Pat

The heavy grey wind slapped across my face as I walked home to my car in the afternoon with the dull rumble of the river beside me and the sting of my hair in my eyes. With every gust my wrap dress would unwrap and lift then tangle itself between my thighs and little bites would come through my stockings into my legs and hip. I shivered walking, underdressed for once and hugged my bag against my side, the dangling arm holding my lunch pail cooling and whitening. The car was warm inside, having been parked outside all day and the leather had swelled and softened with it as I snuggled into it before putting my key in its holder and pressing the button that turns the car on and flinching from the too loud radio over the whine of the engine.

I backed out and began to drive, heading towards the mountains that hover protectively over our little hill and tried to let the tension seep out of my shoulders into the warm leather. Rubbing my dry lips together and feeling the flake of my matte lipstick as I indicated left for our street.

As the tension uncoiled, the tiredness began to set in and the fog of it surrounded me until I was wrapped securely in it unable and unwilling to break free. Thinking of dinner and wanting, wishing more than anything to not make and not cook and not eat anything but instead to crawl into bed and sleep for a week. But like always, I parked my car in its spot and turned off the engine. Sitting quietly listening to the radio for a few minutes as I always do before climbing out, collecting the bin and tapping my heels against the polished floor boards as I clicked into the kitchen and began the second round.

When Bingley's contract ended on his last job, it was of little concern. He's never been out of work since he graduated and has jumped his way up the career ladder as he always planned. And when 3 months later I returned from my time away, it was not so much of a worry that there was not much on the horizon because something always turns up. And we still had savings and we could keep on keeping on. Then Christmas came and the cool hand of it started to play around in my chest at times, as I watched our little nest egg erode.

Then it was 7 months then 8 and I would wake in a cold sweat thinking of it. Thinking how I couldn't support us all alone. Not without many things giving. And I love working, but we're a team, and all of the responsibility would suffocate me in the night until I sat up gasping.

At 9 months the cracks started to appear, and I began to feel each day that someone had a hold of the key in my side and was winding too much every day, and I worried about how many more winds I could take before the spring cracked and I was broken. But when I was at work I could shut it all out. I could be busy and work hard and not have time to dwell or be anxious. I could be good at my work and while the spectre of a looming exam was never far from my thoughts, I would chase my fear of failure and of study and of financial responsibility away and would instead throw myself into learning and procedures and having one thing in perfect harmony.

And it worked, most of the time, until the morning I came in and found out that the gentleman I'd done a procedure on the previous day had died. Had died of a complication that had come from the procedure that I'd done. That had it not been for me he and his kindly eyes and his soft voice would have still had life and his family would still have had warm hands to hold. And all the rest of that wretched day I worked, but the tears would not stay out of my eyes, and all I could think of was how I never see my children and I work so hard and in the end I have taken a life instead of given it. That that poor man's family would
have been called and if he had not met me, if it had been someone else, maybe he would have lived.

I came home that night and sat on my bed with my feet on the floor and I sobbed. I sobbed until all the tears had gone and the spirit had gone from my breath and so the only sounds that came were the sounds of the shudder as it racked through my chest. Bingley came in and stroked my head as it continued until the nausea began and I started retching, all done. Finished. Complete.

And for all those months that I'd planned how I'd celebrate for him, surprise him when he got a new job, of all days it was that one when Bingley could finally lift some of the weight from my shoulders. But there was a catch, that as my sobs subsided in the warmth of his belly as he held me there with my feet still flat on the floor, that started the sobs anew. This new job is away. Far away and he would be leaving in 3 days time. For weeks.

I thought of getting the girls to school and the Possum to kindy and then getting to work and I thought I could do that, that the rush rush rush I had not missed, but I could do that. Then I thought of coming home every night, of rushing home in the traffic and the rapidly darkening day as the sun tucks herself under her golden pink covers and making dinner and supervising home work and tidying and ironing and washing and sorting everything and whatever strength I had deserted me. I was 4 weeks out of an exam. A specialist exam with a pass rate of 25%. And I pulled my feet up off the floor, curled up under the blanket and cried some more.

Of course, eventually I got up, because what other choice is there? I could have lain there forever. I could have used any and all of those excuses for why I just can't do or be. But what sort of life would that be? There is a steely core within me. Some stubborn tenacious sort of fibre that refuses to break, and I set about making things work. I hired a new after school nanny, I wrote up a timetable, I had a family meeting and I had most of all a long, hard talk with myself and I told myself I could do this because there is and was no other choice.

