Sanitary and Wholesome

If walls could talk, I’d tell you the miracle that I am. I contain the essence of survival, of ingenuity, of human compassion. I also contain the sorrows and the pains, the sufferings and afflictions. I am sanitary and wholesome. Wires snake through my walls like a pulse of dedication to feed into technology that scans and cuts and diagnoses. Mortality is a fragile reality, and too often people are snuffed out of such marvels. But here within my domain, I watch individuals come together to clutch at threads, pull, weave, fasten, and save a life that would have otherwise been consumed to injury, infection, or malicious cells.

Within my pristine walls I watch both the heartache and the joy as souls pass, souls recover, and new ones come crying into this life from the womb. I watch the humans in their gowns and gloves and masks and all I can say is they are heroes. I focus on the ICU or the nursery, or the front bay doors where ambulances pull up and paramedics rush the blood-soaked bodies in for immediate care. I am the culmination of human self–

“...Lost my job last week. So, is there any way that before the bill gets processed, or I don’t know, that I can get my new insurance,” says a woman in a place where I pay little attention. The ER check-in.

She is a small woman, thin with hollowed cheeks and black hair. A little girl stands at her mother’s side and pulls on her jacket. My doors open and icy, winter breath leeches in. The small girl whines to her mother in Spanish. I know enough, since many of the workers who constructed me spoke this language. It is cold. She is tired. Hungry. How long must they wait?

Why the consternation, I wonder. Moments ago, the ambulance and EMT crew had hauled in a young boy with irregular heart palpitations. I am a hospital, and the cardiopulmonary surgery will be successful. Hardly invasive. But the woman’s nerves tremble. Perhaps she worries the boy’s recovery will be unsuccessful.

“I’m sorry, but that is a discussion to have with your insurance company.”

“That is what I’m trying to say,” the woman says. Her accent is thick and her panic is not for her son, but for something else. “My application from the healthcare.gov has been processing for weeks. They keep saying there is, I don’t know, error.”

“I’m sorry to hear that.” The person sitting behind the chair is a tired looking soul who seems to have to deal with these questions.

“How much will it cost? How much will his surgery cost?”

“I cannot say, until the billing department processes the costs.”

The mother rattles off a string of less than friendly Spanish words for her child to hear. She sits down at a chair holding the girl who whines and squirms in her mother’s arms. So I retreat to the ICU and find the surgery wing where Dr. Paskal, one of the state’s best heart surgeons, carefully does his magic. My energies pulse and feed the EKG and the overhead lights, the oxygen, and steady controlled, sterile air conditioning.

The man takes a breath, sews the chest back shut and an assistant removes his red-glossed gloves. The boy sits in comatose, with tubes in and out of his face and arms. The chest now rises steadily and the heart rhythm pulses as a youth’s should.

See, young mother, my facilities have saved your son. There is nothing to worry about.

In fact, the doctor finishes removing the cap and gown and mask and mutters his jargon to the nurses who record instructions. He walks down sterile halls past busy-bodying men and women and reaches the woman waiting, sleep deprived, and rocking her now dozing child on her lap.

“Ms. Montoya,” the man says. She jumps at his approach. “I’m Dr. Paskal and I just want to let you know the surgery was a success. Your son is stable, but now I want to discuss with you the next steps to his heart’s condition. He has what we call congenital heart defect, or CHD. It’s not common, but luckily your son’s condition is manageable, we will not need a heart transplant, assuming everything proceeds as normal.”

This is the difficult part. Unfortunately, his chronic condition, discovered on this near death pass, is something my facilities cannot mend indefinitely. And Paskal walks her through such terms and conditions.

“He will need to stay here in recovery for about a week,” Paskal says, “To make sure everything stabilizes, or is normal.”

“A week? How much will they charge me, my insurance, it, it…”

“The billing department will figure that out at a later time,” the doctor says, but I notice a twitch to his eye as he utters such rote dialogue. His expression softens and he places a hand on her shoulder. “He’ll be just fine. I’ve prescribed some diuretics for him. This will help with the blood flow and fluid balance for his heart. Once he gets out of the hospital he will be fine. There may be side effects, but for now, he’ll be just fine.”

“How much will the medicine cost?” the woman asks.

Again, Paskal follows the same routine and says, “They should be done moving him to his room shortly, you’ll be able to see him,” and leaves her.

