You awake? 

I was not awake. I see Kate’s text message six hours later when I rise for  work, just after five. It’s still dark outside, before the sky cracks open. I am now! All okay? 

She writes back instantly. There was a shooter in Atlanta. 

*** 

I fumble into scrubs with my phone kinked between shoulder and ear.  I make the coffee like always, fill the travel tumbler with warm milk until  the coffee turns from black to brown, sip its bitter heat. I let the dogs out  and scoop kibble into their bowls and leave a note on the kitchen counter  for my girls. Sometimes I leave a riddle or a joke but today it’s just a note:  Have a great day!!! Love you!!! XOXO –Mom with two chipped lollipops on top. 

I slip out the back door as the sky turns pink, dusky and grayish like  hydrangeas in neutral soil or a capillary bed deprived of oxygen. The Earth  rotates sufficiently inside seven minutes that the sun peeks over the train  tracks when I arrive on the platform. 

The Metra rattles through the suburban Chicago landscape past strip  malls and rail yards toward the shiny hospital downtown where I work. I am a pediatric intensive care physician, which means I resuscitate dying children  for a living. I am not sure I can do this today, but it’s my turn so I go. In a  seat across from the emergency exit, I send Kate links to websites with tips  about how to discuss high-profile acts of violence with kids. I locate the  links easily in a recent text thread with my Nashville friends. The gesture  feels hollow, impotent. Repetitive. 

Kate will kneel when she tells her son Max, the tops of their copper heads  even. His impish grin will vanish, possibly for days, when he learns why his  school was on lockdown yesterday. Kate won’t say manhunt and she won’t say  murderer, but she will say died. Forthright and honest, stoic but gentle, that’s Kate. 

I wipe away tears with the backs of my thumbs and stream a worn-out  playlist through my earbuds as I scramble off the platform with the crowd. 

***  

The first person I see on the unit is my partner, Craig. Craig looks like  Santa in middle age: stout, peppered beard, kind blue eyes cradled in creases  from decades of laughter. The creases rest slack now, expressionless. Everything  he feels transmits through those watery eyes, glazed now with grief and rage. 

“How are you doing?” I ask him. 

“I am apoplectic,” he says. 

Craig only needs to say one word and I understand him. Perhaps it has  more to do with the specificity of the word than any personal connection I  have with Craig but still, I understand him. 

The baby on ECMO is bleeding to death. ECMO, short for extracorporeal  membrane oxygenation, is a machine that removes blood from the body to  clean it of carbon dioxide and enrich it with oxygen before pumping it back  in, effectively replacing vital organs with a snarl of silicone and metal. Blood  normally clots when exposed to foreign surfaces, so ECMO requires heparin  to prevent the whole contraption from clogging to a halt. Maybe this is why  the baby bleeds so badly, or maybe the infection that destroyed his lungs also  wrecked his clotting system, or maybe he bears an unseen wound somewhere  deep in his chest. Craig is not apoplectic because the baby is bleeding. 

Craig is apoplectic because our group has yet to properly address the  last ECMO case complicated by bleeding. Even in the best hands, the odds of surviving ECMO approximate a coin toss. Craig knows this and does  not ask for perfection. He asks for reflection. He counts the days out loud  since the last child died, tracking our inertia. “Forty-six days,” he told me  last week. “Fifty-three days,” he says today. In fifty-three days, our group  has not paused our practice. We have not changed our approach. We have  not even considered whether or how we should. 

The pandemic steamrolled us. There is no time to grieve. 

Are we too burned out to examine our mistakes? 

*** 

I head to my office before rounds to call Kate. She still uses her Boston  number even though she has lived in Atlanta for more than a decade. My tears  roll when she answers. I feel like an asshole, crying like this when I called to  support her. My next-door neighbor didn’t just get shot. I don’t have to tell  my eight-year-old son that his friends’ mom is dead. What business have I  to cry like this at Kate? I tell her it’s okay to skip her residency class reunion  this weekend and it’s okay to go, whatever she wants; there is no right or  wrong answer. She thanks me for saying so. She is measured and wise and  calm. She is unflappable, but maybe right now she just seems that way. 

“My deck faces her deck,” she says before we hang up. 

I picture Kate’s deck in Atlanta, lush and green. Trees everywhere. Her golden  retriever sniffing among Max’s forgotten Pokémon cards, his nose twitching over  the mossy wood to track loamy scents from the foothills of Appalachia. 

*** 

I station myself at the baby’s bedside all morning so Craig can round  on his other patients. The baby’s body is swollen and purple, penetrated  by tubes and crisscrossed with wires, but the jarring thing is how beautiful  he is anyway. His family comes from the same country as Tati, the au pair  who takes care of my family when I work like this. Tati is sweet and kind  and good, so I think the baby’s parents must be like that too. I realize this  is some stupid form of vicarious nationalism, but I love Tati and my soul is  raw today so I can’t help it.