It's not been all sunshine and roses. I can't be the worker I was before he died because he still haunts the periphery so that there's a tremble sometimes when I finish a procedure now, and an assumption that all things can and will go wrong. I have none of the confidence that comes from ignorance and I have tasted real fear for the first time in my life. There is a new quietness, and I was never loud in the first place. I withdrew so far into my shell that I'm blinded even coming near the light, and part of me doesn't want to come out again, but prefers to stay hidden and safe.

I am thinner again. My elbows are pointier and when I lie flat my anterior superior iliac spines are visible, tenting the pale skin above that does not pull taut but instead drapes across them. My belly again has the slack softness where it was stretched by the Possum and faded into silveriness and no longer has anything to hold it out so it falls. My jaw is stronger and has shadows underneath and there are little hollows in my cheeks that suck against my teeth when I am tired. Strangely, my breasts have remained full and soft and have not emptied with the rest of me, I am glad of this, to have one thing left of what it used to be like to be me.

There are lines around my eyes, still faint and not permanent yet, but they will be, and I am handsomer now than I was at 21 or 25. Not that I was or will ever be pretty, but my features are less harsh on this tired face than they were on the pillowy roundness of youth. My arms and my legs are thinner and my feet are smaller too. Who knew that feet could change in size. My hair is nearly down to my waist again and is darker too, and falls out in strands that get stuck in the bristles of the broom.

When Bingley is away I have no appetite and when the exam came I did not eat because I could not. And as I lay in my hammock afterwards, drifting listlessly in the pale afternoon light I was given food and forced to eat it for all I did not want it, because people were becoming concerned and I suppose they had reason. So I ate.

And now I live by my schedule where everything must be fitted in and around and somehow squished into the few hours of each day. And the children are happy and settled. They are thriving on all the routine and are helping. They miss Bingley too, but they know he is coming home and they know how much he needed to work. We read at night on the white sofa with the cuddly grey blankets in the pale white lamplight and they snuggle into me as I choke up reading Charlotte's Web. And I turn off all the lights at a sensible hour, and I climb into bed, feeling satisfied that the washing is folded and put away and that the kitchen is clean and the ironing is done.

And I lie here in bed, in my cold bed with the late Autumn wind whispering over me and I tell myself to sleep, because the tiredness makes my bones ache and I am doing far too much for one person who does not get enough sleep. And sleep evades me, night after night. So I read and I write and I compose stories in my head. And I miss the warmth in my bed that even on my worst days was always there, that I could somehow absorb into until his regular breathing became my breathing. Or the days when the tears came when I could burrow into the warmth and have it envelop me, encase me and penetrate me until all the cold was chased away.

I'm afraid to cry, but also I don't want to. The little thread inside me, the little core that refuses to break but instead tenaciously holds every piece together is intact. And while my skin may be softer than ever before and the legs that are holding me upright are whittled down, there is still a fire that burns there in the middle, and refuses to go out and believes all this is for a purpose. If only to prove that I can do anything, if I put my mind to it.

But I'm so tired.

Mind reader

When I was a teenager, a friend used to say I could read her mind - as if I somehow had the ability to poke around in her head, and sometimes see things that even she couldn't. A close friend from a few years ago remarked something similar - that I had free access to thoughts that had never been verbalised. It was always a privilege to see inside someone, an intimacy of which few can boast.

The full moon was bright over the road as I drove into work that night and climbed into my chair, bare feet tucked up under me as I scrolled through the inside of other people's heads yet again. Silently assessing, appraising, categorising. Most of the heads I looked at were old, and the memories of a lifetime were gradually fading away. I wondered at some, as I scrolled past a dark spot, the herald of loss of a bundle of neurons, of what memory had gone with them. What moonlit walk, what tragic loss, what phone number or frisson of potential had held its place in memory.

I continued to work hard that night, steadily, playing my part in my little warm room as the patients came and went. Until he came in and I looked at his brain. His brain was young. Far younger than the brains I am used to seeing, a brain full of all the things that a young, fit, healthy, clever young person should have. Or it was once, before the accident that brought him into my care in the first place.

I wasn't in my little dark room as I looked at his head. I was in the bright room. The frigidly cold room to keep the machinery operating well. The machines that go beep were in there too as I stood at the terminal and began to scroll. And all those memories and that fun and that life and that spark were closed to me and all the people standing behind me, listening to every word I said. Until I stopped speaking and the room began to empty and the shoulders of all around me slumped. The adrenaline high that pulls you in in the middle of the night to do your best and do good futile at that point.

