Arts & Culture » Fiction

The Highest Goodness Is Like Water



When Ella first started working at the hospital, three months ago, Marcus would see her in the cafeteria, and say, "When you headed back to the vegetable garden?"


"The veggie garden, girl."

After a few times it dawned on her what he meant: he was talking about where they worked, in the Persistent Vegetative State Pediatric Ward. The joke sounded callous, but Marcus was tender and gentle with the babies. He sang to them even though they were deaf. Ella, a care assistant, liked to believe that the children she diapered and fed were angels of sorts, their consciousness hovering between heaven and earth.

To her this helped explain their silence, the way their blind eyes shifted. They were all severely brain damaged; in most cases only the brain stem still functioned. Many had never been outside the hospital walls, yet they'd been alive for months, sometimes years.

There were eight cribs in the ward; five were occupied. At the end of each row of cribs sat a rocking chair with cushions covered in a patchwork-patterned vinyl. The parents used these when they visited. If Ella had any extra time, which she rarely did, she sometimes sat and rocked a baby, particularly Jamal, her favorite because of his liquid brown eyes.

This morning Dr. Patel stood talking to the parents of the latest arrival, Samuel, two months old. The doctor's melodious voice seemed to have a hypnotic effect: the parents nodded, not interrupting, although several times the father frowned.

After the doctor left, Ella approached the parents carefully, holding the feeding catheter and the plastic bag of formula. The mother held Samuel on her lap, stroking his silky hair. The father stood behind her, gripping the back of the chair so tightly his knuckles were white. The baby had come here yesterday, after stabilizing in the Neonatal ICU.

Both parents were slender, athletic-looking. Both were tattooed: the mother's left biceps with a bracelet of tiny circles that progressed from white to black; the father's arms with what looked like Chinese characters, though he was Caucasian, a blond. Their stylish eyeglasses and insolent beauty made them look as if they had walked out of an iPhone ad.

Ella smiled at them cautiously. She was 20, and plump in contrast to their leanness. She, too, had a tattoo, a butterfly on her right ankle, although it was hidden under her baggy uniform. Because of the tattoos she felt a small solidarity with them.

"Would you like to feed him?" she asked.

The mother looked shocked, as if Ella had suggested she attempt to fly. Then she recovered and nodded. The father stepped back and folded his arms across his chest as Ella demonstrated how to insert the tube. The baby's head jerked as it slid down his throat.

"He doesn't like it," the father said.

Ella said nothing. Samuel couldn't be bottle-fed because he lacked the sucking reflex, the case for most of the children here. The mother's eyes filled with tears as she watched her baby twitch.

"Why do you force it?" the father said, glaring at Ella.

"He'll starve otherwise," Ella said briskly, imitating the tone she heard the nurses use. ("Don't ever let relatives get the upper hand," Nurse Anne had told her. "They need to know who's in charge.")

"And he's not dying anyway. Would you like a tube down your throat?"

Ella flushed.

"Honey," the mother said, cautioning him.

"It's my job to feed him," Ella told him.

"Really," he said, blinking rapidly behind the rectangular black frames of his glasses. "I thought your job was to care for them."

Flustered, Ella couldn't think of anything to say. She wished she could empty the entire contents of the bag into the baby at once and be done with it. The mother stroked the baby's head, murmuring apologies to him.

The ward could be demoralizing and scary, and not just to parents. Staff turnover was high. Only last week Marcus had applied for a transfer after Noelle, who had been on the ward for three years, had died on his shift. Everything was backward here: these babies who couldn't see or hear, who would never grow or walk, were the result of progress. Twenty years ago, they would have died within a few days or weeks of birth. Now modern medicine could save them; having been saved, they must be cared for.

Before she came to work here, Ella hadn't known such children existed. She loved babies, their sugary scent, the pleats of their eyelids, their tender, perfect skin—and these were no exception. She still found it hard to believe that none of them were getting better, none were going home.

"Little lambs," her mother called them when Ella talked about them after work. "They must be on this earth for a reason." And that was when Ella developed her theory that the babies were angels, on earth to teach us something: otherwise, how could this be endured?

