September 1969 Nuwara-Eliya
Shiro put an old kettle on the stove in the hospital staff room. She spooned four teaspoons of tea into the teapot. Picking up the kettle on the first boil she filled the teapot, waited the mandatory five minutes, and poured the brew into three cups.
She turned to her two fellow medical students, Nandan and Krishna. ‘Guys, get off your bottoms and drink your tea. We promised to cover the afternoon wards for the registrar, remember?’ She added milk and sugar to the cups of tea and handed it to the boys.
‘The one good thing about this clinical placement,’ Nandan mused, ‘is the fact that we get to drink the best tea in the country.’
Shiro sipped and sniffed the cup. ‘True. I think this is BOP fanning.’
‘Top of the class, sexy and a tea taster. No wonder old brachial plexus is mad about you.’
‘He is a friend.’ Shiro swiped Krishna with her stethoscope. ‘Come on, boys. Let’s get to the wards.’
Nandan stretched and yawned. ‘Why bother? Nothing exciting happens in surgery. I’ve sutured a couple of coolies and cleaned a million abscesses. Can’t wait to get back to Colombo General.’
Shiro slipped on her white ward coat. ‘I like it here in the medical ward. The nurses treat me almost like I’m a doctor already.’
The door to the staff tea room swung open. ‘Doctor, come quickl!’ The nurse gestured to Shiro. Shiro rolled her eyes to the boys and followed the nurse. ‘What is it, nurse?
The nurse ran down the corridor, forcing Shiro to follow.
A man was slumped over in the wheelchair, his right hand gripping the shirt over his heart. He groaned and retched into the pan the attendant held. The profuse sweating, the pallor, the rapid staccato breath – Shiro didn’t need an ECG for the diagnosis. This was a cardiac, probably a big one.
She turned to the nurse. ‘Where’s Dr Nirmalan?’
‘He said he would be at home. To call him if we need.’
‘Ring him. And get this man on a bed. Set up an ECG and get me a morphine. Also an intravenous.’ Shiro picked up the admission form, then looked at the patient’s face.
The hoarse whisper was a miserable echo of the arrogant tone that had ordered her and Jega off the veranda of the Watakälé superintendent’s bungalow yesterday. ‘What the hell are you doing here?’
Shiro took a deep breath. This was a patient. Who he was should not matter. ‘I believe you are having a heart attack, Mr Ashley-Cooper.’ She struggled to keep her voice calm. ‘The doctor will be here shortly, but meanwhile I will give you something for the pain and set up a drip to keep you from going into shock.’
Shiro gestured to the nurse and attendant. ‘One – two – three.’ They shifted William on to the hospital bed. The nurse set up the ECG leads. The attendant held William’s hand down. Shiro slipped on a pair of surgical gloves and picked up the intravenous needle.
‘I don’t want you touching me. How the hell do I know you are qualified?’ William stammered.
The nurse connecting the ECG leads reached over William. ‘Sir, miss is a medical student. She knows what she is doing. She is trained.’
‘And,’ the attendant snarled at William, ‘you better be thankful that she is here to help you.’
The attendant held William’s writhing body down on the bed. ‘Madam, let him die,’ he grumbled in guttural Indian Tamil ‘He is a real devil. I know what he does on the estate.’ Shiro bit her lip to keep from laughing. William would understand every word.
She concentrated on inserting the intravenous lead and injecting the morphine. She set up the saline drip, then stood up to study the ECG recording spitting out of the machine. She picked it up. A chill ran through her at the sight. A bizarre, irregular, random waveform with no clearly identifiable QRS complexes or P waves. William was in ventricular fibrillation. She picked up her stethoscope and placed it on her chest. No heart sounds.
‘Nurse,’ she said, ‘do you have a defibrillator?’
She pulled the curtains to isolate the bed from the rest of the ward.
Ripping off William’s shirt, Shiro brought her palms together over his chest. She had to try manual resuscitation. She repeated the compression.
The nurse wheeled in the defibrillator.
Shiromi glanced at the attendant. ‘Look what I am doing. Can you do this while I set up the machine?’
