comfortable now?” Lisa asked.

“Yeah, I’m perfect,” Mr. Rodriguez said.

“That’s good. I’ll be here if you need me. All you have to do is press that little call button.”

“I think I’ll be ok. I’m going to try and get some rest.”

“Sleep well Mr. Rodriguez.” Lisa closed the curtain. I took my cue to leave.

People cope in different ways to being sick. Some withdraw. Some latch on. Some lash out. Patients are labeled things like difficult, drug-seeking, depressive, or delusional. But being sick is inherently disempowering.

Cancer becomes the every day norm. We see death all day long, 90 hours a week. You eventually stop thinking about it as individual tragedies and instead as letters on a paper, or numbers on a clipboard. Some doctors think of it as an inconvenience. But to the patient, it’s likely the worst news they’ll hear in their life. Last week, an intern in a different department casually let slip that the patient’s symptoms indicated he likely had cancer. He said it offhandedly. But only the senior staff members give the bad news. After some immediate crisis intervention, the intern’s supervisor pulled the intern into the hallway. I’ve never seen someone get chewed out so badly. The intern looked like he wanted to sink into his shoes.

11:00 PM

I do my second set of rounds before my lunch break. Mr. Rodriguez’s bed is empty. Someone had placed flowers by his bedside. Daffodils. The rest of his belongings are gone. The surgery was supposed to start at nine, and it was a four hour procedure. I found out it had lasted only an hour.

Cancer looks like a bulbous, mutilated mass when you open someone up. It has a hard foreign consistency. But medicine has come a long way. With the advent of robotic laparoscopic surgeries also known as keyhole surgeries, procedures have become very minimally invasive and recovery times are much shorter. But sometimes doctors have to make traditionally large incisions when the cancer becomes too large. Doctors have to caution families not to expect surgery to be a miracle cure. That every time you go under the knife, it’s a big risk. It’s inherently violent, and you make the patient a lot sicker before they can hopefully become healthier. Doctors have to inform families of the financial cost as well. But after the surgery is done, the hardest part is the long walk down the hall to the waiting room.

The cafeteria is like the rest of the hospital, an over air-conditioned, sterile, insulated box. The food objectively tastes decent, but the air makes it feel unsavory in my mouth. I chew to get some nutrients in my body before the latter half of my shift.

“Paging Dr. Stork,” the loudspeaker blares.

I text my girlfriend about my morning. Kerry is an intern at a neighboring hospital. An intern is the most junior member of the team after you first receive your medical license out of school. She works in Cardiology, but she hopes to eventually be a gynecologist. I tell her about my morning. She’ll respond when she wakes up. My girlfriend works the night shift, from five at night to nine in the morning. Since I get home at eight, we haven’t seen each other in a month even though we live together. It’s like a ghost resides in my house. Albeit a friendly ghost who does the dishes and leaves cookies on the counter.

1:00 PM

My pager goes off. It’s time for the differential diagnosis meeting on the new patients. We evaluate what possible diseases or conditions there are based on the symptoms and narrow them down collectively.

I brace myself and walk in the meeting area.

The chief resident, Dr. Han says, “Great, you’re finally here. We’re doing a whip around.” Everyone else in the room stares at me, some with encouraging looks, some with apathy, and some with tired contempt.

Dr. Han asks, “What medication is most viable for a patient exhibiting the following symptoms and why?”

I categorize each piece of information and cycle through hundreds of pages of my reference books. The chief resident crosses his arms and tenses his shoulders.

“Um, um,” I stutter.

“Alright next. Dr. Johnson, what would your recommendation be?” Dr. Johnson is the intern on our team and he can’t come up with an answer. The chief resident moves to the 2^nd Year doctor, Dr. Diaz and asks the same question. His tone is even and unfeeling. She responds promptly. Dr. Johnson shakes his head at me. The Dr. Diaz gives me a weak smile. Sporadically, the chief resident will quiz each member of the staff on a relevant question, and if they can’t answer in thirty seconds, he moves on. I’ve seen him ask six doctors until he gets a valid response in time.

We run our differential and I listen and absorb as much as I can. My cheeks are flush. My hands are still clenched. The session passes in a blur, with each doctor rapid fire eliminating non-answers. By the time I am done evaluating one idea, the group is already three steps ahead. The way they talk to each other, I can’t even begin to fathom reaching that level of critical thinking. Their entire frame of mind is on an entirely different plane than mine. The chief resident can reference every major oncology study for the last fifty years. I can barely remember where my keys are in the morning.

I walk out of the room the same way I walked out of a bar last Saturday. When you are on four hours of sleep consistently, a study showed that it’s the equivalent of being drunk all the time. But there’s so much information a doctor has to learn that 90-100 hour weeks are the only way to get enough experience. I look at my watch. It’s only two o’ clock. Six hours left in my shift.

2:00 PM

I go to the ICU to check in with a few specific patients. The chief resident gave me a list of things to take care of in his absence. He had to give a consultation at the Nephrology Department and would be occupied for a few hours. He told me if I had any questions, to feel free to ask Dr. Diaz for help. All I have to do is check their status.. Nurses check vitals. Most of the patients on the list are stable and everything comes back at predictable levels.

“Code Grey, Incoming,” the loudspeaker says. Means the stroke victim is on his way.

I’ve visited Mrs. Wendy Henderson in her room every day since I started my rotation at the hospital. She has a very poor prognosis, so I have to stop by frequently to check her vitals.

“Good afternoon, Mrs. Henderson.”

“Call me Wendy, please.”

“Good afternoon Wendy. And it’s good to see you too Rita,” I say.

Wendy and her daughter Rita apparently had a falling out a few years ago, but when Wendy got sick, Rita came back. They don’t tell me the details. Rita’s face looks weathered. Her skin is pulled tight against her face. I notice old pockmarked scars around her basilic vein in the bend of her elbow.

I tell them that they  look so much alike. They stifle a giggle.

Wendy tells me that when Rita’s mother was on her deathbed, she told Rita’s father to marry someone nice like Wendy, the family babysitter. So he did. He married Wendy. Wendy was twenty-three years old taking care of three year old child who had her mother’s fire and her father’s lack of fear.

Rita says she just accepted the resemblance, but Wendy always had a long hearty laugh. But it took time for Rita call Wendy, “Mom”, even though they seem so close now.

Rita told us the story when Rita and Wendy were walking around the mall. Rita was begging for some candy and Wendy would have none of it. Rita shouted, “You’re not my mom!” The employees called the cops. They had to call Rita’s father to clear things up.

When Rita was eight, she came down with the chicken pox, and she had to miss a lot of school. Rita called her friends but everyone was busy during the week. Wendy had found Rita’s mom’s old cookbook, so she made some chicken soup. The broth was made from scratch, with chicken bones, veggies, boiled for four hours.

Rita tasted it and cried. Wendy asked her if she was sad, and Rita told her she was sad and happy. Sad her mom wasn’t around, but happy that she could have her soup again. She asked Wendy what her “real” mom was like. And Wendy was good friends with Rita’s mom, so Wendy had quite a few adventures to share. They stayed up all night. Wendy ended up catching a cold. When Rita finally got better, she told her friends about her fun mom who kept her company.

