Rage

My rage has a color and a shape-it’s bright orange and round like an egg. The rage doesn’t just happen when I turn on the news-it is triggered by almost any gurgle in my day-a patient whose vein I can’t find because she’s too skinny, a woman coughing without covering her mouth in the frozen food aisle of Wegmans, a dead raccoon flattened on the side of the road.  I feel it in the tips of my fingers, as if I need to squeeze something very hard. As a nurse caring for fragile women, teenage girls (and sometimes teenage boys) who are starving themselves to death, this can be a liability.

Today, I must find a way to make up for yesterday’s work outburst.

Bedside manner has never been my strength. Since taking this job five months ago, I’ve been given one verbal warning, and now written up once. The verbal warning came after I threw a paper towel roll at Tina T. “Throwing” is an exaggeration. I would say it was more like tossing. Like, a gentle tossing of the roll in the direction of Tina’s head. I thought she would catch it, but instead it hit her in the nose, which started bleeding.

If I screw up again, I will be let go. I don’t care. Nursing jobs are easy to come by. I know because I’ve had five in the last two years. Fuck you, nursing is hard.

However, because I don’t have another plan just yet, I spend fifteen minutes in my car in the August sun, breathing in and out, trying not to get pissed off by the man parked in his giant gas-guzzling Ford next to me and blasting twangy country music for all the world to hear. I open the door fast, banging into the body of his truck. He glances over at me, and I smile and shrug, like, Whoops!

Imagine a white fluffy cloud, passing over a blue sky with the relentless summer sun poking through. 

I walk through the electric doors of the clinic with slow steps in my padded white sneakers. My other latest self-help thing is to think in terms of gratitude. Thank you that I can walk. Thank you that only two of the three Tina’s are working today. Thank you that I did not get gang-raped in the parking lot after my late shift last night. 

I work with three Tina’s. All three grew up in the surrounding towns of rural PA and graduated from Penn State Nursing School. I imagine they have dads who wear camouflage on the weekends and moms who bake meatloaf. Two out of three Tina’s have bumper stickers with American flags on them. I’m as patriotic as the next atheist, but do not feel the need to advertise.

My supervisor, Tina B., is a busty blond with an overbite who brings in brownies on a regular basis. She never eats any of the baked goods she offers, telling us they are made from a gluten-free mix she got at the Publix grocery store (as if we care). When I walk into her office, she glances pointedly at the Mickey Mouse clock on the wall. Each number on the face is a black floating Mickey Mouse head and, on the hour, the clock plays “It’s a Small World After All,” which can make you wish you had a hammer.

I have been told many times to walk it off. I try to take this advice, but it never works.  I have a full file floating around, the phrases “overly involved” and “inability to separate” written in multiple places. My school record has similar marks in it, “lack of respect for authority,” “constant questioning,” and “unwillingness to maintain the status quo.” aka a troublemaker.

She waits for me to sit down and then she clears her throat.  “How are you liking it here?”

“I love it,” I say, staring at her snow globe on her desk. It has little plastic creatures in it, penguins or possibly dancing opossums or tiny rats. I fight the urge to pick it up and shake it.

“Okay, I am glad to hear that because it seems you’ve had some difficulties adjusting. We like to think of ourselves as a team, like the Three Musketeers.”  There are more than three nurses on the ward though. “And if one of us is unhappy, it impacts all of us.” I bob my head, as if agreeing.  “Think of this place like a little terrarium. You have one of those when you were a kid?

“No. We didn’t have pets.” We had cockroaches. Our cockroaches had pets. 

“Okay, well, I had one and I loved it to death. It came in this aquarium-like thing, and you had one layer which was stones and then earth and then grass, and so on. Ferns and what not.  And the plants only grew if the other parts were working. So, the ecosystems are dependent on one another, for air, moisture, growth. If one of the things is off, it impacts the whole environment.”

I look into the distance nodding like, Gee, I never thought of it that way.

