The Fifth Horseman

It’s not appendicitis

Nurul took a long hard stare at her wallpaper. She wasn’t sure when she put it up, but there was a time when she cared about interior decorating. ‘How many years has it been?’ She wondered. A doe-eyed constable in uniform, all those nights manning roadblocks, eyeing weary drivers, catching some or none at all. She took a long journey to get to where she was. It made her wonder about the girl that picked the wallpaper and whatever happened to her, to shape her in such a way that 25 years down the line she would hardly call it self reflective. This was not her. ‘How boring,’ she jeered, alone by the edge of her mattress.

Her pants pocket vibrated, sending a soft hum over her thighs. She removed her cell phone and was immediately tickled when she saw the text message.

‘I might know a way…’ it read from Jenny, the eager house officer now aligned with Nurul on the case of the death of her friend.

***

Daniel woke up to a shock. Though it was just a nudge on his ankles, his overwhelming exhaustion had put his mind his a stuporous slumber so deep, it felt like he was a giant being toppled by another giant, bearing the weight of the world on his every joint. He lumbered up as he heard in the distance the screaming wails of the ambulance sirens. Red-zone had a patient and it was part of his training that no matter what he would be there.

He forced his knees to hold him, carry him to the sink and swiftly he washed his face and gargle his mouth. ‘Allah, save me,’ he chanted as he barged out the door of their tiny in house sleeping quarters and into the bustling Emergency Department.

It was Daniel’s 4th week, and he had to be ready at all times. That was just how Emergency was. The paramedics hurriedly regurgitated a handover. ’35-year-old female, driver, skidded over the freeway, carrying 2 other passengers assumed to be her children. She suffered memory loss, bleeding from her scalp, and is having a tender neck. Otherwise, her GCS is fluctuating around 10.

They kept her on a collar. Daniel proceeded to make an exchange with the patient. She kept mumbling phrases and Daniel grew suspicious. He assessed her pain and noted her eyes were closed the whole time.

‘Ma’am, ma’am?’ He yelled. He couldn’t panic. He called for the crash cart.

‘I’m going to intubate,’ he yelled, before glancing over to his superior watching in a distance. She nodded, giving him her blessing and the boy promptly attempted to stick the endotracheal tube down the patient’s throat.

After two failed attempts going down the wrong track, he was already perspiring profusely from his brows and the crash cart monitor kept beeping faster and faster. He calmed himself down, chanted a little prayer and tried one last time.

It was in. He blew a sigh of relief. The nurse immediately connected the tube to the ventilator. ‘Great job Doc,’ one even passed flattery.

Daniel quickly rushed to the phones. He called the Imaging department for a head CT along with the Neurosurgery Medical Officer on-call.

He stood minutes later watching events unfold. The Neurosurgeons went back and forth on the CT films and the arguments on both sides were interesting to watch.

A loud lip whistle distracted Daniel.

A senior called him over with just his fingers. Daniel obliged.

‘You done over there right?’

‘I want to see how it plays out,’

‘You made your phone calls. Now it’s their problem.’

Daniel frowned. He wouldn’t care for such an attitude.

‘You judging me boy?’ He laughed. ‘Why don’t you answer to the hundreds waiting outside of Green-Zone.’

The superior had a point. Daniel peered passed the window only to see countless waiting in line to see the doctor. If there was something Daniel learned in his almost two years as an intern; seniors do know better. So it’s best to hear them out first before drawing conclusions, no matter how right he may be.

Daniel rushed to a table, checked if everything was there and buzzed in 2035, the next one on the list.

In came a lady, in her mid-40s, with a jacket and a ponytail, holding on to her lower abdomen.

‘Where does it hurt Ma’am?’

‘Miss…’ she corrected. ‘And call me Nurul,’

‘Sorry, Miss Nurul. You mind if I quickly assess you?’

Daniel appreciated that the abdomen was most tender at the lower right.

‘Your blood values are normal and your urine is normal as well. You mind if I do a quick ultrasound?’

‘I’m sure there is not a baby in there Doc,’

Daniel cackled. ‘It’s to check your appendix, Miss. Normally a clinical diagnosis should be enough, but in this particular instance, it’s not what we doctors consider classical.’

Daniel summed up his findings in his notes and was quite confident it wasn’t what he feared. Trusting his judgment, he started to prep her for discharge.

Nurul grew impatient. ‘Dr Daniel. Please admit me into the surgical ward. I’m sure I’m not well.’

‘Oh you will be fine Miss Nurul. You just need some rest and hydration that’s all.’

‘It’s Inspector… and I think you know why I’m here.’

