The Fifth Horseman

Ego

The Medical Wards of Hospital Puchong, renowned for its high bed count and soaring admission rates, and bustling atmosphere, it boasted an ego of being the best tertiary care unit in the district. The attitude was ‘come what may’ and ‘to hell or highwater,’ and that was the culture all year round. Everything was seasonal; there was the allergy season, the infection season, the diabetic season also known as the holidays, and then there was Dengue season, where mosquitoes aplenty came out for some good times, mingling, mating and laying their eggs. It was a record high epidemic. The disease was back with a thirstful vengeance this year and nearly a quarter of the patients admitted would be cycled in and out of intensive care at some point of their admission. As patient loads climbed, so did the demand, from mattresses to fresh sheets, to pills and syringes. As the multitude of staff slogged and slaved to hold the upkeep, tension rose like hot steam whirring through a pipeline, little by little pushing off the screws that held the system together.

‘Blueeeekkk!’

‘Bed 47 just hurled!’ Nadia, the afternoon shift staff nurse cried out. She pressed the dial right next to her and called for an immediate clean-up.

‘I have 3 more vomits in 3 more corridors. It will take a while,’ the lady replied irritated.

‘Fine,’ the nurse hung up the phone and took a deep breath. She massaged her temple trying to find her moment of Zen as a house officer dropped a thick folder just inches before her.

‘She looked up at Dr Rashid, the man who ruined her moment, wishing she could just grab his stethoscope and strangle him with it. ‘What?’

‘Change the drip setting on Bed 6, 8cc per hour,’

‘But you were just AT Bed 6,’

‘Yes, and?’

She closed her eyes again while he rummaged her little desk for another file. ‘I can’t find Bed 30,’

‘Just LET ME!’ she scowled and pulled it out the first thing she saw before handing it over to him.

‘Remember! 8cc,’

‘YEAH, YEAH!’

Nadia pulled herself up and dragged her weary legs to Bed 6 with the patient’s chart. As soon as she reached the cubicle, the man on the bed, as per his usual self, kept awkwardly smiling at her. ‘Old creep!’ she sneered while she pretended to reciprocate. As per protocol, she checked the line, the patency and the flow of fluid into the patient’s veins. Then she looked at the monitor, beeping, with an indicator. ‘8cc/hr’ it read. ‘Wait!’

She opened the chart to check the notes once more. There was an entry by the house officer earlier, ‘Reduce to 8cc/hr,’ it read. ‘What a dick!’ she cursed.

Just then Sheila walked in. ’8?’ she screamed.

‘Hey, Sheila,’

‘Hey, Nad,’

‘Can you believe Dr Rashid? He tells me to walk all the way from the back just to meddle with the setting and he’d already done it himself,’

The patient started to chuckle.

‘What the hell is so funny?’ Nadia thought but did not say.

‘Well, you know how some of us can be?’

‘Yes, I do know. I already hate his guts. Tell me he is leaving soon.’

‘Everybody leaves but me, Nad,’

Nadia rolled her eyes at her. ‘You know what I mean,’

Sheila laughed. ‘Yes, Nad. I’m just messing with you.’

It was the first time the patient ever saw the nurse’s genuine smile. Sheila approached closer to the edge of the bed. ‘You mind if I check you, Mr Shamsuddin?’

‘He is a renal patient, right?’ Sheila checked with Nadia.

‘Yes, why?’ the nurse answered.

‘Let me just…’ Sheila checked his eyes, his hands, his pulse and used her stethoscope to hear his lungs.

‘Hmph…’ she pursed her lips into a corner.

‘What?’

‘There must be a mistake. I’m sure Julie wouldn’t have just signed off on this.’

‘You want to?’

‘Stop the fluids’

‘You sure?’

‘He can only take in at most half a litre of fluid in a day.’

Ned passed her the charts and watched as Sheila’s eyes skimmed through the numbers and run the math in her head. ’I’m right. Stop the fluids!’

‘Alright Boss,’ Nadia quickly stopped the intravenous flow and disconnected the catheter from the drip stand. While she turned to walk out, the patient quickly mustered his courage to blurt out, ‘Am I going to be OK? Nurse?’

Unfortunate to have heard him, she felt the need to at least acknowledge it. ‘YEAH, you’ll be fine,’ her voice trailed off into the distance.

Sheila stared at him. ‘You know she’s single right?’

‘I am old and on dialysis. But damn it, Doctor, she is so damn cute,’

Sheila chuckled. ‘Get her something nice. She’ll talk to you.’

