Writers’ Work-in-Progress showcases the work of new and long-published authors. This is what their first pages look like now—perhaps the published versions will read exactly the same, perhaps they will be quite changed. That part of the mutable beauty of writing—always a work in progress, until the book hits the shelves.
The following is the work of Kathy Crowley, a member of Beyond the Margins a Boston-based writer’s blog (which I belong to.) Kathy is a writer and doctor whose work reflects a deeply empathic understanding of the everyday problems we all face, and the sometimes mountainous hurdles we must climb. She is as talented a writer as she is wise about the human condition.
On Locust Street
By Kathy Crowley
August 17, 1995
I started taking care of people a long time ago. A long time before anybody gave me a degree and paid me to do it. When I was eleven, my mother got sick with the sort of thing that doesn’t get better, so I learned to come straight home after school and look after my brothers and sisters. I played with them in the afternoons, then bathed my toddler sisters and herded them all to bed at night. That was the beginning of my caretaking, and there is no end in sight.
The E.R. is quiet, almost empty, on this very early Thursday morning. I don’t have to look to know that in our waiting room, there are a few sleeping drunks, a TV no one is watching, a triage nurse restocking a cabinet or finishing some notes or reading a magazine.
Here, in the conference room on the pediatric side, we are draped with the early morning haze of fluorescence and fading caffeine. I push aside a few empty soda cans and a candy wrapper to make space, then settle down to write my charts. The pediatric resident sitting across from me is deep into her own charts. I can see the grey cast of exhaustion over her shoulders, draining the youth from her twenty-something face. Out in the main room Arnie, the other attending doctor working tonight, stares at a set of c-spine films on the light board. He yawns, removes his reading glasses from the shirt pocket of his scrubs and slips them on, peering closely at the vertebrae, ghostly white discs aligned like beads on an invisible string. Arnie is pushing sixty, balding, short, skinny, always in scrubs. He’s been working the E.R. for years, but he hasn’t burned out. Not yet. A rare thing among the older docs. Arnie still feels for even the toughest kids – the surly boys with the knife wounds they refuse to explain, the sixteen year-old girls who come back in every few months with gonorrhea or chlamydia.
Just beyond him, curled on a gurney in Bay 4, lies a little girl on whom I have just performed a lumbar puncture. She is exhausted, all cried out, finally asleep, a bedraggled stuffed panda clutched tight to her chest. The band aid on her back is visible through the open flaps of her johnny. After all these years you’d think I’d be used to it — but I’m not. The pale knuckles of the nurse as she struggles to hold the child still, knees up, chin to chest, spine stretched like a slinky, the gaping maw of even a small gauge needle as it pierces the skin.
I hate it every time.
I had to do a central line, too.
“I’m sorry, I couldn’t get an IV on her,” Betsy said to me. She had tried just about everywhere – arms, legs, even scalp – before coming to me with the central line kit.
“It’s alright,” I told her. “Kids aren’t easy.”
““I wish what’s-her-name was still here.”
“Yes, Troya. She always got it.”
Troya used to work here as a phlebotomist — not even an IV nurse — but we called her down to the ER anyway when we couldn’t get a line because she could, as we like to say, find a vein in a rock. It’s been a few years since she left, but every once in a while, when we can’t get a line, someone says what Betsy has just said.
So I did them both — the LP and the central line — and now, finally, the little girl is asleep.
I pull down the first from my stack of charts and get writing. I don’t like the exhaustion, but there is something about this time and place I do like: a hospital deep in the night, a species of quiet I haven’t found anywhere else.
Arnie shuffles over and leans against the doorway. He stretches his skinny neck, scratches his ten hours of beard and looks at me. Years of working with him tell me that he is about to ask for my take on the c-spine films when the triage line erupts with its harsh buzz. Latanya, the ER secretary, looks up from a solitaire game on the computer, her don’t-you-bother-me-without-damn-good-reason demeanor still intact, and snatches up the phone, gold fingernails shining like talons.
She hangs up the receiver only a second later and spins around to face the rest of us.
“Rhonda says get out to the waiting room NOW. Some kid.”
Like a school of fish jolted out of momentary rest, we – the resident, Arnie, Betsy, and I — stream toward the E.R.’s double doors, my fist striking the panel to open them just in time. No one talks and the only sounds are the dull clatter of surgical clogs, the squeak of sneakers, the thump of the door as it opens fully and hits the rubber stop on the wall.
In the waiting room, Rhonda stands beside an orange vinyl triage bench on which there are three boys, all alike in their t-shirts, their falling-off jean shorts, two in do-rags, one wearing a backwards baseball cap. All alike except that two of them are conscious and the third — slumped between the other two, a blood pressure cuff on one arm, Rhonda bracing his heavy, lolling head, shining a pocket flashlight into his dark eyes — is not.