Apparently, that’s the limit of her inspirational speaking abilities because she caps her pen and says, “Now, let’s problem-solve this interaction before the parents arrive.” I understand that Tina B. also does not want to be here at 7 a.m. on a Saturday morning. She may wish her humongous iced coffee were not leaking all over her desk. She may wish she didn’t have an eggplant-shaped nose and a face only a blind mother could love. Thank you, universe, that I do not have Tina B.’s genetic profile. I straighten up as if prepared to listen. “You tell them that you’re sorry if your words upset them, and that you’ve thought it over and realized you need to work on professionalism.”

I nod. I’ve taken out a pad of paper. In teeny, tiny script, I write, “Say sorry.”

She takes a noisy slurp of her coffee. “Let’s remember that you’re here to service the family, and that your first priority is to do so in a calm manner. Your anxiety will only serve to trigger their anxiety.”

I clear my throat. I do not say that servicing clients sounds like something a prostitute does. “I wasn’t feeling anxious.”

“Don’t interrupt, please.” Her phone rings. She picks it up. “What? Okay, send them in.”

“Hello,” would’ve been the professional way to answer the phone. Hello, this is Tina B. How may I help you?

After a moment, the parents step in, and for the first time, I realize how tall and gangly the dad is and how small the mother is compared to him.

Tina B. stands and beams. “Welcome, welcome, thanks for coming in. Please, have a seat.” She gestures to the white sofa next to her desk, the one with the Disney stuffed animals littering it. They sink into the cushions. The Tigger stuffed animal falls face forward into dad’s lap, and he pushes it away.

The mother’s purse strap keeps falling down and she keeps pushing it up to her shoulder. “Is everything okay?”

“No, it’s not okay.” Tina B. says, shaking her head.

The mother leans forward, the strap falling again. “Marigold?”

Tina B. waves her hand. “No, no, everything is fine with Marigold. She’s really doing well with her treatment.”

This is a lie. After the parents left and she was admitted, we tied Marigold to her bed with soft cotton hand and ankle restraints because she tried to gouge her eyes out with a plastic spoon.

“We are committed to this treatment,” the dad says, and he too leans forward. If he were wearing a hat, he would be holding it in his hands.

“Kit, did you have something to say?” Tina B. smiles at me like a person in a car insurance commercial.

“Sure, yes.” I put on my best serious expression.  “I am really very sorry about how our initial interaction went when you came in. Here at the Wells Fargo Eating Disorder Clinic, we are committed to giving your family the best level of service.” I blather on and they look back at me blankly, neither happy nor sad. I sound like a brochure. In fact, I read the brochure cover to cover last night to prepare for this interaction. The tagline for the clinic is “Bringing light into the darkness,” which sounds like an advertisement for corneal surgery.

Neither parent responds. They sit, waiting for us to say more. I say more. They nod. Tina B. says some more things and makes hand gestures.

It takes a while for us to figure out that they think they’ve been called in because their daughter is going to be kicked out. They are not raging for an apology, they are ready to apologize. Apparently, she has a long history with programs and lighting things on fire, figuratively and literally.

The dad clears his throat. “So, you’re not asking us to take her home?”

Tina B. says, “Goodness no! We just started her treatment.”

“Oh, that’s a relief.”

We all shake hands and the mother swoops toward me like she’s going to hug me, so I bend down, pretending to tie my shoe. A success.

Tina G. has a long blond ponytail and a too loud voice. She brays when she laughs, but not when the doctors are around-then, she is demure and soft-spoken. Tina G. is really named Christina, and she sometimes goes by Chrissy, but prefers Tina, even though there are too many Tina’s already. She has a large Italian family and is always in a fight with her fiancé Joey. I know it sounds like I’m generalizing, but these are the facts.

Tina T. is the youngest and the easiest to boss around. She just graduated from Penn State with her BSN degree and likes to remind us when we get something wrong. She thinks that I’m old, even though I’m barely over thirty. Okay, barely over thirty-four.

