Goldsmiths - University of London

Paula Cheung

Biography - click to expand

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An extract from Somewhat Damaged

CHAPTER ONE

‘Accident patients’ are open wounds and broken bones. Blood is exposed to the world. But instead of feeling most alive, patients feel vulnerable and frightened. ‘Sick patients’, on the contrary, denote many forms of inner attacks leading to disruptions of cells’ ordinary activities. I like both types of patients. Their bodies speak the language of pain which flows through flesh and blood. The language of pain defines the real struggle of survival.

But as a surgeon I am to alleviate or remove a patient’s pain; I am to preserve the continuation of his life, as only so I see a point in mine.

The sickness from within and the accident attack a person differently, but both come by surprise. A surgeon doesn’t like tackling surprises, especially in operating theaters. However you are provided with patients who wouldn’t even notice if you took a blood sample. Patients are inclined to trust their doctor who puts them to sleep and the moment they wake up, they expect everything to be all right again. And usually everything is – on my table anyway.

Todd Wilson is a machinist whose hand got sheared off by the rotating blades of a sprocket. The hand was too mangled to reattach. Though Todd’s mother insisted on keeping what was left of the hand, saying it made up for Todd never giving her a hand with the shopping. He had great pleasure in telling me that his mother had kept it forever frozen. I’m not sure if my mother would have done the same. She didn’t keep my pigtails when a girl-bully had cut them off.

A second date with Todd didn’t occur, because he failed the climax test. I don’t know where that sensational feeling of my climax has gone. Usually during intercourse, a woman’s arousal increases and a great amount of blood rushes toward the pelvic area. By the time she reaches her climax, her labia flatten and open, vehement muscle contractions occur and a continuous rise of heart rate and blood pressure. Physical stimuli always lead back to the process in one’s brain. I feel foreign to descriptions such as “the tingling in the spine” or “on the verge of losing consciousness”. I vaguely remember the climax phenomenon from when I was a child. Back then I still had feelings.

 

Todd, however, was an interesting accident patient on my operation table. Of all men, he seems to have the most interesting tongue. It is a fact that the tongue is the strongest muscle in our body, but nonetheless you wonder how, since it consists of only four intrinsic muscles. On the other hand, some would say the strongest is either the masseter or the gluteus.

What about the composition of a heart?

Physicists will say there are too many different ways to measure strength. Todd might have lost his right hand but he is still alive and as healthy as he was before the accident. The hand is no organ. In human anatomy, however, there are dispensable organs like the appendix and tonsils. Unlike the heart…

I had underestimated myself before accepting the unconditional offer at Mount Sinai in New York nine months ago. Even as a graduate from Yale I would have expected the hospital to send me over to the School of Medicine before deciding on whether or not I was eligible. But if you instantaneously get hired at Mount Sinai, you just do not complain. Ever since the peak of recession, the hospital has avoided hiring more surgeons than necessary. Usually if you have subspecialties, you’re more likely to get hired.

First having gained my Doctor of Medicine and Doctor of Surgery degree in New Haven I became an ophthalmologist’s temporary assistant with only a minimum of involvement in operations, such as holding the retractor. Still undecided in my late twenties about which area of expertise to pursue I returned to New Haven hospital to immerse in further surgical training to eventually become a general surgeon. Eventually New Haven accredited me with the status of a fellow.

My consultant Dr. Richard K. Dick used to praise my precision and reserved nature in the operating theater. Another year of residency had passed and Dr. Dick had become more and more inspiring.

One day when philosophizing about heartbreak, he had conjured a sudden interest in cardiology. He said that each heart could be fixed, but I didn’t believe him. I then assisted him in a severe cardiothoracic surgery. He said that life needed a purpose and that mine would be to heal hearts, as only so I could mend my own. All emotions that I’ve ever known had been crushed under the weight of pain, leaving a sense of numbness like a paralyzed patient with damage in the spinal cord.

Dr. Dick’s retirement had enticed me into immersing in a new project, so I applied at Mount Sinai as a general surgeon and junior cardiac surgeon.

In a cardiac surgery we aim to maintain a working distribution system for the blood flow. So far, at Mount Sinai, I’ve only watched and assisted, but soon the destiny of a heart will be in my hands. Until then I will have to keep myself busy with abdomens, kidneys and thyroids, or whenever I’m required at the Emergency Unit.