Tati’s parents are teachers. Her father commutes through guerilla jungles  to reach the school where he works. She said their town is mostly safe, not  too many bombs, but the mountains around the school are dangerous. Lately,  Tati’s father worries about her safety living with us. He has heard about the  shootings in Chicago. 

Tati traveled with us last year when my family vacationed to the  Wisconsin Dells over the Fourth of July, stuffed in the backseat between  two tiny sticky girls. We rode the duck boats and kayaked on Mirror Lake  before my husband Scott got Covid, and we had to end the trip early. We  jammed our gear in a tangled lump back into the hardpack on the roof of  the Subaru and rolled down all the windows to protect the uninfected. 

We drove nearly halfway home before the news unfolded through texts.  The shooter unloaded his rifle sniper-style from a rooftop over the central  square in Highland Park, Scott’s hometown, blocks from his childhood  home where his parents still live, where their friends and neighbors and their  kids gathered to watch the floats and marching bands in the Independence  Day parade, where we might have joined them had we not tried to show Tati  the Dells. For the rest of the drive, Scott called and texted and texted and  called to find out who was okay. 

Nobody was okay. 

*** 

I order bags of blood that the nurses infuse into the baby’s body and track  the brighter blood pouring out of his body, soaking the gauze around his chest  tubes and trickling through them into a clear plastic box next to his bed. The  entire circulating blood volume of a baby this size measures barely more than  a venti coffee. This fact always astonishes the residents, but the fellows already  know it so I teach them whatever I can about ECMO instead. If I keep my brain  focused on physiology, this science that I worship, it will prevent my senses from  appreciating what is really going on, that a baby is dying right before my eyes. 

If we just keep pushing more blood, maybe it won’t matter that he is  bleeding. 

*** 

I was a senior in college when Columbine happened. I remember abject  disbelief. The notion that anyone could do such a thing horrified and  bewildered me. 

I was pregnant with my daughter Nora during Sandy Hook. I fought  hard against my tears then because her body was still part of my body, and I  did not want her to feel so much sadness. 

She was four for Parkland. We wore bright orange stocking caps with  Everytown buttons pinned to them, and Scott carried Nora through the rally  on his shoulders so she could hold up her sign and see the brave teenagers  onstage with their megaphones. 

She was in third grade for Uvalde, bookended by the grades at Robb  Elementary. I choked through spit and snot and tears until my sides burned  and my breath ran out, but I was careful to stop wailing before she came home  from school. Her bus was late that day and when I saw her I ached to hold  her for the rest of time. 

As for the banks and grocers and nightclubs and concerts and churches  and temples and dance halls and shopping malls, I don’t know where we  were for each of those. 

***  

After Craig finishes rounds, he taps me on the shoulder to assume vigil  at the baby’s bedside. I head to my office to look up the Atlanta news on  my phone. I have two computers at my desk, but for some reason I use my  phone. Small screen, intimate, easy to slam face down and push it away if  I read something gruesome or horrifying. These little screens of gruesome  horrifying news live in pockets, on nightstands, in cars, everywhere. 

If my friend’s friend wasn’t shot, if her son wasn’t drawing pictures of  broken hearts for his playmates, I might not have read about this news at  all. It just barely qualified as a mass shooting: five victims, one death. Amy.  Mother of two. Worked for the CDC. Kind face. She was waiting for an appointment to see her doctor when the shooter opened fire. I know this  last part because Kate told me. The rest I learn on my phone in my office  where the tears well again and I am grateful they haven’t run out. 

***  

After Highland Park, Scott and I began researching countries anywhere  in the world where we could practice medicine in English. We had rallied and  marched and written op-eds and voted and called our senators and spoken on  panels and donated. But Scott’s hometown was sprayed with bullets anyway,  so all that was left to do with our grief was channel it to plan our escape. 

Scott called his friend in Australia and I called mine from Singapore.  We watched a video blog by an American doctor in Ireland and applied  for jobs along the Canadian coasts. We made spreadsheets and a sixty-slide  PowerPoint to summarize our findings. We are numbers people. 

Gun deaths in the United States surpass those of all other nations by  orders of magnitude, but everyone knows that. 

There are more guns in the United States than people. The next most  heavily armed nation bears less than half as many guns per capita, but we  didn’t really want to live in Yemen. 

United States civilians carry more firearms than the police and the  military combined. Police don’t carry firearms at all in Great Britain because  they don’t have to. 

More than three hundred school shootings have occurred in the United  States over the last decade. Second place is Mexico, with eight. 

