Scott had intended to blow his head off, but he didn’t aim the gun properly, so instead he blew off his face. Before the gun fired he thought he didn’t want to live. But after the thing had happened, he knew that what he wanted most was simply to die.
It was her job to keep Scott alive.
When she came onto the afternoon shift, Scott was restrained because after surgery, while he was still in the recovery room, he tried to pull the airways out, and he had been combative whenever he roused from the anesthesia. The nurse going off shift told her that even though this was Scott’s fourth reconstructive surgery, she had better brace herself. But she didn’t want to see Scott; she was afraid that she might gasp or jump.
In nursing school, during her last semester, she found that she did not want to be a nurse. In the middle of her clinical rotation at the children’s hospital, she cared for Melinda, an infant who had been beaten by her father and had received severe head injuries. Melinda’s brain was edematous from the internal damage, so they drilled burr holes to relieve the pressure—but the brain was so swollen that it began to ooze through the burr holes, and in the end, they removed the entire side of the skull. Melinda’s head was twice the size of a normal baby’s, with the lining of the brain lying next to the sterile dressing, visibly pulsating. At first the little thing looked so strange that it was difficult for her to realize that it was actually human.
The otherwise healthy baby was left blind, paralyzed, and mentally retarded. All Melinda would ever know of life would be what she felt and heard. But what could she really know from that? She would never have any language to give her world meaning. And Melinda would never be able to reach for anything to touch. She would always depend on someone else to come to her.
Once she brought Melinda a stuffed rabbit with a music box inside of it. She thought the baby might gain some comfort from the soft fur and the tiny ring of the bells. But after two days, an X-ray technician accidentally dropped it. After that she went to the children’s hospital on the weekends, when there were no school requirements, to hold Melinda and rock her. She didn’t know what else could be done except to hold her, and rock her, back and forth.
That semester she realized that she did not want to be a nurse. She hated everything about nursing. She hated doctors. She hated sick people. She hated needles and tubes. She hated emesis and feces. She hated infections. She hated the smell of alcohol. And she hated wearing white.
It all came to her at two o’clock one morning, when the sky was flat and colorless. She turned toward Joe and tried to tell him that she wasn’t meant to do this, not any of it. It was a mistake, the whole thing was a mistake. Joe moaned softly and rolled out of her light embrace. And in the morning when she asked him what he thought she should do, he couldn’t believe she was considering quitting when she was so close to being finished—they could really use the money. So she finished the program and went to work. It was true, they needed the money.
Joe played jazz drums. He lived for music. In the beginning it was Joe’s music that attracted her. Through his music he seemed to perceive and feel things that she had never realized existed. She wanted him to have feelings for her because she wanted to be a part of what he felt. Wherever Joe was, everything seemed animated and breathing. Before Joe, she always seemed to be standing in the shadows, where things were quiet. But when she was with him, there was always plenty of sound. He had a way with people; everyone liked Joe. There was always laughter, and music, and action where Joe was. At first it made her feel recklessly free, as if the thing she had been were suddenly absolved. And when Joe was in the limelight some of the illumination seemed to reflect onto her. People were always happy to have Joe around, and because she was with him, she thought that they were happy to have her around.
For a while it seemed to work. She had a regular job, so there was reliable money coming in to pay the bills. And Joe had his music. He seemed satisfied, if not happy, and she felt that in supporting him she was somehow responsible for an artist who would soon be known.
But what at first she took for something carefree in Joe, she began to see as something careless. He played, when the gig was available, in the basement of a tiny cafe. People came there regularly, to hear the jazz. At first, they charged a cover. But after the band got to know people, they took donations; and later, when the regulars gave sad stories, they played for free. It was worth it just to have an audience, just to make music. When she complained that it wasn’t fair that she worked at a job she hated while he did nothing to help out with the money, he yelled that she wasn’t supportive, and that she didn’t understand how things were.
She did not understand. And she would wonder how music could give anyone so much satisfaction. What was music anyway? It couldn’t be seen nor touched. It was merely a series of waves in the air. And when the waves stretched out far enough, they stopped existing.
She began to feel Joe cared more for his music than for her. If it were another woman she might know how to deal with it, how to compete, or at least she could see the opponent and realize, in seeing the thing, how he could prefer the other. But this thing was intangible; she couldn’t get a grasp on it.
