Part of being a doctor means facing the death of your patients with courage and not turning away from your job as soon as it becomes difficult. It means dutifully telling the relatives with enough emotion to sound human yet not enough to actually feel anything more than a slight twinge of sadness. Younger doctors struggle with this ability, often finding themselves emotionally wrapped up in the case their dealing with to the point where their feelings impair their judgement.
Being a doctor on a battlefield leaves very little time for emotions, as you must make a diagnosis and stitch the fallen solider up as quickly as possible. There is no telling the relatives or feigning feelings, it's all about saving that person's life right that second and making sure you don't get killed doing it. Bullets and bombs generally build one up to the point where they have nerves of steel.
That being said you would expect someone who had spent the first third of their lives bouncing between the two, their emotional sturdiness likened to something as robust as titanium by their peers, to have superior control over their feelings to the point where they could always be relied upon to make the most rational decision in the face of extreme terror.
Wrong.
There is one vital floor that every person in a dangerous job possess, regardless of whether or not they are aware of it. Being human.
Having a connection with the human race means having a strong bond with those around you, and it's having ties with the world which leave us weak and open to attack. Doctors and army medics are only able to turn emotions off because they cannot treat relatives or loved ones within their place of work. When we see someone we care about in danger or threatened our training is overridden by a distinct urge to protect the person in peril. The closer the person is to us, the less rational we act and the more our empathy for that person drives our actions.
It can lead us to placing ourselves in danger by taking the fall for our relatives, for example, and when that relative is your sister you feel so compelled to protect and defend them that it very often leads to your demise in some way, shape or form. The bond you share with someone other than your parents before and after you embrace adulthood can be the strongest of all, especially when your parents are not a major part of either your or your sister's lives.
But even family bonds have their limits, especially when the dark path your sister sets you on when she turns up in the ED one freezing cold Monday morning overdosed on heroin causes you to take on the task of finding out of the source of what you later find out to be your sister's addiction.
…
"Morning, Tom." Bic Mac said, making an obvious show of ignoring the haughty figure standing beside him.
"Morning Mac. How are you?" Tom asked as cheerfully as he could, also making a show to ignore Sam.
Yet another Monday morning, several weeks after her sister had arrived at the ED, that was as cold as what you might imagine a grave to be. Big Mac, Tom and Sam were all standing outside for a moment, an unfortunate coincidence that they entered the carpark at the same time, warming up their hands outside the building to avoid the sudden change in temperature giving them chill blains.
Sam blocked the rest of the conversation Tom and Big Mac had now struck up out of her head. She didn't care. She had everything she needed in her back left pocket. After shouldering past Tom and ignoring the outraged look on Tess's face, for she had just exited her car as Sam did this, she crossed the ED floor got changed slowly in the locker room.
In truth working was just a formality, as they would get suspicious if she suddenly quit her job. Oh, but how she would love to just sit at home and rest all day, basking in the strip of winter sunlight that pours through her bedroom window and onto her satin sheets on days like this instead of lugging herself around an ED treating people who she couldn't bring herself to care about.
Following the slowest change of clothes known to mankind Sam decided to make an appearance. After all- she would lose her job entirely if Zoe caught her bunking in the locker room. Unfortunately for Sam she was contemplating a day of rest and relaxation, hanging around the ED and being found mysteriously absent at the first sign of any actual work to be done when a massive RTC came bursting through the doors.
Naturally Sam tried her best to move away, moving towards the lift and grabbing a nearby letter off of the reception desk in the hopes that people thought that she was delivering something somewhere, but by this point she had used the same guise several times and everyone had caught on to her little scheme.
"Dr Nicholls!" Barked Dixie.
Sam rolled her eyes and dropped the letter on the ground, ignoring Noel's complaints about littering and headed over to the patient. Sam walked alongside Dixie and Jeff as they wheeled what looked like a teenage girl into rhesus, but it took her a long while to realize that neither Dixie nor Jeff were reeling out the girl's vitals.
"Well?" Sam barked impatiently, knowing full well she had walked into a trap as Zoe was standing by the rhesus doors holding a clipboard, looking up at Sam occasionally as she wrote down something.
