The Fifth Horseman

architecture daylight door entrance

During my time

The night was cold and winds were howling, just as the forecasts had predicted. The city had endured multiple flash floods in her day, and the news anchors were warning civilians to take early precautionary measures.

Dr Satya found it hard to sleep. Both his five and two-year-old sons crept up with the couple in their bed and Dr Satya found himself heading to the kitchen in the middle of 3 am to get a glass of milk.

He noticed the palm trees outside swaying violently.

Dr Satya had given up on sleep and headed for his study.

He switched on his little vintage desk lamp and started to go through some of his case files, just reading up on old history to see if there was anything he had missed. Tzen’s report was on top of the pile and along with that clipped to the side, the drawing the boy had made in his first session.

He then proceeded to scan the insides of his desk drawers, just to see if he could find anything of Sheila’s there.

After much scurrying, he finally found it. It wasn’t a thick file, and it just had two sheets: a short history of who she was, a little bit about her personality and the problem she was having and another sheet; her drawing of a tree.

He peered deeper into the details. It was a lush tree with some hefty bark. It was deeply rooted and many had a cascade of branches on top with many concentric rings over the trunk at the bottom. There was even the detail of a hollow segment in that a bird’s nest would lay. He kept the paper down and started to read the notes.

‘Dr Sheila Thomas, 27 years old, Indian ethnicity, no known medical illnesses,

Premorbidly attentive, extroverted, normal social spectrum.

Chief complaint:

Feeling sad for the past 3 months

History:

The patient complains that the workload has been making her upset, worthless, and unappreciated for the past 3 months. She has been coming late, eating food at odd hours, voluntarily. She skips meals as part of her diet and does minimal exercise whenever she can.

The patient complains that she has been moody, scolds her staff and colleagues, and is paranoid that others are “out to get her”.

She used to enjoy hobbies, such as running in the park, swimming, diving, piano, yoga and reading. All of which she says she can’t quite devote time for any longer due to the lack thereof as well as a general disinterest and fatigue.

Patient claims she has had no ideation of self-harm or suicidal thoughts.

Otherwise,

She has received numerous complaints from several staff members regarding coming to work 5 to 10 minutes late on a daily basis, sometimes up to a month, smelling of tobacco after lunch break, being hypercritical of ‘Muslim’ doctors and their prayer habits, having problems with authority, and wearing clothes not appropriate to the dress code.

Has one record of mismatched blood transfusion in which she administered the wrong blood pack of B+ve to an O+ve patient due to an error in checking the serial numbers and going against the standard of procedure.

Contrarily, she has also received accolades for getting work done quickly, being a people person, empathic, numerous patient satisfaction reviews, exceptional documentation, and having a very pleasant attitude all around.

No significant family or social history pertaining to the current complaint. Only claims that parents were strict during upbringing. She always had to be studious, in shape and have a good complexion, of which she found herself never up to par. Had a history of using several fairness and beauty products as well as slimming pills. No history of ever having any anorexic of bulimic behaviour.

Grew up Christian, however, does not practice religion regularly.

Had many small circles of friends at different periods of life. Had one high school boyfriend from Form 4 to Form 5. No serious relationships since and not currently sexually active.

No tattoos, no history of switching between jobs or prolonged unemployment. Social drinker and according to her, does not smoke nor has dabbled with illicit substances.

Mini-Mental State is a pass. Slight obsessive-compulsive personality.

Conclusion:

No significant medical/psychiatric disorder, possible dysthymia, stress related.

Plan:

For further therapy sessions fortnightly. No medications or sick leaves required as per the current assessment.

 

Dr Satya closed her file. ‘What a load of crap?’ he thought.

‘She was playing me.’

He smiled while he fixated his tired gaze on the entrancing glow of lampstand.

A shadow crept, and quickly he was distracted. A warm figure approached from the rear, extending what felt as familiar arms around his shoulders and gently embraced him. Dr Satya held her hands and played with her gentle fingers.