 

Mount Sinai has always attracted me. Due to the great number of Jewish immigrants in the 19^th century, Mount Sinai was built as one of the first Jewish hospitals in America in the 1850s. What originally drew my attention to this hospital was that Abraham Jacobi, the Father of American Pediatrics, had been one of the visiting physicians at this hospital.

He is the reason why I think all pediatricians should be men and men only.

People still tend to talk about the American dream; I do believe in hope. The eagerness to risk everything you have just to give your life a purpose. Who says you’re not allowed to gamble with your life?

Former work colleagues at New Haven Hospital accused me of going to New York to die. They say a metropolis is a labyrinth with no exit. Apparently people who do not know what to do with their lives either go to New York or California to throw the dice. It’s all or nothing. But that’s not why I came to New York.

 

I longed for a metropolis, a city full of activities, individuals and action. I wanted to dive under, have more hiding places and choose from whom I want attention. These opportunities were non-existent in Connecticut. Living in New York your face in the crowd just comes and goes. People forget about you. People have more important appointments to attend. In the end you are nothing but a ghost, although a never ending line of potential patients comes just to see you.

Fifth Avenue is the road of life – the road of my life, starting at Washington Square Park, which is beautiful for prolonged autumn walks. Whenever you feel that death is holding his sickle tightly behind you in the operating theater, you find balance under the Hangman’s Elm in the park, thinking about all the hanged citizens in the eighteen hundreds – all those wasted lives. The death of patients, on the contrary, isn’t as upsetting. At least you know you’ve tried.

If you are in a different mood and look to lead yourself astray, you turn northwards through the center of Midtown where no one will look you in the face. In Midtown Manhattan, everyone has someplace to go. If you don’t, then breathe the city air, follow the smell that leads you toward the hot dog vendor or please your nostrils with the sweet scent of caramelized peanuts. Or keep on walking eastward till you finally arrive at Central Park where Mount Sinai is situated on the eastern border at 100^th Street and Fifth Avenue where I am standing – outside the building, staring at it, as if it was a magnificent piece of art. It is.

***

Late in the afternoon – I have half an hour before I treat my new patient Bruce Wayn. According to his records, he is a thirty five year old painter with a corneal scarring. I imagine the caped crusader entering my practice room with an eye injury. Since it’s only an eye examination, he has been transferred to me, as our actual ophthalmologist from the Eye Unit, Dr. Mellor, is on leave.

Before any appointments, I clean the treatment room with clinical sanitizer. You are supposed to do this regularly, except that I even sanitize the doorknob, stools and clean underneath the patient’s seat and treatment table, because often peculiar and self-conscious patients leave me their nasal mucus when I am not looking. I remember that my former school principle, in his office, had the habit of cleaning the furniture around the table after every pupil’s visit. His office used to smell of disinfectant every time I visited. It isn’t until now that I completely understand that procedure.

My practice room provides me with a wider range of medical equipment compared to the one in New Haven. The appearance of this fully established and highly professional practice is overwhelming. But it assures the patient of an efficient treatment under my roof. On my desk I have a computer and administration service. My desk name plate is no longer of plastic, but made of metal with my name engraved: “Dr. Ellen Parker”.  

As I leave my practice room to get disposable paper sheets, I bump into a fairly good-looking man who, instead of looking me in the eye, has his eyes fixed on my décolletage. Then I notice that his eyes are opaque. Next to him is Nurse Judy.

“There you go, Mr. Wayn, here she is!” she says.

 

While examining Mr. Wayn’s retina with my ophthalmoscope, I see abnormalities in his fovea – a red region which I call the devil’s bellybutton. The fovea is situated in the centre of the yellowish macula – resembling a discolored belly. The vessels in his choroid are not supplying his fovea with enough oxygen, hence the blurry vision. There are also tiny blisters on the corneal surface.

“So you call it a glass accident, Mr. Wayn?” I ask.

“Yeah...” he says.

“Well, such a scarring is rather unpredictable. The back of your eye is badly impaired. Your transfer papers indicate a deterioration of cone cells since you were thirty. You’ve been using eye drops for cornea treatment ever since…”

“Yes, I still do,” he says.

“So what was the glass accident? ”

He remains silent, swings his hair forward to cover up a part of his face.

“Well, I’m sure you want it to heal, so there are no excuses not to wear eye patches for now. We’ll have to consider a corneal transplant anyhow to restore your vision, I’m afraid.”

“How will that work?”

