Sensing Light (5 page)

XI

W
AITING FOR HER DAUGHTER
outside of Proctor, Gwen saw Eva's new teacher open the school's front door. When he had been introduced to parents during the tense meeting after Eva's old teacher abruptly quit, she had appreciated his engagement and composure. His strong jaw, impish smile, and lithe figure didn't escape her attention either.

He must be a dancer or a runner, she thought. Probably younger than me, but not by much. He might not be gay either.

Eva's teacher recognized her immediately. She imagined touching his chocolate skin, his closely sheared, woolly hair. Aware he had glanced at her bare left ring finger and was looking at her with more interest and enthusiasm than a fourth grader's mother should expect, she blushed.

“Eva's mom, right?” he said eagerly.

“Yeah,” she whispered.

Hoping he wouldn't think she was imitating some sultry film star, her blush deepened. For God's sake, she thought, he'll only be her teacher until June.

“Mr. Parsons, right?”

“Just to the students. I'm Rick.”

“OK. Hi, Rick.”

“Hi..?”

“Gwen.”

“Gwen,” he said, clearly taking pleasure in pronouncing her name. “So… Eva's doing well here.”

“I can tell. She likes school. She likes you, too.”

“The academic part is easy for her,” he said, lowering his voice professorially. “That helps a lot.”

Seeing a giddy sparkle in his eyes at odds with such an earnest assessment, she was emboldened to move beyond talking about Eva.

“So…is this job fun for you?”

“It is. Doesn't pay well, but it is fun. Plus, I get to do something useful. At least I'm not making bombs.”

And there was the grin she was anticipating. Gwen crossed her arms, looked down, and giggled.

“You like what you do?” he asked with an intensity that could hardly be misconstrued as making idle conversation.

“I do. I'm proud of it, too.”

She met his eyes again and thought how wonderful it would be to have this in common—enjoying your work and feeling it made a positive social contribution—how much it would help in building sustainable intimacy. She remembered once sharing that bond with Daniel. It was the main reason she agreed to marry him. What a mistake that had been. But this man didn't take himself so seriously.

As Rick started to ask what she did, Eva stomped between them. She scowled and dug a shoulder into Gwen, knocking her off balance. Gwen regained her footing and gave Eva an exasperated frown.

Though tempted to say, “Use your words, Eva, instead of hitting,” she realized forbearance would make a better impression than treating her daughter like a four year old.

“How was your day, darling?” said Gwen, her sarcasm unconcealed.

“Fine,” Eva growled.

Smiling at Rick, Gwen said, “I think this girl is tired.”

“Yeah,” he agreed wistfully.

“See you.”

Eva took her hand as they walked toward her car.

“Bye,” he sang out to them.

I can wait until June, thought Gwen. Hope you can.

After cleaning the dinner dishes, Gwen plopped on their overstuffed couch, purchased at a flea market. Eva crawled onto her lap and braided Gwen's hair, blond when Eva was a baby, now sandy brown. At eight o'clock, Eva jumped up to turn on the television set. While her focus was on the screen, Gwen watched her laugh at the situation comedy. Eva had Daniel's loose
black curls and aquiline nose and was as quick-witted as her father. Unlike Daniel, she could appreciate the humor of others.

Eva leaned forward in anticipation of her favorite moment, when the loveable bigot would call his son-in-law “Meathead.” Gwen marveled at how much happier Eva seemed than she had been at this age. What would Eva's favorite memory be in twenty years? Watching television at night with her single, working mom? She hoped Eva would have better than that, but laughing at Archie Bunker together would be good enough.

Gwen's best memory from fourth grade was reading alone in her bedroom. That was the year her family disintegrated and she started working hard at school so she could eventually escape to college.

At the first chords of the show's closing theme, Gwen said, “Time for bed.”

Eva did her Frankenstein imitation, arms stretched out, legs stiff, rocking from side to side. As Gwen guided Eva to the bathroom, she thought of how “time for bed” might sound if said seductively to Rick.

“God, I'm pathetic,” she muttered.

Eva went to sleep, and Gwen lay awake listening to her favorite jazz cassette. She loved the piano's quirky melodic line, its unexpected shifts in tempo and key, the naked emotion of the music. She wished she had someone to snuggle next to, someone comfortable with life's capriciousness. This made her think of Daniel, a man with no tolerance for uncertainty. Her fantasy was replaced by resentment.

“What had I been thinking, marrying him?”

They met the summer of 1964 in Hinds County, Mississippi. Gwen, about to be a senior at Stanford, and Daniel, a law school student, were volunteers in a voter registration campaign. Sixty-seven black churches, businesses, and homes were bombed or burned that summer. Three volunteers were murdered by Klansmen. The danger bred fear, but it also fueled their idealism. Gwen was intoxicated by the political discussions and by Daniel, a master at debating the issues. She consented to marry him after graduation.