I follow her through the wide halls of the hospital congested with nurses and specialists, the old and frail keeping their bodies together in the sunset of their lives. Mothers and fathers, are wheeled out with armfuls of swaddled life. A few outpatients hobble with crutches or cough and wheeze on their way in. Reception and security and custodial keeping order and sterility.

She finds her son in recovery and he’s coming to consciousness but still hurts from the stitches and is drowsy from the anesthesia. She and her daughter stayed in the hospital with him, by his side the one night. The staff are kind and give the daughter food. They’re assigned one of the best nurses within my walls. Harvey. Tall, bulky, with purple painted fingernails. He’s perfect for the kids, cheers the daughter up and gets her laughing. The mother is consoled with his upbeat positivity and ready attention to the boy’s needs.

She leaves the next day with her daughter. Later in the evening she’s back and continues the visits–sometimes with her daughter and other times without–until the day comes to release him. The boy has recovered and is to the point, with a bright wonderment, where he’s eager to be on his feet. He asks of the soccer game he missed, the practices he has to catch up on. His mother, trembling each time she pads through my sterile halls encourages him, but some anxiety won’t slip. She’s always on edge asking when they’ll be released, how much they’ll charge for every pain pill, every saline drip. I don’t understand. As I watch the boys vitals and shelter him from the outside elements, I don’t know why she would check him out so soon, he should, truly, stay longer to fully recover.

Yet, the week has passed and it’s time to check the young boy out. Paskal gives her more information and directs her to the pharmacy. I don’t know what’s pegged me to follow this woman, to see her fret when everything within my domain has saved her son.

She finds the pharmacy and approaches a tall desk with a lean woman, Sami, in the lab coat typing on a computer. Behind her are shelves of filled orders, categorized by name and function. Pills and liquids and medications. Sami, with tight blonde hair pulled up in a bun, smiles at the mother.

Once Sami, quite the intelligent woman, realizes the young mother speaks Spanish the two begin their discourse in the mother’s native language.

“Your son has this medication.” Sami puts the pill bottle in a white paper bag.

“Do you have your insurance card?”

The mother squirms, and says, “I, I just lost my job. I’m applying for medicaid, but it’s still processing. I, I hope it will cover once it goes through.”

“Well, let me look up how much…” and Sami trails off. “Um, I’m sorry, let me see if I can compare prices for a second.”

The mother fidgets. A queue starts to form, but Sami seems adamant on helping her. But after a time, Sami looks at the mother with nothing other than the same look many of my doctors must share when the procedures and treatments aren’t enough. She bares the same heavy hearted sobriety when my doctors tell the loved ones of a heart stopped, of a final breath exhaled.

“I was able to find a coupon,” Sami says. “It will be $328.72.”

The mother pales.

“How, how long will this prescription last?”

“A month.”

“I, I…” she clenches her wallet, creasing the cheap plastic casing. “I have to have this for my son?”

“If not, you could be right back in here in a couple of months, a year if you’re lucky,” Sami says.

The lights and walls strain. I strain.

“How much will it be with insurance? With Medicaid? Like when my application goes through.”

Sami shrugs, knowing something more than me, a sad expression on her face. “Usually between $5 and $15.”

“Could I perhaps, I don’t know, wait to buy the medication? Could I come back in a few weeks, once I have coverage, or, or a new job and plan?”

Sami shrugs. “It’s risky, but possible.”

“I can't afford this.”

“Let me see if I can find anything else. Yes ma’am, I understand, I’ll be with you in just a moment,” Sami says when a disgruntled woman with high heels and full lips asks how long they’ll take.

But of course, the mother turns back empty handed.

What is going on? I want to scream.

The lights flicker.

What is happening? This woman had her son’s life saved, by Paskal, by nurse Harvey, the funny guy who paints his nails and makes the children laugh all the time. Why does she sit on the bench like her son just died? Find your next job. Get back on your feet. Come back and get the medicine when it's $15.

The mother leaves with the boy in the wheelchair. I am not a professional, but the boy has yet to stand and if he moves too fast his heart is set a flutter. I do not think he should leave and I now understand Sami’s desperate search for discounts. When the mother leaves, something inside me changes, and it affects the halls and the rooms and counters. I push my conscience through the halls. My perfect ant hill of a system, something, something is off. I hear crying. It’s common. People are in pain, but this time it's the breakroom. It’s Harvey. He’s on the phone weeping.