‘Madam –’ he said.
‘Do it,’ Shiro commanded. ‘Here, put your hands like this. Now push. Then release. Then push. Good. Keep doing it. ’
Shiro slipped her hands into the plastic handles of the metal paddles. ‘The anterior electrode is placed on the right, below the clavicle,’ she said to herself. Go on, girl. You can do this. She threw her mind back to the demonstration she had seen. She placed the paddle in her left hand just below William’s right shoulder. ‘The apex electrode is applied to the left side of the patient, just below and to the left of the pectoral muscle.’ Her right hand moved over to the left of his body. She pressed down on the paddles.
‘Move,’ she said to the attendant. ‘Nurse, switch the machine on.’
The current zipped through William’s body. His body jerked, then went still.
Shiromi looked at the ECG print. They were losing him.
‘Damn. No change. Still fibrillating. Nurse, again.’
The jerk again.
The pointer on the ECG machine moved up, then down. Sinus rhythm. Dropping the paddles, she grabbed the stethoscope and listened to William’s heart. There was a slow, laboured but normal, beat.
A sob. Janet’s voice outside the curtain. ‘Please can I see him? Is he dying?’
Shiro stepped away from the bed. ‘Let her see him.’
Janet stepped through the curtain. ‘Doctor, is he dead?’
‘No Janet, he isn’t dead. You can have him back, for whatever good that does you!’
‘Shiro! But –’
‘Save me the hysterics, Janet.’ Shiro walked away and picked up the admission record. ‘Nurse, stay with the patient.’ She sat down at the ward desk and wrote down what she had done.
Dr Nirmalan bustled into the ward, still in casual jeans and t-shirt. ‘Shiromi, I am so sorry. I was so sure nothing would happen today.’
Shiro handed him the patient notes. ‘It’s all right. It was an interesting challenge.’
Dr Nirmalan glanced down at her notes. ‘You did manual resuscitation and defibrillation? That’s impressive.’
Exhaustion caught up with her. She felt empty and drained right to the soles of her feet. ‘I’m really tired, Dr Nirmalan. Would you mind if I left now?’
He nodded. ‘I’ll take over. Go get some rest.’ He turned and walked through the curtain. ‘Hello, you must be Mrs Ashley-Cooper. I am Dr Nirmalan. Sorry I was out when your husband was brought in, but Miss Rasiah has done an amazing job. Her quick thinking and action saved your husband’s life.’ He glanced at Janet’s face. ‘You should go across to surgery and get a dressing.’
Shiro slipped off the white coat and leaned on the wall outside the ward. She turned at the sound of footsteps. ‘Shiromi, please, I want to thank you,’
Shiro studied Janet’s face. ‘Are you sure, Janet? Did you really want his life saved?’ She stared at the dark shadow around Janet’s bloodshot right eye, then slipped her gaze down to the cut and swollen lip. ‘We should get you to emergency and get your face seen to.’
‘He was upset after you and his – brother, the doctor, left. He threatened Appu, accused him of gossiping. He assaulted Appu. Appu wouldn’t defend himself. I tried to stop William.’ She raised her hand to her face and winced.
Shiro took a deep breath, then let it out slowly. ‘Wife abuse and battery, just another link in the tale of the Ashley-Cooper Empire. Come on, let’s get your face seen to.’
Leaving Janet in the hands of Nandan in Emergency, Shiro stepped out into the hospital gardens just as Jega’s car screeched to a stop in the car park. He jogged across the car park to her.
‘Shiromi, I went back to the manse. There was a call from William’s wife. She said that William has had a heart attack and was being brought here.’
Shiro smiled at him. ‘You were worried for me, Jega?’
‘Of course.’
Shiro placed her hand on his arm. ‘You know what I did, Jega? I saved his life! He was in ventricular fibrillation. I should have left it. Let him die. No. I couldn’t, could I? Hippocratic Oath and all that. I did manual and then defib. The man who destroyed my happiness and killed my father. I saved his life!’
Jega put his hand around her shoulder.
They turned and walked towards the staff quarters.