The Fifth Horseman

I Win

Night presented a strange and ominous quiet, caressed by the steady beeping of monosyllabic monitors, humming a rhythm of somnolence. Sheila was feeling agitated. Something didn’t sit right with her.

Just hours ago, Sheila was forced to tell a family that one of them was probably not going to make the night. She had hoped that if anything were to happen, it should just happen the next day, after 8am- at the end of her shift where she could go home & wash the guilt under a scalding hot shower. She was already feeling irksome, disgusted with herself on how robotic and disconnected she had to be when she told them what she told them.

Still, the inexperience always surfaces, and by the end of it, she was filled with regret. She stuttered, she smiled, she was awkward and worst of all she sort of gave them hope, just grievous hope.

‘What do you guys do? How long are you in town for? I’m sorry this happened. What can I do to help?’

These were empathic yet dangerous questions, especially if the doctor wasn’t it the right state of mind. The mother was getting distracted. She just wanted to talk about something else.

‘So where did you go to medical school? How is home? Do you miss your family?

Sheila felt a little shaken, prodded and vulnerable. She didn’t just make a human connection, she had invited herself close to grieving family’s plight. She wondered if that’s how all Medical Officers felt after a DNR consultation, however there was no one around to either confirm or deny her doubts. All in all, there was much more information shared than needed, all to pass time, all in the attempt to calm the mother and son down; all things that were not presently her job.

A few hours passed and Mr Shamsuddin was eventually wheeled in back from surgery into ICU cubicle, flat unconscious while being transferred from bed to bed, connected to a myriad of monitors with a tube in his throat, veins punctured all over his body, and IVs flowing in spuriously, as if from loose faucet. His blood pressure struggled to keep up with his aching heart now like a weary soldier holding on to his dear life in the aftermath of war.

‘Dr Sheila, can you come down here please,’ the ICU Nurse rang up the ward. ‘Is the family there? If they are, please get them to come along too.’

Sheila was anxious all throughout her elevator ride and as she walked in the ICU. The nurse who called earlier handed her a form as she approached the nurses counter.

‘Dr Julie needs you to sign this,’

‘Dialysis?’ Sheila asked. ‘Why can’t she sign it?’

‘Busy,’ the nurse wasn’t in the mood for banter.

Sheila took out her ballpoint pen to sign it.  “CLICK”

The ICU had its over version of monotonous sombre melodies, but then suddenly, the beeps became wild, loud and alarming. Every staff quickly turned to their monitors. Mr Shamsuddin’s Blood Pressure was crashing and fast.

‘SHIT!’ Sheila cursed under her breath.

The nurses rushed in and ushered the mother out. Crying and sobbing, the old woman noticed the young house officer standing just meters away, feet together, knees locked and arms shaking by her sides. She launched at the girl for a tight embrace.

The house officer knew not how to feel. It’s always been real but never this close.

‘Please…’ the woman begged. ‘He’s dying. Stop him from dying…’

‘But… you didn’t want any CPR.’

‘I… I…’

A nurse immediately walked up and slowly broke loose the mother’s grasp. Though free, Sheila still stood there rigid as a pillar, contemplating.

‘She said no CPR, right?’ the nurse checked again with the house-officer.

‘DOCTOR?’

Sheila’s eye was transfixed on the monitor in the ICU, the falling numbers, the reddening of icons, all seemingly a countdown to inevitable death.

‘DOCTOR?” her voice was lowest playing in background of Sheila’s mind. She kept playing what the mother said. ‘Stop him from dying’. She sensed the cold wet tears of the woman on her soiled cotton blouse, kissing her abdomen- cold.

‘That lady doesn’t know what she wants.’

‘You took the DNR, Doctor. Were you clear in your explanation to them?’

‘Who can make a decision like that? That poor woman?’ Sheila mumbled.

‘A DNR is still a DNR.’ The nurse reiterated. ‘You should get some rest Doctor. You have it here in black and white. If you don’t want any trouble, just drop this. We’ll say a little prayer for him and ease his pain with the morphine.’