“The procedure is easy. We’ll remove the scarred cornea and replace it with a healthy one from a donor.”

He stares at my décolletage again, but I’m sure he isn’t able to see a clear picture of my entire physique. I wonder whether the outline of my body in his blurry vision looks like an impressionist’s painting. The opacity in his eyes clearly blocks the amount of light that he needs in order to make out any kind of object.

“Is finding a donor just as easy? ”

“We’re not looking for an organ donation, Mr. Wayn, so there’s no need to worry. We’ll find suitable corneal tissues for you.”

I recognize indifference in those cloudy eyes.  

“Well, could you give me some bandage contact lenses instead of eye patches, please, so I won’t look like I’ve blinded myself? ”

It’s outrageous that when endangered by blindness, but informed about possible healing measures, patients often take it for granted.

“You’re a picky type, Mr. Wayn.”

He ignores my comment.

“Seriously, who’s going to take me home when I have to wear eye patches?”

“I guess your wife can fetch you.”

He tilts his head to my direction. His eyes are partially red from the eye drop, but I recognize a weak smile at the corner of his mouth. The dimple represents something innocent. It is now that I see an imprint on his ring finger. He lowers his head and his hair overshadows his face again. It’s bad for the eyes to have dusty hair brushing along the face.

“I’m going to get you the contact lenses,” I say.

“Thank you.”

“And I shall see you in a few days for an ultrasound and some further examination.”

If only he could see the syringe that I’m holding to draw his blood. I analyze patients’ blood for diseases and infections, and I do hold their health in high regard – just not only for their benefit.

 

CHAPTER TWO

Wednesdays are my days off, giving me the opportunity to catch up with the afternoon naps, which are impractical at work. I cherish every moment of regeneration that my body gets.

The first thing Kafka did in the morning was wash his hands and so do I, as you never know where your hands have been. Next I put Depeche Mode on. This is how a day begins.

My skin is dry, I feel most dehydrated when I wake up in the morning, so I drink up to a liter of water before jumping into my ten minute shower. I’ve been enduring dermatitis ever since my teenage years. There is no cure for it, you can only control it – control it well. Different to other skin types, my skin, especially on my face, is sensitive to heat. Other allergens such as mold spores and certain type of pollen would induce eczema.

In many occasions I simply have cold showers or I switch temperature numerous times to boost my immune system.

Dermatologists had assented to the stress-related factor; so I decided to undergo meditation after each shower followed by a cosmetic session. This process takes about three hours.

It took me months to achieve the necessary focus of Concentrative Meditation. Now and again my breathing will still be shallow and uneven and my mind will fill with naked males dancing on the dinner table. In Mindfulness Meditation I witness anything peculiar that appears in my head. Ultimately Concentrative Meditation has initiated me into understanding the meaning of control; the concept of balancing mind and body. It’s not easy making friends with your inner faculties. The beauty session is something I’d like to do regularly, but my beautician has strongly advised me against it, calling it an addiction and that it could deteriorate my skin for the future.

For breakfast I have whole grain flakes with honey and fruit in soy milk. I try to avoid caffeine drinks at home, as they make my heart rate increase by 16.5%. Coffee, however, is difficult to avoid at work. The way the aromatic smell pats my cerebral surface reminds me of how daddy used to kiss my hair in the morning before heading to work. His lab coat always smelled of clinical sanitizer.

 

I spend my leisure time in city center, preferably Fifth Avenue – the open road to anywhere you want, be it the eastern part of Central Park or Prada. I’m on my way to do some shopping there, as I’m running out of decent eligible second skins. If only lab coats were appropriate in public.

I first encountered Prada during my holidays in Milan. A Prada associate approached me in his shop, asking me whether he could borrow my body for his prêt-a-porter collection. He wanted my blonde curls to juxtapose with his dark designs. I then realized how Prada’s unusual choice of fabrics distinguished them from all other designers. Prada clothing gives me a sense of safety which I used to only find underneath daddy’s brown bear rug. I was also offered the opportunity to present the clothing on the catwalk, but I declined.

I wasn’t made to walk that lane. I was made to walk through the sterile corridor into the operating theater with plastic overshoes.

Back then I was already a general surgeon fantasizing about performing my first cardiac surgery on someone, hoping that this procedure would mend my own heart. Wherever you go, the past is never far. Like Eurydice, it will walk behind you like a giant shadow, except that when I turn around it won’t disappear. Instead it will urge me to continue my task, including my subtask of finding my climax. When you are young you would imagine your first time to be passionate rather than envisioning some form of semi-impalement. But it was love – only unrequited.

