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In an interview Thursday night with Sean Hannity, trump played down the need for US citizens to have ventilators. The US has 94,000 ICU beds for 310,000,000 people. One ventilator for every 3,297 Americans. Trump: “I don’t believe you need 40,000 or 30,000 ventilators”
In an interview Thursday night with Sean Hannity, trump played down the need for US citizens to have ventilators when they are dying.submitted by Graphenes to NoctilucentNews
“I don’t believe you need 40,000 or 30,000 ventilators,” he said, a reference to New York, where Gov. Andrew Cuomo has appealed for federal help in obtaining them.
Trump said: “You go into major hospitals sometimes, and they’ll have two ventilators."
That is a fucking stupid, moronic, childish and treasonous thing to say. Hospitals in the United States of America run 10% ICU beds in hospitals. ie., a 1,000 bed hospital has 100 ventilators.
The US has 94,000 ICU beds for 310,000,000 people. One ventilator for every 3,297 Americans.
We are actually short by 2,914,000, not 30-40,000. Trump is either a traitor or incomprehensibly callous, completely unsuited to lead any group.
United States Resource Availability for COVID-19https://www.sccm.org/Blog/March-2020/United-States-Resource-Availability-for-COVID-19
Visit sccm.org/disaster for more COVID-19 resources.
With the onset of COVID-19,1 and the strong possibility of large percentages of the U.S. population being admitted to the hospital and intensive care unit (ICU), the Society of Critical Care Medicine (SCCM) has updated its statistics on critical care resources available in the United States.2 Our goal is to provide information regarding the resources both available and needed to care for a potentially overwhelming number of critically ill patients, many of whom may require mechanical ventilation.1 In this report, we address the most current data and estimates on the number of acute care, ICU, and step-down (eg, observation, progressive) beds; ICU occupancy rates; mechanical ventilators; and staffing. We also seek to provide context to the data.
Acute care hospitals, ICU, step-down, and burn beds: The American Hospital Association (AHA) maintains a proprietary dataset of most hospitals in the United States. Data is gathered by voluntary survey. In April 2019, a study published in Critical Care Medicine analyzed the 2015 AHA data.3 For this current report, we extended the analysis from that publication using the most currently available 2018 AHA data and noting minimal changes from 2015.4 The 2018 AHA data indicate that there are 5256 AHA-registered community hospitals in the United States. Of these, 2704 (51.4%) deliver ICU services (Figure 3). These hospitals have 534,964 staffed (operational) acute care beds, including 96,596 ICU beds (Table 1), accounting for a median 16.7% of all hospital beds. The ICU beds can be categorized as adult, pediatric, or neonatal. There are 68,558 adult beds (medical-surgical 46,795, cardiac 14,445, and other ICU 7318), 5137 pediatric ICU beds, and 22,901 neonatal ICU beds. Additionally, there are 25,157 step-down beds, and 1183 burn beds. The proportion of ICU beds that are capable of negative pressure isolation is not recorded in the AHA dataset. The purpose of a negative pressure room is to confine pathogens to a single closed environment and to prevent the release of pathogens into other adjacent spaces. Negative pressure is strongly recommended with heavily communicable diseases such as COVID-19. When negative pressure rooms are not available, HEPA filters are installed in exhaust ducts leading from rooms with infected patients or patients needing isolation are cohorted together (often in separate locations) to facilitate safe and effective patient care. 5
Acute care hospitals by core-based statistical area (CBSA):: Of the 2704 U.S. hospitals with ICU services, 74% (1996) are in metropolitan areas (> 50,000 population), 17% (464) are in micropolitan areas (10,000-49,999 population), and the remaining 9% (244) are in rural areas (< 10,000 population) (Table 2). Concomitantly, 91% (489,337) of acute care beds and 94% (90,561) of ICU beds are in metropolitan hospitals. Only 7% (36,453) of hospital beds and 5% (4715) of ICU beds are in micropolitan areas. Two percent of acute care hospital beds and 1% of ICU beds are in rural areas.
ICU occupancy rates: We have focused on U.S. ICU, step-down, and burn beds as documented by the AHA. ICU bed utilization and occupancy rates, however, are not tracked by the AHA. Instead such data can be calculated from the Healthcare Cost Report Information System (HCRIS), a Centers for Medicare and Medicaid Services dataset composed of the Cost Reports submitted by every Medicare-certified hospital. 6 ICU occupancy rates in in acute care hospitals in 2010 (the most recent data available) are 66.6% in adult units, 61.6% in pediatric units and 67.7% in neonatal units.7 ICU occupancy rates are known to be higher in larger hospitals than in smaller hospitals. For contextual purposes, the occupancy rates do not reflect temporal or seasonal variations.
