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2012 - The OneIt was the End of Times
By Christopher White
AuthorHouseCopyright © 2011 Christopher White MD.
All right reserved.
Ivy Fan hurried to finish her rounds at the Peking University First Hospital. The old 1400 bed facility had been her home for several years now as she completed her Internal Medicine Residency. The big open bay Intensive Care Unit hadn't changed much during her tenure. She hardly noticed the peeling dirty white paint on the walls or the soot covered windows that looked out over her polluted city.
Ivy warmed her stethoscope, rubbing the cold metal on her palm and gently placing it on the chest of a withered body. She listened to the lungs of bed 14, Mr. Chan, a person, not a number. The rales and rhonchi swirled in her ears confirming that his lungs were rapidly filling with fluid.
She moved the large bell of her expensive cardiologist grade instrument to the left of his bony sternum and found the lub-swish-dub of Mr. Chan's heart. The distant sounds were muffled by the pericardial effusion cushioning the failing efforts of his dilated heart, but the systolic murmur was still audible. The weakened organ was close to fibrillating and certainly was not responding to her diuretics and Digoxin. He needed a heart transplant, but he was too old. No one would operate on a 60 year old man. It was out of the question.
"Ivy, there are many more patients that you can help," Professor Ming Wang said in a soft voice near her ear. He put his hand on her shoulder and squeezed. "I'm on my way to a board meeting, or I would stop and continue our debate."
She was not startled by the familiar voice of her mentor. She didn't turn, but continued to listen to the faint surf in Mr. Chan's chest.
Professor Wang smiled and hurried off, his starched white doctor's coat so stiff it did not seem to move as he strode out the heavy double doors of the ICU.
She had entered the field of medicine at the age of 22, believing that she could cure diseases, help people. It was a hope that was slowly fading as her patients continued to die, four this week. She was glad he didn't quote his favorite saying again: "Medicine is an art as well as a science".
"We have limitations," he often told her. "It will help you to realize that you cannot cure everyone."
Yes sir. Thank you, Doctor Wang, she would say. After all he was a very brilliant man, head of the Department of Medicine, and he signed her evaluations.
Ivy knew she was his favorite. They had gone so far as to have dinner once. It had been discrete and Doctor Wang never mentioned it again.
Ivy was attractive, she acknowledged, and she was proud of her full figure when she didn't have to conceal it with an ace bandage. The attention she received from the male members of her team, and from men in general, was a distraction. She did not need any distractions. She stood five feet, two inches and kept her weight under 110 with almost daily exercise. It was one of the few things she did for herself.
A residency in medicine was a full time task master and it was better if she gave it her complete attention and all of her energy. Self denial was a central theme. No sleep, impossible reading and research, endless teaching of the lower level residents and interns, no time for relationships. Dr Wang was a married man. She should forget about the dinner. Still, he did hold her hand, if only for a moment. His hand had been soft and warm. Her heart pounded in her chest as she lost herself in the memory.
The noise of the ventilators and IV alarms brought her sharp mind back into focus.
Ivy refused to admit defeat, even when there was nothing more she could do. It was a debate she carried on with Doctor Wang and any of the Staff who tried to imprint her with their fatalism. Palliation was not in her vocabulary, yet.
She slipped around to bed 15 and looked down at the drawn face, now hardly recognizable as human, his skin sallow and the darkness under his eyes seeming to engulf his face. She fluffed the pillow, his head a dead weight in her strong thin hands. She straightened the wrinkled blue absorbent pad under his bony back, hoping to delay the inevitable bed sores. Some of the Duo-derm gel pads were sticking to it and flaking off, leaving his paper thin skin to abrade on the cotton sheets. Where was the nurse? Dr Wang was right; there was only so much she could do.
She had to move on or she would never finish her rounds. She prided herself on checking each patient personally. Other Chiefs depended upon the junior residents and interns reports. She recognized that the spins put on the presentations by her exhausted team often overlooked something important in an effort to end the shift and find the respite of the little cots in the call rooms where the interns could try to get some sleep.
She finished adjusting the ventilator settings on Wan Li, a 68 year old emphysemic dying of pneumonia, her last patient, and pushed through the CCU doors merging with the crowd of traffic in the narrow hallway.
The service elevator in the center of the hospital was battered from all the gurneys and food carts that had trundled across its' marred doors. The rubber bumpers that had once protected the stainless steel walls were long gone. Only the empty round black sockets remained.
