Upstairs, past midnight, when the pager quiets and the hallway lights are dimmed and the nurses’ stations take on the hush of night, Yael—my Yael—comes to visit. She’s in her scrubs, and tiny biceps protrude from her short sleeves. We’re up on the top floor of the hospital where the couches are arranged in pods and the floors are carpeted in motel blue, a place where the patients’ families congregate by day. At night, it’s ours. Yael sits next to me and our hips touch. She’s on her surgery rotation, and the slight speck of blood on her scrub pants makes her seem strong.
We’re sharing the women’s call room tonight, but I can tell from Yael’s face that it will be awhile before she lies down—she must have finally reached her parents in Venezuela.
“They’re okay?” I ask.
“Fine,” she says. Earlier today, a couple was shot in her parents’ neighborhood in Caracas—several blocks of mostly Jewish homes not far from the Hebraica—and the audio of the attack was caught on a cell phone and replayed on the news. Yael and I were late for morning rounds, sitting at the computer, listening to the attacker’s anti-Semitic rant, listening to the clicks and blasts, the shouts. Yael has been wanting to call her parents all day to see if they knew the couple, to make sure that the chain on their front door still latched, but she was pulled into the operating room early, and then from one surgery to the next.
“No one seems to have known them well,” Yael says.
I look out the window in the direction of Lake Michigan. We may be in Chicago, but it’s the worrying time of night. “Have your parents thought about moving to Israel?” I ask.
“They’re not from Israel,” Yael says. “They’re from Venezuela.”
“They’d be citizens, with the Law of Return—”
“They’re from Venezuela.”
I lean my head on Yael’s shoulder and we sit for a time, willing our pagers not to beep, willing the patients to settle. We’re past the requests for sleeping pills and not quite yet into the chest pains and morning coughs. I’m niggled, though. “My great-grandmother grew up in the Ukraine,” I say. “They had no money, they had the Cossacks to deal with, after awhile they said, Hell with this.”
“Caracas is their home,” Yael says, and I hear that edge creeping into her voice. “We’ve been in Venezuela since the 1800s. You want to tell me where you were in the 1800s?”
“Me?” I give her a little teasing smile. “I don’t think I was—”
“You know how many customers my father had at his shop yesterday?” Yael asks. She’s looking right at me, and her eyes are daring me to argue. “Over fifty. And everyone bought. His plates are used in the best restaurants in the city. Why would he move to Israel? His plates aren’t used in Tel Aviv.”
I let her have the last word. I, a year-and-a-half into the wards, am still nervous about everything: needle sticks, tuberculosis, the patients with headaches and fevers behind isolation signs, the plasticky smell of the droplet-control masks that linger in the nose long after the mask is thrown away. Yael has to remind me sometimes to hide the worry—that it’s unbecoming, like a rash. And I, joking, will ask what kind of rash, whether it’s macular or papular, whether it has little crusts along the edges.
* * *
In the morning, I admit a patient wearing a tichel. She’s sixty and vomiting and in need of IV fluids. The tichel frames her face, its pattern so intricate that the woman appears to wear flowers on her head instead of hair. My eye is drawn to it as I palpate her abdomen and press her legs to check for swelling. I glance at it while listening to her heart. It’s nothing I would usually think much of—I’m so reformed that I’m barely Jewish, but I see plenty of women wearing tichels up in the orthodox part of Rogers Park. Today, though, I look.
The patient, Aviva, has no pain when I push, but the whites of her eyes have a yellowish tinge, and I worry that this doesn’t bode well for her liver. She’s lying back on the bed watching me watch her. I give her a weak smile and offer nausea medications by vein.
She tucks her arm underneath her head. “Are you an intern?”
“Sub-intern,” I say. “Medical student.”
She gives a little smile, but it’s also part frown. “You’re learning me?”
Something in my expression reflects in hers and she lets me listen to her lungs without complaint. She lets me shine a light in her eyes. Later, when I’m finished, she talks to me in a gentle voice, like one might use with a child. “Do you know when the doctor will be in?”
