I.

The heartburn came on behind Ross’s breastbone at ten past six, in the middle of Dee's pontoon story, and there were bubbles in it.

He thumbed a Tums off the roll in his coat pocket and chewed it with his coffee. Coffee on no sleep at the back end of a night shift. He gave himself the answer he gave everybody. Heartburn does not have bubbles in it.

"That's a crime against both," Sam said. "The tablet and the coffee."

"It's a system," Ross said.

"It's a cry for help."

Dee primed a line at the counter. A bubble hung in the tubing under the port and would not move with the fluid. She flicked the plastic with her middle finger. "Come on."

"Don't kill anybody before lunch," Sam said.

"He's ninety-one," Dee said. "He'd thank me."

"That's what scares me about you," Ross said.

Dee flicked it twice more. The bubble broke loose, ran down the line and out the end into the sink. She hung the bag on the pole, wiped her hands down her scrubs, and went to fetch the old man.

Ross pressed his knuckles into his chest. The burn sat where it always did, coal the size of a thumbnail. This morning it had a texture. Champagne standing in a warm glass.

The radio on the file cabinet had been going since six.

“A few storms bubbling up west of Salina this hour. Pressure's dropping ahead of them, and it's dropping quick. It'll come back up behind the front, and that'll be that. We're keeping an eye on it.

Dee reached over the file cabinet and turned it down.

In the quiet, Ross's hand was still on his chest, and Sam was looking at it.

"Describe it," she said. "For science."

"Reflux."

"Describe it the way a patient would."

Ross thought about it longer than the question deserved. "Fizzy," he said. "Effervescent."

"Effervescent," Sam said. "God. You sound like Carol Deitz."

Dee came back through with a chart under her arm. "Who's Carol Deitz?"

"Don't you remember? The elderly lady. Said she was full of bubbles."

"No."

"Yes, you do."

Dee was still waiting.

"Nobody," Ross said. "Room two's ready."

Dee shook two tablets off her own roll and ate them dry. "I've had this since I was a kid. Every spring, soon as the weather turned. My mom's the same. My sister's worse."

By nine, six people were waiting, and the man in the corner had his phone up, showing everybody a grain elevator in Abilene with its top missing. Ross went to his locker for a clean shirt. The revolver rested on the shelf where it had been since somebody came through the back window last spring for the fentanyl box. He shoved it aside, took the shirt, and shut the door.

II.

At one o'clock something pushed under the skin of his left wrist.

Ross stopped in the hall with the chart still open. It was the size of a green pea, and it slid out from under his thumb, went up the inside of his forearm, and stopped at the elbow.

He pressed it there, against the bone.

It came apart. Two of them now, smaller, and one of them went up. He buttoned his sleeve and did a school physical. Somewhere, halfway up his forearm, one of them stopped moving, and he stood with his hand on a ten-year-old's back and waited for it to start again.

It started again.

Then he found Sam in exam three, shut the door, and took his shirt off.

"Tell me what you feel."

Sam put two fingers above his collarbone and pressed, and the skin crackled under them.

She stopped. She did it again, further down. It crackled again.

"Rice krispies," she said.

"Yes."

"Both sides." She pressed under his jaw, and it crackled there too, and she took her hand back and looked at it. "Have you been sick? Vomiting?"

"No."

"Any chest trauma. Any at all. Did you fall?"

"No."

"Then I want a film."

"Later," Ross said, and put his shirt back on.

The lights browned out and came back. Dee's feet went past the door at a run.

The sirens started at 3:56.

Ross came out of exam three with his shirt half buttoned and crossed the hall toward the noise. At the desk Dee had the scanner turned all the way up and both arms full of coats off the rack.

"It's on the ground at Turner," she said. "It's coming up the river."

Through the front glass the sky over the lot had gone green. There were six patients in the waiting room, three staff in the building, and no other way of doing this than walking them across the lot.

Ross got the wheelchair out from behind the desk, put the old man in it and pushed him to the door himself. Sam ran ahead across the lot to open the cellar doors. Dee went next with the mother, holding a coat over the twins' heads against the hail, and she looked back once from halfway across.

"Ross."

"I'm right behind you."

She took them across.

