Noose of suspicion

“I prefer credulity to skepticism and cynicism for there is more promise in almost anything than in nothing at all." - Ralph Perry

Friday afternoon of Grand Prix weekend. The city mayor has issued a decree - all persons found prone on the streets of the city are to be transported by ambo to the nearest hospital within two miles headed away from the racing streets. The rule seemed laughable at the time. Prone persons in the city streets? The ERs would be flooded.

Our patient lucked out, thanks to the decree. The circumstances of her pick-up and arrival were unclear, but since she was nearly full-term in pregnancy, she wound up in L&D's triage, completely unconscious and unarousable. Paramedics must have found an ID, because we had a name, leading to scant records in the system from a past ER visit or two, but little else. No prenatal records, because she didn't see any of our hospital-affiliated OB's for care. No significant demographic or psychosocial information. A mystery heightened by her incapacitated state.

Concern was mounting, however, because her baby was as unresponsive on its heart monitor as she was, and so the debates began. How long did we wait for the baby to wake up before we took her for an emergency c-section? How long did we wait for the mother to wake up and face our inquisition? Should we attempt an overdose-reversing therapy in the interim?

She had no autonomy of decision, because she was asleep and had no advocates, no one we could track down. She had a nurse who was increasingly concerned for the baby. She had a resident who was convinced she was a druggie, intent on getting a high even if it meant screwing her baby over along the way. She had another resident with a cool head, patience and an iota of faith. And all this before she awoke and had a chance to speak even a word in her own defense - not that it made a difference even when she did.

Resident #1 kept evolving her own opinions without ever meeting the patient. Meanwhile, the nurse, resident #2 and I spent 45 minutes trying to stimulate the infant on the monitor and on ultrasound. We managed to engage the patient in spurts of awareness, and piece together haphazard segments of her last 12 hours. Her urine toxicology came back positive for a handful of things, some of which she fessed up to and others that elicited a palpable, visceral shock.

Her grip came to bear on my wrist as tightly as the fetal heart monitor snapped around her abdomen, almost cutting off circulation. What was wrong with her baby? What had she done? In the months of her struggle with psychiatric issues, staying off medication to avoid harm to her baby; in the months of abandonment by her family; in the months of terror, tears and confusion; she had lost her way, more helpless than willfully destructive. And here in the hospital, where she should have been able to expect support and unbiased care, she had to fight not only against her psyche, but also against the ill-informed preconceptions of her own caretakers.

Even as mom woke up and became increasingly aware of her situation, the baby insisted on sleeping in, and eventually dragged its mom into the OR for an emergency c-section. Medically speaking, the situation ended as positively as one could hope - the c-section proceeded without any complications, and the baby came out looking fantastically healthy and alert. Now mom was left to deal with the fall-out, with the questions from social work and CPS.

Everyone was predisposed to believe the worst. Clearly she was a drug-addled woman, unfit to be a mother, callous to her baby's needs, constantly on the prowl for the next high. Never mind that she was scared to death of the possible harm she had caused her kid. Never mind that she was terrified of losing her baby to the system. Never mind that she felt demeaned because no one had the courtesy to treat her like a person and keep her informed - the most basic of courtesies, one could argue, when we hold all the cards and she holds none.

Who will advocate for her? The nurse who is annoyed by the barrage of questions from a perceived irresponsible mother? The staff who discount her incisional pain as the lure of a drug seeker?

I only have unfounded theories about what fosters this unshakable suspicion. Some have probably been burned countless times in the past for giving the benefit of the doubt, and having patients take advantage of their empathy. Some have lost their integrity of faith, maybe had it beaten out of them by the job or job culture. Some are just predisposed to cynicism from the beginning, and they are perhaps the ones we can never sway. I keep hoping I can find the necrosed root and chop it off, even while recognizing it's an impossible feat. At the least, I hope nothing can quash my idealism, however naïve it may prove to be.

Never have I felt this frustration more keenly. We have all, since starting med school, dreamed of the day when we are capable of assisting the nurses, putting in orders, answering patients' queries, and have constantly felt the pang of disappointment when we cannot fulfill any of those. But for the first time this weekend, I felt the hollow sink of failure, confusion from standing alone in my opinion of my patient's needs.

Was I a sucker for empathizing with her helplessness, for believing in her commitment to love and nurture her child? Honestly, the answer to that question is irrelevant.

This job is not easy. Of all the patients we will meet who struggle with addiction, probably 80 percent of them will attempt to exploit us for pain killers. To some degree, they cannot help it, nor can they recognize their helplessness; that task falls to us. Of that 80 percent, maybe 60 percent will claim they want to quit, they need help. And of that 60 percent, maybe 10 percent will mean it. It might start with 2 days clean, then 2 weeks, and for a handful of them, maybe it will graduate to 2 years, or even 20.

