“The Children’s Hospital brings the great promise of Gob’s Grief to fruition; it probes the twined natures of death, grief, and sin with a rare combination of insight, longing, and oracular authority, all tempered by a sense of humor so black it burns. I suspect Chris Adrian will prove to be our culture’s recording angel, our demon brother; and he is certainly one of my favorite authors writing today.” —Emily Barton, author of Brookland

“[Adrian] is a writer of prodigious talent who holds your heart in his hands. . . . And despite or because of his unlikely worldview, he is irresistible. He sails into the inexplicable, seeking meaning; and the reader, gripped by curiosity and admiration, scrambles on board. Adrian’s prose here is writing at its best—medical magical realism, you might call it. . . . We will be lucky as long as he continues to write.” —The Boston Globe

“It’s hard to read a book like Chris Adrian’s new novel, The Children’s Hospital, with its dead under seven miles of water, and not think about Katrina and tsunamis, and then backward and landward to September 11 and other traumas that, if personal, also demanded some kind of collective notice.” —The Village Voice

“Elegant and enormously wondrous . . . Adrian, poetically and with exacting precision, has crafted a prophetic, difficult novel of compassion and healing, but with a keen eye fixed on the damning reach of divine wrath. . . . [He] attempts a near-impossible summit, and delivers a devastating, transformative work that is certain to burn in the minds of readers long after the final page’s end of the end of the world.” —Ian Chipman, Booklist

“To read Chris Adrian is to take part in the exciting process of watching a talented and original writer gain mastery of his powerful gifts.” —Myla Goldberg, The New York Times Book Review

“The Children’s Hospital has echoes of a children’s book, as it takes on questions of good and evil with an earnestness rare in adult fiction, while remaining seriously fun to read; the funky everyday cohabits naturally with the miraculous.” —Shelley Jackson, Los Angeles Times

“This humanistic novel is a heartfelt portrayal of indefatigable spirit in the face of utter helplessness and ruin. . . . Adrian proves to be a suitable successor to the mythological wherewithal of Rushdie or C. S. Lewis, and the book is a solid testament to his array of talents.” —Time Out New York

In all my years of watching I have never hated her, but I have often been bored, and if there are doodles in the margins of her book, and gaps in her story, if I have looked away from her to watch my brothers and sisters at play among the stars and missed here or there an episode of her life, if I have watched her brother, always burning bright to me, even though I knew his story, past and future, already by heart, it is because I am neither a perfect angel nor a perfect witness. I put off perfection with my mortal form, and what a relief to do it.

Never mind, for now, the quotidian discoveries of her infancy; do not look at her yet toddling after her brother, or trudging, head down, through her education. Beauty pageants and swim meets and drugs smoked or snorted under her brother’s tutelage are not the place to start; neither are the flights with her father over the Chesapeake Bay, or the nights drunk-diving into the past with her mother, or the nights she skated over the frozen river to crawl into her lover’s house and lie with him in his single bed. And look away from the funeral years; ignore the miracle her brother wrought. Consider her instead on the edge of her own greatness, separate from and grander than Calvin’s. There she is on the night of the storm, attending a birth, waiting while the rain falls and the clouds are heaping and piling in the sky and I am sighing all around her, finally. Finally!

