His North Star

She clasped them tighter. "Only since I went in the water."

She's lying, was his immediate thought. But why should anybody lie about something like this? "Miss Chopin, I'd like to feel convinced that you're being open with me. How long have your hands been shaking?"

Her mouth took on a hard edge. "I'm being open with you. They only started shaking today."

Nathan gave her a probing look. Yeah, she was lying. "Do you currently use any recreational drugs?"

"Absolutely not! Not now, not in the past, and definitely not in the future!"

Nathan scrutinized her. He'd have her urine analyzed for drugs. In the meantime, he shifted gears. "Have you ever been diagnosed with depression, bipolar disorder, schizophrenia or borderline personality disorder?"

Stéphanie Chopin slumped against her pillows. "No. None of those." Her eyes suddenly welled. "I'm sane. But I need to die. I have no other choice." The tears brimmed over, trickling down her cheeks. "There's nothing left for me. I'm finished."

Nathan sat on the edge of her bed, meeting her gaze. "I've always believed that we all have a choice. I also believe that wherever there's life, there's a future. You could have chosen not to walk into that lake. You could have walked into this ER and told us you're a danger to yourself."

She shook her head. "I couldn't do that. You don't understand. I see you mean well, but you can't just sit beside me and tell me there's hope when I have none. Do you know what it's like to have every light in your life snuffed out? Do you have any idea what total darkness feels like?"

Nathan didn't speak for a beat. Before he could find a reply, she continued.

"I don't have a choice or a future. I used to. I've always been a kid at heart. I had dreams. Silly dreams full of light. But they're gone. I have nothing to dream about. Everything's gone. No good things will ever happen for me."

Nathan held her eyes. He could see it in her—the kid. The kid who existed in every person, no matter how old they became. The kid who dreamed of doing something extraordinary or being someone remarkable 'when I grow up.'

Perhaps, the truest form of death was when The Kid stopped dreaming of light.

"Do you have children, Miss Chopin?" he asked her.

"No."

"Parents? Siblings? Friends?"

"I don't have siblings, but my parents are alive. They're in Québec."

"Aren't they worth sticking around for?"

Her lips hardened. "Nothing's worth sticking around for."

Nathan sighed. "Here's what'll happen. A nurse will come take blood. That's so we can do a culture. I need to make sure you won't become septic. The nurse will also take a urine sample, because I want to do a drug test on you. As I said before, we'll do a chest X-ray and give you some diuretics, then you'll be kept in Observation. From my examination, it's unclear why you're having a headache. I'll send you for an MRI scan to make sure there's no brain swelling or bleeding. While you're in Observation, the hospital psychiatrist will have a long talk with you."

Stéphanie Chopin wiped her tears away. "I'll get an MRI?"

"Yes. Do you have any metallic implants?"

"No."

"Then an MRI should be safe." Nathan stood. "The Radiologist will go through all the contraindications with you. The nurse will come by in a minute." He crossed to the door. As he was about to walk through it, she stopped him.

"Doctor?" she called.

Nathan turned to face her. "Yes?"

She met his eyes. "Thank you. Really. And I'm sorry about earlier."

Nathan smiled at her. "That's okay." He walked out the door.

He went to the nurse's workstation, briefed a nurse on what to do, and started on his next patient.

His shift ended at midnight. It was 11:47pm. when he finished up with his final patient, and a nurse brought Stéphanie Chopin's X-ray results to him.

Nathan examined the X-ray. He was correct about the fluid in her lungs. "Give her 40mg furosemide IV injection." He handed the chart back to the nurse. "Then transfer her to the ICU. Make a note that she should be taken for an MRI, and that she needs a mandatory psychiatric evaluation first thing tomorrow morning."

"Got it."

Nathan left the hospital, sure that Stéphanie Chopin would survive. Yet, that prickle at the back of his neck remained. It stayed with him throughout his drive home, as he made dinner and as he got in bed. Was there anything he'd overlooked while he'd examined her? Had he forgotten something? He went over everything in his mind. No, he hadn't missed anything.

He cleared his mind, and tried to sleep.

**

Like the previous day, his shift began at noon. He got his first break by 5:30pm. After grabbing a sandwich at the cafeteria, he went to the Intensive Care Unit to check on Stéphanie Chopin. That icy shadow still haunted him, not letting him focus until he assured himself that she was okay.

Leaving the cafeteria, Nathan wove through corridors, went up two floors and down another corridor. Pushing open the swing doors, he turned left and was in the ICU Observation Ward.

