On Rotation(97)

“What chamber is this?” she asked, apparently not too tired to pimp me.

“The right ventricle,” I said. “But . . . it looks weird. Is it just the angle, or . . . ?”

Bethany nodded.

“You’re right. It’s not supposed to look like that,” she said. “It’s huge. His lungs are toast, and they’ve done a number on his heart. His kidneys haven’t shown any sign of recovery. That’s three major organs down, not even counting the pressor requirement.” She tucked her lips into her mouth. “You’re close to the family, right?”

I understood what she was saying, but her unspoken request still sent me into a panic.

“Yes,” I said in a small voice.

“I sent an email to your attending this morning,” Bethany said, suddenly gentle. “I cc’d Dr. Milner. We asked if he didn’t mind you missing rounds upstairs today. Figured all of this could still count as part of your education.” She gave me a sympathetic look. “I’m sorry. Are you familiar with goals of care discussions?”

I nodded, my mind racing as I tried to put together my plan of action. Abuela already understood that her son was dying, but did she understand that the next step—the manner in which he died—was up to her? That she could accept him as gone and allow the team to switch their focus to alleviating his suffering . . . or hang on till the last possible second, pummeling him with drugs to raise his blood pressure, dialysis to drag out his fluids, compressions to bring back his heart when it inevitably stopped? Suddenly, I felt like an imposter, a wee medical student playing doctor. None of my shelf exam practice questions could have hoped to prepare me for this.

“Can we get an interpreter?” I asked.

Bethany shook her head.

“Not an in-person one. They don’t work weekends.”* When I groaned, she added, “You can still use the phone one?”

I could have laughed. The grainy telephone line? To deliver news like this?

I texted Ricky. The old thread had long been deleted, and our new one was formal and impersonal (Are you here? Yes. What do you want from the cafeteria? A grilled chicken sandwich, please. Thanks.) and my new addition was no different.

Where are you? I typed.

I found Ricky sitting alone in the family room, his laptop balanced on his crossed legs. When I opened the door, he looked up, greeting me with a grim nod.

“What’s up?” he said, lowering his headphones from his ears. He had bags under his eyes; I doubted he’d slept much all night. I sat down on the couch diagonally from him, trying to formulate the words. How did you tell the man you loved that his father, estranged or not, was dying? Where was the guidebook for that? Thankfully, Ricky seemed to understand why I was there, because he snapped his laptop shut and put it on the cushion next to him.

“There’s nothing left for them to do,” I said, getting straight to the point.

Ricky wiped down his face with both hands. His left leg bounced, and I listened to the sound of his jeans jostling for a long minute.

Then: “So this it, then?” he said. “He’s dying.” When I nodded, he let out a shuddering breath. “Shit.”

“I know,” I said.

“There’s nothing else they can do,” Ricky said, his tone taking on a frantic edge. His hands delved into his hair and gripped, and I watched him, helpless. “They can’t just . . . suck whatever is in his lungs out?”

I bit my lip, shaking my head. It’s the inflammation, I thought. His lungs attacking themselves. They’re supposed to expand, like little balloons. Right now, they’re like pumice. You can’t suck that out. There’s no reversing it.

“It doesn’t work like that,” I said lamely instead, but Ricky didn’t seem to hear me, still lost in his anguish. Eventually, he braced his elbows on his knees, folding his hands together in front of him.

“Okay,” he said. “So now what?”

After a deep, weary sigh, I told him what was left to be done. The longer I spoke, the queasier Ricky looked, his body tight and still with tension. When I was finished, he crumpled forward, dropping his face into his hands.

“You think we should tell them,” he said.

“I can say it in English,” I said. “You can translate. We can have the interpreter on the line to help out if you get stuck.” I looked at my feet, doubt burning the back of my throat. “Unless, you think we should get the team to do it first—”

“No,” Ricky said quickly. “They can come after. They should hear it from us first.” Then he added, quietly, “They trust you. It’ll be better this way.”

I looked up at him, watching his knee begin to bounce again. I remembered a story he’d told me, not long ago, after we’d finished the first season of One Punch Man. I’d been sitting on my couch, he on the floor next to me. The story featured an eight-year-old Ricky, chubby, naive, and, like many little boys, completely obsessed with his father. Back then, Gabriel had seemed like the coolest person on the planet: suave, stylish, capable of giving Abuela what-for when she was being unfair. Gabriel had picked Ricky up and taken him on a rare trip to Chuck E. Cheese, setting him loose on the arcade with an unlimited pass. Ricky had set his sights on a scooter high up on the shelf of prizes, worth more tickets than he could have dreamed of earning, but somehow at the end of the day, Gabriel had procured it.