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  Praise for The Children’s Hospital

  “Chris Adrian’s life is a dedicated exploration of the things that matter most, and his writing is his companion and interlocutor, his guide and interpreter, as he travels a landscape not before seen by other eyes. And every report he makes of that world enriches and enlarges our own sense of the world we thought we knew.” —Marilynne Robinson, author of Gilead

  “Chris Adrian is a novelist, a doctor, a philosopher, a literary explorer, the humble clear-eyed prophet of our time. He is an eloquent anatomist of loss, naming and labeling the bones and sinews of grief; he is a comedian dressed in sackcloth, a winking Virgil leading us through the circles of our own earthly hell. But he is ultimately a healer; the genius of his writing lies in its compassion, its ability to make what is broken whole again. To read him is to be understood: to know you are not alone in your misery, your self-doubt, your sins of pride, your wild joys, your insomnia, your madness, your desire.” —Julie Orringer, author of How to Breathe Underwater

  “Chris Adrian is truly brilliant. I’m not saying this because he’s a writer, and a pediatrician, and now in divinity school. I simply believe him to be a person with a unique way of processing the world around him and the ability to communicate that vision back to us in what is often a startlingly beautiful manner.” —Nathan Englander, author of The Ministry of Special Cases

  “The Children’s Hospital brings the great promise of Gob’s Grief to fruition; it probes the twined natures of death, grief, and sin with a rare combination of insight, longing, and oracular authority, all tempered by a sense of humor so black it burns. I suspect Chris Adrian will prove to be our culture’s recording angel, our demon brother; and he is certainly one of my favorite authors writing today.” —Emily Barton, author of Brookland

  “To read Chris Adrian is to take part in the exciting process of watching a talented and original writer gain mastery of his powerful gifts.” —Myla Goldberg, The New York Times Book Review

  “The Children’s Hospital has echoes of a children’s book, as it takes on questions of good and evil with an earnestness rare in adult fiction, while remaining seriously fun to read; the funky everyday cohabits naturally with the miraculous.” —Shelley Jackson, Los Angeles Times

  “One of the most revelatory novels in recent memory … Cleverly conceived and executed brilliantly.” —Andrew Ervin, San Francisco Chronicle

  “This novel is a singular event: massive, recondite, often electrifying.” —Bookforum

  “Adrian lays out a brave new world that is glorious and miraculous and horrible all at once.” —Entertainment Weekly

  “Suspended between the poles of life and death, the physical and the spiritual, the real and the imagined, Adrian’s vast floating world of a novel is a marvel. The Children’s Hospital is intelligent, seductive and beautifully realized.” —Kit Reed, Hartford Courant

  “[Adrian] is a writer of prodigious talent who holds your heart in his hands. … And despite or because of his unlikely worldview, he is irresistible. He sails into the inexplicable, seeking meaning; and the reader, gripped by curiosity and admiration, scrambles on board. Adrian’s prose here is writing at its best—medical magical realism, you might call it. … We will be lucky as long as he continues to write.” —The Boston Globe

  “Hip, wry and ambitious … Adrian’s knack for surprise and his ability to find meaning in seemingly ridiculous situations is rewarding.” —Publisher’s Weekly (starred review)

  “It’s hard to read a book like Chris Adrian’s new novel, The Children’s Hospital, with its dead under seven miles of water, and not think about Katrina and tsunamis, and then backward and landward to September 11 and other traumas that, if personal, also demanded some kind of collective notice.” —The Village Voice

  “The Children’s Hospital establishes Chris Adrian as a remarkable American fabulist in the tradition of Melvin Jules Bukiet and Tony Kushner, writers who define and confront the terrifying moral choices of a new century. In what may be a terminally sick world, it’s good to have a doctor in the house.” —Elizabeth Hand, The Washington Post

  “Elegant and enormously wondrous … Adrian, poetically and with exacting precision, has crafted a prophetic, difficult novel of compassion and healing, but with a keen eye fixed on the damning reach of divine wrath. … [He] attempts a near-impossible summit, and delivers a devastating, transformative work that is certain to burn in the minds of readers long after the final page’s end of the end of the world.” —Ian Chipman, Booklist

  “This humanistic novel is a heartfelt portrayal of indefatigable spirit in the face of utter helplessness and ruin. … Adrian proves to be a suitable successor to the mythological wherewithal of Rushdie or C. S. Lewis, and the book is a solid testament to his array of talents.” —Time Out New York

  “The Children’s Hospital is born of both medicine and theology, a novel in which Gnosticism collides with diagnoses, and Old Testament-style cataclysms dovetail with IVs. But The Children’s Hospital is, thankfully, more than that awkward marriage; it is also a thing of complex beauty and extraordinary insight … More than a vision that combines fantasy and realism, philosophy and certainty, The Children’s Hospital is also about everything in between. It’s been a while since religion was this fascinating and moving—just as it’s been a while since there was a work of fiction this challenging, inventive, and heartfelt.” —Portland Mercury

  “Chris Adrian, a pediatrician and divinity student, might be contemporary American fiction’s best-kept secret.” —Richmond Times-Dispatch

  “A frighteningly relevant tale of the end of the world, epic within the confines of its setting.” —Paste

  THE CHILDREN’S HOSPITAL

  CHRIS ADRIAN

  Copyright © 2006 Chris Adrian

  All rights reserved.