Where they all went I'm not sure. Some went back to work, and saw the next elderly brain that would shortly wend its way to me to delve through, others I think went home. Others went to see the family that had been woken in the middle of the night and wanted to know and to hope but couldn't. Not after my words that night.

And I sat in my little dark room and became acquainted with every part of his body. Following every line and contour. And at some point in the night I realised my cheeks were wet, as I thought of all the things that were lost. And it was important to me to do things properly, as I looked deep inside him to the parts that no one had ever seen before. To take that privilege and that honour and not take any shortcuts. Even if as I was scrolling his breaths were slowing and those around him were hearing my words from kindly mouths that have had to say them too many times before.

I drove home when the moon was still in the sky but the birds were singing and the sun was glorious through the clouds. So tired that I felt that my limbs were leaden. Few thoughts racing around a usually noisy brain as I indicated for my turnoff and parked my car. The wind chilly as I stepped out, ruffling around my ears and tickling my cheek. And it struck me again, how lucky I am to have thoughts. To record them here. To keep on having thoughts.  And the tears started again, silent ones that kept coming and coming and coming. And I cried as I saluted the sun, stretched out on my yoga mat until my biceps shook with the pain.

And I cried as I drove to the water, and ran into the choppy sea while my hair laced with seaweed and salt. But as later I lay on the sand and it pressed into my cheek the tears finally stopped. And the sun tickled along my bare skin and began to warm me from the inside out.

I can't change what happened to him. It was all over before we'd even met. And I could become cool and hardened like some of those I work with. Who look at organs and wounds and that's all they see, because there are too many sad stories. And it's not because they're lesser people or doctors or somehow innately cold. It's because they will see that tomorrow and the day after and you have to find some way or else it will break you.

But I need to know their stories. Who they are and where they've come from. I need to feel like I've earned the right to the secrets locked up inside that no one else knows. And when I find the secrets, the memories that are lost forever, I see them just for a moment, before I report them gone. And maybe it's silly and maybe it's delusional and maybe I should just buy the bottle of wine like so many others. But as I drove home under the moon tonight, the heavy golden moon, I felt the sadness shift - I did right by him. I did right by others. I will continue to keep on doing my best.

And that's my secret.

Not Paris.

When I arrived she was leaning over the bed, face blue as she gasped for breath. My entrance shepherded by the others called by the emergency page for a young woman who couldn't breathe. The mask went on, the lines went in, like a well greased machine and the clothes were ripped from her chest so that we could stick on the leads for the defibrillator. I was there when she stopped breathing, and it was my hands on her chest as the ECG showed a flat line. Her ribs far springier than any others I'd ever felt, because she was at least 40 years younger than anyone else whose chest I had compressed, the beat of Staying Alive dancing irreverently through my head as I counted 30 - two pumps on the mask. Adrenaline, atropine, bicarbonate, magnesium. My fingers on the cricoid as the ETT went click click click beneath them.

Mobile radiographer arrives, chest compressions continue. There's a rhythm - now it's gone. Tiny pulse, now no output. That smell. That death smell. Pumping on the chest, arms tired, swap with someone else. Keep pumping, 20 minutes, 30 minutes, 40 minutes. Infusion. ABG. Acidotic. Pupils fixed. Compressions cease. 38 years old. Curtains now closed and everything left, just a blanket drawn up. Phone calls in the middle of the night. 

Feel pointless. Wonder if she will get bruises from the futile weight of my arms and hands on her chest. Detach. Sit on the ward and read through her chart, search for an answer for why it all went wrong. Listen to the call to the coroner. Lean back for a bit. Feel morose, feel reminded of all the people who wonder why I do this job and if I agree with them. Shake myself, answer more calls, forget her name and feel guilty about it. It's on a sticker somewhere. 

Pronounced.

When my fingers curl softly over the wrist lying limply at the side, it's always surprising to feel the warmth. As I press against the flesh, feeling between my index and middle fingers for the thick radial pulse, there is always - always - a feeling of fleeting confusion when I can't. The heat of the skin surprises me, as if something momentous should have happened at the time of death and left a cold shell behind. As if warmth somehow equals life.

I hate putting my stethoscope against a chest that stubbornly refuses to rise or fall, and the stillness is eerie. Like children playing games. As if I'm waiting for a wink and a smirk and a "gotcha" moment. And yet the skin as I brace a hand against a shoulder is still warm. Cells still doing their lively thing even though the whole has shut down. The last of the workers hurrying home out the gates even as the lights are turned off.

