They're dropping like flies in that school, your colleague says. My son's friends all have it too.
You have never slept the entire way through the night. If it's not the hospital calling, not one of your daughters crying because her skin is eating her alive and the calamine lotion stinks so badly she won't let you put it on her chicken pox, then it's your pregnant wife heaving herself up with food cravings and not even trying to keep the mattress from bouncing you awake.
It takes a second before your colleague's comment makes sense. You'll never make it through rounds.
You nod, say your two older daughters, who go to the same school, have it and will be giving it to the baby any day now.
Rough, he says, shaking his head like he has water in his ears. Chicken pox. Funny how it's almost nostalgic, like braces and mowing the lawn. Getting chicken pox and watching cartoons.
Your colleague is actually smiling.
You turn away to pour the coffee out into the deep stainless steel sink.
The ICU is quiet. It is a county hospital, not a real hotspot for trauma or disease, usually the occasional farm equipment accident or car wreck. At least your colleague will break the silence.
Your daughters are not even in the second stage of the pox yet.
The first day of their chicken pox, before the itching got too bad and before their fevers had broken 100 degrees, your two older daughters, seven and five, begged you to take pictures of them, naked and staring, mimicking the shots of third-world sufferers they saw on the cover of the medical journal you get every month. They didn't really understand the point of course. They put on headbands and lipstick for the photo shoot, posing, prim and innocent, their faces flushed and their elfish bodies covered in a hundred raised shiny bumps, pink welts that would only get darker and itchier as the week went on. The baby, whose skin was still smooth and pale, watched the whole thing, her round face screwed up in envy.
That was four days ago. The pocks, which then weren't even fully raised or crusted over yet, are swelling, swollen, swallowing your children until all you see is disease, the crawling virus making them mindless. The worst is the scratching – constant, bloody. They have eight or nine days more, and nothing you do helps, not that awful lotion, not acetaminophen for their fevers, not warnings about scars, not even 101 Dalmatians and ice cream. Because of her pregnancy, your wife cannot touch them and carries a forty-ounce pump of hand sanitizer with her through the house. Let them scratch, she says, it's ok, everyone does. What she doesn't understand, no matter how carefully you explain, is that the marks on their perfect china doll skin will never heal. She and the unborn child are safe, walled away like a city in her separate concern.
Your colleague opens the door, says let's get this over with and you follow him out into the blank halls.
It is 6:57 p.m. You are calling your wife in your head as you walk toward your office to call your wife, telling her you'll leave at 7:30. The page comes through, urgent. You turn and will your feet to jog.
By the time you get to the operating room, the nurses already have the patient IV'd and are connecting the monitors. The first looks up at you, her eyes wide. The patient, an old woman, is naked, her legs covered with a sheet. She is misshapen as a rotten peach, deflating, half of her body round, the skin stretched and shining, while the other side is frail and wrinkled. One arm is swollen more than twice the normal size, painted purple and red and black. You take a deep breath, step closer, registering one at a time the abscesses, at least seven, that hang gold and bulging, held only by a thin layer of straining skin. You imagine an artist struggling to capture the urgency of human skin that is almost bursting.
The nurse, your colleague, the nurse, how many are there, all talking at once. This is routine, but not today. Elderly diabetic, sixty-seven, female, hypotension with blood pressure still dropping, cardiac rate weak, ER thinks Staph infection–
You nod. The most severe case you've heard of.
The oxygen monitor, the six liters of IV, the fourteen more liters coming. Your colleague goes out to speak to the daughter that brought this woman in. She has obviously been this way for days. How do things like this happen in the modern world? Page radiology, order a CAT scan, the daughter found her like this and followed the ambulance here.
Replace IV bag. Stop. Study the woman.
The left side of her head, from behind her ear up to her crown, is distended and rubbed mostly hairless, a dark plum-colored shower cap at first glance. The skin of her face is stretched into a bloated mask, her mouth is hanging, her eyes forced shut. It would have been hard to guess her age, though the skin on her normal arm is wrinkled, her right breast hanging. She could be anywhere from fifty to eighty. Walk closer. Where are the nurses? Look at her matted slate-grey hair and try to see it in curlers. You draw a breath through your nose and bile leaps into your throat, a punch.
Two years ago, your oldest daughter mashed up a bowl of grapes and hid it under her bed after seeing on TV how wine was made. She kept her door closed for weeks, so it would be a surprise for you, and you only found it once the smell was so strong it seeped, maliciously, under her door and filled the house. She refused to believe it wouldn't turn into wine, and kicked and wept, her blonde hair stuck to her wet cheeks, when you threw it out, but both you and your wife were laughing too hard to punish the tantrum. Even now, your oldest is embarrassed every time you drink real wine with dinner and tease her about it. You always smile and ruffle her hair, tell her it's the thought that counts, not the end result.
You close your eyes, stomach still wrenching. That same sharp reek of rancid grapes rises now from the woman's flesh.
The nurse finds you. Start her on morphine, you tell her. We need a scalpel, a basin and rolls of gauze, lots of gauze. The nurse does not look at the woman.
The patient is trying to turn her head, and can't. Tears squeeze out of her inflated eyelids, her mouth works, tongue too dry or too swollen to speak. Her face is a purple moon, the face of a giant infant, round and nameless.
Turn to the sink, start running hot water. A monitor screams behind you. The woman is tugging weakly on her IV, only half-awake. Jump forward, gently pull her hand away. You strap her arm to the bed handle with a soft restraint, and she gives an animal sort of moan, still crying. You stand there helpless, what is she trying to say, wishing she could write it, frantic it will be lost even if she lives. You touch her bound wrist.
Shhh, it's going to be ok, just lay back, relax, it's alright now. Your daughter's here, you're going to be alright. I have you.
