Copyright © 1991 by S. N. Dyer, All rights reservedcopynotes. First appeared in Isaac Asimov’s Science Fiction Magazine, July 1991. For the personal use of those who have purchased the ESF 1993 Award anthology only.

THE JULY WARD

S. N. Dyer

There is a place of which all doctors know, but none will speak.

# # #

It is 6:30 in the morning, and hardly worth anyone’s while to try for sleep. The medical student has just finished writing admission orders for the new patient, and the night nurse is studying the page with a mixture of annoyance and disdain.

Watson ignores them, ignoring also the CT scan she has been admiring, with its textbook perfect depiction of a brain demolished by a bullet. She closes her eyes and, in the process of rubbing them, experiences the intensive care unit anew.

There is the breathing of the ancient man with Cheyne-Stokes respirations: shallow, deep, deeper, loud gasp and shudder, shallow, shallower, pause for a long time. An old ventilator is breathing for the newest patient: whoosh clunk sssshh, over and over, 20 times a minute. As counterpoint, the unit’s sole heart monitor beeps an out of sync 80/minute, with the occasional interposed beat of an extra systole, or the brief syncopation of a bigeminal rhythm.

Next, Watson becomes aware of the early morning smells, of blood and decay, tube-feeding and feces, cheap wine and vomitus. Soon, someone will mop the floor and someone else deliver trays, and the odors of ammonia and hospital food will merge into the unsavory whole.

She opens her eyes, taking in the cracked plaster, six beds, shelves piled haphazardly with a random selection of unneeded equipment; sighing, she begins moving towards the door. As she passes the man in bed four, his bandaged head swivels to follow her.

“Waitress!” he calls. “Waitress, I want a tuna fish sandwich!”

The medical student—Watson has just spent twenty-two straight hours in his company and cannot remember his first name, just the inhumanly neat way he signs it—comes to her defense.

“Excuse me, Mr. Johnson,” he says. “You’re not in a restaurant.”

Watson grimaces. The pushy kid is going to try to orient the patient. Had she ever been so naive and idealistic, even on her own second day of the wards? T. His name starts with a T.

“Mr. Johnson, you’re in the neurology/neurosurgery intensive care unit of Warren G. Harding Industrial County Hospital.”

The patient ignores him, repeating angrily, “Waitress, I want a tunafish sandwich.”

Watson says, “Here, let me show you how it’s done.” She approaches the patient, standing at the foot of his hospital bed.

“Waitress…” he begins.

“I’m sorry, sir. This is not my table.”

Grabbing her student by the elbow, she leads him out of the unit. The benches outside are mercifully empty, so they need not be polite to hovering families. “Now what?” he asks.

“Huh?” She is trying to remember if he’s named Tony or Tom or Ted.

“What do we do now?” He has never been on call before, and he’s riding an adrenaline high. Twenty-two hours, and he’s gung-ho for more.

She pauses to think about it. A considerate resident might tell him to go work on his presentation, but who needs to prepare to talk about a simple gunshot wound? Or, up at University Hospital, she might tell him to clean up, change, eat breakfast. But here at Harding the showers in the doctors’ call rooms have no curtains and no water. Besides, it’s accepted that the team coming off call will continue to wear wrinkled, blood-spattered scrubsuits, as a visual reminder to everyone else that they are tired, and short-tempered, and not likely to look charitably upon any attempts at denigration or one-upsmanship. And the cafeteria will not open for another half-hour.

Gazing out the window, Watson can see the sky growing pink behind the silhouettes of the hospital complex. There are half a dozen towers of varying height and architecture, monuments to half a dozen periods of relative affluence. The majority of buildings are now silent and dark.

“It’s kind of like an old castle,” she says. “You know, built with no plan, every generation adding something.”

“With secret passages and haunted dungeons?” asks the kid, getting into the spirit of the matter. This cheers her. She tried to tell this to another student once, eleven long months ago, only to discover he was a cheap knock-off robot with absent humor circuits. Try to tell that kind of medical student a joke, and he’ll reply “Will this be on the test?”

She points to the buildings in turn, starting with the ruins of the nursing dorm. “The original Norman donjon.” Then the infectious disease wing, a gift of the New Deal. “The fenestrated keep, built by the Mad Duke in 1485.” Next, she aims at the New Tower, the last addition, built during the nationwide hospital expansion of the Sixties, and where most of the patients are now housed. “The Georgian wing.”

Getting into the spirit of it all, Tom—she has noticed the nametag on his short white jacket with its pockets crammed full of instruments and manuals—cackles. “Look, that light. Could it be… the la-bor-a-try of Doctor Frankenstein?”

She decides that she likes him after all, and decides what they will do next. Checking her watch—it is now twenty to seven—she nods down the half-lit hall. “Come on.”

They go down the stairwell to the basement, the same basement they have traversed all night, bringing patients from the emergency room to radiology and then to ICU. As they stride, cockroaches scurry angrily from their path. Tom flinches once.

“Jeeze!” he says. “It must be two inches long.”