“From that day on, Rita always called me Mom,” Wendy said.

“Because you are,” Rita said. “Hey mom, I have to go, but I’ll be back later tonight?’

“Promise?” Wendy asked.

“I promise,” Rita said. She kissed her mother on the forehead.

With only the two of us in the room, Wendy tells me, “I feel so bad for that poor boy next door. I can hear him calling out for his father at night. But not once have I seen anyone but his mother come around,” Wendy says.

“I’ll check in on him later,” I say.

“Thank you darling. How are you holding up?” Wendy asks.

“I’m hanging in there,” I say.

“You need to eat more. You look too skinny. I wish I could cook for you.”

“Yes, Mrs. Henderson.”

“Call me Wendy, please.”

“Yes, Wendy, I will try and eat more,” I say.

“That’s better,” she says.

Wendy is a Methodist. She doesn’t drink or gamble. She won’t touch playing cards. She never smoked or did any drugs. She always had her music. Wendy tells me stories about how she played the organ at church. The organ was located on the 2^nd floor and she could look down on the congregation from a tiny window used for ventilation. Summers, it would get so hot that she would play with her jacket off and blouse buttons undone. I always poke fun because who else would take her shirt off at church but Wendy.

She asks, “What they do with dead arms?”

“What do you mean?” I reply.

She says her arm is cold. She can’t move her fingers at all. Last week, Rita wheeled Wendy down to the lunch room. She tried to play the piano but her fingers wouldn’t listen to her. Her right hand was clenched in a claw. Today, no feeling except for the freeze she could not warm.

I feel her arm and feel nothing but sharp bone. Where my triceps muscle was, she had skin. The cancer had metastasized all over her body and atrophied her arm muscles.

She pulls out an easy tunes song book. I see her shaking hand trace the notes. She plays an air piano. Looks at each note and misses the invisible piano key. Wendy puts the book back and says that she wants to rest but she can’t find a comfortable position. She hasn’t left her bed since she found out she can’t play piano anymore. Now she’s developing bed sores. I tell her that she needs to keep moving.

“Don’t worry, I won’t give up,” Wendy says.

I walk out and run into a janitor. I ask him to bring an extra blanket for room 306.

4:00 PM

Wendy is sitting up in bed. She motions me over and puts her finger to her lips. “It’s not a good time to talk right now,” she says. “A man I’ve never seen before just walked into the room next door. It doesn’t look like it’s going to end well.”

“What makes you think that?” I ask.

“You’ll see,” Wendy says.

“Get the fuck out!” I hear the woman next door yelling.

“Please Olivia, I haven’t talked to our son in months,” a man says.

“And whose fault is that?”

“It’s mine. I’m sorry. I’m so sorry.”

“It’s a little too late for that,” she says.

“Don’t say that,” he says. “Please don’t say that. Olivia, I’m sorry.”

“Why are you here?” she responds.

“I just wanted to see him and see if he’s ok”

“Well, he’s not. He really isn’t.” Her voice trails off.

“I brought you some coffee. You look like you could use some,” he says.

“Thanks.”

“How are you holding up?” he asks.

“I’m fine,” she says.

“Can I sit down?” he asks. I hear a chair move.

“No, I’d rather you not.”

“I know I fucked up, but please let’s not make it about us. It’s our son we’re talking about. That’s why I’m here.”

“Now what? You show up for the first time in months and you expect me to welcome you?”

“No, I… I didn’t know what to expect.”

“It’s been hard. It’s been really hard.”

“I’m sorry,” he says.

“Look, I can’t do this right now Matt. Let Timmy rest. He hasn’t been sleeping well,” she says.”

“Because of the chemo?”

“He can’t keep anything down. He has to get up in the middle of the night all the time.”

“Is there anything the doctors can do to help?”

“It’s chemo, Matt. It’s not exactly the best thing for your body.”

“But can’t the doctors give him something to help with the nausea?” he asks.

“He’s been taking something called Emend, but it hasn’t really been helping,” she says.

“I can talk to the doctors to see if we can’t switch his prescription.”

“Please don’t.”

“You look tired. I can help. It’s not a problem.”

“No.”

“I’m his father, and I should be part of his medical decisions.”

“Matt, I don’t have the energy for this right now. I don’t have it in me anymore.”

“I should leave,” he says.

“You should,” she says. “We really needed you Matt, and you weren’t there. And now you’re here, when there’s nothing we can do. There’s nothing.” She sniffs, holding back tears.

“Olivia, I missed you,” he says. “Every night I went to sleep thinking about you.”

“Me too.”

“Do you remember when you took me to the hospital on our first date?” he asks.

“Of course I do.”

“Man that car came out of nowhere,” he says. “I’m still hazy on the details.”

“I thought you were an idiot. A brave idiot, but still an idiot.”

“Hey, I wasn’t about to let my date get run down by a car.”

“Like I said, brave idiot.”

“I thought you looked like an angel. But that was probably the concussion talking.”

“Probably.”

“You should drink some of the coffee I got you. It’s getting cold.”

“Yeah.” She takes deep, labored gulps. I hear a chair scrunch as the man sits.

I think about Timmy’s file. It indicates his sedation comes from the Xanax he has to take for his anxiety. It has a supplementary narcotic effect to the morphine. We think he’s in so much pain he can’t process it any more. He had hallucinations during his last round of chemotherapy. He saw his grandmother. Olivia told us that the grandma passed away last year. We called in the psychiatrist. We didn’t know what it meant.

“What’s the doctor’s prognosis?” he asks.

“Not good. He only has a few months left. He wants to see his friends at church for the Christmas service. He’s sad he can’t join in this year. They said he could come anyways, but I don’t think he’s ever going to leave this place.”

“I got him a bunch of new comics for an early Christmas present. I figured he’d be bored having to be here all day,” Matt says.

“That was nice of you.”

“I hope I got all of his favorites. I think I got them all.”

“I’m glad you didn’t wait until his birthday to come. He was asking for some comics for Christmas. He knows his birthday in April is too far away. Look at him. He looks so peaceful,” she says.

“He really does,” he says. The room is quiet, except for regular beeps of the electrocardiogram. “I know it’s not under the best circumstances, but it’s good to see you, Olivia.”

“I wish I could say the same,” Olivia says. The boy stirs in bed.

“Timmy, are you awake?” Matt says.

“Dad, why are you here?” Timmy says, his voice frail and dry.

“You’re awake! It’s so good to see you son,” Matt says.

“Mom, why is Dad here?” Timmy asks Olivia.

“He’s here to see you,” Olivia says.

“And I brought something for you, don’t you want to find out?” Matt says. He places the comics on the bed.

“Please dad, leave,” Timmy says.

“What?”

“Dad, I don’t want to see you.”

“But…”

“Dad, get out.”

“But son…”

“I said get out!” I see a comic book fly out of the room.

“I’m sorry son.”

“I hate you. I never want to see you again.” Matt doesn’t respond. He exits the room with dragging footsteps. It’s always disquieting to see a grown man weep.

The beats from the electrocardiogram accelerate at a worrying pace. Timmy’s breaths become short and labored.

