“The trauma gowns are either Big Bird or piss colored,” Fran said.

The charge nurse and respiratory therapist said nothing and kept staring at the EMS bay doors. Fran frowned at the box of gowns, and returned to charting on the portable computer.

The old-timers ignored nervous chatter. They saved their energy for CPR or ordering takeout. But even then, an economy of words mattered. They spent their words pouring over Panda Bowl and Waffle Hut takeout menus that accumulated by the EMS radio. Crustier night shift nurses gossiped about residents who wore thongs visible above the waistband of their scrubs or certain nurses’ tramp stamps.

Two nurses leaned against the desk, taking the weight off their sore feet. They gossiped in lowered tones about an ultrasound tech on nights grubbing to hook up with a radiologist out of residency. The prevailing theory being debated was whether the tech was aiming to quit work once she got pregnant.

Fran suspected she’d been placed in the latter category, even though she would sooner gouge out her own eyes than screw a doctor. The idea of them dissecting her after a break up or sifting through her motivations over cheap paper cups of burnt cafeteria coffee sent viscous ropes of shame oozing through her.

She reached up to touch her neck. There would be angry crimson dotting her skin.

Not ladylike.

“You have such a delicate complexion, Frannie Mae.” Mama could make anything sound appealing, as if being a leopard when she got embarrassed should make her proud.

Fran tried to forget her skin, tried to focus instead on the coming trauma call as they waited.

But the bugs.

Outside in the ambulance bay, biting insects hovered, bathed by the glow of the emergency room. A medical team assembled for the next truck swatted at invisible assailants.

Fran could not remember a time when nature didn’t make her skin crawl. She had vague recollections of hopping insects flinging themselves at her during sleepover bible camp. And when she was barely four and discovered a cricket in her mother’s gardening bag. She’d lifted it out with a pink handled trowel to inspect it, trying to stroke its articulated legs. A horrified screech from her mother frightened her so terribly she’d flung the bug to the sidewalk. Her mother had stomped the cricket into black paste before it could escape into the grass. She scolded Frannie for ripping her hose and staining her new dress in the dirt. She’d stormed inside, straw hat wobbling like the rings of Saturn.

Jackson knew these stories, regaled by Big Earl during two fingers of holiday whiskey and slices of pumpkin pie. When her fiancée dropped the unexpected request for a picturesque outdoor ceremony, Fran cringed but agreed because Jackson never expected anything. He accepted, he loved, he encouraged but never expected. She tried to hide it from him but the idea of a ceremony full of mosquitos and pill bugs horrified her. The idea of marching down a plastic lined runner staked to the grass, in Manolo Blahnik heels and a custom Vera Wang dress only made it worse. It would be a perfect photo op. She’d ruin everything by sweating into watered white silk in the unseasonably warm Carolina spring and leaving yellow stains on it.

She silently gave thanks to whatever forces conspired to keep her late at the end of her shift on the day Jackson dropped that bomb. Fran bet hard cash her mama suffered apoplectic fits before pasting on her best runway pageant smile, kissing Jackson’s cheek, and assuring him she would take care of everything.  Big Earl probably smiled and patted her mother’s hand. Her daddy knew he was on the hook for every slim dime Mama decided to layer on.

Mama made that clear to both of them.

Big Earl’s contribution consisted of signing checks without complaint when Mama shoved them under his nose then showing up to walk her down the aisle with the correct colored tie on. A tie Mama would pick out, matched precisely to the bridal flowers and tied to the correct proportions on the appointed day. Fran could not imagine what Jackson could have been thinking, asking for an outdoor ceremony.

A technician slammed a plastic tray onto the counter beside her.

Fran jumped, frowned at the woman. The tech ignored her, refilled the tray with tubes and rubber tourniquets and needles, sterile alcohol swabs, cramming them into all the available slots until the tray could hold not hold one more thing, then turned and walked away without a word of acknowledgement.

Bitch. Fran stuck her tongue out at the woman’s retreating form.

EMS tones alarmed, signaling a new rig backing into the bay. She stood beside the computer station near the entrance to the bay, where she’d snuck earlier to catch up on documentation before end of shift. Another nurse standing nearby called out and tossed Fran the small collar bowtie her mother had commissioned for her new puppy.  Fran crammed it into her pocket with a nod. She mouthed Thank you, and tipped her chin back to her screen, trying to focus on the words. The chart refused to transform into something more interesting, so Fran gave in to the temptation to check her text messages.

