By Dr. Robert Balentine, Jr.
Content warning: TW // Suicide
This story contains discussion of a highly sensitive nature relating to suicide that may be triggering for some individuals. If you or someone you know is thinking of suicide please make sure that you intervene and give them the emergency telephone number for suicide prevention (988).
—————-
‘North, East, South, West! The ER Handles Trauma Best!’ read the laminated sign on the sliding glass door leading into the doctor’s dictation room. Inside at a desk, sat a young, fair headed doctor in scrubs, head in hands, staring down at flecks of blood marring the emerald palette of his pants. Hanging from his lapel, a freshly minted badge declared, ‘Dr. Alstrom, EM Resident’ in block black script next to a picture of its smiling owner.
“I don’t think I can do this,” Alstrom said, the words directed at his own lap.
A white-haired man in a thigh-length white coat stretched his legs from the chair he sat in to another one serving as a makeshift ottoman. He flicked at a bruised spot on the apple he was slicing up, campfire style, with the blade of an ornate folding penknife. The words ‘Dr. Ignatius, EM Attending’ were barely visible on his badge beside his time-bleached portrait. He cocked his head, studying the fledgling resident physician with a curious, owl-like expression.
“Nah, you’ll be fine, kid,” Dr. Ignatius said, his permanent smirk doubling with seemingly authentic amusement. “Pretty soon it’ll all be water under a bridge. Water off a duck’s back…something aqueous, at any rate.”
“But that was a five-month-old,” Alstrom said, words still aimed floor-ward. “A five-month-old,” he reiterated, dotting each word with an emphatic linguistic brushstroke.
“Yes,” Dr. Ignatius said, making a sudden upright change in his posture that sent the ottoman skittering away to bump into the beige-paneled cubicle walls. “Dad probably got mad and shook him. Happens.”
“Will the kid make it?”
Dr. Ignatius lifted one corner of his mouth dubiously. “It’ll be a vegetable even if it does. Might be kinder if it doesn’t.”
“And that…that doesn’t bother you?” Alstrom asked, lifting his head to look over one shoulder at his implacable attending physician.
Dr. Ignatius exhaled cheap coffee-scented resignation. “No,” he replied. “And I’m not even bothered by the fact that it doesn’t bother me, truth be told.” He allowed his eyes to focus on a far shore somewhere beyond the white, sterile hospital walls before shrugging in something between apology and apathy.
A cartoonish Wilhelm scream broke the silence. The doctors’ eyes met and both faces contorted in an effort to conceal their mirth. When the second, identical scream sounded a moment later, both lost their composure and fell into full, body-shaking laughter.
Dr. Ignatius picked up the radio and pushed the button to talk, stifling chuckles. “What is that atrocious screaming?”
Another pitch-perfect Wilhelm responded and the two doctors chuckled again. Then another with still no answer over the radio. By the fifth scream, the humor of the situation had dried to a tumbleweed husk and rolled away across the planes of their respective expressions.
Dr. Ignatius sighed, rose from his chair, and motioned for Alstrom to follow.
Once they neared the room, Ignatius waved aside a sea of nurses in baby blue scrubs theatrically, Charlton Heston’s Moses minus the burled oak staff. At the center of the parted swell lay a pale man Alstrom estimated to be in his early seventies, his thin, gray hair matted to his forehead with perspiration. His pained expression pulled his eyelids down wearily. When he blinked, a single tear rolled down one cheek. A sudden, invisible jolt caused him to stiffen and he let out another scream, muted in comparison, as if he was a tea kettle losing steam.
“His defibrillator keeps shocking him,” an older nurse attaching leads to the man’s chest informed them. “He was here last month. Has a bad heart and he’s been talking to hospice, but hasn’t joined up with them yet.”
“Amiodarone drip,” Ignatius said, the command almost subconscious.
“Already one going,” the nurse replied. “It isn’t doing anything.”
“Lidocaine.”
“Just hung that, too.”
“Let’s get a meperidine PCA run–” He stopped short as the nurse pointed to the already running PCA at bedside. His face remained neutral, but the air in the room changed.
“Mr….Larry Bellamy,” Dr. Ignatius said, reading the name from the man’s hospital wristband. “I’m Dr. Ignatius and this is my resident, Dr. Alstrom. What seems to be the problem?”
Bellamy grimaced. Alstrom glanced up at the EKG tracing, which showed a flurry of rapid oscillations, a single, vertical slash, then a return to the textbook normal EKG. The patient whimpered a moment before he was able to speak. “I…I can’t keep doing this. This thing has been shocking me nonstop for the last six hours. I…I just can’t.”