"Sally Mitchel, 15, involved in an RTC with a lorry. She was in the car which was hit, suffered a blunt force trauma to the abdomen and has suffered burns around her face and neck from the airbag. She KO'd briefly on route has had ten of morphine and is not complaining of any pain other than around her stomach area." Dixie said as quickly as she could.
"Ok let's give her ten of morphine." Sam said, but again found herself being stared at by a nurse who was refusing to move.
"I.." The nurse began, suddenly scared of the impatient look on Sam's face.
"Well get it then!" Sam sad impatiently as she made to remove the straps around the girl's neck.
"She's already had 10ml Sam!" Dixie exclaimed as she stopped Sam from taking of the straps that were keeping the girl's neck still, "And you need to send her for an X-Ray before we take those off! Her abdomen is the primary focus right now!"
Sam would have gone bright red if she could have forced herself to give a damn. Instead all she could manage was a very flat sounding 'oh'.
"Well then... let me examine her abdomen and can someone dig up her notes and call for a portable X-ray? She looks too unstable to move." Sam said, realizing, but not really caring, that she had only just saved this awkward situation and her career judging by the look on Zoe's face by a thread.
Seemingly satisfied by this course of action, or more likely because Zoe had signalled them to leave, Dixie and Jeff headed for the Rhesus doors and stalked out, muttering between themselves.
Sam was left to deal with her patient alone save for the ever watchful gaze of Zoe and a couple of yawns she did a reasonably good job, feigning concern when the young girl came around and starting calling for her mum. She even allowed the girl to grip her forearm for comfort during the X-ray, though she did spend the entire time silently begging her to not grip the sore part of her arm where the tracks of needle marks still hadn't healed yet so hard.
"Where are my parents?" The girl asked once the X-Ray was over.
"They'll be here soon." Sam said flatly as she flicked through the girl's notes.
Satisfied that there was nothing in them to cause concern, Sam replaced the notes in the holder at the end of her bed and began looking at the heart rate monitor, making a mental note of the fact that the girl's blood pressure was elevated.
Just as she did this Tom burst through the Rhesus doors with another patient and a couple of paramedics, and this patient looked to be in a far more serious condition than hers. Zoe immediately rushed over and began to help, her observation of Sam forgotten, and Sam watched from the sidelines as they all rushed about attempting to save his life while she wondered why they were bothering.
The man looked to be homeless as his bomber jacket was filthy, his hair unwashed and unkempt. His grey matted beard was covering most of his chest, and there were patches of dirt all over him. He looked to be between fifty and sixty years old, though in truth Sam was assuming that the supposed years of living on the street had aged him to look far older, and so he could have been around seventy if the deducted years were added back on.
Tom was barking out commands to nearby nurses and doctors, ordering them to hook the patient up to a nearby heart rate monitor as one of the paramedics reeled of his vitals, but before he could finish the monitor revealed that the man was in cardiac arrest and Zoe was shouting for a defibrillator.
After the man was bought back Sam found herself rapidly losing interest in the case and returning to her own daydreams of her bedroom and that glorious strip of sunlight. She dreamt of sleeping all day, waking only to inject herself with her lifeline or eat, maybe to go out for a late night stroll to the alleyway where they were waiting for her. The tiny part of her mind that had not been consumed by the intoxicating substance being pumped around ever blood vessel in her body knew that she should fear and hate the people who had made her so devoid of emotion but the reason she didn't was an answer within itself.
Just as her hand started drifting towards her back left pocket once again she realized her daydreams were about to cost her dearly, as her patient's life was suddenly hanging in the balance. The young girl was now struggling to breath and looking around as though she was confused .She kept on trying to speak but it was slurred, which was making her panic even more.
"Anaphylaxis..." Sam muttered, "But how?!"
Sam quickly grabbed the notes of her patient once more and scanned them for a long moment. There, at the top of the last page on bold letters was what she had missed. The girl was allergic to morphine.
"Can I have some help over here?" Sam called as she lowered the headboard on the trolley so the girl was lying flat.
"What's wrong with her?!" Zoe called out over the screen that was separating her and Tom's patient.
"Anaphylaxis!" Sam called back before demanding the nearby nurse administer 0.3mg of adrenaline.
