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She cuts the little nurse off by jabbing the needle back into the vial’s rubber top, fills it, jerks it out, and lays it on the tray. I watch her hand reach for another empty needle, watch it dart out, hinge over it, drop.

“You seem to forget, Miss Flinn, that this is an institution for the insane.”

* * *

The Big Nurse tends to get real put out if something keeps her outfit from running like a smooth, accurate, precision-made machine. The slightest thing messy or out of kilter or in the way ties her into a little white knot of tight-smiled fury. She walks around with that same doll smile crimped between her chin and her nose and that same calm whir coming from her eyes, but down inside of her she’s tense as steel. I know, I can feel it. And she don’t relax a hair till she gets the nuisance attended to – what she calls “adjusted to surroundings.”

Under her rule the ward Inside is almost completely adjusted to surroundings. But the thing is she can’t be on the ward all the time. She’s got to spend some time Outside. So she works with an eye to adjusting the Outside world too. Working alongside others like her who I call the “Combine,” which is a huge organization that aims to adjust the Outside as well as she has the Inside, has made her a real veteran at adjusting things. She was already the Big Nurse in the old place when I came in from the Outside so long back, and she’d been dedicating herself to adjustment for God knows how long.

And I’ve watched her get more and more skillful over the years. Practice has steadied and strengthened her until now she wields a sure power that extends in all directions on hairlike wires too small for anybody’s eye but mine; I see her sit in the center of this web of wires like a watchful robot, tend her network with mechanical insect skill, know every second which wire runs where and just what current to send up to get the results she wants. I was an electrician’s assistant in training camp before the Army shipped me to Germany and I had some electronics in my year in college is how I learned about the way these things can be rigged.

What she dreams of there in the center of those wires is a world of precision efficiency and tidiness like a pocket watch with a glass back, a place where the schedule is unbreakable and all the patients who aren’t Outside, obedient under her beam, are wheelchair Chronics with catheter tubes run direct from every pantleg to the sewer under the floor. Year by year she accumulates her ideal staff: doctors, all ages and types, come and rise up in front of her with ideas of their own about the way a ward should be run, some with backbone enough to stand behind their ideas, and she fixes these doctors with dry-ice eyes day in, day out, until they retreat with unnatural chills. “I tell you I don’t know what it is,” they tell the guy in charge of personnel. “Since I started on that ward with that woman I feel like my veins are running ammonia. I shiver all the time, my kids won’t sit in my lap, my wife won’t sleep with me. I insist on a transfer – neurology bin, the alky tank, pediatrics, I just don’t care!”

She keeps this up for years. The doctors last three weeks, three months. Until she finally settles for a little man with a big wide forehead and wide jewly cheeks and squeezed narrow across his tiny eyes like he once wore glasses that were way too small, wore them for so long they crimped his face in the middle, so now he has glasses on a string to his collar button; they teeter on the purple bridge of his little nose and they are always slipping one side or the other so he’ll tip his head when he talks just to keep his glasses level. That’s her doctor.

Her three daytime black boys she acquires after more years of testing and rejecting thousands. They come at her in a long black row of sulky, big-nosed masks, hating her and her chalk doll whiteness from the first look they get. She appraises them and their hate for a month or so, then lets them go because they don’t hate enough. When she finally gets the three she wants – gets them one at a time over a number of years, weaving them into her plan and her network – she’s damn positive they hate enough to be capable.

The first one she gets five years after I been on the ward, a twisted sinewy dwarf the color of cold asphalt. His mother was raped in Georgia while his papa stood by tied to the hot iron stove with plow traces, blood streaming into his shoes. The boy watched from a closet, five years old and squinting his eye to peep out the crack between the door and the jamb, and he never grew an inch after. Now his eyelids hang loose and thin from his brow like he’s got a bat perched on the bridge of his nose. Eyelids like thin gray leather, he lifts them up just a bit whenever a new white man comes on the ward, peeks out from under them and studies the man up and down and nods just once like he’s oh yes made positive certain of something he was already sure of. He wanted to carry a sock full of birdshot when he first came on the job, to work the patients into shape, but she told him they didn’t do it that way anymore, made him leave the sap at home and taught him her own technique; taught him not to show his hate and to be calm and wait, wait for a little advantage, a little slack, then twist the rope and keep the pressure steady. All the time. That’s the way you get them into shape, she taught him.

The other two black boys come two years later, coming to work only about a month apart and both looking so much alike I think she had a replica made of the one who came first. They are tall and sharp and bony and their faces are chipped into expressions that never change, like flint arrowheads. Their eyes come to points. If you brush against their hair it rasps the hide right off you.

All of them black as telephones. The blacker they are, she learned from that long dark row that came before them, the more time they are likely to devote to cleaning and scrubbing and keeping the ward in order. For instance, all three of these boys’ uniforms are always spotless as snow.

White and cold and stiff as her own.

All three wear starched snow-white pants and white shirts with metal snaps down one side and white shoes polished like ice, and the shoes have red rubber soles silent as mice up and down the hall. They never make any noise when they move. They materialize in different parts of the ward every time a patient figures to check himself in private or whisper some secret to another guy. A patient’ll be in a corner all by himself, when all of a sudden there’s a squeak and frost forms along his cheek, and he turns in that direction and there’s a cold stone mask floating above him against the wall. He just sees the black face. No body. The walls are white as the white suits, polished clean as a refrigerator door, and the black face and hands seem to float against it like a ghost.

Years of training, and all three black boys tune in closer and closer with the Big Nurse’s frequency. One by one they are able to disconnect the direct wires and operate on beams. She never gives orders out loud or leaves written instructions that might be found by a visiting wife or schoolteacher. Doesn’t need to any more. They are in contact on a high-voltage wave length of hate, and the black boys are out there performing her bidding before she even thinks it.

So after the nurse gets her staff, efficiency locks the ward like a watchman’s clock. Everything the guys think and say and do is all worked out months in advance, based on the little notes the nurse makes during the day. This is typed and fed into the machine I hear humming behind the steel door in the rear of the Nurses’ Station. A number of Order Daily Cards are returned, punched with a pattern of little square holes. At the beginning of each day the properly dated OD card is inserted in a slot in the steel door and the walls hum up: lights flash on in the dorm at six-thirty: the Acutes up out of bed quick as the black boys can prod them out, get them to work buffing the floor, emptying ash trays, polishing the scratch marks off the wall where one old fellow shorted out a day ago, went down in an awful twist of smoke and smell of burned rubber. The Wheelers swing dead log legs out on the floor and wait like seated statues for somebody to roll chairs in to them. The Vegetables piss the bed, activating an electric shock and buzzer, rolls them off on the tile where the black boys can hose them down and get them in clean greens…