The Fifth Horseman

 

 

 

The Roof Part 1

If there is one thing anybody who works in a hospital will agree to, it will be the fact no day ever feels the same. Some elect the various jobs in tertiary healthcare for that exact reason, and in Dr Lily’s ward, some days can get particularly capricious. This was always one of if not the biggest challenge for hospital personnel especially the house officers.

Sheila had a task-list like most of them did and, as always it was prone to amendments. Things change, patients crash, people complain, new admissions take priority, iv lines leak and some nurses wouldn’t get off your back until you had changed it for them. Some say the very definition of housemanship is basically to always be on top of your task-list and that was pretty much it but still it was no easy feat.

Sheila was trying very hard to set her patient’s iv line. She had no tool to image her veins like in private centres, rather it was part of the training do it the old fashion way with a more tactile approach like feeling for the veins and mapping their course before puncturing a 18G cannula into the cephalic. Unfortunately being a kidney patient meant Mr Ahmed’s veins were no longer as youthfully healthy, bouncy and compressible as they once were rather collapsed and stretchy like an old deflated party balloon. She had 3 more of such lines on different patients that needed her attention but his was most important as the ice box that carried the next pack of blood were ready to be transfused.

‘We’ll check it together?’ the nurse politely reaffirmed preparing the forms on the table waiting eagerly for Sheila to finish up. Each time she punctured through his skin he writhed in pain and it only discouraged retries. She knew not to get frustrated and more importantly not to frustrate the patient. She promised one last try and after letting him catch a hold of his breath, they decided to for another try.

‘BINGO’ she said excitedly, Mr Ahmed sighed in relief so loud that it made the nurse smile. ‘She’s a good doctor,’ she said. ‘Yes, yes she is,’ he replied. Sheila replied with a bashful ‘Thanks’, took off her gloves and proceeded to help check the blood products and fill in the necessary forms before she moved on to the next patient. The nurse told to leave. ‘I’ll handle it,’ she said and Sheila grabbed her shoulders and thanked her before moving on.

At 8am sharp, she realised she had no more urgent duties, so it was finally time to get back to patient reviews. She noticed her colleagues unceremoniously leave instead of doing their own work. ‘Why?’ she called out.

‘Meeting! Dr Richard is demanding full attendance,’

That only meant Sheila had to go as well and if not for beeping of the cardiac monitor behind her, she would have. ‘Desat! Desat!’ the nurse cried her eyes transfixed at Sheila. For a brief second, the young girl was blank, not knowing what to do and if the training thought you one thing, it was how to snap right back. She threw her coat on a desk chair, gloved up and made haste. It was Mr Ahmed again, but now he was holding on to his chest.

‘ECG?’

‘He can’t breathe,’

‘Fine, O2 first, get him on high flow, and get an ABG, sublingual nitrates, then ECG.’

The nurses starred back at her. ‘STAT’ Sheila asserted.

‘You’ll have to do the ABG,’ someone around commented.

‘Yes, I am aware of that,’ she replied without looking at whom. ‘I’m sorry Mr Ahmed, I have to poke you again,’ he nodded gasping for air while they brought him a ventilation mask to fasten.

**

‘Everyone here?’ Dr Richards surveyed the crowd who showed up to the small room in front of the ward. It was where they usually had little tutorial sessions whenever there was a little free time. The heads of department always stressed that teaching sessions had to be a part of regular practice. Despite specialists having varying opinions on houseman gatherings, meetings and tutorials, they still loved doing it.

‘Sheila is still inside, handling a RESUS. 3 people are not working today, and another 3 are having evening shifts,’ said Lokman, the elected houseman leader for their current batch of interns.

‘RESUS?’ Dr Richard queried, ‘What’s the case?’ and the response was a predictable silence because nobody actually knew.

‘Well it’s alright,’ he continued, ‘she’ll handle it. The Medical Officers are having their own meeting this morning and if she needs any help she will call one them.’

The crowd of tired, sleep-deprived house officers now back for their Monday morning shifts nodded in unison. It was a familiar rhetoric so much so it had lost all its meaning. This was going to be one of ‘those’ speeches. They crowd wondered who screwed up as to necessitate this meeting and waste everyone’s time. He went on and on about responsibility, how to respect the oath, not let personal judgements get in the way and how to always look out for the patient. ‘Personal wants are always by any means secondary’, and that was the motto. However, not all what Dr Richard had to say that morning was to be considered as ‘same old, same old.’