“I’m sorry, but I need to go,” I say.”

“Do what you have to, son,” Wendy says.

The chief resident’s distinct pace clears through the closed curtains. I follow eager to learn from him.

“Dr. Han, please help!” Dr. Han has had Timmy as a patient for a long time.

“Timmy, nod if you can hear me. Everything is going to be ok. Deep breaths now.”

6:00 PM

It’s time for Wendy’s chemotherapy session.  She’ll be on the fourth floor. I’ll go keep her company.

“I’m going to pray for them,” she tells me. Wendy has a prayer notebook. She spoke of God as if He was an old friend who she had become reacquainted with. She says she fell away from God after her husband died. How lost she felt. But she tells me had to find Jesus when she got sick. And Jesus helped her find Rita again.

Wendy has stage four pancreatic cancer. Only a 4% chance to live. People wonder where doctors get these statistics from. We don’t pull them out of a hat. They’re based on exhaustive medical studies averaging mortality rates among a wide population. However, the average person is a late twenties, early thirties male without other exacerbating medical conditions. And that young John Doe only has a four percent chance to survive stage four pancreatic cancer. What am I supposed to say to sixty-five year old woman who’s has a bad heart?

Wendy’s daughter asked me why we couldn’t operate. I could explain that the pancreas is a central organ connected to pretty much everything in some way. I could talk about the different necessary endocrine systems, its physical location, or its multifunctional purposes. I choose to defer.

“Sorry, Dr. Diaz can probably give you a better answer than I can. I’m only a medical student Let me page her,” I say.

Dr. Diaz arrives five minutes later with a psychiatrist. We take Rita to a different, more private room. It’s never really quiet in a hospital. Different machines make a cacophony of noises, a disjointed chorus calling out which patients are alive. Occasionally, a flat note pierces the buzz. A voice calls out the time of death, and the flat line ceases.

The psychiatrist held Rita’s hand. She says we know Wendy is going to die tomorrow. Not eventually. Tomorrow. They try to calm her down and say the psychiatrist was just trying to be nice. She says there has to be something bad you aren’t telling me.

“We never tell anyone they will die tomorrow. because really everybody is different and while you can estimate hours or days of such, we sometimes get surprised,” says Dr. Diaz.

“This is the first time in my life that I didn’t want a surprise,” Rita says.

Dr. Diaz and the daughter walk out of the room. “Can I get you something to drink Rita?” Dr. Diaz asks. She guides Rita to chair, her hand in the small of Rita’s back.

“A bottle of whiskey would be nice,” Rita says.

“Sorry, I can’t help you there. But let me get you a cup of water.”

“That would be great,” Rita says. “I need to sit for a little bit. It’s too much to handle right now.”

“Paging Dr. Diaz,” the loudspeaker says.

“Excuse me, but I have to go,” Dr. Diaz says.

“I understand,” Rita says. Dr. Diaz briskly takes her leave.

Rita finishes her cup of water and places it on the couch. Rummaging through her purse, she takes a small chip out and puts it in the cup. Rita says good-bye to Wendy, but she never meets her mother’s gaze. Wendy calls out, but Rita is gone.

Wendy calls me back in her room.

She asks, “What are doing for Christmas?” Her eyes are red.

I tell her that I’m going home to see my family in D.C.

“That’s a shame. I would have like for you to join me and Rita for dinner. Let me give you my number in case you change your mind,” she scribbles a number on a coaster next to her bed. It’s a different one than the one in her file.

In the cup, Rita had placed her five year Alcohol Anonymous chip.

7:00 PM

Last patient on my agenda before my sign-outs and debriefing session. I step into the bathroom to text Kerry. Shouldn’t have my phone out in public. Inbox is empty. Kerry is in surgery all day.

“Could you send me something to cheer me up? It’s been a day.” I press send.

Timmy is the last patient on my agenda before I do my final sign-outs and head home for the night. I’m shadowing his two RN’s, Lisa and Jen. Since the events in the afternoon with his family, we’ve been closely monitoring his vitals. He’s resting now. His mother hasn’t said anything for a long time.

“Timmy are you ok?” Lisa says. “Timmy?” She gives him a gentle shake. “I can’t get a pulse. Checking respiration. He’s not breathing.”

“Call in the code,” Jen says to me. “Can we get some help in here!” Jen yells out the door.

“Code Blue, Room 404, Code Blue, Room 404,” I relay to the desk. Another nurse rushes into the room. I don’t know her name. She escorts the mother to the side of the room and explains the coming procedure. Olivia hears the nurse but her eyes look unfocused and watery.

Jen lowers the bed. “Engaging in CPR,” she says. She counts off the beats to the rhythm of “Staying Alive,” or more morbidly, “Another One Bites the Dust.”

“Good job with compressions. Make sure you do the whole cycle,” Lisa says. On TV, Code Blue looks like a chaotic storm of haphazard defibrillator shocks and frantic shouts. But in real life, panic is the opposite state of mind you want to be.

The two nurses see the situation.  One says, “I’ll go get the crash cart.” The other nurse takes off his nasal cannula, which delivers oxygen.

Dr. Han and Dr. Diaz arrive. “I’m Dr. Han and I’m going to be running the code,” Dr. Han says, “What’s the situation?”

“He just went into V-Tech,” Lisa says.

“I’ll do the documentation,” Dr. Diaz says. She grabs the Code Blue paperwork from the cart. Everyone communicates their roles clearly. It’s still a whirlwind of activity. The room is always crammed full of different personnel so everyone has to be on the same page.

“Stop the CPR so we can roll him over,” Dr. Han says. “Bring out the respirator.”

“I’ll take care of respiration,” Jen says.

The pharmacist enters. “What IV’s do you have running?” he asks.

Lisa says, “Normal Saline and 20 mg’s of Nitroglycerin.”

Dr. Han says, “Run his fluids wide open, turn off the nitro drip. Continue chest compressions for another two minutes. Dr. Diaz, you’re keeping track of time.”

“Switch out with me,” Lisa says. CPR commences. A lull in the room sets in. While Lisa’s counts under her breath, the squeaks of the bed springs stand out . I hear a rib crack. A common occurrence during CPR. Beads of sweat accumulate on her face. Jen switches in and out to respirate the patient. Everyone in the room watches for any sign of response.

“Two minutes CPR completed,” Dr. Diaz says. During a Code Blue, everything has to be carefully documented.

“Let’s do a pulse and rhythm check,” Dr. Han says. Lisa takes a step back and takes deep belly breaths.

“No pulse. I have flat line on the monitor,” Jen says.

“Deliver 1 mg of epinephrine and resume CPR, for two minutes. Keep on that respirator,” Dr. Han says.

The new nurse says, “I’ll switch in.” She counts off. “1,2,3,4,5,6,7…” Jen respirates.

“1 mg of epinephrine ready to be delivered,” the pharmacist says. Lisa tells him he has a central line. Lisa sets up the IV.

“1 milli epinephrine delivered,” Lisa says. 

“Is he still bagging ok?” Dr. Han asks.

“It’s becoming more difficult,” Jen says.

“Let’s set up for intubation,” Dr. Han says. “Get out the Code Blue panel from the crash cart,”

“1,2,3,4,5,6,7…” Another rib cracks.