Watson feels momentarily sorry for him. His origins are written all over him: a neat, lawned half-acre in some well-kept suburb. The medical school has charged her with his education, and what has she done for him so far? Shown him drunks puking up blood and wine; a battered woman who attempts to steal his stethoscope when he leaves the room to get her a pain shot; children with needle tracks; and his final wonder, six-legged vermin that he has previously known only from the jokes on TV. But now she will show him something to make up for it all. Veering from the yellow line painted on the floor, the line that brings them home through the maze of corridors, she pries open a door that has been painted closed.

“There is a dimension beyond time and space…” she says, in her best Rod Serling voice, and leads him up dustcaked stairs illuminated only by their penlights. Two flights up, they lean hard against another door, and emerge into a large room.

“This is part of the original hospital,” she says, her voice echoing against high ceilings. Her breath forms mist in the air—many windows are broken—and Tom tries to button his jacket, but the bulging pockets prevent it. “They built the new parts over and around the old foundation. But these are the first wards. They were still used up until the late Seventies.”

They prowl the empty ward, which is hesitantly brightening with sunrise. As the shadows diminish, they begin to make out cobwebs and cracked plaster. Pigeons, nesting in the rafters, glare at the intruders.

“There’d be patients down both sides, and in the summer when it got full, they’d run a row of beds down the middle. You’d move screens to examine a patient, or if someone was terminal.”

“Look at this!” Tom has found a wooden wheelchair, not that much more antique or decrepit than those they have been using all night to transport patients, and sits on the hard, uncomfortable seat. Watson pushes him past the nursing desk in the hall, and into the adjoining ward. “They built them long and thin like this to maximize fresh air. The Florence Nightingale approach. This would be the woman’s ward.” One of the tires is flat, and the student bounces regularly as they progress. The chair leaves thin tracks in the dirt.

Tom leaps from the chair and runs to an incredibly tall floor fan, reaching to his breast-pocket. “Great!” His footsteps raise clouds of dust that smell like guano.

“When it got hot, they’d put a tub of ice at the front of a ward, and aim a fan over it.” A patient had told her that, an old, old woman who’d been a nurse at this very hospital during the Depression. When Watson had met her, she’d been in her nineties, boney and pale, identical in appearance to all other patients in their nineties, as if those final ten years erase the distinguishing characterisitics that make up the individual. But she had been surprisingly aware, and when she had died…

“Where’s this go?” asks Tom, waving at a heavy darkwood door on the outside wall, a door that should, by rights, lead nowhere.

“Don’t open that! It’s not time to open that—We’d better get back,” snaps Watson, turning abruptly. Her footsteps bleed into street noises that are only now growing audible. Tom looks briefly about the ward, allows his gaze to linger upon the door, then runs to follow his resident.

# # #

At breakfast, their table is invaded by the surgery housestaff. They are in streetclothes, and even the ones who have been up all night wear ties and neatly pressed short white coats. It is barely seven, but they have already completed an hour of rounding , and soon will be in the operating room. Tom stares in disbelief at their trays, piled high with pancakes, sausage, bacon, pints of chocolate milk, and large styrofoam cups of coffee. Surgeons are very serio us about breakfast. They usually don’t get a second meal.

The surgeons glance in Watson’s general direction. “Hey,” says the tallest one. He must be their chief resident; his white coat is knee-length. Also, years of work and abuse and sleep deprivation have worn away what little tact or courtesy he might ever h ave possessed. “Hey, you neuro?”

“Uh huh.”

“You got that gunshot?”

Watson takes a long sip of coffee before replying. “John Doe #3.” It has been a busy night for the unidentified.

Tom has been told that the gentleman in question is his patient, so he volunteers further information. “Thirty-eight caliber. The entrance is right occipital, and the exit left fronto-parietal.” Saying this makes him feel very professional.

“Condition?” asks the surgeon, looking at Watson instead. She does not appreciate his snubbing her medical student, and knows also that if her own chief were here, he would be ignoring her as well. He has an arrogant manner that makes her uncertain if she feels furious or worthless.

“Bullet turned the brain to jello. He’s herniated.”

“Braindead?”

“Not yet. But soon.”

“Suicide?”

“No. Met the Dude Brothers.”

Tom asks, “Huh?”

She looks away from the surgery chief to explain, a carefully calculated breach of etiquette. “You ask someone in the E.R. who beat them up, it’s always ‘some dudes.’ No one will ever tell you who did it, or admit that it was only one guy.”

“The Dude Brothers,” Tom repeats, pleased, as if every new bit of slang makes him that much closer to being a doctor.

“Homicide,” the surgeon is saying. “That’s a little tougher, but the coroner’s usually cooperative. He a druggie?”

She shakes her head. There is a drug war going on, and the wound pattern is that favored in street executions. But, like the previous victims in the current conflict, her patient appears to have been an enforcer, not an addict. “No tracks. He’s a great s pecimen.”

The surgeon smiles. Finally. She knows exactly what he is thinking. One heart. One liver. Two kidneys.