I don't like the sensation of prising open eyelids to check for a pupillary reflex. It feels grotesque somehow, to force this person that is no longer a person to suffer this last indignity. But it gives me a chance to close them again, which when someone hasn't died with their eyes closed makes me feel better. I don't like the cloudiness that shadows beautiful irises that looked at me and laughed a few days before.

I have rarely had to pronounce someone who I have cared for. Through some odd twist of fate those who I have grown close to have died when I was not there, and I have not been called to touch their still warm skin. I have performed this ritual for many now, but mostly it has been for those I've never met, except perhaps to write up something for pain. And it has often been relief I've heard that a favourite patient has died, and that their suffering is now ended.

Two weeks ago today, on a crazy Monday with too much to do, I was called to see a patient who may or may not have been unwell. The nurses were a bit concerned, but not panicky, and I strolled over to the outpatient area to see this patient who was a bit short of breath. He was braced in the bed, holding the rails, and gasping into his hudson mask, distressed by the sensation of not getting in enough breath. The nurses were pottering around nearby, but were not overly concerned. Me though, the second I met this man, my adrenals kicked in as if someone had given me a punch to the back.

After examining him I had taken his blood, called for a CT scan and had started writing out the forms to take to radiology. I had given him some medication to help him breathe and had organised for him to be admitted to hospital. His ECG and his radiology forms clamped in my hand, I started doing some of the other jobs on my list and stopped for a moment to chat to a friend, conscious of my unwell patient and waiting for his bloods to become available so that I could request his scan.

20 minutes later, unheard of for my busy hospital I was called on my mobile, by a frantic radiology registrar because of the not good things on the scan that needed to be dealt with right now. It showed a pericardial effusion - or fluid around the heart causing tamponade. Essentially the fluid builds up so that the heart can't fill and contract so it feebly lists like a deflated balloon, the chambers collapsing in on themselves between times. I had found out why my man was breathless, and had diagnosed something that most had just attributed to his cancer. I had found something fixable - at least for the short term.

I watched in grim amazement later, in semi darkness as a Cardiologist did a bedside echocardiogram and watched his heart flutter in this pool of fluid and hoped that they would offer him something. This was a man that wanted to be treated, and I wanted him to be treated to. He was young, young by cancer and hospital standards, and though we were never going to cure his disease, there was something wrong about him dying like this, without trying. He wasn't at peace, he didn't have a loving wife gripping his hand as they made the decision to go... he was fighting. For every laboured breath.

They drained that fluid - dark, bloody and full of cancer, and I saw him again 3 days later when he left coronary care, minus nearly a kilo and a half of pericardial fluid and he was talking. Smiling. Sitting up out of bed and calling me Sunshine. Delighted that I'd worked out what was going wrong and giving him these days of sitting out of bed, reading the paper and breathing. Not thinking about it, not working for it, but breathing.

We had a few chats, even though he was brusque and obnoxious with most of the staff who tended to him. He liked me, waxed on about all I'd done for him, and it embarrassed me. He still had his moments, and the Sunshine name was a joke, because everytime I saw him it seemed I was giving him crap news, but I was even more delighted than he was to see him sitting out of bed. He had one single wish, and that was to go and walk on the beach just one. more. time. And I believed I could give it to him. I fervently wanted to. I had been to that same beach he was talking about just a few weekends before with my girls and I wanted him to have that last late afternoon heat off the sand and the crash of the waves and that wintry blue. All of that, just one more time.

On Thursday night when I stopped by to see how he was doing, he had the oxygen back on. He was still speaking in sentences, but he needed the prongs on, and I should have known then. I think I kind of did. I know he certainly did. But there had been nearly a week of improvement. Of getting stronger every day. And I just wanted him to see his beach. Friday though I knew, I couldn't even pretend. As he spoke in short phrases, broken by gasps to bring air into his lungs, I knew what it was. And I got everyone to see him I could. I weathered the cranky abusive call of a registrar on a Friday afternoon who liberally dropped expletives when I asked him to come and see him.

And he knew. He knew he'd had enough, knew that we were fighting the losing battle, and even though I could give him more days, that just wasn't enough. He wasn't going to see his beach, so what was the point? We offered, he said no thanks, and took the braver route.

Sunday morning I saw him, in pain, so breathless that he could do nothing but writhe in bed and tinged with the yellow that heralds multiorgan failure, and I stepped up. Sunshine might not be able to cure him, but I sure as hell could take away that pain, and that horrible feeling of not getting enough breath, and that rattle in his chest. And so I did, and by Sunday afternoon he was sleeping. Still going to die, still not getting in enough oxygen to feed his cells, but no longer distressed, no longer in agnoising pain. And I sat there, in the quiet darkened room, as the shadows played on the walls beside the bed, and held the hand rail. Watched the rise and fall of his chest, not quite as rhythmic as those that are going to live, but gentler than the morning when everything had hurt.