Contingency and crisis beds for critically ill patients: The outbreak of COVID-19 has generated concern that critically ill patients may overwhelm existing ICU bed availability. When contingency plans are implemented and elective surgeries and procedures are cancelled, ICU beds normally used to provide perioperative support would become available to provide COVID-19 care, as would operating rooms (with ventilators) and post-anesthesia care unit beds.8 Additional monitored hospital beds such as step-down unit beds may also be drafted into ICU service. At crisis levels, even non-monitored hospital beds may be mobilized but a significant investment of ICU-level facility infrastructure (eg oxygen, gas, power, drainage), devices (eg, mechanical ventilators, crash carts) and staff uptraining would be required. Making facility changes on this scale can take significant time and cause serious operational disruption at a time when those beds are most needed.
Beyond adjusting distribution and usage of existing hospital beds, there are a host of other options. In China, the government rapidly constructed hospitals solely for COVID-19 patients. This could be done in the United States. Local governments can also consider regionalizing or cohorting their critically ill COVID-19 patients into designated high-acuity large medical centers. The benefit of this approach is that these medical centers already have great numbers of well-equipped ICU and step-down beds and trained staff, thereby leaving the remaining hospitals to care for non-COVID-19 critically ill patients. Additionally, opening previously shuttered hospital facilities or medical wards and updating their supportive utilities (eg, power, data, air, oxygen, and suction) should be considered. Retrofitting existing nonmedical buildings (eg, hotels, dormitories) into COVID-19 care facilities has also been suggested, although this would be a very labor-intensive and expensive undertaking. These choices may be affected by a shortage of supportive medical devices and administrative and clinical staff.
The U.S. government has additional resources such as the USNS Mercy (T-AH-19) and USNS Comfort (T-AH-20), which can be deployed to assist in coastal areas. Each of these hospital ships contains 12 fully equipped operating rooms, a 1000-bed hospital facility (including 80 intensive care beds, 20 surgical recovery beds, and 280 intermediate-care [step-down] beds), digital radiologic services, medical laboratory, pharmacy, optometry laboratory, CT capability, and two oxygen-producing plants. Each ship is equipped with a helicopter deck capable of landing large military helicopters. The ships have side ports to take on patients at sea. Their crew comprises 71 civilians and up to 1200 Navy medical and communications personnel when operating at full capacity.
Mechanical ventilators: Reports from ICUs worldwide suggest that the most common reason for COVID-19 patient admission to the ICU is severe hypoxic respiratory failure requiring mechanical ventilation.
Supply of mechanical ventilators in U.S. acute care hospitals: Based on a 2009 survey of AHA hospitals, U.S. acute care hospitals are estimated to own approximately 62,000 full-featured mechanical ventilators.10,11 Approximately 46% of these can be used to ventilate pediatric and neonatal patients. Additionally, some hospitals keep older models for emergency purposes. Older models, which are not full featured but may provide basic functions, add an additional 98,738 ventilators to the U.S. supply.10 The older devices include 22,976 noninvasive ventilators, 32,668 automatic resuscitators, and 8567 continuous positive airway pressure units.
Centers for Disease Control and Prevention Strategic National Stockpile (SNS) and other ventilator sources: The SNS has an estimated 12,700 ventilators for emergency deployment, according to recent public announcements from National Institutes of Health officials.12 These devices are also not full featured but offer basic ventilatory modes. In simulation testing they performed very well despite long-term storage.13 Accessing the SNS requires hospital administrators to request that state health officials ask for access to this equipment. SNS can deliver ventilators within 24-36 hours of the federal decision to deploy them. States may have their own ventilator stockpiles as well.14 Respiratory therapy departments also rent ventilators from local companies to meet either baseline and/or seasonal demand, further expanding their supply. Additionally, many modern anesthesia machines are capable of ventilating patients and can be used to increase hospitals' surge capacity.