I wouldn’t have been able to deal with the attention on a catwalk anyway. Being in Italy made no difference; I didn’t want to become a model in Europe or anywhere else.

 

As I enter Prada, a middle-aged gentleman welcomes me. I’ve never seen him there before and I can’t tell whether he is either well-built or slightly chubby. His black Armani suit is of fine cotton, but shimmers like silk – a hyper real illusion. I can see why some would mistake it for Prada. Both brands express a similar darkness, except that Armani embodies more mystery. Men wear Armani to conceal their secret, whereas women wear it to allure.

“Please do not hesitate to ask for any help, ma’am. I’m Joe.” He has a deep friendly voice. Despite his sincere way of welcoming me, I notice drops of sweat on his shiny bald head.

“I’d like to see your latest spring collection in the shoe department.”

“Follow me.”

They have a remarkable new range of shoes in stock which are the exact equivalent of those I’ve seen in my latest dream. Joe fetches every pair that I ask for.

The number of sweat pearls on his head has increased. I wonder if he is only unfit. His pretty blue eyes look tired, like those of a milkman in the morning.

As he helps me slip into the patent pumps, he gets in contact with my big toe and flinches.

“I’m sorry if my feet aren’t pleasant.”

“Oh no, no! You have elegant feet, ma’am.”

I can see sweat on his upper lip.

“Are you all right?” I ask.

At this point he stands up; I see him press the lid of the shoe box against his crotch. He’s pale. I bet his body lacks magnesium and calcium. He might also need more zinc to help him maintain a normal adrenal function.

“I like your perfume, ma’am.”

“Thanks” I say whilst checking the size of his fingers. They are short and chubby.

 “Jil Sander?” he asks.

“I’m impressed!”

He has pointed out my next most admired designer. Jil Sander is a German fashion designer and an eminent perfumer in Europe. From her fashion side, I’m mostly attracted by her cashmere products or anything that’s black and plain grey, for whenever I feel low.

Joe has already finished dressing my feet and is waiting for me to stand up.

“Thanks.”

The high heels are sharp – I appear about two inches taller than him. He is staring at me with self-conscious eyes. I know what that Prada associate saw in me and I’m also aware of what he could have given me.

“I’ll take them.”

 

I drop by at work to pick up the documents on tomorrow’s heart surgery.

Everyone looks at me differently when I’m not veiled underneath a lab coat. Male colleagues wink at me whereas the females only throw me a swift smile. My cream-colored cotton blouse and my neutral black skirt are merely the dress code of busy New Yorkers. And yet I wonder what these people really see.

William Dylan, our best neurosurgeon, is approaching me with open arms, but I keep mine folded and pressed against my chest.

Despite having been a successful neurosurgeon for eight years followed by a fellowship accreditation, he is a devious analysis machine that reads people like an X-ray generator. His eyes are scanning me from top to bottom. The last thing I need is someone claiming he knows all about my brain and peripheral nerves.

“Here comes the lady whose shell I can’t crack. You look like someone who should be in Hollywood or on the catwalk. Looking stunning today. So how’s Eleanoré?”

“I’m good, Will.”

“Good will, eh? Are we talking business or philosophy here?”

The savior coming for my rescue is my supervisor Stuart McCormick – the attending surgeon in cardiology. He is the only one who looks me in the eye under all circumstances. He places his hand on Will’s shoulder, signaling for him to leave. Will shoots me another wink before leaving. Stuart always runs his hand through his wavy brown hair when thinking sharply and tilts his glasses before speaking.

“Parker! Good you’re here. Tomorrow’s surgery starts at seven, not at eight.”

“Pardon?”

Mrs. Stott, a 72 year old lady, is in a critical condition with cardiac dysrhythmia, an irregularity of the heartbeat. We’ve only met once when I had interrupted her conversation with Stuart. The moment he introduced me as his partner, she mistook it for wife, and threw a fierce glare at me. Mrs. Stott and her son were arguing about her insistence on signing the Living Will document, also called Self-Determination Act. By signing it she will hold the right to make her own decisions for future medical treatments.

“In fact, be there at six.” Stuart says.

“Did she sign the paper?”

“Yes, she did. Hey, please have a word with Mrs. Stott. She doesn’t seem to like you much!”