Ross pushed the chair out into the wind, and Sam took the handles off him at the step. Ross went back inside, locked the staff toilet door, and was sick until there was nothing left. The pain ran up his ribs one at a time and stood on his breastbone and jumped.

He ran the tap, rinsed his mouth, put his coat on. The keys he saved for last. He took them out and held them in his fist where she would see them.

Sam was still holding the door with her shoulder. The wind had her hair across her face.

"Go," Ross said. "Fifteen minutes and I'm in the basement with a beer."

"Text me when you're in."

"Bar the door."

"It's a church, Ross."

She let go of the door.

The lot was empty in eleven seconds. Forty feet to the truck. Keys ready. No hail yet.

He thought about the cellar. Eleven people on a concrete floor for two hours with nothing to do but look at him.

Then he thought about Carol Deitz.

March. The barn. A deputy he played cards with told him they found her in two rooms.

Ross had gone home that night and eaten his dinner.

This morning, at that desk, he had called her nobody.

He put the keys back in his pocket, headed down the back hall to the sleep room, and lay down on the cot in the dark.

III.

The dark came all at once. Somewhere out past the lot a transformer went with a bang. The hum that had been in the walls all day stopped, and the quiet after it was the loudest thing in the building.

Ross lay on his back on the cot and put his palm flat on his stomach. They were everywhere now. Moving together, in the same direction. Up. He put the phone on for the light. It said 4:31 and 62 percent, and it lit up six of them standing under the skin.

The pressure was in his ears, the way it is in a plane going up. He worked his jaw, and it did not clear.

He had known since one o'clock. He held his arm up and counted a slow ten. They got bigger. Not by much. By enough.

Carol Deitz died on a Thursday. He had driven to work that morning through the front of a storm with the wipers going and his ears blocked the whole way.

He put both hands over his face and held them there.

He stayed like that for a while. Out past the lot, the hail was on the roof, then it stopped being hail and started being rain, and he listened to it change.

Then he took them down. He was a doctor, and there was a diagnosis in front of him, so he put the light back on it.

Run it, then.

Gas in the tissue. No wound. No infection. No tear. He went down the list the way he would have done for anybody. Decompression. He had not been in any water. Trauma. None.

Nothing on the list fit.

That was what he had told her. Nothing on the list, Carol, so there's nothing there. He had said it with his fingers already on the doorknob.

Up close, the skin had gone white and shiny at the top of each one, and the hairs on his forearm were pushed apart where it had stretched.

He put the nail of his thumb on the biggest one and pressed. It burst under the nail. The skin came away from the hole and hung there in a wet flap, and the fluid came out of him warm, more of it than a thing that size should hold.

Something let go under his breastbone, and for one breath there was nothing there at all. He got up off the cot, went out to the sink in the hall and held the phone up to the mirror.

The skin of his chest was moving like boiling milk.

There was a line of them down his throat, evenly spaced, and when he swallowed they swallowed half a second after him.

The scale was on the floor by the supply shelf. At his physical in October he weighed 181 pounds. He stood on it in the dark, and the needle came up and settled at 166.

He stepped off. He stepped back on.

165.

He wanted his mother. I want my mother, he thought. That was it. That was the whole of what was in his head. She was in a home in Topeka and had not heard his voice since the winter, and he wanted her anyway.

The need to go had been there since four. In the staff bathroom, he set the phone on the cistern with the light pointing up at the ceiling.

There were nine of them along the shaft, the same as the ones on his arm. Evenly spaced, the skin white at the top. There was one sitting in the opening, and it was the biggest of them, and it was corking it.

He tried, and nothing came.

He reached for it and could not.

His bladder let go before he was ready, and there was nothing he could do to stop it.

The one in the opening blew out ahead of the stream. It made the sound a cork makes and left a hole.

The urine came through the hole and through the opening at the same time, in two lines. They crossed in the air, missed the bowl, and hit the wall, the floor, his own legs.

Ross put his forearm in his mouth and bit down.

Four more of them burst under his teeth.

He was not going to survive this. And she went through it on her own, he thought, with my voice in her head telling her there was nothing there.

He took the paper towels from under the sink, got down on the floor, cleaned the wall, the tiles and the front of the pan. He put the towels in the bin, washed his hands with the pink soap and dried them on his coat.