“Right,” I say and flush. “Of course. The doctor.”
She receives her nausea medication and, on morning rounds, she gets her doctor. I stand flat against the wall with my team of residents and students and observe as the attending physician asks her if she’s travelled outside of the country, if she’s eaten food sitting out in the sun.
She pushes a stray hair out of her face, tucking it up so it disappears underneath the tichel. I watch, wondering whether the couple attacked in Yael’s old neighborhood wore their own faith on the outside—whether the shooter’s eye was attracted by a yarmulke; whether he followed the couple down the block after seeing a fashionable head scarf bought on a Sunday afternoon off the Bulevar de Sabana Grande.
Aviva eyes our team of residents and students and we shift, embarrassed to be watching. Seeing me, she offers a distant smile before turning back to the attending physician and showing him where it hurts.
* * *
I talk to Yael in my mind sometimes, since I’ve learned there are some things you just don’t say aloud. Yael, I’ll say to myself, a year from now, if I make a typo on an order, I could kill someone, or: Yael, when all the residents and students were running toward that code, my instinct was to get out of the way.
I noticed Yael before we ever talked. I watched her from the other side of the classroom. She’s not beautiful—she has a swath of dark hair that falls past her shoulders and features that are a little too heavy—but I’m not sure I could fall in love with a beautiful woman. It hadn’t been her eyes themselves that caught my attention, but what she could do with them, how they teased and sharpened. I have little use for beautiful eyes. You could paint a pair of beautiful eyes on a canvas, and there they’d be, but they wouldn’t do you any good.
Yael pages me between surgeries and I meet her downstairs in the holding area where the nurses and attending physicians look at charts before going into the OR. She’s in scrubs and surgical booties. She tells me her mother heard from a friend that the victims who were shot lived three blocks away from her. The man’s still alive, in critical condition. Two bullets to the abdomen, no trauma to the head. He’s in his thirties, and he and the woman have a child together. A girl.
Yael’s quiet, frowning. “This shit is everywhere in Caracas now. You know what my mother saw in the subway last week? A star of David with an X marked through it. Right there on the wall, in green paint.”
We stand so close our hair is almost touching. But after a minute, I get punchy. I always get punchy when things are too somber. Yael says it’s my way of running away. “Did I ever tell you,” I say, “my grandmother says she’s a Levite. Not a generic Israelite, mind you. But an in-the-flesh Levite. How you know after all those centuries, I have no idea.”
Yael is still frowning.
“She gets a kick out of it, too,” I say. “You wouldn’t think she’d care. None of us went to synagogue. I went to Hebrew School for one day. I hated it, so they let me drop out. I was the kid who could never quite follow along at the other kids’ Bat Mitzvahs.”
“What I wonder,” Yael says, “is who the child is comforting. Who she’s offering a drink from her sippy cup—her aunt or her grandfather—so that they’ll smile at her instead of looking so sad. Because it always works that way, doesn’t it?” I look at Yael, curious. Her pager goes off, and she makes a face and then she’s at the phone, looking herself again, cradling it to her ear, taking notes, twisting the cord with the other hand.
* * *
It’s not the liver. It’s the pancreas. I stand next to the radiologist and stare at the little white nodule on the CT. I’ve been in the hospital long enough to know nodules. If they’re in your adrenals, you’re probably okay. If they’re in your pancreas, you’re not. I talk to Yael in my mind: I must be some kind of carnivore to make a career out of despair. Yael doesn’t answer, and the radiologist asks me if I have other CT scans I’d like him to review.