The addition of older hospital ventilators, SNS ventilators, and anesthesia machines increases the absolute number of ventilators to possibly above 200,000 units nationally. Many of the additional and older ventilators, however, may not be capable of sustained use or of adequately supporting patients with severe acute respiratory failure. Also, supplies for these ventilators may be unavailable due to interruptions in the international supply chain. Alternatively, ventilator manufacturers could be encouraged to rapidly produce modern full-featured ventilators to allow experienced clinicians to use supplemental ventilators that are familiar to them and can be readily incorporated into the hospital ventilator fleet and informatics systems. An analysis of the literature suggests, however, that U.S. hospitals could absorb a maximum of 26,000 to 56,000 additional ventilators at the peak of a national pandemic, as safe use of ventilators requires trained personnel.15
Estimates of hospitalized patients requiring critical care and mechanical ventilation: The U.S. Department of Health and Human Services estimated in 2005 that 865,000 U.S. residents would be hospitalized during a moderate pandemic (as in the 1957 and 1968 influenza pandemics) and 9.9 million during a severe pandemic (as in the 1918 influenza pandemic).16 A recent AHA webinar on COVID-19 projected that 30% (96 million) of the U.S. population will test positive, with 5% (4.8 million) being hospitalized. Of the hospitalized patients, 40% (1.9 million) would be admitted to the ICU, and 50% of the ICU admissions (960,000) would require ventilatory support.17 Such projections, however, are gross estimates. Some assumptions underlying these projections are uncertain, and the pacing of a large outbreak would influence whether ICU resources in isolated locations or nationally are severely taxed over many months or quickly overwhelmed over a shorter period. Additionally, COVID-19 patients may remain mechanically ventilated for indeterminate periods of time, with some developing prolonged or chronic critical illness requiring the extended use of ICU beds, ventilators, supplies, and trained clinicians.
Staffing to care for critically ill patients: As large numbers of critically ill patients are admitted to ICU, step-down, and other expansion beds, it must be determined who will care for them. Having an adequate supply of beds and equipment is not enough. Based on AHA 2015 data, there are 28,808 intensivists who are privileged to deliver care in the ICUs of U.S. acute care hospitals. Intensivists are physicians with training in one of several primary specialties (eg, internal medicine, anesthesiology, emergency medicine, surgery, pediatrics ) and additional specialized critical care training. However, 48% of acute care hospitals have no intensivists on their staffs.3 Based on the demands of the critically ill COVID-19 patient, the intensivist deficit will be strongly felt. Additionally, there are an estimated 34,000 critical care advanced practice providers (APPs) available to care for critically ill patients.18 Other physicians with hospital privileges, especially those with previous exposure to critical care training or overlapping skill sets, may be pressed into service as outpatient clinics and elective surgery are suspended. All other ICU staff (eg, APPs, nurses, pharmacists, respiratory therapists) will also be in short supply. Without these key members of the ICU team, high-quality critical care cannot be adequately delivered. Moreover, an indeterminate number of experienced ICU staff may become ill, further straining the system as need and capacity surge.
At forecasted crisis levels, we estimate that the projected shortages of intensivists, critical care APPs and nurses, and respiratory therapists trained in mechanical ventilation would limit care of critically ill ventilated patients.15 Therefore, priority should focus not only on increasing the numbers of mechanical ventilators, but on growing the number of trained professionals, for both the near and long term, who will be needed to both mechanically ventilate patients with COVID-19 and to care for other critically ill patients who will require ICU care.
Resources may be overwhelmed: Hospitals and their critical care organizations must include in their pandemic resource planning an ethical and legal approach to triage and resource allocation that would be activated only if the pandemic is perceived to be overwhelming the hospital’s surge capacity strategies.8,19,20 It is crucial that all staff have full access to the pandemic resource plan and know in advance who will help guide difficult decisions if the plan is activated. Topics that must be considered are the potential for unfair allocation of treatment, use of experimental interventions, and the conduct of medical research at times of healthcare crisis. SCCM provides guidance in its Ethics of Outbreaks Position Statement.21
Interconnectedness: It should be apparent to the reader that all hospital and ICU resources discussed in this report are interconnected and cannot work independently. Each of the three domains, ICU beds, ventilators, and critical care staff, are an essential component of the resources to manage a COVID-19 pandemic. For example, if a hospital has mechanical ventilators but not appropriate staff to operate them, the ventilators are not useful for patient care. Simply adding more of one resource element without considering the interconnectedness of the healthcare system’s many assets is unwise and potentially unsafe in planning for or managing a pandemic such as COVID-19.
