Date: Wed, 15 Dec 2010 14:53:26 -0500
From: Dashiell Walraven <dashiell.walraven@gmail.com>
Subject: Steward's New Patient

STEWARD'S NEW PATIENT
by Dashiell Walraven
Copyright © 2010

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A map with a highlighted, one-hour route to the Deever home lay on the seat
next to him.  Steward pulled out of the coffee shop with a double-shot
latte in one hand, and desperately wanted a cigarette.  Setting down the
coffee at a stoplight, his eye caught a glint from the new name tag affixed
to his neatly pressed shirt.  "Steward Smith, R.N.," it read.  Steward
smiled to himself, and flicked a mote of lint from the tag and smoothed the
shirt against his chest.

His first forays into private duty nursing had been a welcome change of
pace from the hectic ICU and ER scenes.  At first, he'd craved the action
and adrenaline, but lately it didn't seem as much fun.  Much of that had to
do with a whirlwind affair with one of the residents that proved disastrous
for both of them.  Steward winced as he sipped the hot coffee, turned up
the radio, and hit the highway.  Even with the radio blaring, Steward was
still able to focus and think about his new patient.  A review of the file
showed that Michael Deever, 18 years old with cerebral palsy, was pretty
high maintenance.  Michael's regular private-duty nurse was taking
maternity leave and the office stuck him with the job.  Being the new guy,
Steward reasoned that he would catch all the scut work that nobody else
wanted, and to date, that is mostly what happened.  From the respiratory
cases that required a lot of suctioning, or the colostomy and ileostomy
patients that required changing of bags and wound care.  Stinky stuff
didn't bother Steward, his time in the ER innured him to just about every
nasty and viscous fluid that might come from a human body.  Steward
mentally ticked off a quick checklist of the things he knew about cerebral
palsy, its causes and sequelae, and the normal things one looks for and
treats in chronic, bed or wheelchair bound patients.  By the time he pulled
into the driveway of the Deever home, he felt prepared.

The drive was long and lined with tall trees as it wound from the road up
to the house.  A large colonial, it perfectly suited its New England
surroundings and looked like something out of an Eric Sloane painting.
Stone walls criss-crossed the property, with white fences and several barns
in the distance.  Steward heard a horse whinny from one of them as he got
out of the car and slung his backpack over a shoulder.  The house was big
enough that he had trouble figuring out just where the front entrance was,
or even if he should use it if he found it.  His eyes focused on a red door
near the garage where other cars were parked, so he chose that one and
rapped the large brass knocker.

"Jes?" a hispanic woman in a domestic uniform answered the door.  Steward
stuck out his hand and smiled.

"Hello, Steward Smith, I'm the replacement nurse for Michael Deevers?"

"Oh," she said smiling back and opening the door, "Please, please, come
in."  Steward stepped into the expansive mud-room and looked around.  "My
name is Carmen," she said politely, "you are new?"

"Yes," Steward said, "I've been working for the agency for about two months
now."

"Okay," she said quietly, "Do djou have much esperience with ceepee?"

"I'm sorry, with what?"

"CeePee?"

"Uhm..." Steward stuttered, "CeePee? What is that?"

"I sorry," Carmen apologized sheepish, "djou know... Sara Brell... Pall...
Pale..."

"Cerebral Palsy?"

"Jes!" Carmen said happily, "I sorry, my english is not so good."

"It's fine," Steward smiled warmly at her.  He briefly entertained the
notion of saying something flippant about having her teach him spanish, but
he didn't think he be around that long.  "Can you take me to him?"

"Yes," she said, her face suddenly cloudy, "I want you to know, I love
Michael very much, and that last lady, I don't she take good care of him."

"Really?" Steward was surprised.

"She was the one, you know... enciente?" she made a motion in front of her
indicating a large, pregnant belly.

"Yes," Steward nodded.

"She was a bitch to Michael, I no like her at all.  I am happy she go."
Carmen stamped her foot as if to put a period on the statement.  Her cheeks
had turned a little scarlet and she stood there, waiting for Steward to say
something.  Deep within the recesses of the house, an animal like shriek
echoed.  "He is awake," she said, "come."

