Motol Hospital, Prague, Czech Republic
November 28
The cough was ragged, so grating it was surprising no blood came out with the mucus. Anouma held the plastic bowl close to his mouth and leaned him forward so it was all out. He gasped for air and fell back, lying on the sweaty mattress he called his home. His arms moved helplessly at his sides, waving back and forth as if he were drowning.
The pit nurse checked her clipboard, glanced at the man’s tag number.
“So he had no ID on him?” she asked, checking through papers quickly.
“None,” said Anouma softly. “He was dumped outside in a hospital gown.”
“Cast-offs from Františku Hospital again?”
“It could be. I have heard they are closing soon.”
The nurse sighed, flipped a few more pages, looked at the patient.
“So what’s his diagnosis? We need to find a place to move him. He’s end-stage, isn’t he?”
Anouma urgently motioned for the nurse to follow her away from the bed, down a short distance to a spot where most of the patients were still asleep.
“Be careful what you say,” she whispered angrily. “He can hear you.”
“But he—”
“He is fully conscious. He knows what is happening to him, but he cannot control his body enough to tell us. His motor control is gone, his lungs are failing, and he is living with endless pain we cannot treat. Do not add to his misery.”
The nurse looked sufficiently chastised, met Anouma’s eyes.
“Fine. I’m sorry,” she grumbled. “But what I want to know is if he’s going to die soon, we’ll leave him here. Otherwise, he’s going upstairs.”
Anouma sighed, looked out over the floor.
“He will survive indefinitely. It is how it works.”
“Upstairs, then,” said the nurse, and started to leave, before Anouma caught her arm. She pulled a nearby IV bag towards her, twisted it. The side of the bag was wet, and a tiny drop fell off the edge when it moved. The nurse looked closer, too, mouth hanging open.
“How did this happen? Are these being re-used?” Anouma asked squinting at it.
“Can’t be. Those are fresh from upstairs. Must be a defect.”
Anouma let it go, frowned down the row of beds, their own bags dangling above patients like bulbous flowers in a field of white.
“Double-check the supply room. We will lose a great deal of volume if there are others like this.”
The nurse gave Anouma a withering look that went unnoticed.
“Yes, doctor,” she glowered, then walked back to her muted patient, clipboard in hand. She kicked the brakes on the bed and began navigating it out of the room, clanging against other patients as she went.
Anouma rubbed her eyes with weary hands, slow and agonizing.
“Long day, doctor?” asked a voice from behind her. She turned, saw an old man laying in bed, his face covered with boils so big he almost didn’t look human anymore. Still, somewhere in the mass of distorted flesh were brown eyes, dancing.
“Every day is a long day,” Anouma said to him, picking up his chart and glancing over it. “How are you feeling today?”
“As well as I should, I think.”
She checked his meds, eyed him cautiously.
“You are not depressed? Fatigued? Thoughts of suicide?”
The man laughed — or at least, laughed as much as he could without being able to move his face to smile.
“Because I won’t be on the cover of a fashion magazine? No, I’ll live.”
Anouma laughed, clipped the chart back to his bed.
“Perhaps not a fashion magazine, but you should qualify for a medical journal write-up soon. It is widely assumed that Lumberger’s causes depression as one of its symptoms. Apparently that is not the case.”
“No, they’re all just sad they look like burnt mozzarella,” he replied. “Me, I’m used to being called ugly. I’ve been married for fifty years.”
Anouma smiled, patted him on a clear shoulder, and he patted her gloved hand back. Then she saw it… another drop falling off the edge of his IV bag. She squeezed it gently, and saw a tiny trickle from the side of the bag, running saline down onto her glove.
“Odd,” she whispered. “Another one…”
The patient tried to turn his head to see what she was looking at, but was prevented by his ailment.
“What’s what? What’s wrong?”
Anouma let go of the bag, shook her head.
“Nothing. We have to get you another bag. Some seem to be leaking for some reason. I will fetch a new one now, I think. Just wait a moment while I—”
“Help!” came a shout from the far end of the room, and two paramedics in heavy masks burst in the doors dragging a wretchedly battered woman in their arms, her chest all bloodied and her head hanging limp, bouncing lifelessly as they pulled her onto a stretcher. Anouma made a dash for them, saw Dr Bastien hang up a chart and start running too.
“What happened?” Anouma asked, swapping gloves and swinging her stethoscope around, checking vitals.
“White female, mid-twenties, looks like a knife attack. Three lacerations to the abdomen, one to the neck.”
They lifted some gauze off her neck and blood sprayed out, making them both flinch.
“Hold it steady,” she ordered.
“But—”
“If you are scared of blood, you are in the wrong job! Vitals?”
The paramedics scrambled to answer. Anouma ignored them, checked the wounds, probing with gentle fingers.
“Very deep. Liver, maybe. Vitals! Now!”
“We couldn’t check,” said one of the paramedics, backing up again at the sight of blood. Anouma glared at him.
