Going Under

by Sonia Henry

  ‘Yeah, that happened to me too,’ Estelle says gloomily, staring into her coffee. ‘In emergency I think I’ll have to put in heaps of cannulas. It’s awful.’

  Max is shaking his head. ‘I’m so glad I haven’t started on a surgical or emergency term like you guys. Respiratory is so great.’

  Max has had the incredibly good fortune of being rotated to a respiratory term in summer. Pneumonia being traditionally a winter illness, he only has two or three patients to look after. Sadly, neurosurgical patients don’t seem to have a climatic preference.

  Interns operate on a system of terms. You have some choice in this, but there are standard experiences every junior doctor needs to have under their belt before the medical board deems us fit to progress. At a bare minimum, you need to do a surgical term, a medical term and an emergency term. I’ve requested nearly all surgical terms. It’s inevitable, really, that I will be a surgeon. My fate was sealed years ago in a delivery suite at the Royal Hospital for Women, with an innocuous comment by an unsuspecting midwife. I was nine minutes old.

  ‘Look how long her fingers are,’ the nurse said to my mother, touching my hands as she cradled me. ‘Maybe she’ll be a concert pianist …’

  Mum, despite having just gone through labour, snapped to attention. ‘Maybe she’ll be a surgeon,’ she said firmly, examining my hands.

  Thanks, Mum—no pressure or anything. I’m certainly doing my best to live up to my mother’s expectations. My first term is neurosurgery, before we’re shipped off to the middle of nowhere in the great Aussie outback for our rural medical secondment. Then, aside from a single mandatory term in the emergency department, I’ll spend the rest of the year inside the operating theatre. Or attempting to get in there, at least, as a lot of the time surgical interns are stuck trying to manage the catastrophes sitting on the surgical ward.

  ‘Why are you so keen to be a surgeon, Kitty?’ Estelle asks me now, as if reading my thoughts. ‘I hate the operating theatre.’

  I consider this. Even as a student the surgical terms were always my favourite. The whole romance of the operating theatre appeals to me. It’s the closest you can get to treading the precarious line between controlled life and equally uncontrolled deterioration and death. And it isn’t called a theatre for no reason. It’s a stage of sorts. The surgeons are movie stars with egos to match. The patients play their role to perfection, being helpless and unconscious. Bodies are cut open, lives are saved and lost—and everyone acts as if it is just another day, which for them it is, I suppose. I’ve heard other doctors say they enjoy surgery because it’s straightforward; they can just ‘go and get things done’. It’s a world away from the complexities of human interactions with difficult patients on that other planet—the ward. But that’s not at all how I see surgery. I like the grace and precision it requires, while all the time being aware that at any moment things can go wrong, that the careful choreography of the theatre can descend into chaos. The fact that so often it doesn’t is, for me, miraculous. The operating theatre is a place where magic happens.

  Estelle is staring at me. ‘Earth to Kitty …’

  I snap myself back to the present. ‘You know,’ I say, in answer to her question, ‘blood and knives and power and pain and mercy and magic. It’s all in there.’

  Estelle smiles. ‘There’s the Kitty Holliday I know and love: half surgeon, half writer.’

  ‘How’s the book going, mate?’ Max asks, upending his milkshake to drain the dregs.

  I sigh. Despite the subliminal pressure to become a doctor—a surgeon, no less—I also grew up in a house full of literature with an English teacher for a mother. She instilled in me a love for language; words are my oldest and greatest friends. Mum’s texts asking if I was studying for my medical exams were always peppered with quotes from obscure poets. No wonder I have an identity crisis. It’s because I’m on the Pisces–Aries cusp, I reckon. The creative dreamer is always doing battle with the pragmatic, determined future surgeon. I write to escape, and for the last few years—ever since I started medical school—I’ve been working on a novel. But progress has been slow; there was always another anatomy lecture to attend, or exam to study for. And now that I’m finally a real doctor, my dreams of a literary life seem further away than ever.

  ‘Badly,’ I admit. ‘But as my mum always says: novelists starve, doctors don’t.’

  ‘I can’t believe this is our first day as real doctors,’ Max says dreamily, no doubt envisaging his almost-empty ward and blank to-do list. ‘I reckon I’ll finish early. I told Winnie we could have a drink to celebrate. Want to walk home with me?’