As Ella squeezed the plastic bag of formula, Samuel's father stalked away, toward the sliding glass door, which looked out on a small, concrete patio. The patio was mostly used by family members of patients in the brain injury unit across the way. One young man, tied into his wheelchair and put out there late mornings as the city's fog was burning off, was so startlingly handsome that Ella fantasized about working in the rehab unit, where people learned to walk and talk again and went home. The stories of temper tantrums, however, frightened her. One could not find more peaceful patients than these babies.

Ella had seen the certificate program for care assistants advertised on television a year ago. It had seemed better than working in the deli, and it was. Yet there were moments when she wondered if she was in the wrong occupation. Unlike the deli, where a simple list of rules was stapled to a wooden post in the stock room, the hospital's employee binder was two inches thick, and those were just the official regulations. There were vast and shifting numbers of unspoken rules as well: each doctor's and nurse's preferences needed to be catered to. Then there were the parents, some who rarely visited, some who arrived sedated, all of them in states of unbearable grief.

Ella's arm cramped as she tried to hold the bag of formula at the proper angle. She was touching Samuel, holding the tube in his mouth, but she did not want to have any physical contact with his mother. It seemed safer that way.

"You're so pretty," the mother said wonderingly. She was talking to the baby. As her fingers stroked his cheek, her elbow brushed against Ella's smock, briefly, then leaped away.

"Excuse me," she said. It seemed she did not want to touch Ella either.

"Not a problem," Ella replied. She thought about saying more ("He's beautiful" perhaps) but she was afraid if she said anything kind or sympathetic, the mother would cry (her lower lip was already trembling). Then the father would blame her, Ella thought.

Generally she pretended to ignore parental tears. As they cried, she quietly went on with her tasks, keeping her voice low and trying to minimize the squeaking of her clogs on the vinyl floor.

"Just a little longer, Sammy," the mother said, apologetically. Her sleeveless black blouse was silky, with a puckered texture. It looked expensive. Studying the tattoo encircling the mother's smooth, tan arm, Ella realized that it was the lunar cycle. Tiny moon circles gradually filled with black ink: half moon, crescent, and on to the completely black new moon.

"I like your tattoo," said Ella.

"Thanks," said the mother, without glancing up. She kissed the top of her baby's head.

Samuel's head was round. His clear blue eyes were in the right place, one on each side of his soft cushiony nose. His sleek little mouth began to open and close around the tube like a fish.

"Could we try a bottle?" the mother asked. "It looks like he's sucking."

"Maybe the next feeding," Ella said. She had four more babies to attend to before noon, all needing to be fed, bathed, and diapered. Anne, the RN on the ward this morning, was rigid about schedules and just as rigid about what she considered to be her duties and what were those of the care aides. Some of the nurses pitched in as a matter of course. But not once since Ella had worked here had Anne changed as much as a diaper.

"Why not now?" the mother said. Tears fogged the lenses of her green-rimmed spectacles.

A spark of annoyance went off in Ella; did this mother think her baby was the only patient on the ward? They didn't even keep bottles on the unit. They would have to order one from supply.

"Let me check with the nurse," she said. She slipped the tube out of Samuel's mouth and laid the feeding implements in the crib. She walked across the room.

Anne was wrapping a tiny blood pressure cuff around Jamal's thin arm.

"Absolutely not," she said.

"Could you tell them?" Ella whispered.

"I'm busy." Anne lifted her eyebrows. "Go on."

As Ella trudged back, her heart pounding, she saw that the mother had lifted her blouse and was holding Samuel's head so that his mouth was pressed over her left nipple. The father squatted next to her. Both parents were gazing at the baby intently. The mother tickled his cheek. But he wasn't latching on. His body was flaccid; his disinterest evident.

"He's tired," the father said. "We'll try again later."

Ella walked past them, out into the hallway, where she took a deep breath before she prepared Mackenzie's feeding catheter. She was relieved the parents had taken matters into their own hands. Better for them to figure it out on their own. He was their baby.

By the time Ella was finished with Mackenzie, Samuel's parents had returned him to his crib and left.

The remainder of the day was peaceful, although Anne snapped at her when she found Samuel's feeding catheter, which Ella had forgotten, leaking formula onto the sheets.