When Tina G. turned twenty-five last week, she brought in a frosted cake for herself in the shape of a parrot. Tina T. jumped up and down, clapping her hands. She said, “Oh, my God, you’re halfway to thirty!”

I said, “Actually, she’s halfway to fifty,” and took a big slice of the cake from the end piece.

None of the Tina’s laughed. I took most of the cake home and ate it by myself while watching reruns of Dateline. Spoiler alert for any episode: the husband murdered the wife. The husband will have always murdered the wife.

My shift starts with an update from Tina G. who is basically shouting into my ear. She wears her hair in that perpetual crunchy state, so that it always looks like it is wet and possibly made of glass, like if you squeezed an end, it would break.

Today, she has a dark stain on her white uniform and yellowish gunk on her sneakers. “It was wild today,” she says, tightening her ponytail. “Full moon tonight or what?”  She fills me in on a new intake, a young mother, age thirty-two, Caucasian, who is six months pregnant and weighs ninety-four pounds. For once, Tina G. speaks in a hissing whisper. “She’s starving that baby. You can’t even tell that she’s pregnant. If this continues, the baby will be born underweight and then DFC could be called. Doesn’t she get that?”

Except we don’t take babies away from mom’s who are just starving themselves. They have to be co-contaminated. That means they have to be starving themselves and injecting heroin. Or starving themselves and smoking meth. Or starving themselves and in a Christian rock band.

I enter room 102. “Hey, I’m Kit, and I’ll be the nurse on duty today.” The mother looks at me and throws up, just bile, and maybe the juice they gave her this morning. Tina G. is right; she doesn’t look pregnant, she looks a little bloated around her abdomen, like she’s had a big dinner, though the bones in her arms are thin twigs, and her face has that insect look they get when they are in starvation mode—wide and dry, the lashes and most of her hair has fallen out.

She wants her phone. Now. “I’m expecting a call from my pediatrician.”

I look at her chart. “Dr. Marks will be informed that you’re here. We’ve already reached out to her, so she’ll call us.”

She slaps her skinny little thigh so hard it will likely leave a hematoma (translation: surface bruise). “She doesn’t work for this place.”

“We have an affiliation, so she might turn up to take a look at you.” She shuts her mouth.  I take her blood pressure, and ask her if she’s in any pain.

“No, no pain.” I watch in amazement as her stomach moves and realize that it’s the baby. Her skin is so taut and her body so thin, I can almost see the tiny fist jutting out, like, Save me!  She says, “I hate when it does that.”

“Yeah, I’m sure that feels weird.”

“It feels like I need to poop when it does that.”

What I’d like to ask her is, “Did you not want this baby that you’re calling an ‘it?’ Was this not part of the plan?” But I button my lip and make sure she has what she needs before I leave the room.

I go back to the nurses’ station to get Tina G.’s notes. Husband is out of town, and the neighbor called an ambulance when the woman collapsed on the front lawn doing yoga, and then the family was implored to admit her. History of depression and bulimia, but no psychotic episodes, unless you count the starving-your-baby-thing.

The right thing to do would be to call social services. That’s if you’re not worried about keeping your job. I do it anyway, making the call with my hand over the receiver, telling lies, telling the truth.

Next, I wrangle with the new intake whose parents I (sort of) just apologized to: Marigold. She’s 5’9″ and I was right about her weight: ninety-two pounds. She’s beautiful and concave, like a gorgeous alien thing that has landed among us. She is a ballerina/aspiring model whose agent has told her she needs to lose five more pounds. What does he care? The industry needs women who look like pieces of art, all corners and sharp angles, collarbones that look like you could rest your drink on them.  Her teeth are perfect and straight, her hair like a wave down her back, eyes blue and wide with long lashes, a living deer with legs as thin as my arms.

I am new to the job, but not new to nursing, so I say, “Well, you know, let’s get you checked out and comfortable and we’ll see where we are.” I have already taken her vitals, and given her a new set of hospital wear in extra petite, a child-sized gown with the tag ripped out because these girls, I’m learning, want to fit into the smallest of the small. They want to be a size negative 15, as long as that’s the tiniest. They would like to wear baby onesies if at all possible.

