Dizzy and breathing heavily, Jack Carton held his chest as if willing it into health and went to the hospital. It was September. Two weeks earlier he had quit his job and enrolled in the university, more than a decade since dropping out. He had made the decision impulsively after a hot summer when wildfires had trapped yellow, camp-like smoke in the valley and the dry desert air made his crows’ feet tighten and the skin over his elbows crack. He was thirty-five and even though he had worried about the difficulty of college courses, he was happy to find the work came easily. It was only in the pressures of his free time that he began to unravel. He lived on student loans and attended class sixteen hours a week. Without full time employment the equilibrium he had learned to maintain began to sway and jostle leading to entire days spent in a bored stupor.
He lived four blocks from the school. His neighborhood didn’t have sidewalks or curbs. The poorly kept lawns ended in uneven lines at the street, and at night there were college kids outside, women’s high-pitched cackling and deep-throated, enthusiastic yells from young men. His apartment was the bottom floor of a duplex. It had a concrete patio that was sheltered by the upstair neighbor’s wooden porch, and in the afternoons sunlight spilled through the gaps between the two-by-fours. He spent most of his time alone: at class, at coffee shops, on listless walks, at the library, at movie theaters, at bars. He had enrolled in college to increase time to himself and he had thought he would make the most of a solitary life, one that emulated the tragic loners he had admired during youth. His neighbor – whom he mostly knew from footsteps above him and echoes through his bathroom air duct – was a short, muscular ex-navy man named Joseph. He had a feminine voice that must have been the object of derision on an American submarine, and Jack had never given much effort to strike a consistent acquaintance. Once they had drunk together. On his porch they had sipped beers, looked at the sunset, and listened to music on a boom box. Even though he was considerably younger, Joseph was a nontraditional student and made Jack feel at ease. Jack became drunk and comfortable and voiced pessimistic thoughts that occupied him during a particular type of intoxication. They talked history. Jack said progress didn't exist and that there were only repeating cycles. Joseph became annoyed. He called Jack a narcissist, but most likely meant misanthrope. Jack didn’t claim to be better than humanity; what troubled him was that he considered himself a good person which, with all of his faults, said something frightening about mankind.
It was on a Saturday when Jack's health failed. He awoke feeling fine. He lay in bed watching pornography, his laptop on his stomach rising up and down as he breathed. The foot of his twin bed faced the window, and he watched the monitor eclipse and recede over the morning sun that pierced through the closed window shades. As his pace quickened, he felt the familiar aching flow of his body coalesce into a single center about to erupt. He was approaching the precipice when he felt the edges of withdrawal come over him, a vividness in his vision and something like indigestion in his chest as if a bubble of gas had risen from his belly and had become trapped behind his heart. At first none of this alarmed him. He had grown accustomed to gradual worsening of his hangovers, his body like a slyly pernicious color spectrum, by grades darkening imperceptibly. He closed his eyes and continued. Cool lines of moisture ran down his forehead and rested below his eyes. He could feel sweat soaking into the bed under him, and when he lifted his knees, the sheets clung to his calves. He was nearly there, gasping in anticipation but he stopped and sat up in bed pushing the laptop onto the floor and ripping his earbuds from his head. There was a sharp pang in his ribs. Pain throbbed down his arm. His laptop, lying open on its side like a standing birthday card, still showed the video he had been watching, the lecherous sound of which played muffled through his headphones on the floor. The pain did not subside, and Jack looked at his hands. He opened and closed them. They were small, and his palms were pale and wrinkled. There were dots of dead, white skin.
He jumped from bed and paced around the small apartment. Over the living room window he had tacked a green sheet that made the room glow. An oscillating fan hit the sheet making ripples across the walls and empty beer cans that sat on the coffee table and greasy, translucent fast food wrappers that were crumpled into the futon cushions. He walked between the living room and the kitchen. He pressed his first two fingers into his neck. As he counted his pulse, he moved faster trying to match his footsteps to his heartbeat. He was short of breath and dizzy and had a thought that flushed hot blood into his head making the cartilage at the tops of his ears warm. This was how it happened: how a person felt before falling out, collapsing in an empty room.