Jemma thought that witnessing a birth ought to make a person exactly the opposite of horny. The rush of blood and fluid; the bitter odors; the screaming of a mother arrived too late for an epidural; and worst of all, the hideous dilation, the vagina that permitted the entrance of hands and arms and instruments sized and shaped more appropriately for barbeque than surgery, and disgorged the bloody cantaloupe. They should freeze you up, but they never froze her up, and sometimes, like on the night of the great storm, they put the need in her. So she found herself distracted by thoughts of Rob Dickens even at the most challenging and complicated delivery of her third-year medical student career: a gruesome baby born to a gruesome mother. The child, the expression of a jumble of chromosomal additions and deletions so unique that she was her very own syndrome, was hideous—too long and too short, too wide and too thin, with things that were not eyes where her eyes ought to have been, and a cuttlefish mouth—but she seemed sweet to Jemma, who stood over her among the white-suited pediatricians, a fellow, a resident, and an intern. Her cry was more dulcet than any Jemma had ever heard, probably because she was half dead and lacked the energy to voice a truly irritating scream. “Rub,” Jemma’s senior resident said to her, because she was only blotting at the wet baby with her towel. The mother was lovely in her flesh but seemed deformed in her soul. She shouted curses at her child while the anesthesiologist, scowling, pushed white, milky propofol into her veins, trying to shut her up. Not even her epithets and her screams cooled Jemma. Rob Dickens was not among the pediatricians in their bunny suits—one raised a laryngoscope with a flourish like a hoodlum clicking out a folding knife and then swooped in to intubate the now quiet and rather blue baby—but she knew where he was, waiting with the other students, residents, and staff for this unfortunately interesting case to arrive across the glass hall that connected the county hospital to the children’s hospital.

While she ought to have been calculating one-minute apgars for the child, she pictured Rob Dickens in his scrubs, his arms naked almost to the shoulder. When the resident asked her for the score she blushed and fumbled in her mind for the number, forgetting the categories—tone, cry, grimace, color, and what else? Not grace, not style, not symmetry, but these were what she thought of. The resident—a third-year named Natalie famous for the black cloud of acuity that hovered over her call nights—stared at Jemma coolly over her surgical mask, and Jemma remembered to count the heartbeat. She reached out to pinch the umbilicus and feel the pulse, much slower than her own, which always raced when she was mortified by the ignorance and confusion she manifested when faced with one of these student tasks. “Four,” she said at last.

“Generous,” said Natalie, and turned her attention fully to the task of bag-ventilating the infant. Despite the sedatives, the mother was still telling them to kill the baby with a knife, with a brick, with a smothering pillow. She sat up suddenly, an obscene apparition, hauling herself up by her knees, her perfect, unnatural breasts glaring over the sterile blue drape, a tongue of clotted blood lolling out of her vagina. She calmed briefly and spoke in sane, gentle tones. “Just do it now, before she gets us. It’s easy now but it won’t always be so easy.” She reached out, grabbing for the instrument tray, until two nurses pushed her back. Jemma thought of Rob, pacing with his hands folded on top of his head, like he always did when he was impatient for a particular thing to happen. She thought of his arms again. She didn’t have to close her eyes to be able to see them.

“Let’s go,” said Natalie. She jerked her head imperiously at her intern, Dr. Chandra, who had got his stethoscope caught up in the oxygen tubing and was trying to untangle it. Natalie looked back expectantly at the fellow, Emma, who gave one sharp nod to indicate her blessing. They moved out of the operating room and down the long beige halls of the county hospital. Patients, women walking in the hope of accelerating their labor, spun out of their way as the team raced along, Emma pushing the isolette, Natalie bagging, and Dr. Chandra still trying to untangle his stethoscope. Jemma, not a good hurrier, trailed after the isolette. It had been part of the reason she failed her surgery rotation, this reluctance to hustle, and even when her grade was at stake she could never bring herself to be snappy, or do that wiggling power walk on rounds, or even run full-out to a code or a trauma—if you were too fast, after all, you got there first. She ran a few steps, then slowed, then ran again. As they approached the bridge, Natalie called back to her to get the door, since Dr. Chandra had also entangled his name tag and calculator in the mess of tubing.

Jemma ran ahead to slap the giant steel button that opened the doors. They swung out leisurely, opening on the storm that flashed and raged around the glass hall. The team pushed through even before the doors were fully open. Jemma ran ahead again, meaning to slap the far button with the same authority and force with which she’d hit the near one, but she tripped, then rolled fast and heavy into the door. Natalie yelled, “Get out of the way!” Jemma hit the button and the second set of doors swung open, less leisurely than those at the other end of the hall, but not fast. She scooted on her bottom, pushed aside by the door and finally wedged against the glass wall as the isolette flew past. Lightning arched overhead and showed her a vast parking lot, empty except for a few dozen dead cars stranded in water up to their headlights.