“Good Job,” Lisa says. She pats the other nurse on the shoulder.  “We’ll get a chest x-ray when this is all done.”

“Two minutes CPR completed,” Dr. Diaz says.

“I’m going to go ahead and intubate,” Dr. Han says. He completes the procedure with practiced efficiency. “Check for pulse and rhythm,” he says after the patient’s breath stabilizes. “See if there’s color change. He looks around the room. “Lisa, could you listen for blood breath sounds?”

“We have V-Tech on the monitor and no pulse,” Jen says.

“Amiodorone 300 mg, IV,” Dr. Han says.

“Amiodorone 300 mg, ready,” The pharmacist says.

“Amiodorone is in,” Lisa says.

“Two min CPR again.” The new nurse continues on.

“How are you doing?” Lisa asks the nurse. She doesn’t respond. Lisa says, “Change out.” She takes over the CPR procedure.

“Two minutes CPR completed,” Dr. Diaz says.

“Pulse and Rhythm check,” Dr. Han says. His tone remains calm and collected. Timmy still has no response.

“Blood sugar 75 and dropping,” Lisa says.

“Deliver 1 mg of epinephrine,” Dr. Han says. “Resume CPR, two minutes. Call in the EEG and

“Lets brainstorm. Mrs. Tanner, could you describe the lead up to this?” Dr. Han says.

“I don’t know what happened. We were talking, I was just trying to get him to calm down, but he was so angry, so angry. But then he started breathing weird and he wouldn’t say anything, and his heart monitor went crazy and then it just stopped. Please, I don’t know what I’m going to do if he dies.”

“We’re not at that point yet Mrs. Tanner,” Dr. Han says.

“I shouldn’t have let him stay. This is all my fault,” Olivia says to herself. Another nurse comes in.

“Call in the Chaplain on an outside phone,” Dr. Diaz tells the arriving nurse.

“Increase ventilatory rate,” Dr. Han says.

“Increasing respiratory rate,” Jen says. They complete another cycle of CPR. No response. Timmy’s lips take on a blue hue. They do another pulse and rhythm check. No response.

Cease CPR. I’m calling it. Time of death. 7:15 PM. October 16, 2015,” Doctor Han walks out the door without another word. Dr. Diaz guides Olivia to the Chaplain. Olivia stopped crying. She collapses into a chair and begins to hyperventilate. Dr. Diaz attends to her.

“Debrief at nurses station in five minutes,” Lisa says. “Please sign the code blue documentation before you leave.” Lisa lifts the head of the bed up a little. It’s to drain the blood down so they don't look as blue and bloated and to make Timmy presentable for his family.

I excuse myself so I do not lose composure in front of Timmy’s mother. I see Dr. Han go into the staff room.

I open the door. Dr. Han is crumpled against the couch. His body shakes as he gasps for air. I reach out my hand to console him, hesitate, and close the door behind me.

8:00 PM

I’m changed back into my street clothes. Dr. Han has cleaned himself up since I last saw him. He’s waiting by the exit.

“I will see you tomorrow,” Dr. Han says. “Good work today.”

“Thank you Dr. Han.” All the tension in my body dissipates.

“Keep it up,” he says.

“I’ll try,” I say.

“Code Blue, Room 306,” the loudspeaker says. My heart shutters. I turn to race back in the hospital. Dr. Han holds me back.

“Don’t worry, I’ll take care of it. You go home and get some sleep. You’ll need it for tomorrow.”

“Ok, Dr. Han, have a good night.”

“Rest well,” Dr. Han says.

I walk out the automatic doors and do not look back. The winter air bites my face.

8:30 PM

The parking spot across the street from my apartment is available for once. The front door always gives me trouble. I jiggle my keys and work the lock open.

“Hello empty apartment,” I say, kicking off my shoes and letting my white coat fall to the ground. Before I do anything else, I always have to take a shower. Hallway still steamy, I open the fridge and its empty.  My girlfriend and I haven’t gone grocery shopping in weeks.

I pull out my phone to order some food. One new message. It’s a picture of Kerry smiling. She’s wearing my sweatshirt. It’s the first message she sent me when we started dating. I asked her to cheer me up during midterms week and she sent me this picture.

I lie down on her side of the bed and rest on her pillow. It smells like her shampoo. I set my alarm for four hours later and wonder to myself if she still had my sweater. My bedroom is so cold.

Just

Lauren said she’d kill herself if I didn’t come over right away. I went over, like I always did when she called me crying. I told her that she needed to find help. She said she had help and that I shouldn’t worry; she got overwhelmed for a little. But everything was better after I got there. I told her that she shouldn’t joke about this and that the next time I would have to call the police because I wouldn’t take it anymore. I had said that once before and she called my bluff.

She said “no really, this is the last time I’m talking to someone about my issues and I’m getting better.” I nodded, hugged her, and kissed her hard. I told her I had to leave; my mom would worry if I stayed out too late. She said she understood and told me I was the best boyfriend ever. I smiled and walked out.

I stumbled into school the next day. I hadn’t slept much. My bones ached. Football practice was going to suck. I liked to show up early to school since Lauren slept in a lot. She always had a doctor’s note from a family friend. The school was mostly empty. I said hi to Tim, the janitor. He grunted back, which meant his wife wasn’t doing well that day. The hallways smelled musty. Tim tried to get rid of the smell, but the school building was old. A few other students wandered around. Many parents worked early shifts and had to drop their kids off early. Most parents wanted to get rid of their hassle as soon as possible. They walked about in a silent daze. Tim huffed as he mopped the floor. He spilled his bucket and I helped him clean it up. We soaked up the dirty water and when we finished, he nodded and shook my hand.

I went to my locker, picked up my beat-up books, and went to homeroom. My friend sat in the back and read a book she didn’t have to read. Her back was hunched over the book and she gripped the sides hard; I could tell since her knuckles were white. The air felt soggy: a heat wave in the first month of school. Emily wore a baby blue cardigan; I think that’s what they’re called, she told me before. It was buttoned up to the top. She developed early. The other girls resented her for that. My girlfriend never grew past an A cup. Emily and I used to be neighbors but my family moved to a better neighborhood. I couldn’t recall the last time I hung out with her outside of school. Her hair looked different that day. She had it brushed to the right side and had her bangs clipped back with a bobby pin. Her hair shined like fresh ink. It smelled rosy, and I could tell she changed her shampoo. Her skin was pale; I knew she didn’t go out much over the summer. Some people call her Casper. My secret nickname for her was ‘dumpling,” cause of her fluffy cupid cheeks. She said she’d kill me if I ever told anyone. I used to poke them when I was a kid. She’d puff up her cheeks and I’d poke the air out. I don’t know why that memory came up but I smiled. I sat down next to her. Her shoulders tensed. She sniffled. She closed the book.

“Another sad story?” I asked her. She said yes. I asked her why she reads stories like those since she always got so affected by them. She said she felt more human when she read those stories. I didn’t reply. She said “It’s the only way I know how to feel anymore.” I told her I understood, but I didn’t. She told me the story was about a young boy who ran away from home because his parents beat him. It was winter and he was too young, too lost, and he froze to death. I said, “That must be a terrible way to die, completely numb and alone.” Emily said she thought it would be very peaceful.