It was a big, busy ward and he didn't have time to scour it, so he went to the nurse's workstation. "Hi," he said to the nurse. "I want to check up on a Miss Chopin transferred last night from the Emergency Department."

"Miss Chopin?" The nurse's brow furrowed. She reached for the wire file basket on the desk. "I started my shift literally 5 minutes ago, so I'm not caught up on the overnight admissions. Let me see..." She thumbed through the files. "Ah! Here we are." She pulled the file out and opened it. Her face fell as she read.

Nathan gripped the counter's edge. No...

Giving a helpless little smile, the nurse raised her eyes to his. "She died at 3:44am. this morning."

An invisible fist punched Nathan in the gut. She was dead. He'd left her alive, but now she was dead. It took him a full fifteen seconds to find his voice. "Who reviewed her?"

"That would be Dr Sousa." The nurse pointed across the busy ward at a man. He stood writing in a chart outside a patient's room. "That's him there."

"Thanks." Nathan pushed away from the workstation, crossing to the doctor. "Dr Sousa?"

Dr Sousa looked up from his chart. There were shadows under his eyes. His mouth drooped with exhaustion. He looked Nathan over, glancing at his staff ID badge. "Dr Bellamy?"

"Yeah. Hi." Nathan stopped a few feet from him. "I'm from Emergency. I had a patient transferred here last night. Stéphanie Chopin. Attempted suicide. Last I knew, she was stable."

"Oh. Her." Dr Sousa pinched the bridge of his nose. "Well, it turns out that the drowning wasn't her only suicide attempt. She had a plan, that one. I reviewed her when she was brought here, gave her a follow-up dose of the furosemide you prescribed, and sent her down for the MRI. As soon as she got the gadolinium shot, she went into anaphylaxis."

Nathan ran a hand over his face. "Shit. Shit."

Gadolinium injections were given before MRI scans to make the images clearer. Only about 0.01% of patients had serious allergic reactions to the shot. This was a stroke of shitty luck.

Nathan frowned at Dr Sousa. "But what do you mean about her having a plan? She couldn't have known she was allergic to gadolinium."

"Oh, she knew alright. She knew exactly what she was doing. I phoned her family doctor in Québec early this morning. He gave me a rundown of her medical history. She'd already had a severe reaction to gadolinium a year ago, but was resuscitated. She knew that any other gadolinium shot would kill her. He also told me she was diagnosed with ALS four months ago."

A harder punch landed in Nathan's gut.

ALS. It began with muscle weakness in the limbs, then progressively killed every motor neuron until there was complete paralysis. No movement. No speech. A mind became imprisoned in its own body.

There was no cure and no escape...except suicide.

Nathan closed his eyes as everything clicked. Her shaking hands had been the ALS tremors.

He'd known she was lying about when the tremors began, but his first thought had been drugs. 9 times out of 10, it was drugs. People came to the ER because they'd overdosed on drugs, or had been in a fight over drugs, or were hoping to fool an inexperienced doctor into giving them drugs.

It hadn't been drugs this time. Now, it made sense why he'd seen no signs of head trauma. There'd been no trauma. She'd faked the headache so he'd send her for an MRI scan. She'd known that the usual thing with MRIs was to get a gadolinium shot. She'd known she was allergic to gadolinium.

She'd known all that. She'd used it. She'd used him.

Nathan's hand tightened.

It was probably why she'd come here from Canada. She'd come to a place that was easy to travel to, but where her medical history was unknown—and difficult to access at the time she'd picked to drown herself. She'd thought everything through. Drowning had been Plan A. Gadolinium had been Plan B.

If he'd known her medical history, there was no way in hell he'd have let anyone near her with a gadolinium syringe. But he'd hadn't known, so he'd made the best choice. And in so doing, he'd sentenced her to death.

She'd even shown gratitude for it. After he'd told her about sending her for the MRI, she'd called him back to say: "Thank you. Really."

He'd killed a patient. This was the prickle that had been shadowing him.

Her tearful words came back to him. "...You don't understand...I have no choice... I had dreams full of light, but they don't exist anymore...I'm finished..."

She'd been diagnosed with ALS four months ago. That was why she'd killed herself.

Nathan stood rooted to the spot, his soul withering, his eyes stinging drily. He'd helped her kill herself.

Dr Sousa was watching him. "You okay?"

Nathan willed his mouth to speak. "I'm fine. Thanks for letting me know."

"No problem. It's nice of you to come and ask. I know it's so hectic in the ER that you guys can't usually do follow-ups."

