I think my drummer has Asperger’s.
Don’t get me wrong. I love the man. It wouldn’t be too far a stretch, in fact, to call him one of my best friends. But in a contingent sort of way. Like the way I call my wife the same. When she’s not compelling me to punch my fist through a wall.
Or maybe Asperger’s is too harsh, too clinical, too forced an attempt to cram the shape of another human’s idiosyncrasies into a hole with a name. What I mean to say is he speaks his mind. Without a filter. About things everyone without Asperger’s knows nobody else wants to hear.
Fuck that. I’d shut it down. Protect yourself. You and your family are all that matter.
But what about the patients?
Fuck them. Let ‘em burn, with their contagion and disease. You think they wouldn’t do the same to you?
I considered the question, angry that doctoring had wedged its way in even here. Amongst the E-minors and the War Pigs and the 30-minute jams in which finally, improbably, every detail of the world locks into its perfect and proper place. I stared at the burning joint between his fingers, the barriers we erect to separate this world and that. The silver strand of smoke weaved its defiance upwards against gravity, dense and opaque at its base, thinning out and fading as time stretched. I stood hypnotized, straddling two worlds that shouldn’t mix, two worlds that equally belonged to me, caught between the who I should be and the who I sometimes am.
No, they wouldn’t do the same. They would stand and fight, risk themselves for those they were meant to protect.
And so, I did the same. Not because I disagreed with him. But because it was more complicated than that. Choice and what’s right isn’t so black and white as kicks and snares. And, if I’m really being honest, it would have taken more effort to stop, to rip free from the current of this river I both chose and chose me.
And so, every weekday at noon, we swab patients for the disease. They sit in their cars as their A/C’s drip black on the pavement. And we stand in their wet with our shoe covers and virus-proof suits. They cough and we hide. Behind our masks and our shields and our denial and our hope. The windows roll down. We jab our swabs in their nose. They gag. We probe deeper. They recoil. We twist longer. Their noses drip. We hold our breaths. Their faces sweat. We shut our eyes.
The windows roll up. The cars pull away.
And then we can breathe.
We tear off our gowns. Peel back our gloves. Rip off our shields and our goggles and our masks. We scrub our hands. We scrub our arms. We splash water on our face.
Only then are we safe.
And then we wait. The doctors. The nurses. The sick.
Then, the results trickle in. Positive or negative, black or white.
Smitty rolled in by ambulance early in the evening. It was a slow day. Time to do my rehab. Time to start a new book. Time to watch a stupid comedy that made me forget for 90 minutes I hadn’t seen my family for 3 nights. It had been a few hours since my last real patient. Mahealani. A 15-year-old with diabetes and a rebellion that fit her age. I had seen her 3 times this year for diabetic ketoacidosis, DKA for short. But this time was the worst. And so, I had sent her to Kapiolani with a blood pH of 7.0 — too acidic to sustain life. I could still see her smile, her innocence, her eyes so full of dreams. Sassy. Falsely confident. And a little bit afraid. I marveled at it. Her unmasked face. Her corniced lips. Her perfect skin unique to youth. I remembered she wouldn’t keep her mask on. It dangled diagonally off one ear like a one-shouldered backpack on a kid that’s too cool. But I didn’t mind. She was low risk. DKA. No cough, no exposures, no fever. Mahea was from the world of before.
The phone rang. It was the nurse, just outside the call room.
Ambulance is bringing in a guy they might code.
What’s he got?
Maybe an allergic reaction. They don’t know.
Past history?
Don’t even know his name.
How long?
Two minutes, but that was 20 seconds ago.
I grabbed my mask, the one I’d been wearing all shift. One of the cloth ones that aren’t good enough. The ones we all wear. To the grocery store. To buy beer. To pick up our kids from the surf but not their friend’s houses and not from school. The ones on the faces of our friends we don’t recognize, the ones we don’t hug if we do. The ones on the uncles whose hands we don’t shake. The ones on the aunties whose cheeks we don’t kiss. I miss their smell. It used to remind me of Mom.
One minute, 20 seconds. An ocean between my now-racing mind and that comedy, the one in which the squirrely protagonist invited the wrong girl to Hawaii on their second date. Maybe an allergic reaction. A guy they might code. The two didn’t connect. Elevator thoughts, a professor used to call them. The pre-game silent dialogue in which we doctors indulge. Waiting. Rushing. Standing still in the elevator. On the way up to the floor. They never moved fast enough. Those elevators and their still-shut doors.
On Molokai there’s no elevator. Just the call room door. The storm outside.