“And a partridge in a pear tree,” she adds aloud, confirming the surgeons’ opinion that you gotta crazy to go into neurology. “Just one problem. He’s a John Doe. No organ donor card. No family. And even if we found them…”

The surgeon gives her that look, like he’s Bonaparte, Caesar, Patton, and she’s some worthless footsoldier assigned to hold the ridge.

“Let me worry about that. You just keep him going ‘til we get permission to harvest the organs.”

# # #

They straggle in to morning rounds, clutching styrofoam lifelines. Breakfast and caffeine have worked paradoxically; the now off-call team is starting to crash. Watson is shivering as she tells the group (her fellow junior resident, the chief resident, two internal medicine interns, two nameless third-year medical students) about the new admissions. Tom is leaning against the wall, yawning, occasionally pinching himself, and in no way following the rules of medical decorum that he so carefully memorized a few days ago. For a second he actually drifts off to sleep, and sees the ghost of Osler coming through the ICU door, shouting “You will never be a doctor!” But then one of his classmates takes pity on him, and nudges him awake.

The residents are looking at him with bemused expressions. The years have almost numbed them to the pain of sleep deprivation, but they vaguely remember a time when they were still aware of their suffering. But the memories are dreamlike and uncertain, like a view into a prior incarnation.

“You get used to it,” Watson says encouragingly.

The other resident grins at his students, who have not yet experienced an on-call night, and asks Tom, “So how’s it feel, now that you’re not a virgin anymore?”

“Rounds,” the chief reminds them.

They move to the bedside of the gunshot victim, and Tom begins a formal and totally disorganized presentation. The chief cuts him short after less than a minute. “Save it the attending,” he suggests. “Make it quick and dirty for work rounds.”

Tom looks at Watson, who nods. He says, “John Doe #3. Met the Dude Brothers.” The other medical students look puzzled, and their resident whispers, “Later.”

They retire to the viewbox, where the chief resident makes funny humming noises while reviewing the CAT scan, briefly pimps the students (who cannot yet tell a bullet fragment from a calcified pineal gland), and then they return to the man on the bed. A fly has landed on the patient’s half open right eye.

“Shit,” says Watson. “I told the nurse to lacrilube them shut.” She respects for corneas, even though John Doe #3 will never need his again.

The chief demonstrates the way that the lids no longer spring closed, then shines a light in each eye. The pupils do not react.

“Midposition, fixed,” he says. “What’s that mean?”

The students stare blankly.

“What’s with you guys? Don’t you know any neuro?”

The other resident whispers at the chief. The medical student year is not quite in sync with the housestaff’s; their students last week had been at the end of third-year, almost seniors—knowledgeable, canny, battle hardened. Now they have raw recruits again.

“Okay,” the chief says. “I’ll show you how to examine a comatose patient. First thing, you see if he can breathe on his own.” So he disconnects the tube that connects the ventilator to John Doe’s endotracheal tube, and they watch to see if any breaths occur. The respirator alarm begins to blare. Unfortunately, as it is an old machine, the alarm can’t be switched off. Watson puts fingers in her ears to block out the raucous noise.

“Tell me if he starts,” the chief directs, and runs through the rest of the exam, squeezing fingers and toes to cause pain, sticking q-tips in the eyes, tongue blades down the throat, ice water in the ears. The patient makes no response to any of these noxious stimuli, and after three breathless minutes, Watson reattaches the respirator. The alarm stops.

“Papilledema. Take a look,” directs the chief, handing his ophthalmoscope to a student. She bends in close to an eye, trying to focus through the pupil to the retina behind, like trying to look through one keyhole and into another keyhole. It is a technique that requires skill the student does not yet possess, and made even more difficult by corneas clouded by exposure and neglect.

Watson notices that the medical student is holding her breath, and grins sympathetically. No one ever says anything about it, but the braindead smell different. Not a particularly unpleasant odor, like gangrene or enteric bacteria, but a faint, cold, wet, indefinable smell that Watson associates with patients with liquified cortex.

“Okay, enough, you can come back later,” the chief says, changing his mind. Each student attempting fundoscopy will run through what little rounding time is left. “Three minutes without any respiratory effort? Okay, so he’s braindead. What now?”

“Surgery wants him.”

The other resident snickers. “Hey buddy, they want your body.” The interns laugh, and the students look at them distastefully, except for Tom. He’s starting to grasp the housestaff’s grim humor.

“Fine with me,” says the chief. “Get an EEG to confirm it, and they can have him whenever they want.”

Watson point to the name on the wristband. John Doe.

“Oh. That’s a problem.” He looks around the unit. There is still one empty bed. “He can stay while they work that out. But if we need the bed…”

An intern—he trained at one of those small Caribbean schools, looks a little like Dennis the Meanace grown up, and is always a bit slow on the uptake—says “Hey, wait a minute. Organ donation? Don’t we need permission from next-of-kin?”

Watson lets her mouth drop open. “Holy shit, you’re right! Quick, Fred, go call the Doe family and ask them!”

The intern is halfway to the phone before he realizes that he’s been had.

