THE FOLDED FLAG | Gaetan Sgro
Along a mustard-yellow corridor, a man in a tan uniform shirt was mopping furiously. His granddaughter’s colic had ruffled his sleep, and he’d smashed the snooze button too many times. Now, he was playing catch-up, rushing to erase yesterday’s scuff marks before the coming wave of squeaky feet.
Outside a double room he overheard two men arguing.
“You’re going to die in here if you don’t wise up,” said the old man on the darker side of the curtain.
Between the old man and daylight lay a web of entanglements: wires for monitoring; oxygen tubing; a braid of sheets and blankets; and on the other side of the curtain, a much younger man in a second hospital bed.
The young man wheezed as he laughed. “Thanks for the pep talk but I think I’ll be OK.”
“Does that mean you’re going to take the medicine?” the old man snapped back.
“Don’t know. Haven’t decided.”
“You haven’t decided? What’s to decide?”
“What do you mean, what’s to decide?”
“I mean— just take it,” said the old man, adjusting his oxygen and pulling a wheeled tray in towards his chest.
“Yeah, well, what if it makes me sick? I’m not putting something in my body that hasn’t been tested.”
“It’s not gonna— It keeps you from getting sicker. Didn’t you hear what the doctor said?”
“Yeah, I heard her. I’m not stupid. But I’m not going to put something in my body—" He paused for a breath. “Just because some doctor—”
The old man felt a hot spot simmering at the base of his spine. He leaned to one side, felt cool air on his creased and clammy skin. As soon as he fell back, the soreness flared again.
“Heaven forbid you listen to the doctor. I’m sure you know better,” said the old man.
“Yeah, well, maybe I do.”
The young man spent yesterday restless between bed and chair. Today, his muscles throbbed with an ache he could not reach. He pushed earbuds in and let loud music play.
The old man rummaged through a week’s worth of papers and disposable cutlery. With his good hand he fished a pair of glasses from their clam shell case.
“Well if you want my advice, I’d take the medicine. I took it and look at me— I’m doing great.
The young man nodded off momentarily until, with a burst of distorted vocals, he jerked awake.
“And I’m about ten times your age,” the old man went on. “Doc says if I can stay on course I might be getting out of here in the next couple days.”
“Are you still going?” said the young man, removing his earbuds. “Look, man, I get it. Every other guy in this place wants to be my dad,” he said, staring out at the metal sky.
At the edge of the parking lot he could see a red antennae and, beyond that, one corner of the city’s skyline and, beyond that, bridges and the grey river winding west into coal country.
“Honestly, I think your generation is just better at taking orders.”
“Oh, is that right? What else can you tell me about my generation?”
“All I’m saying is, I need to do my own research.”
“Is that what you call the garbage you’ve been watching? Research?”
The young man plucked a tablet from his tray and locked eyes with the screen.
“All I’m saying is nobody tells me what to think,” he said, tensing as an RPG exploded a zombie’s body. The carnage triggered a coughing jag.
“Well, all I’m saying is you’d better make up your mind. Doc said the medicine only works if you take it early.”
The old man’s bad arm fell heavy on the mattress, a sock filled with worthless coins. The good hand crawled spider-like around his breakfast tray, tipping lids and trying packaging, seeking a path of least resistance.
As soon as he managed to load his fork, the nurse’s cart darkened the doorway. The nurse lifted the bad arm off the bed and aimed a scanner at the wristband as if pricing tenderloin.
“Time for my cereal, eh?” said the old man.
The nurse smiled and unpackaged a dozen pills, depositing a small paper cup on the old man’s tray.
He set his fork down and raised a toast with the cup full of pills.
The nurse spent a few minutes attending to the computer screen while the old man pushed food around his plate.
“Hey. Psst,” said the old man to the nurse. “Will you see if you can talk some sense into my roommate? Doc wants him to take the treatment but he won’t make up his mind. I’m starting to worry. He’s really huffing and puffing.”
“I don’t have him today but I’ll pass it on,” she said.
On the bright side of the curtain, the young man’s silhouette reared up from the bed then crashed down again. The old man thought of whales he chased in the Navy.
“Hey. Roomie,” said the young man, “I can hear you talking about me. I get what you’re trying—” A volley of wet coughs interrupted his speech.
“Yeah, well, if someone gave me the option of not dying, I think I’d have a pretty easy time—” said the old man, chuckling.
“You know, you haven’t shut up long enough to let me think. I can’t even piss without you yakking."
The old man chuckled. “You got stage fright?”
“No. It’s just they’ve got me on a short frickin’ leash here and I can’t use this goddamn thing.”
A plastic urinal slapped against the floor and lodged beneath a radiator.
“Oh, you sound like me. I don’t know why but I’ve always preferred to sit when I pee.”
“I don’t sit! I just— It’s not working today. Nothing’s working.”
The young man’s coughing intensified and the monitor above his bed began to ping.