The lightning passed, and then the glass wall showed Jemma her own haggard face. Nursery call was beginning to wear on her. They were always flying to one delivery or another, back and forth across this sky bridge at all hours of the morning, day, and night. Here in a hospital that attracted the riskiest pregnancies, the ones that ended with the expulsion of a half dead baby, there was no rest for a person afflicted with a delivery pager. Jemma rose and leaned against the glass, closing her eyes and imagining that the little creature in her high-tech bassinet was wheeling away at a thousand miles an hour, on her way to Heaven instead of a hell of needles and tubes. When the lightning flashed again in the sky she opened her eyes and saw how the rain was falling in sheets. “All pediatricians are nice,” Rob had told her two weeks before, on the evening before the rotation started. “These are going to be the best six weeks of your life.”

“What am I doing here?” she asked herself softly, not for the first time wondering what she was doing in the hospital at four in the morning, what she was doing training for a profession to which she felt no true calling, doing work she knew she could tolerate but never love. She pressed her head further into the glass, conscious of but not caring about the security camera recording her episode of self-pity. She was imagining again the other professions she might have pursued—airline pilot, horticulturist, tomb raider—when a terrible noise, a nasty, wet slap, startled her. She leaped away from the glass and saw the bird: the tremendous wind had blown a gull against the bridge. Its beady eye caught and held hers, and it opened and closed its mouth four times, thrusting out its red tongue in a gesture both exhausted-looking and suggestive, before the wind lifted it and sent it sliding over the arch of the glass to spin away into the darkness.

Jemma had lived in the city three years and never seen a storm like this. Rob had lived there all his life and judged this one pretty tame so far. They’d walked that morning from her apartment to the hospital complex, Jemma soaking her scrub pants to the knees when she waded through puddles in her rubber clogs. The hospital was just a big white lump in the rain, its lofty spirals and curling edges obscured, so it looked to Jemma like it was melting, and she wondered if they would even have found their way there if not for the giant round lights on the roof.

She turned away from the glass and kicked the big silver button to open the doors, then passed into the children’s hospital. As many times as she’d passed from the hospital behind her into the hospital before her, she was still struck by the change. The beige walls of the adult hospital were replaced by a motley of primary color, linoleum the color of bile turned to firm carpet printed with hopscotch numbers, and the path to the NICU was laid out in the tiniest footprints. Jemma followed them, thinking as she walked how they might have been left by some impossibly toddling preemie—they were as red as the bloody red feet of a twenty-four-weeker, one of those unfinished things whose skin slipped off between your fingers if you pinched too hard. She walked past the giant pictures on the walls, six-foot by four-foot photos of healthy children at play. She thought it strange to hang pictures like these in a place where sick children lived, as if to scream at them: Look what you’re missing. Closer to the unit the pictures gave way to magnified newspaper articles detailing the triumphant progress made by the hospital in saving smaller and smaller babies. One sentence, picked out in bold beneath a photo of Dr. Bump, one of the supreme neonatologists, always caught her eye: One day we’ll be able to save the ones so small you can’t even see them. Jemma raised a hand to flick him in his nose as she passed—he was famously cruel to students and had just that week made her friend Vivian cry secret, locked-in-the-bathroom tears. Jemma pressed her ID badge to a sensor by the double doors of the unit and they opened with a hiss. The hall inside was quiet, but she could see through another set of doors into the first bay, where a cluster of doctors, nurses, and technicians were gathered around a bed she knew must be the new baby’s. She strode past the nurses lounging and gossiping in the hall, making her face a mask of purpose to discourage them from challenging her, like they usually did, with “Are you lost, sweetie?” Inside the bay, she was shooed into a corner. She watched the muttering cluster of bodies around the bed until it disgorged Rob, who clutched an endotracheal tube forlornly as he sidled up next to her, touching her arm with his arm.