Nathan made some response, then he left the ICU, walking back to the Emergency Department on robotic legs.

When he got to the ER, he didn't go to pick his next patient. He went to the office of his direct boss, Dr Elizabeth Elgar. He knocked on her door. It wasn't yet 6:00pm., so she should still be here. She'd been an Attending for 12 years, and the seniority meant she did more day shifts than evening ones.

"Come in," she said from inside.

Nathan opened the door, barely recognizing his own dead voice as he asked, "This a good time?"

Dr Elizabeth Elgar was a pint-sized woman of middle age. "I was about to leave but I've got a minute for you. Come on in, shut the door and sit down." She eyed him. "What's up?"

Nathan sat. The icy corrosive lump was back in his throat. His eyes burned, but he had no tears. "I need to be taken off the schedule."

"Why? Have you lost a patient who mattered?"

"I lost two. The first one was on Monday night. The second one was last night. Both suicides."

"Well, this is the time of year for it." Dr Elgar heaved a sigh. "You know yourself better than anyone. If you think you need a break, you're probably right. I'll keep you off the schedule for a week, effective from next week. We'll take it out of your vacation days."

"I'll need longer than a week."

Dr Elgar stared at him. "You're not thinking of quitting? Because you won't quit over a couple of suicides. Not if I have anything to say about it."

"I'm not quitting." Nathan hesitated. He'd been the tool a woman had used to commit suicide. The possibility of ALS hadn't occurred to him. What kind of doctor was he, if the possibility of an incurable illness hadn't occurred to him? What was he even doing here? Aloud he amended, "I don't think I'm quitting. Honestly, I'm wondering how long I'll last in this specialty. I need time to figure that out."

"Nathan." It was rare for Dr Elizabeth Elgar to use any co-worker's first name, but she did it now. She reached across the desk to lay her hand on his. "We lose patients. That's part of the job, and it's true for any specialty. We both know that. The natural thing is to blame ourselves, but I told you from the start that you need to learn whatever you can and move on."

"Easier said than done."

"I guess so." She drew her hand away. "Like I said, you know yourself best. How long will you need?"

"A few weeks. Maybe a month."

She arched an eyebrow. "You expect me to ask the Chief of Medicine to place a resident on months of paid leave?"

"I don't expect to be paid. All I'm asking is to have a job when I come back."

"Okay. I can do that for you."

"Thanks."

They sat in silence awhile, then she said: "Go off and have your existential crisis, but not for too long. I want you back here in six weeks tops. You're my favorite resident, and you're only 5 months away from finishing your program. If there was ever a time to quit, this isn't it."

Nathan left her office shortly after. He finished his shift by midnight, and for the first time in 4 years, he drove away from Delta Lake Hospital without knowing precisely when he'd return to it.

By 1:00am., he lay awake in his bed, the walls closing in on him as he recalled the dead woman's words. "I've always been a kid at heart. I had dreams. Silly dreams full of light. But they're gone. No good things will ever happen for me."

As for 18-year-old Jason Holst, he'd been abandoned by his father, bullied at school, out of touch with his sister, and struggling with his grades. He too had probably stopped believing that anything good would happen to him. So he'd killed himself by swallowing bleach pills.

Nathan had also had dreams of light. It was those dreams that had pushed him into medicine, because he'd wanted to be someone worthwhile.

But was this career really worthwhile? Or was he merely fooling himself?

The light was difficult to see. What he saw were all the people he couldn't save. The teenagers who drank bleach. The adults with ALS. The drug addicts and the battered wives.

So, then, was being a doctor worth it? The long hours, the breakneck pace, the deep personal investment...

Was it worth it?

Nathan fell asleep at dawn, unable to answer that question.

When he got up late in the morning, he dragged himself into the shower then brewed coffee. He'd planned to head to Binghamton today, to visit his family. That was no longer on the cards. He was in no mood to see anyone.

He needed to get out of this apartment, though. He'd always liked his space, but it suffocated him now. The restrictive walls had no answers. All his questions bounced back to him with visions of a dead kid and a dead kid-at-heart.

He needed to get far away from here.

Coffee cup in hand, he went to the spare room he'd converted to an office. On one wall was a corkboard where he'd spread a global map. He went to his desk drawer and took a pushpin. Facing the map, Nathan threw the pushpin. It sailed through the air, hit the map and lodged in the cork.

He looked at where the pushpin had landed—Brasil.

