#scribbler scribbles

Myrcellla hates her skirts. She always hates them, but never more than now, running behind her little brother. Tommen’s legs are tubby still, unlike hers, but these skirts of hers ruin it all the time.

Light gently heralds dawn, and Myrcella has to work to keep the sound of her steps down, lest one of the servants hear and tell mother of this. Mother always stresses the importance of curtailing one’s baser emotions and abhors the sight of tears.

But Tommen is her beloved younger brother, unlike Joffrey the terror, so she dares to raise her voice, even if it is only once. “Tommen!” Myrcella is lost for comforting words to follow his name, never having heard much of them. She resolves to try, nonetheless.

While she had been casting for words and for ways to keep her balance, she’d nearly lost sight of him. He bumps into a shadow which clinks of armor, and Myrcella winces. Mother will definitely know of this.

“Merda inferna,’- Myrcella has to giggle in spite of herself, for she knows enough to understand that those were curse words, not suitable for children. She wonders who has the consideration to swear in High Western, even when they sound quite tired and sleepy, when she recognises the speaker.

“Your Grace?” Tommen abandons all pretense of manly composure once he looks up and sees their uncle. “Uncle Jaime!”

Uncle Jaime holds Tommen close, wrapping him in his cloak, uncaring of his helm dropping from his hands. He finds a moment to give Myrcella a small smile. “What is the matter? What are you and your sister doing here at this time? Do you”- He’s saved from the trouble of asking further when Tommen, sniffling, mumbles, “Bad dream. Joff knifed Lady Boots. Again.” Uncle Jaime frowns. “Lady Boots?” “She is his cat,” pipes in Myrcella, trying to help.

“Joff knifed her?” He sounds almost horrified, something she had not expected from Uncle Jaime, for she thought he agreed with Mother on everything, and Mother was proud of Joff, no matter what.

“Joff did!” exclaims Tommen. “And mother was not even angry…she said he’s growing into his manhood. Is that what manhood is, uncle?” “It most definitely is not.” Uncle Jaime’s tone is clipped, curt. Tommen flinches. Myrcella takes a step, about to stand between them lest Uncle Jaime raise his hand to her brother against all reason, but Uncle Jaime sighs. “I am not angry at you,” he tells her brother gently. “I will have a word with Cersei, ensure the both of your safety, rest assured of that.” His words ring true, and Myrcella relaxes.

He does have a word with Mother. Myrcella can hear her mother’s voice shouting clearly, for all that the Septa tutting at her poor stitches is trying to distract her. “Remember that you are a knight of the Kingsguard, Ser. And they are my children. How dare you suggest that I am remiss! I am their mother, and I know best!” Uncle Jaime’s voice is too low to be heard, but the slap that follows rings clear, so loud that even the Septa drops her stitches. Mother’s voice stutters, lowered all of a sudden. “J-Jaime, listen…” she trails off. “Your Grace is too kind,” she hears Uncle Jaime’s voice reply, cool and smooth, lilting as always. “I see I must needs speak to His Grace.”

When Myrcella is able to hear Uncle Jaime’s footsteps, she too, tries to look as immersed in her stitches as the Septa does. She does not know what else to do.

However, Uncle Jaime is in front of her, facing the septa, and she dares to take a little peek up at him. He’s as charming as ever, smile wide on his face, beneath his helm. He manages to winkle Myrcella from her Septa for a while, bowing gallantly to both of them. The Septa actually blushes, and Myrcella giggles as he sweeps into another bow, this one only for her. “May I seek the honour of your company, your Grace?” he asks. Myrcella manages to remember her courtesies. “The honour is mine, good Ser.” She tries her best to sound grown up, but evidently she is not very successful, because Uncle Jaime laughs. Myrcella finds that she doesn’t mind. She likes hearing Uncle Jaime laugh.

It is only when they are on their way to the White Sword Tower that Myrcella realises she still has her mess of stitches clutched in her hands. That, however, is secondary. First, she needs to make sure uncle Jaime is fine. “Uncle Jaime,” she whispers. He stops. his steps in step with her own. “Yes?” “Are you…alright? Mother-she didn’t-she didn’t hurt you very badly, did she?”