A garbage cart rolled onto the elevator to share the ride up. The custodian wore the familiar tan uniform of the cleaning staff, smiled, exposing his poor dentition. "You are looking very nice today, Doctor Fan," he said, eyeing her up and down as he chewed some dark substance and spit into the garbage cart, wiping his chin with his stained sleeve.
Ivy tried not to stare at the black caries eating away at his remaining front teeth. It seemed all the male personnel knew her name. His name badge was turned backwards. She ignored his comment.
The red bags did a pretty good job of containing the foul blood stained gauze and bandages. There was hardly any odor. She drew in a quick breath as she glimpsed the tobacco spittle running down the side of one of the bags.
There were stacks of plastic buckets of brown and red fluid in its bottom which must have come from the OR, the result of suction, irritation and the like. Judging from the number of canisters it had been a busy day in surgery. Garbage, patients, food, this elevator carried it all without prejudice.
The metal doors opened with a squeak at the top floor. Ivy squeezed past the cart, trying to keep her white coat clean. She had to set the example for her lower level residents and interns. The little man in the elevator waved and smiled his horrible smile.
She shared an office, really nothing more than a sterile closet with the four other service Chief Residents. She slipped into the tiny refuge and immediately exhaled as she closed the door, shutting out the turmoil, if only for a moment. It was her only sanctuary. Most of the morning had been spent surrounded by the eager interns and lower level residents. She taught them the lessons she had learned from those before her in this three and sometimes up to five-year gauntlet known as an Internal Medicine Residency.
The information she passed on was as valuable as gold and she smiled as she looked at the small gold ring set with a single pearl that she wore on her right hand. It had been given to her by her predecessor and she would hand it down to the next chief. The significance was immense. The kernels of knowledge she taught her team were known as pearls. The ring was given to the Chief Resident, the possessor and distributor of pearls.
The thought that the ring also symbolized her marriage to medicine crossed her mind. This did not elicit a smile. She had chosen this lonely course for herself. She'd tried putting the ring on her left hand, but it was a loose fit on that finger. Perhaps this was a good sign, perhaps she could still hope to one day marry and have a life outside the walls of Peking University First Hospital.
Like a mother hen followed by her flock of chirping chicks, Ivy dutifully cared for the residents, but the overwhelming neediness of their questions, and the self aggrandizing, long winded dissertations the junior residents seemed compelled to give at the bedside of each patient, as the sleep deprived interns vapidly looked on, threatened to wear down her well practiced serene and God-like persona.
In contrast to the propaganda filled halls of the government run facility, the walls in her little space were covered with the sheets of monthly call schedules taped end to end like the music on her neglected piano her grandmother had purchased years ago so she would be cultured and learn music, an endeavor that had not succeeded past a rudimentary level. Her grandmother had been disappointed, but Ivy knew the old woman's love was unconditional, and she had been very supportive of Ivy's desire to study medicine.
Ivy had taken down the omnipresent picture of Chairman Mao and covered the tell tale shadow with the schedules. It was a small but significant protest on her part. The venerated, if somewhat dusty, mass produced tool of the communist propaganda machine rested behind her desk, innocently, in case government agents made an unannounced tour of the facility. She could restore the picture quickly if need be.
Lists of new interns and forms detailing the upcoming changes in rotating residents sat on her tiny wooden desk which she imagined was older than she was. A small picture of her grandmother in an oval frame acted as a paper weight. She sighed to think of starting the teaching process yet again with a fresh group of trainees. Maybe she was not cut out to be a mentor. She loved medicine, but with her promotion to Chief Resident she found the endless teaching exasperating.
She picked up the little coffee pot in the corner, the chief resident's only luxury, and poured herself a cup. The heavy wooden chair creaked as she leaned back and inhaled the aroma, the old cup hot against her lips as she sipped. This was the first time today she had been able to sit down. Her feet ached and she stretched her legs kicking off her shoes under the desk and reached for the rotary phone.
She asked her chubby friend Ping, the operator, to connect the call. She had been calling her grandmother, who lived 200 kilometers to the west of the city in the rural village where Ivy had been born, every Sunday since she had moved to Beijing to begin her studies. Her grandmother had raised her after her mother died in childbirth and her father disappeared. Ping knew the number by heart.
Her grandmother picked up on the first ring. "Ivy, is that you?" Ivy knew she looked forward to these Sunday phone visits with her only granddaughter.
"Yes. It's me," Ivy replied. She could almost see the wrinkled face of the woman who had worked so hard to save every Jiao to send her to school. "Grandmother, are you alright?"
"Yes dear, I'm fine. You know they say something horrible is going to happen today? The television and newspapers are full of scary stories, like the end of the world." Grandmother's voice was always tremulous from her battle with Parkinson's disease, but today she sounded more worried.