# # #

They are barely finished rounding on the ward when the other resident is beeped to the E.R. He calls down, then gathers up his students and starts out. “Gunshot,” he calls to Watson and the chief. He jabs his female student right about the midthoracic spine.

“The Dude Brothers have been busy little boys today,” says the chief. “Take a ‘tern; the studs should stay for attending rounds.” The students look disappointed, worried they’ll miss something exciting.

The team files into the conference room, a grimy place with mismatched chairs, windows nailed shut to prevent patient suicides, and a single window air conditioner that barely works. A few textbooks—the most recent at least ten years out of date—and dozens of x-ray folders litter the counters, near a primitive monocular microscope, bottles of outdated stain reagents, and a hemocytometer box labelled STEAL THIS AND DIE! The box is empty.

On the wall is an x-ray view box that looks old enough that, in a rare whimsical mood brought on by acute and chronic exhaustion, Watson tries to visualize when it was new, in a room where the wood panelling and marble are as yet unplastered. She imagines a conference of doctors, in high collars and starched white coats. On the view box, a visiting Dr. Dandy is showing off his first pneumoencephalogram.

She returns to the present and her own conference. A professor has come down from the University to hear the new cases and offer advice. Unfortunately, their current attending is junior faculty, newly arrived from one of the more civilized programs. Did they present to him complex, obscure, and abstruse cases, perhaps something due to an enzyme deficiency isolated only last week, or a rare cranial nerve syndrome first described in l925, he should be informative and invaluable. Instead, they confront him daily with the same and the mundane: alcohol withdrawal seizures, delirium tremens, head trauma, alcohol withdrawal seizures. Tom presents his case and shows him John Doe’s brain scan, and after the professor has pimped the students on which is bullet and which is calcified pineal, he has little else to add.

Later, back in the ICU, Watson sees the surgical chief resident going through John Doe’s chart. She strides over quickly. As she passes bed four, the patient with the bandage starts up again.

“Waitress, I want…”

“It’s not her table,” snaps Tom.

Watson says, in her most unctuous voice, “May I help you?”

The alien chief wants blood and histocompatibility typing, cultures, more frequent vital signs, stat syphilis and AIDS serologies. He wants the intravenous fluids changed to the surgeons’ favorite, lactated ringers. He wants everything to be thoroughly buffed when he triumphantly delivers the still-beating heart, the gleaming red liver, the happily perfusing kidneys, and the extraneous shell of body that surrounds them, to the transplant team up at the University Hospital.

The neurology chief steps in. “Look, I know this is important to you, and we’ll help all we can. But there isn’t any family to give permission yet, and the man’s braindead.” He decides to elaborate. General surgery residents are notorious for their incomprehension of neurologic principles.

“Everything upstairs is gone, including the autonomic centers in the medulla. His heart and blood pressure and kidneys are on autopilot now, and pretty soon they’ll just get out of control, like an untuned engine that idles faster and faster and then goes haywire. You can keep a brainstem preparation going for months, but this guy’s braindead; he won’t last three days, and that’s if we work hard.”

“Then work hard. Or is that too much for you guys?”

Watson’s chief gives him his if you had one more neuron you’d have a synapse smile, and answers sweetly, “We’ll keep him as long as we can, or until we need a unit bed. And we’re full now.”

“You’ve got one empty!” protests the surgeon.

At that minute the ICU doors swing open and the other resident and Fred the intern roll in a new patient.

“Besides,” says the chief. “Even if you find the family, I’ll bet a beer you don’t get the parts. I’ve been here a long time and I’ve never…”

The surgeon nods, stalking out. “A beer.” No one ever pays off on these bets.

The chief notices Tom standing there, mouth agape, and decides to finish his sentence. “…I’ve never had anyone donate organs. Face it, the families of people who live and die by violence just don’t tend to be altruistic.”

Tom frowns, trying to absorb and properly file away that bit of information.

As the new patient is being lifted off the gurney, he gazes across at John Doe and laughs. “Hey! Johnny! Hey, they got you too? Serves you right, you son of a bitch.”

# # #

At noon, bored policemen descend upon the unit. They que stion the new patient, who won’t tell them anything —his occupation, his assailants’ identities, John Doe’s real name. The police don’t seem to care much. “It’s not like they’re shooting innocent kids or housewives or something,” one of them remarks to the chief. Life might even improve, if every drug deale r in the city shot every other.

Tom hovers about the periphery, wearing an expression of intense fascination that he tries unsuccessfully to hide. He has not been this close to an actual policemen since Mister Traffic Safety reminded his first grade class to look both ways before crossing.

“What about our John Doe?” asks Watson.

“Is he gonna die?” the cop replies.

“He is dead. Technically brain dead. I could turn off the ventilator now, only surgery’s dying to use his parts for transplant. For that, we need family permission.”

“We’re running his prints.”

“He’s bound to have priors,” the other policeman says.

Watson nods. “We’ll keep him alive until you give us a name. Right, Tom?”

Pleased to be inc luded, the student nods. “Right.”