In 2018, there were 5256 AHA-registered community hospitals. Of these, 3976 (76%) responded to the AHA survey. Of these, 2704 met our criteria for acute care hospitals that deliver critical care services. Only a minority of Department of Veterans Affairs and Department of Defense hospitals participate in the AHA survey; none were included in this report because they were not classified as community hospitals by the AHA.
a. Acute care hospital beds include general medical and surgical adult, pediatric, obstetric, neonatal intermediate, ICU, step-down, and burn beds. Rehabilitation, alcohol/drug abuse or dependency, psychiatric, skilled nursing facility, intermediate nursing, and other long-term beds are excluded. b. Units refers to the number of hospitals reporting more than one bed per ICU type. Each hospital can have a maximum of five AHA-designated ICU types. c. Burn and other special care beds (observation, step-down, progressive) are not commonly counted in the ICU bed totals.
a. Metropolitan areas: > 50,000 population, micropolitan areas: 10,000-49,999 population, rural areas: < 10,000 population.
Additional Resources on Mechanical Ventilator Supply:
As The Pandemic Spreads, Will There Be Enough Ventilators? (NPR) Ventilator Stockpiling and Availability in the US (Center for Health Security) Fast Facts on U.S. Hospitals, 2020 (American Hospital Association)
Press Release Shortage of ICU Providers Who Can Operate Ventilators Would Severely Limit Care During COVID-19 Outbreak (March 16, 2020)
There's Something Awful at Maple Meadow Apartment, Pt. IV
God, I love Jack. As I'm giving myself a pep talk to write this part out, he's sitting on the couch, laptop open, sucked into a Reddit Hole. He is talking to the screen, having conversations with everyone who has commented so far. (aside: the person who commented saying that they used to live in Michigan, but now live in Boston, I've had to explain 15 times to Jack that even though we now live an hour outside Boston, we probably do not actually know you)
So yeah. That's my freshly minted Reddit junkie husband- talking back to everyone in the comments section.
And that was fine by us. Life was settling into a new, happy normal almost instantly. We announced our pregnancy and everybody lost their minds, congratulating and offering name suggestions and making sure there was always O’Doul’s at every gathering (pro-tip: if you’re pregnant or have any reason to avoid alcohol, go ahead and skip the O’Douls, too. It’s repugnant.). I was happy to put the whole thing behind me, because I had this new life growing in me, and I didn’t want a single evil, dark thing to ever touch him or her.
I took my job as “gatekeeper to the unborn baby” so seriously that I may have gone overboard. I wouldn’t watch anything violent on TV or movies- after all, who knows what a baby picks up in utero? I skipped the news; I wouldn’t touch caffeine. Hell, I wouldn’t even paint my nails because I’d read somewhere on the internet that the chemicals from nail polish can leech into your bloodstream via the nailbed and who wants to douse their baby with nail polish?
Like I said- I may have gone overboard.
On the way to and from work every day, I’d only listen to audiobooks, because the radio stations just played junk. I mean, I’m sure that Usher and Kelly Clarkson weren’t intending to do damage to my little one, but the heavy repeat the radio stations had them on was sure to have some detrimental effects. So if you will indulge a first time mother her capricious behavior, you can imagine my irritation one day when the CD player stopped working halfway through my drive to work.
I was doubly- no probably triply- pissed. One: I was having a great time ridiculing the author of the book I was listening to- that book about the secret messages painted into The Last Supper? Two: 93.1 came on and was playing some advertisement for Art Van’s newest sale and I immediately began ranting about our consumerist culture and how Jack and I were going to raise our children differently and Three (probably the most influential): I was four months pregnant and flooded with hormones.
I kept trying to get the CD player to work again- jabbing the disc back in with an angry hand, but it kept stubbornly sliding back out at me- until I swore, then promptly apologized to the baby for swearing, and resigned myself to listening to whatever crap the radio would throw at me.
The commercials ended, and the morning DJ came on with one of those community service appeals local radio stations sometimes do. Animal shelter adopt-a-thon, 5K fun run to raise money for an area charity, that sort of thing. This time, the DJ, instead of his usual manic upbeat voice, sounded positively sick. He tells of a local family who just lost their rental home in a fire. The father died as a result of burns sustained when he ran back inside to rescue his seven-year-old daughter. The two survivors- the mom and the kid- were living at a local homeless shelter until insurance stopped being bureaucratic dicks and gave them money for a hotel. The DJ didn’t even have to sell it.
