Stay Alert, Control Your Thoughts and Save Lives

I find it interesting that when we’re calm and our chattering minds eventually rest we suddenly remember an appointment, or find a solution to a problem. When confronted with important decisions we often have a ‘gut’ feeling about the choices we make. Occasionally, we get a sense of danger and act accordingly. The more alert we are to our inner guidance and intuition, the smoother – and safer – ride we should have in life.

Robert Louis Stevenson had the idea for his famous novel Dr Jekyll and Mr Hyde while sleeping and Stephen King got inspiration for his brilliant novel Misery while drifting off to sleep. Our subconscious mind is a memory bank. It stores information which controls our behaviour without our awareness and can be accessed when our active mind becomes relaxed.

I thought it would be interesting to write a short story from the point of view of the subconscious mind.

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Stay Alert, Control Your Thoughts and Save Lives

When Josh punctured the lung of 46-year-old Mrs Landau, causing death due to complications of a haemothorax, I sensed a fragmentation in our relationship; a dichotomy in our thinking. I tried to convince him that a series of mistakes had contributed to her demise but Josh maintained he was ultimately responsible.

Now, as he blocks my communications, allowing me only the rarest of appearances, I’m finding it increasingly difficult to halt his self-destruction.

Seven days after the death of Mrs Landau Josh glances at his watch. Fifteen minutes to the end of three, very long days on-call and he’s mentally ordering a double whisky while running through the events of the day. Has he forgotten anything? Yes, of course he has! How could he not when he hasn’t even had time to piss.

He orders an X-ray for the elderly lady on Cheshire Ward, requested that morning by the consultant when learning, on ward round, she had fallen out of bed the previous evening. Mindful of a lawsuit, no doubt. Josh then writes up antibiotics for an eight year old girl. A difficult decision required on an elderly gentleman on the respiratory ward had cast the request for antibiotics for the child straight into the wind. The elderly gentleman subsequently died but Josh does not consider himself responsible for that one.

Whereas weekdays carry the full complement of staff, decisions at the weekend are sometimes left to novices, like Josh, who rely on a good phone signal to enable a Google search for guidance. A Registrar is available but rarely has time to hold the Junior’s hand while he attends to all the emergencies the Junior is too inexperienced to cover.

Mistakes are made.

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Five minutes to end of shift, exhausted and fed up, Josh’s bleep buzzes. He considers banging his head against the wall and presenting himself in Casualty with suspected concussion but I gently remind him he is still officially on duty and under investigation regarding the death of Mrs Landau.

He answers. It’s Nurse Seema from Oncology.

‘Hi Josh. Sorry, love, I know you’re about to leave but Nicos is still in Resuscitation. What a bloody day, eh? Can you come and do a catheter before you go?’

Josh’s heartbeat accelerates but forgets to send oxygen to his brain. His head swims; tendrils of red swirl round his body as anger and fear surge. On legs that no longer remember how to carry his weight he makes his way to Oncology. His responsibilities officially end during the walk to the ward but he is now committed. While his mind is busy I have little chance of getting through.

Josh takes one look at the patient and feels a sense of panic as I try to warn him by feeding him a memory from an episode while on a previous rotation. An F1, fresh out of medical school, had been coerced into inserting a catheter in an elderly cancer patient when a radiologist was unavailable and it hadn’t gone well.

‘I’m not experienced to do this. You need to call in a radiologist or surgeon,’ says Josh.

‘But there’s nobody available. Please?’ Nurse Seema begs.

Josh hesitates and during the pause she hands him a catheter tube and flashes him a smile.

‘Thanks Josh, you’re a star. Can’t leave the old fella with nowhere to pee otherwise he’ll probably burst his bladder!”

Josh holds the catheter – completely forgetting to check whether it’s the correct size – in his clammy hands. He baulks at the odour that rises to his nostrils before realising it’s a mixture of sweat and fear emanating from his own body. Clutching the tube he has difficulty deciding what to do. His thoughts try to grab onto something solid as he rubs the back of his neck unable to make up his mind whether to allow the nurse to bully him into performing the procedure or whether he has the courage to refuse.