Their marriage fared well while the rigors of medical school and internship distracted her from Daniel's pettiness, the judgmental comments aimed
at her. She didn't fully understand her mistake until Eva turned one, and she was ready to find a job. Gwen wanted to hire a nanny. Daniel, now a public defender, was adamantly opposed. He wanted Eva in day-care, like working-class children. Their kitchen became a courtroom where she was pilloried for her reactionary tendencies and bourgeois conventions. Civility disappeared once Gwen, concerned that Daniel rarely held Eva, started criticizing his failure to bond with their daughter. His attacks on her selfishness and privilege escalated. The day he categorically refused to try couples therapy, she faced reality and began looking for an attorney. Daniel fought it like a death row case. It took them three years to settle the divorce terms. Meanwhile, both her parents had died. She used her inheritance to buy a two-bedroom bungalow in the Oakland hills.

Angry with herself for replaying the same old complaints and rationalizations, Gwen turned off the cassette. She thought about being a medicine resident. She wasn't ambivalent. She had to change her life. That decided, she fell asleep.

Just as the sky lightened, Gwen awoke from a dream. She had been in her childhood bed, almost asleep, when startled by loud noise. Her parents' voices were raised in argument, unheard of in this household. Over and over, they shouted, “Larry! Larry!”

The dream had been eerily precise. Every detail—the feel of her pillow and blanket, the plaid pajamas she was wearing, the pine odor of the cleaning solution her mother used to mop the floors—was identical to the real event, except for the name they had shouted.

Gwen's older brother, Jack, had been sixteen at the time. His temper was igniting at the least frustration. The morning after her parents' argument woke her, Jack slammed a window shut, shattering the pane. He was still upstairs when she left the house. At recess, a girl with an older sister at Pasadena High told her Jack had been suspended from school for fighting.

Jack's name continued to be shouted behind her parents' bedroom door. A week later, her father moved out of the house.

Jack went back to school, briefly. He was arrested for car theft and sent to juvenile hall. Her mother wept fiercely, but Gwen didn't offer comfort.
She was infuriated by her mother's incompetence and terrified of the consequences. Jack was a criminal, her father had abandoned them, and her remaining parent was falling apart.

After three months in detention, Jack came home. Her mother wouldn't discuss Jack with her, yet she demanded Gwen's presence whenever she spoke to him, leaving Gwen to wonder if she needed her daughter's moral support or simply a witness in order to confront him. The same day Gwen received a letter from her father announcing he was divorcing her mother and moving to New York City, Jack informed them he had flunked out of high school.

Her mother finally took a stand. She refused to give Jack spending money. He got a job as a dishwasher in a drive-in restaurant. Jack had odd hours and often didn't return at night. Then he stopped coming home at all.

When Jack eventually did reappear, his lips were dry and cracked. His hands trembled, and he smelled of vomit. The few words he said were untethered to each other. Her mother sat speechless, dabbing her eyes.

“What are your plans?” Gwen asked him meekly, prepared to receive a volley of verbal abuse.

Head down, Jack didn't answer. He gave her a furtive, hangdog glance.

“Please, Jack. We need to know.”

“I'm going to enlist,” he said, staring at his plate.

“Enlist?”

“In the army.”

“Why?”

“So I won't have to steal to pay for brandy. Sooner or later, probably sooner, I'll get caught and go to prison. No juvenile hall next time.”

“How will joining the army help?”

“I can't drink, except when they give me a pass. Then I can use my paycheck to cover bar bills.”

“That's silly. You don't have to join the army to stop drinking.”

“Easy for you to say,” he snarled. “You don't have to live with being like this.”

The next morning, they drove Jack to a recruitment center where he boarded a bus for boot-camp in the Mohave Desert. Gwen saw him once
more. He came to her high school graduation dressed in a spotless, starched khaki uniform. They corresponded by letter afterwards. She was certain he would have come to her college graduation too, if it hadn't been for a sniper's bullet in Vietnam.

XII

K
EVIN WAS BACK IN
the ICU at dawn. He found every oxygen reading from Larry Winton's arterial blood line had been less than fifty since midnight. Larry's cheeks were the dusky grey-blue of dying violets. It was miraculous he hadn't died yet from a cardiac arrest. Kevin adjusted and re-adjusted ventilator settings, without seeing any improvement.

After rounding with his interns and student on the team's other patients, Kevin returned to the ICU to write a progress note. Slumped on a stool, he transcribed data onto a clean sheet of lined paper—breathing and heart rates, sodium and potassium levels, blood carbon dioxide and oxygen pressures. As soon as he finished listing the facts, he was defeated. All he could write in the “Assessment” section of the note was “Idiopathic pneumonia. Grim prognosis.” Neither Kevin nor any of the attending physicians involved in the case could explain the cause of Larry Winton's impending demise.

Twenty-seven years old and a benign medical history, Kevin thought. OK, he used to shoot drugs, but that was years ago. He was gay, but why would that matter?
What did I miss?
Previously healthy twenty-seven-year-olds admitted to the hospital do not die unless the house staff royally blow it.
Shit!

He wrote “Plan” and left the rest of the page blank. His only plan was to wait for Herb to bring news from pathology and deliver an opinion on whether this patient's life might be salvageable.