‘You never really lose sleep over a patient. The last time I’ve seen you do this was before we were married.’

Dr Satya smiled. ‘Well, I guess I must have been very content then,’

She chuckled. ‘Always the charmer,’ he stroked his greying locks. ‘If it takes you away from me, then it must really be something,’ she peered at file resting on his desk. ‘Isn’t that the houseman who…’

‘Yes,’

‘You’re still blaming yourself,’ she lifted herself on to the desk and stared right at him. ‘Don’t let it become an unhealthy obsession. We have been through this before. You can’t be that person again. I am not strong enough.’

Dr Satya felt a pang of sudden guilt creep from his past. ‘No, no, no… please don’t worry. That was a different man. That was a different case.’

‘He came into our house and threatened our first born,’

‘I know. I was still a Masters student then, and the one thing I couldn’t see was the thin line between work and home.’ He stood up and approached her while gently wrapping his arms around the silk over the small of her back. ‘You made realise that. I won’t let anything like that happen again. I promise,’

‘So, what are you going to do?’

‘I can’t just drop it. She’s was just kid you know, and she had so much pain. I mean we’ve all been there. You have as well. I had sessions with her, I spoke to her, and I thought I built a rapport, but turns out I failed her.’

‘Oh please, ours was a different time. These kids can only imagine what we went through, the scars we kept.’

‘True.’ Dr Satya massaged his tired eyelids. He looked at his forearm, caressing an old scar.

His wife got up to kiss him, thrusting her body against his, with a palm stroking his cheek, and the other hand fiddling around the underside of the desk until she found the switch for the lamp and flipped it off, turning the whole place dark, cold and romantic.

 

**

 

The 80s were a very different time. Computers were a new fad and hospitals were just beginning to embrace it. Smoking as a trend was now losing traction, but its supporters were plenty and some of them were Dr Satya’s own specialists, still conducting rounds with sticks burning between their teeth.

He was just 2 years into his postgraduate training, and despite loving the field, the one place he absolutely hated was the psychiatry ward. He hated just sitting there, watching the others taunt him. They weren’t like other patients as they didn’t exactly exhibit clear cut physical symptoms of weakness, rather they were more unpredictable. They laughed, cried, screamed and assaulted people without a clear purpose. Things went always prone to go wrong, but nothing quick sedative and some shock therapy couldn’t fix. Technology had come a long way from shamans and frontal lobectomies.

Dr Satya as per usual was sitting by the nurses’ station, on a lonely night finishing up paperwork. There was this one patient he absolutely detested. The man was a schizophrenic and his “alter-ego” as he would call him would tell him to do the strangest things like hitting the person next to him or turn on the television with the volume cranked up. This day though, the man just sat on his bed, looking down, paying attention to no one.

The nurses were afraid to approach so they told Dr Satya to have a look. It was creeping them out as he annoyingly kept growling imitating a rabid animal.

‘Hey, Ramli?’ he called out. Ramli didn’t budge.

Dr Satya braved himself to get up and approach.

‘Ramli!’ he called out a few meters away. Ramli’s eyes were wide open but kept his posture the same, growling.

‘Ramli,’ Dr Satya nudged his shoulders.

Immediately, the patient grew hostile and opened his mouth wide open. All his teeth were visible, sharp and yellow tinged. He bit straight into Dr Satya’s arm.

The doctor screamed in horror as he defended himself by using his other arm to punch Ramli repeatedly in the face. The patient didn’t let go until a group of male wardens rushed in to help and free the doctor while holding the patient down.

The bite wound was deep and he had to undergo a small surgery along with some intravenous antibiotics over the next weeks.