“Get respiratory down here now,” Arnie shouts back toward the desk. “And we need a gurney,” he adds. I can hear the wheels rolling behind us, though, and I know it is already coming. The gurney arrives beside the bench, and with only Rhonda’s under-her-breath “One, two three,” we hoist the boy up onto it. Overhead the hospital operator’s tobacco-ravaged voice breaks the quiet: “RESPIRATORY TO THE PEDIATRIC E.R., RESPIRATORY TO THE PEDIATRIC E.R., RESPIRATORY…”
The boy’s mouth is slightly open and his skin is moist with sweat. He is thirteen, fourteen, fifteen at the outside.
“What’s the story?” I say, glancing at the boys and then back at Rhonda.
“Three guesses,” she answers as she searches for the gurney strap. “Pinpoint pupils, temp 94.9, pressure’s 70 over palp, heart rate 52.”
“Respirations?” Arnie asks.
He looks up quickly and catches my eye. The fourth time in a couple of weeks. Different kid, same story. The kid has overdosed, most likely on heroin, the drug of choice these days, and now his body is slowing down, chilling, moving toward a deep sleep freeze on a hot night. Too much of some drug is not unusual here, unfortunately, but this kid strikes me as younger than our regulars. Arnie glances up at the boys who brought him in and says, “Listen, we’re going to wheel your buddy to the back. Can you wait out here for a few minutes so that one of us can come back and talk to you?”
I catch sight of them as I raise the rails on the side of the stretcher. Their faces carry a guarded look, false boredom masking fear, their eyes never quite meeting ours. The older one issues the smallest of nods as we start to roll the gurney away, through the double doors.
In the back we descend on the kid like a tribe of lions assaulting a fresh kill, cutting through his pants and tearing off his t-shirt, sticking monitor leads on across his chest, oxygen mask and ambue bag, all at the same time. I am listening quickly to his heart and lungs while Rhonda tapes his arm down and places a line.
“Name?” Arnie says to Rhonda.
“Victor. Victor Neves.”
“Do you know what he took?” I ask her. Branding is the thing with drugs these days, and the names they carry are darkly poetic: “Viper” and “Volcano,” “Death Shot” and “Dead Calm,” “Super Buick” and “I’ll Be Back.”
“No,” she says. She whisks another strip of tape off of her shirt and places it deftly over the line. “His friends found him this way about a half an hour ago. There’s an injection site on his left arm but no tracks.” She pauses. “His friends didn’t say a whole lot.”
“How long was he down?” Arnie asks.
Rhonda shakes her head. “No idea. They haven’t seen him all day.”
The respiratory tech arrives at a run, slips in behind us and begins setting up the respirator. A moment later Arnie’s got the laryngoscope in, and in the next minute the tube is down the boy’s throat.
“Chaser?” Betsy holds a syringe drawn and ready — naloxone, the “anti-narcotic”, the drug to bring him back.
“You are downright clairvoyant.” Arnie says, without looking up. Betsy hands the needle to the resident, who slips it into the IV port, forcing the medication slowly and steadily through the syringe. Then the odd, almost breathless lull – the minute or two before it takes effect. The boy’s eyelids flicker and he coughs – or tries to anyway, gagging against the endotracheal tube — and the activity resumes.
“Bingo.” Arnie says. “I love it when it works. Almost makes you believe in what you’re doing.”
Arnie and I tape the ET tube in place. “I don’t suppose we have any info on the family. Do they know he’s here?” Arnie asks, stepping back to survey the boy, as though, in the rush of procedures, he hasn’t actually seen him. Stripped of his clothes and do-rag, his hairless chest swelling and diminishing in this drug-induced sleep, he looks more like the child that he is.
“I didn’t get a chance to ask,” Rhonda answers. “I just buzzed for help. I think he’s Brazilian. Or Cape Verdean. I heard his friends speaking Portuguese.” She looks up at Arnie and me. “I’m going back out to triage. I’ll let them know that one of you will be coming to talk to them.”
From there, we finish up quickly. Betsy gathers the boy’s ripped clothes and puts them into a plastic bag. Arnie begins making his cryptic notes on the chart handed to us by the secretary while the resident calls up to the Pediatric ICU. An x-ray tech wheels in his zamboni-like machine and takes a chest film. All the lines are in and the boy’s heart rate has come up to 64. Minutes later the Pedi ICU team — a shuffling herd of blue-scrubs– arrives downstairs to transport him to the unit. I hold the tubes of blood Rhonda has drawn — electrolytes, cbc, tox screen, a blood gas – while she prints out labels. The tubes are still warm when I drop them into a transport bag and send them off.
And it’s quiet again.
Kathy Crowley’s short stories have appeared in Ontario Review, Fish Stories, The Literary Review, New Millenium Writings and The Marlboro Review. Her stories have been short-listed for Best American Short Stories, nominated for a Pushcart Prize and anthologized. In 2006 she was awarded a Massachusetts Cultural Council Grant. She recently finished her first novel, On Locust Street. When she’s not busy preparing for her future literary fame and fortune, she provides care and feeding to her three children and works as a physician at Boston Medical Center. She is a graduate of Brown University and Tufts University School of Medicine. Kathy is a member of the group blog Beyond the Margins and can be found on Twitter at @Kathy_Crowley.