Steward followed her into the house, passing museum-like rooms furnished
with expensive looking furniture and fixtures.  It all looked completely
un-lived-in.  Steward followed her into the home, climbing to the third
floor suite for Michael.  The noises Michael made grew quickly more
frantic, Carmen picked up her pace.  By the time she made the door to
Michael's suite, she was nearly at a dead run.  She swung the door wide and
Michael's cries were suddenly louder and more piercing.  Steward could see
his bony limbs flailing in the bed as she reached over and starting
clucking in soothing tones, caressing his face.  Michael quickly calmed as
Carmen smoothed his hair and rubbed his cheek.

"There baby boy, its good," she smiled at him, "I brought you somebody
nice, you don't have to worry about that no good woman anymore."  Carmen
waved Stweard over and he walked in, taking a good look at the place.

Michael's suite was set up like one would imagine any private hospital
would be.  Fine cabinetry, gleaming clean and white, Carmen's handiwork no
doubt, and fine appointments made the room look like a strange cross
between an ICU bed and a superb hotel. Michael's bed was of a very
expensive type designed to place no pressure on any one point of the body,
thus avoiding bed sores.  The linens were all very crisp and clean, and
Michael had a flat panel display above the foot of his bed.  Steward came
around to look at Michael and was somewhat shocked by what he saw.

Michael looked at Steward with deep brown, gold flecked eyes, his black
hair combed fairly neatly across his head, save for one stubborn cowlick
toward the back.  He did not look to Steward like an 18 year old boy at
all.  Even taking into account for Michael's somewhat contracted stature,
he barely looked 5 feet long and couldn't have weighed much beyond 60 or 70
pounds.  A wide, somewhat distorted smile split Michael's face and he waved
his arms, his two useless looking hands flopping to and fro.

"Gah!" he exlaimed loudly.  Carmen beamed at me.

"Michael is a very good judge of character Mr. Nurse," she said
confidently, "and he likes you.  Look, he is saying 'hello' to you."

"Please," he said modestly, "Call me Steward, that will be fine."

Carmen showed Steward around the room, they opened cabinets and drawers.
Throughout, Carmen kept a running conversation with Michael, telling him
what they were doing and being generally chatty.  Michael's eyes followed
them around the room, smiling and clapping his hands.

"Gah!" he shouted again.

"Does that mean anything in particular Carmen?" Steward asked.

"It is his word," she shrugged, "it is what he says for everything."
Steward nodded in understanding.  Carmen showed him the desk on the side of
the room, near the window, where his predecessor had filed all of her notes
and care journals.  Steward scanned the documents and found her notes to be
thorough, complete and professional.  She certainly was competant,
regardless of what Carmen may have thought.  Steward looked for notes from
the night nurse.

"Carmen?" he asked, "Who takes care of Michael at night?"  Carmen looked
into the air, as if checking some airborne calendar.

"Uhm, Saturday night it was his father Robert; last night was his mother
Betty, and tonight will be his brother Marshall."  Steward raised an
eyebrow and gave himself a mental kick in the shins.  He had completely
misjudged the family assuming them to be rich snobs who couldn't be
bothered to care for their severely disabled son and brother.  From the
records he saw before him, he'd been comletely unfair in his snap
judgement.

Carmen excused herself to return to her duties; Steward set about getting
started on the day with Michael.

"So Mr. Deevers," Steward said brightly, "Let's see about getting you
bathed this morning so I can check you over while I'm at it, shall we?"
Michael's eyes shone brightly as he watch Steward busy himself by warming
the disposable, premoistened bath towels in a the microwave oven.  Michael
seemed to be always smiling when Steward looked at him, thoroughly engaged
in whatever Steward was doing.

The microwave beeped and the bath towels emerged warm and steamy, Steward
brought them to the bedside and set them on the small table there.
Reaching over, whistling to himself, Steward unsnapped the buttons at
Michaels shoulders, and pulled his night shirt from his body, tossing it to
the laundry bin nearby.  Steward pulled one towel from the plastic
container, and testing it on his wrist, found it to be nicely warm and not
too hot.  The moment the towel touched Michael, his eyes rolled upwards in
obvious pleasure as Steward gently scrubbed at the skin of his forehead and
face.  Steward took particular care with Michael's ears, gently scrubbing
at the inner folds with a deft, yet careful finger; Michael seemed to
particularly enjoy this.  Steward looked up to see Carmen had paused by the
door, watching him.