 

**

 

Tzen’s testimony had made an effective impact on the psychiatrist. There was this renewed interest he suddenly had on the case of Sheila. Much of his interventions post-Sheila’s suicide were immediately put on hold by the Director once she realised how much traction it was getting from the police and media. ‘There was no reason to keep digging what was already a closed case,’ she told him. Still, people were actively trying to see if there were individuals to hold culpable.

Dr Julie had just completed a subclavian line insertion for her kidney patient, and her back was killing her. She escaped to the pantry for a coffee and some sandwiches. It was then that she was surprised to see Dr Satya just sitting there, alone by himself In front of the small table, looking at tiles on the wall.

‘Am I interrupting something?’ she opened the door of the fridge and removed a microwavable box.

‘No, please, go ahead,’ he replied, watching her place it the microwave and wait.

‘You don’t have any patients here,’ Dr Julie replied. As soon as her meal was ready, she sat opposite him, took the lid off and started to bite into a tuna sandwich, just the thickest of spreads.

‘How often do you actually see housemen in here?’

‘Not as much, they usually work through lunch,’

‘You ever think back about how It was, back in our day? Well, your day I mean?’

‘You mean…’ she paused to swallow, ‘back when I was a houseman?’

She paused to chew then continued after forming her thoughts, ‘During my time, I did everything, not just part of the work. I was one setting the central lines, but now, I’m still doing that. The kids these days are just so damn coddled. They don’t learn anything anymore.’

‘Yet we trust them to care for our sick, and after two years we call them colleagues regardless,’

‘Sad fact, yes,’

‘We were so different?’

‘Oh come, Dr Satya, of course, we were. We took care of entire wards, we knew every detail of our patients, and we did whatever we could for them, even with our limited resources. Please don’t compare. I don’t want to say it, but the millennials have it good.’

‘And yet that Sheila girl died. And in some other place, another medical officer gets into a fatal car accident after a tiring shift. Some quit, some go into depression and start seeing people like me,’

‘Well, it’s part of their millennial upbringing maybe. If you can’t hack it, don’t join. I’m not generalizing but…’

‘But you are,’ Dr Satya coyly smiled.

‘Seriously,’ Dr Julie paused for another bite of her sandwich, ‘why are you here Doctor? Is there a patient coming up?’

‘No, I just wanted to know what the fuss was all about those sandwiches you are having right now,’

‘Here,’ she offered him some to try but he politely refused.

 

**

 

The 90s were a considerable step up, as Malaysia embraced a more modern outlook, hospitals started to embrace a warmer more customer friendly approach compared to the more medieval façade it used to have. Still, patient loads and complaints were all the same.  For Dr Julie, her houseman years were another level of ‘hell’ as she would say. She would arrive at work by 3 am, and start wracking her brain trying to memorize her cases, sometimes even wake sleeping patients up just so she could do her morning rounds before the break of dawn and stroll her cart along from bed to bed with her needles and syringes for blood taking,

She fell asleep once in front of a patient, just before wrapping a tourniquet around his wrist to look for a vein, her eyes forced her just take a few minutes of slumber and hours later she woke up, cursing about frantic.

‘Shit, what time is it?’

‘Fuck, 6 am?’

She immediately started to rush her work. ‘Surprise, surprise. No breakfast again today I guess,’ she told herself and quickly readied the charts for rounds. She ran down to the lab to stand in line for “the computer”, the one place to quickly trace lab results. This area was always a marketplace, each house officer bargaining to be first in line, each with their own sob story on why they needed to be first. Dr Julie understood the game and she played her part equally well.

Still, rounds were as petrifying as any other day. Her specialist, Dr Frederick, a Middle Eastern migrant was not the nicest person to be around. He was what everyone called a grade-A pompous prick. He was arrogant and a huge pervert. He would grope the nurses, give unnecessary hugs and to house officers, he treated them as, in Dr Julie words, ‘unpaid slaves’.

He would make them wash his car, take his laundry, buy him dinner in expensive restaurants, all in the promise of giving them a good credit by the end of their rotations. There were three rotations back then, and the internship was just a year instead of two but the torment all the same.