As soon as Sam injected the hormone the girl's breathing immediately began to return to normal, and her chest began to rise and fall more slowly. Sam would have breathed out a sigh of relief had she been able to drum up the slightest bit of sympathy.
"How the hell did you miss this?" Zoe exclaimed.
Sam spun around and came face to face with an irate looking Zoe holding the girl's notes and pointing to the red writing Sam had only noticed moments before.
"I didn't see it." Sam stated.
"Someone call Ash and tell him to take over here. Sam, my office. Now." Zoe said in a voice which would have made a grown man shudder but yet again Sam was unaffected.
As she was led across the ED floor once more and into Zoe's office she noticed that Tess had left her nurse's station and joined Zoe. Sam was also aware of the fact that she was no the centre of attention as even though she doubted Noel and Louise, who were standing at reception staring at her, had heard Zoe's shouts behind the closed Rhesus doors but the colour Zoe's face had turned told them all they needed to know. Sam was in big trouble and she didn't seem to care on bit.
"Please tell me you have suddenly gone blind and the fact that you missed the big bold red letters on that girl's notes which was a clear indication that the girl was allergic to morphine was not due to your incompetence!" Zoe said in an oddly flat voice.
"No I'm not blind but I did miss the writing. I guess I didn't see the last page." Sam said calmly.
"How the hell" Began Zoe in a voice that Sam not so fondly remembered was the exact tone she always used before blowing up at someone, "Did a senior member of staff come so close to killing a teenage girl?"
"Like I said." Sam said flatly, fully aware that her ears were about to ring but not really caring, "I must have missed it."
"Sam. I am going to give you one chance to change your attitude and apologize for what you've done here or I am going to put you on report and confine you to working in cubicles for the next month." Zoe said as the tension in her voice built up.
"I don't think that's likely." Tess said as she folded her arms and gave Sam one of her sternest stares, "She's been rude to my nurses and refused to apologize every time I've bought it up."
Sam didn't bother listening to what Tess had to say, already positive that it was most likely her blathering on about her poor overworked underpaid nurses or something similar. Internally she was almost happy. Being confined to cubicles meant she didn't have to spend hours on end with one patient, and could hide away more easily. She didn't want to work in Rhesus and this seemed like the perfect way out. She thought it best to make a show of how little she cared by raising her eyebrows as she replied,
"Zoe how many times do I have to tell you? I didn't see the big red letters. I don't see why I should apologize when it's clearly whatever stupid nurse or doctor decided it would be a good idea to write crucial information at the back of a patient's notes instead of at the front's fault."
"Tess." Zoe said in a sickly sweet tone that sounded just as pleasing to the ears as nails on a blackboard, "Would you mind leaving?"
"My pleasure." Tess said, sparing a moment to give Sam one of her most distasteful glares before shutting the door behind her.
"Sam. I am going to repeat this once, and only once. Apologize. Now." Zoe said with a furious undertone.
If Sam could have drummed up enough emotion she would have smiled internally.
"I am not going to apologize for someone else's mistake." She replied flatly.
"And I am not going to stand for this incompetence for one more second!" Zoe yelled.
"Please tell me how exactly I am incompetent when it is clear that, as I have already said, whoever decided to write crucial information at the back of someone's notes instead of the front is clearly to blame."
"I'm not just talking about today! You've been like this for the last month: avoiding Rhesus patients, hanging around reception pretending that you're doing things when really you don't even have a reason to be there, sleeping in the On-Call room for hours on end, being extremely rude to the nurses and when you actually do some work god forbid you are rude to the patients as well!" Zoe shouted, counting the reasons off on her fingers.
"I resent those accusations." Sam said in a monotone which showed Zoe just how much she cared.
In truth Sam had bigger problems. The tiny amount of human emotion she was left with was now starting to grow, which could only mean one thing. She needed a fix, and fast. She could feel it, that nagging pain in her head and that yearning feeling in her gut. Her body was crying out for its poison and Sam not being able to provide it with it's toxic nourishment was causing it to hurt her until it got what it required. To her surprise, however, something unusual was happening to Zoe when she looked back up.
She was sitting at her desk with her head in her hands, glasses on the table. Sam was no longer the best judge of human emotion, but Zoe did appear to be upset.