I ask her when her last meal was, and she says, with a laugh, “That sounds like you’re one of the apostles. My last meal was wine made from blood.”

I like her and feel like I can relax a little, be myself a tiny bit more than usual. “We haven’t gotten to the substance abuse questions yet.”

“Oh, god, do you even know how many calories are in alcohol? It’s a waste.”

“Last time you ate though?”

She taps her finger to her chin. “What day is it?” She’s pretty, which shouldn’t matter, and she shouldn’t be, because her chart tells me that I was right about her weight. Ninety-two pounds, but she still has her hair, and a fine coating of extra animal hair along her arms that comes from starvation. The body starts to grow to keep you warmer. This should tell you that sometimes the body knows better than the brain. “Don’t believe everything you think,” is a bumper sticker I would buy if I could commit to one.

She refuses the grilled chicken. She picks it up and throws it in my general direction. I don’t duck, and it hits me on the cheek, and then lands with a splat on the floor. I page the kitchen to ask for an orderly to bring up another chicken breast.  Marigold folds herself up in the chair like a piece of elaborate origami, all elbows, knees, and sharp chin. You could see how she would make a Kate Spade purse look irresistible with it covering her entire tiny body.

“I hate those shoes,” she says, chewing on a hangnail. She has no implements in the room to hurt herself, so she uses her teeth to tear at her skin.  She thinks she can turn herself invisible because that would have saved her a lot of trouble with her ballet teacher. Or her choir director. Or her dad. On the other end of this program, he waits. Here, I could add a statistic about how girls who have eating disorders are often trying to disappear because they were molested. Or the stat about how if you are raped or molested once, your chances of being abused again double.  It does something to your mind and your body. It makes you into a different creature, one who is more like a jellyfish, easier to see through and manipulate. But Marigold is not a wilting flower, she wants to gnash her teeth at everyone who comes in contact.

When the second chicken arrives, she spits at it. “I don’t want this fucking piece of fucking disgusting fucking animal meat they’re calling chicken.” We both look at it lying on the plate, this unappetizing beige-ish hunk with grill marks in it. “Would you eat this?”

My nurse self should say, Yes of course. It’s filled with nutrients to make you healthy again so you can play a doll in The Nutcracker. My real self says, “It looks gross.”

“Thank you! It is gross. I’m vegan. I told them that.”

We could negotiate a different piece of food, but it’s not about the piece of food, it’s about the consumption of it. “Okay, well, you have to eat it or I’ve been direct to administer an IV.” They all hate the IV.  It makes them feel out of control, all of these disgusting, fat-inducing calories pouring directly into their veins. I hate the IV too, because it’s a temporary solution aimed solely at the body, not the mind. “Cut it up into as many pieces as you want.”

“With what?”

She is not allowed a knife, especially after last night. “Use your canines. You can make each bite as small as you like, but you have to eat it.”

“How many bites do you think it will take to finish this chicken? Is this like that old lollipop commercial?” She says, waving the piece of meat in the air.

“How do you even know about that?”

“I wasn’t hatched yesterday, not like this poor chicken. I bet they kept him in a cage and he didn’t even have enough strength in his legs to walk. I bet the legs would fold right over if he tried to stand on them.”

“Can you eat the pieces and talk about Harvey while you do it?” I know from her intake notes that Harvey is her ballet teacher.

She pinches off a tiny piece of meat. I look away as she puts it in her mouth and swallows it like a pill. “He has a blue dog.”

“What’s the dog’s name?”

“Blueberry. So original. I know, it’s funny, because he doesn’t even like blueberries, but it’s this little white dog and they dye it blue.” I see from the corner of my eye that she has taken another bite, with a grimace of disgust.

What I’ve learned so far is that you can jam these girls with nutrients, force-feed them. You can give them calming mantras and therapy around positivity and how they have their own journey to go on and they will still not eat. They can lose all of their hair, grow a pelt on their backs, find it difficult to sleep because of the jutting bones in their back, and they will still not eat.