Daniel was puzzled at first but then Nurul started to give him a little context. ‘Let’s just say you have a very small circle of friends that just got smaller. I’m here to figure out why.’

***

Siti had sent out in texts in bold writing the very next morning to two of her doctors.

The Satya read out aloud, ‘EMERGENCY MEETING, STAT’, so loud in fact everyone at rounds could hear it before he made his happy exit.

He walked into her office watching her tap her fingers vigorously over the broad wooden table. Sitting across from her was Mr Jamal. Dr Satya joined their little conference.

‘You know?’ She popped up her eyebrows.

‘Elaborate won’t you,’ Dr Satya perplexed by her nervous demeanour.

‘I already told you Siti, just call the Director-General or the Health Minister. This goes way above our pay grade,’ Mr Jamal answered.

‘And let her poke her nose everywhere around the hospital and make me look bad to the boys upstairs? You don’t get it, do you? This is on me. I should have control over it.’

Dr Satya peered into her computer screen a watched a looping CCTV footage. ‘This about her?’ He guessed watching CID Inspector Nurul registering herself into Emergency.

‘Yes, she’s police. And not a soul knew until the rumour mill kept churning and eventually reached me in the elevator by some night shift nurses. Apparently one of your residents thought it would be a good idea for her to spend the night in the ward just in case it was appendicitis.’

‘And why am I here?’ Dr Satya pressed.

‘She met Daniel in Emergency. He is a patient right?’

‘You’re not asking me to extort information from him regarding this?’

‘Of course not. I want you to want it yourself,’

Mr Jamal interjected. ‘Maybe it is appendi…’

‘IT’S NOT APPENDICITIS,’ she yelled. Siti brought her palms to her forehead and started to breathe.

Mr Jamal got up from his seat. He adjusted his green-silver striped tie and started to walk out. Dr Satya was immediately thrown off. ‘I…well…will keep you posted,’ he nodded his head signalling his leave as well.

Dr Satya stepped out only to notice Mr Jamal still at the door, playing with his tie. The man had a resolute look about him, a feeling came over that didn’t quite sit right with the psychiatrist.

‘Jamal?’ He stopped him.

‘Yes?’ Mr Jamal answered dutifully. Dr Satya had long heard rumours about the Head of Surgery; about his impressive track record, his skills, his numerous award-winning publications, his warmth and his temperament, as well as the stories of his philandering; the deviant and slippery man he was. Still, rumours had stayed rumours and nothing was ever offical with this man, not anyone in HR spoke a word, nor did any whispers reach his own ear. It was best not to assume at such an early stage.

‘Nice tie,’ the psychiatrist reserved his judgement.

Mr Jamal did find the exchange strange but was quick to let it pass. With a quick nod of acknowledgement, the surgeon rushed out to start his rounds.

***

The ward knew ahead that the head of surgery was coming that morning. The beds had been prepped, the patients themselves told to be in their cubicles during the hour. The Ward Sisters had their lists checked twice. Hand sanitizers, charts, gloves and dressing kits, all ready and extra ready at their stations. Interns had their cases memorized, ready to roll out from the tips of their tongues. They stood by their beds waiting. Today was no day for slip-ups.

Mr Jamal and his posse walked in with a fitting grandiose demeanour. The interns would read out in verbatim to how they have it in their charts just with little tweaks here and there to make their voices seem more natural. Mr Jamal ran a steely operation, and draconian though it may be but it was the tradition and surgeons were suckers for those.

‘And her?’ Mr Jamal sounded. The intern was ready to present. He cleared his throat and started. ‘This patient is a 43 year old female, came in last night with a complaint of…’

‘So what do you think it is?’ Mr Jamal turned toward his distracted Medical Officer, immediately putting his phone away.

‘Clinically it didn’t seem to look like appendicitis. Alvarado’s score was not suggestive, so we proceeded with an…’

‘Ultrasound?’

The house officer quickly drew out the report. ‘The report reads as…’

‘Normal?’

The House Officer skimmed down to the bottom. ‘Erm…no free fluid, compressible, Doppler flow is also normal.’

‘Then? Is she still in pain? No? Why is she still here then? I’m sure Miss…’

‘Nurul…’ the detective laid tucked in under her clean sheets, lowering her book, smiling, her eyes transfixed on Mr Jamal.

‘Miss Nurul surely has better things to do with her time,’ the surgeon voiced out. Some of the others were nodding in agreement.

‘Oh, it’s no bother. At least I finally got to see this place after hearing so much about it,’ Nurul retorted.

The others exchanged looks. What exactly was going on with these two? The tension was grossly apparent as their staring contest grew past awkwardness.