* * *
Sometimes Yael’s face will give a flinch and I’ll wonder if she’s thinking about her last morning in Caracas. She’s mentioned it only once. She had been accepted as an undergraduate at the University of Chicago, and her mother—a woman as persistent as Yael—had pushed for her to go. Never mind that the brochure made Chicago seem a place cold and colorless. Never mind the green Yael would leave behind. She didn’t want Yael to become one of those postgraduates who sit outside the panaderías with nowhere to go on weekday afternoons. And the crime. The inflation. The night Yael was pushed up against a wall by a man whose smile she hadn’t returned, how his fingers had slithered up her leg and cupped her ass. You want to be responsible for my heart attack when they find your body in the street?
That last morning, Yael had already said goodbye to her parents and aunts and uncles and a best friend who had always been a secret crush. Avital. In those last hours before Yael left for the airport, it came to her in a thought both vague and intense that now, with the consequences soon to be erased, she could tell Avital that she loved her. Heady with the idea, Yael walked down the block to Avital’s townhouse, but there was no answer when she knocked on the door. No matter—Avital often went out for a few minutes at a time—down to the market for an extra bag of coffee, over to a neighbor’s house to borrow manioc flour or milk. I picture Yael’s last walk around the neighborhood, up and down the block, to the Parque and around and back again in figure eights, each time passing Avital’s townhouse, each time glancing at the front stoop, at the empty driveway for a car. I picture how the sun must have filtered through the trees and studded the pavement with little flecks of light; how the garlic wafting from the bakery must have mixed with humid air. The plane ride itself, Yael’s never mentioned, but a hundred times I’ve heard about that bakery.
* * *
In the evenings, Yael and I wander the blocks around the hospital where the lights of the city meld together into a low ambient haze. Tonight, I’m practicing words aloud—nodule, growth, mass, spot—but none of them have the right ring. It’s going to be my job to tell Aviva about the pancreatic situation. Medical students need to learn to deliver bad news.
“Lesion,” I try.
Yael winces. “Don’t say lesion,” she says. “It sounds like a fungus.” We’re headed east, towards that strip of Lake Michigan flanked by concrete instead of sand. There’s a decent wind coming off the Lake tonight and we huddle in our jackets and lean into it. “You could try something from that Patient Viewpoints class,” Yael says.
“Empathy class?” I snort. Patient Viewpoints was a class we took our first semester of medical school, a quasi-humanity that some administrator invented as a way to teach us to care. Yael and I were in separate classes but we learned the same general rules—to hand patients a Kleenex box when they cried (not one Kleenex—better to offer the entire box); to nod and lean towards patients when they talk, even if they’re just recounting what they had for dinner. I say, “That was the most fraudulent piece of—”
A little smile creeps up onto Yael’s face. “It wasn’t that bad.”
“To trick patients?” I ask. “That’s not bad? To trick them with a Kleenex box?”
“How is that tricking—”
“They’re teaching us to pretend,” I say. We’ve reached the pedestrian tunnel that runs under Lake Shore, and we peer inside to make sure its empty before we enter. “I remember, the first day, my group instructor stood in front of the classroom and asked us if any of us had been hospitalized. And hands just flew in the air. Big, enthusiastic waves. Their stories started routinely enough: a broken arm, a bumped head, but then they became more and more exotic—a case of typhoid in India, an injury while building a hut for villagers in Brazil. ‘I almost died,’ people said. And I realized that they were competing. They were all clamoring for the most exotic illness, eyeing each other to see who had been in the enviable position of having come closest to death.”
Just past the tunnel, we sit on big concrete slabs that face the Lake. Yael pulls a bottle of cheap red wine out of her backpack, takes a drink from it and passes it to me. “I don’t know how to break it to the patient,” she says. “I guess you just say it quick.” That uncertain look is rare for her. I don’t like it. Yael’s a fixer. Strong. She puts in her own feeding tubes, her own central lines. It’s always been a comfort to be the indecisive one, between us.
I take a longer drink from the bottle and we pass it back and forth. I kick Yael’s foot and she kicks back, and then I’m kicking and she’s kicking, and, my feet tangled with hers, I relax a little.