She looked at me and her eyes shimmered. She told me I had huge bags under my eyes. I felt my skin and it felt soft and loose. She said, “It’s Lauren again, isn’t it?”

I exhaled. I looked worse than I did last week when Lauren called me in the middle of the night. She said, “Look, I’m not going to tell you what to do. But, I’ve said this before, you should break up with her.” I said I loved her and couldn’t break up with her because it wouldn’t be right. Emily asked me if I knew what love was. I told her it’s when you care about someone more than you care about yourself. I read that somewhere I couldn’t recall. I had dated Lauren for a year and isn’t that what you are supposed to say after a while? “That’s not what love is.” Emily, you haven’t had a boyfriend how would you know. She said she knew.

She asked me if I was still drawing. I said, “I doodle from time to time.” She told me I should draw more. I didn’t have enough time, but I know I’m making excuses. She placed a pen in my hand. It was lacquered and looked custom-made. A friend had made it for her, but she said I should keep it. She knew that I hid my passion. I wanted to talk about something else. With a smirk, she said “the truth hurts.” She put her hand on my hand. I didn’t realize I had pushed my chair so close to her. I squeezed her hand. It was cold and I wanted to warm her. I didn’t know what to say. Emily always knew what to say. She talked about more stories from writer around the world, about people she never met but felt as though they were lifelong friends. Her words washed over me like a cleansing shower. I listened and her voice calmed me. My hand was shaking but it stopped.   

The bell rang. I looked around and people were staring. I jerked my hand back and sped away. My classroom was split down the middle. The geeks sat on the left side while the jocks and cheerleaders sat on the right. The football team sat by the door. Bobby waved me over. Sam sat fuming. Ben leaned against the wall. Everyone calls them “The Three Amigos.” I don’t really call them anything.

“What the hell are you doing with her, my sister's gonna be pissed,” Sam said. He was right, but I felt Emily’s heat linger on my hand and smiled. Sam said what are you smiling for? He was the biggest one, did most of the blocking while I took the glory. I told him, “You know that Emily and I grew up next to each other. I just needed some help with last night’s homework.” Sam said, “Yeahsuuure.” I don’t think they saw Emily and I holding hands. Bobby told Sam to leave me alone. Bobby’s arms were bare again. He liked how defined his muscles got after weight training. Bobby recently made the varsity squad while Sam and I started since middle school. Bobby said it’s too early to be fighting. Sam backed off. Bobby said “You know Lauren would be furious if she saw you.” I said, “You know Lauren never shows up for homeroom.” Sam said, “She gets away with everything, it’s not fair.” Ben said, “If you ladies are done talking, we should sit down or Mr. Henry will give us detention.” We did.

I pulled my headphone wire through my sleeve and put the earplug in. Leaned on my arm to cover it up. Mr. Henry came and taught a lesson about stuff I already knew. I did the homework, and the next night’s homework, actually the next week’s because it was interesting. I dozed off. Mr. Henry left me alone because I always aced the tests and I was probably tired from the big football game. The bell rang and I opened my eyes. I looked at the back of the room. Emily was gone.

I walked toward the door and Mr. Henry stopped me. He shook my hand and wished me luck. You’re only a hundred yards from breaking the school’s rushing record. I shrugged my shoulders and left. The rest of the morning block was the same. Every teacher wished me luck even though I fell asleep in the class or doodled the whole time.

I hated lunch because the food tasted like compost. I saw the cheerleaders: Lauren, with Sarah and Jane, her best friends. I joked that a flashlight would shine through their ears. Sam and Bobby sat at the table by the door. Emily came late. She walked past their table. Sam tripped her. She fell forward and caught herself with her hands. Her plate crashed onto the ground. Her grape juice splashed up and stained her cardigan. I knew she couldn’t afford another plate. Sam laughed. The girls laughed louder. Bobby gave a crooked smile, saw me and waved me over. I looked up at the clock. Forty minutes left in the lunch period.

I ran over and helped Emily up. I picked up her tray and gave her my food. Our eyes met and she was about to say something. I said not to worry about it but that she should get out of here. She hurried to the corner table without looking back. I told Sam he was a dick. “Emily is cool and you know her family’s not doing well right now”, I said. He said, “Ok, ok, ok,” but didn’t understand. Bobby said, “Leave him alone, he was just messing around.” Lauren smiled blankly. Sarah looked down at her food. Jane sat on her hands. Bobby and I flashed a glance of concern. Sam shifted in his seat. Lauren said, “It’s ok, my brother’s just an idiot. How are you, honey?” I said, “I’m tired.” She averted her eyes. Lauren was a bit tired too. Sam was about to speak but I glared at him and he knew not to talk about our business. The other two girls turned to each other and talked rapid fire: how gross the nerds were. How they need to shower. How they should grow up and stop playing children’s games. How much they hated it when they looked at them. How they feel like they undress every cute girl with their eyes. How the girls at the corner table are the worst. Especially that girl with the big tits. She looks like a cow. She walks all proud like she’s better than us. Lauren joined in. She said she hated that girl. She looked at me and said, “Sorry, honey, I know you used to be friends with her, but I just thought I should be honest. I just want you to stay away from her.” The other girls agreed. I kept my mouth firmly shut, lips pressed. One of the girls said, “Let’s talk about something nicer. What are you doing this weekend?” They spoke even faster.

Bobby leaned in and whispered, “Don’t worry, it’s just girls being girls.” Sam nodded. “Why do they keep saying ‘just?’” I got up and wasn’t feeling well. Lauren said, “Honey, it’s because you didn’t eat; you shouldn’t have given your food away to that slut.” I really did feel sick.

I went to the nurse’s office and got out of the rest of classes for the day. Asked the nurse if I could rest in her office, she said “of course” and pointed to a mat in the back. She closed the curtain around me. I tried sleeping, but I kept tossing and turning. The mat was too thin and my back hurt and my mind jittered in my skull. I massaged my temples and I could smell a remnant of Emily’s hand; she used good soap. My head stopped hurting and my chest tightened. I felt nauseous but not in an unpleasant way. It felt like my stomach was being tickled. I lay there with my hand held on my nose. I drifted to sleep and I woke up when the nurse told me school was over.

“You should be one hundred percent by game time,” the nurse said. I thanked her, took some candy off of her desk, and hurried to the field to tell coach that I would be missing practice.

I showed up without my football gear and he was furious. I told him I wasn’t feeling well and that the nurse said I was exempt from practice for today. He snatched the note from my hand and said, “You are practicing today.” I responded, “The nurse thought you would say that and told me to tell you that legally the note exempts me from practice.” He was screaming at me and I responded with a blank stare. Once he was out of breath, his face purple and his voice raspy, he tried to say, “Leave.” but it sounded more like a cough. I said, “I’m going home now,” but I knew I wouldn’t, I knew where I wanted to go.

