Melpomene, the muse of Tragedies.
Inspiration: Losing a patient. I know that as a writer, I tend to draw on my experiences. Sometimes more loosely than others, but this little one, barring the name changes and obvious PoT-isms, was completely taken from one of my shifts.
Seigaku: There's something tragic about Kaidoh. Misunderstood, misrepresented and under his tough shell, so fragile inside.
Note: As indicated by the chapter title, this chapter is not a fun one. It may make you feel upset but it is a much more accurate account of my experiences than something like Casualty or House (I don't own either of these shows).
It was nearing the end of the week for Dr Kaoru Kaidoh. As a newly qualified doctor, he was contracted to work only 48 hours a week (1), but given his assignment to Ward 18, he hadn't worked that since he started working at the large Seigaku hospital. Ward 18 was the gastroenterology ward after all. His patients were a mix of all kinds of people. He dealt with the irritable patients who were admitted to recover from their alcohol induced pancreatitis. Invariably, he was the one the nurses called when said patients were being unreasonable. Once he had even had to glare a patient into submission after they tried to drink the alcohol hand gel just to get ethanol into their system (2).
When he wasn't dealing with the unrepentant alcoholics, he had the paediatric patients who had contracted appendicitis or swallowed something from underneath the kitchen sink. He had to endure the overbearing behaviour of their parents who wouldn't even let him examine their precious children even though they were the ones who put the caustic bleach in the unlocked cupboard within their "little angel's" reach.
The other group of patients were the nice ones. The lovely little old women and men who offered him sweets that they weren't allowed or nicely put up with his ministrations when changing their tubes around. He enjoyed dealing with those patients.
His life was not helped by the other junior doctors on his ward. Dr Takeshi "call me Momo" Momoshiro was more interested in talking the nurses into doing his jobs than doing them himself. He and Momo had trained at the same medical school and had been mild rivals during exam weeks. The other, Dr Ryoma Echizen, was mostly unknown to Kaidoh. He had trained in America and kept mostly to himself but did his work well. Unfortunately, his interaction with the nurses was worse than Kaidoh's own. Especially with staff nurse Ryuuzaki, the granddaughter of the Chief of Medicine in the hospital. For some reason, Echizen could not remember her name at all and left her crying about three times a day.
As he sat behind the desk, preparing the patient's notes for the morning ward round, Kaidoh mused about his life. Medicine had lost much of its appeal since completing his degree. When he entered university, being a doctor was such a brilliant idea. He wanted to help people, he wanted to learn much about people, he wanted to cure disease, but now that he was one, much of the sparkle had left him. There was much more paperwork involved than he had first thought and he was constantly on his guard. Ever since that one ward at Fudoumine Hospital had been discovered as substandard and all the doctors on that ward struck off, Kaidoh was paranoid about losing his job.
His musing was brought to an abrupt end when the consultant for the ward came on to start the round. Mister Kunimitsu Tezuka was a brilliant surgeon (3). Apparently he'd injured his arm when he was younger so to become a world renowned gastrointestinal surgeon was astounding. His registrar, Mister Syuusuke Fuji, was in his customary place, on Tezuka's left, with his customary grin on his face. Kaidoh felt a presence behind his left shoulder and saw that Echizen had appeared there, carrying the rest of the notes with him. Considering that Echizen was at least a head smaller than Fuji, who was shorter than average as well, it was an achievement.
They exchanged no words but Echizen's golden brown eyes slid in his direction in a vague acknowledgement of his existence. He nodded silently, received one from Kaidoh and both turned to face their two seniors.
"Are we ready to begin?" Tezuka asked, looking at the clock. It was 8.05, an entire five minutes after his usual start time. He spared a mild glare at Fuji, who smiled back unapologetically. There was a sound of crashing through the ward doors and everyone's attention was drawn to the new comer. A tall, violet eyed man rushed through the doors, pulling his stethoscope from his ears and looking at his bleep at the same time. Tezuka opened his mouth to chastise him but a subtle nudge from Fuji directed him to the other bleep Momo had. The bright red one (4).
As Momo reached the group of doctors, someone emerged from behind the desk. Charge Nurse Takashi Kawamura was ready for the rounds as well, ready to give his input to the doctors as he was better acquainted with the patients.
Halfway through the round they came upon a new patient that was admitted overnight.
"Who admitted this patient?" Tezuka asked and Echizen, who had been on the night shift, raised his hand.