“I can’t do this anymore, man,” the hulking, normally ball of joy gasps. “I, I want to quit, man.” A voice mumbles on the other end. “I’m running around with too many patients. You know that nice old lady I was tending. She’d been lying in her urine for three hours. I couldn’t change it till just now. His hands, those neon violet fingernails, run through his sweaty hair.

He cries.

I zoom out. Baggy eyes, frazzled nerves. My nurses. My doctors, at the brink. Paskal sits in a quiet corner and takes deep breaths. “Two more hours. Two more hours.”

Something must be off. So, to check, I move upstairs with a rapid pulse as nearly as fast as the electricity within my walls. I go to the administrative wing. I have spent little time here. It’s boring. Simply cubicles of people calculating bills and taking calls and payments and boring meetings with administrative staff and men and women in business suits.

But I find a board meeting going on in the large conference room. The CFO, I think its called, maybe his name was Perry–I rarely pay attention here–stands with a graphical analysis shown on the board. Men and a single woman, line the perimeter of the table reclined in soft cushioned chairs. A few have pens in their mouths, a couple are scribbling on pads or scrolling through the presentation on their tablets.

“Numbers are up, my friends,” he says. He has thin rimmed glasses and a beaming smile that melts executive and investors’ hearts. “Profits are showing to be a fifteen percent increase from last year with this hospital and the one down in Glenfield. If numbers keep the way they are, we’re looking at perhaps three hundred and fifty million by the end of the fiscal year.”

“That’s incredible. Thank you Piers,” and there stands the hospital CEO in a perfectly pressed business coat and suit. “Our hospitals couldn’t be in better conditions.”

I shrink back, a pinched wire in my system. The lights flicker, the wifi cuts and Piers slide hesitates before loading the new ad. As I’m leaving the woman stands. “As you know, the state legislature proposed a bill that will regulate the patient to nurse ratio. Here’s the campaign ad my team just finalized and is ready to push.”

I retreat. I retreat down to the bustling halls of the nursery. A mother holds an infant. A couple stares through the plexiglass wall at their new baby. Another couple wrings their hands together as their baby, blue and squirming without lung power is halted off to NICU. Another father is pacing the room while a mother chides him. “You’re stressing me out.”

“Just wait, honey, just wait. We’ll get this bill and the ibuprofen, the whole four pills you took, will be $60.”

I close my eyes. I close my eyes and head down to the boilers and the utilities and the custodial wing where I listen to the thunder of battle, the life and death above, surrounded by furnaces and breakers and water tanks.

But my denial cannot last.

No. I’m a facility of life and death… I’m a facility that fights for life. I see those clutching to the strings of mortality enter. Most exit. But some do not. Some bring in new life, others have spent their lifetime and must succumb.

But it hurts. It hurts my foundations and struts, when an ambulance roars into the parking lot again. Not even two months have passed. The paramedics push through my doors and wheel in a boy–a chilled air but the sweet hint of spring teasing warmth. They rattle off his vitals with urgency and the boy is pushed into ICU with no break or pause. I almost miss it. I know this boy. I’ve watched his heart stabilize and return to normal rhythms before.

And sure enough, to the sagging of my essence, the same hispanic woman, Montoya, the mother rushes in. This time the daughter is not with her. She, this time, has a small card to pass to the check-in desk. It’s scanned. Waiting. Waiting. Waiting. Deductible $3,000. Out of Pocket max, $7,500. Add-on third party insurance will automatically cover 80%. She’s prepared.

But it does matter. Paskal is cursing in the breakroom after the bloody gloves are peeled from his skin. A flat line on the EKG. No one to cheer up Paskal or the mother or any child in the ER. Harvey has taken extended vacation for mental health leave. No one is there to tell the joke to break the tension.

These are my walls, this is my legacy, if I could talk, I’d tell you the miracle that I am. I contain the essence of survival, of ingenuity, of human compassion. I also contain the sorrows and the pains, the sufferings and afflictions. I am sanitary and regulated. Wires snake through my walls like a pulse of dedication to feed into technology that scans and cuts and collects. Mortality is a bleak reality, and too often people are snuffed out despite such marvels. But here within my domain, I lean over to the mother and whisper in her ear.

“I’m sorry for your loss.”

She doesn’t respond, but continues in Spanish, praying. Praying to her deity and faith.

The mother sits in the lobby, waiting for Paskal, and weeps.