“The man who was shot was an engineer,” Yael says. She’s been talking with her mother again. “He got his degree from Universidad Central. But he had been out of work for over a year, so he stayed at home with his daughter. My mother met a woman in line at the supermarket who had been friends with the couple—two hours they stood in that line and the store was out of toilet paper by the time they got to the front. The woman who was shot was a nurse.”
I pick at a thread near my sleeve, remembering how we tried sending Yael’s parents supplies a few months ago. Hand towels, dish soap, dense foods that could be packed tightly in a box—tuna and dried fruit, almonds, bags of shredded coconut. We filled a cart at Dominick’s. At the store, weighing and considering, I felt like I was finally helping someone. It was a dumb stunt. We knew the package would be lost in the mail at some point before it reached Yael’s parents; even as we packed the box, we knew.
Yael, drinking the wine too fast, is starting to turn red in the cheeks and lips. “I have to tell you,” she says, “I’m a terrible Jew. I stole on Yom Kippur one year.”
I take another slug from the bottle.
“I was still living in Caracas,” Yael says. “I was at a market. It was hot and I had some kind of stomach bug, and I got the idea that if I could get a couple of guavas in me, I’d feel better. Bad in itself, I know. Horrible. I’ve never fasted for more than a few hours. So I’m at the stall, I fill the bag with eight guavas, and when the vendor asks me how many I have, I say six. I pay for them and I’m almost home, and something hits me in the pit of my stomach. Agnostic as I am, it hits me. And it doesn’t go away until I take the guavas back to the stall and make up a story about how they’re rotten so the vendor takes them back and undoes my theft.”
“So you lied on Yom Kippur instead,” I say.
She gives me a swat.
“Hey Yael,” I say. “Do you think a person is still a Jew if she never went to Hebrew School?”
Yael seems to consider the question for a minute, and then she shrugs and we sit and listen to traffic.
“I’d love to show you that market,” Yael says, and her expression makes me want to huddle closer to her, to assure myself that she’s still here. It’s the same expression she gets when she says that you can’t get a good zapote anywhere in the city, and that the first flurries of the season give her migraines.
Looking over, she laughs at whatever expression she sees on my face. “Call it a nodule when you talk to the patient tomorrow,” she says, passing the bottle back to me. “To call her mass a spot is condescending.”
* * *
I call it nothing at all for the first few seconds, hesitating at the doorframe to Aviva’s room. Aviva is sitting in bed reading, but when she sees me at the door, she sets the book down and waves me inside. When I do speak, I offer practiced words: “You’ve got a growth on your pancreas, just a little one, bigger than the point of a pencil but smaller than a raisin.”
Aviva looks at me, unblinking.
“We don’t know what it is,” I say. “Yet.” I assure her that we have an army of tests at our disposal, that between our ultrasounds and our surgical tools and our excellent pathology department—best in the Midwest—we’ll make this little spot spill its secrets. I don’t assure her of more than this. She doesn’t ask. Her face gives that little flinch that I’m becoming too familiar with.
She says, “The beds here are ridiculous. You push the wrong button, your legs are sticking up in the air.”
“We’ve scheduled a scope,” I say. “They’ll give you something to relax. Fentanyl. I hear it’s kind of nice.”
Aviva puts on her reading glasses and opens her book, but when I look closely, I see that her eyes are not scanning along the page. “I held down apple juice,” she says. “This morning. They gave me two of those horrid little plastic cups and I kept them both down.”
I smile. “I could get you another—”
She’s still staring at the book. “I think I’d be okay at home,” she says. “I’ll stick to juice for awhile. Grape, mostly. The grandkids like grape. They’re always bringing over those little juice boxes, the ones that stain—”
“You have a test this afternoon,” I say.
“I’ll talk to my family doctor.”
I scratch the bridge of my nose. “We’ve scheduled a scope.”
Aviva looks at me over the rim of her glasses. “I’ll talk to my doctor.” Her voice is stronger than I’ve heard it, maybe because the vomiting is under control.