“I was supposed to get to do the UA catheter, but then Natalie did it. Like she needed to do another one—she’s only done a million of them. I was supposed to get to intubate after she pulled out her tube, but then they wouldn’t let me intubate a baby with a cleft palate. Chandra did it, or he tried. When he screwed it up, Emma took over. I didn’t do anything. Why am I even here?” He shook his head. “Did you know that she’s the daughter of a king?” Jemma nodded. It was common knowledge: this baby’s father was some sort of latter-day satrap, a king of the East who had fetched himself a blond, horse-toothed bride from a women’s college in New Jersey. The hospital attracted these stories. The giant-headed, cancerous, rotting offspring of the wealthy and fabulous mingled with the children whose living and lineage were common but whose diseases were so exclusive they were, if not entirely unique, limited to a select handful of sufferers. They came from all over the country and the world to put themselves at the mercy of bright minds.

“Come with me,” Jemma said. “I need you.” He watched her finger as she raised it very slowly to place it on top of her head. It was not a seductive or even graceful maneuver, but he started at it, his eyes widened, and he looked back and forth from Jemma to the baby to Jemma again. “Come on,” she said.

He lifted the ET tube toward her and shook it once, looked back again at the baby and smiled. “I don’t know,” he said.

“You said it yourself,” she said. “Why are you here?” She turned her leg out, wondering as she did it why she was presenting him with her beefy hip. It was not her best feature, and if he had ever praised it, it was only when he was drunk or utterly overcome with lust.

“Maybe we shouldn’t.”

“Maybe not,” she said, but she put her finger on her head again, and stood there a moment with her hip thrust out and her foot extended—it was the pose of a retarded ballerina, but it was all it took to get him to follow her out.

They know where we are going, and they know what we are going to do, Jemma thought as they passed by the nurses’ station. It always seemed to her that people must know, and yet she was sure that nobody did. There were stories told of promiscuous decades long past, where people fucked madly in call rooms, operating rooms, or under the beds of the comatose, but she had never heard of it happening this year, or in this new hospital, not yet even a year old. The first time had been just two weeks before, at the beginning of the rotations that had landed them in the children’s hospital with the same call schedule. He had comforted her with it when Jemma came seeking him after her first delivery, a harrowing festival of abuse where it seemed that everyone had yelled at her for her incompetence: the obstetric and pediatric residents when she fumbled and nearly dropped the slimy baby; the baby’s mother, understandably cranky but too shrill, really, for any occasion save her own stabbing death; and even the baby himself, who parted his blue lips to caw at her, and who shat tarry meconium down her shirt. She cleaned up in Rob’s call room and he met her with a towel when she came out of the shower, rubbing her beyond dry. They considered, before formally beginning it, that they should not, and before continuing and finishing had a brief conversation in which they decided that they should not continue, let alone finish. That night, and again on their second and third call nights, Jemma had said, “We had better not ever do this again,” and he had said, “Not here, anyway.”

But it always seemed like such a good idea when they did it, and it never took much more than their prearranged signal—the single finger placed on top of the head—to get him to agree. And it hardly seemed so bad, even after they finished and lay panting against each other, face to face, both staring guiltily at their pagers as if inviting from them a shrill, musical reprimand. There were worse things one could be doing. There were a multitude of drugs available for the consumption of the enterprising medical student—Rob was a competent enough hacker and Jemma a thief with long childhood experience, and not even the monolithic pyxis system that guarded every medication would have been able to withstand them if they had chosen to shoot up some propofol or snort morphine or place a row of fentanyl patches along their spines. They could be exceeding their authority in all sorts of ways—more a temptation for Rob than for Jemma—by attempting complicated procedures without supervision. There were babies they could have been dropping and children whose unshielded eyes might cry to a more sinister couple to be plucked out and parents vulnerable to lies and rumors of cure or of death. There was mischief worse than kissing Rob and lifting off his shirt. She was reluctant to give up his lips but eager to bare his belly and his chest, and because she would not pull her mouth away from his he left the shirt hanging, a collar around his neck. It was nothing to hand each other the gift of a screwing, and more than nothing. It was a great thing, and the greatest thing—not the end of the world but a way to put the world utterly at bay and escape momentarily and intermittently from her awful past, her anxious present, and her dispiriting future, a way to escape from the hospital, a way to not be here—to undo the pink cord that held up his scrubs, pull down his pants, sing out the long O, and fall on him with her mouth.