It occurs to me then that they may be enraged too—some just handle it differently, turning it inward, not outward. That’s the problem.

Marigold keeps talking and tucking away bites, but only when my eyes are averted. When she’s finally done, I look at her face, and her clean plate. I clap.

“Ta-da,” she says, giving me jazz hands. “Now you can leave.”

I have forgotten my lunch, and so browse the shared refrigerator in the nurse’s lounge. You might have guessed that working with starving people makes food have new and terrible associations. Most of the nurses avoid talking about dieting around the patients but seem unable to stop themselves from counting calories.

Since I started here, I’ve lost ten pounds, mostly through the atmospheric osmosis of general panic around food.

Most of the rest of my day is spent shuffling around in my too big uniform, doling out meds. The Tina’s have all decided they’ll deal with extra small, even though they’re all clearly medium or bigger. But they seem to prefer to have to suck their stomachs in all day, to go home with button-hole indents from the pants, to be bursting out of the tops. I would like to bring that up to Tina G., because I feel like it goes against code, not to mention decency, and sets a bad example for our starving patients who are nothing if not body conscious. Instead, I say nothing.

The orange man is on the TV in the hospital lounge again, his ass-like pucker of a mouth spewing hate. You keep turning the channel, and he keeps popping up everywhere like a villainous marionette. I find the remote and change it to the travel show. A gondola floats by, and the voice-over narrator says, “Even on these peaceful waterways, navigation can be trickier than you might expect.”

My shift is nearly over. I have managed to make it through the day without getting into any kind of additional trouble.  Over the last sixteen hours, I’ve had to repeatedly wipe the ass of a young woman who has ingested forty-five diuretics and won’t stop shitting water on the bed, on me, on herself. I was not gentle. I threatened a diaper in a low voice. She threatened to tell her parents. I hissed back that she could lose her phone privileges. She agreed to sit on the toilet, even though she said it hurt her butt. This is probably true, she was all flesh stretched over bones. I have checked on Marigold, checked on the pregnant woman who is reading a book called, What to Expect When You’re Expecting, as if she were a normal pregnant woman.

Last on my list is Janice, a woman who has been here for about a week. She’s no-nonsense, doesn’t like small talk. Me neither. We get along fine.

I check her vitals while she talks on the phone. She’s holding a cup of water and taking small rapid sips like she’s about to run a race.  I put the blood pressure cuff around her tiny arm, and she drops the phone. She says, “Goddamn–” and then she lets out a loud burp. Her eyes go wide, and she hiccups. The hiccup becomes a sharp cough and then we watch in amazement as a fountain of blood spews from her mouth.

“Oopsie,” I say, reaching for a wipe. She coughs again and another river of blood gushes out, onto her gown and the bed. Her eyes go wild with panic. She tries to talk but gags instead. Her teeth are covered in blood, and then her arm jerks away and the cup flies across the room.

I push the red alarm button. She grabs my arm with strength that doesn’t seem possible, her eyes on mine, hand squeezing. “It’s okay,” I say, though it is definitely not okay. My mind scrambles for a reason. A burst stomach ulcer. A ruptured esophagus. Organ failure.

The room swarms with people–Dr. Patel, two residents, and Tina T. who is supposed to take over for me at the end of my shift.

Dr. Patel is a handsome Indian man in his early forties. He wears funky purple glasses and is good with the patients, friendly but not flirtatious. Now, he becomes very focused, very fast. He’s calm in executing orders for drugs and in making sure her airway is clear.

I keep hold of her hand though it has gone limp.  Dr. Patel is feeling her stomach, trying to locate the problem, but the heart monitor tells us what it is. It’s beeping like crazy. This activity, combined with the seizures and the blood, means she’s going into cardiac arrest. I don’t need to suggest this, because the next moment, the monitor flatlines and the paddles are charged and then Tina T. pulls up the patient’s gown. Tiny body, no breasts, her bones protruding from her chest and collar, she is a sliver of a human.  I can’t imagine now how she had the ability to talk to me a moment before.