She fished in her pocket for her phone and caught the edge of her fingernail on the seam of her scrubs. She yanked it out, tapping out a quick message to Jackson. As she typed, she noticed a small chip in her manicure.

Damn it. Fran typed: Cancel dinner.

Jackson: WTF? 

Fran: EMS

Jackson: K

Fran: Sorry

Tones bleated overhead again and a gruff voice sounded from the radio at the corner of the desk. EMS radio: Lumberton County EMS- cardiac arrest inbound.

Her phone buzzed in her hand.

Jackson: BTW-got Coop frm groomer

Fran: Thnx

Jackson: Smells like a hooker.

Jackson: Ur mama will luv.

Fran: LOL

Her mama adored him and had never approved of Fran so much as when she agreed to marry Jackson Lamb III. Graduating with her nursing degree hadn’t impressed her mother. No, Mama fretted Fran might become a dried-up old auntie, one who spent solitary nights knitting toilet tissue cozies as she drank gin sours from a teacup. The sort of woman who didn’t shave her legs or wax her mustache and only attended church luncheons because it allowed her the opportunity to criticize her neighbors’ pineapple divinity or their ham casseroles. The kind of woman who wore push pedals with open toe sandals or white after Labor Day. The kind whose hair get natural gray at the roots after sixty.

Jackson extracted gales of laughter from her as he speculated on how Mama hallucinated visions of her spinster daughter during the summer. He declared her brains scrambled beneath a Lycra shell and overpowering hairspray fumes.  By her mother’s estimation, one liberally offered; Fran would be wise to consider the aspiration of school nursing. It meant no working weekends or holidays.  And no work when Fran finally birthed hers and Big Earl’s first grandbaby. Emergency department shift work placed Fran in a type of moral peril her mama could not fathom as being sensible, her sense of accomplishment didn’t measure up against any yardstick of menial labor. As her mother put it, she was “wiping bottoms for goodness’ sake, Frannie Mae!”

She impressed Big Earl by breathing, and Jackson treasured her for existing. Her daddy made moon eyes at his baby girl after she emerged bloody and screaming, the very first attempt to escape her mother. The sun and moon set on Big Earl’s “Frannie.” He still spoke to her as gently as if she were in blonde pigtails. He still kissed her fingertips goodbye when she brought him coffee.

EMS tones rang out again.

Fran was up for the next ambulance rotation.

The charge nurse walked to the corner of a Formica counter inside the EMS bay, waving one of the canary yellow gowns in her direction. The obnoxious color pulled Fran to reality, dispelling thoughts of Big Earl, Jackson and her Mama. She snatched the gown from the squat woman and shimmied into it, tying the upper tabs and lifting her ponytail out of the tangled neckline.

The charge nurse frowned as Fran pulled her phone out again.

“Put it away,” the older woman said.

Fran swatted her gown, irritated by the chiding. The thin water-resistant material stifled her. It swished between her legs as she tried to move, like she was wading through an invisible river. She ignored it by standing at attention by the nurse’s station, a sharp tang from an antibacterial gel dispenser filling her nostrils.

Nothing ladylike about Big Bird yellow, Fran thought.

She couldn’t say anything at dinner, and she knew she should try to go. If she dared complain about staying late or wiping butts or cleaning up the vomit from Saturday night drunks, her mother’s eyes would narrow to slits, and she would cluck her tongue like an overgrown chicken and then move in for the kill. Fran didn’t want to hear it tonight. They still needed to go over the wedding invitations her mother had picked out. They had been arguing over them for three weeks and had narrowed it down to two finalists, neither of which Fran liked all that much.

EMS Update: Lumberton EMS, we are inbound five-minute ETA, continuing CPR, still no rhythm. Two rounds of epi, no response.”

Fran’s cell phone tempted her by an insistent buzzing.

She expected an avalanche of texts after Jackson broke the news about maybe canceling their plans because of her shift. Her parents had paid for a photo shoot with Cooper wearing a bowtie, tucked in Big Earl’s arms. Her mother commissioned matching Clemson ties for Big Earl and her new American bully pup. These nods to her alma mater were meant to placate Fran but only made her more annoyed when her mother tried to match the wedding bouquet to them. She did not want orange and purple flowers. She didn’t mind having her puppy as a ring bearer but that was the limit to her tolerance of Southern charming.