Sheila had an irksome feeling. She didn’t like it- any of it. She didn’t like who she was and what she had become. Everything she does here is devoid of humanity. What if they were wrong? What if there was a slight chance? Who was she to take it away from good, gullible, working class folk who would just put their entire trust on her judgement? The roof gave Sheila a second chance. What if it didn’t?

She got too close to the case. Her mind was clouded, devoid of reason, and plagued with emotional clutter.

Sheila took a deep breath and made a conscious decision for the unconscious man about to lose everything he ever loved in just a couple of seconds.

‘SCREW IT!’ She rushed inside his cubicle.

**

Another week passed, and the story of Mr Shamsuddin and the posthumous lawsuit resounded across the halls of the mortuary all the way up to the Board of Directors Office. It was Datuk Dr Siti’s first time hearing of the infamous Sheila, her entire story and waves she had been creating for the past few months. A closed-door meeting was arranged with necessary individuals, excluding the young intern.

Instead, the whole point of the meeting was to point the proverbial finger, and once decided, the accused was finally summoned in.

In her best heels, a long skirt, freshly powdered cheeks, lush lipstick and perfume, she clomped her way into the office of Datuk Dr Siti. There in that room would be in attendance, a panel of members she could only guess their identities. It had been years since anything had caused her this much tremor and anxiety.

The doctor knocked forcefully on the door, trying to stay confident.

‘Come in, Julie.’

She observed the panel; the director, her head of department, Dr Satya, and someone whom she could only guess was a non-clinical simpleton from HR.

‘You know what this is about.’ Her boss Dr Cheryl Ann spoke out first.

‘Mr Shamsuddin.’

‘Yes, you were there last week when we discussed it.’

‘But this is not about that,’ Dr Siti interjected. ‘Do you know why YOU are here?’

‘Lawsuit?’

‘Precisely.’

Dr Julie noticed her friend the psychiatrist slowly nodding his head, hiding behind a gentle smile without yet a word from his lips.

‘I was on call that night. I had multiple Resus cases, I had procedures and then I went down to Emergency to handle the asthma bay because those idiots couldn’t handle it themselves. I…’ she stopped.

‘You gave Infectious disease a call.’

‘I did. From our discussion, it was apparent that it wasn’t dengue, and only on the day of his death did we realise that we were dealing with HIV-AIDS. Whatever that infected him was far more sinister. The man had no chance of coming back. So, I didn’t want to cause more harm.

‘And Dr Sheila was among your many house officer that night?’ Dr Satya interrupted.

Julie turned to him. ‘I trusted that girl. She was the only one I could,’

‘You COULD have called the specialist on- call that night to lend you a hand.’ Dr Siti remarked.

Dr Julie smiled and turned ever slightly to meet her gaze. ‘I couldn’t do that. I would be a laughing stock. Nobody does that,’

‘Some people do. You obviously think you’re above that,’ Dr Cheryl sternly replied, displeased with her answer.

‘I…’

Dr Siti stopped her. ‘You instead decided to leave an important task to a House Officer.’

‘The interns deliver DNRs all the time.’

‘They aren’t real Doctors, Julie. They hold no actual responsibility but to themselves and their moral codes perhaps, but everything on paper traces back to you, and that in that vein, to “ME”. You made a clear mistake. Don’t you agree?’

Dr Julie turned to Dr Satya again, the only person she trusted in the entire room, but she was left barren. He noticed her swallowing a rather large bout, nervous.

The only thing Julie was guilty of was following a common practice, and on that day of all days, her luck failed her and exposed her for using the system’s weak points.

‘I’m sorry.’ She replied with a heavy heart, her once strong impenetrable ego torn to shreds.

‘Were you really busy at Emergency?’ Dr Cheryl prodded further, her brows filled with curiosity and distrust.

‘Of course,’ she defended, vulnerable.

‘Then what’s this I hear about locum practices. Were they even approved?’

Julie sat back. It wasn’t just the luck of that day. They had everything on her. There was no way she was winning this argument. ‘It wasn’t’’

‘What do you have to say?’

‘I’m sorry,’ she shook her head, her walls crumbling down.

‘I’m sorry Julie. You’re a good doctor and will make a great physician. After all these years of experience I wonder why you still aren’t one already. But I’m sorry, because despite all of that, I believe this is grounds for disciplinary action, on top of the lawsuit.’