Dr. Ignatius pointed at the IV bag hanging from the pole at bedside. “That right there is going to stop all those nasty arrhythmias that are making it go off. Few minutes more is all it will ta–”
Bellamy screamed again. Above his head, squiggles preceded slash, then normal green lines in telegraphed synchronicity. Dr. Ignatius seemed momentarily perplexed, but a half-second later his expression was a practiced smirk, eyes shining with grandfatherly affectation.
“Angie,” Dr. Ignatius said, addressing the nurse, “have we contacted the electrophysiologist?”
“Dr. Woodford told me that…” Angie paused to read from a blue post-it note stuck against the IV machine. “If I do any more ablations on that man, I’ll have fried every circuit in his cardiac pathways.”
“That is…unfortunate,” Dr. Ignatius responded. “And what about–”
“Cardiology and the CT surgeon both hung up on me after they heard Mr. Bellamy’s name.”
“Well, I guess we could sedate and intubate him so he won’t have to feel the shocks until we can figure something out,” Dr. Ignatius said. “Maybe Procainamide and Sotalol?”
“I’m not going on a machine,” Bellamy said, plainly. “Doc, tell me…what will….what will happen if you just turn this thing off?” He tapped a raised area of skin on his left upper chest with two fingers.
“Well…the next time you go into that rhythm, it would continue and eventually convert into something fatal and you’d–”
“Would it hurt?”
Dr. Ignatius froze, mouth open mid-sentence.
“It wouldn’t hurt,” Alstrom said, hoping he wasn’t lying. “At least, it wouldn’t hurt nearly as much as the shocks you’ve been getting. Isn’t that correct, Dr. Ignatius?”
The attending grasped the lapels of his coat and straightened, as if approaching a lectern to give a speech. “The young doctor is correct yes, it–”
Bellamy screamed, drawing his legs up to his chest, as if trying to form a singularity in the center of the bed into which he could disappear.
“That should be preventing those shocks,” Dr. Ignatius muttered.
Alstrom wondered privately if the attending physician was trying to convince the patient or himself.
“Listen, doc. I don’t want to die. I really don’t, but I can’t take anymore of this,” Bellamy said, choking back tears. “Can you stop this thing?”
Dr. Ignatius stared, silent.
“We can put a magnet on the defibrillator,” Alstrom replied, when it became clear no one else would answer. “It would keep it from shocking you again.”
Bellamy nodded and pressed his lips into a thin line. “Let’s…let’s do that, then.”
Dr. Ignatius seemed to deflate inside his coat. “You understand this would be fatal?”
The patient nodded again.
“If that’s what you want, of course. That’s your decision to make. Is there anyone you’d like us to call?”
Bellamy shook his head. “I haven’t talked to my boys for years. They would think I was just trying to get attention and my ex-wife…well…”
“Sorry,” he said, locking eyes with the elder physician.
Dr. Ignatius gave the man the same owl-like look he’d given Alstrom earlier. “Whatever for?”
Bellamy shrugged. “It just seemed like something I should apologize for.”
Dr. Ignatius stepped forward and took the man’s right hand in his own. “Sir, you have nothing to apologize for. Never again.”
Bellamy nodded. “Sor–” He shook Dr. Ignatius’ hand, then released it.
Removing the magnet from the side of the EKG machine, the attending physician held it above the man’s chest.
“You’re sure?”
Bellamy nodded for the last time. Dr. Ignatius placed the magnet upon the mound of skin overlying the defibrillator. After a few seconds, the EKG tracing changed to the rapid oscillations once more and this time did not stop. Bellamy’s breathing became more labored and he searched around the room as if looking for someone he’d lost.
“Larry,” Dr. Ignatius said. “It’s okay, Larry.” He stepped forward and took the man’s hand again. “I won’t leave you. It’s okay.”
Larry relaxed his shoulders and maintained eye contact with the doctor. After a few more minutes, the EKG changed to a disorganized series of squiggles. The patient stiffened, lifting his arms to the sky. Dr. Ignatius laid his free hand on the man’s scalp and began stroking it, soothingly.
“It’s okay, Dad. It’s okay.”
The squiggles became less pronounced, then settled into a flat line.
“He’s gone,” Alstrom said, voice like lead. He sniffed and rubbed the corner of an eye with the back of his hand.
“Yes,” Dr. Ignatius agreed. He stared down at the patient’s serene expression, as if trying to memorize it. After a moment he rolled his shoulders back, let go of the patient’s hand, and grasped his lapels again.
“Are you okay, Dr. Ignatius?”
Dr. Ignatius plastered a smile across his face. “Never better. Water off a duck’s back.”
“It’s just, you called him ‘Dad’ there.”
“Did I? Slip of the tongue I guess.” He swept out of the room with oversized strides and Alstrom padded along in his wake.