“Bag him or get out,” she said coldly.
“How many?” Dr Bastien asked, arriving at her side, pulling on fresh gloves.
“Three at the chest, one at the neck.”
“Blood pressure?”
“We do not know yet,” she said, glaring at the paramedics.
Dr Bastien snuffed, knocked the brakes off the stretcher and wheeled the patient over to the makeshift trauma area. Anouma kicked a pedal up and down near the bed, priming the generator. A short cough later, the lights came on, beaming bright white onto the blood.
One of the paramedics had already disappeared.
“Do a blood test on her, for god’s sake,” Anouma hissed to the other. He nodded, pushed a portable testing unit against the woman’s arm and backed away as Dr Bastien pushed his way in, feeling the chest wounds.
“Decreased lung function on the left,” he said to Anouma, squinting as he listened, looked. Blood bubbled up and out of the cuts. The woman’s eyes suddenly shot open and the shock of what was happening to her made her convulse violently. She jerked upwards, trying to escape, gasped and coughed, spitting blood across herself and onto the doctors.
“Blood pressure dropping,” Anouma called out, watching the monitor she’d hooked up herself. Dr Bastien grabbed a scalpel off a tray, began work on the highest of the wounds. Anouma grabbed the suction tube and was about to hand it over when she noticed it was already bloody. She threw it to the ground.
“Suction contaminated,” she growled. “I will find another.”
“I’m losing her pulse,” Bastien said as the monitors wailed. “Skip the suction. We need to stop the bleeding!”
Anouma nodded, passed him a new package of scalpels and gauze, and then swung back for a pack of clamps. The cart with supplies was too far away… she reached for it, but the monitors whined loudly, warning the patient was crashing.
“Twenty cc’s of Entophin!” Bastien called, starting compressions. Anouma snatched a vial off the cart, punched a syringe into the needle dispenser and drew serum. She aimed for a bulging vein on the patient’s arm.
The woman convulsed again, and Anouma’s hand was hit so suddenly the needle missed its target and slid across the back of her right glove, ripping latex and hitting her skin.
The paramedic gasped, but Anouma didn’t flinch, tried again and pushed the meds. The woman’s heart rate started coming back up, and the monitor calmed, but the blood was still pouring from her wounds.
“I need suction,” Bastien called, already cutting and probing without the aid of the clamps Anouma had missed. She pulled off her gloves, opened a drawer with her fingertips, removed a packaged suction head and swapped out the old one. She handed it over to Bastien, who took it without looking.
The back of her hand was bleeding slightly, but she ignored it, threw on a new set of gloves and re-joined the crisis. The paramedic eyed her anxiously.
“You will need a packer,” she said, checking the stats. She started to go back to the cupboard, but Bastien caught her hand, letting the suction drop out and away, and twisted it so he could see the blood beneath her glove.
“When did this happen?” he said gravely.
“Just now,” she offered, tried to pull away.
“Fanta,” he said, holding tight. “when?”
She met his eyes, cold and unforgiving.
“Yes, I came in contact,” she admitted.
Bastien pushed down on the wound he was working on to stop the bleeding, waved a bloodied hand out to the paramedic.
“Give me the test results!” he shouted. The paramedic was startled, jumped up and almost tossed the device towards Bastien, who caught it deftly and quickly paged through screens.
“TB-G 14,” he sighed, threw the device at the side of the bed, then looked at Anouma. “Go clean that, and stay away from the patient, Fanta.”
Anouma shook her head, grabbed the suction, started back. Bastien caught her wrist, squeezed.
“Dr Anouma, leave the room.”
“You need me.”
“Find Dr Laroche!” Bastien barked at the paramedic. “Now!”
Anouma tried to break free, but she wasn’t nearly as strong as the old man. His eyes were cold and menacing.
“It is a tiny scratch,” she tried. “you need me now.”
“TB-G 14 could kill you!” he boomed. “You don’t have the antibodies. Someone else will take your place. That’s final. Now back away so I can save this patient!”
The ferocity of it make her flinch, and she reluctantly stepped back, held her hand gingerly, watched him work on his own.
“TB-G is not the same as Tuberculosis,” she said quietly. “I am in virtually no danger of contracting it from her.”
“‘Virtually’ is not ‘absolutely’, Fanta. There’s a very large gulf between them. One I’ve lost many colleagues to.”
She didn’t want to leave, hesitated, but saw he wouldn’t hear any more objections. She nodded. Slightly. Turned halfway.
“I will go clean this out. And… find Dr Laroche.”
He didn’t reply, just kept working.
She stormed into the side room and hit the water on harder than she needed to. She started scrubbing disinfectant onto her hands, her teeth clenched shut and her eyes not watching what she was doing. She heard the sound of the monitors coding again, and though Dr Laroche ran past her as she stood there, by the sounds and shouts and panic in the air, she knew it was too late.
She gripped the edge of the sink, her head bowed, and refused to cry.