But we have no way of knowing who that handful will be, and who are we to project a perceived fate onto anyone? That falls outside of our purview.

We should be the torchbearers of faith, believing that any person walking through our doors could be among the handful. And if we nurture them as such, maybe that handful will grow. If we lose faith in them, who will they hang their dreams on? 

Mile markers

The purple of her hands taunted me with their frailty

Zip.

Zip. Zip.

Arun's hoodie engulfed me - just as well, since I was desperately trying to ignore the shrill noises of the highway. I chanced a peek forward, Ty was driving. When did he grow a foot? His toes still barely grazed the acceleration. My little guy.

Speedometer, 148mph. Gas, empty, full, running on empty. A stuttering hysterical laugh threatened to break free from my throat. Ty, driving? Ty, swerving. On a packed, deserted highway. Sports cars racing past us, chasing us. Glance out the window, nothing. Ty, underage, younger than age, shorter than height, running in the driver's seat.

Ty, sitting in the witness box. "Lighten your chest, son." "Not your son."

Ty, glaring insolently. "You will answer the question." "Fine. Lighten my chest." He let loose a lusty breath, a brazen smirk flitting across his face. "Yeah?" The cloud of air dissipated, no trace. 

Ty, poker-faced. "She was too much." "Too much?" "You heard me."

I was barely enough. A tease of a taste, inspiring a craving - a single pistachio, the early hours of a TV marathon. Nicknames sagging with the weight of nightmares and sanguine expectation.

Blink, and suddenly it's dad in the driver's seat. Ty's next to me in the backseat, yanking my ponytail while shoving his size 3 foot under my rib cage. The car rang with the impish cheer of his two-index-finger years, vibrated with the thrum of the highway.

Arun sized him up, ever the skeptic, then huffed out a rueful chuckle. "Harass me? If anything, I was the bad influence. I gave her the caffeine addiction, after all. And phone calls at 3 in the morning." "And then she screwed up."

"Yes?" His whisper fell heavy with rust and ashes. "Wish I could say yes. The only thing she did wrong was ask for too much. And I knocked her down for it. Repeatedly."

Because I had too much to give. It pounded through me, clawed out of me, innocence with wax fingers running from a frenzied blaze.

Adrenaline swept through my veins like chilled lava. My hand inched out from the sleeve, its destination left stranded as my grip collapsed. An origami kitten fluttered to the seat by Ty's foot, traces of red ink visible through the folds.

"She cared too much." Angel carded her fingers through her own hair, a distorted mirror of a taunting memory - an impertinent vision of thrones and grapes and a hand languidly soothing over my scalp. "I wrote her letters. I handed her my story, mystery, in a soundtrack. She listened to it, heard what I didn't even know was there. And I couldn't take it back. So I took me back instead."

Because I didn't belong, until you. You translated the crescendo of shadows into a symphony, and now without you, it's morphed into a chanting litany, static in my ear.

The car weaved through ghosts on the street, Dad at helm. Suddenly, gunshot, a red rose bloomed from his shoulder, proud green stem and prickly thorns. No bullet. Another pop, a bullet hole nowhere close to us, yet in the car seat next to Ty, next to me, no, Ty, no, wait…

If I closed my eyes, I could almost pretend it sounded like popcorn exploding in the microwave at movie night. Loud, irregular.

Mrs. Relnik's fingernails tapped a staccato rhythm against the rail. "She forged her mom's signature on a form once." "See, Your Honor, a bad--"

A distracted musing cut through his slow build. "She made a pop-up book about dinosaurs on long-lost planets. I framed one of the patterns she colored for me." "Framed, ma'am?" A stammer - he cut himself off in surprise.

I won a spelling bee for you. It's been my little secret.

Steady. If they would just steady, if the lurches would settle, if the bullets would stop whizzing, I could play the game. Massage the magic spot on my neck, vanish for a little while. Maybe a long one…

The knowledge lurked, crushing and panting, behind his languid gaze. "We could've been twins, you know? Should've been." "T--twins?"

Xavi's eyebrow quirked up even as his voice quieted to a murmur. "Well, different moms. Different birthdays. Minor details." He tossed out a nonchalant smirk.

The smirk was always your tell. Yours to show, mine to know, a bitter aftertaste in both our jugulars.

Ty, all trust and bristling energy, squirming to the tempo of the silencer. His earnest, naïve adoration drools a flood, painting a lake over the road. And the car grows gestures, beating through the sweat of vision.

"I guess...I guess it got too hard." "What did?"

She gave a helpless chuckle, a frantic hand wave with long, artists' fingers -- tried to encompass the words she couldn't lift, the milky threads of burning summer woven into a raging waterfall. "Everything. Phonecalls. Emails. Goodness, I make it sound like we broke up or something. Listen, I don't know, okay! Ask me anything else and I'll know. But if I knew this… well, you wouldn't have dragged me here if I knew." "Listen, Ms. Penny--"

And there was the haughty stare, relishing in delivering a challenge. "Penny to my friends. That's Penelope to you, sir. Why would I tell you anything worth sharing?"