“I’m not asking you guys to send in clothes and teddy bears,” he said, clearly upset. “What they need now is a place to stay. If you know anyone who has a rental house, or who can put them up somewhere, that’s what we’re looking for. We’re talking about a little girl who just lost her father in a fire, and she and her mom are living in a homeless shelter because they cannot afford to go anywhere else.”
I started crying. Again, pregnancy does a hell of a thing to your hormones, but beyond that, it was just too awful. This poor woman and kid. I imagined what Christmas would be like for them- can you even find a silver lining in something like that?
All day long at work, my thoughts were with that family. I drove past St. Genevieve, our parish, and there was a banner out front, “Welcome the Stranger”: a promo for the fundraiser Fr. Scott was doing to raise money for migrant worker outreach, but I read it very differently. Finally, construction on 96 caused me to have to take such a convoluted detour that I wound up driving past the apartment complex and I knew it was a sign.
Jack came home that night, and I explained it to him.
“They have nothing. Nothing other than the two of them. They lost everything- including the husband and father. They’re living in a homeless shelter.” Jack just stared at a point three feet above my head.
“Honey, it just makes sense. We never cancelled the lease. It’s still our apartment. It’s just sitting there. We could give this mom and her kid a place to live, rent-free for the next three months. That could be a life changer for them.” He didn’t say anything. Just staring. I had to bring out the big guns.
“Baby, I really think this is what we need to do to move past…to move past whatever we think we saw there. If we could have this amazing footnote- that we helped out a family in need- at the end of the apartment story, wouldn’t that be great?” He sort of shrugged, and I- to my great shame- decided to play the pregnancy card.
“Jack,” I leaned forward so I could put one hand on his arm, and the other hand on my belly. “What if it were us? Would you want me and the baby staying in a shelter when there’s an empty, free apartment we could stay in?”
His shoulders sagged as he sighed and I knew that he wouldn’t fight me on it. I called the radio station that evening and told them that I had an apartment the family could use, rent-free, for the next three months. The woman I spoke to sounded ecstatic. She called me “an angel” as she took my contact information down.
I’m not an angel. No angels were anywhere then this happened. Well, no good ones, anyway.
Early the next week, I got a phone call from the mom. Her voice was rough and deep- what my dad romantically calls “a whisky voice” but to me just sounded like someone with a pack-a-day Marlborough Red habit. She identified herself as Jen, I told her I could meet her at the apartment tomorrow with a key, and gave her the address.
The pack-a-day habit was confirmed the moment Jen got out of the car to meet me. I could smell stale smoke rolling off her a good seven feet away. She was short, with a solid bone structure, but hollow cheeks. Her hair was the brassy, brittle color of old bleach jobs, and she stood there in the early December wind without a winter coat on. I gave her the key to the apartment, and walked with her as far as the door. She unlocked it, and turned to me, as if waiting for me to go in and show her around, but I took a step back.
At that moment, the passenger side door of Jen’s beat up old car opened, and out came a little girl, about seven years old. She was dressed in a purple coat that seemed several sizes too big for her, and had long, tangled blonde hair spilling out from a Red Wings stocking cap. She looked at her mom and me, clutching a sketch pad to her chest. I heard her mom, behind me, give out a sigh of irritation.
“Sienna, I told you to stay in the damn car!” If the mom saw me flinch, I don’t know, but Sienna did. Her eyes softened for a moment, and she took a step closer to me. I smiled at her and held out my hand to introduce myself. She looked over my shoulder, at her mom, then stepped backwards, unwilling to shake.
I turned back to the mom. “The lease is up on the 28th of February,” I said. “Just call me a couple days before so I can get the keys back from you.” The mom just grunted. No word of thanks, no sign of gratitude. I immediately chastised myself for expecting some- for wanting it. Hadn’t this family been through enough without me needing them to proclaim me their savior?
As I walked back to my car, I passed Sienna. She looked at me from the corner of her eyes, and smiled a little. Then, ever so slightly, she pulled the sketch pad away from her chest and tipped it towards me. It was a picture of a circus tent, with elephants and an acrobat on a thin wire. There, sitting on empty seats, were three figures- a little girl, a woman, and an adult man. They were all eating cotton candy and smiling.
I drove back home from the apartment, bawling my eyes out.
Eventually, I settled down and didn’t think about Sienna and her mom anymore. December and January passed, and it wasn’t until mid-February that the broken little family came back to mind. It was almost time for the lease at that apartment to be done, and we’d finally be truly rid of the place. I tried calling the number left on my phone history to get in touch with Jen, but it went to voice mail. I called the radio station to see if they had any other contact info, but they had nothing. Eventually, I stopped by the apartment one afternoon to stick an envelope in the door- “Lease is up in two weeks. Please call me so I can get the key from you.”
