lost and found

The call room is musty, cold, silent except for the whir of a fan. But in my bed, it is dark, warm. Blankets around me, layers and layers of comfort.

Outside, they are rounding.

They are rounding again, obsessively, as they do, as usual every four hours, a low-pitched muttering; the sounds of discussion are a distant waterfall, with snatches of words I only half-understand. An anxious backdrop to an already anxious ward. The labour ward. Beneath all, the sound of the cardiotocogram, the device which listens to foetal heartbeat. Tapping away in the background, a constant stream of noise, rising and falling according to the whims of the fetus silently waiting in each woman’s womb.

Lying silently in the dark, I do not realise that I had already lost it, maybe a few hours ago, early into the overnight call. I do not think about it at all. Instead I think to myself: Jiahui must be rounding, bless her soul. I imagine her prowling the half-dark corridors, typing rapidly, her face lit by her laptop.

It is easy to lose track of things, on call. A hospital is a place for lost things. It starts small, like maybe a pen. Always there is a secret black market of pens in every hospital, traded for and exchanged furtively between the medical students and patient service staff and registrars and so on. Another common thing to lose is a stethoscope. As every charge nurse knows, each ward has a lost-and-found full of stethoscopes, every type, from delicate Littmann Cardio IVs to those black Classic ones. The worst thing I had lost was a laptop charger. Probably it was stolen. It belonged to Singhealth so I had to pay through the nose for it, a few hundred dollars.

I decide to join Jiahui. It is my turn to round, after all. I have slept maybe two shaky hours, but Jiahui has not slept at all. Stepping out, I smell blood in the air. One of the rooms has a Code Green. The nurses rush like ants around the ward, getting ready to push the poor girl to the OT for a Caesarean.

Show me the bloods, the registrar keeps saying. I once thought that obstetrics is about pregnancy but it is actually a specialty about blood. Cross-match the blood; test the blood for this, test for that. Stab the umbilical cord, get the cord bloods. The mother gives blood to the child. Often she gives too much blood. The vagina gapes like the gates of hell, flooding with blood, the blood pooling everywhere, filling the room with a blood haze.

Jiahui sees me, puts down her laptop. I’ll do the Caesarean, then go to sleep after. You just round, she says. She is awkwardly tall, pimply, straight black hair tied back in a bun, surgical-type, a nose-ring. A good kid. She sees me and we both know it the moment after she tries to speak to me. I had lost it, on this call, somehow, some way. Your name, Jiahui says, worried. What is your name? You lost it. I open my mouth to say my name but nothing comes out. I do not know my name. I have lost my name. I am now nameless.

How can I be a nameless houseman?

As it turns out, it is quite convenient to be nameless. It actually does not matter whether a houseman has a name. It matters whether a houseman can put up ward round notes on time and get CT scans and call endocrine registrars to ask for insulin dosages. Actually it is even better for a houseman to work without a name, because now angry surgeons could not find who it is they wanted to shout at, and angry endocrine registrars could not direct their anger onto any specific individual. On the other hand, I knew all the endocrine registrars by name; I had them on speed-dial, Jiahui joked. They hated me. I was an effective houseman. Nameless, but effective. Effective, because I was nameless.

I find this out only weeks later. At first, I try to search for it. Maybe I had just left it somewhere in the labour ward, or one of the call rooms. Jiahui helps me, since we are both post-call.

We go to the security room, first. A large man sat inside on a swivelly chair. What’s the problem, he says, swiveling around on the chair. I explain, and he nods, then shakes his head, saying “No” with the whole of his pudgy body. Your name is your responsibility, he says, swiveling in circles. Do you know how many housemen have lost their names? I am filled with unfathomable rage and Jiahui has to pull me away from the room. How many consecutive hours has the security guard been working? Is he on his 24th hour without proper sleep, like the both of us? And what about the CCTVs? Calm down, Jiahui says. Try to think about when you last saw it or used it.

We go through the motions. We all know what it is like to lose something, to be so absolutely frustrated, how could I lose the damn thing, to retrace steps again and again. No use. I check and re-check Singpass obsessively, but all I find are my NRIC, my driver’s license, everything intact except the space where my name is supposed to be which instead held a string of gibberish. My emails, my certificates. Nothing.

Jiahui and I have breakfast at Mam Mam, our usual, then we go up to discharge half the ward. Go home, the other house officers tell us eventually. Thank goodness Onco Two is functional.

I reach home, grateful for a short reprieve, and fall quickly into a deep sleep. I tend to dream hard when I am sleep deprived. So I dream, of things that happened or could happen or did not happen on call, in the long and dark nights before sunrise.

In the dream, I am running the cord bloods in the labour ward. They put the stillbirths in the same room, so I have to poke blood from an umbilical cord while standing next to a small cot with a tiny dead baby inside. I always bow my head to show respect; I have enough problems, I cannot afford to also be haunted by ghosts. But because this is a dream there is not one stillbirth but many, a sea of stillborn children, small and tiny and pink and raw with beady black eyes, wearing their little hats and pajamas, watching me as I scramble around the ward. They speak to me. They tell me their names, every single one. What is your name? they ask of me. I cannot answer. I have no name, I say. They shake their little heads. Then you will be forgotten. I wake up, cold and sweating. Maybe I will end up a part of the secret black market of things in the hospital, exchanged again and again between registrars and surgical teams, forgotten, a lost thing destined to eternal inpatient work.