  No part of this book may be reproduced in any form or by any electronic or mechanical means, or the facilitation thereof, including information storage and retrieval systems, without permission in writing from the publisher, except by a reviewer, who may quote brief passages in a review. Any members of educational institutions wishing to photocopy part or all of the work for classroom use, or publishers who would like to obtain permission to include the work in an anthology, should send their inquiries to Grove/Atlantic, Inc., 841 Broadway, New York, NY 10003.

  First published in 2006 by McSweeney’s Books, San Francisco

  Icons by Amelia Bauer

  Printed simultaneoulsy in Canada

  Printed in the United States of America

  eBook ISBN-13: 978-0-8021-9979-9

  Grove Press

  an imprint of Grove/Atlantic, Inc.

  841 Broadway

  New York, NY 10003

  Distributed by Publishers Group West

  www.groveatlantic.com

  for my parents

  Table of Contents

  Title Page

  Copyright Page

  Dedication

  chapter 01

  chapter 02

  chapter 03

  chapter 04

  chapter 05

  chapter 06

  chapter 07

  chapter 08

  chapter 09

  chapter 10

  chapter 11

  chapter 12

  chapter 13

  chapter 14

  chapter 15

  chapter 16

  chapter 17

  chapter 18

  chapter 19

  chapter 20

  chapter 21

  chapter 22

  chapter 23

  chapter 24

  chapter 25

  chapter 26

  chapter 27

  chapter 28


  chapter 29

  chapter 30

  chapter 31

  chapter 32

  chapter 33

  chapter 34

  chapter 35

  chapter 36

  chapter 37

  chapter 38

  chapter 39

  chapter 40

  chapter 41

  chapter 42

  chapter 43

  chapter 44

  chapter 45

  chapter 46

  chapter 47

  chapter 48

  chapter 49

  chapter 50

  chapter 51

  chapter 52

  chapter 53

  chapter 54

  chapter 55

  chapter 56

  chapter 57

  chapter 58

  chapter 59

  chapter 60

  chapter 61

  chapter 62

  chapter 63

  chapter 64

  chapter 65

  chapter 66

  chapter 67

  chapter 68

  chapter 69

  chapter 70

  chapter 71

  chapter 72

  chapter 73

  chapter 74

  chapter 75

  chapter 76

  chapter 77

  chapter 78

  chapter 79

  chapter 80

  chapter 81

  chapter 82

  chapter 83

  chapter 84

  chapter 85

  chapter 86

  chapter 87

  chapter 88

  Acknowledgments

  Lettera gesta docet, quid credas allegoria;

  Moralis quid agas, quo tendas anagogia.

  —Augustine of Dacia

  Rotulus pugillaris

  I am the recording angel, doomed to watch.

  Never mind my sin. Here is my expiation and my reward: to orbit Jemma Claflin from her birth to her death, and fix my eyes always on her face the way better angels always look upon God’s glory. I fell back to earth and back through time to the night of her birth, and, bound to her heart by chains of air and spirit, have never since been more than a few hundred feet from her body. Whenever I tried to flee—there was a whole world to rediscover and witness, after all, and all the curving ways of time lay open before me, and a billion anguished lives called out to me to come and watch them, instead of a toddler with peas on her cheek—the chains would pull tight, hooks in my flesh. In all my years of watching I have never hated her, but I have often been bored, and if there are doodles in the margins of her book, and gaps in her story, if I have looked away from her to watch my brothers and sisters at play among the stars and missed here or there an episode of her life, if I have watched her brother, always burning bright to me, even though I knew his story, past and future, already by heart, it is because I am neither a perfect angel nor a perfect witness. I put off perfection with my mortal form, and what a relief to do it.

  Never mind, for now, the quotidian discoveries of her infancy; do not look at her yet toddling after her brother, or trudging, head down, through her education. Beauty pageants and swim meets and drugs smoked or snorted under her brother’s tutelage are not the place to start; neither are the flights with her father over the Chesapeake Bay, or the nights drunk-diving into the past with her mother, or the nights she skated over the frozen river to crawl into her lover’s house and lie with him in his single bed. And look away from the funeral years; ignore the miracle her brother wrought. Consider her instead on the edge of her own greatness, separate from and grander than Calvin’s. There she is on the night of the storm, attending a birth, waiting while the rain falls and the clouds are heaping and piling in the sky and I am sighing all around her, finally. Finally!