I hightailed it out of there like the devil himself was chasing me.
That evening, there was a knock at the door. I looked out the window and saw two police officers standing on the porch. I called to Jack, who was reading in the kitchen, and he came and opened the door.
“James and Rosalind St. Clare?” the one officer said, while the second peered over our shoulders into the house.
Jack nodded. “That’s us, what’s the problem, officer?”
“Do you have a lease at 1490B, Maple Way Circle, Livonia?” We both nodded, again.
“We have some questions we’d like to ask you about the apartment, may we come in?”
Now, I’d be lying if I said that Jack’s dad didn’t have a bit of an anti-establishment streak running through him. The number of times dinner conversation at my in-laws’ house consisted of state’s rights, individual rights, what a law enforcement officer may and may not expect from you, I can’t even keep count of. Raised on this stuff, I truly expected Jack to draw himself up and say something like, “I’m sorry officer, I cannot let you into my house without probable cause,” or something like that.
But no. Jack just mutely stepped to the side and gestured the police in. It was as if the mere mention of the old apartment had frozen my husband in place.
The one officer took out a notebook. “You have the lease at 1490B, correct?” Jack nodded again, and the officer made a mark in his book. “And you do not currently reside there?” Jack nodded again, and I watched the other cop search our house with his eyes. I suddenly wondered if I’d remembered to dust the corners of the ceilings, or if there were cobwebs gathering there.
“Do you know who is currently living at that residence?” I looked at Jack, who seemed to be doing a pretty good impersonation of a deer in the headlights, and took pity on him.
“Their names were Jen and Sienna….something,” I said. “Davidson? Or Donaldson? I don’t remember. I heard on the radio station that their house had burned down and they were living in a homeless shelter. The station was asking if anyone had a place for them to stay for a while, and we did. We’d moved out of the apartment a while ago, but still had the lease. It was just empty. So I offered it to them.” The officer made a couple more notes.
“How often did you speak to the family?” He said, and I shrugged. “Only the one time, when I met them at the apartment to give them a key. I’ve been trying to get a hold of them for a week now, since the lease is almost up and I need to make sure they’re moved out before then. But the phone just goes to voice mail, and so I stuck a note in their door just today.” More notes scribbled down.
“And the child? How often were you in contact with her?” I stared at him, confused.
“Sienna? I never talked to her other than the one time I handed her mom the key,” I said, suddenly feeling like I couldn’t breathe. “Is she ok? What’s this about? Do you know where they are?”
Neither officer answered me. The one kept writing notes and the other one, who had been silent until now said, “If you hear from either of them, please let us know immediately.”
Then they turned and left. As soon as they were out of sight, I called Amy on the phone.
“Amy, what the hell?” I said. To which my perfectly unflappable friend replied, “And a lovely evening to you, too, Rosie.”
“Do you have any idea who Jen and Sienna Davidson or Donaldson are, and why the cops would be at my door asking about them?” Amy was silent for a moment, and then said, “Did you say Sienna Davidson?” And that’s when I knew it wasn’t my pregnancy-induced imagination- things really were bad.
“Yeah. Why?” Amy was silent for a moment, then said, “Are you still not watching news because of the baby?” I counted to five before answering so I didn’t sound defensive.
“That’s a good idea, actually,” was Amy’s sensible response. Then she told me that an Amber Alert had been issued last week for a girl named Sienna Davidson. A Sienna Davidson whose last known address was our old apartment. Numbly, I thanked Amy and hung up the phone, feeling faint. I stumbled into the living room, where Jack was sitting on the couch, staring at his hands, and I told him what Amy’d said. I got the words out, Jack held his arms out to me, and I started sobbing uncontrollably.
At first, I couldn’t bear to look at the news reports myself, so I asked Jack to do it. But after a day or two of him telling me that there just wasn’t any updates about Sienna, I was convinced that he was lying and braved the papers myself.
He was right. There was no mention of the little girl. No updates on radio, TV, the papers or even the internet. It was as if the media had dutifully reported her initial absence and then dropped her from its collective mind.