The patient smiled back at her.

Rounds began at 2 pm. Dr Julie was a kettle at boiling point, screaming and yelling at every intern walking with her. ‘Some days you are incompetent, and some days I just think your mother dropped you when you were baby. Do you know what I mean, Rashid?’

Dr Rashid, cowered in shame while the others tried to control their laughter albeit knowing their turn was next. The woman grabbed the charts and scribbled all over the place. ‘I trust you will all kill people in the future. We’re making future killers here, people. And you will be head honcho, Rashid. Just to be safe, consider Forensics. At least they are already dead. I mean look at this,’ she rambled on as she pointed on the charts. ‘7cc? Look at him struggling to breathe.’

The patient of Bed 5 seemed anxious, gasping and his O2 levels read lower on the monitor than usual. ‘Sheila, what would you do?’

Surprised that Dr Julie came for her when least expected, she was thankful at least that she wasn’t daydreaming.

‘I would do a blood gas. Depending on how low his oxygen levels are, I would then give him extra O2 support.’

‘Well, don’t just stand there.’ Dr Julie blasted and proceeded to the next patient.

Just as Sheila was about to separate herself from the group, Dr Julie stopped her. ‘What the hell?’ she screamed looking at Sheila’s notes in the file of the next patient. ‘No fluids?’

‘Yes,’ the house officer defended herself.

‘You want our patient to shrivel like a prune and die of shock, is that it? I guess the three extra months in here aren’t really helping you at all aren’t they?’

Sheila tried not to be intimidated. Every chance Dr Julie got, she would bring that up and embarrass her in an open space for all to hear. ‘I… I… didn’t want him to overload him with fluids. He could collapse from pulmonary oedema. He would die.’

‘Well, you are buying him an Express ticket.’

‘Sorry! He is a renal patient on dialysis. So I thought…,’

‘Third “Sorry” this week.’ Dr Julie reminded that she was keeping track. ‘Wait? Did you say a renal patient?’

She looked at Mr Shamsuddin awkwardly smiling and nodding his head. Julie didn’t allow her embarrassment to overrule her ego. Instead, she went with a solid, ‘Fine,’ and immediately proceeded by ‘NEXT!’

Sheila separated herself from the group to run that blood gas she was instructed to. ‘Shit,’ she cursed while she yearned for some smoke in her lungs.

**

‘She did what now?’ Jenny shook her head while Sheila complained to her about the daily toils.

‘It’s like she knows it’s getting to me,’

‘Come on girl, you’re the toughest person I know. And the smartest.’

‘And the prettiest.’

‘Well, yeah. That too.’ Jenny rolled her eyes.

She handed Sheila another slice of pizza from the box they ordered earlier. ‘Julie is doing what she is doing because she has higher expectations.’

‘She walks around like a bloody specialist. I mean you are just a “medical officer”. I will be one in like a year from now and then she and I are just the same you know. The audacity she has with everyone wrapped around her fucking fingers like that.’ Sheila commented.

‘Yeah, some specialists too.’

The girls chuckled again. ‘What you aren’t referring to what I think you’re referring too,’ Sheila tested her friend. They were both hoping to say the same person’s name.

‘MR…’

‘DR…’

‘Oh!’ Sheila was disappointed. ‘MR?’

‘Oh, come on,’ Jenny stared at her friend. ‘It’s old gossip. Don’t’ tell me you don’t know?’

‘What?’ Sheila was getting very curious.

‘Mr Jamal?’

‘NOOOO! WHAAAT?”

‘I can’t believe you are shocked.’

‘You mean they are like…’ Sheila made suggestive hand gestures with her fingers.

‘She goes to his room upstairs when he is on-call sometimes. The nurses talk. I don’t know. But it isn’t that farfetched,’

‘Mr Jamal eh?’

‘Yup. That creep. Remember he hit on you once?’

‘Yup, the first week I was here. While waiting in line to clock out,’

‘Exactly,’

‘How is he by the way? You’re in Surgical. Come on. Details?’ Sheila pressed on.

‘He’s actually pretty good. He is a wonderful surgeon, like experience-wise.’

‘Not something I wouldn’t expect from a consultant. Come on. You know what I mean. You’re pretty. He hasn’t like… you know…’ Sheila was yearning for more stories. She knew Jenny’s ‘tell’ quite well living in close quarters with her. It’s how she felt she knew Daniel with intrinsic detail without really talking that much to him, and when Jenny made that little smile and her lower lips cornered in that distinctive way, Sheila went ballistic. ‘WHAAT?” Sheila jumped off the couch, ‘YOU SLUT! What would Daniel think?’