Uncle Jaime looks startled for a moment. Then he laughs once more. “No, not at all. I’m quite used to it, to be honest. It’s nothing to worry about, ‘tis just a sibling spat. I am as I always am, Princess.” He doesn’t seem to be lying, but Myrcella doesn’t understand. Only Joffrey hit her and pulled at her hair, wasn’t that wrong? She shakes her head. He seems comfortable enough, so he must be right, she decides. She smiles back at him. “Cella,” she replies. “I’m Cella, not Princess, not to you. You may be a Kingsguard, Ser Uncle, but I am your niece first.”

Uncle Jaime averts his eyes from hers for a moment, then kneels in front of her. “Cella it is. And I am quite fond of Ser Uncle as a title as well,” he replies, laughter in his voice, though Myrcella doesn’t think she imagined the sheen in his liquid green eyes. “Alright, Ser Uncle it is!” she replies, offering no further comment. Men don’t like to be seen when they are emotional, and for so fine a knight, surely it must be even more of an insult.

His eyes are on her messy stitches. He snorts a little. “And what masterpiece, pray tell, is this?” She blushes. “Septa despairs at my stitches” she mumbles. “Is that so? Well, we can’t have that, can we? I suppose that is what we will do.” “What will we do?” she asks, curious. He winks at her. “Wait and see,” he replies, as they ascend the stairs to his chambers.

Uncle Jaime fiddles with his drawers, clearly looking for something. “Ah!” his quiet exclamation is triumphant. “I only have red, gold and white threads,” he tells her casually, looking once more at the mess she’d stitched, “but we can salvage most of this quite quickly.” Myrcella knows that she’s wide eyed. “You can stitch?” she exclaims. Uncle Jaime smiles with a shrug. “Quite a fair bit,” he replies, “and I suppose I’ll only get better with practice.” “How did you learn?” She is intrigued. She had thought that knights scoffed at womanly pursuits. “That is a story for another day, Cella,” answers Uncle Jaime. His deft hands unpick her stitches quickly. “We don’t have much time, do we? Your Septa would probably return soon from her prayers, and you will have to be returned to her tender hands.” She scoffs. “Your hands are far more tender than hers.” she grumbles. He raises an eyebrow, his eyes comically wide. “Mine?” he whispers, affecting awe, keeping his hands at the level of her eyes. “Surely you don’t mean these callused palms.” She nods, as regal as she could, and presses a kiss on each palm. “These indeed, Ser Uncle.” She answers with a grin. He laughs, his hands picking again at the stitches, somehow managing to straighten a few of them. “We’d make a fine troupe,” he laughs. “Unfortunately, not all songs I know are suitable for such fine ears as yours.” “Perhaps you could learn,” she ripostes.

Before he could reply, they are interrupted by a knock. “S-Ser L-Lan-Lannister?” Uncle Jaime gets to his feet, opening the door. “Aye. I’m not about to bite you, lad. Say what you will.” A boy stands without, his hair tousled, freckles standing against his fair skin. “S-Septa s-said that-that the Princess has her lessons. And-and the Lord Commander s-said that the King is in his chambers, should you wish to meet him.” Uncle Jaime nods, and turns to her. “Shall we, Princess Cella?” She puts on a sigh. “Must we, Ser Uncle?” He nods gravely. “Needs must, Princess. Fear not, however. Your knight shall be waiting for you.”

He takes her hand, pressing a kiss to it. “We would make a fine troupe!” she grins at him, her hand in his, his steps with hers, as they walk out of his room.

She coughs a little, ignoring the rasp in her throat, wishing she could reach for her water bottle, but is impeded by the sheer number of people between her and the bottle in question. She reaches for the hand rub instead, the familiar smell of ethanol almost soothing for a moment. She blinks, turning to the older man sitting across her, the familiar questions on her lips.

‘Can you tell me why you’re here?’ she asks, noting down the man’s anxiety, trying to make her voice sound soothing. That is all the prompting he needs to launch into his long-winded story. She stretches a little, noticing the line of people in front of her, and the students hanging on each of her words standing behind her chair.

She smiles, looking behind her at the students, gesturing subtly for one of them to take over. ‘Make sure to examine him properly,’ she instructs. The student she had instructed nods, her eyes wide. ‘Yes, ma’am,’ the younger girl responds, leading the man to a bed. She can see the couple of students who had bothered to attend all clustered together, their discussion hushed.