I’m not surprised. And having signed the paper makes tomorrow’s surgery almost absurd.  Signing these forms can only mean that the patient is either religious or they have a death wish, whichever it is – I find these decisions hard to approve. Even when you are fed through a tube during coma, you’re still a living organism to your doctor. Endurance is partial to life or should I say pain? Patients fantasizing about death have stepped their foot into the wrong place. It’s upsetting that my first responsible heart surgery will be done on her.

Before paying the old lady a visit, I go to the staffroom to get changed. There, I bump into Sarah Donald, our pathologist. She is 29, two years my senior, a graduate from Stanford University with a specialty in surgical pathology. Her unbearable Hollywood smile is a movie with no plot. She has the tendency to cling to our well known male surgeons. Ever since she has stepped her foot into this hospital, I have noticed her sycophantic nature.

Ten months ago she got hired instantly, because we had been short of staff in the Pathology Department. She proved her outstanding skills in identifying benign specimens by merely looking at them. Like my dad can smell whether or not you’re ill.

This woman, however, seems to recognize good in almost everything, except this one time, I remember performing a percutaneous liver biopsy on a patient and when handing the liver tissue to her, her face turned pale and you knew the tissue was malignant. That look of hers was more genuine than that perpetual Hollywood smile.  

“Hey, don’t you have a day off?”

“Technically, yes, but I can already see myself staying here overnight.”

“You and Stuey are operating on that crazy woman, right? Have you spoken to her? She seems really grumpy! Earlier this morning Stuey had to hold her back, ‘cos she was beating her son. Has she got anger issues? Why are they on such bad terms? ”

Her inquisitive nature is another characteristic that I associate with child-like thinking.

“I don’t know, I shall find out in a minute.”

“Oh, you’re gonna do a ward round? Good luck! Oh and did you see Willy Billy? He’s really flirtatious today! Sometimes you wonder whether a neurosurgery has been done on him before he came here, ha ha!”

I quickly put my lab coat over my blouse and walk towards the door. “Well you know what he’s like.”

 

Ward rounds are nerve-racking. Now that I am here to speak to Mrs. Stott I might as well check on all the other patients that are awaiting surgery in the next few days. It’s late in the afternoon; hence the great number of visitors who have just finished work and come to visit their loved ones. I greet Nurse Judy at the reception and then I head down to Room 308. My attempt to first peer through the door fails as soon as a man runs into me.

“Oh, I’m sorry, nurse!” he says and rushes down the hallway somewhat indignantly. I look at him until he disappears in the corner. I walk into the room and find Mrs. Stott sitting up on her bed with a stern look in her eyes. There’s always something about the eyes of seniors; eyes that are unable to hide their personalities. My former ophthalmologist trainer used to say that eyes don’t reflect one’s soul, but one’s past.

“Good afternoon, Mrs. Stott. How are we today?”

She scans me from top to bottom as if I was an object at an exposition.

“Don’t you have a day off? What brings you here after shopping for fancy shoes?”

I suddenly notice that I’m still wearing my Prada pumps.

“I could hear you miles down the hallway…nurse!”

Her patronizing smile is the first smile I’ve ever seen on this old woman’s face, which is covered with numerous liver spots. She has a mole on her lower lip, too. The smile evolves into hoarse chuckles. She’s coughing up phlegm. The sharpness of her shoulders indicates a kind of determination and stubbornness that you don’t want to mess with.

“Your son looked distressed,” I say.

“Leave him be. Kids never will listen to their folks.”

I sit down on the chair next to her bed; it’s still warm from Mr. Stott’s behind. I look at her brittle hands, fingers still sharp with obstinacy.

“And you my dear…”

“What about me, Mrs. Stott? ”

“You’ve picked the wrong job!”

“What makes you say that? ”

I still can’t believe that my first accountable heart surgery will be on her. Besides, it’s not a heart surgery, but the implantation of an ICD. She coughs again and touches her forehead.

“Are you feeling faint?” I ask.

“Don’t we all feel this way? What are you gonna implant into my heart again? What’s it called?”

“It’s a defibrillator and the implantation does not occur in your heart. Has Dr. McCormick gone through the procedure again with you today? It’s important that you know exactly what we’re going to do.”

She is not listening. The cardioverter-defibrillator will be implanted into the ribcage area with electro wires connected to the appropriate chambers of the heart. The little apparatus will automatically correct the heart’s rhythm with electricity when it’s at fault. This will improve the quality of her life.