“Why are you grunting?” Joseph said from above. His voice echoed through the bathroom air duct. “Are you talking to me on the toilet?”
Jack sat on his closed toilet seat. His computer rested on his lap, and it flickered a medical article he had found online. After yelling for help, Joseph had called down saying he was too busy to walk downstairs, so Jack started reading the article outloud and asking Joseph if any of the things he read were happening to him.
“Calm down,” Joseph was saying. His high voice strained through the building.“You hit it a little too hard last night. Just get some sun. Usually when people get sick they’re not getting enough sunshine.”
“How would that affect my chest?”
“I said, ‘how would that affect my chest?’”
“I don’t know. Just go for a walk. If you feel bad afterward, you can take the next step.”
“I hardly got any of that.”
“It says here chest pain can be serious.”
“Get off the computer. ”
“But what if I think it’s a little thing when it’s actually not?”
“Get some sun. Vitamin D helps. They give it to people with Jaundice.”
“Just so their skin isn’t yellow.”
“It helps inside too.”
“Hold on, I’m going to look it up.”
Joseph took a breath. “ I have a lot to do today. Do I have to give you a ride to the hospital or what?”
But Jack ended up taking himself. Forty-five minutes later after he had stood over the kitchen sink and drunk his last two beers, letting lines of alcohol run down his chin and throat and feeling his Adam’s apple move under his jaw and, reluctantly, gazing into the bathroom mirror to see a big-eyed, red-faced, bald, pudgy man without his ironic smile and whose breath was shallow and metallic, he found himself on a bumbling bus that moved past the green lawns and swaying maple trees of a residential neighborhood and into the gray tiles of downtown. Eventually, the bus spat him out at a corner across from the large Catholic facility. The hospital was a multiple-block complex made of several buildings connected by skyways. The tallest tower was arranged in the center surrounded by four smaller buildings, and a two-lane road encircled the tower, running between the perimeter buildings and colliding into traffic circles that feathered into downtown. Before finding the Urgent Care – his mind tactfully avoiding any thought of the emergency room – he walked aimlessly on the road. He was off the sidewalk stepping between the bike lane and the curb. The sound between the buildings was loud, echoing chatter and sirens and passing cars, and above him men and women in white coats and wheel chairs moved in the skyways.
He found a map. It was a prism that rose from the concrete near one of the entrances and showed blue prints of each floor, the rooms labeled with letters and numbers beside a key – like what might be seen in a shopping mall. He walked down a corridor on the fifth floor that changed from clinical white into a carpeted hallway with auburn wainscoting and stained wooden hand rails. Urgent Care was on the other side of a glass door.
The waiting room was small and nearly empty. Beside the long front desk there was a square of chairs around a coffee table. A young woman sat reading a magazine. At the desk a man stood speaking to the receptionist. Beside her, another woman’s head bobbed lightly to the sound of typing, her face lit by an unseen computer monitor. At the far wall a window overlooked downtown’s foothills.
“Sorry about that,” the front desk woman told him. Jack had had to wait while she argued with a patient over the price of a bill. The patient had spoken condescendingly and had even attempted to solicit Jack’s sympathy (“Can you believe this fella,” he had said turning to him. “I’d run out of here before they touch you”), but throughout, the front desk woman had smiled like a hotel concierge. There was a levity about her that felt incongruous. “I argue with him most everyday,” she said. She had graying hair and acne scars on her cheeks. She wore a dress shirt with a pink floral design across the chest. “Anyway, do you have an appointment?”
He said that he didn’t and she asked what the problem was.
“I’m having pain in my-” He made a gesture with his fist moving up from his stomach and stopping at his heart.
