Read an Excerpt
Winter Wine Dementia Facility had a distinctive odor Susan finally decided represented a unique combination of body odor, urine, disinfectants, and 2–nonenal, the musty omega–7 fatty acid degradation product known in slang as “old person’s smell.” The front entrance brought Susan and Kendall into a clean waiting area with neat rows of chairs on a deep blue carpet, off–white walls, and an enormous desk surrounded by windows. Hallways branched off on either side of the desk, where a middle–aged woman dressed in white scrubs leaned over a pile of papers. She looked up as the residents entered, then smiled. “You must be the new doctors.”
“We must be,” Kendall said, striding forward with his right hand extended. “Kendall Stevens and Susan Calvin reporting for duty.” He jabbed his left thumb over his shoulder. “That one’s Susan.”
Susan let the door snap closed behind her.
Still grinning, the woman took Kendall’s hand. “Well, I certainly hope so, Dr. Stevens.”
Susan stepped forward. “Just call me Susan, please. If you say Dr. Calvin, I’ll be looking over my shoulder for my father.”
The woman dropped Kendall’s hand to take Susan’s and give it a brief shake. “Ah, so you followed in his medical footsteps.”
“Only if you consider robotics medical.” Susan reclaimed her hand. “He has a PhD in engineering.”
“Ah,” the woman said. “That kind of doctor.” There was a hint of condescension in her tone, which bothered Susan. She never understood why people gave less credence to university doctorates than medical–school graduates.
Kendall must have noted it, also, and came to the subtle defense of PhD’s everywhere. “I’m sure Dr. Calvin could diagnose what ails you, too. If, for example, you were an exponential assembly unit having difficulty with your kinematic influence coefficients.”
Silence followed the remark, during which the woman studied Kendall as if trying to determine whether he had insulted her. Apparently deciding he had not, she smiled again. “I’m Hazel Atkinson. I’m a CNA. Most medical receptionists are these days, so we can pull double duty.”
Susan nodded. It made sense for medical centers of all types to hire certified nursing assistants as receptionists so the front–desk personnel had at least a minimal understanding of medical terminology and could help in a crisis. “Nice to meet you, Ms. Atkinson.”
“Hazel,” she corrected, to Susan’s relief. It would seem entirely weird for the CNA to address the doctor by her first name while the doctor used the receptionist’s title. “Let me show you around.”
Susan appreciated that. She still suffered from suffocating ennui, and the July 1 date only made it seem worse. The sooner they jumped into medical work, even of a depressing nature, the better.
Hazel pointed to the hallway to the right of her station. “That’s the entrance to the foyer, where we take the families through to see their loved ones.”
Susan caught a glimpse of the same fresh blue carpeting and clean walls as in the entry room before being herded down the left hallway. Her soles clicked against worn tile flooring, and the walls, though the same color, looked infinitely drabber. Though well scrubbed, they had clearly not been painted for years. The odor Susan had parsed earlier grew stronger and more unpleasant as they wandered farther into the bowels of Winter Wine Dementia Facility, and the hallway opened into a small charting area filled with palm–prosses and larger computers. Currently, only a pair of white–scrub–clad nurses occupied the area, chatting softly with one another. As Hazel approached, they both rose.
Hazel made the introductions: “Doctors Susan Calvin and Kendall Stevens, this is Gray Halbrin.” The larger of the two men bowed and raised his head. He had dark curls, brown eyes, and a short goatee. The other nurse was a shorter blond with a broad baby face and brilliant blue eyes. “And this”—Hazel indicated the blond—“is Milan Penderghast.” Heads bobbed all around, and Hazel pushed open a heavy door to lead the young doctors deeper into the facility.
As the door closed behind them, Susan noticed a bright red sign on it reading CAUTION: DO NOT ENTER.
Noticing the direction of Susan’s gaze, Hazel explained. “That’s not for you. It’s to keep the patients from wandering outside.”
“Does it work?” Kendall asked.
“Quite well.” Hazel walked through a short empty space, more air lock than hallway. “Most of our patients can’t manipulate the heavy metal doors. If they do, we nearly always catch them in this area.” She gestured the hallway, then pulled open the far door to reveal another hallway, this one broken by several doors. Again, Susan noticed a sign on the door they had come through, this time stating staff only.
Several of the new doors also sported signs. Three had only numbers, one was labeled STAFF & VISITORS' RESTROOM, and another WAITING AREA. Three others contained no signs. Susan noted all the numbered doors had keyholes and sturdy twist knobs, which would make them more difficult to open. The others had handles easily depressed, even with full arms.
Hazel opened the door marked 3 and leaned against it to hold it open for the doctors. “Might as well start with the end–stagers.”
A blast of the smell Susan associated with the dementia facility assaulted them, partially covered by a rosy scent clearly intended to help mask the odor. They entered an enormous room filled with rows of hospital beds, the walls lined with chairs. Thick privacy curtains surrounded each bed, most of them fully open to reveal patients dressed mainly in pajamas and nightgowns. Most stared blankly at the ceiling or walls, their jaws working soundlessly. Others wandered aimlessly around the room or sat in one of the chairs. Susan saw feet beneath the few drawn curtains; staff working on patients in delicate stages of dress, or family members visiting. No sound emerged from these areas. Apparently, the fabric fully muffled conversation, keeping visits and medical interventions private.