  Our housemate Winnie is the only person in our group of friends who isn’t a doctor. She’s a lawyer, which she generally hates. She texts me between billable hours to ask if I’ve met any hot surgeons yet like on TV. Her favourite little joke is that if I do finally ever write my novel I should call it Fifty Shades of Grey’s Anatomy.

  ‘I’ll be here for hours,’ I tell Max. ‘My registrar’s at a course today so I haven’t even met her yet; I’ve sort of just been going it alone.’

  The hierarchy of medicine is confusing, even for people inside the system. Interns are at the absolute bottom of the food chain. Above us are the consultants in training, or registrars. And above them are the godlike fully blown consultants, junior and senior. Most departments have a few of each. Junior consultants have a bit more to do with us interns than their senior colleagues, who are so far removed from their years as junior doctors it’s like they never happened. They spend most of their time (when they’re not on the fairway or in Aspen) making money in the private hospital. The hospital, in all its wisdom, has scheduled registrar orientation for the same time as our first day as interns, and the junior consultant who might have been able to offer me some direction has been in theatre the last five hours. I have thus spent my morning with no supervision and perpetually confused.

  ‘I should have stayed a stripper, I reckon,’ Estelle says suddenly. ‘I was such a good stripper.’

  I’d met Estelle at the start of my medical degree when we ended up at the pub together after sneaking out of the last lecture early. Half a beer in, Estelle told me that she’d worked on and off as a stripper for the last few years, as well as engaging in some hard-core partying, but had decided it was time to go straight, so to speak. After blitzing a year of a science degree, she’d transferred across to medicine. I can still picture Estelle standing next to me in the coffee line on our first day of medical school, in her white summery dress with her Longines watch, lying through her teeth to the guy next to us that she wanted to become a doctor to save the masses. Even at the time I thought she looked like she’d be more comfortable in day spas rather than medical tents inside third-world war zones.

  ‘Do you think I’d be a good stripper?’ Max asks hopefully. ‘We could leave all this behind and start a doctors’ strip show. What do you reckon, Kitty? Stripping would have to be more fun than surgery. Think about it—no more cannulas.’

  ‘It’d definitely be a niche market, the stripper who nearly gives you a heart attack with their amazing sex appeal but then turns around and is able to save your life with effective CPR,’ I agree, ‘and kind of hot.’ But even though I know he’s only joking, it makes me think. What is it that I really want? Why have I spent the last billion years of my life struggling through medical school? It’s for a purpose, something far more than just a job. That’s why I’m here, now: because being a doctor is the most noble and worthy profession I can think of. I picture myself in a surgical mask under the bright lights of an operating theatre, knowing I have the absolute confidence to pick up a scalpel and press it down onto skin, watching the blood spring up as I complete the first incision. Only doctors have that kind of power, born from years of training to hone their skills, all to make another human being’s life better, or even, hopefully, save it. That’s the whole point of being a doctor … isn’t it?

  two

  Eight hours later
, I’m finally about to leave the hospital and head home. I have just walked out the front doors, the words HOLY INNOCENTS HOSPITAL glowing blue above me, when my phone starts to ring. The sound immediately sets my pulse racing.

  I pull the phone from my pocket and stare at the screen. Maybe it’s Max, I think hopefully, wondering why I’m not home yet.

  ‘Is this Katarina?’ a man’s voice demands before I can say ‘hello’. He has a slight accent which I can’t quite identify.

  ‘Ah …’

  ‘Katarina Halliday?’

  ‘Holliday.’ I knee-jerk correct my mystery caller.

  ‘What?’

  ‘It’s Katarina Holliday,’ I explain, wondering for a second why I’m bothering. ‘Like vacation. Holliday, as in going on a holiday.’

  ‘Whatever. Where are you? I’m on the ward.’ The voice sounds irritated.

  Sounds like you need a holiday, I want to remark. Instead I say, ‘I was just … leaving.’

  There’s a silence, during which I wonder who’s on the other end of the phone. It must be someone senior. This is a rather bad start, I can’t help thinking.