Fear metastasises to every cell, freezing the synapses in his brain. The patient is in pain and the Registrar is unavailable. Josh doesn’t heed my warning and, against his better judgement, begins the procedure. 

Deep breaths, Josh, I tell him. Calm your frazzled, overworked brain and allow me to help you. With hands shaking worse than some of the patients on the neurology ward, Josh inserts the catheter, successfully completes the task and then prays there will be no complications as he goes to change out of his scrubs.

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Josh keeps his head down as he leaves the hospital. The euphoria he felt at the end of shift is short-lived as the death of Mrs Landau surfaces in all its colours and he senses eyes of judgement following every step he takes. Wispy clouds of murky blue reside in his aura as he struggles to quell the shame that lurks in his mind.

Josh tells himself he can’t do this any more. There’s no way he’s going back through those hospital doors and subjecting one more patient to his poor decisions. His body tenses and he lashes out at a lamp post with the fervour of an England striker. Wham! A torrent of pain floods his foot and ankle, sending sparks to his brain. He sways as the light temporarily dims and his breath momentarily ceases.

He clutches the lamp post and clings tightly until equilibrium returns. Tears course down his cheeks as self-pity usurps rationality. He hobbles to the pub, the pain – and the prospect of temporary annihilation from worry – give him unexpected joy.

When he downs the first double whisky in a few gulps, then orders another, I’m afraid. No, Josh, No! Just go home. You’re a good doctor. You just lack experience – and support is not always available. It’s not your fault.

Josh pauses as he raises the glass to his lips. I think I might be getting through. I hope he realises he is not responsible for the failures of the system.

But no. My pleas go unheard – or ignored. Four hours later Josh is slumped, unconscious, against a green wheelie bin, stalactites of barely digested McDonalds hang from his mouth; his jeans covered in vomit. An icy wind threatens to extinguish life as Josh knows it.

I need to up my game.

Josh! I yell. Get up and go home before you die of hypothermia. He stirs. I’m hopeful. But he remains out of reach. I want to shake him but that’s not possible.

Two teenagers approach. They’re both very drunk and I sense they’re looking for fun. Instinctively I know Josh is in trouble. I yell to him again as the tall, lanky one starts unbuckling Josh’s belt. There’s laughter and whoops of delight as they remove his dirty jeans and underwear.

Josh! Wake up! I screech at his prone body. He doesn’t hear me. Nobody does.

A quick search of Josh’s jeans reveal his wallet, which the short, skinny one pockets. They throw Josh’s jeans and pants in the wheelie bin, miasma from its putrid contents slither out as the lid is raised. About to walk off, Lanky unzips his trousers and sends a torrent of steaming urine over Josh’s face. The kids laugh and saunter off.

I hate to say it but they’ve done Josh a favour.

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Roused from oblivion, unaware he’s been shamefully abused, Josh manages to drag himself to standing position and hobble, naked from the waist down, along the road while I feed him directions to his flat and instruct him to crawl under the duvet.

I’m relieved. He’s been spared from the clutches of the grim reaper and the police – for tonight at least. It’s an arduous task watching your personality destroy itself, unable to prevent the haemorrhaging of self- respect as it drowns in a quagmire of guilt.

Josh dreams he returns home from work drunk and slumps on the sofa while smoking a cigarette. He smells burning. Flames leap around him. His daughter is dead.

Josh wakes, panic fluttering in his chest, as he recalls the terror of his nocturnal memories. For it is not a dream. I have pushed this true event, from a previous lifetime, to the surface in the hope he will ‘remember’ he vowed never to drink again.

After showering off the nauseating body smells (he still has no idea he was urinated on before staggering home semi-naked) Josh calls the hospital.

Louisa, an F2 like him, answers the phone.

‘Just checking to see if everything’s ok. No problems from the weekend?’ Asks Josh.

‘Everything’s fine. You don’t need to check in every time you have a day off to make sure you haven’t killed anyone!’ Louisa laughs but stops abruptly when she realises he is, in fact, responsible for killing someone.