Another eruption of blood explodes from her mouth and lands on my face in a hot rush. I think I’m okay, but then when I blink, my left eye blurs and burns. I rub at it while looking with my other eye for something to clean the blood away.

When Tina T. sees my face, she says, “You need to flush that immediately.” She pushes me toward the bathroom.

The heart monitor buzzes. I splash cold water on my face. I rub at my eye. A flash of pain needles through my head. More water, and it’s still burning. I peer into the mirror, seeing a blurry face, and try to move more carefully, opening up the burning eye and reaching for my contact, which has moved up to the corner of my vision. When I finally get it out, it’s got a speck of blood on it. I look back in the mirror and see my own eye, puffy and red, unfamiliar.

I drop the contact, turn the taps on full force, splash my face again and again. My eye is ribboned with red lines and a single red dot. My rational mind names it subdermal hematoma, it’s not dangerous, only if the woman is HIV positive, which is unlikely. I stumble back to the room and cover my bad eye with my hand.

In the blur that is the room, I see bodies bent over Janice, and, at first, they look like ghosts, all in white, moving toward her like something I remember from a dream. They are trying to start her heart, but the compressions and the paddles are violent. The action seems medieval even though they’re surrounded by equipment.

Dr. Patel swears and asks for the paddles again. Heather’s eyes have rolled back in her head, but the snap of the paddle on her chest causes her body to seize off the bed, as if levitating or freeing evil spirits.

As we fail to get a pulse, time grows taffy-slow, stretchy. Every minute down is a minute away from survival.

The monitor gives a weak bleep, and then stays flat-lined. They charge and apply the paddles again, Dr. Patel doing compressions in between. A snapping noise like a twig breaking means he has likely broken one of her ribs with the force of his compressions. Bones get fragile without nutrients so it can’t be helped.

They apply the paddles. Nothing on the monitor.

They do it again.

They do it again.

They do it again.

Each time, I feel a surge that’s like the electricity going into her body. Each time, she lifts up and then falls flat.

They do it again, and the monitor blips.  The heartbeat is thready, short. We stare at the slow lines moving in blips. Dr. Patel turns to Tina T. “How long has she been down?”

“Forty-seven minutes.” She keeps her tone neutral, but the twist of her mouth tells me that this is a very bad thing.

“Too long.” He thumps his head with the palm of his hand, three times. He has some kind of tick-he has to do things in threes. “I’ll call the family.” He does an about face, nearly colliding with me. “If you do not mind, please clean up the body.”

“And that’s how Monday goes,” says Tina T. in a shaky voice. She’s looking for another gown, one that isn’t stained with dark red blood.  I grab a gown from the cart outside the room and hand it to her.  “Thanks.” She tries to smile and lets out a sob.

“Oh,” I say. I am having trouble seeing and have one hand covering my eye.

“Sorry!” She swipes at her nose. “This is my first one.” She gestures toward the bed, toward the body. Janice is not a person anymore. With that much time elapsed, her brain activity will be nil.

The doors are just shutting when Dr. Patel steps in. He nods, his funky, violet glasses glinting. As the doors shut, he says, “The apnea test will show us that she had no blood flow to the brain. The woman.” He presses the button for his floor three more times.

“No chance of recovery?”

“She can be a donor if the family agrees.” he says. “One good thing, I guess,” Our reflections in the elevator doors are wavy, as though we are underwater.  “I should not have kept at it,” he says. “I should have stopped to compressions. Now, the family is suffering because they think she will live.” I’ve never witnessed this particular thing before: a doctor admitting a mistake. The elevator dings again, and the doors open to the ICU floor. He nods and strides away, a real human person.

I feel something in my body, not rage, something else—it’s harder to identify, it’s something I struggle not to let in. The anger, I realize, is just the cover.