  ‘I’m at bed seven thirty-two,’ the voice informs me bluntly. ‘I need the chart.’

  I sigh and retrace my steps to the surgical ward. It’s 9 pm, and I’ve been at work since 7 am. Aside from my coffee with Estelle and Max, I haven’t eaten or drunk anything all day. I am going to be thin enough to be faxed in a few weeks, I think, using one of Max’s favourite lines. Thin enough to be faxed. Holy enough to be canonised. Dedicated enough to be surgeonised. Scared enough to be miserable. Tired enough to be dead. The thoughts come from nowhere, but Dr Halliday, definitely not having a holiday, suppresses them quickly. She wants to be an angel of healing, and this is just what must be done. If it was easy, everyone would be doing it, I remind myself, quoting one of my lecturers from medical school. Doctors aren’t everyone. We just can’t be.

  I arrive at bed 732 with the chart to see a man standing there prodding at the stitches in Mr Jacobsen’s head. Mr Jacobsen looks terrible—he has just had a massive brain tumour cut out. I smile at him, then feel bad for smiling, so look at my shoes instead. They’re really scuffed and dirty, I notice. I need a new pair. I also need a pay cheque, to buy the shoes.

  ‘Don’t ever leave the hospital again without telling me first,’ my mystery superior snaps as I follow him into the doctors’ room.

  ‘Sorry,’ I say. ‘It’s just that it’s past nine o’clock, so I figured it would be okay.’

  ‘When I was an intern I never left until I’d done a night round with my registrar.’

  He starts scrolling through the CT scans on the computer, then stops and looks over at me. ‘Can you scroll?’ He sits back and rests his foot on the desk, his hands behind his head. The implication is clear: I’m WAITING.

  For a second I am filled with disbelief. Like, can’t he use a mouse? But no, I realise: he actually means it. He is going to sit there, with perfect motor function and the ability to use a mouse, and make me do it instead.

  What I really want to do is tell this guy to Fuck. Right. Off. Instead, I reach for the mouse.

  ‘I’m your boss, Dr David Hyde,’ he says, finally identifying himself. ‘You have three bosses: me, Dr Prince and Dr Bird.’

  I nod, not taking my hand from the mouse nor my eyes from the two-dimensional black-and-white brain in front of me.

  ‘Dr Prince and Dr Bird are too senior to spend much time with you. I’ve been in this job a year and I’m only staying because I think I’ll get a senior consultant job here next year.’

  I don’t know what to say to any of this. I feel my phone vibrating in my pocket and this time I’m sure it’s Max. I picture him and Winnie drunk and happy on cheap white wine, and feel an overwhelming urge to cry.

  ‘Keep scrolling.’

  I keep scrolling.

  ‘Normally Rachel, the registrar, would be dealing with you on the ward, but since she’s away I’ve had to cover for her.’

  Scroll, scroll.

  ‘Stop scrolling.’

  I stop scrolling.

  He peers at the image. ‘What do you see?’

  I look. Subdural, I think to myself. Subdural haemorrhage, but not totally white, so maybe a bit old. Subacute subdural, then?

  ‘I don’t know,’ I say finally, scared to get it wrong.

  ‘It’s a subacute subdural,’ he says. ‘You should have known that.’

  I hate myself.

  ‘I thought that—’

  ‘You didn’t think anything,’ he says flatly. ‘Don’t pretend.’

  Our eyes meet for a moment. He has brown eyes, and is tall with blondish hair. If I’d met him at a bar, I would have thought he was good-looking—sexy even. He would tell me he was a doctor—a brain surgeon, no less—and I would be impressed. I’d hope that he would buy me a drink. Maybe more than one. I would tell my mother about him and hope that he wanted to be my boyfriend. A real-life brain surgeon. Wow.

  ‘Interns always pretend,’ he says, ‘but we always know when you’re lying.’

  I stretch my lips in a smile, as if he has made a joke. I read an article once that said even if you’re feeling really unhappy, when you smile it triggers off the happy response in your brain. So even in the worst of situations, the article advised, force yourself to smile and you’ll feel better. Simple brain connections and chemistry. Happiness is just dopamine, a few neural pathways, and a big, fake smile. I should know. I am a happy young doctor, after all.