The hallways were empty except for Tim who was scraping gum off of a flipped desk. A kid must have thought it would be funny to see how many pieces he could stick to it in one class period. I walked up to him and started saying, “I’m sorry, that’s horrible,” but he cut me off. “Why are you saying sorry? You didn’t do this.” I asked him if he needed help while tapping my foot and glancing down the hall. He said, “Don’t worry about it, you look like you are in a rush. I know when a man has a woman on his mind.” I blushed. Tim laughed a deep throaty laugh. I asked him if he knew where the gaming club met since they’re always here the latest. “Third door down on the right side.” I turned and ran, forgetting to say thanks. His laughs turned to bellows that echoed down the hall.

I cracked the door open and peered inside. No one noticed. The club members sat across from each other in three pairs. They looked like they were playing poker. They stared daggers at their opponents. On the table, there were six play mats decorated with different dragons, angels, and demons. On the play mats, each player had a stack of cards in colored protective sleeves. One of the club members had Star Wars sleeves. In front of each person, there were about a dozen face up cards organized in a grid. The cards also had the same style fantasy artwork. They spoke strange jargon, like moving to “draw phase” or “do you declare blockers or counter target spell” or “I have priority in this game action.” I had no idea what they were talking about. They moved the cards around like chess pieces. I leaned on the door, and Emily wrenched it open.

I fell forward and landed flat on my face. Emily held out her hand and pulled me up. The club members stared wide-eyed at me. “Always the graceful one,” she said. I said, “You’re a jerk.”

“I was waiting for you to lean on the door.”

“How did you know it was me?”                       

“You walk like a dinosaur.” She said she could recognize my thumping from a mile away. I laughed and called her a punk. None of the club members said anything, but their mouths hung open. Some wouldn’t look me in the eye. Emily asked, “What’s up?” I told her, “I’m skipping football practice because I wanted to hang out with you.” Her cheeks turned rosy red. Closing the door, I said, “I’m sorry about what happened earlier with Sam,” noticing the blotchy purple stain on her cardigan. “Don’t worry about it. Not your fault.” “It was still a shitty thing to do.” “You must be starving,” she noted, as my stomach grumbled. Shoving me her dinner, she said “Shut up and eat or I will make you eat.” The food tasted sweet. She asked if I wanted to play with them. I sat down and said, “Teach me.”

Their names were Harry, James, Will, Ryan, Colin and George. Harry had a bony, frail, elongated body. His elbows stuck out at weird angles. But I found out he was a writer. He liked to write mostly short fiction. He told me some of his favorite authors, and he had good taste. I made him promise me to show me his stories. It took a while, but he eventually agreed. James was tiny and had a baby face. I found out he was my age, but he had a growth hormone deficiency. I told him that must be hard. He said no way, I get kid prices on everything and clothes and shoes are so much cheaper. Always look on the bright side of life. James loved fantasy football. He loved the mathematics behind the athletics. He showed me his statistical analyses and they were thorough to say the least. Will built things. His dad was a carpenter so he knew his way around a wood shop. I asked him what things he made. He listed things like handmade pens, benches, bird houses, a porch. I asked him what he was working on now, and he said he was making a wood sculpture of himself. I learned how many different kinds of saws there are. Lots. Ryan was quiet, he didn’t say a word to me. But I found out from the others that his mom was really sick and that he’d been up late every night for the past month taking care of her. He was the first person I played a real game with, and I borrowed Emily’s cards but he crushed me mercilessly. Colin was the first one to talk to me of the six. He had the worst jokes ever and talked a ridiculous amount of trash. He was loud, and his voice cracked a lot. But I couldn’t stop laughing hearing the wild things he said. And I will always respect someone who can quote Monty Python on command. George had a nervous twitch. He said it was from his Tourette syndrome. I asked if it was like the guy who can’t stop cursing. He sighed and said that was only one kind of Tourettes called coprolalia. I said copro as in the root for shit? He said wow how did you know that. Emily and I used to do a ton of pretend spelling bees. I think I’m up 21-20. Emily said you’re dreaming, it’s the reverse. I said let’s decide it here and now.

George and Harry pulled up a word bank from past national spelling bees and we breezed through them. When we hit the words from the final rounds, we both struggled, me more than her. At this point, Harry, James, Will, Colin, George and even Ryan were cheering and doing fist pumps. Colin was the one reading off the words. He looked at the screen and a devilish grin crossed his face. He said the word slowly, enunciating each deceitful syllable. Emily looked at me and I hadn’t seen her that frustrated since I beat her in Connect Four back in middle school. My mind was blank. All six saw our confusion and heckled us. I heard a rap at the door. Tim popped his head in and said what the hell is going on here. I said a battle for the ages is happening. Tim shook his head and said he had to kick us out. We didn’t notice the sun had set. I declared the battle shall continue another day. Emily punched me in the ribs. We packed up our stuff, and I put Emily’s cards in my bag. We left the building. Ryan walked next to me and said I never knew you were this smart. You’ve never shown it before. I thought you were just another dumb jock. I told him dumb is easier. Emily and I split off from the group toward our homes. I realized I had been holding her hand.

I felt her soft hand mold to fit mine, as if it always belonged there. I could feel my palm pulsate. My breaths were short and labored. My stomach churned but I wasn’t hungry. My ears burned and my cheeks hurt. Despite my attempts to hide my joy, a goofy smile emerged. I could hear her breathe and I could tell she was out of breath. I had to resist the urge to look at her because I thought if I looked down I wouldn’t be able to look away. But I gave in and glanced down. She looked straight ahead. Her cheeks were flushed. I never noticed she had a tiny dimple. I don’t think I’ve ever seen her smile so wide. Our hands trembled. We took the long way home.

I was lost. I forgot how to get to her house; she lived on a hidden dead end off the main road. She guided me through the darkness. We got to her house and I realized I hadn't been there in over a year. Dandelions covered the yard. I thought they were pretty as a kid, but I learned they are weeds and look bad to adults. Her dad's old muscle car sat on cinderblocks. Last time I was here, he said he would rebuild his baby, make her brand new. Rust dotted the frame. The grass driveway was overgrown, and the plants wrapped around the bricks. A vine crept up the side of her house. I remember when I helped her mother install the siding and I didn't know what I was doing but she let me help anyways. Looked crooked and a few nails jutted out. Her house had two bedrooms, a kitchen, and a bathroom jammed into one story. The front door was closed. The screen door was slightly off its hinges and the screen was ripped. The lights were off and I could see Emily's pained face in the moonlight.

Emily said thank god the lights are off. That means either my parents aren’t home or dad’s passed out. Let’s sit over by the old tree. I remembered the tire swing but it wasn’t there anymore. I asked what happened. “Dad,” and shook her head. The biggest root split in two, and made a perfect seat. I sat down and Emily nestled in my lap. She hunched her body together. Her head rested in the hollow of my shoulder. I held her tight. She leaned back. I brushed her hair. It was as smooth as I imagined. I wrapped my hands around her waist. She turned her head and looked at me and no one had ever looked at me that way before. She closed her eyes and leaned in.

I said no. What are we doing I have a girlfriend.

She said, “you are an idiot.” I said I know.

“No you don’t know.” I asked why.

She put her hand on my chest and asked what are you feeling right now. I said I feel like my heart is dancing. I feel lost. I don’t know how I feel. She put my hand on her neck. I felt her pulse race.