In nursing school, we learned how to take a patient’s vitals, how to defer to doctors, how to swat away pharmaceutical salesmen/women, how to give CPR, how to administer an epi-pen, how to wash someone’s ass, how to give an enema, how to help a patient who was hyperventilating, how to dislodge a penny from the esophagus, how to administer mouth-to-mouth, how to read if someone was altered because of drugs or biology, how to triage a gaping wound, how to evaluate if a person was being abused, how to pinpoint an alcoholic, how to bathe a paraplegic, how to bath a quadriplegic, how to identify PTSD, how to gauge a person’s true pain level (a person will always say it hurts more than it does), how to remember the chronics, the ones who came in for drugs versus treatment, how to irrigate a wound, how to treat hypothermia, how to quickly dress burn victims so as to minimize scarring, how to call a death, how to put a face back on after a dog attack, how to manage a seizure, how to take someone out of shock, how to wrap a clean a body before the family saw it, how to clean a wound, how to clear an air passage, how to look for signs of sexual abuse in a baby, a toddler, an adolescent, a young girl, an old woman, how to give a rape kit, how to take skin tissue from under fingernails when someone was attacked, how to staunch a knife wound versus a gunshot wound, how to give quick stitches if the doctor wasn’t available, how to take out stitches, how to give a shot, how to give an IV, how to temporarily set a broken bone, how to push a bone back into place when it’s come out of its socket, how to treat a bee allergy, a nut allergy, a poinsettia allergy, how to work with homeless patients, how to breathe through our mouths, how to get a sock off a person with a gangrened foot, how to stitch up a superficial wound, how to put teeth back together, how to set a broken nose, how to help someone vomit, or use a bed pan, how to clean up someone after he was unable to get to the bed pan, how to turn a body so that bedsores would not begin to diamond across the skin, how to recognize the sound of death rattle in the throats. No one ever taught us how to manage the grief.

When I finally leave the clinic, it’s three a.m. and my contacts are stuck to my eyeballs, and the right one still feels damaged.

The subway car is mostly empty, except for a man sleeping fully laid out on two of the seats, his body made compact, his feet hanging over the end. The rocking of the subway car can be like a cradle, lulling, and the conductor leaves him alone.

At the Belmont stop, a guy gets on, eyes glassy, hair wild. He assesses the car, sees it’s only me, sitting with my backpack on my lap, knees together, still in blue scrubs.

He walks to my end of the car and sits across from me, all the other seats empty. I stare at the sign above his head. See something, say something, the newest anti-bullying campaign meant to keep people safer while also creating a greater paranoia, in this big brother way: God is watching.

He says softly, “Hey, lady.” He’s leaning forward, hands dangling between his legs. “Hey. Lady.” I move my gaze to him. I can’t smell alcohol, but he’s altered, that’s clear by the dullness of his eyes and his slow speech. Altered or not, he is bigger than me and stronger. “You all alone this late, huh?”

He’s leaning even further forward and I know, just know, that he’s about to unzip his pants and take out his member. It is too late, and I am too tired, but I get a jolt of energy, thinking about our patient who died, the one I didn’t even know how to save.

I feel a tingling in my fingers and at the base of my neck. I stand up, ready to move away. He stands up too, at the same time, and reaches for me. I spin away, a dancer’s pirouette I didn’t know I had in me, and at the same time, this other part of me is reacting in a surprising way, my arm is coming up and in one motion, I have swung my bag, at his head, upwards and hear it connect to his face with a dull sound. He steps back. I swing at him again, connect again, feeling the weight of the bike lock in the bottom of my bag, and the satisfying way it hits him in the temple. He staggers, sits, puts his hand to his head. It happens in three seconds and he’s bleeding, a trickle of blood, down the side of his face.

I say, “You should get that looked at,” and move away down the car, open the door at the end, step between the speeding cars, and into the next one which is populated with a half a dozen late shift workers talking about their boss.

I sit near but not next to the people. I regret nothing. The rage—it serves a purpose.