"These aren't the only parents who're going to be a piece of work," Anne said. "They're not your patients, the babies are. Remember that."

Ella nodded submissively. Anne was right, although it seemed that the parents suffered at least as much as their babies did, possibly more. After the failed breast-feeding attempt, Samuel's parents had slipped away without a word.

Returning from a lunch of a Reuben sandwich and fruit salad in the hospital cafeteria, Ella fed all five babies twice more, cleaned their faces, and changed their diapers. Not one of them would ever taste pastrami, or strawberries, grapes, or watermelon. They were like little dolls or a kind of unusual royalty. It was a shame they weren't allowed to wear any of the pretty clothes made for babies nowadays instead of the boring hospital wraps.

It wasn't until Ella was riding the bus home that Samuel's father's angry words rose up in her head and began pricking at her once more. "I thought your job was to care for them," he'd said.

"Starving them is what would be cruel," she thought as the bus passed through the city park. Deep inside, Samuel's parents had to be aware of the reality of the situation. That they were angry about it was understandable. But the father didn't have to be hurtful. Ella, thin-skinned and plodding, always did her best to please. Sharp comments sliced swiftly and deep, like razors. "There goeth the brown-noser cow," she had overheard Justin snicker to Zadie in the stock room at the deli one night. Did they think she was invisible or was she meant to hear it? She had been walking past them to get a fresh jar of mayonnaise. "You don't even know me," she wanted to say to Justin, and to Samuel's father, too. They thought she was dull and unfeeling because she wasn't clever and because she followed the rules. But weren't there rules for a reason? At the deli to keep the food from spoiling, at the hospital to ensure the safety of the patients.

She gazed out the window as the bus passed the ornate glass conservatory, which contained lush tropical plants. The temperature in the ward was always hothouse warm, each baby floating in the center of his or her crib like a water lily in a pond. They needed to be turned frequently, to be held upright so that their small lungs didn't fill with fluid. She trimmed their soft nails; she clipped their feathery hair. She smoothed diaper ointment onto bottoms smaller than her hand.

After the conservatory came the bowl-shaped meadow of green grass, and beyond that, a playground, with slides, a climbing structure, swings. It was quiet now. No children or parents, only a man with a golden retriever on a leash.

At the next corner, just past the park, Ella got off the bus. She went to the corner store and bought a carton of milk, a pint of peach ice cream, and two falafel sandwiches so that she would not have to cook herself and her mother dinner. As she waited for the woman behind the counter to fix the sandwiches, the owner's little girl ran out from the back room. She had black hair cut in bangs straight across her forehead, pierced ears, and precise, determined features. Ella smiled at her and the girl flashed a brilliant grin in return. Ella thought of what her friend Charlotte who worked as a preschool teacher had said to her once: "It's never the children who give me problems, only the parents."

The dark odor of cigarettes struck Ella when she got home. No matter what kind of air freshener she bought (a plug-in type that was supposed to smell like rain; the kind with a timer that sprayed out lavender oil), this ashtray scent was always dominant. Tigger, the cat, wove about her legs as she made her way down the hall.

Her mother called to her from the kitchen. "Ella! You have a package!"

She was at the kitchen table with her walker next to her. On the table sat a large cardboard box.

"How did you get this in here?" Ella scolded.

"Mr. UPS," said her mother. She corralled anyone that rang the doorbell, using the intercom speaker that she carried in an apron pocket along with her cigarettes. The utility man, Jehovah's Witnesses, people collecting signatures for petitions were all invited in. "Come in and rest a minute," she told them. Ella worried that some day her mother would urge the wrong person inside: a thief or worse. Already the Jehovah's Witnesses visited daily.

"Open it!"

"Hold on," said Ella, although she, too, was excited. She put the ice cream in the freezer and the milk in the fridge. Then she stood at the table and sliced open the packing tape with a kitchen knife.

Encased in bubble wrap and Styrofoam was a globe. Ella had ordered it from the shopping channel. "Thirteen-inch Gemstone Table Globe" the label said. The stand was brass, the oceans were lapis lazuli, and each major country was laminated in a different semiprecious stone: Brazil was rose quartz, the U.S. aventurine.