This is what she thought of when she began her rounds. She thought of Joe and of how he would be playing his drums tonight in the basement of the tiny cafe. She thought of the smoke-filled room and of the regulars who would come to drink coffee and lie back and hear jazz. She became angry when she thought of the cafe and of the space in the basement that would be temporarily filled with sound. She was angry that he could find pleasure in that tiny, crowded room, that she had nothing.
And now it all seemed to have come to this. She felt very old—weak, and tired, and very old, as if life had stopped. She knew that the earth continued to rotate on its axis, that air continued to move through her lungs, but life—that thing indescribable, that thing which took one beyond mere existence—had stopped. She couldn’t seem to remember when or how it all began, but she thought, at that moment, that this was all there would ever be for her: she had spent her life. And she pushed the door of Scott’s room open.
Scott was sleeping, turned toward her so that she could see what was, or should have been his face. From just below the orbits of his eyes there began a cavity which sank at an incline until it came even with his neck. There was no nose nor bridge of a nose, only a tissue, pink and shiny like new skin, pulled in tight toward what might have been a mouth. But it wasn’t exactly a mouth. There were no lips, no shape to the opening, just a quarter-sized hole attached to no moveable muscles. After Scott had shot himself there was very little skin left to put him back together with. Three patches of skin had been grafted to the area that would have formed his cheeks. Two of the grafts had been taken from his back, but a third graft was composed of skin from his thigh. From the skin of this third graft, long, thick, wiry hairs stood out, growing where no beard would grow. Out of the area where his nose had been, two catheters protruded from the taut skin. Each tube was stitched in place with heavy thread, crusted with brown blood. The ends of the catheters had been clipped so that there was a direct opening for the air to lead into the back of Scott’s throat. A thin string of bloody mucus was oozing out of one of the airways. Scott had a tracheostomy to ensure proper breathing, and at the end of his trach tube a tiny bubble of saliva grew and burst as Scott breathed in his sleep. Looking at him sleeping there, she wondered who he was—this person with no face.
Several months ago she had gone to the doctor with stomach problems. She had vomited blood twice, and the pain, which had been constant for some time now, had become more intense. She had all of the routine abdominal examinations. When the results of the exams came back and the doctor told her that there didn’t appear to be anything physically wrong, she sat silently with her head bent, as if she were guilty.
The doctor asked her how things were at home, and before she realized what was happening she found herself crying in violent sobs. The doctor suggested she get some counseling and referred her to Dr. Jenkens, a psychologist. He thinks I’ve gone crazy, she thought; is this what crazy’s like? After two visits Jenkens asked her to bring Joe along. But Joe didn’t see the point; she was the one with the stomach problems. So she continued to see Jenkens alone.
The first thing Scott communicated to her was his desire for pain medication. But Scott was unable to talk. There were only two molars left on the bottom right-hand side of his mouth. The jaw bone, which would one day be reconstructed from ribs, was completely missing. Three-fourths of his tongue was gone; what was left of his tongue was a thin narrow strip, like a lizard’s tongue, but Scott’s tongue was fixed to the floor of his mouth. No moveable part was left. Scott’s eyes were the only part of his face that had any human look. But because of the contractures of the skin grafts, his bottom lashes were pulled down so that they lay flat against the skin. His eyes were blue, and they never connected with another’s eyes.
There was a pad of paper and a pencil at Scott’s nightstand. Forty-five minutes after the shift had started Scott pressed his nurse’s call button. When she came into the room she handed him the pad and pencil and he wrote: I’m hurting. She checked the nurses’ bedside notes and saw that his last injection had been given only two hours ago. She told him that according to the notes, it was an hour too early for any more narcotics, but she told him that she would bring a shot as soon as it was time. I hurt now, he wrote. She shrugged and told him that she would bring it as soon as she could. He turned away from her, as much as possible, in spite of the restraints, so that he faced the wall.
Twenty minutes later she brought a syringe into Scott’s room. She told him not to let anyone know. Scott bared his right hip for the needle.
She told Jenkens that when she was young she loved to go bird watching. She once knew the names of all the birds, and would spend hours alone in the foothills watching their quiet ways. Once she stayed out longer than usual. She had lost track of the time and it became dark before she made it home. As she walked the dark road toward her home, her father drove up. He yelled at her for losing track of the time. And he decided that she was not to go out alone again—who knew what kind of crazies might be running around in the dark? It was no place for a girl to be out alone. She remembered distinctly, at that time, hating who she was. And her brother roamed the hills whenever he wanted.