# # #

The new admission has a bullet lodged in his vertebral canal at T-10. In a way, he’s lucky. If the bullet had not stopped there, it would have continued on though lung, diaphragm and liver, leaving an awful mess. However, the man is now permanently paraly zed below the umbilicus, never again to feel his legs, walk, fornicate, or control his bowels and bladder. He does not have a great appreciation for his good luck, or for the medical care that he is receiving, and e veryone is secretly pleased when the consulting neurosurgeon decides that the wound needs to be debrided operatively. General anesthesia will give everyone a temporary break from his complaints.

Before leaving for the day, Tom and Watson look in on John Doe #3 one last time. He lies quietly, no movements except the periodic rise and fall of his chest as the respirator cycles. His body temperature is starting to climb and, though Watson expects it is just due to hypothalamic dysfunction, she orders chest x-ray, blood and urine cultures, puts him on a cooling blanket and tylenol suppositories, and covers potential infection with a broad-spectrum antibiotic.

“Say goodnight, John Doe,” she says as she exits.

“Goodnight, John Doe,” replies Tom, in a high-pitched voice.

# # #

The next morning they find out their patient’s real name; it is not as memorable as John Doe, so they continue to refer to him as such. No one is surprised to find that he has more arrests than their attending has publications. He even has an outstanding warrant for murder, so the police put a shackle about the irreversibly comatose man’s ankle to chain him to the bedframe, and assign three shifts of deputies to sit at the foot of the bed and make sure he does not escape.

“Great use of our tax dollars, huh?” asks Watson. She hauls Doe’s knee into the air and tries for a reflex, knowing well that he has none, but enjoying the way the shackles clink as she does it.

The deputy is ready for retirement, and looks about as dangerous as any fat, elderly, napping man, but the presence of a uniform and a gun give the chief resident some comfort. Their paraplegic patient is contemplating singing to the police, giving them details of the drug war, its strategies, finances, and generals. The chief is convinced that, any moment now, Uzi-wielding dope dealers will enter the ICU and spray it with bullets, taking out their erstwhile colleague and any unlucky witnesses. Whenever the doors swing open, the chief flinches and starts to duck, and finally decides that it’s time to visit the lab where he’ll be working next month.

His paranoia infects the rest of the team. The other resident and an intern remember that they really ought to be in outpatient clinic; the students decamp to the library; Fred actually volunteers to scrub with a bad-tempered neurosurgeon on a routine back surgery.

Watson manages to reach John Doe’s mother, in another state. The woman has the usual reaction to bad news. “How could this happen?” Watson avoids the response on the tip of her tongue—“Because he’s a murderer, and this time someone got him first”—and tries to be kind and supportive. She explains how they’ve done everything medically possible, but the damage from the bullet is just too great. She expresses condolences, and finally broaches the subject of organ donation.

“It’s so unfortunate,” she says. A life cut short at only twenty-eight. Family and children—none of them legitimate—bereaved. But there’s an opportunity for some good to come from this tragedy. His kidneys, liver, and heart can give life and hope to some other women’s sons, some other childrens’ fathers.

“Are you crazy?” replies John Doe’s mother. “That stuff’s his. We’re not giving nothing away.”

“Fine,” says Watson. She has given up arguing with selfishness—all it’s ever accomplished is to increase her aggravation. Senseless tragedy is senseless tragedy, and it won’t be redeemed.

Tom is checking John Doe’s pressure. “It’s going down.”

“No shit,” replies Watson, nudging the foley collection bag with her foot. It is almost topping off with dilute urine. “When was this changed?”

“Half an hour ago. I think.”

“He’s pissing out pure water. So, what’s that mean?”

The student looks at her blankly.

“Diabetes insipidus,” she explains. “Posterior pituitary’s gone.”

He looks at her with surprise. Despite all the lectures and exam questions on renal physiology and sodium homeostasis, he has not until this moment realized that the facts he learned might apply to actual patients. “What do we do?”

She considers. If she follows the logical path, now that the next-of-kin has refused organ donation, and simply turns off the ventilator, she will have to notify the family, declare the patient legally dead, and go through all the other beaurocratic nonsense that such a case entails. There just isn’t time for this; she has patients waiting in the emergency room.

“Vasopressin, and chase the fluids,” she says, pointing at the as yet uncreased Manual of Medical Therapeutics in Tom’s right coat pocket. “Read about D.I. Hey, what a learning experience!”

Hearing her voice, the bandaged patient across the aisle wakes. “Waitress, I want a tunafish sandwich.”

# # #

It is almost five before she finishes in the emergency room, having seen a succession of head injuries, hysterics, seizures (alcohol withdrawal, and patients with epilepsy who neglected to take their pills), and finally a hemorrhagic stroke (a hypertensiv e who did not take his pills).

She calls the unit. Fred the intern comes on the line. “Got a big bleed, needs a bed in the unit. I’ll be right up, and disconnect John Doe.”

“Too late,” replies Fred. “He crashed and Tom couldn’t handle it. I just declared him.”

“Great.” That will save her some time. Then she hears yelling in the background. “What’s up?”

“That surgeon. He came in just when Doe transferred to the Eternal Care Unit, and he’s pitching a fit.”