I watch her pretend to read for a time. She’s no doubt thinking that if she doesn’t say another word, the student will give up and leave. But when I start to tell her that she’s not understanding the gravity of her situation, she sets down the book and pushes aside the blanket and stands. She sidesteps, a little unsteady. I move towards her, worried that she’ll faint after all that vomiting, and she leans away from me, almost as if repulsed.
She makes her way to the cupboard and pulls out the plastic Patient Belongings bag, then takes it into the bathroom. When she comes out, she’s in a dress, her hospital gown draped over the sink. She puts lipstick on at the mirror, blotting onto her hand. “I came in for nausea pills,” she says. “You’re not giving me cancer.”
She’s not looking at me, but from her tone, I can feel her fury. Once called out for what it is, the mass can’t be undone.
But watching her put on her makeup at the mirror as if I’m not in the room, I flush hot and my own words come out more harshly than they should. “I didn’t give you that mass,” I say. “That mass has been there long before you came into the hospital.”
She looks at me through the mirror and I can tell that my words have had their impact. And I am almost stunned by this thing that I have done. I’ve taken away her ability to talk down her own worry; I’ve set into play what she’ll later remember as the dividing line between before and after in her life.
“I’d like to sign out,” Aviva says, her voice low.
“Don’t sign out,” I say.
“—And I’ll need the nurse to take this IV out.”
Fighting the urge to apologize, I tell her that a discharge would be against medical advice. “Bring me the form, then,” Aviva says. “I’ll sign the form.” It’s her body, her call. And I, six months from a medical degree, can do little more than watch her walk down the hallway, her bag on her shoulder and her gait improved, pretending that I, too, can pick up my bag and leave, until my pager goes off with the next admission.
* * *
The child is staying with her grandparents, Yael tells me. She’s probably doing well, considering. Nobody has heard whether her mother lived, or whether her father’s gunshot wounds are healing. But the child has been seen with her grandmother entering and leaving the Hospital Clínico Universitario and was spotted at the market just this morning. This, Yael takes as a good sign, but it’s all speculative, in the end.
Yael and I are on call again—always on call—upstairs on the couches eating vending machine food since the cafeteria closed at ten. I’m lying on my back with my head on the arm rest and my legs up on Yael’s lap, trying to listen to her story, trying to forget Aviva’s face. Her eyes.
“Imagine if I dropped out of med school,” I say, filling my mouth with chocolate. I don’t mean it; the words had just come to me, but once out, they echo in my ears so beautifully that I don’t take them back, not just yet.
“And leave me here?” Yael says, unfazed.
“I’ll become a photographer,” I say. “I’ll work for National Geographic. They’ll send me to the Himalayas to film the snow leopards.”
I lean my head backwards so that the nurses’ station is upside down and watch two medical assistants drink from gigantic plastic jugs of water, their movements slow with night.
“I’m only half-kidding,” I say to Yael. She seems not to believe me, because she throws an M&M at my head.
“People make moves when a better life is involved,” I say. “Look at you. Twenty-five hundred miles away, and you up and move. Cojones, you have.”
It’s only when the hand on my leg hesitates that I realize the stupidity of my words.
“Some people run,” Yael says. “Some stay and try to make things better, some run.” When I look up, her mouth is tight and her eyes are hard and something about her seems a little smaller, a little more condensed. I am almost awed to see her this way; I had not thought her reducible.
With a slight nausea creeping into my stomach, I think, she wants to go back home. It’s nothing we’ve talked about. It’s something I’ve always half-known. I push myself up and put my arms around her, and she puts her head on my shoulder and closes her eyes, hating herself for leaving Caracas, missing the people she’s left behind. And I’m taken with a sudden gratitude to be here, in this moment, this night-limbo between yesterday and tomorrow, not yet knowing whether Aviva’s mass is cancer, not yet knowing whether the couple attacked near the Hebraica will live, not yet knowing whether Yael will one day move back to Venezuela, things that cannot be taken back once told.