‘NO Bitch! He’s like a father figure.’

‘Yeah, you mean more like a DADDY-figure,’ Sheila cheekily laughed.

 ‘I will kill you, Sheila,’ Jenny kept smiling from ear to ear. ‘I mean he does text us a lot; the Housemen. He wants to know what we are doing. Are we studying when we get home?’

‘What you’re wearing? Jammies or nude?’ Sheila continued to pedantically irritate.

‘That’s it. NO MORE PIZZA FOR YOU. The last slice is mine,’

‘NOOOO!’

Jenny pulled the box away and grabbed the last slice for herself. While she chomped hurriedly, her mind went back to Daniel. ‘I don’t… know what… it is… about… men.’ She mumbled gobbling her food.

‘You don’t know what… about what?’

‘MEN!’ Jenny swallowed.  ‘Daniel reacted the same way.’

‘Duh! He’s jealous. I mean you have a thing for Malay guys. I don’t get it. Is it the circumcised penises or something?’

Jenny pretended not the indulge her friend further.

‘Why would he be jealous? I LOVE HIM! Like when you come home, and the family is all there. He is that person. He is “HOME”. You know?’

‘First of all, ‘YUCK”. Secondly, maybe he realises that he and Mr Jamal aren’t that different.’

‘Meaning?’ Jenny bit into another mouthful.

‘Sheila got up and came close to whisper. ‘They both have a thing for Chinese women.’

Jenny lingered on that thought for a quite a bit.

**

Sheila went to work as per usual, day in and day out, the usual toil. She drowned herself in her music only focusing on was good about work, and that was the actual work, about patients and healthcare and saving lives, without all the politics she had come to detest. She was feeling good about herself. In 2 months, she would be done with this posting and finally move on to General Surgery, and come what may, she was ready.

That Tuesday morning was like any other. She kept playing fantasies in her head about her next holiday while she drove her car using the same route she always did, thinking about the ‘Where’ and the ‘How’ and before she knew it, she was there at the hospital, in the parking lot, about to begin another day-shift.

As she barged in, she took her headphones off and embraced the chaos of rustling clothes, shoes and beeping monitors. That’s when she noticed Syikin, the newcomer, standing strong in the corridors, demanding to see her charts, writing prescriptions, signing waivers and consent forms with utmost confidence. ‘Our little girl is all grown up,’ she smiled from afar. They exchanged nods and passed a friendly smile at each other.

As Sheila approached the whiteboard, she saw the task division. As per usual, she was given the most taxing beds; the annoying ones, the ones that never leave, the ones that gave poor history, the ones that had the most difficult lines, and even the ones that were aggressive. Sheila was only sceptical at first that Dr Julie might have rigged it such to make her life a living hell, but then a few weeks earlier, by sheer happenstance, her houseman leader spilled the beans over a regular coffee break.

Still, Sheila tried to keep calm. ‘Just do what you can to stay out of her radar and you will be alright,’ she would tell herself.

Dr Grace, the resident Nephrologist, did her rounds that morning and demanded to see all her cases before they went for dialysis. ‘And this one has Dengue Fever?’ she asked politely.

‘Yes, he was unfortunately started on too much fluid. He goes in and out of HDW but he is better now.’ Dr Julie narrated the updates on Bed 6 to her boss while the herd of house officers stood around watchfully waiting. The patient still smiled awkwardly at Nadia, standing among the rest trying to keep her calm.

Dr Grace flipped through the charts. She was meticulous, eyeing every entry. Then she suddenly stopped at a page, pondering long. Dr Julie furrowed her brows in that span of rising tension. ‘Yes?’

‘It says here he had 10cc/hr infusion rate of Saline drips. Then it was reduced to 8?’

‘Yes, my house officers you know. I gave them an earful.’

‘No! According to this right here, another immediately switched it off. She figured the one right thing to do. Who is this girl?’ SHEILA! Is she here?’

Sheila raised her hand amidst the crowd.

‘Good thinking lass. Julie you shouldn’t have started on 10cc to begin with. It’s not as though the blood levels were that bad.’

‘Well, we didn’t have that history from the start Doctor,’ Dr Julie stammered while flipping through the charts.

‘We? Or YOU, Julie? It says here that you are the one who took the initial history. Are you trying to come up with an excuse? Come on I have been doing this for 20 years dear girl. Just admit that you made a mistake.’

‘We thought it would be best we start we adequate resuscitation first, then taper the fluids down slowly. That’s all. Rashid over here decided to continue at 10cc.’