  Jemma thought that witnessing a birth ought to make a person exactly the opposite of horny. The rush of blood and fluid; the bitter odors; the screaming of a mother arrived too late for an epidural; and worst of all, the hideous dilation, the vagina that permitted the entrance of hands and arms and instruments sized and shaped more appropriately for barbeque than surgery, and disgorged the bloody cantaloupe. They should freeze you up, but they never froze her up, and sometimes, like on the night of the great storm, they put the need in her. So she found herself distracted by thoughts of Rob Dickens even at the most challenging and complicated delivery of her third-year medical student career: a gruesome baby born to a gruesome mother. The child, the expression of a jumble of chromosomal additions and deletions so unique that she was her very own syndrome, was hideous—too long and too short, too wide and too thin, with things that were not eyes where her eyes ought to have been, and a cuttlefish mouth—but she seemed sweet to Jemma, who stood over her among the white-suited pediatricians, a fellow, a resident, and an intern. Her cry was more dulcet than any Jemma had ever heard, probably because she was half dead and lacked the energy to voice a truly irritating scream. “Rub,” Jemma’s senior resident said to her, because she was only blotting at the wet baby with her towel. The mother was lovely in her flesh but seemed deformed in her soul. She shouted curses at her child while the anesthesiologist, scowling, pushed white, milky propofol into her veins, trying to shut her up. Not even her epithets and her screams cooled Jemma. Rob Dickens was not among the pediatricians in their bunny suits—one raised a laryngoscope with a flourish like a hoodlum clicking out a folding knife and then swooped in to intubate the now quiet and rather blue baby—but she knew where he was, waiting with the other students, residents, and staff for this unfortunately interesting case to arrive across the glass hall that connected the county hospital to the children’s hospital.

  While she ought to have been calculating one-minute apgars for the child, she pictured Rob Dickens in his scrubs, his arms naked almost to the shoulder. When the resident asked her for the score she blushed and fumbled in her mind for the number, forgetting the categories—tone, cry, grimace, color, and what else? Not grace, not style, not symmetry, but these were what she thought of. The resident—a third-year named Natalie famous for the black cloud of acuity that hovered over her call nights—stared at Jemma coolly over her surgical mask, and Jemma remembered to count the heartbeat. She reached out to pinch the umbilicus and feel the pulse, much slower than her own, which always raced when she was mortified by the ignorance and confusion she manifested when faced with one of these student tasks. “Four,” she said at last.

  “Generous,” said Natalie, and turned her attention fully to the task of bag-ventilating the infant. Despite the sedatives, the mother was still telling them to kill the baby with a knife, with a brick, with a smothering pillow. She sat up suddenly, an obscene apparition, hauling herself up by her knees, her perfect, unnatural breasts glaring over the sterile blue drape, a tongue of clotted blood lolling out of her vagina. She calmed briefly and spoke in sane, gentle tones. “Just do it now, before she gets us. It’s easy now but it won’t always be so easy.” She reached out, grabbing for the instrument tray, until two nurses pushed her back. Jemma thought of Rob, pacing with his hands folded on top of his head, like he always did when he was impatient for a particular thing to happen. She thought of his arms again. She didn’t have to close her eyes to be able to see them.

  “Let’s go,” said Natalie. She jerked her head imperiously at her intern, Dr. Chandra, who had got his stethoscope caught up in the oxygen tubing and was trying to untangle it. Natalie looked back expectantly at the fellow, Emma, who gave one sharp nod to indicate her blessing. They moved out of the operating room and down the long beige halls of the county hospital. Patients, women walking in the hope of accelerating their labor, spun out of their way as the team raced along, Emma pushing the isolette, Natalie bagging, and Dr. Chandra still trying to untangle his stethoscope. Jemma, not a good hurrier, trailed after the isolette. It had been part of the reason she failed her surgery rotation, this reluctance to hustle, and even when her grade was at stake she could never bring herself to be snappy, or do that w
iggling power walk on rounds, or even run full-out to a code or a trauma—if you were too fast, after all, you got there first. She ran a few steps, then slowed, then ran again. As they approached the bridge, Natalie called back to her to get the door, since Dr. Chandra had also entangled his name tag and calculator in the mess of tubing.

  Jemma ran ahead to slap the giant steel button that opened the doors. They swung out leisurely, opening on the storm that flashed and raged around the glass hall. The team pushed through even before the doors were fully open. Jemma ran ahead again, meaning to slap the far button with the same authority and force with which she’d hit the near one, but she tripped, then rolled fast and heavy into the door. Natalie yelled, “Get out of the way!” Jemma hit the button and the second set of doors swung open, less leisurely than those at the other end of the hall, but not fast. She scooted on her bottom, pushed aside by the door and finally wedged against the glass wall as the isolette flew past. Lightning arched overhead and showed her a vast parking lot, empty except for a few dozen dead cars stranded in water up to their headlights.

  The lightning passed, and then the glass wall showed Jemma her own haggard face. Nursery call was beginning to wear on her. They were always flying to one delivery or another, back and forth across this sky bridge at all hours of the morning, day, and night. Here in a hospital that attracted the riskiest pregnancies, the ones that ended with the expulsion of a half dead baby, there was no rest for a person afflicted with a delivery pager. Jemma rose and leaned against the glass, closing her eyes and imagining that the little creature in her high-tech bassinet was wheeling away at a thousand miles an hour, on her way to Heaven instead of a hell of needles and tubes. When the lightning flashed again in the sky she opened her eyes and saw how the rain was falling in sheets. “All pediatricians are nice,” Rob had told her two weeks before, on the evening before the rotation started. “These are going to be the best six weeks of your life.”