As Ella and her mother ate, they studied the globe.

Pointing to a glittering India, Ella said, "This is where Dr. Patel was born and raised."

"He seems like a nice man," said her mother. "Handsome?"

"He's old," Ella said. "His hair is white."

Her mother liked pretending to give Ella permission to find herself a boyfriend.

"There's a gorgeous guy in the rehab," said Ella.


"They put him out in the patio in the mornings, with a bib on."

"He doesn't sound very promising," said her mother with a laugh.

It had never been decided that Ella would care for her mother. It was just something that had happened. Ella and her roommates had lost the lease on their apartment, and Ella had moved back home, temporarily. Then her mother had had the car accident. Sometimes Ella resented the responsibility. She worked all day feeding, bathing, and dressing, then she came home and did the same thing. But she was comfortable at home; she liked her mother. She didn't pay rent and for the first time in her life had accumulated savings. But the longer she worked at the hospital, the less interested she was in going out. After a shift she was exhausted. And on the weekends, when she'd tried to explain to her friends what it was like to care for the babies, they became restless and changed the subject. Last Saturday, after a few too many beers, she'd told them that Marcus called the ward "the vegetable garden."

"You're making this up," Ben had said.

Ashley had tried to understand. "It's like that TV show. ER. They make sick jokes to protect themselves."

Ben rubbed his round face with his beer bottle. "I'm never having kids," he said. Then he began to laugh. "You are totally twisted, Ella."

Blurred by the alcohol, Ella gazed at her friends morosely. They seemed as flat as cardboard.

"Sorry," she said. "I'm tired." But what she was sorriest about was that she had betrayed the ward to people too clueless to understand.

After dinner, Ella placed the globe on the mantel next to the family photos. Its surface was smooth and cold in her hands, though not as cold or as smooth as the crystal ball that she had bought last month, which nestled in a short wooden stand on the coffee table.

At eight, her mother turned on the television and they watched "Girlicious," clicking their tongues at the catty behavior. The nicest girls were always the first to be eliminated from the competition. Natalie, super mean and narcissistic, was fighting with one of the other contestants. Ella feared that she would win. It was wrong that the cruel rose to the top, as if viciousness were cream—enough to make Ella want to hide in a cave and never leave.

When the show was over, Ella helped her mother change into her nightgown and climb into bed.

"Good night, treasure," said her mother.


The next day, Samuel's parents appeared promptly at 11, the earliest the hospital allowed visitors, bringing with them a large canvas bag.

Ella was in the middle of giving Mackenzie a bath. She watched out of the corner of her eye as Samuel's father lifted him out of the crib and put him in his mother's lap. He moved slowly and deliberately, a coiled tension in his movements, his muscled arms taut under the black tattoos. Out of the bag he pulled a baby bottle, removing the plastic top that covered the rubber nipple.

Ella's heart began to hammer. That was a major rule broken right there. No outside food allowed. Staff needed to know exactly what went into the patients. They kept track down to the nearest milligram. Besides, what if they were feeding him something strange—goat's milk or some herbal concoction?

She couldn't leave Mackenzie unattended. She didn't want to shout across the room at them. Instead, she pressed the red button on the pager phone next to the sink.

Anne took forever to appear.

While the mother tickled Samuel's unresponsive lips with the nipple, the father glared at Ella, daring her to say something. Ella turned away, returning her attention to Mackenzie's bath. Mackenzie's black hair was pasted to her skull. Ella rinsed her chest and belly, then lifted her legs to rinse her bottom. Mackenzie neither liked nor disliked her bath. She was as imperturbable as stone.

Anne's voice was loud and firm. "Ella should have told you. No outside food. It's completely against hospital regulations."

"We don't want him tube fed," said the father.

"Then ask Ella to prepare you a bottle."

Hadn't Anne said "Absolutely not" only yesterday?

Ella's hands trembled as she toweled Mackenzie dry. She decided to act as if she hadn't heard a thing. She put a diaper on Mackenzie and swaddled her snugly.

Anne came up behind Ella as she was settling Mackenzie into the crib.

