In April, something shifted in one of her patients and she was the first to notice.
Not a dramatic shift — clinical changes rarely announced themselves dramatically. This one was a change in affect, in the particular quality of a man's presence in his own body. He was fifty-three, cardiac, on the general ward for a monitoring admission. He'd been cheerful in the specific way of patients who had decided that cheerfulness was the most efficient approach to a hospital stay.
Then on a Tuesday — she kept a private tally of Tuesdays and their tendency to carry weight — he wasn't cheerful and wasn't quite present, the way a tide went out before a wave.
She finished the observation and went to Enfermeira Sousa.
"The man in bay four," she said.
"Mr. Carvalho," Sousa said.
"Something changed t