"Hi Carmen," Steward acknowledged, "how am I doing?"  Carmen smiled
approvingly, gave Steward a quick thumbs-up and moved on.  Steward looked
back down to grin at his patient and continue bathing him.  Discarding the
first cloth, Steward pulled a fresh one and scrubbed at Michael's black
hair.  With the tips of his fingers, he massaged the moist towel deeply
through Michael's hair and scrubbed at the scalp.  Michael gave a deep,
throaty moan, and clapped his hands together in enjoyment.

"You like getting your hair washed, don't you?" Steward asked him.

"Gah!" came Michael's exuberant reply.  Steward chuckled, brushing
Michael's damp hair with a soft brush.  Steward looked at Michael's hair;
what had been a dark, coarse looking wet mop, transformed into a finely
brushed head of hair that shone like obsidian in the bright sunlight of the
morning.  Each strand of hair, while deeply black, picked up the light and
fairly sparkled like glass.  It was then that Steward really started to
look at his patient.

Michael's palsy had rendered its typical distortions to his features.  His
muscles lacked much tone, and his facial features were somewhat slackened.
Michael generally breathed through is mouth, which was rarely closed. The
upper mandible seemed prominent as the lower jaw fell away.  Still, beyond
that, Michael was still a handsome young man.  Steward found himself
wondering what the rest of the family looked like, and where he would see
the resemblances. He continued on with Michael's bath.

With another fresh, warm towel, he rolled Michael over onto his side to
scrub down his back.  Michael responded by reaching over and grasping the
rail on the opposite side, helping to steady himself.  Steward stopped for
a moment, watching Michael do this, surprised.  Michael seemed to be able
to pull up and hold almost his whole weight.  Steward resolved to do a
complete assessment of Michael's strength and muscle tone.

Steward moved the cloth in circles around Michael's back, noting how the
muscles there rippled with pleasure as he did so.  Steward hummed quietly
to himself, busily scrubbing at a bit of scaly skin.  Steward took the time
to scan Michael's back for signs of bed sores.  The special mattress of the
bed had done its work well, as there not even any red marks where the
weight of Michael's body had produced any pressure spots.  Steward was
impressed.  So often he'd found patients in home and private-duty care, who
had pressure sores from laying in the same position for hours on end.  In
Steward's mind, it showed that Michael was indeed, extremely well cared
for, and surely very loved.

Steward rolled Michael back after wiping down the backs of his legs.  As
Michael returned to lay on his back, Steward observed the front of
Michael's diaper was tented up.  Steward professionally ignored the
erection and continued to Michal's feet.  Steward knew that by moving away
from Michael's midsection, the erection would go away of its own accord.
He looked up at Michael, who was looking back and watching him with a happy
grin.

"Let's get those feet and toes clean shall we?" Steward said brightly,
noticing Michael's "bump" was already subsiding.  This confimed for Steward
what he already suspected, which was that Michael's erection had less to do
with physical stimulation, than the simple mechanics of his disease.
General lack of muscle tone in a bed bound patient meant that when being
moved and rolled around, blood tends to move towards the pull of gravity.
When Michael was turned over, blood would have naturally flowed into the
chambers of his penis, causing it to become engorged and partially erect.
This effect can take several minutes to go away.  If the patient is aware,
it can be acutely embarassing, which is why nurses are trained to ignore it
and move on to something else.  Michael, didn't seem very aware, or the
slightest bit bashful about it, so Steward simply went about cleaning his
feet.

Michael giggled some as Steward scrubbed his feet and in between his toes.
Working his way upward from the ankles, Steward made quick work of
Michael's legs.  Removing Michael's diaper, Steward balled it up around the
small bit of stool he found there, and tossed it to the garbage bin.  He
rolled Michael once more and gently cleaned his anus and perineum.  Steward
noticed some rash to the skin there, and applied some Desitin ointment.
Steward rolled Michael back onto a fresh, opened diaper, lifted his
testicles and cleaned beneath them.

Steward looked at Michael's genitals and considered that they seemed
proportional, but not entirely developed to the extent he would expect for
a boy of 18 years.  There was a downy patch of black pubic hair, but not
much, and the scrotum and perineum were completely bare.  Michael's penis
lay to the side, and looked no longer than perhaps 4 inches even in it's
slightly "chubbed" state.  Overall, Michael could have easily passed for a
14 or 15 year old, maybe 16 at maximum.  Steward shrugged, most likely
Michael's puberty had been delayed by the effects of his cebral palsy.  In
his experience, he'd seen this before, so it didn't concern him.