I couldn’t drop her from my mind. I kept seeing her pale little face, her body swallowed up by the too-big coat, the aching tenderness of the circus scene she shyly showed me. When my cell rang on the Friday of my mid-winter break, and the caller ID flashed “Maple Meadow Apr”, my hand shook more than a little when I answered.
It was the landlady, Rhonda, and she was pissed. “Listen,” she said, with no preamble, “your lease is up in two weeks and I know you aren’t living there anymore, but you still have to deal with that God awful stink coming from the apartment. The damn neighbors keep bothering me, calling about it, and I walked by today and I can smell it from the damn sidewalk. So get back here and deal with the smell, or I’m going to take your whole deposit and sue your ass for vandalism.”
Rhonda has ever had a poetic way with words.
I assured her that the apartment had been left in suitable condition, but certainly, we would be by that weekend to do a final walk-through before turning our keys in to her and signing off on the paperwork. She angrily said she wouldn’t be around this weekend, and she’d just send us the paperwork once she did her own walkthrough and assessed the damage, but we could “drop the damn key off at the damn office,” then hung up.
When Jack got home that evening and I told him about Rhonda’s call, he frowned. “Smell?” he said, nervously playing with a carton of Chinese food he’d brought home for us. “Think it’s from the Douche Bag’s apartment?” I shrugged. He continued. “Maybe it was cigarettes. You said that mom reeked like an ashtray, maybe that’s it.” I shrugged again, and dully dished vegetable fried rice into two bowls. Jack scratched his chin and sighed. “Well, we’ll go deal with it tomorrow, I guess. I still have my key- Rhonda’s just going to have to deal with half a set of keys returned.”
I slept fitfully that night, and judging by the amount of tossing and turning coming from Jack’s side of the bed, so did he. We woke up Saturday morning bleary eyed and silent. I gathered up cleaning supplies while Jack made himself coffee. We drove over to the apartment without speaking, as snow clouds, grey and towering, gathered on the horizon.
We could both smell it as soon as we got out of the car. Rhonda wasn’t kidding. There was a smell pouring out of the apartment- a smell that is unmistakable. When I was at State, I lived in a house with five other people. One of my housemates had a pet boa constrictor named Pete. He’d had Pete since he was in the 6th grade, and this snake was HUGE. The guy was graduating that spring, and was flying out to California every other weekend for job interviews. One weekend, I came back to the house after being at the library, and as I walked up the stairs to my room, I was overcome with a smell of death. The smell was so terrible, so strong, that I started gagging. I traced the smell to the guy’s room, which was directly across the hallway from mine. Turns out, the guy’s 6-foot, 200 lb. boa constrictor had died, and was liquefying under the heat from the lamp and warming rock that was in its cage. When my housemate came back, he was overcome with sadness that his childhood pet had died, but I was just glad the source of the smell was gone.
That’s what I smelled when I stood in front of our old apartment. The smell of death. The smell of rot. It was so strong that I started dry heaving. Jack motioned me to walk back to the car, and he unlocked the door, then promptly turned and retched into the azalea bush by the landing.
He stumbled his way over to me, and we sat on the hood of the car for a solid 10 minutes, both to let the smell to air out as well as to gather up our courage. Finally, Jack turned to me and said, in an attempted joking voice, “Well, I suppose there’s no point in telling you to stay here, is there? You’re just going to ignore me, aren’t you?” I could tell by the badly hidden glint in his eye that he needed me to come up with him- that the apartment freaked him out enough to ask his six-months pregnant wife to accompany him- and so I played my part.
“Um. Hell no. You’re not telling me to sit here. I’m not the little woman.” And he pretended to be irritated, but I could see the relief in his face. So together, Jack leading the way, clutching my hand, and me bringing up the train, clutching the bucket of cleaning supplies (which, in the face of such stench, were now revealed to be woefully underpowered), we climbed the stairs into that hellish apartment.
I wish there were a word to describe what we saw up there. “Disaster” doesn’t cover it. “Vile” doesn’t do it, either. We need a word to sum up that despair and stink and carnage of a crack den combined with a slaughterhouse.
There were large, dark stains on all the stairs, like somebody had dragged a bowling ball in an oily sack. The stain left a trail up the stairs, into the living room, across the kitchen, and down the hallway into the bedroom. Jack and I stood there, standing in the living room, stunned. There were flies everywhere. The balcony door was so thick with smudges and grime you couldn’t even see out of it. And everywhere, everywhere was that stench, so thick that even the reek of cigarettes couldn’t cover it.
