The Queen of Hearts(50)

She was twenty-seven. She was pregnant.

Again, I felt the nausea rise as I thought of my carelessness in preparing for the intubation. “I do and I don’t,” I said to Graham in a tiny voice.

“It’s okay if you want to tell somebody,” he said. “I think it’s making you sick.”

My tears surged up, little balloons of shame against my closed lids. An indeterminate choking noise escaped me.

I felt Graham slide over, and then his big arms were around me. “What I did, it’s unforgivable,” I told him, my tears wetting the front of his soft flannel shirt. He was quiet, patting my hair gently from time to time until I got ahold of myself. I could hear his heartbeat, a steady, distant, reassuring thud.

“Nothing’s unforgivable, Zadie,” he whispered.

I shuddered and closed my eyes. We sat like that, lost in our separate reflections, until my voice was steady enough to talk. Graham listened silently to my account, his face hardening as I talked.

“How could Dr. X—” he began.

“What’s wrong with Zadie?”

We both looked up, startled. I scooted out of Graham’s arms. Emma peered down at us, undoing her pinned-up knot of hair, releasing a buttery flow of silk. With her pink cheeks and swimming-pool-clear blue eyes, she looked like an arctic beauty queen.

Graham gestured to the futon. Emma sat down beside me, primly perched at the edge, her head half-cocked. “Are you okay?” she asked.

I shook my head, knowing if I tried to speak, I’d start wailing again. I glanced helplessly at Graham.

He leaned around me toward Emma and, in a low tone I could barely hear, filled her in. She listened, quietly at first, and then with increasing incredulousness.

“Zadie, none of that is your fault!” Emma sounded appalled. “Where were the respiratory therapists when this happened?”

“He asked me if I had everything ready, and I said yes.” I shut my eyes, remembering. “It was just the two of us; there weren’t any RTs there. Ni— Dr. X knows all about ventilators; he gave us the lecture on ventilator management, remember? We paged them, but he got tired of waiting and told me to go ahead. So I did.”

Emma jumped up. “Dr. X holds one hundred percent of the responsibility there. He never should have attempted a complicated intubation in a pregnant trauma patient without the respiratory techs present, let alone tell an absolutely ignorant third-year medical student to ‘get everything set up.’ And the truth is, that girl was never going to survive anyway.”

“You don’t know that,” I said miserably. “I kept pestering him to let me do it. I thought I knew what I was doing, and I didn’t. And he probably only let me do it because . . .” My voice trailed off. I didn’t have to say what we were all thinking. Nick had let me do the procedure without adequate preparation because I was sleeping with him.

“Anyway, the short version is, I messed it up. I failed that patient.” I spoke quietly. I thought of the suction I hadn’t hooked up, the disconnected oxygen. “It turned out her airway was swollen. I couldn’t see anything at all when I looked with the laryngoscope. Her lungs were already trashed, so she didn’t have any reserve. He finally did it somehow, but . . . she died a few hours later, when her family decided to pull the plug.”

I hesitated and then gave voice to the thought I’d been trying to suppress:

“I don’t think I can be a doctor now.”

Graham and Emma began speaking at once; Graham’s voice was steady and quiet, Emma’s higher-pitched and insistent. Graham deferred to her and went silent, both of us absorbed by her vehemence. She swung in my direction.

“Listen to me, Zadie.” Her eyes bored into mine. “I could go on and on about how none of us are perfect, how everyone makes mistakes, and all of that shit. It’s trite, but it’s true. And in your case, she was going to die anyway, and I don’t think the responsibility lies with you. But regardless, there’s good that will come from this terrible thing. And it’s not you giving up a career you’re going to be great at.”

I dropped my eyes.

Emma twisted until I looked at her again. “Maybe none of us can be truly gifted at medicine until we’ve grasped the consequences of what we do. In most jobs, most of the time, you can put in a half-assed effort and the world isn’t going to stop spinning. But in this case, the world did stop spinning, at least for one person—two people, actually. It’s not enough to understand intellectually that lives depend on you. You have to feel it; and maybe you have to experience the crushing weight of responsibility that comes with all the accolades and respect and financial comfort accompanying medicine. You’d be a brilliant physician and a caring one no matter what. Now you’ll be the most conscientious doctor you can be, because you know what it’s like to fall into the depths. Maybe it seems easier to quit at this point, but, Zadie, you owe it to her to keep going.”

I tried not to cry again—all this crying was getting really old—but there was no stopping it. I recognized some truth in what Emma said. But even if there was a silver lining, the thought of benefiting from the grotesquerie of someone’s death in any way seemed monstrous. I thought of the way she’d looked—her delicate jaw, her dark hair fashioned in a pixie cut—and misery swamped me so thoroughly I wondered if it was possible to die from it. I cried, feeling as cut off and alone as it was possible to feel, spinning away in my own little joyless universe.