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A Novel

Subduction opening lines

The patient, a healthy woman aged thirty-two recovering from a simple knee operation, suffered a fever spiking at 103 degrees. She moaned and rasped when, at the dragging end of a second consecutive day making rounds, I fought off a yawn and asked her where it hurt. Only a first-year resident, I was well on my way to becoming a brilliant diagnostician.

She could only wave a hand as if fanning herself from head to toe. Non-localized pain, I wrote in her file. Her surgery wound appeared clean from infection. There were no rashes or unusual skin discoloration. She moaned when I pressed lightly on her abdomen.

"What's going on here, Endo?"

My supervisor, the knife-eyed Head Resident, peered over my shoulder.

"Fever, some pain, some sensitivity in the abdomen. No sign of infection but we should do a blood test."

The Head Resident grabbed the file and scanned it. "We should not do a blood test. Clearly it's gastroenteritis. Give her a dose of morphine for the pain. For the other, fluids and something for nausea."


The Head Resident's face turned red as his eyes widened then narrowed to mere slits. He shoved the file into my hands and left me with the patient. I wrote up his diagnosis and treatment. A first-year resident never challenges a head resident. Not without consequences.

The case wasn't the first time the Head Resident forced a diagnosis and treatment on me, but it was the first time I couldn't sleep thinking about it. My usual reaction was to acknowledge my limitations, accept his superior diagnostic ability. I have to admit I wasn't the best student in my medical school class. Okay, I was near the bottom, although I don't believe I was less intelligent than my classmates; most were as average as eggs. The main trouble plaguing my performance was poor cognitive attention. In class I would listen to the professor until my mind wandered to some other thought. For instance, the professor might be talking about muscle tissue and I might wonder what causes cramps. I would be thinking about that for a few minutes, not listening to the lecture. When my attention returned, I'd be lost and would spend another few minutes figuring out what the professor was talking about. Of course, as soon as I caught up, my mind would wander again. I simply couldn't help it.

Then there were the tests. Success on medical school exams is robustly correlated with gross memorization. As you can imagine, a med student with a wandering mind will have trouble trying to focus long enough to memorize all the facts. As in a lecture, I'd read a fact which would take me off on a different path from the topic at hand. I'd browse through reference books, trying to answer this question or that.

Back to the patient with the post-surgery fever. A simple blood test might have pointed to a possible cause of her fever and pain, but the Head Resident's look told me it was an inefficient use of time and resources. Anyway, the Head Resident probably was correct in his diagnosis. So, no, it wasn't the diagnosis keeping me awake; it was the image of the pain congealed around the patient's eyes and mouth like a death mask.

I told her there was nothing to be alarmed about.

The doorbell to my hospital dorm room rang, waking me after what seemed a short nap, but the clock retorted it had been a solid seven-hour sleep. Still dressed from the day before, I groggily shuffled to the door and opened it to find the Head Resident and a senior hospital administrator.

I made spaces for them to sit down in my room, then opened the window to freshen the room's stuffy air. Thinking an offer of something to drink would be appropriate, I started to mention it, but they didn't look to be in the mood for refreshments. The hospital administrator rested her hands on her lap, properly and professionally. Contrasting with her, the tirelessly rigid Head Resident lounged casually as if bored.

After a brief apology for interrupting my downtime, the administrator said, "We regret to inform you that your patient, Ms. Sunada passed away."

Ms. Sunada? The knee operation patient?

The Head Resident spoke so quietly I barely recognized his voice. "She died, Endo, of a burst appendix."

"That's severe but treatable." I barely recognized my own squeaky voice.

"She passed out from the morphine. No one checked on her until the morning."

"By then it was too late," added the administrator, her head bowed.

We were quiet for a moment, as if in respect for the dead. But I was reeling from the shock, my mind roiling and my heart thumping as if I'd sprinted up Mt. Fuji. I wanted to vomit violently.

The Head Resident broke the silence. "If only you'd done a simple blood test."

My head whirled in his direction. His expression was as blank as the wall he was staring at, the wall of my dingy tiny room, my dingy tiny life. I knew then what was going to happen. And it was not good.

All text and images copyright Todd and L.J.C. Shimoda, 2012
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