He added a caveat which was more a personal experience, of how even he messed up once, and he called it his one and only. ‘When I was 24, I started my housemanship, and it was in the north of the country in an old shabby looking hospital. My patient came in with abdominal pain, and he was young, he had a slight fever and we were sure it was an appendicitis. We even removed it for him. That night, I was busy, and I had it rough. I don’t remember why exactly, but I do recall I was feeling very bad for an insult someone had just made. I tried to get myself 2 hours of sleep, and I told myself 2 hours would be enough.’ Dr Richards noticed the crowd regaining interest in his story.

‘The phone rang, twice and I didn’t realise it. The only reason I knew later was because of my Medical Officer and how he blasted the door open and hurled me out of bed. “HE CRASHED, and here you are sleeping. You’re not being paid to sleep,” he said. That I remember clearly. We rushed to the patient and booked him for a laparotomy. It turns out we didn’t fully get rid of the whole thing the first time and his peritoneum got infected. There was a huge outcry soon to follow, and maybe even a lawsuit if I’m not mistaken. But I was an intern and we are not liable for anything. That’s why it’s so good to be you guys. Nobody actually blames you. But that doesn’t mean you can go around consequence free like it’s freaking Woodstock.’

‘Woodstock?’ one of the attentive house officers managed to hold in his laughter, ‘How old is this guy?’ he mumbled under his breath.

‘What I’m trying to say is, actions have consequences. Mark my words kiddos, you will all have your first kill and take that quote with you to the grave because it is true. You will feel pain and you will feel remorse, but that’s what separates you from a sociopath. Otherwise, nobody is going to trust you and neither should you yourself. When you learn to discern this, then you will feel the actual weight of the stethoscopes around your necks.’

The house officers were enthralled and not an eyelid was closed shut.

‘Well I said what I needed to say. You’re all dismissed.’ Dr Richards ended before exiting the room and the ward altogether heading back to his office.

**

‘What did I miss?’ Dr Julie rushed in shocked at all the clamour. Sheila was on top of the patient, performing chest compressions. Dr Julie quickly read the room, told all non-essentials to leave and stared at the cardiac monitor.

‘Your chest compressions aren’t doing anything. Look the rhythm is still flat,’

Sheila nodded but she was getting tired herself. ‘Get off of him,’ Dr Julie commanded, ‘you’ she said pointing at another house officer just back from the meeting, and urged at him to take over.

‘So, let me guess, Type II allergic reaction? Or was volume too much for him to handle? What’s the pre transfusion Hb like? And when was the last dialysis?’

Sheila held on to her knees trying to regain her breathing, her index finger raised demanding for a second.

‘2 days ago was his last and he is due for transfusion tomorrow but he has been having symptomatic anemia with very low blood levels so it was Mr Abdul’s decision last night was to transfuse him. Pre transfusion Hb was 4mg/dl.

‘So why this now?’

‘I don’t know,’ Sheila replied

‘I do,’ Dr Julie flipped through the forms and noted something. Sheila studied Dr Julie’s expression, and it did not look good for her.

‘Get out!’ she yelled. ‘He’s no longer your patient.’ Before Sheila could answer, she took out her cell phone and speed dialled the anaesthesiologist. ‘Sheila, what did the ABG show?’

‘Respiratory failure Type I,’

‘Are you’re surprised?’

Sheila bowed her head and left quietly. She wiped away her watery eyes and went back to her task-list.

About an hour had past and Sheila noticed a multitude of people in scrubs carrying Mr Ahmed on to a stretcher. Intubated, sedated and with a cardiac monitor on, he was going to be transferred into the ICU. The nursing staff handed over their notes passing a quick glance toward Sheila’s direction before uncomfortably looking back.

That evening the rainfall was heavy, Sheila just sat quietly in her car watching the vipers repeatedly clear the windshield. She recalled her psychiatric patient from last week and the conversation they had once.

‘You’re very beautiful,’ Sheila had remarked and the patient, who was called Suzana instantly opened up to her.

‘Nobody calls me that anymore. Not even my husband. You think after 10 years of being married he wouldn’t have had the balls to cheat. And he knows how I am. I yell, I throw things but I never meant harm. And look, here I am,’ she tugged on her restraints, ‘proving him right.’

‘Men have a way of driving us crazy huh?’

‘It’s not men, just our expectations of them. You don’t think things change. You never think on your wedding day that the man you are marrying is not going to be same guy 5 years from then, after 2 children, a mortgage, and everything else that comes with it.’

‘But he cheated on you though, and you’re Muslim. He could have just been honest,’

‘Yes, he could have, but that’s the point. He didn’t want another wife. He can’t afford our own house. I don’t think he even liked her. He just wanted this to end for good. And I played into his old act. He triggered me and I fell for it.