Then he took the phone off the cistern and called Sam.

5:12.

She picked up on the second ring and the cellar came in behind her, all low voices and one child crying and not stopping.

"You in?" she said.

"Yeah."

"Basement?"

"Yeah."

The child was still going behind her. A woman said it was her stomach, that it started when they came down.

"You sound terrible."

"I'm lying down."

"Good. Stay down. It's going to be a couple hours." A gap, and her voice went away from the phone and came back. "Ross, that thing this afternoon. The crackling. I've been thinking about it, and I don't like it. First thing tomorrow, you and me, we're driving to Truman."

"Okay."

"You're not going to argue."

"No."

That got her. He listened to her not saying anything.

"Sam. Do me a favour."

"What?"

"Carol Deitz. Pull her chart when you get in."

"Why?"

"Pull it and read what I wrote."

"Ross."

"And Sam, put two fingers under your own collarbone. Press."

"What?"

"Just do it. Now, while I'm—"

The line went. The phone said no service and 58 percent.

IV.

By six there was one on his eye.

Two fingers held the lid open. It sat on the white, off to the side, a clear dome with a red vessel running beneath it, going nowhere, and then it moved. A quarter of an inch toward the iris, and it stopped.

Ross let the lid go, covered his eye, and did not move.

Thirty years of putting a light in other people's eyes and telling them they were fine, and there was nobody to do it for him.

He said his own name out loud. Two tones came out at once, and the second one whistled.

His teeth had come loose. All of them. He closed his mouth, and his teeth met on the left before they met on the right. He ran his tongue along the gum, and it moved away from the teeth, all the way to the root.

There was another one under his left thumbnail. It had come up in the corner, the nail was standing off the bed, and the flesh under it was the colour of a raw chicken breast left out overnight.

He put the edge of the nail against the metal frame of the cot and pushed down.

It came away almost without a sound.

He turned the thumb over and held the phone close. The nail bed was wet and pink. It had a dome in the middle.

Then, it moved.

He shut his fist on it. He sat down on the cot, held the fist in his other palm, pressed it against his sternum and stayed like that. The blood came down his wrist and went into his sleeve, and after a while it got to his elbow, and he let it.

Colorado. That was all it had ever been. A house at altitude, a dog, a woman who ran the pharmacy counter at the Walgreens on Southwest Boulevard, whom he had said good morning to four times a week for eleven years and nothing else, and a plan to say it in the spring when he had less on. Two hundred and sixty thousand dollars. A truck. A house with nobody in it. Thirty years of telling himself he had time.

The needles were in the second drawer down.

He got one out, took the cap off with his remaining teeth, and put his fingers on his chest, counting down the ribs, and he had done it to a hundred people and never once thought about what it was.

It hurt more than anything had ever hurt him.

It went in through the muscle and grated. He made a noise he had never made before, and then it was through, and the air came out of him in one long hiss and did not stop.

He sat down on the floor with the needle standing out of his chest, his back against the drawers, and for a minute he was a man sitting on a floor and nothing more than that.

Then it filled again, and he got out another one.

He was still doing it at half past seven. There were needles all down both sides of his chest, and he had stopped being able to hold them straight. The last one went in and did nothing at all.

The box was empty.

Nothing else in the clinic was going to help him. But there was a filing cabinet behind the desk, and there was somebody it could still help.

She was still in the drawer. Nobody had taken her out, because nobody had ever needed to.

The file opened on the counter, the phone turned so the page came up out of the dark, and there it was, halfway down, in his own writing.

“Patient reports effervescent sensation. Anxiety likely. Reassured, discharged.

Eight words.

Room two. Her handbag on her knees.

"It's bubbles, doctor. They come up at night. I can hear them."

Twice. The second time slower, in case he had not heard her.

The stethoscope had gone on her sternum and stayed there for eight seconds. January. February. Nothing written at all.

He got a blank intake form off the stack, clipped it to a board, and wrote in caps with the pen on the chain.

CHIEF COMPLAINT. BUBBLES.

HISTORY. ONSET 0610. HEARTBURN. GAS UNDER THE SKIN BY 1300.