“Are you still confused what love is? I said nothing.

Emily told me she lied earlier when she said she didn’t know how to feel. Do you remember this morning when you asked me if I knew what love was and I said yes. I’ve always known. Too bad I’m in love with an idiot. I pulled her in closer. She wrapped her hands around my back. We touched foreheads and rubbed noses. She giggled. Eskimo kisses. I put my thumb on her chin and pushed her up toward my lips.

The patio light turned on. “Shit why now. My dad’s awake. You need to get out of here now before my dad sees you.” I heard her father yell EM GET IN HERE NOW. Emily told me to leave, and before I could debate, she said go now. Now. I said see you tomorrow dumpling. She blushed and said I told you not to call me that. See ya tomorrow. EM I’M COMING OUT THERE I HEAR YOU. Emily said weakly, I’m coming dad sorry sorry sorry.

When I got home, I called out for mom and dad. They must have gotten the night shift again. I went to the fridge. My stomach was in knots. I brought a few boxes of leftovers up to my room. I shoveled them in, taking the occasional breath. I should have left mom a message saying I got home ok. She must have gotten a call from school about my sick day. I looked at my phone and saw I missed thirteen calls and my inbox was full. I forgot I turned my phone on silent. I hit the first speed dial and took a deep breath.

I heard a three rings and then she picked up. Hello Lauren. I heard heavy breathing. Then my phone exploded.

She screamed, “why haven’t you been picking up the phone or answering my texts, you have a lot of answering to do.”

I told her I forgot and she said bullshit.

Sam told me he saw you and that whore holding hands.

I asked when?

When you left the school with that pack of losers.

They are not losers, they are really cool.

Shut the fuck up.

No you shut the fuck up.

Did you kiss her? Did you? Huh? Answer me.

I said no, of course not, we are just friends.

You are a fucking liar and you know it.

I said look Lauren, you are my girlfriend and you are the only one for me.

She said you are a liar and you are going to pay for this. She hung up the phone. What the hell have I gotten myself into.

As usual, I got to school an hour early. I saw Tim and he was mopping the floor. He said hello. That meant his wife was able to sleep through the night. He asked how’d it go. I beamed. He said that good? That good. He gave me a firm slap on the back. Attaboy. Tim, do you need help? No, but I know you have somewhere to be. Thanks.

Homeroom was empty. I went to school with Emily since we were kids and this was the first time she wasn’t at homeroom early. I sat down where she normally sat. I looked at the desk to see if she had carved my name, but I knew I wouldn’t find anything. I sat there alone and I couldn’t help but replay the events from last night in my head. Did I screw up? Did I scare her off? She’s right, I’m an idiot. I should have never mentioned Lauren. I should have just gone for it. I hope she’s ok. God I hope she’s ok. Her father. I forgot. Damn, why am I making this all about me. I hope he was sober but he didn’t sound like it. I hoped she was safe. I wanted to see her. I wanted to hold her and tell her everything is going to be ok and I’m here. I would break up with Lauren today. I don’t know why I lied last night over the phone. Emily, where are you?

It was five minutes before the bell and she wasn’t there. Harry, James, Will, Ryan, Colin and George sat in front of me and they reassured me that everything would be ok. I said thanks because what else was I supposed to say. About half the class had arrived. Sam and Bobby strutted in the room. Sam looked at me like I stabbed his dog. Bobby gave me a pleading look. He mouthed what the hell when he saw who I was sitting with. They sat on the opposite side of the room. Ben walked in right after. Sam and Bobby pushed a chair out but Ben ignored them and sat in the front. Right before the bell rang, Lauren strolled in the door. She was dolled up, and she knew how to do her make up. Sam looked down and rubbed his forehead. Bobby did a double take. The gaming club members gave me a look of concern. She smiled at me and I shrank away. She sat next to me and said good morning honey. I didn’t respond.

The bell rang and Mr. Henry showed up a couple minutes late. No one talked for those few minutes. He walked in and said is everything ok? Everyone seems on edge this morning. Lauren said nothing’s wrong, I think you’re just tired. He said yeah, I just need my coffee and I’ll be ok. He took attendance but paused when Emily didn’t answer. He repeated her name and scanned the room. He said wow, first time for everything. He taught for the next half hour, but everyone stared at me and Lauren. She sat up straight, got in perfect posture and turned the corners of her mouth up. Near the end of class, I heard the door open. Emily slumped into class, her bangs down. She wore a white sweater with a matching white skirt. Mr. Henry asked if she was ok and she sat down and said everything is fine. She let her hair flow down and cover her face. I counted the seconds until class ended. The bell rang and I shot up. Emily was already halfway out of the door. Lauren grabbed my arm. I shouted to Emily, please wait. She was gone.

Lauren hung on my arm as we walked to the next class. I fixed my eyes on the open door. The teacher waved her hand in front of my face. Said my name a couple times. Snapped her fingers. I saw Emily speed past the door, a white blur. I stood up and said I really need to go to the bathroom, it’s an emergency. Lauren reached for my arm but I swatted it away. My teacher said that’s why you were zoned out. Go ahead but hurry back. I left before she finished talking.

I saw Emily at the end of the hallway and I sprinted. I needed to get to her as fast as I could. She stopped and leaned on a locker and turned around. You run like a dinosaur too, she said. I sucked in air to reply but I couldn’t think a full thought. I moved her bangs behind her ear. Her right eye was purplish and swollen half-shut. The bruising spread out to her upper cheek and the bridge of her nose. I quaked with anger. I’m going to kill him. She laughed. He’s a combat trained vet. He’ll snap your neck and say it was self-defense. The cops are always on his side. I asked are you ok. She said I’m fine. I sneezed and my teacher saw the bruise. Told me to go to the nurse right away and that she needed to make a call. I touched her face and said does it hurt a lot? She said I’m used to it. I moved in to hug her, but she said no. I can’t. Why not? I just can’t. Why do people keep saying that word? She asked what word. I said everyone says just, like nothing’s a big deal. Please talk to me. She shook her head. The bell rang. A hall monitor poked me. She said go to class now, both of you. I said can’t you see I’m busy. I’m talking to my friend here. She said what friend are you talking about. Emily wasn’t there.

I went to my next class and noticed Lauren, her two friends and Sam weren’t there. Shit, Emily please be ok. I swear if any of you touch her, I will hurt you. I asked to leave class and I said I wasn’t feeling well. My teacher said ok, feel better for the big game. I paced up and down the hallways, but she wasn’t in any of the classrooms. I checked the nurse’s office but she said she hasn’t had anyone come in today. The hallways were empty. Tim was probably on his break. I realized I didn’t check the bathrooms. As I ran down, I heard a girl scream someone help me please. The screams came from the girls’ bathroom.