He looked up as Gwen was entering Larry's room. He saw her flinch on discovering Larry paralyzed and comatose, an endotracheal tube in his nose, a gastric suction tube in his mouth. Still, Kevin was glad to see her. He wanted to commiserate.

“What did the bronch show?” she asked when he appeared at the bedside.

“Not much. More confirmation it's not bacterial pneumonia or TB. There are still some special stains pending.”

“God, I completely blew it. He was in my exam room two weeks ago. Our social worker would have given him a taxi voucher to come here the same day if I'd just asked.”

“Hey, we're all in the dark. Herb and Flagler don't even have a good guess as to what the diagnosis is. If nobody can figure out why he's dying, a delayed diagnosis doesn't change the inevitable.”

“Thanks, Kevin, but if a bronch had been done two weeks ago and it was negative, you'd have had time to get a surgeon to do an open lung biopsy before he was this far gone.”

“Maybe,” he conceded, chastened by having underestimated her clinical acumen, “though elective OR procedures like that get pushed back for days by all the trauma cases coming here. Actually, I'm afraid we're going to find something I should have thought about when he first walked in the ER door. That'll be on me.”

Gwen nodded sympathetically then frowned.

“Then the two weeks before that are on me.”

“I don't think so. The bar is totally different for a clinic doc. You'd need ESP to pick out the one in ten thousand patients with a cough and weight loss who's going to turn out to be a zebra
and
crash like this.”

“Maybe.”

She looked at the ICU entrance and said, “Uh-oh.”

Kevin turned around to see Herb marching toward them. He jumped up to intercept Herb at the nurse's station.

“What's his arterial oxygen?” Herb demanded.

Herb had never spoken to him so curtly. It unnerved Kevin. He responded immediately, forthrightly, as he had when a schoolboy, caught red-handed committing a venial sin by one of the nuns.

“It's been in the forties since midnight,” Kevin confessed, half-expecting Herb would order him to say thirty Hail Mary's.

Instead, Herb's shoulders sagged. Head bent down, he whispered an expletive. When Herb lifted his gaze, Kevin saw no anger, only resignation.

Gwen joined them. Herb mechanically acknowledged her presence.

“The silver stain is positive for Pneumocystis,” said Herb.

“That's what the path showed?” said Kevin in disbelief. “Isn't Pneumocystis a parasite?”

“That's right.”

“I thought it just occurred in immunocompromised people?”

“Exactly.”

Gwen, who knew even less about Pneumocystis than Kevin, asked if the infection could be treated.

“We can give him trimethoprim-sulfamethoxazole. Though at this point, it's not likely to make a difference.”

Holding up the blood gas printout as evidence, Herb added, “He's had so much lung destruction, the odds of his ever getting off the ventilator are nil. And with these numbers, he's had enough hypoxic brain damage that if he does survive, it'll be in a vegetative state.”

Kevin and Gwen reddened simultaneously.

Gwen stared at Kevin. How could he possibly think it was his fault now, she asked herself.

“Guys,” Herb said gently, “treating Pneumocystis pneumonia is just winning a battle. You still lose the war if the underlying immune deficiency can't be reversed.”

Neither Kevin nor Gwen was mollified.

Herb looked away and said, “You're right. There's no good excuse for losing a patient to a treatable infection, especially when it's one you've seen before.”

Gwen's remorse was supplanted by amazement. This senior specialist had just taken on the entire responsibility for Larry Winton's imminent death, while two other candidates stood by, ready and willing to accept the blame.

“You're sure it's Pneumocystis?” asked Kevin, his eyes deflected downward.

“Think about it. The x-ray appearance, the time course of his illness, the negative micro studies, no history of an autoimmune condition to account for his lung disease. At NIH, I saw kids with leukemia who developed Pneumocystis pneumonia on chemotherapy. Clinical course and findings
exactly
like this case. Which is why I asked the lab to do a silver stain on the bronch washing. They thought I was nuts, but the slide had textbook cysts. Lots of them. Of course, that raises the question of why the hell this young
man's immune system wasn't working. He wasn't getting chemotherapy. He wasn't getting steroids. He didn't have a history of serious infections like someone with a congenital immune deficiency would have. It doesn't make sense.”

Perplexed, Gwen nodded in agreement. Kevin went off to retrieve the chart and began writing a medication order for trimethoprim-sulfamethoxazole. As he asked Herb about the dose, she returned to Larry's room. She watched the monitor tracking his heart's electrical activity. A white dot moved across the screen, forming a series of identical waves. Suddenly, the pattern disintegrated into chaotic spikes.

“Code Blue!” she screamed.

Kevin rushed in, followed by Herb and two nurses. The white dot now made a flat line as it crossed the screen. Reflexively, Kevin stacked the heels of his palms over Larry's sternum. Arms outstretched, he rocked up and down until he saw Herb shaking his head mournfully.

Kevin stopped rocking. He looked at the wall clock. He was supposed to say the time of death out loud. He couldn't make himself do it.