THE HEALTH BENEFITS OF BUTTERFLY PEAFLOWER TEA

Are you well, Khun?”

Ladarat asked out of politeness, as one must. But truth be told, the man facing her across the medical records counter did not look well at all. In fact, he looked harried. His face was pale—even paler than is normal for a man who works in the windowless basement of a large hospital. And his short hair was mussed in odd, swept-back whorls as if he’d been running his hands over his head in frustration, as he did reflexively when he greeted her.

Of course Panit Booniliang was harried. He knew, as she did, that the hospital inspectors were likely to focus very intently on their medical records. The inspectors usually asked for many charts, and when they did, they wanted them immediately. It was almost as if, despite the fact that they were supposed to be interested in how well a hospital cared for patients, they forgot that, all around them, conscientious staff were trying to do just that. When they wanted a chart, they had to have it. So Panit Booniliang was a very nervous man.

He smiled the yim yae yae smile, which could be loosely translated as: “Well, it’s awful, but really, what can you do?”

This smile, she knew, told the story of why Khun Panit was in charge of medical records. He would do whatever he could to prepare. And still he would be nervous. That was most un-Thai. His worrying was almost American. But in the event, he would realize that he’d done everything he could do and would retreat into the Thai state of choie, or imperturbable calm.

Alas, he was not quite there yet, as his roving glances across the wide, neat countertop revealed. He was still looking around for files out of place, as if he might see something that would remind him of a task he had forgotten. She hated to bother him now, but it couldn’t be helped.

Ladarat offered her own version of the yim yae yae smile and said she needed his help.

“It is about a matter to do with the care that we gave to an unfortunate man in the emergency room last week.”

“Yes, Khun?” She had gained at least a sliver of his attention. That was good, but she needed his full concentration for the matter at hand.

“He died,” she said. “It seems he died before he came to our hospital, but his death was pronounced officially here.”

“I see. And how old was this unfortunate man?”

“I believe he was about fifty.”

“And what time did he die?”

That was when Ladarat knew these questions weren’t prompted by idle curiosity or by concern. Not that Khun Panit was a heartless man, but his questions were typical of Thais faced with news about the death of someone they didn’t know. In a culture that was wrapped in superstition and beliefs about numbers, the story of a man’s death—his age, birthday, time of death—provide the raw ingredients for speculation that led, all too often, to a selection of numbers for that day’s lottery.

Once she’d even witnessed, much to her dismay, a gaggle of nursing students speculating about the death of a young woman—a katoey. A woman’s spirit trapped in a man’s body. Unable to cope with that cruel joke of fortune, she’d thrown herself off the roof of the Empress Hotel, one of the highest buildings in Chiang Mai. Ladarat was deeply ashamed of her profession to hear these nurses discussing how many floors the poor creature fell, so they could play those numbers in the lottery.

Panit Booniliang wasn’t like that. No, this was just the force of habit. These were the questions one asked. It was a reflex. That was all.

Still, better to cut off further questions to which she wouldn’t know the answer—birthdate, occupation… So she was perhaps a little more direct than she would have been in other circumstances,

“We have a problem.”

This got Khun Panit’s attention.

“I see, Khun. That is bad. What sort of problem?”

He was too polite to ask the question that was no doubt on his mind: What sort of problem could one have with a patient who is dead? Surely this couldn’t be a very important problem. Surely it couldn’t be more important than, say, preparing for next week’s inspection?

She would need to choose her words carefully. She mustn’t cause alarm, of course. Yet she must convey the gravity of the situation to a man who was understandably preoccupied.

There was a saying in Thai to which she’d had recourse many times in her career: Kling wai korn, pho sorn wai. Roughly: Do whatever needs to be done, to get through the moment.

Odd that in the United States such an aphorism would denote a strong-willed determination and a fundamental belief that defeat is impossible. But the Thai version was an illustration of creative pragmatism. Especially the importance of maintaining grace and smoothness, and a willingness to bend the truth if that’s what was required. And in this case, it most certainly was.

“We have received word that the inspectors are very interested in the care of patients who have died,” she announced, with what she hoped was a perfectly neutral face.

“Ahhh. This is from… an inside source?”

“It is.”

“Indeed?”

“Indeed. That is, they are interested in the care of patients who have died suddenly. They will want to see records of patients in particular like this man, Zhang Wei, who died suddenly two nights ago.”

“But why?” Khun Panit could not hide his confusion. “Why would they be so interested in such a patient, when there are hundreds of other patients in this hospital right now?”

Why indeed? That was an excellent question.

“Besides, which,” he added, “from what you’ve told me, it seems that this man died outside our hospital. What could we have done that was good or bad?”

“Ah, but you see, that is perhaps the most important part of the practice of medicine.”

“It is?”

Ladarat was as surprised as Khun Panit had been to hear this. But she needed to invent an explanation. Quickly.