She suppresses a grin. They’ll learn. She herself had. And indeed, one of the the students comes forward tentatively, stopping her peer who had been taking the man’s history, and begins the examination.

She turns to her work, leaving the students occupied for now. It’s a familiar battleground of questions and answers, having to rush the patients because of the lack of time. ‘Ma’am?’ it’s a young gentleman. ‘Yes, sir?’ ‘I am sorry,’ he says hesitantly, ‘I don’t understand what you said.’ She nods. Clears her throat, looking wistfully at the bottle that still is too far to reach, and too empty besides. Looking at it only diverts her attention to the humidity the fan is doing little for, the sweat trickling down her back.

She shakes her head. Do not divert your attention. Her colleague shoots her an understanding look, as she explains the prescription once again. He nods, with a quiet ‘thank you.’ She nods back at him as he leaves.

‘Ma’am?’ She turns once more. If nothing else, she muses wryly, choosing medicine has definitely taught me to multitask. The students lead the first man back to her, their clinical skills enthusiastic if a touch inexperienced. One of the girls excitedly details the sound of an ejection click. She smiles, lending the younger girl her own stethoscope. The girl listens in with the man’s permission in quiet absorption, the ritual being repeated by each of her friends, all of them clearly awed.

The gentleman looks amused at the furore the click of his valves, amplified by his metallic pacemaker, has elicited. She corrects them when needed, leading to a response of all heads nodding at once.

As the clock strikes 1, the students ask for leave to disperse and the crowd of patients mercifully thins. She tells them to go and come back for a short class in the evening, finally leaving behind the pursuit of her elusive lunch and the all-important water.

Her lunch in front of her, her thirst finally quenched, she ruffles through her iPad for information to make the class slides for tomorrow’s discussion. All too soon the short break is over, the slides still unfinished, and she stands, following her friends out of the Duty Doctors’ Room to go on ward rounds. Her eyes flit to a notification on her News app, of a doctor being beaten by goons. She sighs. There is no use pondering over this. I can only do my best. She knows protests do little good, so she hardens her heart and strides out, sliding her phone in her pocket.

Somewhere in the middle of the rounds, the students following her and the senior doctor like ducklings following mother duck, one of them comes running to her. ‘Ma’am,’ his voice is high with fear. She gives him her immediate attention. ‘There’s a man on that bed…’ the boy points, ‘…17, he’s…he’s not really breathing.’

Oh, no. Her friend steps up, running to the patient, while she looks for his details, adrenaline sharpening her senses.

He is a new patient, there is next to nothing on his chart. She can hear a lady wailing and she winces. No one should see their loved one in such a situation, she thinks, even as she squares her shoulders, moving towards the bed, shaking her head at her friend, who had already started CPR. She gently moves the lady aside, trying to console her, even when there is fear in her own heart that the news she might have to deliver could be irredeemable.

‘Doctor?’ asks the lady querulously, ‘you’ll save him, won’t you?’ She looks down for a moment, before meeting the lady’s gaze. ‘We will do our best,’ she replies quietly, grave as the situation is. The lady nods, tears still pooling in her eyes.

She can hear her friend panting. Quiet and quick, she swaps her place with him, continuing CPR. He shoots her a grateful look. She turns her attention to the patient. Between the three of them, they manage to get the patient breathing, she notes with relief. That relief doesn’t last long, though, as she looks the patient over. The catheter connected to him, filled with orange urine, the gross ascites and icterus. He’s on Rifampicin. TB with hepatic encephalopathy. One glance at her friend tells her that he, too, is thinking the same.

The lady with the patient…his wife by the sound of it, reads the grave news on their faces, facilitated, perhaps, by her intubated husband’s gasps of breath. She sinks into the bars of the hospital bed for support. She is at a loss for a moment, as she always is when confronted by the inevitability of death. She kneels then, her hand on the lady’s shoulder, silently commiserating.

When she stands, she looks at the downcast yet awed students and forces a smile. ‘Well,’ she says, stopping them as they turn away, towards the exit, clearly assuming that class is cancelled for the day. She has no intention of doing that, though. They need to learn that life doesn’t stop for those of us still hale.