Sam shot out of the bathroom and slammed me against the wall. He wore a torn wife beater and loose athletic shorts and he had scratches on his arms. I screamed let me go, is that Emily in there? I swear to God, I’m going to kill you. What did you do to her? He said I saw everything. He said why’d you choose Emily. Her screams pierced my ears. Sam wept. Why Emily. Why, Why, Why. I’m sorry Emily, so sorry. The teachers heard the noise and saw Sam pinning me down. Mr. Henry pulled him off, and said what the hell is going on. Sam slunk to the office. I got up and I saw Lauren and her two friends strut out of the bathroom cackling with glee. I said what did you do. Lauren said you’ll see. The bitch got what she deserved. A small crowd had gathered. The teachers told them to go back to their classrooms but no one listened of course. Emily fell out of the bathroom. No one helped her up.

Emily wasn’t crying. She sat up and rocked back and forth. They lopped off her long hair and ripped her sweater off. Her shirt was down the middle and her bare bra hung loose. All the guys stared at her chest. I stared at her arms. From shoulder to wrist, there were precise, horizontal slashes. The scars looked old. Mr. Henry went and put his blazer over her shoulders. She shrieked when he touched her. I stepped backwards. Lauren and her friends laughed. The teachers shoved them down the hallway into the office. They cheered all the way down the hall.

People cleared out, there was nothing more to see. A teacher grabbed my wrist and said we should go. Emily hugged her knees and her knuckles were ghost white. Her jaw was slack. I couldn’t take my eyes off her scars. I felt afraid. I felt nauseous. I felt repulsed I felt like she was something alien, not the girl I grew up with. My perfect, innocent girl was broken. She stopped rocking and looked up at me. I sat next to her. I put my arm around her shoulders. She screamed and shook violently. I went back to class.

That night I got a text from Lauren. My life is over. They kicked me out of school. It was just a prank that got out of hand. Oh god, my life is over. I should just end it all.

I replied then go fucking do it.

Emily didn’t go to school for a week. I called, but her phone was off the hook. I never visited her house. Then one day, she was there in homeroom an hour early. Her hair was neatly tied into a short ponytail. She wore a red button-up sweater. She was sitting in her usual seat. No book. She had a serene smile. I couldn’t look at her. I should have tried harder to contact her. I should have stayed with her that day. I sat on the other side of the classroom. My mind felt heavy. I buried my head into my textbook. The kids filed in but no one sat next to me or Emily. Mr. Henry came in, saw Emily and opened his mouth to speak. She whispered don’t.

Lunch came, and I chose an empty table. Or the empty table chose me. I went up to Ben earlier and said I quit football. He didn’t protest. The jocks looked at me with disgust. Harry, James, Will, Ryan, Colin and George sat as far away as possible. I force fed myself. I heard a rustle. Emily sat down next to me. A hushed whisper ran through the cafeteria. I froze. I just couldn’t look at her. Lunch ended and I didn’t say a word to her. My lips opened and closed each time I wanted to say I’m sorry. Everyone hurried out of the room. We stayed. She calmly said everything is going to be ok. I said it’s not ok. I should have protected you, I should have been there for you. She said you can’t protect me from everything. I said I knew Lauren was going to do something to you. She said you could never have foreseen what happened. I said why, oh why, do you have to suffer so much. It’s wrong. She kissed me on the cheek. She said nothing’s just. I felt her place something in my hand. It was a small gold key. She said promise to keep it safe. And goodbye.

She hung herself a few hours later. Her mom found her body. They say she pulled the belt so tight that her skin turned purplish-blue. No open casket at the funeral.

The funeral was simple. Not many people showed up. A pastor said a series of memorized lines. The groundskeepers lowered her coffin into the grave. Filled the hole in. The dirt sounded like rain when it hit the coffin. The geeks were there, but left right when the service finished. I was the only guest who lingered. Emily’s father knelt at her grave. He wasn’t crying. He trembled and whispered to himself. I could hear him repeat over and over I’m sorry.

Emily’s mother took measured steps toward me. She stood at eye level, a step too close. She said I didn’t see you cry, not once during the whole service. I said I didn’t know why. Her eyes filled with tears. For the past year, you treated her like dirt. She dug her nails into her palm. You meant everything to her. I couldn’t make eye contact. She said look at me. I did. She pulled out a small book from her jacket pocket. This had a post it attached with your name. I assume she wanted you read her last words. I didn’t put my hand up to accept it. She slid the book into my front pocket. She said read it. You owe her that much.

I got home and went to bed. I was tired, so very tired. But Emily’s mother’s words echoed in my ears. I pulled the book out and placed it on my desk. I took her key out of my treasure box. Emily and I used to fill it with the silliest stuff. When we were in third grade, we put slugs in there and they bred. We forgot about the box and after a month the whole inside was goop. Took hours to clean. When I heard about Emily’s death, I trashed everything that reminded me of her. But I kept our box and her key. I took a deep breath and unlocked the diary’s latch.

On the first page, she saved the first drawing I gave her. It was two stick figures holding hands. It said forever and ever. I turned the page, and I saw a picture of us playing baseball. I had a soft face and she had short cut hair and dressed in a t-shirt and jeans every day and people thought we were brothers. Had her big blushing dumpling cheeks. I turned the page and read about the first time her father beat her. She sounded so confused. I turned the page and I found dried leaves taped to the paper. They were our fourth grade science project. I turned the page and found more memories, memories I had long forgotten. The time I went on one knee and slid a ring pop on her finger. I said I wanted to try it, I saw someone do it on tv. She said it was super cheesy. I neared the end and I turned the page. All it said was I’m in love. There was a blood splatter at the bottom of the page. The next seven pages were torn out. I stopped. I knew the final page held her last words and they were for me.

I’m sorry. There is nothing I can say that will make what I'm going to do ok, but I hope you can forgive me. You should know I’m not angry at you. You could never make me angry. And I’m not angry anymore. I’ve been angry about so many things in my life, but I'm going to make the pain stop. I know I’m selfish and I’m going to hurt you. But you’ll be ok, you are a strong man. You’ll forget about me, find a wonderful wife and live a happy life. Live a good life for both of us. Never stop drawing. Don’t lose yourself. You are an amazing person, and I love you. I will always love you.

Goodbye.

Emily

There was more writing at the bottom of the page.

Please tell me you felt something that night. Please tell me that I’m not making this all up. What’s the point of asking now. I’ll be gone by the time you read this. Forgive me.

I leaned back in my chair and let myself fall to the ground. I shimmied into the corner and buried my face into my hands. A wall of tears blocked my sight. It was as if I had forgotten how to cry, and my body was making up for lost time. When I felt as though no more tears were left, a new torrent would flood down my face. My mouth made screaming motions but nothing came out. I felt like a ball was stuck in my throat. I gasped for air, and I tried calling for help, to my parents, to God, to anyone who would answer. Yet I could not speak, and silence responded.

I stayed in that corner until dawn.

I saw the sun pierce through my blinds. I got up and went to school. The hallways were empty except for Tim. I waved to him. He shook his head. His eyes were watery. I got to homeroom and it was empty. I reached into my bag to find something to do and I found Emily’s cards.  Started playing a game against myself. I lost.

I pulled out my notebook and a pen. I realized it was the pen she gave me. I sketched the outline of a face. I filled in the skeletal structure, saving her dumpling cheeks for last. I added the finer details like her button nose, her hair just how I remembered it, her wispy eyelashes.

The tip of the pen broke. I was almost done.

Drops of ink blotted the page.