Steward pulled a fresh cloth from the warm bin, took Michael's penis with
one hand, and gently cleaned it with the other.  Slowly, Steward retracted
the foreskin, and wiped away the small amount of gathered smegma.  Again,
no surprises there, Steward was becoming accustomed to the fact that
Michael's family and caregivers has seen well to his hygiene.  As Steward
cleaned, he noticed that Michael was once again becoming erect.  By the
time he was nearly done, Michael was fully hard and it bounced with each
pulse of his heart.

Michael's breathing had become strangely quiet and Steward noticed that he
was looking away and chewing on his lower lip anxiously.  Steward
understood the signs of Michael's embarassment, and finished cleaning him
up.  The one last swipe with the cloth however, proved to much for Michael.
His abdominal muscles tensed and his hips gave a buck as his penis swelled
and started to spasm.  Hot jets of semen arced through the air, landing on
his belly and across Steward's wrist.  Michael moaned deeply and started
sobbing quietly.  Steward felt his heart break for the boy.  Quickly wiping
his arm, Steward went straight to Michael's face and smoothed his hair.

"Shhh Michael," he said soothingly, "it's fine, don't worry, it's a
perfectly normal thing to have happen." Michael appeared lost and lonely as
he sniffled and sobbed.  Steward gently rubbed his fingers through
Michael's soft hair and pressed them gently to the back of his neck.
Steward quietly apologized to Michael and explained that sometimes these
things happened, and to not be embarassed.  Michael's crying eventually
abated and Steward pulled a new cloth from the pack, and gently washed
Michael's face again.  He appeared comforted and gradually, his signature
smile started to return.  He seemed to sense Steward's care and concern and
appeared relieved Steward was not angry.  Steward wondered if this had
happened before with the other nurse, and guessed her response might have
been a bit harsher.  Steward took the remaining towel, and cleaned up
Michael's little explosion before taping the diaper snuggly into place.
Michael's erection had gone its merry way and he was returning to his
normal, ebullient self.

After attaching the feeding tube to Michael, Steward dressed him for the
day. He picked out a nice button down shirt, some black pants and shoes,
and lifted him to his customized chair.

The wheelchair, canted back at a slight angle, with special padding and
rests to help him hold his head upright, looked comfortable enough for him.
He moved his hand to the joystick and slowly moved the chair across the
room and planted himself in front of the television.  Steward held up
several movie choices, and Michael pointed at one obviously well-worn
favorite, and Steward left him to be transported off to the magical world
of wizards and muggles while he took a break to go to the bathroom.

Upon Steward's return, he found Michael had dozed off.  Checking his
breathing quickly, Steward found nothing alarming, and set about changing
the bags in the garbage and laundry bins.  Taking them both downstairs, he
bumped into Carmen.

"Can you tell me where to dump the garbage?" Steward asked.  Carmen showed
him the dumpster just beyond the kitchen door and then attempted to take
the bag of laundry from him.  "I'll be happy to do that Carmen," he said,
"just show me where the machines are."  Carmen paused for a moment and eyed
him suspiciously.

"Are you sure Mr. Nurse?"

"I'm sure," Steward laughed, "why, did the other nurse not do this sort of
thing?"

"Pssht!" she made a dismissive wave,"no way.  She just tell me when the
laundry full.  I got a whole house to keep clean you know?  I'm not her
personal house maid," Carmen muttered darkly.

"Well, I'll be happy to share my part of the workload Carmen, don't worry
about that."

"You know, you keep this up," she said, wagging a finger at Steward, "I
never gonna let you go back, you gotta stay and watch after my Michael for
good."  Steward laughed out loud at that and wagged his finger back at her.

"Be careful what you wish for!"  They both laughed lightly as Carmen waved
at him to follow her through to the laundry room.  As she showed Steward
where to find the detergent, bleach and how to work the controls, they
talked about the four years Carmen had worked for the Deevers.