"Mamoru Inoue, 47, presented last night with jaundice. He has no risk factors for the usual causes, doesn't smoke and has no abdominal pain. He also reported steatorrhoea and dark urine and a six kilogram weight loss. His U&Es were mildly deranged, his FBC showed slightly raised white cells and his LFTs showed a raised Alk Phos and conjugated bilirubin. I called Dr Inui in radiology last night to arrange a CT scan, which has been booked for this morning. (5)"
Tezuka nodded at the quick summary of his condition and approached him to do his own examination. Despite his yellow appearance, Inoue was completely comfortable during the examination. Tezuka and Fuji exchanged glances with one another.
"Right, Kawamura, keep him nil by mouth until his CT scan. Inoue-san, we'll wait for the results of the scans but there are several possible causes for your symptoms. At the moment, we're trying to rule some of them out, so please could you be patient with us."
Inoue smiled and nodded in understanding. "Of course doctor. Thank you for your time."
And then, like a business transaction, both moved onwards; Inoue went back to his tennis magazine and Tezuka led the ward round on to the next patient.
"Momo, present."
"Ryuuji Sasabe, 56, presented yesterday with complications of alcoholic liver disease…" (6)
It was at the end of the rounds and Kaidoh sat down with Echizen and Momo to divide up the jobs to be done that day. All the blood requests, imaging requests and things had to be delegated and done. Since Momo was covering the emergency bleep, Echizen and Kaidoh covered most of his jobs. Momo, more relaxed than he had been this morning, decided to regale them with the tale as to why he was delayed this morning.
"So, I was just getting in, and I'd just picked up the bleep from Arai, who covered last night and it went off. I was called to MAU (7) to deal with this patient who had just had a fit. And then I had to get them back into bed and they must have weighed a ton at least!" he regaled, complete with hand gestures and arm movements. Echizen and Kaidoh exchanged exasperated glances as they went back to their notes but Momo wasn't paying attention.
"It is highly improbable that the patient weighed a ton, metric or imperial," a voice intoned behind them, making all three of them jump. They turned to see the flashing glasses of Dr Inui, the consultant radiologist.
"It was a hyperbole, Dr Inui," Echizen drawled.
"Ah, of course," the tall consultant said. He was stood in front of the desk with an electronic pad, jotting down information. Whether that information was pertinent or not was unknown.
"Dr Inui, who are you here for today?" Kaidoh hissed but still respectful towards a senior.
"Echizen asked that I do a CT scan on patient Inoue today. I came to assess his suitability," he said. His head turned in Echizen's direction but it was impossible to tell whether he was looking at him as the lenses of his glasses were very thick.
"Bay 3 bed 6," Echizen said and the radiologist nodded and headed off.
It was two in the afternoon and Kaidoh had just returned from patient Sasabe in bay 3 bed 5. His family had arrived and were demanding investigations and tests for their father. The two sons had loudly proclaimed the incompetence of the hospital, the ineptitude of the nursing staff and even the illegitimacy of Kaidoh's parentage. Needless to say, neither Kaidoh, Senior Nurse Kawamura nor Dr Ryuuzaki, the chief of medicine, was impressed.
And a great many members of staff were also insulted, from Dr Tezuka, one of the highest consultants in the hospital, to Kachiru, a member of the domiciliary staff. So no one really protested when Dr Ryuuzaki marched from her office down to the gastroenterology ward, accompanied by two burly security guards to forcibly remove the two loudly protesting males. Ryuuji Sasabe looked on in self-righteous anger but deflated quickly when Dr Ryuuzaki, almost apoplectic with rage, stated that she would not tolerate abuse to her staff and if it happened again, it wouldn't just be the sons that were forcibly ejected from her hospital.
After witnessing that small piece of drama that afternoon, Kaidoh was thoroughly prepared for a mundane afternoon with form filling, jobs and apologising to people he had inadvertently scared with his strong looks. His planning was interrupted by the presence of Dr Inui, for the second time that day.
Now, it was rare for Dr Inui to leave the darkened confines of his scanning room, so seeing him once a day was a novelty. Seeing him twice was a portent of doom.
"Kaidoh, I wonder if I could have a word please?" he asked and Kaidoh hissed his affirmation. They went to the doctor's office and Kaidoh prepared himself for a long, winding monologue about something or other that he'd done incorrectly.
What he heard ruined his day.