“Whoa, easy over there, tough guy. Take it easy. You’re making this harder than it has to be.”
The old man stared up at the television. Below it hung a glossy poster promoting R-e-i-k-i. Beside that was a whiteboard announcing today’s program: “OOB to chair. Incentive spirometry QID.”
The young man’s nurse hurried in.
“You feeling alright?” asked the nurse over the monitor’s beeps.
“Yeah. I feel fine. Better if you could kill that thing.”
“Here, let’s just—” the nurse repositioned the prongs of the cannula within the young man’s nostrils. “Okay. Just lie still and take some deep breaths. Good. That’s it. Deep breath.”
“Can I please get some real coffee? I can’t drink this shit.”
“I need you to be still right now. You’re on a lot of oxygen. Just relax and keep taking those deep breaths. I just paged your doctor.”
The nurse watched the monitor as she backed slowly away.
“Do you need anything?” she said as she passed.
The nurse saved her best smile for the old man, wishing he were her assignment, but the old man stared blanky. He was off visiting with his grandson, coaching him through a session at the cages, reminding him to keep his elbows in and roll his wrists. If only the kid had stuck with it, he might have played in college. He might—
“I’m sorry. What’d you say?” asked the old man, returning.
“Just wondering if you needed anything.”
“No ma’am. I’m peachy. Just a little worried about you know who,” he said, nodding.
“The doctor’s on her way.”
The young man reached for his phone and flipped to voicemail. The screen filled with a column of messages, all of them from “Brenda mom.” He picked one in the middle and pressed play.
Brian, please call me back. You got mail today that looks important. I’ve got clients all afternoon but I’ll have my phone on. Love you.
He flipped back to the list and chose another.
Hey, honey, it’s me. I’m about to go shop for this weekend and I’d love to know if you’re coming with. Call me. Love you.
And another.
Uh, hello. This message is for Brian Smyth. Please call as soon—
The young man’s nose began to twitch. He slammed the phone face down on the tray table, rolled onto his feet and stumbled, the walls beginning to shift.
“What the hell are you doing now?” said the old man. He tensed as if about to leap up but the dead weight of his bad side anchored him.
“I’m getting’ dressed,” said the young man, flatly. “Do you want to come over and help me with my underpants?”
“Funny. I think you need to do what she said and stay put. Look, I had a few bad days like you’re having but I came through it.”
“I’m sorry, man. I— I can’t be in here.”
“So that’s it? What about oxygen?”
“I don’t need frickin’ oxygen,” said the young man, pawing at his face.
“There. Problem solved,” he said.
The alarm started again.
“It doesn’t sound solved. I think you should take the medicine.”
The young man lurched and, falling, caught the curtain to keep from going down. Metal anchors popped as they pulled away from the ceiling track.
“Son of a—” said the young man, wincing.
The young man’s shirt hung open, revealing skin that sucked in and out between his ribs. His breaths were shallow and quick.
“Easy,” said the old man. “I’m sorry if I—”
Staff were rushing in, followed by a red tool cabinet that rammed the old man’s trash can and scattered its contents. Rubber gloves coaxed the young man back into bed.
“Where’s his oxygen?” shouted a tall woman.
“Over here, under the bed.”
“We need a face mask. Is that a real sat?”
“Is someone recording? We need a set of vitals. Who’s here from respiratory?”
A goateed man pushed forward.
“Can we do high flow on this unit?”
“I’ll get a setup.”
“Okay just relax. Try to take some deep breaths.”
The young man closed his eyes and snuck off into darkness, going straight to his uncle’s cabin. He and his cousins lying out on the dock, the sun burning their pale, bird-cage chests. Bonfires with high school friends, flipping bottles into the flames, the labels curling as they melted. Years later, driving up there with his girlfriend, with his best friend’s girlfriend, ignoring the other car, shouldering open the door, flipping the switch and finding his uncle skin to skin with some wrinkled man.
He felt he was going to be sick. He tried to escape but a thicket of hands blocked his path. More hands pressed down around the face mask. They blew air into him.
The darkness gave way to more voices and flashes, some that flickered and passed and others that carved wide berths in the stillness. Fist fight with the best friend. A glary morning spent knee deep in a stream, finessing his line and feeling for a catch. A snowy weekend playing cards and getting drunk with his parents.
The longer he stayed, the more he wished to remain wrapped in the warmth of these visions. But he understood that, once he gave in, he could never come back.
He woke in a different room, private. There was the burble of humidified oxygen, the metronome tick of an IV pump, the strange, sonar-like ping above his head. Beneath a sink, a pull-out toilet.
His skeleton ached like he’d been in a wreck, but his throat was most urgent. He reached for a cup, brought the straw to his lips, and instantly regretted it.
“Hey. Hey—” He tried to raise his voice but the pain stopped him. “Anyone there?” he hissed.
A minute later a glass door slid open and a new nurse slipped in.
“You’re awake,” she said, checking the screen.
“Where am I?”