Dr Julie froze. Her jaws tightened, and she was filled with rage. As vague as that statement was, the underlying subtext was clear. Her record will now have an irremovable stain, enough to end her carrier in Medicine, all because of that one girl.

**

Sheila drowned herself in alcohol, almost every night after work and on mornings after night shifts. She imaged his broken rib cage each time she forced her palms, pounding on his heart. Pain was all he had, all he experienced and for what? She had robbed him of his last few minutes, instead of letting his mind drift off to Nadia, his ex, or his mother.

Things eventually simmered down. As she did with many others in the past, Sheila allowed time to move her forward. There were still many other sick people.

Dengue though had reached the end of its peak. The hospital had now switched to different season; Haze!

Sheila never thought the day would come. In total she had spent seven miserable months in a department she truly detested. Today, as per her requirement, would be her last day here before moving into General Surgery.

She had come prepared, with her best ironed out blouse, fragrant perfume, she was going to walk into the wards with cupcakes she had specifically ordered from a popular local bakery.

The intern had a little party in the pantry where she invited all the staff members for food and photo sessions. She was going to miss her nurses especially Nadia, one whom she formed a tight kinship with. They spent many nights consoling each other after what had happened, and like Sheila, Nadia too allowed her overwhelming work schedule to dull out the noise. She still had sudden uncontrollable urges to strangle Dr Rashid every now and then, but she would smile and claim she was “working on it” every time Sheila asked her.

Sheila’s colleagues showed up periodically between work just to congratulate and wish her well. There was no animosity that day, and whatever pesky little squabbles they might have had before about the job, the patients, the errands, everything was out of the window. The cupcakes were Damia’s idea for a different reason. She had told her once that cupcakes had an effect on people Sheila wouldn’t understand. Today, she did.

Sheila noticed from the pantry’s slim doorway, Dr Julie walking into the little office by the side of the corridor. Sheila grabbed a box of cupcakes singled out from the rest.

‘It’s time to bury the hatchet,’ she told Nadia before excusing herself.

Julie sat in her reclining chair, her lights off, AC on full blast, enjoying the quiet hums.

Sheila knocked thrice.

Tired, the doctor took a moment before answering. ‘Come in.’ Then, she saw her, her pupils struggling to accommodate the glow of exogenous light beaming in, beautiful, angelic in her white coat, the house officer of her nightmares carrying in a box of condiments, and worst of all, smiling.

‘Dr Julie, I…’ she stuttered.

‘You what? Sheila… I’m busy,’

There was an obvious contradiction, with The PC was off, the desk cleared, much less in the dark. The girl chose not to let the insult get to her. The woman was evidently just avoiding everyone.

‘I… brought you something,’ she placed the quaint little cardboard box on the table. The aroma lingered quickly up Julie’s nares. She took a fast look at the house officer, with all her daring and courage, standing in front of her, tall, with her shoulders open.

‘So, what is this? A peace offering, or you just want to rub in my face?’

Sheila raised a cheek. ‘Neither. It’s to thank you,’

‘For?’

‘I thought I was dying to leave this department, this ward, the clinic, and all the staff that kept bashing me to the ground, but I realise I’m actually going to miss it, and you the most really, Dr Julie. You taught me so much.’

‘I have my ways,’

‘That you do,’ Sheila chuckled. ‘I’m genuinely sorry about reporting you. All the stuff I did seems so petty now.’

Sheila hadn’t the slightest idea.

‘Get to where I am, then we’ll talk about all the stuff you did.’

‘Yeah, about that. Would you believe it if I told you I’m seriously considering Internal Medicine as my choice? I mean as crazy as it sounds, people usually shy away the from postings they detest but I have fallen in love with everything here, considerably more than anything else before. I know I’m still half-way there, but I doubt my mind would change if you were to ask me a year from now.’

Dr Julie couldn’t take her eyes of the box, pondering if she smash the cake right then with one blow, stopping the girls heart so she could drop dead right in front of her. Dr Satya once told her in passing that Sheila reminded her much of younger herself, of her bold inquisitive nature, her drive, and her passion but needless Satya say, she also reminded her of her mistakes. If Juile could advise her younger self, it would be ‘never walk in the hospital with stethoscope again, because no matter how good you are at your job, you will never be fulfilled.’ Watching the glee in the girl’s eyes while she bore her chest to her made Julie’s blood boil.