By the following day, everybody who worked on the ward knew. Possibly due to the loud mouths of both the ward clerk Tomoko and the porter Horio, possibly due to the way people just know these things in hospitals but it was undeniable that everyone knew. There was a solemn note to the air as everyone went about their business and Kaidoh's tasks were to be the same as every other day barring his newest task of contacting Dr Syuuichiro Oishi in the palliative care department so as to transfer patient information over to him.
Mamoru Inoue had end stage pancreatic cancer. Inoperable and incurable.
He had told Inoue yesterday and he had been so nice about it, it hurt. He had smiled and gently asked what could be done. He'd thanked Kaidoh for his time and care and praised him for his actions up to then.
And Kaidoh hated it. He wanted him to shout. To scream. To cry. He could deal with that. He could handle those emotions. But to be thanked for telling someone they were going to die, even though they felt completely healthy…
Kaidoh felt like he was the one dying.
He was sat there, like yesterday, behind the desk, but now he couldn't concentrate. Mr Sasabe's liver enzymes were becoming more and more deranged but he couldn't motivate himself to find an answer. He was preoccupied with Mr Inoue, who was meeting with the Clinical Nurse Specialist Eiji Kikumaru. The cheerful redhead had greeted him thirty minutes prior and they had gone to a quiet side room to talk.
Officially, he wasn't even Kaidoh's patient anymore, but that didn't mean he stopped caring about him.
A cough behind him dragged his attention to Echizen, who was stood there with a scowl on his face. However, underneath the scowl was a slight blush which told Kaidoh he'd recently been approached by Nurse Ryuuzaki. Again.
"Are you going to do anything about that Alk Phos?" he asked tonelessly, "Or are you going to wait for Mr Sasabe's liver to heal itself?"
And that was enough to prod Kaidoh back to his job. He hissed at Echizen but slouched out of the chair and went to Sasabe's bed to root out the problem with his deteriorating liver.
It was two weeks before Inoue transferred out of the ward and to a specialist unit. In those two weeks, Kaidoh, Momo and Echizen interacted with him daily and treat him as they did all their patients. Kaidoh often took on Inoue's tests and examinations and they bonded with each other over a mutual love of tennis whilst Kaidoh pierced Inoue's veins for more blood.
In that time, Inoue lost more weight. He began to look a little gaunt and paler. His appetite diminished and he was mostly on a liquid diet. By the time he transferred out, he looked nothing like the man that transferred in.
But he still smiled. He still thanked the doctors for their efforts and thanked the nurses for their care. He waved jauntily from his bed as he was wheeled out of the ward on his last day, smiling as his wife Saori (8) bowed insistently to the staff. Many people stopped what they were doing to bow or wave back, truly happy that they had met such a lovely man.
Then they remembered why he was being transferred. And the smiles drooped slightly.
And then, life went on. Patients came and went from the ward, tended to with the loving care of the nursing staff and the wonderful bedside manner of the junior doctors. Inoue Mamoru became a much loved patient, spoken of with wistful tones.
Kaidoh got on with his life. His day settled back into his previous routine and he didn't think much of Inoue until he received a phone call one afternoon whilst he was in the doctor's office doing paperwork.
"Ward 18, Kaidoh speaking," he said, still half concentrating on his TTO (9). He stopped everything soon enough.
"Kaidoh? It's Dr Oishi, from the palliative care department," the kind voice on the other end spoke. It was easy to tell why Oishi went into palliation since he had such a calming presence.
"Yes sir. Was there something you wanted?"
"It's regarding the patient you transferred to us two weeks ago? A Mamoru Inoue?"
"Yes, I remember. Is anything wrong?"
"Mr Inoue passed on this morning." Kaidoh's heart stopped for a moment. That wonderful, cheerful man had gone? How? When? How was his wife doing? All these questions raced through his head but the only thing he could actually say was:
"Oh."
"Before he passed, he wanted me to thank you for everything you did for him whilst he was under you care. Both he and his wife were grateful for everything you did for him," Oishi's kind voice washed over him as he sat there in disbelief. That man must have had more important things to do and think about but he wanted to thank the scary looking junior doctor who couldn't do anything?
Kaidoh was shocked.
"I have to go now Kaidoh, but I want you to know that he went as peacefully and as painlessly as possible. If you ever need to talk, you know where to find me," Oishi concluded.
"Yes, thank you sir." And that was it. It was over.
Three hours later, Echizen entered the doctor's office to make a phone call before the evening hand over and he found Kaidoh, sitting shell-shocked at the desk, a half completed TTO in front of him on the computer. Echizen was never very good at talking to people but Kaidoh looked so lost he had to do something.
