I leave Dean’s bedside to make 2 a.m. rounds. His are the only lights, besides those in the nursing station, that are on. The in-patient unit at the children’s hospital is dim and empty—silent except for a metallic hum that can be heard, just barely, in the air. 1 am in my nursing assistant uniform, white, except for the splotch of creamed ham I spilled on the leg during a now distant daytime meal. Besides Dean, there are 10 other patients, all children, the oldest 19, only three years younger than I. They are all disabled—cerebral palsy, spina biñ¯da, failure-to-thrive, hyperactivity. Bu that is during the day. They are asleep now, free from their daytime gnawings and spasms.
My job tonight is to go from one room to the next, checking diapers and catheters. There are not many to check this round. So I just listen to their breathing, and if it is too silent, I place my hand on their rib cage, gently, to feel the measure of their sleep. I am glad it is not the designated hour to reposition them, to wake them up, interrupt, and, if they have had surgery, to cause them pain. That time is two hours away. For now, I can just watch and feel for their breath, celebrating the trail of drool for what it means: peace. Sleep the elixir. I am extra quiet.
I return to Dean’s bedside once again, alone. There is a blue swelling near his ankle where, earlier in the evening, Dr. Van Skeldt tried to insert an IV needle, again and again. It was clear then that we would have to transfer him to the main hospital, where they are better equipped to deal with him. Dr. Van Skeldt has left to make arrangements. The night nurse enters, her support hose rubbing and swishing, to register what vitals she can. “Why did he bring him here in the first place?” she says. “He knew we wouldn’t be able to take care of him. He knew that.” But the care facility won’t take him back, I remind her. Maybe this is the only place he has. “Well, I don’t know about that.”
She is right in a way, our small unit isn’t equipped to handle a patient like Dean. But nevertheless he is lying in a bed here. Dean won’t live much longer. He has severe cerebral palsy, which means he choked during birth, which means the rhythm of the contractions were wrong. His lungs opened too soon. He has lived 17 years, barely. I have been with Dean tonight for over two hours,just sitting on the side of his bed and watching his rib cage extend then collapse: up … down …up, up, up … down. His lips, dry, are collecting a thin film of mucus. His auburn hair shines with nearly three days’ oil. He is so emaciated that when the fluorescent light casts blue upon his twisted limbs, it sends shadows in odd places, unexpected: pelvis, upper lip, ribs . . .
An hour later I leave to clean the sunroom. This is the children’s playroom, now empty. Around me the carpet, the plastic chairs and tables are covered with the daytime patterns of childhood, lingering. Toys and pieces of toys lay here and there, always everywhere, weaving together messy spirals and rhythms and textures. Yellow, red, blue. Mini-houses, Ken heads, Fisher-Price farms, hollow plastic bulbs— some together, some not. I pick them up, one by one, and put them in their designated places. ï used to work the evening shift here, just after supper, when the sunroom is full of children, of wet hair and pajamas; movement and noise; tricycles, story-books, gossip; house, cops, robbers; tossing, chasing, shouting. John, John, John, they called from all corners, all sides. The supervisor’s big butt, Dan’s booger, Kara’s farts. Faster and faster, the kinetic energy of their play seemed to raise the small hairs on my neck and arms . . . But I’d forget. On the mat, near the television, would be the other patients like Dean. Quiet, except for tiny rockings from seizures or masturbation. Movement would flurry about them, balls would accidentally bounce off their heads as we nursing assistants played with the other children; all of us believing, hoping, that because these patients lay quietly, just breathing and rocking, they were pacified. With bright colors spinning around us, we would tuck them and their gnarled fingers into the back of our minds and forget them. But here on the night shift I remember.
I return to Dean’s bedside. His steamer is stuttering. I lift off the top, and add another pint of distilled water. James, my only brother, is on my mind tonight. He was buried 15 years ago in soft blue, terry-cloth pajamas at a funeral I wasn’t allowed to attend. A stillborn, lost during labor. I sometimes dream about that funeral, but not very often anymore. In fact, I haven’t thought of James much at all recently But tonight is different. From Dean’s windows I can see a distant intersection, where the traffic lights are changing by themselves. Green, yellow, red, again and again … no one is awake to heed them except me. I am on the night shift, and I feel as if I am privy to the secrets of day existence; privy to the secret knowledge that pedestrian buttons on traffic lights are an illusion. There is no real control. The traffic lights change according to timers, predetermined rhythms that go unnoticed during the day like the regular seizures of children who lay on playro’om mats. But at night I can see them changing wl·iüe others sleep.