“Doesn’t he know the family refused?”

A phrase comes through, barely comprehensible. “You killed him! Now you’ve killed four other people too!”

“Shit,” Watson cries. “Get him off of Tom. I’ll be right there.” She drops the receiver back onto the hook, tells a nurse “Hold him here in the E.R. til we clear the bed,” and strides the yellow line in the basement to the stairway. Bounding up the stairs , she almost collides with the surgery chief.

“Where the hell do you get the right to yell at my student?”

“You stupid shits let him die!”

“He was already dead, goddamn it.”

She pushes past him, not hearing his reply in its entirety. It just doesn’t pay to fight with people who are taller and more powerful. Heading into the unit, she sees the nurse and her aide already fussing over the body. The room is quieter now that the r espirator has stopped its cycling. The deputy is awake, and talking softly into the telephone.

“Tom? Hey, Fred, where’s Tom?”

The intern is writing the death note. Not looking up, he points out the doors.

“Where’d he go?”

The nurse smiles as she replies . She hates her deadend, thankless, underpaid job in this awful excuse for a hospital. The distress of young doctors in training is one of the few things in her life that gives her any pleasure. “That doctor kept calling him a murderer, and he looked like he was going to cry, and he left.”

“Oh God,” Watson whispers. She knows where he has gone. She knows she has to stop him.

# # #

There is a place of which all doctors know, though none are told. It may be reached by many paths. Watson runs to the stairwell in the basement, and then up to the old ward. She can see fresh footprints in the dust, leading to the door that should not be there. It opens with a wrench, and she takes the dark and twisted stairs cautiously. At the bottom, she is in the basement again, unlit save by small, high windows half-blocked by debris. The air is still and musty, and the only sounds are her breathing, and the rustle of something that she hopes is a mouse.

“Tom?” she calls, then heads off down the corridor. Further down it is lined with cabinets filled with pathology slides. They spill out of the drawers and a few lie upon the floor. Stopping as the basement becomes a tunnel, she leans briefly against a cabinet. A slide falls to the ground, shattering. Watson bends over, glancing at the remnants.

A slice of cervical spinal cord lies embedded for eternity between glass and coverslip. The stain has faded over the years, but the dorsal and lateral columns are clearly paler. This is the autopsy relic of some man or woman born years before Watson, or even Watson’s parents; to die then also, of a disease that now Watson can recognize with an offhand glance, and could treat easily with B-12 injections. Is life fair? she thinks. Not hardly.

She stands and sprints down the tunnel.A veritable catacomb lies beneath the hospital. There are tunnels between buildings; dank tunnels to the mental hospital a block away (said to be more safe than crossing the street in the middle of the night, but none the less avoided); unknown tunnels to unknown places. Every few years a drunk will wander out of the emergency room and get lost in the tunnels, to be found weeks later by horrified engineers. And then there is this tunnel, which intersects with none of the others.

A single window is set into the wall. Watson pauses, wipes clear a circle on the glass, and finds herself looking into the hospital’s pathology suite from an unexpected view. She is down low, near the antique autopsy table with its grooves and pails. Across from her is the door into the morgue, and to the left she can see the steep, hard rows of the amphitheatre.

She runs on. It is close now. If she stops, holds her breath, concentrates, she might hear a variety of sounds. Sobs. Moans. Agonal respirations. The lamentations of the living and the final exhalations of the dying. The screams of the delirious and the shrieks of the unanaesthetized.

Ahead is a halo of light, coming around the edges of a door in the wall at the end of the tunnel. It is a wooden door, dark, ponderous, smooth and pale about the handle, and the brass embossed sign, in square letters with serifs, bears a name. THE JULY WARD.

Tom has his hand upon the knob, and is preparing to enter. “No!” shouts Watson, managing to reach him and slam shut the door, while spinning him away from it. “No, it’s not your time yet…”

He looks at her with reddened eyes. Where does the light come from, now that the door is closed? She only knows that she can see the tears, welling in the inner canthi of his eyes.

“It’s not your time yet,” she repeats. “You’re not a doctor, you can’t go in there. Or you’ll never come out.”

“But I killed him… The surgery chief said…”

“The surgery chief is an asshole. You didn’t kill John Doe. He was already dead!”

She leads him back down the hall. “You can’t go in there yet. Not yet.

“In two years, on July first, you’ll become an intern. Someday you’ll have a patient. You won’t know what’s wrong—you’re young, inexperienced, you can’t know everything, and ultimately no one else can help you. It’s inevitable. Someday—maybe it’ll be in July, maybe it won’t—someday, someone will die because you don’t know something, or you made a wrong decision. And you’re a doctor. Then, you can come here. You may be in another hospital entirely, but you’ll come here, and you’ll find your patient…”

He looks back. The door seems indistinct now. “Did you…”

“Do you know how many pages there are in Harrison’s Textbook of Internal Medicine?” she asks. “At least 1200, big pages, with little print. You know how much mention rhabdomyolysis gets in Harrison’s? One line. One line about a fairly frequent, potentially fatal condition. I’ve read a sixty page paper on it. But that was a little late.”