I twisted the handle. Took a step. That’s when I saw them. Like bouncing balls of oil all skittish on their wok of fire. They donned gowns. Put on hoods. Adjusted goggles. Tightened N-95’s. They lowered their face shields. Pulled at rubber cuffs. They stretched their gloved fingers into their second pairs of gloves. Latex snaps like saltless popcorn between the pregnant sterile halls.
You gotta protect yourself. These nurses and CNA’s and receptionists heeded my drummer’s words. I thought of them now, these young women, beyond the scene in which they played. Their husbands, their boyfriends, their moms and their grandpas, their aunties and dads. I thought of the boy named Oden who had blond hair and wide eyes. He was five. I had sat behind him and his mom, one of my nurses, on the puddle jumper from Moloka’i to Oahu on my last trip home. Oden had sat in the front row. Right behind the pilot. There was no door on the cockpit. Oden could see all the levers and gauges, the window full of sky and a thousand million knobs.
One minute. An allergic reaction. In a guy they might code. I wrestled my mind back to its training. Pushed the humanity and its fear back behind the what’s-next. Nothing made sense. Not the story. Not this new world.
I ducked back into my room. Ripped the cloth mask from my ears. I secured the N-95. Pulled the straps on my goggles tight. I lowered the face shield. I took a breath. It felt as if breathing through a long rubber hose. My lungs relaxed. Their humid pink air sacks filled my vision with fog.
Fuckin’ Covid. This job was hard before.
Smitty hit the door like a 247-pound bomb. Bile-soaked vomit bubbled like lava from his purple swollen lips, oozing down the leeward ridge of his right cheek and dribbling down his chest. His eyes were rolled backwards, empty of whatever it is that fills this life. There was blood was on his T-shirt where the paramedics had ripped out the dialysis catheter from the Gore-tex sleeve buried within his skin. Haunted death groans escaped his mouth. Nervous firemen in yellow smoky coats. Two EMTs, familiar faces over all these years, with only question marks in their tale.
What’s the story?
Don’t know much. Found him at dialysis like this.
Past history?
Renal disease. That’s all we got.
Name?
Working on it.
What’d he get?
Benadryl and Epi. Dialysis nurse thought it may be an allergy.
Allergy? Allergy to what?
They looked back with the same opaque stare. They had no more secrets to share. Time was up. The elevator doors had opened. Now was my time to brave the storm.
Get suction. And another IV. Let’s give him another Epi, subcu. And 125 of Solumedrol, IM.
One nurse flicked a switch on the wall. The throaty slurp of a vacuum pulled at chunks of vomit, sucked at time. Another nurse fumbled with a vial of epi and a syringe. A nurse’s assistant worked the monitors, peeling paper from sticky pads of gel, reaching beneath the vomit and blood in search of a piece of skin on which they’d stick. I listened to his lungs. Tight. Wheezes like a still night’s leaves. His barrel chest flexing, heaving, failing. The sun-leather face of another Native Hawaiian whose life slipstreams away.
Get me two amps of albuterol. I don’t think it’s Covid. We’re gonna nebulize him. Either that or we tube him now.
I looked from his face to the monitor. O2 sat’s at 84, 83, 82. I didn’t want to tube him. We didn’t have access yet. And I couldn’t knock him out without an IV. Besides, there’s a line you cross when you tube a man. Or, to be more exact, in the moment just before. When you push the meds to paralyze, when you relax the muscles of the jaw but so too the muscles needed to breathe. It’s like grabbing the steering wheel from the wrong seat. His life becomes yours to lose. And the will another man holds on his life is rendered helpless. Like a thought without a tongue. And then of course there’s that voice. The one inside that doubts, that questions, that fears. Its whisper in your ear above the monitor’s beeps and the frantic chaos and the ripping screeching vacuum that sucks on fleeting time. What if I miss? What if I can’t pass the tube through the cords? What if he’s paralyzed and he dies and it’s on me?
But nebulizing him carried a heavier risk. Not for the patient. But to them. To us. What little we knew about Covid warns us to go against our instincts and fears and take the wheel early. Tube ‘em right away. And never, ever, give them neb’s. It aerosolizes the virus. Spreads it like paint splatter from a spinning wheel.
I don’t think it’s Covid, I said again. If anyone thinks I’m wrong, you can step outside.
So many lives on the pinpoint of an intuition, a hope, a guess.