“Yes, indeed. When a patient dies, our responsibilities don’t end.”

“They don’t?”

“No, of course not.” Ladarat shook her head, warming to her topic. And wondering what words were going to come out of her mouth next.

Words were like that, she thought. Sometimes they surprised you by appearing. Or by failing to appear. Hopefully that wouldn’t happen in this case.

And indeed it did not.

“No,” she heard herself saying. “We still have an obligation—a duty—to help support the family. That means offering emotional support, for instance, and the chance to pray with one of our monks. It also means making sure the family has enough information about the cause of the patient’s death.”

The medical records clerk was nodding now, listening attentively.

“Because if families leave with unanswered questions, and if they are worried that perhaps not everything was done that could have been done…”

“Then there are ghosts. Phi tai hong.” He shuddered.

Ghosts? Ah, indeed. Ghosts (phi) were commonplace in Thai culture, and phi tai hong were particularly feared. They were vengeful ghosts of people who died suddenly, without the necessary preparation or Buddhist rituals.

Were such ghosts real? That was not a question that Ladarat had ever felt comfortable with. It was a wrong question. Unanswerable and unproductive.

A better question, perhaps, was what these ghosts meant to Thai people. That meaning was certainly real. And Ladarat had always thought that these beliefs—and beliefs about tai hong ghosts in particular—were a way of putting a face to guilty feelings. Guilty feelings for the bad things you may have said or done to a person during life. Or things you should have said but did not. A ghost was a way of doing penance for those things—expunging them through the fear that one felt.

Ah, but she was not a psychologist. Already a nurse, and an ethicist. And now perhaps a detective. That was enough professions for one diminutive Thai woman to take on in her lifetime. She would leave those sorts of theories to those who were better prepared.

The medical records clerk was watching her expectantly, as if waiting for her to confirm or deny the existence of phi tai hong. Instead, she simply nodded. “That is one concern, to be sure,” she said.

“Then they bring a lawsuit.”

“Well, yes, that is another concern,” Ladarat admitted. And one that, presumably, Khun Panit knew more about than ghosts, because whenever there was a lawsuit, it was he who was responsible for gathering all of a patient’s records. “But there is also the distress and anger and guilt that the family may feel. This is also our responsibility, is it not?”

Faced with such unassailable logic, Panit Booniliang had to agree that this was, in fact, their responsibility.

“But you see,” she concluded, “we don’t always support families as we should.”

“We don’t?”

“No.” She shook her head sadly. “We do not. It is easy to simply walk away from a patient who has died. And easier, usually, to walk away from his family. They are distressed and sad, and sometimes angry.”

“Ah, I see, so these inspectors, they want to see that our staff comforted the family. And that we—”

“Determined the cause of death, and shared that with his wife. Yes. They will want to see this. So,” she concluded, “I need to review this man’s records, and his laboratory tests, to see whether the inspectors are likely to be satisfied with what they see.”

Ladarat was quite proud of herself. And even prouder when Khun Panit nodded once—a quick bob of his head—and disappeared through the double swinging doors behind him. During the short time he was gone, she had the opportunity to think about what she’d said. It was, she decided, as neat an example of kling wai korn, pho sorn wai as she’d ever accomplished.

And even better, it was true. That is, as health-care providers they should continue to care for families just as they did the patient. And it was true, too, what she said about walking away. Doctors and nurses today, they didn’t want the stress of those conversations. It was easier, they realized, to simply hand the death certificate to the ward clerk and disappear into another patient’s room where they couldn’t be disturbed.

She was still thinking about that, and how Thai culture was uniquely ill suited for these sorts of difficult conversations, when the medical records clerk reappeared. His smile suggested that he was not bringing good news.

Without saying anything, he held the chart by one corner, letting it flap open. There were no lab results inside, she could see. Nor were there any notes. Nor, honestly, was there anything else. The folder was entirely empty.

“Is it possible,” she asked hopefully, “that notes or tests haven’t been added to the chart?”

Khun Panit shook his head with a finality that she found disheartening, “No, Khun. A chart cannot be filed if there are pending tests, or if there are notes that need to be written.” He paused. “I suppose this is bad for us?”

Ladarat nodded. “Yes, it is bad.” Although perhaps not for the reasons she had divulged. No, what it meant was nothing that would give them any clues about whether this poor man’s death really was suspicious.

But… there. Stapled to the back of the chart. There were two sheets of paper. She reached for the chart and Khun Panit released it reluctantly.

One was a death certificate. As she’d expected, it had little information. Doctors hardly ever took the time to fill them in correctly. Just the patient’s name, and his age, and his diagnosis: cardiac arrest. That’s all.

The second page was the other thing that she’d hoped to find: a marriage certificate. Someone had known that they needed a copy to release the body and—better—had made sure to keep it in the chart. You couldn’t trust doctors, but the clerks, at least, were reliable.