They find themselves, strangely, in the basement of the hospital near the yellow line, which they follow towards the ICU. A gurney passes by, pushed by an orderly. Something large and wrapped in plastic lies on the gurney, its identity undisguised by a sheet.

Watson and Tom stand to the side, letting the gurney pass. She waves. “Goodbye, John Doe #3.”

“Now what?”

She shrugs. “Now you go home and get a good night’s sleep. We’re on call again tomorrow.” She stops a moment, frowning. “I imagine it’ll be a tough day too. The chief won’t stay around much, now that we’ve lost our deputy.”

# # #

Tomorrow is indeed a bad day. They miss lunch, they miss dinner. The Dude Brothers have been busy. The unit is full of head trauma cases, with more on the ward, making do with less careful observation. The paraplegic patient, still in the unit because of a mysterious fever, has gone beyond anger and is depressed now, speaking to no one. To either side of him, semi-conscious men moan and occasionally retch. As Watson passes the bandaged man in bed four, he sits bolt upright, stares at her, and shouts “I want a tunafish sandwich!”

“Stand in line,” she replies.

Tom has been futilely sticking a syringe over and over into one of the new admissions, trying to start an intravenous line. Watson comes over to watch him.

“You’re getting the hang of it,” she remarks. “Only you’ll never get this one.”

He shakes his head. “These are great veins. They’re standing right up, you can see them… It must be my technique.”

“Your technique’s fine, the fault’s his. He’s a junkie. Those veins are thrombosed.” She takes away the arm, and hunts. There’s something on the right thumb that she may be able to thread with a 22-guage butterfly needle. It’s that, or a central line.

“Make you a deal,” she says. “You go forburgers, and I’ll get the IV.”

“Fries and a shake?”

“Diet cola.”

He laughs, hunts his many pockets for car keys, and leaves. She sits down and reapplies the tournequit, slapping the man’s forearm to bring up the veins. They’re all shot, literally. Maybe she should go on TV, as a public service announcement. Don’t shoot dope, kids. You’ll ruin your veins. Then, when the doctors need to put in an IV, they’ll have to stick a big old needle right into the major veins in your chest, with the chance of bleeding, or infection, or a collapsed lung.

“Aha.” She decides she can get that sucker on the thumb after all, maybe even with a 20-gauge. Having surviving an internship, Watson has the hubris to believe that she could draw blood from a turnip. She tears off strips of tape, opens the betadine ointment, has everything ready, then wipes alcohol onto the vein and stops.

“Damn.” She’ll need an armboard. “Hey,” she calls. No one answers. The night nurse must be busy, or asleep somewhere. She drops the arm back on the bed, tournequit still on. Were he conscious, the man would be writhing in pain. She goes into the stock room in front, hunting angrily. Don’t they have anything? And if so, why isn’t it where it should be?

She hears the doors to the unit open.

“Good,” she mutters. It’s past visiting hours, so it can only be the nurse returning. She’ll know where the armboards are. Unless, of course, it’s Tom, coming back to see if she prefers Burger King or Macdonalds. She heads out of the supply room, and freezes.

“What do you guys want?” says the voice of the paraplegic drug dealer.

“We don’t want you to talk,” a voice replies.

“Oh shit,” Watson starts to say, and shrinks back into the doorway. Oh shit. The chief resident’s paranoia was on target.

She can hear the sound of a gun, of silenced bullets going into soft flesh and the mattress behind. Thock thock thock. Just like on TV. She holds her breath, afraid to breathe. They’ll be looking around the unit now; anyone else they need to waste? They are going from bed to bed, now they are at the back end of the unit. Two of them. Pistols, not Uzis. The chief resident was wrong. If they’ll just go in to check the nursing lounge, maybe she can duck out.

She is almost to the front door when the patient in bed four sees her. “Waitress!”

The men with guns bolt out of the lounge, and she abandons silence and begins to run. A bullet passes by her head. Pistols must be hard to aim. No wonder the bullets always seem to wind up in unexpected places in her patients.

Ducking into the stairwell, she wishes she’d stayed in better shape. She can work 36 hours straight, but running is beyond her. Already, as she heads down the basement, hearing the stairwell door slam and then open again behind her, already she is winded.

Where to go? The pharmacy? Locked. The emergency room? They do have a guard there. But by the time he figures out what’s going on, figures out how to draw his gun, the place will be an abattoir. Where to go?

She knows.

She cuts off into a tunnel. Why did they have to build the morgue so far away, so cut off even from the original hospital? Was it to contain germs? Or as some kind of symbolic gesture?

“Stop, motherfucker!” a man’s voice yells at her. The shot that follows makes compliance unlikely. Goddam, which way? She’s only been to one autopsy here. Go ahead, they tell the docs. Keep Dad or Grampa or little Joey alive long after he should be allowed to die. So we keep his heart going and his lungs working and keep him in agony because his body can’t survive, but they won’t let us let him go. And then when he finally dies, days or weeks or months after he should have—You want an autopsy? What, are you crazy? Hasn’t he suffered enough?