"I've requested a bottle from supply," she said.

Ella turned around. "But what if he doesn't suck?" she said.

Anne leaned forward and whispered, "The night staff can run an IV. Some people aren't worth arguing with."

"OK," said Ella.

It took an hour for the bottle to arrive. The mother tickled Samuel's lips and, astonishingly, he began to suck. Not greedily or avidly as a healthy baby would. Nevertheless, his mouth moved and he swallowed. Ella was stunned.

The mother wept and smiled. "There you go, Sammy," the father crooned. Both parents were ecstatic—pleased that their instincts were correct, that their baby was behaving normally. Only Anne seemed unmoved, leaving the ward to input her charts at the nurse's station.

Ella's heart beat excitedly as she finished Jamal's tube feeding and returned him to his crib. If she brought Jamal a bottle, would he suck? She didn't dare ask Anne, who would probably sneer and say that fiddling with a bottle took too long and that he wouldn't get enough nourishment, making it a complete waste of time.

The father, his face bright, began roaming the ward, peering into the cribs. Ella felt his heat as he came up behind her; suddenly her movements turned clumsy. She feared that Dorie would resist the tube, that he would make a cutting remark.

"How long has she been here?" he asked.

"I think about a year."


"It's wonderful that Samuel is sucking," she said.

"He's awesome," said the father. He moved closer, briefly touching Dorie's blonde ringlets. "They all are." Then he walked away. Perhaps he thought she should try a bottle with Dorie. Unfortunately, there was no time for experimentation here. If Dorie didn't suck, and likely she would not, then she would have to be tube fed after all, and the other babies would suffer for the delay.

Ella had the next day off. She did laundry and bought groceries and took her mother to the doctor. In the evening after putting her mother to bed, Ella left the house and walked two blocks to a Starbucks, which was nearly empty. She ordered a caramel Frappuccino and drank it sitting in a soft leather armchair. One minute the cafe was quiet, the next it was overrun with a group of students chattering like monkeys. Ella studied them, feeling invisible. Not a single man glanced her way. She forced herself to smile, then realized how strange that was, sitting alone, smiling for no apparent reason. She got up and left.

When she returned to work, Ella had a surprise: Samuel was gone. From Ruby, the aide whose shift overlapped hers, Ella learned that his parents had removed him from the hospital. There had been a huge dustup. Shouting, accusations, the parents saying he was not being properly cared for.

Ella was glad that she had not been around for this, and relieved, too, that the thin, stylish parents would not be coming back.

As she began inserting the tube for Jamal's feeding, Ella quietly apologized. Jamal accepted it without a struggle. That in itself was alarming. More alarming was his general listlessness. His skin had a waxy look, a yellowish tinge. As Ella held him close, she noticed that his sugary scent was gone, replaced by an odor with sinister undertones.

"Jamal doesn't look good," she said to Anne.

"I know."

"Shouldn't we let his parents know?"

"It's handled," said Anne. "They're coming tonight. Don't worry. This was bound to happen." She gave Ella a warning look.

After that, Ella found it difficult to concentrate. She bathed Mackenzie and diapered her, then went back to Jamal's crib to check on him, although Connor was next on the list. Jamal's parents were immigrants from Ethiopia. They didn't visit as frequently as many of the other parents. Ella supposed this was because they worked long hours trying to make ends meet; they had other children at home as well.

Jamal might die like that, alone, before his parents had a chance to say good-bye, with nothing to touch him but the plastic diaper and the bleached sheets. Only an evil person deserved that, a murderer perhaps. She laid a hand on his head, the hair so soft.

At lunchtime, sitting alone in the hospital cafeteria, she hatched the bare outlines of a plan.

Back in the ward, she rushed through her afternoon feedings, and waited for Anne to finish her shift. Violet appeared for the swing shift as she was swaddling Jamal.

"I've been told to take Jamal to Dr. Patel for some tests," Ella told her.

"Whatever," said Violet, who was only here until she could get a transfer.