Gunfire is the leading cause of death among U.S. children, more than  car crashes or cancer. For every Swedish child killed with a gun, a thousand  American children are killed with guns. 

*** 

I heat up my leftovers in a splattered communal microwave and bring  the steaming bowl to my office to eat lunch alone while I read the news.  The shooter served in the Coast Guard. He grappled with anxiety and  depression. He had a hard time getting treatment. 

I startle to a knock on my office door. My colleague Colleen arrives  to learn about the patients on my service before she takes over for me  tomorrow. The list is short and straightforward but still, I am too distracted  to give a coherent report. If I feel like shit about how scattered my brain is,  Colleen does not judge me. She is kind and careful and smart. She will take  good care of the kids. 

After signing out, I finish eating and text Craig. On my way up. Go get  lunch. Grab me a diet soda please? I said pop until I trained in Boston, and now  I say soda even though I haven’t lived in Boston for fourteen years. Craig is  from Connecticut so he understands soda. 

I head back upstairs to the ECMO bedspace. Nothing has changed.  The baby is bleeding into his chest tubes, bleeding into his breathing  tube, bleeding into his body cavities that nobody can see. I could present a  slideshow here of every child I have admitted to the pediatric ICU bleeding  from a gunshot wound, but trust me, nobody wants to see that. I’m not even  sure I could count them. 

Craig leaves for lunch, gives me a smile and a pat on the shoulder as we  trade places. His smiles emerge easily because his spirit needs somewhere to  go. His spirit is too big for his body, so it seeps out through his face even  when he is recently apoplectic. 

Each minute at the ECMO bedspace I become more comfortable letting  myself junk out on physiology. I teach the fellow, Alisha, about pulmonary  vascular resistance and ventricular wall stress and coronary ischemia. Her curly  hair bounces against her eyelashes and she blinks often because of this, so her  earnestness registers before she speaks. Alisha is going to be great, she has it in  her bones, but she is still learning. She is in her first year of fellowship, and I  am more than a dozen years past mine and we are both still learning. 

Alisha has already spent four years in medical school and three years  in general pediatrics residency to qualify for this fellowship, another three year odyssey to certify as an intensivist. Aside from being fastidious and  compassionate, pediatric intensivists must be brave, decisive, nimble, and extremely good at compartmentalizing. I wonder if Alisha knows what she  signed up for. I wonder if she realizes how deep the wounds can cut. I don’t  think I realized it when I stood where she is standing. 

I position myself behind her to coach as she gives updates to the baby’s  parents through a Spanish interpreter. She uses short sentences and takes  breaks for translation, just like she was taught. Her explanation is clear but  not overly detailed. She invites questions. 

The parents have just one. 

¿Se pondrá bien, doctor? 

***  

Rates of gun violence in Illinois are worse than the national average  despite strong laws, partly because of Chicago and partly because of the  iron pipeline from neighboring states with weaker laws, like Indiana. The  worst places, like Louisiana and the District of Columbia, bear rates of gun  death like Tati’s neighbors in South America. The safest states, like Hawaii  and a few on the East Coast, compare to Scandinavian countries. So it is  decided: We will move to Hawaii. The aloha spirit will save us. 

I have a job contract but haven’t signed it yet because I am on service  and tired and emotional, and Scott says to wait until I am better rested with  a clearer perspective. How to gain perspective with babies dying and moms  getting shot and the world crumbling at our feet? 

I zoom out on the map using two fingers to shrink and stretch and roll  the Earth on the screen in my palm to frame my home and these islands  together. To zoom out far enough, you have to see the curve of the Earth  until the islands are little specks of dust floating on the surface of a blue  planet orbiting the sun. 

* 

Craig signals his return from lunch with a text: I got your diet Poopsie.  I have been pushing blood and fluid and blood and fluid and watching  the baby’s circulation cut in and cut out. The surgeons know the baby is  bleeding; there is nothing left to do. I have given him whole plasma rich with clotting proteins and stopped the heparin infusion and done all the  things I know how to do. Still he bleeds and bleeds and bleeds. When Craig comes back, I update him and ask him to decide when it is  time to stop. Craig has cared for this baby all week. He guided the baby through  three procedures and at least two trips to the operating room. He carries the  weight of our past failures into every decision he makes to help save this baby.  He is fried. He says he is fried. I see he is fried. I want to help him, but I can’t.  He does not need help from me. He needs a break. He will go home and play  guitar and hug his kids and smoke some weed. I think he will be okay. Craig practices medicine with his whole heart and it hurts to do it that  way sometimes. I know this. I love this about Craig. But I worry for him too. After I check on my other patients, I sign them out to the overnight  attending physician and hand over the code pager. Back in my office, I hang  the gray lab coat on its hook and put on my windbreaker. I always feel like  Mister Rogers when I do this. Sometimes I even change my shoes but not  today. Now since the pandemic has receded and we don’t require masks  anymore, I no longer feel like my shoes are toxic waste. But they probably  still are and I shouldn’t wear them home. I zip my laptop into my backpack  and head upstairs to check on Craig. 