“ICU. You self-extubated last night. They tried to put you back on but you just kept bucking the vent. After a while they gave up and decided to let you fly.”
“How long was I out?”
“Uh, I’m not sure exactly. I’ve been here since Tuesday and I’ve had you the whole time. I can check the chart.”
“What day is it now?”
“Friday. Today’s Friday.”
“What happened to my roommate?”
“What roommate? You don’t have a roommate.”
“No. The guy from before. He was older— Korea I think.”
“Oh, that must have been up on the floor. I can check with the unit?”
The young man sank back into the mattress, newly aware of a pain in his groin. His hand moved instinctively, brushing the tubing, causing the pain to brighten.
He asked for something and soon the nurse was pushing ice water into his IV. At first, he didn’t feel anything. He wanted to ask again. Then, he slept.
He woke to a presence. The ICU nurse was chatting with the nice nurse from before.
“There he is. How’s my guy doing?”
“Hey. Sorry, a little out of it.”
“Oh, no worries. I’ve been off for a few days. To be honest, I didn’t think you’d be here when I got back. I’ve been a black cloud lately.”
“Oh yeah?” said the young man, not understanding.
“Lara said you were asking about the old guy, Mr. Bishop. I’m sorry to tell you but he passed away. He crashed maybe a day after you tried to die on us. It’s really bad right now. But he had a DNR, so at least we were able to keep him comfortable.”
The young man’s lips parted but no words came.
“When can I get out of here? At least get this out?”
“Oh the foley? said Lara. “Let me check with the doctor. Do you think you can pee?”
He nodded.
“You’re lucky. You know that,” said the nice nurse, patting him on the shoulder.
“Yeah,” said the young man, trying not to swallow.
When Lara came back she was holding a syringe. She raised his gown and used the syringe to take down the balloon that held the catheter in place. He winced as one glove gripped his penis and the other withdrew the catheter. Drops of hot urine burned his raw skin. She helped him reposition.
“Good?”
“Yeah, good. Thanks.”
“No problem. Just let me know the next time you need to go. The doctor wants me to do a bladder scan after. Make sure everything’s working.”
The young man nodded.
He waited for a minute after hearing the glass door click. The floor was cold and firm against his tender feet. He took a few half steps and crash-landed on the toilet. He sat for a long time, his ass throbbing, belly sore from straining, until he gave up and limped back to bed.
Beyond the sliding glass door staff milled about the nurses station. A clerk spun in a chair, phone tucked between chin and shoulder, taking notes and nibbling carrots. A group of doctors gestured towards a mobile computer screen. A woman in a face shield and a blue cardigan ambled over to the big white board and erased two of the names.
The young man’s eyes closed again.
That night, Lara stayed two hours past the end of her shift, keeping watch as a resident placed a central line then tidying the room before a video chat with the patient’s family. She had absorbed from her mentors a reverence for process, believing certain rituals of care—a clean dressing centered perfectly over the insertion site, attentiveness to the bed’s positioning, fluffed pillows and crisp sheets—were as essential to the healing process as CT scans and antibiotics.
Meanwhile, in a post-war apartment building eight bus stops away, Lara’s husband mashed sweet potatoes and danced to country songs in the kitchen with their baby. By the time Lara got home, they both were asleep.
The young man’s fever rose and fell and rose again as he dreamed. His chest fluttered periodically, as if something were trying to escape. He knew he needed to pin it down, to concentrate. Gradually, the concern faded until he could barely sense it, until it was no longer his.
On the morning that staff from Decedent Affairs came to collect the young man’s body, a volunteer honor guard placed a scaffold over his bed and covered it with a flag. The unit clerk made an announcement on the PA, and all the busy teams stood at attention as the procession passed. A nursing student, whose grandmother was, at that very moment, dying on the other side of the world, bowed her head and prayed. A surgical resident, who wasn’t sure she’d have time enough to finish training, find a partner, and start a family, fidgeted. And Matthew, an elderly patient escort, whose father had been shattered by a German mine, blinked rapidly.
Before signing out for the day, an intern completed the red packet and signed the death certificate, then took a notepad from his pocket and wrote down a name.
Thursday was a bright, unseasonably warm day in that part of the country. A few friends followed the hearse to the cemetery where a slender Marine played “Taps.” Two sets of white gloved hands took great care to prepare the flag for the family, tucking red and white stripes beneath a wedge of cotton stars. A Canada goose landed lightly on the water, so as not to disturb the scene. From a folding chair on a plastic mat before the open grave, the young man’s uncle rose to receive the folded flag.
Gaetan Sgro is an internal medicine doctor, girl dad, and associate professor of medicine at the University of Pittsburgh School of Medicine where he directs a program in the medical humanities. His writing has appeared in Rattle, The Bellevue Literary Review, Hippocampus, Gravel, Hektoen International, The Healing Muse, Annals of Internal Medicine, JAMA, Best New Poets, and elsewhere. Read more of his work at GaetanSgro.com