Ella swaddled Jamal in an extra flannel blanket, then, holding him firmly, went out the sliding glass door into the little patio. She just wanted him to feel the sun on his head, to breathe fresh air for once in his life. But as she turned to close the door behind her, she heard Dr. Patel's voice in the hallway. She panicked and walked straight across the patio into the brain injury unit in order to avoid him. A man in a wheelchair gazed at her openmouthed. Ella walked faster.

She took an unfamiliar long green hallway, and, following the exit arrow, another that terminated in a door to the parking lot. As soon as she opened the door, Jamal's hospital bracelet set the alarm ringing, so she was forced to keep walking, to pretend nothing was wrong or out of the ordinary.

"Everything will be fine," she promised him. She held him close as she negotiated her way across the parking lot and through a loose hedge onto the sidewalk.

There was an elementary school down the street, closed for the summer. It was late afternoon and the sun reflected off the poles of the tire swings. Toward evening, the fog would spill back over the streets; for now, the sky was cloudless. As Ella took a seat by the swings, Jamal twitched inside the blankets.

He might be too hot. Ella unwrapped him slightly and he convulsed. If she hadn't cared for him for months, she might have been alarmed.

"This is air," she told him. "This is sun."

Jamal's wrinkled little face remained impassive. She didn't expect him to respond, though she prayed for it: a look of puzzlement, perhaps, or contentment: an indication that he had some awareness of the fierce warmth of the sun, the dazzling brightness of the afternoon.

She heard women's voices and children shrieking happily, feet running. Two boys appeared from around a corner of the building, racing for the tire swing. The mothers appeared shortly after, one pushing a curly-haired toddler in a stroller.

One of the women nodded a greeting to Ella, her eyes narrowing curiously. The other woman was busy talking, too engaged in her own narrative to take much notice of what her friend found strange: a woman wearing hospital scrubs holding a swaddled infant.

What appeared wrong, Ella realized, as she watched the mother lifting the toddler out of the stroller, was that she had no diaper bag. And of course they'd never seen her here before.

Jamal's convulsions stopped and he went limp. Panic seized Ella again. She pressed her fingers to the side of his neck, feeling for the pulse. Which was there. She sighed.

"How old?" It was the mother who'd been doing all the talking.

"Six months," said Ella.

The woman sat down next to her. Ella noticed that she was pregnant.

The other mother was helping the toddler onto the tire swing. The older boys clambered up the play structure.

"Pretty baby," the woman said.

"Thank you," said Ella.

Jamal's eyes locked; he was staring straight at the sun. Ella covered his eyes hastily. He would burn his retinas. Although he was blind anyhow.

"Is he yours?" the woman asked her.

"He's severely brain damaged," said Ella. "I've been told he needs to feel the sun."

"My god, I'm so sorry," said the woman, looking shocked. Her hand went to her belly and cupped it protectively.

The top of Jamal's head was damp, his hair wilted into thin streaks across his skull.

The mother with the toddler walked over. "May we see?"

Ella unwrapped Jamal a little, feeling oddly proud, as though she were unveiling her own child.

"Maddie look," said the mother. "A baby."

"Baby," said Maddie. Her fat fist grasped the blanket. The mother peeled her fingers off. "Don't," she said sternly. "Gentle." Maddie backed away and put her fingers in her mouth.

"Nice to meet you," said Ella to the toddler. "She's a pretty girl, isn't she, Jamal?"

Jamal's beautiful eyes were glazed. Ella could see that his pupils were different sizes, one large, one small, and that the brown irises had flecks of amber. She touched his immobile lips with a finger.

One of the older boys appeared, snatched goldfish crackers out of a plastic bag, and glanced carelessly at Jamal. "What's wrong with him?"

"Stop that," said his mother sharply.

Ella pressed her fingers against the tiny neck again. There was still the light throb of a heartbeat. She smoothed Jamal's hair.

Two police cars zipped past, their lights flashing, and pulled into the hospital parking lot. If they had come because of Jamal, she supposed this meant she was fired.

Ella stood. "I should be going," she said to the mothers.

"Good luck," said one. The other eyed her suspiciously, cupping her pregnant belly as though guarding it from thieves.

Ella forced herself to walk slowly, toward the hospital, her clogs clopping on the asphalt, Jamal's head warm in the crook of her arm.v


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