“You need to go to the emergency room.”
“No please. I’m pretty sure its indigestion. I’m too young to be having a…well…right?”
“I’m not medically trained. I do administration.”
“Our policy says to send anyone to the emergency room if they report chest pain.”
And she wouldn’t admit him right away. He first had to speak to a humorless nurse who smacked her jaws on a piece of gum. She walked him behind the front desk to an examination room.
“No. Don’t,” the nurse said when he was climbing onto an exam table. “I need to ask you some questions before we can treat you.”
He sat in a chair near a small pile of magazines. The nurse stood over him. Her back was against the sink, and she bent one knee and pressed the flat of her white sneaker against the floor cupboard’s door handle.
“I don’t want to set off any alarms,” he said. “I know it’s my stomach.”
“How long has it been going on?”
“A few hours.”
“Does the pain increase when you eat?”
“Do you have dizziness or blurred vision?”
“Hard to breathe?”
“It’s my stomach.”
“Is the pain spreading to your back or arms or jaws or anywhere else?”
“Is your groin hurting?”
“You seem to be moving your hand over your crotch.”
“Nervous habit.” He laughed uneasily. “Like tugging on my finger or my ear.”
“Oh. I see.”
The nurse led him back to the waiting room. He sat at a chair across from the receptionist; he was in a corner sequestered from other the waiting patients by the length and curve of the front desk.
“It’s great we can treat you,” the front desk woman said. “I just wanted to make sure. We don’t want you wasting time here if next door can save your life.”
She took his university insurance card and his birthdate and had him fill out medical history on a clipboard. When he was done, she looked at him. “I’m glad it’s nothing serious. Not that stomach stuff isn’t serious but considering what else it could be…I mean this is better…but not too good all the same.
“That belly can do some weird things, can’t it? A friend of mine once told me she knew someone whose stomach acid traveled so far up his gullet that it burnt his vocal cords, dissolved them. Afterwards, he could hardly speak like those cancer patients who press microphones against their throats.” She sighed, considering the frailty of the human body. “Again, though, I’m not a doctor,” she added.
Jack sat down in the waiting area. He tried to crack his neck thinking that maybe the pain now was some sort of back spasm. Across from him the young woman still read a magazine. She wore tight black pants that stopped midway at the shin. Her hair was short and brown and there were no creases around her eyes. She sat, curled attractively between the armrests. Her sandaled feet were on the seat cushion; they were lightly dusted with dirt, and as she wiggled her toes, he could see pale skin like tan lines behind the flip flop straps. Above her head and through the window, the valley’s foothills loomed over the modest downtown. Near the treeline there were acres of blackened soil and twisted sagebrush trunks where the summer wildfire had burned.
His name was called, and the same nurse led him to another exam room where he waited for the doctor pushing on his breastbone and checking his pulse.
“Do you have a family history of heart problems?” the doctor asked when she entered. She was a thin woman, a few years younger than Jack. Her face was arranged between two perfectly symmetrical dimples, and she spoke in a deep, relaxing voice that sounded formal and vaguely strained as if she were reading aloud. As she talked, she glanced at a white plastic clipboard she held by pressing it between her belly and her unclenched hand.
“No. Yes, my uncle had a pacemaker.”
“Hmmm. Electrical. How old was he?”
“Older than me.”
She placed the clipboard onto the counter beside the sink. Under a hand sanitizer dispenser that was mounted to the wall, a white box lay, and she plucked two latex gloves out of it as she would Kleenex. She put them on looking at him.
“Working in Urgent Care I had to develop a certain methodology,” she said. “Every person must. There are insecurities you have to combat and ways to avoid possible self-doubt or self-hatred.” She placed her hand on his forehead and laid him down on the exam table. “I sometimes envy surgeons. They look at patients like carpenters look at wood. They have clear objectives for their cases; there are few diagnostic elements, few exploratory surgeries.” She kept her hand on his forehead. “But, I’m not a surgeon. I have to deal with diagnosis.”