"I hope not," Ivy sighed, wishing her grandmother would not watch so much television.
Suddenly a loud crack broke the connection and the line went dead. Ivy tried to redial the operator. As she turned the dial, a thunderous boom like a giant blacksmith's hammer crashed down upon her. Ivy was stunned by the shock wave. She shook her head and struggled to reorient her mind. She quickly slipped her shoes back on and stood gripping the desk.
"Grandmother!" Ivy gasped as she ran to look out the window from the top floor of the old hospital. The window faced west.
The horizon was ablaze. Flames shot skyward in a tidal wave of blinding light. Clouds of black and gray smoke, like mountains rising from the west seemed to battle the flames to dominate the brightness. An enormous new sun filled the sky and rose rapidly into the heavens. The sea of dark smoke swirled beneath the blazing globe lapping at the white hot ball. This was followed closely by another sonic boom and a shudder that rocked the building.
She gripped the window frame and crouched low, in case another shock came and blew out the glass. She knew she should seek shelter in the interior of the building, but was unable to pull her gaze away from the window.
The floor lurched again and Ivy was thrown to the hard linoleum. Glass broke overhead and sirens filled the air outside. She lay flat as the floor rose beneath her and IV bottles rolled past. An IV pole fell, just missing her as she scrambled back to the window.
Ivy pulled herself up and struggled to peer over the sill. She saw people, hundreds of people, pouring out of the doorways of the buildings that lined the busy street. Like tributaries they flowed together, creating a raging river, the torrent crashing over cars and trampling the weak, showing no mercy.
This must be the calamity the government controlled media had tried to avert. But, despite all their censorship and propaganda, this reality could not be denied. The great city of 22 million seemed to have taken to the streets at the same time, forcing traffic to a standstill as the panicked faces blurred.
Fire and smoke shouldered between the buildings and the sky was burning, a wall of smoke rising as the sun seemed to go out, a light switched off, suddenly midnight.
Ivy squinted to make out the scene below, but the smoke blocked her probing eyes. As she waited her eyes began to adjust to the dark.
She considered trying to run, but she couldn't leave her patients. She made the decision to stay. Regardless, there was no time. The massive black cloud was approaching rapidly from the west, like an ominous dust cloud following a stampeding herd of wild Mongolian horses that covered the entire world. Her mind raced just as fast, but it was clear that there would be no escape.
From her perch she could now make out people running over one another and bodies strewn on the street between the rows of cars. Drivers abandoned their vehicles and joined the stampede.
Yelling, screaming voices mixed with honking horns to create a blast of noise muffled slightly by the height of Ivy's building and the window. She pressed her face against the cold glass as she watched. Her breath fogged the window and she wiped it with the sleeve of her spotless white coat, she hardly noticed the grime.
The smoke and ash fell across the street below like a billowing cloud. The people on the street vanished in the cloud and as it engulfed her building the ventilator alarms suddenly screamed in unison from the CCU across the hall. She tore herself from window.
The emergency lights cast the dark hall in an eerie red glow as smoke began to seep in through the vents on the fifth floor. She touched the heavy wooden door of the CCU for heat and sensing none, pushed it open.
She blinked and then put her hand over her mouth. The ventilators were still working, but the patients were gone. They had vanished. The CCU was filled with machines and noise. Every bed had been filled, but like a nightmarish scene from a horror movie, now the beds were empty.
Adrenalin shot through her veins as she ran from ward to ward only to find the same incredible spectacle. Her heart pounded. Her mouth was dry. Where were her patients? Her head was splitting open and her hands were shaking.
IV machines' alarms were sounding, joining the ventilators. Pulling back the sheets, she found only gowns and tubes and IV fluids running, soaking the bedding. Bed after bed, the white sheets billowed and sank to the floor like ghosts.
Foley catheters lay in the beds. Some of them had fallen to the floor. Their bags of yellow urine hung on the sides of the beds. Nasogastric tubes stained the white pillows with blood and bilious gastric secretions, a reminder of where they had been.
There was something under this sheet. She pulled it back to find a Titanium hip prosthesis and a neat row of metallic staples lying beside it. The shaft of the femoral component was warm. She drew back almost touching her hand to her mouth. Were these things all that remained of her patients?
She thought better of taking the elevator and hurried to the end of the hall. She pulled open the stairwell door and ran down the stairs. But running from what?
Excerpted from 2012 - The One by Christopher White Copyright © 2011 by Christopher White MD.. Excerpted by permission of AuthorHouse. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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