Jack took a couple hesitant steps towards the kitchen, and that’s when we saw it. The mural in the hallway was completely visible again, but now there were…additions to it.
In the same childish hand I saw on that sweet little circus scene Sienna had shown me, there were now three figures hanging, one from each maple tree. Unable to stop ourselves, Jack and I knelt down next to them, taking in every nightmarish detail.
The figures were children- children hanging from the tree by ropes. Two black boys, one white boy. Two of them had blood coming from their mouths. One of them appeared to have his skull crushed. Sure enough, there on the ground under the base of a tree, was a bloody rock. And at the very tops of the trees, twining around the branches like smoke, was a ragged figure painted all in black.
Jack shot up, and pulled me- hard- by the arm. “C’mon honey,” he said. “Come on. Let’s get out of here. Fuck our deposit. Fuck this apartment. Let’s go.”
I nodded, forcing myself to turn away from the mural. Jack and I walked back to the stairs, and as I passed the kitchen, I noticed the oven door hanging open. There, sitting in the middle of the top rack, was a rock the size of a softball. Despite the swarm of flies crawling on it, I could still see chunks of flesh on it, ripe with maggots.
Jack and I had a brief but violent argument once back at the car. I had reached for my phone to call 911 when Jack swiped at my hand, knocking the phone to the floor. I stared at him incredulously.
“The hell?” I said, reaching down to retrieve my phone.
“Don’t do it,” Jack said fiercely. I looked at him, feeling anger immediately rise to the surface.
“Don’t do WHAT?” I snarled.
“Don’t call the cops. Do not do it.” This was madness.
“Jack, I absolutely am going to call the cops. A little girl is missing. The place she lived looks like a fucking charnel house. There is a fucking rock, covered with maggots and tissue in the FUCKING OVEN.” My voice was raw and hysterical.
“Yeah. And there’s also a giant ass painting of LITTLE MURDERED BOYS on the wall. We call the cops and they’re going to put us down as suspects. Our name is on the lease. We lived here. We called the police about three fucked up kids beating their heads in. You don’t think that all adds up to us getting arrested?” He was breathing hard, sweat beading his forehead, despite the chill.
I took a deep breath, trying to calm down. Nothing was going to be solved while we were both panic raging at each other.
“Jack. Honey. It’s not illegal to paint messed up things. It’s horrible, and you and I wouldn’t do it, but even if we had, the cops cannot arrest us over that. And there is a little girl who is missing, and maybe, maybe there is some evidence in there that the cops can find and use now to save her. Jack,” I stopped for a second, my voice catching. “Jack. It’s my fault that Sienna is missing. You didn’t want to offer them the apartment, and I didn’t listen. Even with all the shit we experienced there, I still just let that woman bring her daughter in it. I can feel it in my gut- something horrible happened to that little seven year old girl, and it’s my fault, and if the cops can find some clue that can help find her, that’s the least I can do.” And I broke down, crying so hard I could hardly breathe.
It took a while for me to realize that Jack was rubbing my back. It took even longer for me to realize he was talking to me.
“Baby. This is not your fault. You have a heart big enough for the whole world, and you offered shelter to a homeless family. What happened to that little girl is 100% not your fault, not by intention or consequence. Do you hear me?” I nodded my head, knowing everything he was saying was a lie. I was a murderer. My sweet unborn child was silently growing inside a woman who murdered a little girl by sending her, unwarned, into that apartment. Absently, I watched Jack take the phone from my hand and call 911. We waited there in the car, me trying to pull myself together, and let the police in when they got there.
They asked us a couple of questions, got our phone number and address for “follow up purposes”, and we drove home in silence. Our porch light was on when we got home, glowing warm and comforting in the darkness. We went inside, took showers, and retreated to the safety of our bed, to the oblivion of sleep.
We were never contacted by the police for follow up questions. To this day, Sienna has never been found. Three weeks after our last visit to the apartment, we got a letter in the mail from Maple Meadow. It explained in tense legalese that, given the condition of the apartment, we had forfeited out deposit. Additionally, we were being charged $400 for carpet cleaning and that failure to comply within 90 days would result in legal action. I filled out a check immediately, sticking it in the mailbox before the ink had even dried.
For the relief of finally having all ties to that apartment severed, I would have written that check ten times over.
I was so wrong. Tomorrow, I'll show you the police report, and the terrible theory Amy has. Then I swear, I'm washing my hands of that whole place and shoving it so far down in my brain it'll never come up for air again.