The second nurse was still fumbling with the second epi. He had raced to get the Solumedrol, a steroid, when I’d barked too many orders at once. I watched his fingers struggle with the tiny bottle, smaller than a newborn’s thumb. The vacuum’s ripping like a hurricane. The gurgling of primal life as it fights against the heavy gravity of Death Itself. I grabbed the epi from his hands. Pulled the needle from its plastic sleeve.
I’ll push the epi. You prep the neb’s.
I drew up the medicine. Tiny bubbles like locusts, like fireflies against the Sun. The nurse scurried away. I wore my calm like a costume. He, his fear like a sin. The first nurse was still working the IV. Dialysis patients are famous for having no access. I jabbed the medicine in his arm without the alcohol swipe to sterilize the skin. Hawaiian arms as thick as tree trunks. Covered in inked thatch work, black triangles stacked in pyramids, weaved hala like the generations, pride and history in the koko that courses through. This whole island would know him, or know of him. That’s the Moloka’i way.
Get me the dialysis nurse on the phone. And another dose of epi. Get X-ray. I want a portable chest, stat.
Another needle through a rubber stopper. Clear liquid like hope in a volume too small to be significant. 247 pounds of life like an elephant on a string. Its fraying ends. Its hollow trebly twangs like a high E string when it snaps. I should tube him, a thought from the subconscious abyss, bubbling up through all the fear.
His wife’s outside.
Soon there would be more. I’ve stared into that sea too many times over too many years after too many situations just like this. My cheeks wet and eyes searching, my voice choking on hollow words that won’t come. It’s amazing how quickly those searching eyes find the one loved-one to whom it matters most, the one whose drip-castle universe is about to fall down. The heart as it turns to stone by only words, cursed words, imperfect words that I don’t want to say but I say them and all the stars they die, turn to darkness, and fall down.
Dialysis nurse is on the phone.
The purr of nebulizers and their steamy cloud. Anaphylactic lungs sipping at medicine like a cat’s tongue at the sea. My eyes to the monitor. His sat’s were improving, but not fast enough. I looked at the cloud that obscured his face. With each tiny breath it would disappear and then grow. Medicine in. God-knows-what out.
What’d you give him? To the phone. To the nurse on the other side of this panic.
It was the same story. Nothing new. But now I had a name.
Smitty! Can you hear me? Smitty! My knuckles like grinders on his chest. His eyes rolling back from the light that awaits us all. A clearing in the clouds. Two men’s eyes as they find the other, as they see.
Grgghhh.
A word. Unintelligible. But a word. My own voice too from so far away. As if beneath the surface. Through the panic. The responsibility for Smitty’s life that was mine. Through the face shield and the N-95 and through that concrete-thick fear. You’re gonna be alright, I told us both. I grabbed my stethoscope again, my own, another Covid faux pa. I could barely hear through the paper hood I wore on my head, the one to keep the Covid out. The disposable stethoscope only made it worse. I struggled to hear through the white fibers and the chaos, pierce through that barrier between Smitty’s truth and my own. I could hear his breathing louder better. Stronger wheezes meant more flow.
Two more nebulizers of albuterol.
If this was Covid, these neb’s would contaminate the entire department, the whole floor.
And close the door.
Wife’s still waiting outside.
Where’s X-ray?
I pulled the stethoscope from my ears. Draped it across my contaminated shoulders. Leaned forward on the bed’s rail. It was the first time inside the bubble that was Smitty’s. Inside his contagion and his dying. Inside his secrets and his disease. It was an incalculable risk. One with zero benefits. But maybe getting closer would prove the difference. Inside Smitty’s bubble, I hoped I might glimpse a clue that his guarded breath couldn’t, wouldn’t share.
In such moments, time slows. And then, time — flowing ceaseless time — it stops. And in that moment’s stoppage, something magical, impossible, occurs.
Space. Infinitely. Expands.
Thoughts fall away.
Just this massive presence.
This tremendous presence, shared.
The line between patient and doctor, sick and healthy, you and me fades away.
And the universe, once three-dimensional and thick and so cluttered with countless planets and bursting stars and voracious holes, it spreads out. Like a canvas laid flat. And me, no longer within, but floating above. I could see all the paths that lead from here. All the afters. All the befores.
And still, my drummer, the one with Asperger’s, the smoke he’d passed me that keeps messing with my head. Blurring lines. Mixing two worlds that shouldn’t mix. The what with the why.
Fuck that, he’d said. I’d shut it down. He was talking about the clinic. There it’s safe. But here. Here it’s not.
