The hospital is a huge beast that eats but does not sleep. Its silent nighttime chambers lie heavily, pressing all around. Slowly breathing. The indrawn swell of air, the exhalation of steam from grated vents, is a tide that slows at night. The weight of the beast settles more heavily in these hours; there are fewer souls to hold it up. The hour between five and six am is when the hospital comes closest to a sleep state. But it does not sleep.
Neither do you.
Somewhere there is a bed, a narrow and lumpy mattress that leans dangerously and has a plastic covering that keeps the sheets damp with sweat. There is no sleep there, only tossing and turning until your pager goes off. The labour of dragging yourself upright is worse between five and six than if you had never lain down. Better to float along the quiet and mellowly lit hallways, alone. Better to shy from the fluorescent light.
Fluorescent light is an assault between five and six. Those who work in it are angrily awake. It scours the eyes, throwing ugly, dark, half moons under them. It yellows skin and glistens in the thin grease at the hairline. Every unsavoury detail of being awake so late is heightened under fluorescent light. Feet in wool socks and sandals smell sharp; socks stiffen at the heels. The cheap, ropy collar of your surgical scrubs scratches at an oily pimple forming on the back of your neck. The rough top shifts across the dry itchy skin between your shoulder blades, giving off a rich whiff of armpit. Your teeth feel dull and mossy under white fluorescent light; you try to drown bad breath with black coffee. You stay, whenever possible, out of fluorescent light. You favour instead an old lounge with stale ashtrays. You look out the window, across the emergency department parking lot.
The winter air outside is becoming lit from within, turning from black into blue. Huge stars of frost expand on the silent car windshields. Steam rising from the vents outside thins to ribbons, dissolves into the clean air. This hour is yours alone. At this hour, the pager is eerily dormant. Window glass is cold against your forehead; your eyes are red and dry. You breathe the cool air close to the pane. Snow and ice make everything look so clean outside in the parking lot, even the frozen vomit, pink with yellow corn. The hospital will begin to shift and stir soon enough, but for now its thoughts wander.
Perhaps it, too, looks outward, at the world. In this quiet moment, you watch another day being birthed between the cars in the parking lot.
Somewhere, deep inside one of the seven stomachs of the beast, an anesthesiology resident sits, wearing scrubs, on the lid of a toilet. Snaking out from each arm is a clear plastic tube. The bathroom door is locked. He turns and places his wire-rimmed spectacles on top of the toilet tank. He won't need them where he is going. The beast holds its breath. The anesthesiology resident closes his eyes for a moment. At last he leans forward, perhaps with a small, relieved smile. He leans forward, and opens up each of the IV lines wide. First the left, then the right. Fluid and medicines flow into his veins, and he leans back against the tank, loosing a papery sigh. He has been trained exactly how to do this; to first anesthetize, then paralyze; to numb, then cut.
Now the quiet beast stirs. The hallways seem to widen a bit. The pressure of its fleshy weight lifts, ever so slightly. Bulbs set to timers flicker, then illuminate, pushing corners away, widening the atrium. The scrub nurses are arriving, their mouths set in firm lines that will not waver under their surgical masks all day. Custodians and cleaning crews arrive in blue uniforms, stamping snow off their boots. Riding the elevator up to the cafeteria, you fall asleep on your feet. You miss your floor; you sink back down, awakening in the lobby. You push the button again; this time you stay awake by laughing in the empty elevator. You laugh with a quiet solitary ferocity, your eyes shut, your head leaned back.
The cafeteria is still closed. It is empty in the hall, except for an ancient-looking coffee machine; the huge kind with large tan-coloured buttons and a dusty looking picture of coffee beans on the front. It drops a paper cup into which it morosely dribbles a mix of boiling amber fluid and artificial creamer. You take the cup by its top and bottom edge; the sides are too hot. You walk back toward the elevators. The coffee is too hot to sip just yet so stand there, and notice another window. You notice the light growing behind it. You suddenly yearn for that light, feeling desperate and small.
The elevator dings and rumbles open, issuing a plume of brightly dressed nurses, bringing wisps of the cold outside air with them. They are out of place, smiling and too loud, their hair freshly washed. Their scrubs are purple and red and new, their makeup bright. Their smells, hairspray, powder and perfume will quickly succumb to the high vinegar of the cafeteria. They file past without so much as a glance; you stay camouflaged in dull shades of yellow and amber. A trial sip of coffee singes your tongue. A hiss of pain, and then the pager erupts. Between five and six is over. The elevator stands open, waiting. You walk into the elevator without giving the window a second look. The hospital closes its walls around you.
Sean Gupton Emergency Physician Minneapolis, Minn.