Carmen found herself immediately warming to Steward.  She fancied herself a
very astute judge of character, and her instincts told her Steward could be
entrusted with Michael's care.  She had lost her own son to an aneurysm
about a year before she came to work for the Deevers, and Michael
apparently was about the same age when she started.  She fully understood
the reasons why she attached herself to Michael, but it didn't matter.
Here was a boy that needed looking after, and she was a mother who needed
to look after one.  Carmen even confessed to thinking about going to
nursing school to learn how to care for Michael.  Steward smiled at that
and told her she should do it.

"Nurses make better money than housekeepers," Steward said, immediately
regretting it, "no offense of course."

"None taken," Carmen said in a mock snooty tone, "besides, the Deevers pay
me good and I been saving my money so I gonna do it someday, you watch me."
Steward did not doubt her, and wished her the best of luck.

While they were talking, Marshall Deevers' sneakers barked against the
tiles, startling both of them.  Marshall stopped at the hallway as he
crossed into the kitchen, and waved to Carmen.

"Hey Carmen," he said cheerily.  She waved him into the laundry.

"Marshall, come here and meet Michael's new nurse," she encouraged.
Marshall dropped a backpack to the floor and walked in, coming face to face
with Steward.

"Oh... hiya," Marshall said extending his hand.  Steward shook his hand and
looked at Marshall in shock.

"Uhm... hi," he said slowly to the boy, "Steward.  Steward Smith."

"Steward Smith R.N." Marshall corrected, reading Steward's nametag.

"Uh..., yes..." Steward stumbled over his words, "I guess that's what it
says..."

"Nobody told you about me, huh?"  Marshall said, with the same sideways
grin I'd seen on Michael.

"Well, I've only been here a short time, I haven't gotten the full skinny
on everything I guess."  Steward said, recovering quickly.  He looked the
boy over; the resemblance was stunning.  If Michael could have walked, you
would have been unable to very well distinguish him from his brother.  "I
didn't know you have CP too."

"Yup," Marshall nodded, "Michael and I are twins, Mom had eclampsia before
we were born prematurely, Michael got the worst of the deal, I'm a bit more
mobile."  Marshall's speech was somewhat muffled by a speech impediment,
but it was easily accommodated by the ear.  Marshall wheeled around and
retrieved his backpack, slinging it up to his shoulder and started walking
toward's Michael's room with a peculiar, swinging gait.  "Come walk with
me, Steward Smith R.N., let's talk."  Steward quickly sprinted to catch up
and matched his pace.

"This is a beautiful place you folks have." Not knowing what else to say,
Steward thought he might try some small talk.

"Thanks," Marshall said, shuffling along, "Michael and I bought it."  That
stopped Steward in his tracks.

"What?"

"Dunno all the details, but Mom was pretty sick during her pregnancy with
us, and her doctor apparently never checked her blood pressure and told my
parents her headaches and puffiness were normal, stuff like that."

"So, he missed the pre-eclampsia?"

"Pretty much," Marshal continued, "then Mom had a massive seizure at home
one day.  They took her to Yale, where they did a C-section, delivered us
and basically saved all our lives."

"So, they think the seizure caused the cerebral palsy?"

"I'd say it's a fair guess, wouldn't you?

"So this," Steward said, widening his arms to indicate the house where they
stood," is the result of a malpractice lawsuit then."

"Oh yes," Marshall nodded, "kept in trust for us until we are 21.  The
trustees of the fund saw to it that we would be housed rather comfortably
and with plenty of help."  Marshall resumed his shuffle up the stairs to
Michael's room.  "I'm going to Fairfield University, but during the
weekends, I care for Michael on the overnights.  Mom and Dad switch off
during the week.

"Wow," Steward whistled, "That's what I call family togetherness."

"Gah!" Michael called from inside his room, he heard Marshall, became
excited and started clapping his hands.

"Gah!" he repeated as Marshall rounded the corner and launched himself at
Michael's chair.

"Hey dude!" Marshall exclaimed, wrapping his arms around Michael's neck and
kissing him directly on the mouth.

"Ma-maarshaaaaalll," Michael drew his name out but it was clear as day.

"He can say other words too?" Steward asked, blinking..

"Of course," Marshall teased gently, "silly."

"SSSSSIIIILLY!" Michael chimed in.  Steward shook his head, it appeared he
was making a habit of undersestimating this family, he was going to have to
stop that.

"How much can he understand?" Marshall stood up and looked back and forth
between Michael and Steward.