“It breaks into three strands,” she continued. “There’s the first and most important: my observations. For the most part these are objective. Your blood pressure. Your breathing. Whether you’re red and sweating. Your consciousness.
“The second – and this is where it gets slippery – is patient report. What you say.” She lifted his t-shirt to his armpits. His stomach was hairy and round. With two fingers she pushed on his belly above the navel and then walked her fingers on a center line toward his ribcage. As she stood over him, a gold necklace fell out of her shirt and dangled below her chest. There was no medallion, just a chain. “You would think both the patient and I would have a shared interest, but you’d be surprised. Often, a patient believes that whatever their ailment, it is not particularly serious. They give optimistic reports or they simply lie. I understand the impulse. No one wants to find out they’re dying. Plus, there’s the added dimension of cost where a person must weigh death with financial ruin…So, can I believe a patient? Whatever the answer, the issue is delicate; some would say I must use intuition to assess whether a patient is presenting me with the truth or not. But, deciding a patient is lying brings its own set of trouble. I may order expensive tests for no reason and those tests may conjure supporting evidence for a problem that doesn’t exist. On the other hand, I may be enabling the patient to die.
“It’s difficult. It never stops being difficult. But, I’ve learned to mitigate potential guilt by eliminating the final thread. In as much as I am able, I don’t use my intuition. I choose to believe my patients unless it directly contradicts something I have observed. Do you understand?”
“ I have stomach problems,” Jack added.
She pushed down on a tender point below his breastbone.
“Is it sensitive here?” she said.
She took off her gloves and walked away to write on a notepad. She told him she thought it was gastritis and that a valve was malfunctioning and letting stomach acid seep into the esophagus. She wrote a prescription and was walking out of the room.
“What do I do about the pain?”
Jack looked at her. He pulled his shirt down and sat up on the table. From a drawer she grabbed three orange packets and handed them to him.
“Yes, they work well. Remember, though, if the body becomes accustomed to constant acid reducers then the stomach creates more acid during a withdrawal period.”
“Can I take them all?”
The waiting room was the same as he had left it. The front desk woman smiled at him as he walked around in front of her.
“Will you be needing another appointment?” she asked.
He heard himself say of course not, everything had been taken care of, but as he spoke, his hand rested on the desk in front of him and he felt far away as if a film iris had obfuscated the edges of his eyes. But it wasn’t his vision that made his heart begin to pump hard and the pain to return – it had gently subsided while he lay on the exam table. It was the thought he was now passing through some final barrier and that he would remember this very moment as his last opportunity.
The front desk woman handed him a pen and asked him to sign some final bit of paperwork, but Jack let it go through his fingers and fall to the floor. Looking at it, a black pen against a blue carpet, he saw dark flecks move toward him and heard a buzzing, mechanical shock resonate in his ears. Decorating the carpet there were orange and red flourishes that swirled and slowly they seemed to flare and ebb like flames and soon the pen disappeared somewhere behind the cool, flat surface of the floor with its potmarks of wildfire.
“Oh my God…are you okay?”
The young woman from the waiting room looked at him. Jack had stumbled away from the front desk, and his hand was now on her shoulder leaning on her, his body bent slightly at the waist and his other hand hitting his chest. She stood, and he fell in her arms. She lowered him to the floor. He looked up into the tiled ceiling, squinting into the large squares of fluorescent light. The circumference of his pain had expanded to include his throat and jaw and as far down as his groin. At the corners of his vision the young woman stared down at him with her hands over her mouth. The woman doctor entered view and pushed her aside and then knelt beside him. Under the ceiling lights the doctor’s individual hairs stuck out from the curved edge of her head like jagged twigs. The pain in his chest was sharp, and his breath was short, and his toes were numb. He could hear fast-moving wheels stop as two large men stood over him. They were dressed in collared short-sleeve shirts and had radios snapped to their belts. They reached their hands down to him, and he felt weightless before being lowered onto something soft that he sunk into.