The worst things about the desert are the mirages. A gleefully tempered tempest turned into a parched wasteland, turn of the hat. You put super glue on my idioms, until I sagged under the agony and tore through skin.

Floating an achingly idyllic path as Airplane Ty whizzes around the car, his lilt tripping over his tongue, undulating with eternity. The brakes suddenly hydroplane a powerful void, leaving behind lather and a choppy shore.

"Once in a dozen paces--" "--Excuse me?"

"You're excused." "That's not what I--"

"I know that's not what you. So what are you?" "This isn't about--"

"--Like hell it isn't!"

[AHEM]

"Ma'am, let me finish. Once in a dozen paces, and it wasn't enough. But you knead the dough and hope like hell [AHEM] it rises." "Yes, but--"

"I do believe I'm getting kicked out for impertinence. Just too bad, hm?"

The gavel banged onto its bed of petals, deep maroon pulsing with rusted hope.

One Year Later

So much can happen in one year.

One year ago,

I moved to a new city

Rohit, Varun and I started on the next big journeys of our lives

I had to relearn how to forge new friendships

Meghu started her last year of high school

Neha was about to get married

The world was a little bit less of a minefield. Or a little bit more. Sometimes, it’s hard to tell.

One year ago, September 11th was the last day I saw you.

One year ago, September 16th was the day you took your last breath.

Anniversaries are strange creatures. They force you to remember, and dredge up the oddest musings along the way.

Mama and Papa redid your room a couple of months after, and converted it to a mandir. I think it helped lift the stifling aura of grief that had engulfed the room for seven years, since Barimama left us from there, right where your bed was. It was a ‘circle of life’ moment, where my two doting grandparents, who had devoted their lives to caring for each other and their family, inhabited and vacated the same space.

Whenever I need a moment, some breathing room, I sit in your room, and I can see both your faces – okay, okay, I confess, that might be because your portraits are hanging on the wall. But you know what I mean. You usually have. It sounds corny, but…I feel like I’m enveloped by that same sense of security and comfort I used to get when I was five years old, running rampant around the house under your watchful eyes. I had missed that, for the past few years, and you helped me find it again when I wasn’t expecting to.

Meghu and I still cannot bring ourselves to use your bathroom. The whole room was your space, but the bathroom especially feels like an invasion of space. It feels wrong. You had your weakest moments there, which broke our hearts even as they wove us closer together. I used it once, for the first time this summer since you left, and I couldn’t go back in afterward.

I’ve been working on my letter to you for the past 24 hours, struggling with what I wanted to share, what I was feeling, how to articulate the thoughts that have been running rampant in my head for the past several days. Today, one of my very good friends pulled me out of my head and helped me re-energize. It was a variation on your question, you know? Beta, itna kyun sochthe ho?

I never got a chance to work through a lot of my feelings surrounding how you left us, those last couple of years. Everyone should get a mandatory vacation from life for a few days after having to bid someone adieu – we need that time to process what happened, and I don’t know if I ever properly did.

While you were alive, somehow there was always an irrational hope for a miracle, defying all common sense and scientific precedent. You were my grandfather. You survived a motorcycle accident. You swam from shore-to-shore of the Ganga. You could survive anything.

When Barimama left, I was there for all the days leading up to it, and I was there minutes after it happened. When you left, I wasn’t there for those last two weeks; I last saw you five days before it happened, and couldn’t make it home until 24 hours after. Until today, I don’t think I ever realized what a significant impact that left on me.

I felt guilty for the longest time, for not being there with you. And sometimes it still doesn’t feel real, until I go back home for the weekend and the house is dead silent.

At times I feel as if I never got a chance to process that you were gone and not coming back. You left right as I began on the path that I had told you I would follow when I was a six-year-old who refused to acknowledge that she couldn’t fix her grandmother. You would treat me to a gentle smile, maybe a little indulgent, but you never laughed off my childish insistence. And that persistent support pushed me forward, reminded me what I was working toward.

Today I can say, while I fervently wish you were here to share these moments with me in person, I know you and Barimama are both watching from somewhere – probably shaking your heads and laughing a little at my antics along the way. I know, I know, I have a ways to go. But you set me on the right track, and I intend to keep at it.

Your leaving brought with it a sense of vulnerability – in sense of self, in relationships, in my perceptions of strength and eternity. You were our center, I think. And now that you’re gone, the rest of us are still trying to find and hold onto a new one. 

मेरी हँसी तो मेरे ग़मों का लिबास है, लेकिन ज़माना कहाँ उतना ग़म्शनास है । 
जब मैं उदास था तो ज़माना था खुश, अब मैं खुश हूँ तो ज़माना उदास है ।।