It seems unimportant, unless you realize that just over the curve of the earth, surrounding our sleep-time, are day-time lands and cities where people and machines are pounding and cars jam clover-leaf junctions and planes are landing and emerging through thunder. People barbecuing, starving, mowing lawns, riding camels or tugboats or the backs of lovers in pounding, ceaseless, pulsating patterns and rhythms that blend into palimpsestic nonsense until just once— just once—the synchronization goes bad, and you find yourself standing near a Dean and counting the number of times his rib cage rises, watching as a doctor jabs and jabs and jabs an IV needle into the tender flesh of his foot in the hope of finding a vessel with a pulse. Or you find yourself a woman in labor, in an empty hospital room in April, whimpering as you feel the frantic kicking against your abdomen slowly dwindle to silence. Or you find yourself a father standing outside your remaining son’s doorway, the night before Easter, letting the heavy candy drop from your hand and onto the carpet, one by one by one. Or, at 7, you find yourself alone, tearing out your hair in fists because secretly, for some forgotten reason, you had onœ wished the baby dead, and indeed it had been born so. Dean coughs, just a little, then returns to the wet labor of his breathing. Softly, carefully, I slip my thumb into his small velvet palm and caress the top of his hand with my index finger. I don’t know if he notices, but I feel the need. The need to shout him on, to set the pace of his life stream, to fill arteries and lungs and heart with the measure of strong, rosy-cheeked life. On my caress he’ll live out the evening, keep breathing, stop choking, become born. Or so I imagine. But who is this boy to me, anyway? Why am I drawn to him? Perhaps because James was my brother, and because I was the only male child, out of three, to survive birth. Perhaps because James was born at night, and because it was a night nurse who left my mother in a room alone. Perhaps Dean is what James would have been if he had lived, a good portion of his brain suffocated. Perhaps I am just unusually sensitive tonight. I don’t know. I don’t know why I’m sitting here. Why, out of the hundreds of children I’ve assisted in this place, some terminally ill, I should feel the need to especially comfort this boy on this night. I just do. So I sit and I caress and I listen, beneath the hum of machines, for the breath of life, and the secret rhythms of compassion.
Too quickly, Dr. Van Skeldt enters the room, and the night nurse is with him. They have brought a cart for the transfer. He has decided not to use motor transport, and I wonder why. Why push him when you could drive him the short, bumpy distance to Main? I don’t know a lot about Dr. Van Skeldt except that he arrived from Boston, is divorced, and lives alone, no children. Usually, he walks around the halls with a grave brow, checking a file or a patient or two, rarely going too far out of his way for patient or staff. He’s considered rather cold.
But his relationship to Dean has been an enigma for everyone. Among staff, Dean is referred to as Dr. Van Skeldt’s personal “project.” He checks in on Dean every evening, meeting with staff in the process, courteously begging favors from us for his care: Could you put a pillow there please? And tonight, when Dean whimpered as the needle kept missing its mark, I thought I read, on Dr.Van Skeldt’s brow, a wrinkle of pain. He has had to move Dean from one facility to the next, trying to find a place willing to take care of him until he dies. Now we can’t keep him either.
Dr. Van Skeldt takes the two far ends of Dean’s bed sheet, and I grab the near. Slowly we lift him, with the nurse’s help, from his bed to the cart. Dean’s eyes are moving back and forth, and his breath stretches to squeak out a whimper. He is crying, I can tell, and frightened. Slowly we start to move—Dr. Van Skeldt in front, me in back—past the nurse, out the door and onto the cracked sidewalk that leads to the main hospital. It is an Iowa summer at night. It is a time when the slopes and lulls of the river valley bear the thick steam of vegetable life, soaking the fur of rabbits as they nibble, calling witness to the indisputable fact that the earth itself breathes. In the air is the smell of damp earth, and the faint hint of late blooming lilacs. Suddenly, we stop moving.
“Now isn’t that pretty?” Dr. Van Skeldt says to himself, or maybe to Dean. “I caught that scent earlier. I was hoping it would still be here for us. It reminds me of California when I was a boy. During those summers the smell from those blossoms filled the air. My mother used to say that if you breathed too much of it you would faint away or lose your socks or something. That’s what she used to say then. There it is again . . . isn’t that something?”
Dr. Van Skeldt pauses, then touches Dean’s shoulder, lightly. He checks the IV pole. And then we move on, toward the bright fluorescent lights of Main.