‘All you did was punch him, I saw him yesterday when he visited, it didn’t look so bad,’

They chuckled.

‘How about you doctor. I sense that other Indian doctor seems to have something for you. I don’t know if you see it but it’s pretty obvious from where I am lying,’

‘Who? Ram? No! He’s just a very good friend,’

Suzana smiled cheekily, knowing she got the hint.

‘I just want this whole damn internship to be over,’ Sheila changed the subject.

‘It will, and you will become like that angry lady who has her minions around her all the time.

‘You’re mean,’ Sheila retorted trying not to smile.

‘I’m serious, maybe introduce her to my husband, one desperately wants to get laid and another really needs to,’

Sheila gave up on containing herself and just excused a soft chuckle. ‘So, what are you going to do now?’ she casually asked.

‘I’m going to keep trying,’

‘At your marriage,’

‘No, that’s over. I’m not going stop trying to end my life. I tried poison, I tried rope Let’s see what’s next.’

Sheila’s face suddenly changed and Suzana noticed her slowly reaching for the charts.

‘I’m sorry Doctor for yelling at you that day,’

‘Hey I told repeatedly that it’s ok,’ Sheila responded as her eyes scanned through Dr Satya’s recent entry. ‘Borderline Personality, Major Depressive and a bunch more complex psychiatric lingos scribbled everywhere.

‘You have that look,’ Suzana expressed.

‘What look?’

‘The patronizing one. Now you are going to talk to me differently, and you think I wouldn’t know the difference,’

‘I am not your doctor, so we can keep talking about things just like anyone else,’ she closed the folder and kept it back on the table. She reached for the seat next to her, folded her white coat forwards and sat.

‘How does it feel, just before you do it?’ Sheila asked, inquisitive.

‘Freeing,’ she continued, ‘just for second, absolutely freeing.’

**

Sheila paced from left to right in her apartment. Jenny was not home, and God knows what the boys downstairs were doing. She had sent random messages in their text group but the only reply was from Tzen and that too was just a ‘thumbs up’ emoji. She was embarrassed at what had happened and wasn’t really in a sharing mood. However, she needed a distraction and since she couldn’t find any she took one look at her hand tremors and decided for herself.

‘Ok, I got to find out,’ she spoke aloud before changing her shorts into some long pants and grabbed her car keys. She needed to get to the ICU, and look for herself.

She sped on the highway, and when they police stopped her, they let her go with a warning on the account she had her stethoscope hanging over the rear-view mirror and her documentation were up to date.

She eventually reached the hospital, took the elevator to the 1st floor, approached the wing that was the ICU, changed into scrubs, swung her access to card to the reader and was granted access in.

She found him lying in a separate cubicle, glass walls everywhere in a room just for him like all the other patients there. ‘And you are?’ the nurse in charge of Mr Ahmed had a keen eye and noticed very quickly that this doctor had no business being here.

‘He’s from the ward. Can I know his condition?’

‘Oh so you’re Dr Sheila,’ she commented with slight condescension in her tone.

Sheila paid no heed. She rummaged through the nursing counter top and found the folder she was looking for.

The diagnosis read, ‘Fluid Overload and Acute Hemolytic Reaction possibly due to blood transfusion error,’ and she felt the blood leave her face. She waved her arms around until she found herself a chair to rest while she gathered her thoughts. She kept flipping the pages, trying to find anything that resembled progress in terms of his management.

‘He’s alive,’ a voice sounded from over her, ‘that’s all we have for now.’

Sheila looked up to see Dr Yong, the anaesthesiologist on-call.

‘I’m sorry,’ Sheila winced, about to burst into tears.

‘Get up girl,’ her maternal voice so inviting that it conned Sheila into anticipating a warm embrace. ‘Look outside that glass door,’ Dr Yong showed to the exit. Sheila saw a huge group of anxious visitors looking past the glass, some of them familiar from ward visiting hours. ‘What do you think about them? The things we had to say to them to calm them down. How do you think they feel about this, especially those two little ones running around, not really ready to accept that daddy’s hanging on by a thread?’

‘I’ll apologize to them,’

‘NO!’ Dr Yong warned, ‘you do that and maybe we’ll have to undo that damage too. Just go home and get some rest girl. Are you working tomorrow?’

‘I have to be back by 7am.’

‘Then get some sleep. Enough rest and maybe you won’t be making any more mistakes I hope.’

Sheila watched the children play, unlike everyone else around them drowning in worry, She was envious of their carefree look toward life. She washed her hands and approached Mr Ahmed, now hooked to a respirator, on IV fluids, adrenaline and steroids. She patted him on the shoulder. ‘I’m sorry,’ she said. ‘You’ll get through this. Please do. Please, please do.’