During the whole fiasco, Dr Grace shook her head as if genuinely entertained. Sheila loved every second of it, just watching Julie squirm, squeezing her thighs, clenching her teeth, trying to shift the blame, just unable to do what all housemen would have easily done by now; just say “sorry”. She was looking at a woman who had long forgotten her humble roots. Julie was so used to being correct all the time, that the alternative was all too much for her.

Dr Grace decided to end the pointless charade, ‘Well, I’m glad you guys did the right thing,’ and moved on.

Sheila kept eyeing her watch. Her palms were sweaty, her toes were fidgeting in her shoes. She needed some tobacco in her instantly. ‘Have I become addicted?’ she asked herself, despite knowing the obvious answer.

1 pm eventually arrived and Sheila took off to the stairs dashed up to the roof. She hurriedly drew a stick and missed a few times before correctly placing it between her lips and lit it. She watched the end of the butt burn in a raging red glow as she sucked in all that warm satisfying smoke. Her eyelids closed shut enjoying every moment of it.

The door to the roof stormed open and to her surprise it was Daniel. ‘So, this place does exist.’ He said aloud. ‘Smoke?’ Sheila offered. Daniel appeared startled to see her through an obvious exaggeration and a clear sign that the man couldn’t act.

‘No, I just wanted to see it for myself.’ He said.

‘It’s a roof, Daniel. All buildings have roofs.’ Sheila scoffed.

There was still silence as Sheila dropped her first cigarette and moved on the next. Daniel looked at the sky and admired the scenery.

‘Well then,’ he replied before turning back to leave.

‘She sent you up here, didn’t she?’

‘Pardon?’

‘Or he did?

‘I don’t know what you are…’

Sheila interrupted, ‘you can tell our nosy friends that I’m fine. It’s just for the extension. After Internal Medicine is over, I am planning to quit smoking altogether. OK?’

‘I…’ Daniel was clearly ill-prepared for this conversation.

‘That means OK,’

‘OK!’ and he left.

**

Sheila happy the clock finally struck 9.00pm, and she was as she called it ‘half passed dead.’ She wobbled into her car, her knees and ankles swollen, her eyelids already playing with her. She slapped herself for an adrenaline spike, knowing she shouldn’t be behind the wheel, but just the thought of a hot shower and a quick bite was all too dreamy to pass on.

As she was just about to leave the parking lot, she noticed something peculiar in her windscreen. Dr Julie was exiting to the parking lot as well, and by the looks of it, from the specialist wing, where a few flights of stairs up would be their on-call rooms. Sheila couldn’t see any alternative to why this woman was here. Sheila had never seen her around these parts at this odd hour before. It was all too untimely and unprecedented. ‘Uh-huh, the walk of shame! And it isn’t even the morning after,’ Sheila had assumed the worst; a scandalous affair, a desperate cry for help, and if the rumours were true, how tastily embarrassing it would be for her. Sheila had a subconsciously evil smile and hoped her superior wouldn’t accidentally cross paths with her before she got in her own Honda.

The house officer decided to leave when the coast was clear. The suspenseful intrigue gave her just the exact amount of adrenaline she needed, and for a long while she stayed on the same route as Julie, just a few vehicles behind in traffic.

The lights turned green and Sheila noticed that Dr Julie turn in to a side corner by a strip mall. ‘Tan & Tan’s Family Clinic’ it read. ‘So, she does night locum?’ Sheila mumbled.

‘Wait!’

She drew out her phone and quickly checked the on-call roster, periodically eyeing the road. ‘SHIT! She’s on-call! And she’s out here! Where she is- NOT- SUPPOSED TOOO BEEEEEEEEEE!’ Julie broke into a high pitch melody.

Sheila was happy. ‘Could this be it? Could this finally be leverage?’

Sheila turned the Toyota around to get to the strip mall and quickly parked in a box. She was excited, barging out like a boxer into a ring just as he heard the bell. She stormed in the clinic.

‘Yes?’ asked the receptionist.

‘I am… erm… feeling… pain…’ she didn’t think it through. ‘Who’s the doctor?’

‘Tonight, we have a locum Doctor. Doctor Julie. Would you like to see her?’ answered the receptionist sceptical of the woman’s alleged symptom.

‘Yes, I would like that, thank you.’ The house officer answered pretending to be just a lay person with no medical background. ‘I got you now, bitch,’ she thought. Sheila couldn’t stop smiling from ear to ear. ‘Where do I sign?’

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