  He smiles back at me. We sit there, stretching our lips at each other. His teeth gleam, reflecting the light of the computer screen. I have an image of the Joker, with his painted-on red grin, teeth bared.

  I am saved when his phone starts to ring. It’s recovery. The last patient on the list, the cervical spine fusion, has a neck swelling that is getting bigger. His presence is required.

  ‘Don’t forget the morning trauma meeting is tomorrow,’ he says as he stands up. ‘It’s held every Tuesday. We go through all the emergency trauma cases that have come in. You need practice, and you need to look at more scans. I can’t believe you didn’t pick up that subdural. Dr Bird will be there. He’s the head of department so make sure you’re on time.’

  ‘I’ll be on time,’ I say to his retreating back.

  I take a deep breath, and let out a very long sigh. I feel my pocket vibrating again. I answer the phone. As I expected, it’s Max.

  ‘Where. The Fuck. Are you?!’ he shouts into my ear.

  ‘She’s not still at work, is she?’ I hear Winnie say in the background.

  ‘I’m on my way,’ I say, suddenly sure that if I don’t leave this place immediately I will suffer some kind of catastrophic cardiac event.

  Even though we’re not meant to use this exit, I take the fire escape steps four at a time and burst through the door leading onto North Avenue, my street.

  I walk up the road quickly. When I reach the little white cottage with the overgrown front yard I almost cry in relief. It might be only two hundred metres from the hospital, but 19 North Avenue feels like it is on the other side of the planet.

  Outwardly, our house doesn’t have a lot going for it. It’s extremely old and rundown, and it floods at the first hint of rain. We have to use an umbrella to go to the bathroom in bad weather because it used to be an outdoor toilet. The previous tenants we suspect used this indoor-outdoor bathroom area as some sort of greenhouse to grow illegal hydroponic vegetation. We haven’t ruled out continuing their legacy but I’ve a feeling our neighbours have above-average scent detection, if their formidable hearing is anything to go by. Max always says there’d be better money in flogging Endone on the deep web but, as I remind him, this is unethical and could lead to deregistration, so Operation Oxycodone remains his pipe dream.

  We pay way too much rent, our neighbours hate us, and we are definitely the worst house in a good street. But none of that matters to me. With its steep staircase and high ceilings and
fireplaces, number 19 North Avenue is my own little slice of paradise.

  ‘Let’s have a house party,’ I can hear Max saying as I walk down the hall towards the living room. His voice is slow, meaning only one thing.

  ‘Have you been taking valiums out of the shoebox again?’ I demand as I enter the room, stepping over a squashed grape which has been sitting on the floorboards for at least six days. I ignore it.

  ‘We’ve earned it,’ Winnie says, leaning back on the couch and gesturing at the cardboard shoebox which houses our more questionable pharmaceuticals. ‘Did I tell you about the date I went on last night?’

  Winnie has a dating track record even worse than mine. Her experiences are so random and bizarre, it’s like she has set herself a personal challenge.

  I met Winnie when I was nine years old and we have been inseparable ever since, other than a period when her family relocated to the UK for a few years during our teens. We don’t talk about that time too much, because Winnie’s mother died over there after a sudden diagnosis of pancreatic cancer. I know she thinks about it, though—sometimes a dark cloud will come over her face, and Max and I sense to leave her alone.

  ‘The fitness instructor?’ I say.

  Winnie rolls her eyes. ‘I should have known. A fitness freak who doesn’t drink. Stupid.’

  ‘Non-drinking is a huge red flag,’ Max offers helpfully. ‘Madness.’

  ‘Anyway, forget about the fitness instructor—we want to have a house party,’ Winnie tells me. ‘This house would be great for a party.’

  I can feel number 19 smiling.

  By the time we finish another bottle of wine it’s settled. We were born to party, and number 19 is a house born to be partied in.

  ‘How was the rest of your day, mate?’ Max asks. ‘Do you reckon you’ll have to stay that late every day?’

  I shrug, feeling demoralised. ‘I hope not.’

  ‘Did you meet any sexy doctors?’ Winnie asks.

  ‘Just one guy, the junior consultant,’ I say, suddenly realising I’ll have to see the Joker again in the morning and feeling even more dejected.