The air in the dictation room hung still and solemn. Dr. Ignatius turned his penknife over and over in his hands, then held it up and ran his fingers along the side of the blade.
“This was a gift from my father.”
Alstrom spun in his chair to face him, leaving Mr. Bellamy’s note unfinished.
“My father died like that,” Dr. Ignatius said, folding the knife and pressing it between his palms as he raised them into something akin to a prayer, pressing them to his lips. “His name was Lawrence, though everyone called him Dr. Larry at work.”
“Heart problems?”
“Liver failure,” Dr. Ignatius replied. “He was a surgeon and fond of the drink after, and sometimes during, work. What I meant was that he died alone.”
“Well, Mr. Bellamy had us there, at least.”
“Yes, but it’s not the same.” Dr. Ignatius stood and looked out the observation window at the constant scurry of nurses, techs, and sanitation workers. “We got the call to his death bed, but me and my brothers thought that he was getting what he deserved for all those drunken beatings he gave us as children. My uncle claimed the body.” He opened his hands to look at the knife again. “This is the only thing I have left to remember him by.”
He handed the knife to Alstrom, who unfolded the blade to read the inscription. It read, ‘May your wit always stay as sharp as this blade – Love, Dad’.
Alstrom pushed the release on the handle, closed the knife and handed it back to Dr. Ignatius.
“I should have gone to see him,” Dr. Ignatius said, stuffing the knife into the pocket of his white coat. “No one should die alone.” After a moment he added, “Not even him.”
Dr. Ignatius glanced at his wristwatch. “Well, it’s about time for me to head out. Dr. Conner should be coming on shortly.”
“Dr. Ignatius…” Alstrom said, worried at the persistent glisten in the older man’s eyes.
“Not to worry, my boy,” Dr. Ignatius said, placing a hand on Alstrom’s shoulder as he passed on his way to the door. “Just a momentary lapse of sentimentality. Won’t happen again. Not good for staff morale.” He patted his ample belly with both hands and plastered a smile across his face that did not reach his eyes. “See? No chinks in the armor.”
He turned and paused at the door as if he was going to say something, but gave a small shake of his head as if thinking better of it.
A tech, attempting to enter the nurse’s station while holding a large stack of boxes, wobbled under the load and Dr. Ignatius dashed forward to grab one as it tumbled from her arms.
“Easy,” Ignatius said, continuing his unnerving smile. “What do I have here, Penelope?”
“Just a box of oxygen tubing,” Penelope replied, cheeks flushed with either embarrassment or effort. “I was taking it to the supply closet.”
“Well, that’s on the way out to the doctor’s lot. Why don’t I take those for you?”
“No, sir, I can’t let you do that!”
“Nonsense. Doctors don’t forget how to behave like normal humans when they tack those letters after our name. You’re needed here. I’m on my way home.”
“Are you sure?”
“Absolutely.”
Dr. Ignatius looked closely at the box of tubing, eyes unfocusing as if he was considering its contents, before shoving it beneath one arm and walking down the hall, his usual waltz step more of a funeral march.
Alstrom returned to his computer, centering his efforts on documentation as a distraction until he was interrupted by a breathless Dr. Conner bursting into the dictation room, strands of brown hair swinging free from her ponytail holder.
“Hey, sorry I’m late,” she said. “Wreck on the interstate. Is Dr. Ignatius in the bathroom or something? He didn’t answer my texts.”
Alstrom raised an eyebrow. “He left about a half hour ago.”
“But his car is still in the lot.”
They walked to the monitor bank and found the camera that oversaw the doctor’s parking. Dr. Ignatius’ white Mercedes sat unattended, still tucked neatly into his designated spot.
“That’s weir–”
A woman’s scream and the crash of something heavy echoed through the corridor, causing the nurses to scurry into the hall. Dr. Conner and Alstrom followed them to find a group of people staring through the open door of the supply closet, hands over their mouths, as if holding in some yet unspoken emotion.
Alstrom pushed past them into the room to find a shadow rocking gently beneath the fluorescent light, a kicked-aside chair beside a pool of coiled oxygen tubing tumbling waterfall-like from ceiling rafter to floor. Alstrom took ginger steps to where Ignatius’ hospital badge lay, discarded, beside his open penknife. Carved into the badge’s faded surface was a single word: ‘SORRY.’
As Dr. Alstrom rose, his shoulder, the same one Ignatius had laid a hand on earlier, bumped the dangling feet of his attending, causing them to spin in a clockwise circle.
North. East. South. West.
Dr. Robert Balentine, Jr., is a Hospitalist and Emergency Medicine Physician and a graduate of the UAMS Medical School Class of 2005. His previous works have been featured most recently in The Colored Lens, Daily Science Fiction, and Fabula Argentea. Links to other published pieces can be found online at robbalentine.com.