The radio emitted a high pitch squeal, signaling the arrival of Lumberton EMS. Fran, Dr. Miles, and a respiratory therapist headed to the doors.

“This always happens at the end of a shift,” Fran said.

She blew the hair from her face in a frustrated puff.

“It’s a person, not a complication,” the respiratory therapist said. He glanced at the charge nurse. Stubble on his bald scalp broke up the reflection of the overhead lights.

“Isn’t everyone?”

Fran rolled her eyes and grabbed exam gloves, twirling them around her finger before slipping them on. Sweltering air blasted the doors as a set of paramedics pushed a stretcher inside the building. The lead medic’s hand splayed across an inert form as listless arms flopped with each compression of the torso, bouncing against the mattress. There was a clear plastic tube sticking out between white teeth, taped tight on waxen skin. The pressure of it pinched blueberry lips. One medic steered their stretcher. He depressed a bag over a pixie shaped face, keeping pace as they hustled through the hallway.

“A four-year-old male found submerged in a neighbor’s swimming pool. Unknown downtime. Mom was getting ready for church, no one noticed he was missing. CPR started by the neighbor on scene. Mom being transported by the neighbor. Advanced life support en route, no response to resuscitation efforts.”

The paramedic relaying information pressed the chest of the tiny form. The child was swallowed by the sheets on the stretcher.

“How long?” Dr. Miles took over squeezing the Ambu bag as they reached the trauma bay. He stood at the child’s head. With one hand, he placed a stethoscope in his ears, leaned down and listened for breath sounds. He squeezed the reservoir using measured, deliberate pressure. In, out. In, out.

“Thirty minutes, ten on the scene and twenty en route,” said the paramedic, wiping sweat from his eyes.

At Dr. Miles’s signal, the team wrapped the sheets over the motionless form and moved him to the emergency department stretcher. The respiratory therapist stroked the boy’s cheek and carefully repositioned the tube in his mouth. Fran watched the grown man, eyes shining as he murmured by the boy’s ear. He placed a folded towel beneath elfin thin shoulders, fanned blonde ringlets falling around his scalp like a halo.

Fran stared at the pale spindly arms dressed in a button-down shirt the color of robin’s eggs and a bowtie. One foot clad in sock and shoe, the other blanched and bare. She watched his stillness, broken only by jerky movements when someone jostled his limbs or depressed his chest.

“We’ll give it one more round of epinephrine. He’s been down too long,” Dr. Miles said.

He looked at each of them, paused and moved on to the next, seeking affirmation or objection. No one spoke. Fran watched the therapist and paramedic working on the child, the doctor. They crowded the bed with swift and gentle movement, as if it might disturb him. The damp outline of him soaked the sheet where he rested. He moved only in the violence of the person trying to coax his heart back to life.

The charge nurse laid a striped measuring tape beside the inert form, calling a color. Fran yanked the code drugs from the drawer, slamming it closed against the back of the cart. She grabbed an epinephrine syringe, and measured out the correct dose. She rechecked her calculation on the colored dosing card, her fingers creasing the cardboard.

Fran moved to the bed and picked up the boy’s hand, rejecting his stillness. For a moment, blind instinct to rub his fingers between her two hands to warm them overwhelmed her. She wrestled it down, continued on automatic. Fran pushed epinephrine into the intravenous line. Squeezed some saline in.

Someone resumed compressions.

After a time, the doctor signaled to pause.

Everyone focused on the cardiac monitor, waiting for the blip or flutter.

I can hold his hand again when he wakes up, Fran thought.

“Nothing,” the respiratory therapist called out to the doctor.

Dr. Miles listened to the child’s chest.

Fran studied the tiny boy laid out on the stretcher, memorizing the features of his face. She would dream of him that night, and the next and the next. A fringe of honey eyelashes rested against whitewashed cheeks. She saw in her sleep, eyes the color of green grass beneath his lids. Saw the smattering of cocoa freckles sprinkling the tip of his nose and his chin.

Dr. Miles held up a hand, hushing the room.

The monitor blared alarms at them.

No rhythm.

High pitched alarm, warning of absent measurements.

Unwavering lines slipped across the screen.

The respiratory therapist took over ventilation, breathing for the little boy, depressing the bag as Dr. Miles pressed two thoughtful fingers to the base of his neck.

