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1 a.m. Refill

Rebecca Grossman-Kahn

It’s 1:00 a.m. and the emergency department is cold. The bright overhead lights illuminate the rows of empty desk chairs. I hear the tap-tap of rubber clogs shuffling in a far corner. There are only two patients here— the man in Room 18 with abdominal pain, and you.

From outside Room 11, I peer in through the glass walls. The privacy curtain is pulled halfway, exposing only a computer on wheels. I briefly struggle to open the door until it gives way with a click. A toddler is sleeping on the hospital bed, limbs and hair scattered, somehow taking up the entire single bed. You’re sitting next to her on the edge of a chair, wearing jeans, a T-shirt, and work boots with flecks of grayish mud. You haven’t shaved in days. I look back to the girl, and you must see my surprise at seeing a child in an adult emergency-department bed.

“It’s me,” you say. “I’m the patient. Just here for a refill.”

Just your antidepressant, you tell me, and then you’ll be out of here. You thought you could do without it, so you stopped it a few months ago. But then a family member died, the pandemic raged on, and then yesterday you couldn’t stop crying. The medicine worked. You wish you hadn’t stopped it. Your shoulders are slightly tensed; your posture rigid.

I think to myself, It’s past midnight and you came for a refill? I take a seat in the stool on wheels, fiddle with the levels to adjust the height, and roll it awkwardly with my feet until we’re facing each other.

You work twelve-hour days in construction, you explain, so you can’t come to the clinic during normal hours. You tried calling but ran out of break time while the hold music played on. You put your daughter to bed as usual tonight, then waited for her to fall asleep before gently transporting her to the car so you could drive the two hours to get here. I ask a few more questions before slipping out to the corridor computer. I scan your chart, clicking through the electronic tabs. The late-night timing and long drive to get here give me an uneasy feeling. I find one hospital discharge summary from a few years ago. The reason for admission: a serious suicide attempt.

My body feels heavy as I walk back to your room and sink into the padded stool. Your face, angled toward the floor, tells me you know I’ve read your chart. Your daughter is awake now, groggily asking where she is, and you squeeze her shoulder and tell her you’ll get her back home soon. Then you lean over to rummage in a backpack under your chair, eventually producing a bag of cookies.

I want to send you on your way, with a plastic vial of the medicine in hand. In five hours, you’ll drive the toddler to daycare and then report to the construction site. In five hours, I’ll scramble to my day job, where there will be more refills to send, more phone calls to return, more hold music from pharmacies to endure.

I ask if you can come to a clinic appointment during the day; you can’t afford the time off. I know the answer is the same for therapy, but I ask anyway. “Is there anyone in your life you can lean on?”

You shake your head no.

“Any family you could call in a pinch?”

You shake your head again, slowly. You have no one. You tell me things
fell apart after you returned from Afghanistan. You saw your friends die there. You drank more. That’s when the suicide attempt happened.

You divorced. You moved into a house with a room for the kid—you have her every other week. No, no guns at home. “Not with a curious toddler getting into the drawers,” you say and muster a smile. You’re sober now. Your days are spent working, then collapsing in front of the TV late at night. When you awake suddenly in the dark early morning hours, you feel too weighed down to move.

I hesitate.

“I’ll be okay.” You remind me you stopped the medication because it had worked, because you were actually feeling better. You’re holding the bag of frosted animal crackers in one hand out over the bed, as your daughter helps herself. Half of them are crushed and she sifts through the crumbs to extract whole pieces.

You look me in the eye as if to say, Don’t worry about me. All I wanted was a refill—remember?

“I’ve got her,” you say out loud, somewhat unconvincingly, as you turn to look at her. She, in turn, is silently puzzling over the resuscitation cart she’s noticed in the corner of the room. Your eyes look so tired as you assure me those thoughts of ending your life are long dormant.

My mind flashes to the many documents I’ll fill out tonight, tallying up the pieces of your life deemed risk factors. I’m thinking of the follow-up calls you’ll get from the suicide prevention team. Your past follows you through your medical chart, marking you as someone to keep close tabs on. But it’s not the imprecise calculation of risk that gives me pause.

I picture you at home, in the lonely company of a toddler, making peanut butter sandwiches for dinner. I imagine you falling asleep on the floor while playing pretend kitchen, exhaustion taking over in the middle of a make-believe sip of soup. It will be weeks before I can put into words that it was not worry I felt, but sadness.

I’m out of my usual questions but not quite ready for the visit to end. “Um, what will you do for fun this weekend?”

“We’re going to ride my bike,” your daughter shouts before you can respond. “It’s purple!” Flecks of cookie crumbs spew from her mouth and fly across the bed. You laugh, tell her other people are sleeping, even though we are the only ones in the emergency department. The patient with abdominal pain has already been transported upstairs.

The girl is trying to climb from the hospital bed into your lap. She has two hands on the safety rail and is working out how to get her legs over. You look up at me and quietly say, “She’s right. I promised her we would take her bike to the park.”

I hadn’t realized I was searching for something until I found it in the promise of a purple bike.

“Well then, let’s get you home,” I say, standing up to finish the visit. I add the usual about the nurse coming in shortly with your medicine and the discharge paperwork.

It’s 7:00 a.m. and the hospital yawns, waking up to a fresh day. Figures in scrubs and nametags funnel in through the main entry. The line at the coffee shop snakes through the hall. Staff members assume their daytime posts. Room 11 shows no trace of us. The floor is scrubbed clean of the caked dirt that fell off your boots. Cookie crumbs and your toddler’s wispy hairs have been swept away.

An administrator opens her computer and will see my early-morning notes about your emergency department visit. Based on the check boxes I clicked, she will stratify your risk and either file you away, or forward your name on to someone else’s inbox.

But the administrators won’t see the way you contorted to reach that plastic baggie of animal crackers for your daughter. I was the only one who watched how your body shifted and heard the wooden chair creak as you told me about the friends you lost to war. Only I saw your body ease as you assured your daughter she’d get to ride her bike. Only I saw how your face softened as you told me, “I’ll be okay.”

The notes won’t convey that it took me a while to fall asleep in the call room that smells of stale take-out and old carpet. You handed me your story in the middle of the night and I didn’t know where to shelve it. Nowhere in your chart does it say that I will think of you months after I met you, still holding your story, believing, steadfastly, that you’ll be okay.

It’s 9:00 a.m. on Saturday and you’re miles away. Your toddler is awake and clamoring for waffles. I imagine you and her, lugging her bike to an empty parking lot. From the road, drivers see just a flash of purple. You run alongside her, her little legs pedaling in circles, blurred like a hummingbird’s beating wings. She gains speed on a small descent and screams—equal parts fear and delight because she feels safe with you by her side. You accelerate to keep up with her down the hill. Perhaps, in that moment, you’re briefly weightless.