That particular day, Dr Frederickson was not in a favourable mood. He had come to work sour, and he yelled and made a fuss in front of each bed.

Dr Julie rushed upstairs with her lab results written on her piece of paper.

It was her turn to speak, to present the case of her patient; a 19-year-old female with acute appendicitis, who had severe right abdominal pain from the night before.

‘Err…’ she stammered, ‘we have a 19 year old, female who came to us last night with central abdominal pain that radiated to the right side. There was accompanying fever…’

‘Stop!’ he shrieked. ‘What else about the pain?’

Dr Julie stared blank. ‘The pain…’

‘Yes? What about the pain?’

She knew she prepared the case well, but there some key points that were incomplete in her history, dismissing it as insignificant details. Nonetheless, Dr Frederickson did not approve.

‘I didn’t ask her,’

‘YOU WHAT?’

‘I’m sorry Doctor,’ he retracted, her face looking down she moved back. The patient started to laugh, each contraction sending out excruciating pangs down to her lower abdomen.

‘I know right,’ Dr Frederickson smiled at the patient, ‘I’m sorry you have such an incompetent excuse taking care of you today.’

‘JULIE?!’ he yelled.

‘Yes,’ her voice shuddered.

‘JULIE?’

‘Yes Doctor,’ she repeated herself with chest up.

‘What are lab results like? Come on, redeem yourself,’

‘There’s a problem with the computer downstairs,’ Dr Julie was a nervous wreck. She was sweating from all pores, her face drenched. ‘Please just stop asking me anything else anymore,’ she prayed.

‘I can’t believe this. So how I am to be sure this is appendicitis? You lying to me?

‘No, Doctor,’ Dr Julie defended.

‘Look,’ Dr Frederickson grabbed the chart from the cardiac table and started to flip through the pages one by one. ‘It says here she’s planned for an ultrasound. Are you aware of that? Do you even understand the urgency of this case?’

‘Ultrasound? So that’s what that weird squiggly handwriting was trying to say,’ she scolded herself.

Just before she could answer, she looked up only to realise the actual physical chart was coming her way fast, along with loose papers flying about before it hit her hard against her nose bridge and fell to her side. It was comical and some of the others could contain their chuckles. However, it wasn’t funny for her and many others like her, rather it was painful and utterly humiliating.

‘You are extended, no questions asked. I need you to prepare a talk on appendicitis this evening. Seriously, you people have it so easy, an ultrasound, CT scans, computers to look up data and still such sorry excuses. Just quit already will you?’ Dr Frederickson stormed off the next patient without batting an eye to the house officer sobbing, her feet planted exactly where she stood, wiping off her tears frantically before any reached the ground. She was exhausted, had nothing to eat for the past 5 hours and after all of this, frankly felt like shit.

‘JULIE!’ another voice yelled. ‘This doesn’t mean you don’t have to follow rounds. Just walk it off and stop crying like a baby,’ another Medical Officer scowled.

‘Yes, Doctor,’ she replied while an empathic colleague handed her some tissues and a pat on the back before she got back in line with the rest.

 

**

 

Dr Satya stared long and hard at his engraved name on his door.

‘Dr Satya?’ one of his Medical Officers stopped him, afraid to probe any further.

‘If I could meet my younger self, he wouldn’t believe how far he’d come, don’t you agree?’

She started awkwardly smiling. ‘Hopefully, we’ll get there someday too doctor, with your guidance that is.’

‘Guidance,’ he ominously replied before pausing, then quietly walked into his office.

The Medical officer stared back at her colleagues behind her. They all shared confused expressions, each with their theories on their boss’s downward spiral. ‘Brunch guys?

‘Oh my God, I was thinking the same thing. Where to?’

‘I’m stuffed from breakfast actually. But why not?’ another replied and soon plans were made and a hearty brunch they had.

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