No pulse.

Several minutes passed with everyone going through deliberate motions, staring at one another, mute. Dr. Miles glanced at each of them, made eye contact and then at the last, shook his head.

“We have been down far too long. Resuscitation efforts, though commendable, are unsuccessful and not likely to be successful based on our current information of the events. Does everyone agree?” Everyone in the room nodded slowly or mumbled yes.

“Time of death 1835.” His voice was thick in his throat.

Fran snapped the monitor off. The sound of the beeping ended without excess, an absence of sound filling the room, smothering them.

Dr. Miles ruffled the child’s hair.

“Sorry, little one,” he whispered.

He stood and looked at all the people in the room joined around the bed with him, all numbly cleaning the trash and detritus of death from the floor and the bed. “Thank you everyone. Staff debriefing after family notifications and aftercare.”

“I’ll clean him up,” Fran said. The doctor walked out of the room, shoulders drooping.

She looked at the clock on the wall. The hands ticked on, but she would still make dinner with her parents. She wanted Big Earl to wrap her in his arms and make her feel like she was six, and the world didn’t matter. She would cry into his shoulder and let his beard whiskers scratch her cheeks. She would smell the pipe tobacco smell on his flannel that he didn’t think Mama knew about when he smoked in the shed, and Jackson and Cooper could meet her there, she would exhale, catch her breath. A lump formed in the bottom of Fran’s throat as she walked around the room, picking up bits of tubing, tossing them in the trash, tears bitten back and stuffed down. The chlorine smell of the pool water permeated the air, and a sudden frenzied need to rid the room of the chemical odor gripped her.

Outside the trauma bay, peals of anguish and gutted wails erupted from the family room. Fran’s stomach clenched, roiled and a wave of nausea threatened to upend the contents, and she tugged at the neckline of the yellow gown to cool herself off. Sweat trickled between her shoulder blades but she left the gown, knowing the body aftercare could be unpredictably messy. She turned back to the stretcher and began to clean.

Fran pulled the limp boy squarely on the bed, it took almost no effort to lift him. She avoided looking at his face, not wanting to see the hard plastic protruding from his lips. Instead, she straightened his Sunday church clothes, smoothing his shirt with her fingertips then squaring his small bowtie. Water stained the sheets beneath him. Fran fetched new ones, laying him out on this new blank canvas. She slid the towel roll from under the boy’s shoulders, turned and tossed it into the laundry bin.

Fran walked back to the stretcher, stroked his bare foot with a feather light touch. She felt each plump toe, round like a grape, she held the curve of his heel, its smooth, unblemished sole against her palm, absorbing its coolness, trying to warm it gently in her hand.

The cell phone in her pocket began to vibrate again.

Mama.

Without warning, a black field cricket hopped from beneath the stretcher, lodged itself on Fran’s trauma gown. Her nerves jangled as she listened to keening cries piercing in the hallway. Her head ached.  Fran reached down and grabbed the cricket between two fingers, wanting to crush it viciously until the articulated joints came apart between her fingertips.

She marched to the trash bin, her breath heaving in jagged gasps, tears easing down her cheeks. Without thinking, she reached into her pocket for her puppy’s new bowtie and tossed it into the bin. Let her mother pay for another if she wanted it so much. Fran vowed he would never wear it, not when he was with her. She cupped the cricket gently in her hands, and studied it. It flitted against her palms, tickling her skin as it tried to escape.

Fran walked to the EMS bay doors, walked outside and took a deep gulp of air into her lungs. A June beetle fluttered against the yellow orange sodium light. She opened her cupped hands towards the grass. The cricket leapt out and away.

She reached into her pocket.

Turned off her phone.

Headed back to finish her shift.

Becca Saul lives and works in South Carolina. She has been a registered nurse in trauma, flight and emergency services since 1999 and became a became an ED nurse practitioner in 2007. She outgrew the ED in 2016 because it was time for something new and now works as a nurse practitioner with adolescent patients living with eating disorders and obesity and providing a safe place for them to open up about mental health.  She spends every spare moment tucking seeds into the earth, scribbling words down trying to breathe life into imaginary worlds, and trying figure out how stuff works. Her work can be found in the Magnolia Review, Barely South Review, orangepeel lit mag and Please See Me. She has been writing as far back as she can remember and hopes to keep writing long after her work with patients is done.