‘Well. Anyways we will get your discharge papers soon and you can be off in your way. We wouldn’t want to keep you waiting for no reason.’

‘Really? How disappointing. I was told the head surgeon here does a great deal with his…hands…’

Mr Jamal didn’t flinch. He loved a good verbal challenge.

‘Well, maybe someday then Miss,’ Mr Jamal burst into a hysterical chuckle. The others around him laughed as well to get in on the joke, whatever it was. Nurul, however, knew exactly what he meant, and with a coy smile she replied, ‘maybe, then.’

No one else spoke the entire time. Once Mr Jamal was done, he just moved on to the next bed and never brought her up again.

***

Nurul had a few hours to kill before she was shown the door. She could feel how unwelcome she was. The hospital staffs had been pressured to get everything ready fast. All that delayed her were the house officers, still on their pads, writing her discharge summary and ordering her medication.

‘Quite a quaint little operation you guys run here,’ she texted at Jenny. There was no reply.

There was a knock on the door. Nurul saw passed the window. She remembered that face from her clipboards in her office.

Datuk Dr Siti came right in. With a smile on her face and a dainty stride. She spoke with a lilt in her tone. ‘So I understand you aren’t feeling well,’

‘I believe we are finally speaking in person. You’re a hard woman to meet Dr Siti,’ she pushed herself up.

‘No no don’t get up. I won’t take much of your time. I’m sorry our first meet is under such infelicitous circumstances. Please tell me if there’s anything I can do.’

‘No, you’re staff has been incredible to me. Your interns as well. “Housemans” you call them? They are the bread and butter of the place after all don’t you agree?’

‘Well, we work as a unit; all in their respectful places working EQUALLY hard in making sure the best care is given to our patients. The interns are drilled a little more but for their own good of course. Their contributions though are well noted in their assessments.’

‘Well, don’t worry I tell my constables the same thing.’ A forced bit of passive-aggressive laughter floated in the air.

‘Well, it’s a pleasure to meet you. Please be sure to tell the Commissioner of our services. A good word goes a long way.’

‘I’m sure he already knows,’

‘That’s odd. Because from what I heard you had no visitors. Not a single one since you dropped by. I’m sure at least a colleague should have come. A family member?’

Nurul found it difficult to keep up the smile. ‘I told them all not to worry. It’s not like it’s actual surgery.’

‘That’s right. Still a woman in pain, a decorated officer such as yourself. What is the Commissioner thinking? You know what? I’m having tea with his family this Sunday. I will make sure he doesn’t hear the end of it,’

‘Oh no, you don’t have to,’

‘No. I insist. Perhaps you downplayed it when you spoke to him. He usually takes these things very seriously, as he should. It’s quite unlike him though. Odd right? If he knew, he should have come, shouldn’t he?’

Siti was already under her skin and Nurul’s squeamishness confirmed it. The detective felt she had clearly underestimated the situation and ongoing investigation or not Nurul knew not to be anywhere near the radius of the hospital. Yet, here she was, blatantly ignoring the advice of her superiors.

Nurul gave a cheeky smile and Siti got up from the little chair and dusted her skirt before feeling her hips, turning around and walking out, clomping her heels in arrogance.

Nurul hated the look of the Director’s posterior dancing back at her face, almost mocking her. She stared back at her little book only imagining the music she was about to hear when she got back to her office.

**

Ram came home from a tiring shift, half drenched in his own sweat and grime. His knees begged him to rest but he was inches away from the house. He wobbled till he reached the door and his head fell hard against it. Fumbling for his keys, he eventually swung the door open and dropped face flat on the ground.

The pain forced him up. He slowly crawled to the couch.

He laid his arms wide and hung them by the sides. His head tilted up, a lonely tear rolled down the side of his face, glistening.

‘Bad day Doc?’

‘SHIT’ he shrieked when he saw another person lying there. It was Nurul in her jacket and socks just lying there with a cigarette half burnt. Honestly, he was shocked he didn’t catch the scent sooner.

‘You crying Ram? What, got scolded you for being a bad boy? It’s not like you killed someone right?’

‘Don’t worry about it,’ he wiped his face. She offered him her half-burnt cigarette which he graciously accepted.

‘So Inspector Nurul, the hell are you doing here?’

‘Couldn’t sleep. Appendicitis and shit,’

Ram nodded. ‘What?’ A delayed response followed.

‘Don’t worry about it,’

Ram handed her back her cigarette after a puff they bid each goodnight. He tried to rest in his room, tossing and turning, while Nurul did the same thing on the couch, both restless and in deep thought.

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