This was interesting. It was a marriage certificate dated… January 24, 2009. Several years ago. So what did that mean for the man that the corporal saw with the woman just three months ago? If this couple had been married for almost a decade, had she married two men?

She shook her head in confusion. But there wasn’t time to figure this out now. The medical records clerk was watching her curiously, and she’d be hard-pressed to explain her interest in this marriage certificate if he were to ask. Hopefully he wouldn’t.

There was just one more piece of information she needed. One more… clue. There it was. Anchan Pibul. That was the wife’s name.

And an odd name it was, too. Anchan meant “peaflower,” a local plant that was used to make tea. Ladarat had even enjoyed iced butterfly peaflower tea at her cousin’s tea shop. It was a bright, iridescent blue color that didn’t seem natural at all, but which supposedly had health properties of anti-aging. It also turned your lips blue in a way that Ladarat had to assume had nothing whatsoever to do with long life. And this particular Peaflower did not seem to be offering her husbands any sort of health benefits whatsoever.

Ladarat thanked the patient medical records clerk and made her way back to her office. Down the long, dim hallway, she found herself thinking about this woman. What was motivating her? Why would someone do what she’d done? Or what she might have done?

There was one person she knew who could help her answer these essential questions. One person who, Ladarat had always thought, knew more about the way that people think than anyone she’d ever met. Her cousin was a successful businesswoman not simply because she had a good head for business but because she had finely tuned sense of people. Particularly for the sorts of motivations that many people kept hidden.

She would go to see her cousin that morning and ask for her advice. That was the logical thing to do, was it not? If you had a difficult case involving ethics, you would call on a nurse ethicist. And if you had a difficult case involving people’s more… nefarious impulses, who better to ask than someone who runs a highly successful business that exploits those impulses?

But what of the policies that needed to be reviewed? There were still many—most—that she hadn’t yet examined. How could she take a morning off work when there was so much to do?

Perhaps she could take them home? She would bring a stack with her, and she could sit in her garden to do them. After a dinner of tom yum gung—spicy prawn soup without the coconut milk. A little like hot and sour soup. Such a meal would prepare her for a late session of policy reviews. It would help her to concentrate, would it not?

Ladarat was pondering the intellectual focusing powers of tom yum gung as she reached her plain wooden door. That door identified her as “Ladarat Patalung, Nurse Ethicist.” She was very proud of that door. It was better than a diploma, in a way. Because it reminded her every day of what she’d accomplished.

And she needed those reminders, she knew. Somboon always said she lacked confidence, and she supposed that was true. So it was good to have a reminder that she had accomplished something. That she was… someone. Ladarat knew that when she stood in front of her door. But unfortunately she did not spend all of her time in front of that door. Although sometimes she wished she could.

Today was not one of those days. Her nameplate was there, as it always was. But today there was a white envelope peeking out from under the door. Ladarat picked it up gingerly with her thumb and forefinger, with much the same sense of queasiness that one might pick a slug off one’s Siam tulips.

Opening the single folded piece of paper, Ladarat realized that it was a note from Khun Tippawan. As she knew it would be, the note was written in a careful hand on stationery “From the desk of Tippawan Taksin.” Oh dear.

This was the way that Khun Tippawan operated. She had a unique… gift for being invisible. When was the last time Ladarat had seen her? She couldn’t remember. She would just leave notes and send texts. Like some… poltergeist? Was that the word?

Ladarat smiled. Her boss was a phi tai hong. A vengeful ghost. But her smile faded as she read the brief note.

“I came to check on your progress in reviewing policies but was disappointed to find that you were not yet here. Perhaps you have finished all your reviews? Or perhaps you are not taking your work as an ethicist seriously?”

Oh dear. Ladarat knew that she had read through at most 10 percent of the policies she needed to review. The rest would take the better part of the coming week.

And what did Khun Tippawan mean about her not taking her ethicist responsibilities seriously? Ladarat’s stomach gave a lurch as she read that. How could Khun Tippawan think such a thing?

Of course she took her responsibilities seriously. Did anyone doubt her commitment? Anyone, that is, except Khun Tippawan? They did not. Ladarat was certain of that. The ICU director himself came to her office to ask for her advice. Certainly that was a vote of confidence.

And yet, her primary obligation was to the hospital. That was certainly true. To Sriphat Hospital, and of course to their patients. So perhaps it was wrong to use her time in any other way?

So as she stood outside her door, staring at the reminder that she was a “nurse ethicist,” Ladarat was forced to admit that Khun Tippawan was correct. Her door told her exactly what she was. That door did not announce her identity as a detective. Or as a doctor. Or—most certainly—as a cook. No, it proclaimed to all the world that she was a nurse ethicist.

So that’s what she would be this morning. She would walk into her office—the office of Sriphat Hospital’s one and only nurse ethicist—and she would review as many hospital policies as a dedicated nurse ethicist possibly could.