The morgue. This is the way. She tries the door, then hits it angrily with her palm. Locked. Okay. Up the tunnel. It’s slanting uphill. If you lost your grip on a gurney carrying a corpse, it would careen downhill until it ran into a wall, or came to rest near the outpatient pharmacy, where the clinic patients wait to have their prescriptions filled. Wouldn’t that be a cheerful sight?

The door to the amphitheatre is unlocked. It’s dark inside, except for a light someone’s left on down in front, by the display cases. Did doctors ever trip on these precipitous stairs, interrupting some learned professor’s discourse as they toppled to their deaths? She has to take them slowly, watched by the ancient dissections below. Here are skeletons and bottled fetuses and hands, palms flayed opened to show their inner workings, reaching out as on the Sistine Chapel. Here is the preserved torso of a young man who lived and died before motorcars or radio, and when he was struck down by a horsedrawn trolley, astonished doctors found that his organs were all on the wrong side. Here is the face of an infant with a single eye, and a trunk-like nose above it. Here are legs poised forever to step, hearts waiting forever to beat. Here are the heads of unsuspecting paupers who have been made into demonstrations of normal anatomy, and wear expressions that seem vaguely surprised.

She gets to the door with the window, alongside the guttered table with its century of knife marks. The door is barely noticeable, dark wood faded into dark wood. She grabs the handle and twists. It is not locked. Who would want to try it? But it is stuck, and she takes it with both hands and braces her foot and pulls. The men are coming in the door now, about to take aim but momentarily shocked by the grisly displays.

“Sheeeit,” a man says. The other whistles.

Watson snatches up the nearest object, a breadloafed slice of brain embedded in a block of glass. It is very old; the definition between gray and white matter has faded, and the sloshing liquid inside has a froth at the top, yellow cholesterol leached out over the years. She throws the specimen, then another, and finally the entire cerebellum for good measure. None come close, but the sounds of smashing and the smell of ancient fixative gives her a feeling of accomplishment.

The nearest thug raises his pistol. Watson falls back against the door—and it opens outwards.

“I’ll be damned,” she says, and begins to run down the hall, past the rows of cabinets, too heavy to topple. Behind her, she can hear curses, as her foes try to get down the steep steps, now slick with lipid-rich alcohol and bits of brain.

They aren’t even trying to shoot anymore, just running after her, closing the lead. She doesn’t want to think about what’s going to happen when they catch her. And then she sees it. The dark door and the brass sign.

She pulls it open, and she is inside. Inside the July Ward.

It is an old fashioned ward, beds down either side, but some are the barely pallets, others old-fashioned hospital beds, still others are high tech automatic beds, one even with a ventilator at its side. Patients stare at her from each bed, recognize that she is not the one for whom they wait, and look away. Ghostly orderlies—she cannot make out their details—approach, recognize her as a doctor, and step aside deferentially.

She stops running, smooths her white coat and straightens her scrubsuit, then goes down the row of beds, walking purposefully but sedately, the way a doctor should, glancing at the nametags and the bedside vitals charts. Many of the patients in the newer beds are in their nineties, and all patients in their nineties look alike.

Behind her, she can hear her enemies enter, hears a gunshot that seems to hit the ceiling, hears polite but firm voices (whispery, unreal).

“You cannot be here.”

“Leggo man. Shit, what is this?”

“This is the July Ward,” comes the answer. “In this ward, we admit only special patients: the first patient that a doctor kills. You cannot be here.”

Watson has found the bed she is looking for. There is an old woman on it, frail and edematous, fluids running into an arm marked with bruises and swelling from ancient veins that cannot long support a line. The bag at the end of her catheter shows scant urine, with the faint pink tinge that Watson now knows might mean rhabdomyolysis, muscle breakdown products that, left untreated—or even despite treatment—may kill the kidneys. And the patient.

The woman in the bed looks up. “Yes, dear?” she asks. You can hear the fluid in her lungs as she speaks.

“I came to… say I’m sorry.”

“You’ve already apologized,” the woman replies, very kindly. “You’ll have to stop coming here. It just isn’t healthy.” Watson turns away, and the old woman calls after her, softening the hard advice. “But thank you for visiting, dear. It was very kind.”

Behind her, she can hear the woman address the patient in the next bed. “My doctor. Such a nice girl.”

Watson strides back between the rows of patients, past the two gunmen, subdued now by orderlies. She sees the men, faces blanched with fear, unable to speak as they twist in the grip of arms that will not come into focus. Their eyes are wide with terror and pleading, and she finds it hard to not stop and order their release. But she does have some common sense.

“You keep this ward very well,” Watson says. The orderlies nod. It is always good for a doctor to compliment the staff on a job well done. “I won’t be back.”

She closes the door behind her. What will become of the gunmen? She has no idea. But she knows this: only two kinds of people may enter the July Ward—doctors, and the dead. And only the doctors may leave.

But not completely. Never completely.

# # #

There is a place of which all doctors know, but none will speak.

The July Ward.

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