Huh. Okay. He'd never been there, and it was a massive country. Somewhere in its 3.3 million square miles with coastline, savanna, mountains, archipelagos and rainforest, he might find an answer.

That same morning, he phoned an airline and booked a one-way flight. Two days later, his suitcase and carry-on were packed.

On April 11th, Nathan Bellamy became a wanderer. He drove to Syracuse International Airport and got on his plane. The aircraft ascended at 3:00pm., on the first leg of his journey to Rio de Janeiro.

*****

PART TWO: THE SHRINE
"Sunlight over me, no matter what I do." Fleet Foxes, The Shrine.

Southeast Brasil, April -- May 1982

*

In the evening of April 12th, an aircraft touched down on Galeão Airport in Rio de Janeiro. It was drizzling. After getting through security and baggage claim, Nathan Bellamy stepped into twilight, the sun scattering a deep orange glow as it sank.

In a t-shirt and jeans, Nathan wheeled his suitcase with one hand. His rucksack was slung over his other shoulder. The rain was light enough for him to walk into it. The air hovered close around him, warming his skin and filling his nostrils with petrichor. Around him were voices of those who'd disembarked the same flight. Two languages assailed his ears; the brash English of fellow tourists and the incomprehensible Portuguese of the Brasilians.

"Onde coloquei a chave? Estava no meu bolso quando a gente estava no avião."

"I can't wait to see her. It blows my mind that it's been a year since we visited. I'm sure she's grown. I can't wait to pinch her chubby cheeks."

"Levou muito tempo, mas graças a Deus acabou. Estava com saudades desse lugar."

"My feet are killing me. If that idiot isn't already here to pick us up, I'll strangle him."

"Vou tentar mais uma vez. Se você pisar na bola de novo, ele nunca vai concordar e sei lá o que você vai fazer."

"Benny, you never pay attention to anything! Your suitcase straps are trailing beside the wheel. Pin them together. I only just bought this suitcase for you!"

"Sorry Mom," a child mumbled in reply to this scolding.

Nathan walked past the mother-and-son, wove through the other people in his way, and emerged from the thicker throng. The voices faded. His way clear, he went up the sidewalk to a taxi.

Noticing his approach, a cabbie opened his door and stepped out. He gave Nathan a once-over. "E aí, cara."

Nathan had studied rudimentary Portuguese greetings during his journey, so he knew the cabbie had just said: "Hey, dude."

"E aí," Nathan replied, echoing the greeting. The language felt strange on his tongue, but he spoke the only complete sentence he'd had the time to learn—the phrase to tell his listener that he didn't speak Portuguese. "Eu não falo Português."

The cabbie smiled, teeth flashing white against his sun-bronzed face. "I was thinking you look like a gringo. Every time I see a gringo, I always know. Is OK. I speak English, a little Spanish, and a little German. You sound norte-americano. Are you from the quiet land of Pierre Trudeau, or from the interfering land of Lyndon Johnson and Ronald Reagan?"

It was impossible for Nathan not to smile. "The interfering land. My apologies."

The cabbie laughed. "Ah, well. And you want me to drive you to where?"

"To a hotel called Casarão do Corcovado. You know it?"

"Of course I know. It's in Zona Sul. I know everywhere, everything, and everybody." The cabbie grinned. He opened the trunk, Nathan deposited his bags, and they got in.

The cabbie pulled away from the sidewalk and they were soon on the road. Nathan looked out the window, watching Rio in the vestiges of the dying sun. The air, with its fine rain, poured over his face. New York was roughly 5,000 miles away. Good. The farther he was from home, the better he felt.

The cabbie made a right turn at the end of the road, and water came into view; Guanabara Bay, stretching farther than the eye could see.

"Is your first time in Brasil?" the cabbie asked.

"Yeah."

"You're late for Carnaval. It was in February. That's when the norte-americanos and Europeans come."

"I wasn't aiming to attend Carnival."

"That makes you different." The cabbie smiled cynically. "Carnaval is the only thing everybody comes to Brasil for."

"Then you're right that I'm different. If anything, I'm glad I missed it. I'm here for some peace."

The road flowed into an overpass. The elevation gave a better view of the bay, the waters dark in dusk's light. The overpass became a bridge. When they got off, going downhill into a freeway, traffic got heavier. It was a long road with no variation to the scene, so Nathan shut his eyes.

He reopened them a few minutes later. The buildings in the valleys beyond were grouped together, some unpainted. In the distance, barely possible to make out in the dusk, were hazy mountains.