The next day Scott was to have feedings every three hours through his J-tube. The tube was six inches long and taped in a coil around his navel. The tube entered the stomach through a permanent opening in the abdomen. She filled a 50 cc syringe with Ensure and connected the syringe to the opening of the J-tube. But Scott did not want to eat. He wanted to die. When she began to inject the formula through the tube, Scott inhaled through his trach and held the air in, bearing down. When he did this, the pressure in his abdomen was greater than the pressure in the syringe and the Ensure could not be advanced. She waited until he gasped for air, which forced the pressure he held down to be released, and she quickly pushed the Ensure through. They interacted in this way until 200 cc of Ensure had been given. It took them thirty minutes. The last five minutes Scott clenched his fists and pounded them rhythmically on the bed while she looked out the window and thought of how she hated drums.
In a few days Scott was able to get out of bed, and in addition to her other responsibilities, she now had to help him ambulate so he could get his strength up. Once she had had a patient, an old woman, who almost fainted while walking
down the hall. Since then she always held onto her patients while they walked. She would put one arm around the patient’s waist, and with her other arm she would hold the elbow that was next to her side. This is how she held Scott when he first got up to ambulate. Scott rested the upper part of his body against her so that his upper arm pressed into her breast. With any other patient, she would have let the arm go so that she couldn’t be touched. But she thought of how it was unlikely that Scott would ever touch any woman’s breast, and let the thing pass. As they moved slowly down the hall, other patients moving about would stop their motion and stare in horror. And if Scott had had lips, they would have seen them turn up in delight.
She began to wonder if being unhappy were the same thing as being not happy. She tried to expect nothing, so that she might rid herself of the feeling of being let down. But Jenkens told her that this in itself was a type of expectation.
She told things to Jenkens that Joe never knew about, things that Joe would never hear. They talked of pain and of all the times of pain in which one is grateful for morphine. But he told her that there was a type of pain in which the pain itself becomes the reward, and beauty is the end result.
When Scott was able to ambulate by himself he left the ward without telling anyone and went to the pediatric unit. He ran into the small children’s rooms, making hideous noises while he drooled saliva. Security was called to take him back to his ward. But the children had trouble sleeping that night, and would have trouble for nights to come.
During the midnight shift, Scott would get out of bed and quietly follow the nurses around, hiding behind doors, waiting to jump out at them, loving to hear the sound of another’s scream. At other times he would go into a neighboring patient’s room and stand over the bed, looking until the wide stare of his eyes would call the person out of sleep.
Scott was constantly picking at the suture lines of the skin grafts and the airways. When any of the incisions would start to heal with a new, thin scab, Scott would pull the scab off so that the next time a thicker, deeper scab would form. In the end, the incisions healed, but the scars that they left were thick and white and irregular.
When the surgical wounds healed, Scott was made ready for a three-week discharge before his next surgery. His mother and his stepfather were made his legal guardians, and he was to be released to their care.
A few nights before Scott was to go home, she had a dream. In the dream she was lying in bed next to Joe and her menses started. She dreamed that she was aware of her bleeding, but that this bleeding was different—the blood coming from her now was a cherry-red, and it flowed copiously. She found that she couldn’t rise and get out of bed to take care of herself, and the blood kept flowing. It spread from herself onto Joe, but he did not waken. She opened her mouth to cry out for help, to tell Joe that she was bleeding, but she could make no noise, the blood kept flowing. By now the blood covered all of her from her hips down and had soiled the sheets and most of Joe. In her dream she realized that she was hemorrhaging and would bleed to death if something weren’t done. But the blood kept flowing, and flowing, and flowing—and then she woke, with a light sweat over her body.
On the day Scott was to go home, as she was going over the discharge summary with him, she had the sensation that they had been here before—both she and Scott. But something was different this time; this time she found that something ought to be said. She wanted to say something—anything that might make his life bearable: hang in there; or, things will get better; or, you’ll do all right.
But she found that she—the one with the mouth, the jaw, the tongue, the teeth—had nothing to say. She set the discharge notes down and walked to the window where Scott was standing. The sky was heavy with gray. A flock of birds rose and flew toward a brown smokestack which was adding rainbow tinted layers of smoke into the air. What birds are they? she thought . . . I once knew . . . What birds are they?
The birds made no noise, but flew in a perfect silence. The silence seemed to stretch on, endlessly. And in that perfect silence it came to her.
“They’re starlings,” she said. “Those birds are starlings.”