Her left arm, too puffy for the restraint, is probably too weak to move anyway. The morphine will take effect soon enough. Tuck the sheet across her legs under the mattress – that's enough to keep them from moving.
Wash your hands slowly, carefully – wrists, forearms, hands again, four times. The nurse comes in with scalpel, stainless steel basin, rolls and rolls of gauze on a tray. Stretch on some gloves, stand next to the nurse, next to this woman and her bed. You and the nurse do not make eye contact.
She speaks first. Start with the thigh?
Hesitate, shake your head. Let's save that one for last. The swellings climb along her lymphatic system, starting with her foot and going up. You pick up the scalpel, hold it, the rounded blade, the razor point. It's the moment before, that breath before the push in, the space of choice that you hate most.
The arm, you say. You wait for the nurse to place gauze against the skin under the abscess, hold the basin against the gauze, then lean forward. The point slips in with almost no pressure, and instantly the pus courses out into the basin, pale yellow and thinner than you expected. A good sign. Flush the wound, clean it out, let the nurse pack gauze into the golf ball sized hollow, a gaping mouth of puffy flesh. You work from bad to worse, washing your hands four times in between each. The next abscess is on her side, then her neck, the swelling on her scalp, was that four times, or three? Better be sure, then take the blade carefully, slip into her left foot, then the abscess on her ankle. Each is big enough to hide a yellow apple, a tennis ball, a golden Easter egg. Around the deflated cysts, her purple skin looks burned.
Finally, the thigh. This is the largest and deepest, the closest to a major artery. Breathe in, close and open your eyes. The blade, drawn gently along the crease under the swelling is not doused in the instant run of creamy yellow. The pus here is thick, it's been there longest. Some dribbles down, and you push back the flap of skin to scoop out the rest, coagulated and dark yellow, the consistency of brie. You could bury your fist in the open pit. The nurse is finally staring.
Step back, let her clean and pack gauze inside the hollow. It will take at least two rolls for just that one, and each dressing will have to be changed every few hours. If the woman doesn't have any other complications for the next 48 hours, she might live. Try to imagine what her grandchildren look like. You can't.
Your colleague opens the door to the staff smoking area and comes to stand over you where you are squatting against the wall. Don't turn, just close your eyes against the late sun's heat.
CAT scan's in, he says. Left kidney's abscessed, the size of a grapefruit.
Press your lips. Drag in, hold, out. Ask, Can we drain it?
No. Too big. I called the surgeon, he says.
Focus on the hot concrete stoop. It's been baking in the sun all day. The slow heat burns through your shirt against your back, surreal after the freezing ICU.
You say, She won't make it then.
Your colleague shrugs. She might, the guy's good –
She's fucking sixty-seven. She's a diabetic.
He hesitates, lowers himself down next to you. It's 8:15, he says. You should go home.
Ignore him. Ask if the daughter knows what happened.
She and her kids went on vacation, he says. They checked on grandma before they left. She was happy, watched a lot of TV. Said they came back, went to bring grandma a snow globe, found her like that. Must've been in bed for days, her sheets were crusted with blood and pus. She probably wore her shoes too long, got a blister, got infected, and it spread. You know. That's how it happens.
Silence. He lights his own cigarette. Drag, exhale. I'm sorry, he says. This is shit, this is all just miserable shit.
You stand, I'm really tired, you announce and the sun stares back at you.
Go home, get some food, some sleep. Your colleague squints. You'll feel better tomorrow.
Suck in air until your lungs are straining, then take more, hold it, let it leak out. Say, No, tomorrow it'll just be someone else.
C'mon, you know you can't think like that.
You ask him, Don't you ever wish we could just cure everything and be done with it?
He frowns, says, Well yeah, but that's pretty much what we're doing.
He asks, Isn't it?
Your wife greets you with a spoon in one hand, the sanitizer bottle in the other. You called to tell her you weren't hungry, but she never believes you.
You say, thanks, but I think –
DADDY! The baby shrieks and comes scrambling down the stairs, stark naked, wearing only your wife's pink high heels, finally covered in chicken pox. Daddy, take pictures of me now!
Your wife starts toward her, frustrated, but you touch her arm. No, it's ok, you say. I'll go find the camera. I'll be right back.
You walk back to the bedroom and quietly shut the door. You carefully lower yourself face first onto the bed, a reverse push-up into the waiting mattress, arms shaking. You roll to lie on your back, mouth slacked open, arms at your sides and feet limp at the ankles. You face the closet, where you know the camera is inside on a shelf, but you turn to the other wall. Your wife talks in low tones, herding your daughters back upstairs to their rooms. The baby stomps and whines, wanting her photos. You imagine she has been waiting for you all day, and you feel more helpless than ever.
In bed, you think of the baby in her mother's shoes, covered in angry red bumps, an anthill sacrifice. The picture of innocence to keep a parent awake. You realize, holding the image closer, what it is you have to do. The cure. You rise, careful not to wake your wife, and drift gently from room to room, gathering – your daughter's bedrooms, the kitchen, the garage – until you have what you need.
Sit in the soft dark of the living room. Wait until your eyes adjust. Here are the green walls you thought were worth bickering over. Here is the rocking chair from your grandfather's estate, the plaid couch that has seen the birth of each daughter. There is your reflection in the TV screen as you kneel above the pile you have made of all your daughters' shoes, your wife's, your own. Here is the sharp rising smell of the gasoline, the lighter held at eye level, your idea, the crouching potential. Here is the moment of hesitation, that breath before the push in, the space of choice you hate.
Your wife makes a noise in her sleep. Is it your name? Don't turn, don't sit back on your heels, gasping. Stand, and let the silence flow out of your ears like sand to fill the space around you.