She walked out without passing eye contact to anyone and instead paced hurriedly to the elevator when the bell rang and the door opened with impeccable timing. Her heart stopped.

‘Dr Julie,’

‘You going down?’

‘Yes,’

‘Come in,’ she ushered her in while Sheila swallowed her pride.

The door closed before them and Sheila immediately noticed that no buttons were lit. It was clear that this was Dr Julie’s floor but she had now changed her mind.

‘I thought better of you girl. I mean you had the makings, and you could take the criticism. But today you broke, and a patient suffered for it.’

‘Yes, you’re right.’ Sheila accepted. Dr Julie reached for the ‘G’ button on the elevator.

‘Honest to God, I don’t think this carrier is working out for you. Stupid things like reading a 3 for an 8 on a form is just too juvenile and frankly too dangerous. Please consider quitting, and I mean that as a friend.’

The bell rang and the doors opened again facing an empty corridor leading to the ground floor lobby. Dr Julie walked out first, ‘you’re not coming?’ she asked politely. Sheila shook her head, trying to swallow a huge lump in her throat. The doors closed when she clicked ‘4’.

**

The night was cold after the rain, and the winds were colder. Sheila needed to clear her head. She was back on that roof where the cement was moist and cold fresh after the rain. She hugged herself while shivering and approached her favourite part of the balcony, where full concrete were interspersed with steel railings, all merely waist high. She pressed her hands on the cool hard cement and then she moved to the railings. She peered how low it went over the edge.

Her heart raced, because she knew she wanted to try it and virtually nothing was stopping her at this point. The thoughts were bothering her, and the silence was slowly eating her up. Her phone not even beeped once. She conservatively got barefoot first, but then decided to strip down all the way to her underwear. She pulled herself close and slowly rested her hip on the railings, her left leg reaching out first. She steadily found footing on the narrow part of the ledge on the other side. It was still a moist but she was stable, then slowly she moved her right leg.

Her thoughts raced even more, the winds blew haphazardly and made tiny rattling noises as it brushed again the metal. ‘Free, just for a second,’ she thought to herself before she carefully stood, lifting her bottom off the railings, she was solely supported by the heels on a narrow ledge with nothing else to hold on to.

‘Stupid’, ‘juvenile’, ‘miserable’, ‘idiot’, ‘dark’, ‘fat’ and countless other words popped in her head. The wind slowly kissed her from behind. Her left heel slipped, and her back grazed on the railings on her way down. She quickly turned trying to grab hold of something. ‘Ahh!’ she screamed as her right hand had skipped three bars down to the last railing of which she held on tight. She moved her hands slowly progressively reaching upward, grabbing bar by bar and slowly despite the abrasions over her knees and ankle, she found the strength to flip herself over and drop back on to the balcony.

She cowered in the cold as her skin froze, holding her knees closed to her chest and laughed maniacally. ‘Was that how it felt? To not have any more strings attached and to completely let go?’ The rush ended in seconds, and then she started to tear, and the more she allowed herself, the more tears came rushing through. She just sat for minutes on the cold cement crying, moaning and wailing all to herself. Alone.

Did she reach a dangerous threshold that day? Was there no coming back from it? She would deny it ever happening but she knew deep down that this was her first attempt.

 

Even now, Dr Satya would sit in his office thinking of the conversation he had missed, of how his patient bonded so easily to the house officer before he showed up, and all the conversations they had without him since. Should he have done something then?

Should Jenny have answered her phone, instead of discovering love over candle light in restaurants? Should Daniel have never taken her away from her friend? Should Ram have had the courage to start a meaningful relationship with woman he had a deep crush on? Should have any of them called back or texted anything just to know what was going on?

These questions torture people each at its own way. Everyone has coping mechanism, and everyone finds a reason to move, get up, and ambulate, but not necessarily in a healthy way.

**

Ram understood that he was compelled by sheer anger and vengeful hate but he was not willing to let this just die as old news in print and social media. So he did what he thought was the next best thing and that was to park his car outside the mansion over the hills, and keep watch every single night far from sight.

Mr Jamal brought home to his empty house someone new that night at about 1am. It was young petite looking girl, athletic looking and dressed in a sensual nightgown. Ram took out his phone for a better zoom and got all the pictures he needed for his catalogue. With his binoculars he spied on them as they entered the living room and the lights the turned on along with that of the bedrooms’ as well. Ram sneered, ‘That’s right, do something motherfucker.’

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About BreakingBone

Health professional, writer, media enthusiast, food & fitness lover, modest traveller, loves life & making figurative lemonade outta everything