“Breathe slowly,” the doctor said. “We’re taking care of you.”
He was being wheeled someplace. The walls changed to white. He felt a poke in his arm.
“I’m not a doctor. I’m a physician’s assistant,” she said.
“I’m giving you an IV.”
A blanket was placed over the lower half of Jack’s body, and he tried to kick it off. “Hell no!” he said. “I know that scam.” But, the blanket stayed, and he forgot about it.
Time passed; he wasn’t sure how much. Hands were above him. Some tugged at his shirt, and some held wires with circular ends that looked like suction cups. Jack held his shirt down and hit the hands. He slapped at them and grunted and growled and closed his eyes as a bright light shined down on his face. He jerked as someone yelled, a scream that echoed down the long corridors of wherever he was. It took a moment before he realized it was his own voice.
“Is this a psych case?” someone said, and Jack yelled louder and pressed as hard as he could on his breastbone. He wanted to pulverize his chest; he wanted to tear open his ribs and see what was wrong.
“Breathe,” the deep, relaxing, narrator’s voice said. “Open your eyes… Everyone out… We’ll do the EKG in a moment…just stand outside until I call you back in…thank you…alright, Mr. Carton…are your eyes open?”
They were. The light was still above him and around him he heard the mechanical tics and beeps and compressions he associated with a hospital. Eclipsing the light the doctor’s face came into view and smiled, and he felt her gloved hands rub his temples. From somewhere in the room, at first behind the other hospital noise but then growing and overtaking it, a melody hit his ears, delicate and singular and soon joined by another instrument that ached.
“What is that?”
“Violin and guitar. I’m playing it on my phone.”
“I normally don’t like classical music.”
“I’m beginning to enjoy it,” she said. “This is Lully.”
“Why are we listening to music?”
“I learned it in nonviolent prevention. I work with dementia patients, and it calms them down.”
“I don’t know if it’s helping.”
She said he had to push everything from his mind and concern himself only with the music, measure by measure cataloguing its changes as it built to a climax.
“Here comes the crescendo,” she said. “Do you hear it? What’s changed?”
“They’ve added another violin.”
“Yes. And now?”
“More stuff. The stringed ones that sound lower.”
“The cellos. Right.”
“And now…there’s…they haven’t added instruments but it sounds bigger, it’s getting fast. What is this again?”
“Lully. He stabbed himself with his baton and wouldn’t see a doctor so he died of gangrene.”
“Focus on the music.”
She continued to rub his head, and Jack lay motionless, one arm beside him with a tube running from it and the other hand fingering the edge of the blanket at his belly. He tried to remember the last time he had been comforted by a woman and as he did, a relief passed through him that he would later say was like nothing he had ever experienced. A tingling dotted up and down the length of his limbs, gathering in groups at his knees and elbows like water trapped in switchbacks. The music grew louder and faster and culminated in an apex that abruptly died leaving the monstrous echo of the final note. When the piece ended, Jack felt as he would staring at a place of natural beauty, like a canyon or mountain or seaside cliffs that ascended directly from the water and formed clouds at their peaks from rising mist. He lay in what must have been a gurney and felt the immediacy of life and understood that – at least for a while longer – he would to continue to be part of it.
“There’s no shame in needing help,” she said. “It’s rare for life to be clear enough that you don’t need something to understand it.”
She said he was probably feeling better and she was right. He was back. The chest pain had left, and even though he couldn’t understand why (The antacids? Yes. The antacids were working), he was too preoccupied to care. He focused on his own cursing blood, aware of his softening heartbeat but comfortably so, and with each pulse he could feel strength in his extremities, making him alive and young and manly and when she gasped in shock, he ignored her; he was enraptured in his own quickening and ecstatic breath and the harsh, rhythmic rustling of his hand underneath the blanket.