Walking, sitting, or lying, the patients all wore the same blank stare, their faces wrinkled with age and confusion, their expressions neutral, their eyes dead. No real life looked out from them. They were automatons, emotionally empty, breathing from habit, without intention of any kind. Most had withered to pale, skeletal figures, as if they planned to gradually disappear, leaving no trace of body or soul. Their skin and lips gleamed with emollients intended to prevent cracking and sores. A sense of horror stole over Susan, and she found it difficult to breathe.
Multiple doors led off of this unit; several were labeled as toilets, a couple as bathing areas, and a few others bore no labels at all. Hazel opened and walked through one of these, and Susan followed gratefully. She could scarcely believe she was going to have to spend an entire month catering to patients who no longer had the capacity to care about anything, hopeless cases she had no means to help, people who remembered nothing and could not even recognize their own faces in a mirror.
The psychiatry residents found themselves in another staffing room, this one with desks built into the wall, topped with cupboards, covered with palm–prosses and even a couple of old–fashioned desktop computers too heavy to move. A platter of chocolate chip cookies sat amid a clutter of paper and pens.
Hazel took a seat and flicked on a light attached to the underside of the cupboards. She snatched up a cookie and gestured for Susan and Kendall to do the same. “Winter Wine has three units,” she explained. “And you just saw the worst of them. It’s officially named the End–Stage Dementia Unit, or ESDU, but most of us just call it, DUm.” She pronounced it like “doom.” “If we discuss the possibility of moving there, and the patient responds in any way, they’re not ready for it.” She took a bite of her cookie.
Kendall took a cookie, but Susan found herself wholly without appetite. She had known patients with any type of progressive dementia eventually died from it, but she had never considered the detailed reality of those last few months or years. It seemed like nothing less than profound, unremitting misery. The lucky ones had weak hearts, so they could slip away to true oblivion rather than drag on in a state of living death. “They’re . . . zombies,” she observed.
“Except with less purpose,” Kendall pointed out. “Zombies, at least, have a goal.”
Susan could not imagine what he meant. She hoped he wasn’t working up to a tasteless joke. Though his way of dealing with stress, it seemed grotesquely out of place in this environment. She gave him a pointed stare.
“What?” Kendall surely understood Susan’s consternation but played ignorant. “I just meant to eat human brains.”
His explanation did not help the situation.
Hazel easily joined the morbid conversation. “Zombies are ambulatory. Most of our end–stage patients aren’t. They have no real consciousness, no self–awareness. And, for many of them, that’s a strange sort of blessing.”
Now both R–2s stared at the receptionist.
Hazel shrugged and took another bite of cookie. “It’s the mid–stagers I feel sorry for, the ones on Unit 2. They still have bits and pieces of memory, individual pieces of a puzzle that no longer fits together. The world comes in and out of focus, but it’s a life without sense or logic. The struggle to remember the missing portions, to fill in the gaps, to come to grips with enough detail to make sense of the situation causes them to lash out in ways that suggest they’re in a constant state of agony. It’s only after those last bits of memory are extinguished that they finally find a weird bit of peace in a dementia–induced oblivion.”
Susan turned Kendall another look. This one, she hoped, conveyed anger and betrayal. She could have spent this painful month of renewal in a cushy outpatient clinic. Instead, in the depths of her own depression, she had to deal with the most hopeless creatures in existence. She wondered if she could ever crawl out of the deep black hole that circumstances and a poorly chosen rotation had created.
“Cheery,” Kendall said, popping his own cookie in his mouth and chewing thoughtfully. “These are delicious. I don’t suppose the patients made them.”
Hazel finished her own cookie and dusted the crumbs from her scrubs. “A family member brought them. Sweet, but totally impractical. Most of the end–stagers have forgotten how to swallow properly, and we’d have a run on aspiration pneumonia. We give the family the option of taking the cookies home or leaving them for the staff. Most choose to leave them. One of the few perks of working here.”
Susan brought an image of the unit to her mind’s eye. She supposed families could find a reasonable degree of privacy behind the sound–dampening curtains. “Do many people come and visit their relatives at . . . this stage?”
Hazel leaned back in her chair. “It varies a lot. Some people come every day, some never, and you see everything in between. It’s not always the ones you expect, either. The relatives who kept them home the longest are often the ones who disappear completely when they reach this stage.”
Susan found herself wondering how she would handle a similar situation if her father ever developed Alzheimer’s, then blocked her own considerations before they came to full fruition. Now did not feel like the time to grapple with additional weighty thoughts, no matter how appropriate to the situation. Not only would it borrow trouble at a time when she owned enough, but it was also rarely ever a good idea to judge the motives of patients and families, at least until she managed to get inside their heads. Once she had formed her own ideas of how she would handle a given situation, she could not help comparing it to others’.
Having finished her own cookie, Hazel looked expectantly at Kendall. Noting he had swallowed the last bite of his own, she gestured back toward the door. “Ready to move on to Unit 2?”
Susan doubted she would ever be fully prepared. However, she had never run from a challenge and did not intend to do so now. “Ready,” she said.
“Can’t wait,” Kendall added with a smile.
Susan rolled her eyes, but also forced a grin. She knew he was acting as much to keep her spirits up as his own. When they got off work that evening, they both knew she fully intended to kill him.