Naturally, Julie interrupted.

‘You say I taught you so much. But here is something you should really know. Despite everything I feel no actual ill will toward you. Tomorrow you will be another officer’s problem, and someday someone will be yours.’

Sheila found the whole thing hilarious.

‘And the cycle repeats. Because that’s how it is.’ Dr Julie pointed at the intern’s white coat with the edge of her little logbook sticking out of her pocket. ‘That little thing over there, with all the signatures deeming you worthy to move on, that’s the problem really.’

‘Why?’

‘Because it tells you something you can’t see. It tells you “you’re ready” but are you?’

Sheila was starting to feel a little closed off. Dr Julie was going to broadcast her opinion again as she always does about everything. Only this time, Sheila became anxious knowing it was going to hurt, and regretfully unretractable.’

‘You smile, and the scars heal fast. Patient dies in your conscience and you just move on.’

‘I don’t stop thinking about all the ones I lost,’ Sheila defended. ‘Mr Shamsuddin, Gloria, Dayang, Mr Tan, all of them.

‘How about the ones you are going to lose?’

The house officer glared at her, stunned.

‘Don’t get me wrong, you know your shit, Sheila. You will save many and many will owe you gratitude. Kids will have their fathers longer & mothers will go home to meet their next few grandkids but some wont…’

‘We can’t predict that. We have to do the best we can for as long as we can.’

Julie felt a slap of Déjà Vu.

‘What are you saying, Dr Julie, exactly. That I’m what? Too incompetent? I have heard that too many times and frankly I just think it’s bullshit.’

‘But you still need that validation, don’t you?

Sheila retracted, ‘this is about yourself, or me?’

‘Oh, you and I are very different Sheila. Yes, of course I have seen myself in you, ONCE maybe, and thought I was able to connect with you and pass on what I know and see you climb up the ranks, surpassing me even but I honestly think I’m the only one here who REALLY, TRULY knows you.’

Sheila was started to tear up, and it excited Julie even more. ‘With all the knowledge and skill, you will do well in this carrier, and nobody is going to tell you this but when it comes to times that really matter, when it comes to that split-second decision, that hero moment, you will always fuck up. I’m sorry for using that language but, the truth is the truth and you know this. That’s why you will always seek validation, and with that you will read more, research more and treat more and save more, just to keep telling yourself that maybe you’re not the person you know you are.’

Sheila was numb, wondering if there was any truth to her surrogate mentor’s words. ‘That’s not true.’ She immediately denied, her entire identity questioned, on display and on trial.

‘Let me ask you this then. Would you allow yourself to be the doctor that treats you? In your sickest day, let’s say verge of death, would you want a copy of ‘you’ making the decisions?’

Sheila glared back at the woman, her fists tight, asking herself what had happened that made Julie so cruel.

‘Would you, Sheila?’ she repeated. ‘Because I wouldn’t. If I really was in my deathbed, I pray to God that you- not someone like you, just YOU, would never be even allowed to come near me, let alone endorse my meds or set a fucking line. Because I will be so afraid, knowing what you are capable of.’

Sheila had no answer, on the verge of tears, she was tired of showing weakness. It wasn’t her anymore. This was supposedly her happiest day, to celebrate her momentous occasion. ‘Please enjoy your cake,’ she struggled to pull out those words from beneath her diaphragm halting the conversation to a stop.

Julie opened the box, and inside was freshly baked Red-velvet cupcake with vanilla-lemon icing. Wit it, a card attached to the fancy folded wrap, reading, ‘For all that’s happened, Sorry and Thanks’

Julie smiled, her warmest this week. She gazed at Sheila in front of her, broken, eyes down, hands over elbows and yet another flash of Déjà vu came rushing at her, all but a gash on the girl’s face and it would have been picture perfect.

‘You too.’ Julie had the final say. She tore the plastic wrapper and took out a tiny spork before cutting a herself a tiny little test piece. It was good, a perfect blend of sweet and sour, just what the doctor ordered, but in no way did her make her feel any better or worse.

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