"Kaidoh?" he asked and watched as the other visibly jumped out of his skin at the sound of his voice.
He turned and Echizen caught a glimpse of his eyes. His slightly red rimmed eyes.
"Oh, Echizen. What did you want?" he gruffly asked, his throat sounding hoarse.
"What happened?"
Immediately, Kaidoh's walls raised and he became defensive, seemingly like the hackles rising on an angry cat. "It's nothing to do with you!"
Echizen met the apparent anger with sheer stubbornness and closed and locked the door, standing in front of it with his arms crossed. He said nothing but then again, he didn't need to say anything.
After a few agonising moments of silence and staring, Kaidoh deflated and told him what Oishi had said.
"I can't believe I'm acting like this. I'm a doctor. I've seen death before. I don't know why it's affecting me like this," he said, averting his gaze back to the wall.
Heaving a sigh, Echizen hefted himself forwards until he was stood in front of Kaidoh. A disconnected part of Kaidoh's mind noted that he was still around the same height as him whilst he was seated. What came out of Echizen's mouth afterwards shook Kaidoh to the core.
"I think I'd be more concerned if it didn't affect you. I'm not good at interacting with people. I know this but when I see a patient, I can talk to them and probably communicate better with them than I do with healthy people. I think it might be the same for you Kaidoh.
"So, people like us, we get more attached to our patients than people like Momo. It hits us harder."
His speech was interrupted by the sound of his bleep going off incessantly. Echizen paused and read the number and turned to leave. Just as he reached the door, he turned back to Kaidoh for a mere moment.
"The best doctors are the ones who do not take their patient's deaths lightly. When you lose that feeling, when you can deal with the loss of a patient without flinching, you shouldn't be a doctor anymore. A doctor that doesn't care for their patients is no doctor.
"So, finish whatever you're doing in here and then come out and help me deal with the new patients. It's just Momo and myself out there at the moment, so I'm essentially doing everything myself whilst he flirts with Nurse Ann."
It was after the door had closed behind Echizen that Kaidoh heard a quiet whisper through the door that he knew came from his little colleague.
"Tragedies do not make you weak; they make you strong."
Ten minutes later, Kaidoh and Momo were in one of their infamous shouting matches about laziness, much to the delight of the patients and the horror of Nurse Ryuuzaki. Echizen was stood in the corner, smirking behind a set of notes.
(1) In Europe, there are a set of regulations stating that junior doctors are not allowed to work more than 48 hours in a single week. The European Working Time Directive is a load of cr*p. I have never done a 48 hour week. You stay as long as your patients need you to stay. End of.
(2) True story. When I was on rotation on the gastro ward, there was no hand gel as some of the alcoholic patients kept drinking it for the ethanol.
(3) In the UK, Doctors are medical clinicians whereas Mister/Miss/Mrs are surgeons. That's just the way it is.
(4) The red bleep is the red bleep of doom AKA the crash bleep. When carrying this bleep, every time a patient's condition worsens, you have to go. It involves a lot of running and being late for your normal duties and scowling from consultants. Also, a bleep is a pager. No-one in hospital calls them pagers. Bleep sounds more fun.
(5) Ok, this paragraph probably needs an explanation. Jaundice: is when someone's skin and eyes turn yellowish because the body can't get rid of something called bilirubin. It is a non-specific sign. Usual causes: most commonly caused by gallstones or alcohol, but can be due to autoimmune conditions, infections, cancer or scorpion venom (that's the cause everyone remembers even though it's as rare as hen's teeth). Steatorrhoea: pale stools that float. U&Es: urea and electrolytes is a blood test for kidney function (sodium, potassium, creatinine, urea, etc). FBC: full blood count is a blood test for the components for blood (haemoglobin, number of cells, size of cells, white (infection) cells, etc). LFTs: liver function tests are blood tests for liver function (alkaline phosphatase, Alt, AST, bilirubin, amylase, etc). CT: computer tomography; also known as a CAT (computer assisted tomography) scan.
(6) Sasabe, the father, has no official first name. So now he is Ryuuji. End of.
(7) Medical Admissions Unit
(8) Yes, I married him to Shiba. I know about the age gap but hey, my story, my rules.
(9) TTO: To Take Out. The sheet they send you out with containing a summary of your stay for your normal doctor to look at.
Next up: Polyhymina's Speech
R&R
Bumble x