The sucking vacuum like a jet’s growling engine, turning the fresh air of safety and before to failure, hero, relief, anguish, loss, pride, death, life. So many paths. They all lead from here. Monitors as they beep. Smitty’s wife waiting, desperate, outside. The clock and its circles. Numbers on a screen. 89. 90. 91.
X-ray’s here.
Let her in.
Smitty!
His eyes now on me.
Do you have any pain?
Where am I? How’d I get here? His voice through the mask’s hiss, through the suction, through the beeps. Where’s my wife? Through the fog and face shield. Through the double ear drums of the paper hood. Beneath the goggles. Past every other path whose threads hang dangling, falling, fading away. Time starts anew. Space reforms, inflates to three dimensions, takes on its proper shape. And all that could have been, all that would have been, falls secretly, silently, away.
Thank God.
I walked out the door. Peeled off my gown and hood and gloves. Washed my hands, my wrists, my arms. I took off the shield. Tore my goggles from their straps. I threw it all into the sink where they’d be bleached and dried and given back. That fucking N-95. I looked at it there, green and sinister, next to the computer, on the desk. I gulped at the fresh air as a broken man does his first drink, acutely aware of all that Covid chokes off.
I gulped at the delicious air, at this life.
Smitty didn’t have Covid. How could he? The island hadn’t a case in over a month. He hadn’t traveled. He had no fever. Had abided the orders to stay home. And even if he had, we had taken every precaution. The gown. The hood. The goggles. The face shield. The N-95. The one exception was the nebulizer. And my own stethoscope that lay tangled with my hood and gown in the sink. So much destiny on a whim, a probability, a calculated guess. But we had protected ourselves. Mostly. Even if he did have it, we would probably be safe.
Dr. Rogoff, Kapiolani ICU is on the phone.
This is Dr. Rogoff.
Yes, Dr. Rogoff. This is Dr. Sengwathi from the Pediatric ICU. I’m calling about the 15-year-old girl with DKA you sent over a few hours ago.
I had forgotten about Mahea, the sun-freckled daisy from the storm’s other side. Most type 1 diabetics only get DKA once or twice in their careers as patients. But stable sugars require a stable home. Mahea had logged over a dozen in just three years. The last few times I kept her here. Over the hours it takes to correct all the numbers, I had come to know her well. I liked her. I think she liked me. But sometimes DKA is life threatening. And so, I’d shipped her to the pediatric hospital on Oahu. If Mahea’s condition worsened, I wanted her under the care of doctors more real.
Yes, Doc. Mahea. Thanks for taking care of her. How’s she doing?
And before he answered, that little voice’s whisper, like nails in flesh, rakes on pavement. And that’s when I felt my heart drop past my guts and through the ground. Like an elevator whose cable’s snapped. Falling too fast to think thoughts. In their place, that primal swirl of emotions that we share with the beasts. I had dropped her sugar a bit faster than I would have liked. And given her fluid a bit too fast. Cerebral edema was a potential consequence. A swollen brain would be a catastrophe too consequential to justify as luck’s mistake.
She’s doing great. But I just spoke with my social worker. The reason she was with her birth mother and not her caregiver is that her father had recently come to visit. He’d been incarcerated just before that. There’s a nidus of cases in the Maui jail, as you may know, which puts him, and Mahea, at risk. I just wanted to let you and your staff know that we are running the PCR now and should have the results in a few days.
And then time’s stopping again. The flat and black universe stretching out. But this time things were different. I was no longer above but beneath it. As if underwater, the bending light thick, colors turned grey, so much weight. And hard as I tried, I couldn’t penetrate it, couldn’t push my fingers through the opaque skin of air on water, the mass of every atom and every life and every fear pressing down like all our fates.
Mahealani? Her bronze arms unspoiled by ink? Her pink lips with not even a hint of vomit? Her T-shirt untucked with no stain of blood or sin or real mistake?
And then, every domino that would fall. The nurses just out of school. Their husbands, their kapuna, their kids. Familiar faces in grocery-store masks. Each life like a tiny dot in the sky, a V-line of geese picked off by a shotgun’s blast. The snap of gloves. And little Oden in the front seat. The altimeter’s globe reflecting double in his eyes. The way it floats there in its own little aquarium, how it jiggles and spins and tells the pilots how to fly. The levers as they’re pulled. The wings slippery grip on the wind. That feeling in the guts when the ground falls away, the Earth turns to Sky, and every dream takes flight.
Sometimes I wish I was more like my drummer. The one with Asperger’s. The one that says the things we shouldn’t say.
Fuck that. Let ’em burn.