This morning he needed more pain relief. And as he opened his eyes to my voice, he gasped out a few answers to questions. He was Cheyne Stokes breathing and the apnoeic periods and the shudders between them gave me a flashforward of the next few hours. We called his sister, and his Mum and asked them to come. I knew it would not be long. It was as if having given up hope of the last thing he had to live for he just couldn't be bothered any more. And he was pissed that it was taking so much effort to die. And he held my eyes for a moment, before turning his head to the side, away from me and my eyes. Told me not to look at him like that. And I sat quietly for a while, not liking him being on his own, hands loosely clasped in my lap and bit my lip.

It was the last time he ever saw my eyes, and the last time I ever saw his. A few hours later, after 2pm when I'd raced away to scoff some lunch, I got the call that he'd died. His family was with him, and according to them, just suddenly, he'd stopped. One minute peacefully sleeping, his breathing settled, and then his chest had stopped rising and falling. They were a bit in shock at how fast it was, and saddened that they'd left it too late for the son and grandson that I'd never heard of before that moment to be told what was going on. And I bit my lip then, so hard that it bled, and I blinked my eyes a few times as I curled the soft cool tips of my fingers over his warm wrist and waited for the throb that would not pulse between my fingertips. And auscultated the warm chest where no air stirred. And quickly, opened and closed eyes that no longer saw me, and would never again see the beach.

And I excused myself to write paperwork, sat down at my desk, and stared forwards for 10 straight minutes. Numb.

And just for you, Greg. Here's the beach, just one last time.

Day 15, silhouette

The moon is so bright tonight it is hiding the stars, the sky covered in a pearlescent sheen. It was looking at that cold bright sky tonight, with my eyes blinded by tears that I decided I will never be a surgeon. I could not treat someone as an organ to be sliced and managed, and then passed on when there is nothing left to cut.

I had to make a call tonight, to a girl who is still young enough to be at school and ask her to come to the hospital. I explained as carefully and as gently as I could that her mother had started to deteriorate and that she needed to come to the hospital. I listened to the frank fear in her voice as she understood immediately the implications of the calm words coming out of my mouth in my gentle voice. And it was the hitch in her voice that had my own vision swimming and swallowing hard. That trembled my gentlest voice and made me angry at myself for still not being able to do this without staying professional. To be calm for her.

I had had the same chat with her Dad and her brother, explaining to them that their world, already grey and miserable had started to hail down around them. Raised my voice to be heard over the massive thundering blows that were rocking them where they sat. And as I wrapped up that horrible meeting, with tears in my own eyes and started on the paperwork that goes with something like that, the surgeon that operated on her walked onto the ward. Glancing at the paperwork I was filling out he intoned how sad it was, before turning his attention to another scan, another tumour, another operation. Next.

I felt so disillusioned sitting there, my neat handwriting filling a sheet of progress notes to document what I'd said and what the Palliative Care team had said. When I had never cut her, had not poked around inside her body, had done nothing but care for the shell that was left after the cancer had been scooped out like a hellish icecream. I was not the one who admitted her to hospital, had not explained to her family what was going on. And yet I was the harbringer of death.

I looked at the clock then and realised I was late for the meeting for the Monkey's school orientation session and I swallowed hard, blinked and signed my name under the notes. Other doctors working with me whisking paperwork out of my hands and shooing me out the door knowing that I had needed to be somewhere else while I stubbornly insisted on seeing it through. Knowing that I could be late to the meeting, but that this, this was something that needed to be done properly. Not as an afterthought, not a careless "oh that's sad" but properly. She will only die once, and I don't want it to be thoughtlessly.

And as I looked at the silvery moon, and the almost oily sky, and couldn't see my star, I trembled a little and vowed that I would never be like that. That I would never ever be that person that does not want to be involved at that time. I've been told variously that I would make a brilliant surgeon and that I never could be one. My hand eye coordination is excellent. I am meticulous and driven and pedantic. I am organised and methodical and I have an understanding that means that I would make a great surgeon. Those are not my words, they are transcripts from references that I have in my possession.

But all of that means nothing to me if how I am defined is in the scars that I leave on my patients and their families. I can't have that as the silhouette that chases me on a moonlit night as I leave in the cold and dark, my breath fogging around my face as I cry.