I find him sitting across the hall from the baby’s room, chatting with the  cardiac surgeon. They are smiling and leaning back in their chairs like two  old friends, Craig’s fingers laced behind his head. He stands for a hug when  he sees me. I tell him I hope I never need him, but I want him to take care  of my kids if this ever happens to them. He says he won’t be able to come  all the way to Hawaii. I tell him I can fly him out there. This is my way of  telling Craig I think he is really good at what he does. That is how pediatric  intensivists complement each other, by invoking super morbid shit like their  own kids ending up on ECMO. 

The curtains around the baby’s room are drawn. The parents are inside.  “It went quick,” Craig says, spying my eye wander toward the curtains. The nurses will tend to the baby now, nestling him into his parents’  arms and cleaning his body for what comes next. The doctors step away  because we are not invited. We have failed. It is okay for the parents to think  so. If they blame us and despise us, if they hurl their grief like bricks at our  skulls, that is okay. We will absorb it. That is all we can do for them now.

Thursday’s Child 77 

Catherine Humikowski 

* 

On the elevator to the lobby, I fish out my earbuds and call Kate once  I reach the ground. I leave a voicemail saying I love her and I’m thinking of  her and she doesn’t need to call me back unless she wants to. 

Fading golden light filters through dust-spattered windows on the bus  to the train station. Through them I spy a high-rise under construction,  Stan’s Donuts, the Hampton Social. On lower Wacker, I can see down to the  riverwalk, white umbrellas open under the evening sun, diners enjoying the  Chicago spring weather. The Avett Brothers are saying something important  through my earbuds: If I live the life I’m given I won’t be afraid to die. 

There are no tears left today. They would be so cleansing now. * 

I drink a beer on the Metra sitting alone on the top level in a seat for one,  not concerned about the optics. The guy at the Booze Caboose, the grab-n-go  drink kiosk at Ogilvie train station, gave me a free beer once when I approached  his counter wearing my scrubs. “Thank you for your service,” he said then,  sometime between waves of the pandemic. There is no shame in a beer on the  train when you do what I do. There is no shame in a beer on the train. 

I rest my head against the window and watch the rail yards wobble by.  So much can grow in the cracks between asphalt and cinder block. 

* 

The Metra deposits me in a leafy suburb where I walk the rest of the  way home, just a thousand steps to my girls. I enter the yard and they burst  from the back door all limbs and kinetics, shouting “Mama!” as they race  to bury their faces in my thighs and my gut. “Did you got me a treat?” the  little one titters, an echo of her older sister who knows full well by now that  I have. From the depths of my backpack, I extract two bags of Rold Gold  pretzels purchased at the Booze Caboose, and I might as well have presented  the moon.

78 RT 26.2 Spring 2025 

I can’t name the swell behind my breastbone with a word so simple as  joy or gratitude or relief but whatever it’s called, the onset is breathtaking  and vertiginous. 

After dinner and tuck-ins, Scott pours me a double bourbon over the  good ice, listens to my day, then falls asleep. I slip silently into the bathroom  to sign the contract for the Hawaii job alone before bed. On my phone  again, the portal to everything. 

In the morning Kate texts me photos of the luminaries on her street  in Atlanta and the pictures all the neighbors have drawn for their missing  friend. Amy, we’ve got them one says. 

We’ve got them. 

* 

I will dream about the baby on ECMO for days and days and days. I  will wake to the image of his swollen purple body and wonder and wonder  and wonder what anyone could have done differently to save him. And if the  answer is nothing, there is nothing anyone could have done, he was dying of  a fatal infection and this technology can only reach so far, I will wonder and  wonder and wonder anyway because maybe it will help save the next one. 

I will dream about the vast blue ocean that will soon separate me from  my home, my family, my shiny hospital. Water is like a magnet and I will  wonder and wonder and wonder if it is strong enough way out there in the  middle of the North Pacific to keep us steady. I will wonder and wonder  and wonder if my family will ever forgive me for leaving. I will wonder but  still I will go because maybe it will help save my girls. 

And if the answer here too is nothing, nothing can save them no matter  how desperately anyone fights to stop the bleeding, at least when the end  comes we will have lived on volcanoes with sand between our toes and the  ocean on our skin, caked in salt from a trillion ancient stars.