“Your husband is a looker, isn’t he?” she says as though plunged into delirium. “I know my heart is out of beat, out of rhythm, but ain’t that the way it is when old age kicks in?”

Her sudden mental transition from clear-headed to demented is worrying, minding the fact that she is unaware of tomorrow’s event, too.

“You reckon I’m old enough to die in a nursing home?” she asks.

“Pardon?”

“What will my grandchildren think of me?”

“I wouldn’t know…” I say.

For a second there is sadness, I don’t want to insinuate anything.

“Having a cardiologist as a husband means you won’t ever have your heart broken,” she says. “My Bradley was a ladies’ tailor. You see, you have no reason to check on your man – stop wasting your time here.”

I clench both of my fists while sitting still in the chair.

“What about you? Have you wasted any time?”

“Me? Yes! My whole life! I am wasting time right now!”

“I’m sorry,” I say almost indignantly, as I stand up. 

“All I can think about is my living will – my life – my decision.” Her voice has become hoarser enabling me to visually picture the yellow phlegm in her throat.

“Well, Mrs. Stott, there’s also the Do Not Resuscitate document,” I say while motioning toward the door. It is now that I hear the clacking of my shoes. She has finally shut her mouth.

“Good day,” I say. Without any further comments I leave the room.

 

CHAPTER THREE

I’m in the scrub room with a scrub nurse when I hear them wheeling Mrs. Stott into the anesthetic room where Stuart and Howard are. Usually for this minimally invasive surgery, we only inject a pain-killing local anesthetic, leading the patient to feel dazed, but she insisted on full anesthetic. In the operating theater we have a monitoring nurse, a scrub nurse, Howard the anesthesiologist and Stuart and me.

Seeing Mrs. Stott lying calmly on the bed of the fluoroscopy machine is a soothing sight. She has transformed from a mad lady into an angel. “Don’t waste your time,” I hear her say in my head. I wonder how healing her abominable heart is going to make me feel better, since her unpleasant personality shows no sign of appreciation – not towards me, not to mention life. Has she lived her life to the fullest? What would Dr. Dick advise me in a situation like this?

However it’s not my business. I just want her heart. I want to be close to it, but I need to control my excitement.

I make the first small incision underneath the clavicle and another one slightly below. Her skin feels like sun dried tofu.

Stuart passes me the ICD-device. I adjust the lead which is attached to the top of the device and slowly insert it through the incision and into the vein. There is no chemistry between us, her flesh feels cold. During this mini heart surgery I visualize her cardiac vein and marginal arteries – how they are filled with poison looking to spit in my face through the incision.

“My life! My decision!” I hear her say in my head.

With the help of the fluoroscopy machine, Stuart navigates me towards the right chamber of the heart so I can attach the lead in the right ventricle. Each chamber of the heart is occupied by a purpose, which is the dealing with oxygen - four air-conditioned apartments for you to accommodate happiness or sorrow. It’s a pleasure to invade one of those secret rooms.

The fluorescent view on the screen makes me think of a black and white silent film in which someone pokes a mole with a stick. To my surprise, it’s Mrs. Stott’s heart.

Eventually I place the ICD generator under the cold skin. The installation of a bugging device has been completed.

“Ok good, Parks,” says Stuart after the suture.

Frankly, this wasn’t much of a challenge. The surgery lasted no longer than two hours.

Stuart and I walk towards the doctor’s room to write the report, leaving Howard to administer oxygen to awaken Mrs. Stott.

“By the way…what did you talk about with the old lady yesterday?”

“Why?”

“Because…”

This moment the monitoring nurse storms in, saying: “Quick! We have a CA!”

“Right, CPR,” I say, then rushing back into the operating theater while adjusting my mouth mask.

“Parker, wait!”

I don’t understand his slow reaction to this emergency. I tell the nurse to fetch the external defibrillators while I double check the pulse and breathing - nothing. I don’t understand why Howard shows no reaction, either.

“Why is the ICD not reacting? ” I shout, but my voice seems to fall on deaf ears. “Stuart, we need to open up!”

The nurse must have noticed that something’s wrong.

“Parker…” Stuart begins, “if you look at the monitor you see that the generator is still transmitting electrical shocks to the heart. Without success.”

I want to demand higher voltage, but the world has come to a halt.

“I was just about to tell you that she signed the DNR document yesterday.”