"What happened to you?" Zoe mumbled, staring up at Sam with more than a hint of concern.
"I- Excuse me?" Sam asked, taken aback by the sudden u-turn of emotions.
"Sam, when I hired you you were a strong and competent doctor, able to treat patients with the respect they deserved and diagnose them flawlessly. You had respect for those you worked with and never treated anyone here like they were dirt on your shoe but now… Something's changed. I'm just asking if something has happened, if something's wrong. You're not yourself and I'm concerned. By what I heard you broke up with Tom and he's furious with you for some reason he won't discuss."
"I'm…" Sam began.
More emotions were now seeping through and breaking the weakened barrier of drugs that usually held them back. Sam considered telling Zoe the truth, what happened after her sister was bought into the ED, but she knew she couldn't. A part of her still cared for her job and knew that if she did she would lose it. No one wants a drug addicted doctor.
"I'm fine, Zoe." Sam said as calmly as she could, trying to ignore how the nagging pain in her head had now turned into a distinct throb.
"No. You're not." Zoe said as she straightened up and a hint of her fire returned to her, "Because all the while you act like this you're a danger in my ED. No one want s to help you, no one has your back. If you make a mistake like you did today-don't roll your eyes at me- and no one's around you're going to fall, and fall hard. Usually nurses also check through the notes as they fill in any medications the patient has had, and nurse who was with you didn't bother to alert you to the problem most likely because she was too afraid to. You're not a team player, and people who aren't team players in an emergency department get their patients killed."
Sam stared at Zoe for a long moment, her emotional barriers now down to the point where she could actually feel once more. What's worse was she was beginning to sweat as the strain of trying to ignore the craving took its toll on her.
"So can I go now?" Sam asked as calmly and coldly as she could.
"Yes… But Sam," Zoe said, stopping her with her handle on the door.
"Yes?" Sam called somewhat impatiently.
"If I don't see a marked improvement in your behaviour over the next month you're on report then I am going to be taken action. Understood?"
Sam didn't wait to hear what those measures were going to be, as her mind was focussed on something else. In fact, every part of her body was now focussed on getting what it felt it needed. As soon as she was out of the office Sam headed towards the toilets at a run and pushed opened the door, scaring off the nurse who was in there and hastily checking all the cubicles to make sure no one else was in there.
Satisfied Sam opened the cubicle furthest away form the door and went inside, locking it behind her. Before she sat down she pulled out the small syringe that had been living in her left back pocket and took the protective cap off of the needle. Lying in her hands was the syringe full of what her body so desperately craved. Heroin.
Without waiting Sam rolled up one of the sleeves of the long sleeve shirt she was wearing and began examining her arms for a viable access point, but was slightly worried to discover none. Her body crying out for the drug in her hands she resorted to taking off her trainer and socks and stabbing the needle into the arch of her foot, enjoying the cool sensation as the liquid travelled through her veins.
The effect was instant. One minute Sam was anxious and sweaty and the next she was on a cloud of tranquillity, her body and mind now satisfied that her addiction has been fed. After waiting a few minutes for the tranquillity to wear off somewhat Sam forced herself to stand and after struggling to get her trainer back on, unlocked the cubicle door and stepped out of the toilets onto the ED.
Sam took a moment to stare at the hustling and bustling going on around her before taking a few steps forward, ready to emerge herself in the crowds of nurses and doctors without doing any work. She was about to go over and join then when a tall figure who she didn't recognise immediately as Tom grabbed hr upper arm and frog marched her behind one of the many pillars that were holding the ED ceiling up.
"You're a train wreck." He hissed, "Why haven't you been fired yet?"
"Why are you talking to me?" Sam said flatly back.
"Because you endanger the life of every patient you touch. Zoe should have fired you." Tom said forcefully, staring at Sam with a look of disgust.
"Well thankfully for me it's not up to you to make that call." Sam said in a monotone.
With that Sam pulled her arm out of his grip, rubbing the area where Tom's thumb had upset the needle marks, and walked away. The drug hadn't infiltrated every corner of her mind yet, and the tiny amount of her brain still left with a somewhat normal functioning pattern was worried about whether or not Tom knew how close he was to the truth when he called her a train wreck.
…