RISING AS THE BAROMETER FALLS. WEIGHT 181 OCTOBER. 165 TONIGHT.

EXAM. CREPITUS BOTH SIDES. BLISTERING ARMS, CHEST, THROAT, GENITALS.

ONE ON THE SCLERA OF THE RIGHT EYE.

NEEDLE DECOMPRESSION x11. NO SUSTAINED RELIEF.

REFILL APPROX 20 MIN.

IMPRESSION. I DO NOT KNOW WHAT THIS IS.

SEE C. DEITZ. SAME COMPLAINT. I MISSED IT.

PLAN. ANYONE WITH THE HEARTBURN IS A CASE UNTIL PROVEN OTHERWISE.

GET THEM OUT AHEAD OF THE NEXT ONE.

DO NOT WAIT FOR SOMEBODY TO TELL YOU I WAS RIGHT.

Ross Halloran

Signing it took both hands. The pen pierced the paper on the last letter of his name.

He put the board on the crash cart and pushed the cart into the middle of the hall, so it would be the first thing anybody hit in the dark.

In the glass of the front door there was a man he did not know.

The face had come up in domes from the jaw to the hairline, and there were domes standing on the domes, small ones filling the spaces between, no flat skin left anywhere on it.

Under the chin they joined into one sac that hung down onto his collar, swinging as he turned his head, and the lot outside shone through it, and there was a shape inside it stirring.

He reached out to touch the glass and touched himself instead. He tried to say something to his reflection and no air came up to say it with.

Out past the lot, the water was running off the roof into the drains, and there was nothing else moving.

The locker opened by feel.

It was cold. He turned the cylinder once, out of habit, and it clicked round the way it always had.

He sat down on the cot with it across his knees.

Not the cellar. Eleven people down there who had believed him when he said he was fine.

He was frightened, and nobody was there to see it, so he let himself be.

Not for the pain. That would end on its own, one way or the other, before the hour was out.

So there would be one room. So, Sam would not be picking him out of a cellar full of people who trusted him to get them there. So, there would be enough of him left in one place for his mother to bury.

He thought about the dog he never got.

He thought about the woman at a pharmacy counter he had said good morning to for eleven years.

He thought about the second time Carol told him. How she'd said it slower, looking right at him, like he was the one person left who might believe her.

He put the muzzle to his temple.

He pulled.

V.

Dee let herself in at ten of seven. The fridge was supposed to be checked after any outage over four hours, and she was the one who always remembered, so she came in through the front with the sun already up and the power humming again like nothing had happened.

The fridge read 38 degrees. She initialed the sheet and went to find Ross, because he'd want to know before anybody else did.

The smell reached her before the hallway did.

The sleep room door was open.

Dee had hold of the frame before she knew why.

It was on the ceiling. Not the wall, the ceiling, all the way to the light fixture and dried there in strings.

The cot was on its side with its legs folded under it.

Something small and white lodged in the ceiling tile, and it took her a second to understand it was a tooth. On the pillow there was a blister the size of a grape sitting in the middle of everything without a mark on it.

Dee did not go in.

"Ross," she said.

Nobody answered, and there was no one in the room to answer, and she looked down at the floor because she had to look somewhere. Then she was sick into the bin, gripping the rim, and when she was done she stood back up and dialed.

"Wyandotte County, what's the address of your emergency?"

"Argentine Family Health, on Metropolitan. It's Dr. Ross. I need somebody out here."

"Is the patient breathing?"

"No. There's no."

"Ma'am, are you able to get to the patient?"

"There isn't a patient," Dee said. "I need somebody to come, and I don't know what to tell you."

The dispatcher was still talking, units and minutes. Dee's hip caught the crash cart. The board came off it, and she had hold of it before she knew she'd caught it.

She read it standing there with the phone against her shoulder.

She got as far as the word HEARTBURN.

The burn behind her breastbone had been there since the weather turned. She had never once thought about it. She thumbed a Tums off the roll in her scrub pocket and chewed it.

"Ma'am? Are you still with me?"

There was something under her tongue. It was small and hard, and it slid when she pushed it.

Out in the lot, a car turned in fast and stopped crooked across two spaces. Sam, an hour early, came to drive him to Truman.