It’s only after two cups of coffee and a quarter of a slice of toast that I’m able to make any headway. As his headache begins to recede Josh pulls his legs up onto the sofa and wraps his arms around his knees, dropping his chin onto them. And the conversation begins in Josh’s head.

- Why did I drink so much?

- Guilt. You’re blaming yourself for the death of Mrs Landau.

- Yes, because it was my fault. I should have been more careful aspirating the fluid from her lungs.

- The procedure always carries risks. She was severely overweight making the task more difficult.

- True. But still…she was only forty six and had three children. It shouldn’t have happened.

- A hazard of the job. Nobody goes through a career in medicine without accidentally killing a few people. Also you should have been supervised as you are technically a trainee. At the end of your shift you handed over and when she was screaming from the pain she was given pain killers, rather than a scan to check for anything more serious.

Josh shakes his head, as though this simple act could banish his despair. Clouds of grey wrap around him like a shroud. I know I’ve lost the debate. His dark thoughts suffocate me as I sense Josh give up the fight.

He wants to separate us and send me back to Source whereupon I will take on the responsibility of a new personality. Josh’s experiences will be added to those of the other’s I have recorded and will be available if the new personality is awake and present enough to access the wisdom.

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Josh jumps up from the sofa and lets out a squeal of pain as he lands on his bruised and battered foot. He reaches for his keys, climbs into his car and drives to his parents’ house.

His unexpected arrival sends his mother into a fluster. There’s only enough lunch for two and she has no cakes or biscuits. Shopping day is tomorrow.

Josh reassures his parents that he’s just popped in to say hello as he was passing. He accepts a cup of coffee, smiles and chats with them for half an hour before visiting the bathroom. Although he needs to relieve himself he has an ulterior motive.

Opening the bathroom cabinet, where his parents keep their medication safe from their small grandchildren, Josh finds the morphine tablets his father takes for bone cancer. There are three complete packs of twenty eight pills and one pack with twenty six. He leaves the opened pack of twenty six and pockets one full box hoping it will not immediately be missed.

On leaving, he hugs both his parents tight knowing he will not see them again. He blinks away the tears that threaten. A haze of blue and yellow reflect his calmer mood now he sees a way forward.

Back home Josh closes the curtains, pushes all twenty eight pills from their blisters, brings the half empty bottle of whisky from the kitchen, turns out the light and sits on the sofa.

I try to reason with him. Try to dissuade him from his plan of action because I know that if he can get through this tough time it will make him stronger. He is a good doctor who lacks experience; a kind person who feels the pain of others. Maturity – if he reaches that stage – will iron out the wrinkles caused by lack of confidence.

He picks up a tablet, pops it in his mouth and takes a few gulps of whisky.

Our conversation continues in Josh’s head as I try to make him see sense. I’m working on the assumption there’s still room for debate as he hasn’t taken a handful to swallow. Me v. Him.

I lose again.

He picks up another pill as his mobile phone rings. Caller ID tells him it’s Mum. Josh ignores it, mentally says sorry and washes the pill down with more whisky.

Black and grey clouds swirl around him. Flashes of anger at the interruption cause red streaks to shoot through his aura.

His phone rings again. Hopefully the momentum will be broken and Josh will see sense. Caller ID tells him it’s his sister. He mentally apologises again and picks up another pill. He’s feeling dizzy. His head is fuzzy – more due to the whisky than the morphine.

Nausea rises in his throat and he struggles to keep the contents of his stomach in place. Determined to go through with his plan he takes another tablet and guzzles more whisky.

His phone rings again. Synchronicity kicks in as a flurry of messages fly through the collective consciousness. It’s the hospital and Josh’s instincts as a doctor force him to take the call.

‘Josh. It’s Louisa. Your dad’s just been brought in and your family have desperately been trying to contact you. He’s has a stroke. He wants to see you.’ 

A father trying to save his son, although neither are consciously aware of this.

Josh pauses. A rainbow of hues twist and turn from head to toe as Josh absorbs the information.

‘On my way,’ he says before sweeping the remaining pills into his hand and flushing them down the sink.

We are back on track.

For now.

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THE END

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