At the sound of her voice, they turn as one, looking at her with eyes comparable in size to dinner dishes. ‘I’ll just wash my hands and come back,’ she says firmly. ‘You guys go wait in the Duty Doctors’ Room for your class.’ They keep staring at her for a few moments. ‘Go on,’ she instructs. They obey, darting reverential glances at her, talking in hushed whispers. How could someone literally save a life and just go back to normal like that? She hears one of their voices, quiet, dazzled. Despite knowing the truth, the innocent fascination in the boy’s face makes her smile.

I don’t know! She hears one of his friends reply. I want to be a doctor like that, when I finish my degree, when we really become doctors, the girl says, making her smile wider. The younger girl sounds like a young child deciding the goal of her life.  

She tamps down the giddy joy and the grief simultaneously warring inside her, long since used to contradictory emotions, keeping a straight face as she strides to the washbasin.

When she enters the Duty room for the class, they’re discussing the exposure she could have had. She smiles wryly for a moment. This kind of exposure is a fact of life, she nearly blurts out, deciding not to, enjoying their impressed approval for a moment, before she clears her throat.

They all look abashed. She decides to proceed as if the moment before had not occurred, which was helped by one of them asking about the man she had done the CPR on. She summarises the case, gives them a few topics to read on and sends them home.

Before leaving the hospital proper, she circulates the wards once more. The CPR patient crashes again. This time, though they try long and hard, the lose the man, the beat of his heart forever silenced.

Her senior takes responsibility of the formalities, telling her to leave. Leave she does, casting one last glance back at the shell of the man, helplessness overtaking her for a moment.

She checks in with her colleague manning the night shift if she is free to go, fighting the uncanny feeling of déjà vu that comes with every patient they lose suddenly, the realisation striking anew that life goes on.

It is a leisurely walk back to hostel, the cool air soothing on her sweat-soaked shirt. She is thinking once more of the next day’s presentation, the number of slides still left to finish off.

After a quick wash-up and dinner, she sits with her iPad. It is nearly midnight when she finishes her work, fighting her drooping eyes. She checks in her WhatsApp, shooting a quick goodnight to her parents. The statues of her medico friends are full of calls for justice against the recent violence. Her non-medico friends are, as usual, conspicuously silent on the matter.

Ah, well, she thinks, it’s not like armchair social media posts can actually do much. Besides, this is not an issue that they face. Why judge? They’re probably thinking the same I do.

 She debates posting a status of her own then decides against it, for again, social media can only do so much. The bitter truth can’t be changed.

Her mother’s voice echoes in her head, what mama had said the last time she had shared news of such violence. At least they didn’t kill him. You people get a lot of respect, you know?

She shakes her head, banishing those thoughts. She doesn’t want to have nightmares. Besides, tomorrow, she has to report for ID duty. She needs to be well rested for that. So she thinks of the awestruck students, the young girl’s voice playing in her head. I want to be a doctor like that, she said, when I finish my degree.

She falls asleep with a smile on her face.

When she is leaving for duty the next morning, she loops her stethoscope along the back of her throat, the diaphragm of the steth sitting firmly over her own beating heart. Time for another day at work.

Some terms that might be unknown:

Ejection Click: In some patients with heart problems, there is some backflow of the blood when the heart contracts. This backflow is heard as a ‘click’ sound when a stethoscope is used. This ‘click’ is amplified if the patient has a prosthetic metallic valve, as in case of the old gentleman in the story who is based on a real patient.

Rifampicin: A drug that is part of the four-drug regimen for Tuberculosis (TB). It increases the effect of another drug in the combination, Isoniazid, which is toxic to the liver. India has a huge number of cases of TB, being one of the TB-endemic countries. The orange urine is one of the most noticeable side-effects of using this drug.

Hepatic encephalopathy: Loss of proper brain function due to inability of liver to remove toxins. The patient on whom CPR was administered was in a coma due to this condition. He, too, was based on a real patient.

Ascites: Swelling of the abdomen due to accumulation of fluid in the abdomen.

Icterus: Yellowing of the sclera  (whites of the eyes) and bulbar conjuctiva, a hallmark of jaundice.

The doctor here makes the diagnosis of TB with drug induced hepatic encephalopathy because of the ascites and icterus combined with the rifampicin usage and the coma. It is an unfortunately common condition here.