"What do you think Michael?" Marshall asked.  Michael looked back and forth
between Marshal and Steward several times, and then finally held his limp
hands in the air and shrugged.  Marshall turned back to look at Steward.

"That has been the subject of some controversy," Marshall said quietly,
"and frankly, the way we've worked it out, not to many people know.  His
last nurse, we never told her."

"Told her what?" Steward was getting confused.  He looked back at Michael,
who was grinning at him devilishly.

"Michael is completely and fully aware Mr. Smith," Marshall said quietly.

"Really?" Steward said, directing the question to Michael.  Michael raised
his eyebrows and nodded.  Steward had to sit down, his bathtime adventure
suddenly flashing through his mind.  A pit grew in his belly.

"So, now that I'm here, I guess you can go Mr. Smith," Marshall started,
but Steward interrupted him.

"Uh, I can't," Steward said, "I'm supposed to be here until 7:oo o'clock."

"Oh don't worry about that, I won't tell on ya!" Marshall waved
dismissively at Steward.

"But, what if the agency calls," Steward asked, "They'll check up on me
because this is a new assignment."

"I'll tell 'em you've gone out to get some stuff for me or something, I'll
make it believable," Marshall assured him, "besides I want to give Michael
a bath, he's probably due."

"I uh, did that already, first thing this morning after I got here."
Marshall turned to look at Steward, his face dark.

"You did?"

"Yes, it's a good opportunity to get acquainted and to do a complete
physical survey.  I assure you it is standard..."\

"No worries," Marshall said quietly, "his last nurse probably wouldn't have
bothered, so I guess that's why I didnt expect it.  He stood there, quiet
for a moment.

"Did I uh..." Steward stuttered, "... do something wrong?

"Oh no," Marshall said, snapping out of his brief reverie, "I just, you
know, I usually do it for him, it's kinda like, our thing, I guess."
Marshall appeared far less the confident college boy suddenly, and seemed
nervous.

"Oh," Steward said, "then, if you want, I can leave that to you I suppose.
It is just part of my normal routine, that's all, that's why I went ahead."

"Okay," Marshall muttered, "S'cool."  Steward still couldn't shake the
feeling that he upset the boy somehow.

"Mmaa-sh-shall," Michael said quietly to his brother, "sssaah-wee".
Marshall's head snapped over to look at Michael.

"What Michael?"

"It sounded like he said 'Sorry'," Steward said.

"He did," Marshall said, turning his head to look directly into Steward's
eyes, "did uh... anything happen during Michael's bath?"

"Hmm, no," Steward swallowed, "not that I can think of."  Marshall narrowed
his eyes at Steward and then turned to Michael, smoldering.

"Michael!" he barked, "did you do it again?"  Steward felt suddenly sick,
and looked up to the exchange between the boys.  Michael's eyes were
filling with tears as he nodded, his lower lip wobbling.  Steward stood and
rushed to Michael's side.

"Hey stop!" he exclaimed to Marshall, "it wasn't his fault, it was an
accident, that stuff happens sometimes, he can't control it."  Marshall's
features softened.

"Oh I know he can't," he said quietly, "I've got the same sort of
hair-trigger."  Marshall hung his head.

"Really?" Steward asked.

"Oh yeah," Marshall said, nodding, "I get wood at the drop of a hat and if
I'm not careful, I'll jizz my pants just from the fabric rubbing on it.  It
can be very embarassing."  Steward nodded silently, allowing that it
certainly would. "So..." Marshall continued, "you didn't mind?"

"Nope," Steward shrugged, "like I said, no big deal, happens all the time."
Marshall appeared visibily relieved.

"Meh,." Marshall grunted devilishly, "I wish I could get my own personal
nurse to take care of stuff like that."  Steward looked the boy over, and
before he could stop himself, he spoke.

"Since you both have CP, I could make this a dual trip, and see to your
needs too."

"Really?" Marshall turned to him slowly, "do you mean that?"

"Sure," Steward shrugged, "I'm here, why not?"  Marshall grinned at Steward
once more, but this time, wih a far different look on his face.

"Alright then," Marshall said, "I guess now would be good..."  Steward
glanced down to see the front of Marshall's pants sticking out around 2 to
3 inches.  Steward grinned and began to think about how this just might
turn out to be a perfectly lovely assignment .