Page 29 of Look on the Bright Side

LARK

It was her third week in the ER, and Lark was a little surprised at how competent she felt. In Oncology, the cases were so complex and fraught and challenging, and she had loved that part of it. In the ER, though, things were a bit more straightforward. If a patient was complicated, you did your best to narrow down the reasons, ordered tests and worked the problem. But the problem lasted for only your shift. Either you had the patient admitted, or someone else took over. Granted, she spent the drive home wondering if she’d done the right things, but Dr.Unger was a great supervisor, so she had that reassurance.

She’d worked overnight, and the vibe was different, for sure. Some standard emergencies—a seven-year-old boy with a broken arm, courtesy of a tumble out of his bunk bed, where he’d been wrestling with his brother. A patient who’d overdosed on fentanyl, treated in the field with Narcan, brought in for evaluation. A chef who’d sliced the webbing between his thumb and forefinger and needed a referral to a hand surgeon. A young man who said he was coughing up blood, but really wasn’t…he just had a bad cough, and his throat was irritated, causing a speck or two of blood.

There’d been a toddler with a diaper full of black poop that had his parents thinking he was either bleeding internally or possessed by the devil. Turned out the little guy had just eaten half a quart of blueberries, and that’s how blueberries looked on the other end. The mom had burst into tears of relief.

“You have NPS, I’m afraid,” Lark had said with a smile. “New parent syndrome. My sister brought her daughter to the ER four times in the first year. It’s normal to worry.” She bent down to look at the beautiful little boy. “You are the cutest little guy in the whole world, mister,” she said. He sparkled up at her, all dark gray eyes and drooly smile.

Babies. God, she loved babies. She hoped Addie and Nicole would have another. It was the closest thing to her own she could imagine right now. Would she ever have a family of her own? Her own baby? The kind of love her parents shared? It had once seemed so close, and now was a million miles away, a shimmering city so foreign and far it felt like a barely remembered dream.

Well. Anyway. The ER had also hosted a woman who thought she had a spider in her ear (she didn’t), a young man with a nasty cut on his foot that Lark got to stitch up (so much fun!) while he flirted with her. There’d been a boyfriend patient, as Luis called them…Horace, a sweet little old man who was a repeat customer, in from his assisted living facility with another UTI. Lark knew she spent too much time with him, but she didn’t care.

Emergency room medicine was a microcosm for all that was right and wrong in American healthcare. A couple of true emergencies (the sliced hand, the cut foot, the broken arm); a couple of “it was good that you came” cases, like the blueberry baby. The guy with the cough just needed some antibiotics and cough medicine, but he didn’t have a primary care doctor. The specks of blood had scared him, so rather than a routine visit to the doctor, or a trip to urgent care, he’d ended up in the ER at 10:00 p.m. on a Tuesday, which would cost him a lot more than necessary. Assisted living facilities tended to be revolving doors—the patients lived there, were cared for, but if anything was even slightly off, they were shuttled to the ER, treated and often admitted, returning to their facility to repeat the cycle.

And the computer work! She probably went through twenty-five screens per patient, clicking, dictating notes, checking boxes, logging in, logging out. She was getting better at dictation, and she and Lalita would look at each other and smile, seeing who could murmur their notes in faster. No one was as fast as Howard Unger, though, who sounded like a New Yorker on speed when it came to that.

But in most cases, the patients were happy or relieved to see her (or any one of the doctors, PAs or APRNs). Usually, the staff could either treat the problem or reassure the patient. That’s what she’d wanted in Oncology. Still wanted.

To that end, she’d started volunteering with the hospice program here at the hospital, and had seen her first patient last week—Alice Fontaine, late-stage Alzheimer’s, admitted to the hospital so her daughter, herself in her seventies, could have a little break from caregiving.

“Hello,” Lark had said upon entering. She kept her voice low, since Mrs.Fontaine appeared to be sleeping. “I’m Lark, your hospice volunteer.”

Mrs.Fontaine opened her eyes. “Mama?” she asked. “Will you take me home?”

Immediately, Lark felt tears surge. But no. She was not going to cry in front of this woman. Her job was to provide comfort, a peaceful presence, companionship. Not to make the patient feel worse.

“I’m Lark,” she said, clearing her throat. “I don’t think I know your mother. What’s she like?”

“She’s pretty. She loves me.”

“I bet she does,” Lark said, swallowing. “What do you like doing best with her?”

“I like baking. She makes the best pies. Is she here?”

Was it okay to lie? That hadn’t really been covered in the training sessions. “She’ll be here soon,” Lark said. It seemed kinder. “Is it okay if I call you Alice?”

“That’s my name. Alice.” The old lady reached out for Lark’s hand, her skin so thin and dry and speckled.

“Can I put some lotion on your hands, Alice?” Lark asked.

The patient didn’t answer, so Lark decided it was okay. She always carried some, since she washed her hands so often at work. Now she took out the tube and gently rubbed it into Alice’s little bony hands. She’d done this for Grammy, too.

“That feels nice, Mama,” Alice said.

Lark swallowed again. “I’m glad.” After the lotion, Lark just sat there for a while, watching Mrs.Fontaine sleep. The poor woman had barely eaten in eleven days, according to the notes, and had been refusing water. Her breathing had a catch in it, but wasn’t exactly Cheyne-Stokes just yet, that pattern of erratic breathing that was a harbinger of death. But Mrs.Fontaine looked dead, that was for sure. Her skin was pale, her mouth open, and she was so still. Lark waited, watching her chest. There. Another breath. Another minute.

Lark wished she could stay till the end. Hold Mrs.Fontaine’s hand until the last breath. Whisper something comforting that would help. As it was, she could only sit here and…well…just be. It was hard to wrap her brain around that. She couldn’t do anything as a volunteer, and of course, with the patient’s age and condition, there wasn’t anything to be done. Just bear witness. Just be there.

She sang a lullaby, the same one she sang to Esme and Imogen, an old-fashioned song about flowers falling asleep and mouse babies curling up in their beds. She’d learned it, gosh, in second grade? A memory of a springtime school recital, Justin standing in the row behind her, flashed from the depths of her memory, and she held it gently, its realism and power dissipating even as she tried to keep it close.

The song had stayed in her head all week. Not just the sweet words, but that memory of Justin standing right behind her. It felt possible, though, for someone to be part of your DNA. Your cells. Imprinting so early and so deeply that you would never be apart.

“You going home, sweetie?” Luis patted her shoulder as he walked past her in the locker room.

“Yes.”

“How was your shift?”

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