Male rain, for weeks. The kind that boils furiously across the horizon, barreling down the mesa and covering the sky with angry, rolling, blue-black clouds; the kind that gives you little warning before the sun disappears and the rain attacks you. Violently. Leaving the sand injured in little pockmarks and all of any altitude above it flecked with red and brown patterns of explosions.

And then, that afternoon, female rain. For the first time, really, this year. A gradual darkening of the sky, a lazy progression from light and warmth to a world in shades of blue and grey, the first tentative drops, their fall from grace announcing the end of the monsoon season, and the arrival of autumn in the high desert.

Nights that were cool are now cold. Plants burnt by the heat of the summer are now green and flowering, disconnected from the inner seasons followed absolutely by their sisters in phylum and family.

Darkness shrouding the sandstone until nearly the end of the shift, as the day nurses emerge from their cars with travel mugs brimming with hot coffee, the night nurses quietly packing cold empty mugs into oversize bags, the equivalent toolbox: stethoscope, calculator, a dozen black pens, a few red ones, an illicit blue one, sharpies more precious than gold, a few iodine prep pads, miniature penlight with pupil size printed in millimetres on the side, the ACLS guidelines for emergency and traumatic care, pharmacy pages dogeared for reference.

The night nurses step out into the weak dawn, smell the air, realize that everything has changed, and suddenly the preceeding twelve hours make sense, and they realize they will be able to sleep after all.

The arrival of autumn changed them all.

He sat in the back room, secluded from the rest of the patients, two security guards posted outside the door as he sang bits of songs, shouted expletives and nonsense words at irrational intervals, attempted to manipulate the nurses into giving him bits of string to play with now that his shoelaces had been taken away. He slipped past the guards and locked himself in the bathroom to vomit for ten minutes. And then unlocked the door and walked out, smiling.

His mother sat at the other end of the ER, deep in conference with the doctor and, via a phone line to Tucson, the lead clinical nurse for the inpatient psychiatric ward.

“When did he threaten to kill himself?”
“This morning. He woke us up screaming.”
“When did he threaten to kill you and his dad?”
“Five minutes after.”

He is twelve years old.

The nurse sighs, says, god, he’s what my son might have been.

At home, she pulls up her sleeves to wash her hands after petting the dog; it showed up a week ago and sleeps curled up in the dirt under the eaves, and eats slowly and cautiously when she feeds it and puts its ears back in quiet joy when she scratches them. On her left arm, forgotten in the long morning of administrative work, are the memories of moments in black ink.

380 mg

Of ceftriaxone, rocephin, 50 mg per kilogram, given intravenously to an infant who can’t breathe. She can hear it from across the room at the desk, the air hunger, the desperate, high-pitched gasps made using overtaxed intercostal muscles to force carbon dioxide and oxygen to trade places across a gulf of fluid and pus in the alveoli.

Diluted in 100 cc of saline, after the infusion and a nebulizer treatment, the child is choking to breathe. The fluid is thinner, loosened from the walls of the bronchii by atrovent and albuterol and 5 litres of high pressure oxygen, but there’s no muscle strength left to clear it. Her lungs gurgle and squeak and crackle in the void in which the nurse wants desperately to hear nothing but a gentle, repetitive hush.

god, 100 cc was too much. I should have run it in in 50

The saturation monitor is taped to her foot. She and the doctor stare at it for what seems like seconds, but was fifteen minutes of agonizing clinical decisions.

83%. “OK, we’ll get her admitted —”
92% Silence. Staring at the wildly fluxuating number in red.
94% “She’s not making this easy.”

There’s no pattern or repetition. Nature has found a mode in which to randomize completely.

As she sends her out the door, curled in her mother’s arms, the nurse can envision her blue and limp I should have run it in in 50 and gasps for air herself, finding no comfort in it.


Typed into the dispensation unit to obtain a suture kit, two sets of sutures, 4×4 pads, iodine, sterile gloves (size 7.5), a fine 24 gauge needle, lidocaine with epinephrine, all of which is brought to the fourth bed in which she lies, her right eye swollen and her scalp rent in a star pattern from the golf club her brother wielded against her after the alcohol overwhelmed them and erased the blood ties.

She privately pontificates that alcohol is the drug of choice because it releases the anger, the desperate, soul-deep, overwhelming, screaming anger of 400 years of genocide, discrimination, hatred, seclusion, patronization, misunderstanding, and now, at the end point, breathless poverty enforced by boundary lines painted by people of another color. Who know no boundaries themselves.

She posits that were she her, on the bed, she, too, would drink, a desperate attempt to clear her throat before the anger rose up and bitterly choked her to death.

buy sweater

Security walked through the back door, where the desperately ill come staggering in, or lying on cots, and says, do you have a blanket? And behind him is a thin person, not a child, not filled out like an adult, asexual with bowl cut hair and baggy clothes, cold to touch, the thermometer placed accurately under the tongue unable to register a body temperature.

I found…him….I think it’s a him….asleep in the parking lot.

In a car?

No. On the asphalt.

How long had he been there?

I don’t know. I did my last walkabout three hours ago…but maybe I missed him.

He is wrapped in heated blankets from the warmer, tucked under his feet, behind his calves, around his head like a turban and across the back of his neck.

I’m fucking warm….he mutters before he falls asleep, unconscious in an alcoholic stupor. She turns off the lights, pulls the curtain, and lets him sleep.

She is freezing after this, as though to care for him she has pulled the cold of the night air and damp asphalt into her own bones. Buy a sweater, acrylic, easily washable if something gets on it.

With a cold empty mug packed in her bag and her timecard clocked out, she walks slowly out the back door, a luxury often not granted to those who come in. And stares at the thin autumn sun on the mesa and breathes in the cold air and rubs her hands together and thinks of the north for a few moments, and her eyes sting and she blames the gently blowing sand.

And thinks, I must not forget how to live, in this moment and all that follow.

Autumn changes us all.

And up on Navajo Mountain, grandmother walks, slowly, limping, her battle scars from the polio war still crippling her nearly a century later, out of her government-issued trailer, away from it and towards the north. She wonders if her family would have to remove the north wall of the trailer if she did not take this walk, and she is not sure, but doesn’t want them to have to go through the trouble.

Pain ignored, she walks down a familiar path to the juniper tree, and sits with her feet facing east to greet the dawn. She can’t run anymore, so sitting will have to do. She stares at the thin autumn sun on the mesa and breathes in the cold air and slowly folds her hands in her lap and closes her eyes. She thinks of her mother and father, of boarding school and mother gone to smallpox when she ran away and came home, too late. She thinks of her husband and their marriage in the hogan when she was sixteen, and knocking out the north wall on her own in terrible, agonizing grief when he fell asleep in her arms sixty years later, twenty years ago, and never woke up again.

And she hears, far down the path she walked on, the high-pitched yell of a great-grandchild, and she thinks, I must not forget how I lived, in this moment and all that came before. And that makes her smile, and she exhales all that is left in her.

And she can run again.

She does not come through the back door.

Autumn changes us all.