Obstetrics posting is not difficult, the seniors say. I know this to be true but I dislike the maternity hospital anyway. They are all so vicious, the registrars and residents with their handbags, trying to draw blood from one another all the time. Sometimes I suspect that the entire hospital is pregnant. Pregnant with what I do not know. It just feels like the air is holding its breath, expectant, whether to shout at me, or praise and coddle me, perhaps I will never know. It is always pregnant, never delivering, holding onto the potential of something unimaginably heavy.

I dream of lacerations. Blood fills my mind, hot and stinking. Find the apex, I hear in my mind. I never forget this lesson. To repair each vaginal tear, the repair must begin from before the beginning. How many of us hold wounds that cannot heal, re-opening, because the beginning is still bleeding and not yet stitched together?

I wake. New posting. Jiahui goes to surgery; I go to orthopaedics. Switching over from obstetrics and gynaecology, the difference is disorienting, blinding, a burst of high-beam headlights from a swerving drunk driver at night.

The orthopod surgeons are racist, sexist, whatever kind of -ist there is to be. They laugh, pot-bellied, wearing the same man-face, basically doing the same thing as the obstetric surgeons except doing the male version of it. At least they are all “bros”. They treat the female housemen (housewomen?) like jewels and the male housemen like dirt, and after that they bring all of us out to lunch on thousand-dollar oyster meals paid for by big-boobed implant reps. Not too bad a time, I think. They treat me well. Being nameless, I may have become genderless as well. Perhaps I have become truly invisible.

On call again. I look at myself in the grimy ward toilet mirror. I look tired, nondescript, too small for my scrubs, insignificant. I can be anybody, maybe a girl who studied in the U.K. who is “adapting”, maybe I am a polytechnic kid who made it to medicine, maybe I am a high-achiever with a dozen publications or a SEA games side-gig. Without my name, I no longer know. I only know to continue with the endless work.

Ortho calls are not supposed to be bad, but my call luck disagreed. The call started the same way as many other calls; desaturations and fevers and hypotensions and patients asking for melatonin. I juggle, self-taught. Eventually I see one of the new admits on the ward. He has just been admitted in the evening for a hip fracture. Now the morphine has worn off and he thrashes in pain, cursing away at the nurses and doctors and the government for some reason, demented in his delirium and delirious in his dementia. Of course, my usual kind of patient.

I stick him for the bloods. It starts out normally. I tourniquet his arm, hold his wrist down. He moans softly, unsure of what I am doing; I explain but he does not hear. He is an old man who has not aged with grace; he is thin, sallow chicken-skin, scraggly, with a sad few strands of hair growing weakly out of a pockmarked scalp. I poke him and he cries out in pain. I miss. The veins blow open. They are shitty to begin with, spidery nothings hardly visible under his pale skin. Now they flower with bruises, looking like little explosions, a garden of personal failures.

I need the bloods. Without the bloods, I cannot do the pre-operative checks. Without the checks, the surgery cannot happen. If a surgery is supposed to happen but cannot happen, a surgeon will become deathly angry. So I keep trying. There is no one to help me except the groans of the old man which become increasingly frantic, as I bury my needles deeper and deeper within his frail flesh. I switch up, change to the houseman vein, then the antecubital fossa. I bring butterfly needles. I lose count of how many times I poke him. Ten times? Maybe fifteen? He looks at me. Despite his delirium he speaks clearly to me, in a clear terrible voice. You’re hurting me. Stop. You’re a horrible doctor. What are you doing? Go away! And he swipes at me so I tumble back, narrowly avoiding stabbing myself with the phlebotomy needle. He curses me, in English, Malay, Hokkien.

It is enough for me. I talk to my senior, an orthopaedic resident sitting in the medical officer room. Keep trying, he says indifferently. He’s demented right? No capacity? Why would you listen to him? I look at the resident, a pleasant-looking man with gelled hair combed and swept back, face wide and blank. In his eyes I see him scanning each patient, each one a skeleton, a bag of broken bones, jigsaw puzzle pieces to be put back together. I sigh and return alone.

Taking the biggest needle I can find I go back to the old man and stab him, deep in the leg, and he screams while the nurses hold him down like an animal being butchered. I get my blood, bright and arterial. I fill all the tubes which suck up the blood greedily; greedy tubes for greedy surgeons. The old man and I stare at each other in the dark, panting, hateful. I look at him proper for the first time, and something in his face is familiar, but I have no time to dwell on it.

The rest of the call is uneventful. It is not always glory and code blues like the TV shows. Usually it is a long string of miserable decisions, on and on through the night, dragging me down underwater, until hours pass and I realise I have not even slept a minute.

Near the end of my call I run into another houseman, covering the general surgical patients in my ward where I covered the orthopaedic ones. He is struggling, sweating away while kneeling next to an old woman. Trouble with bloods, again. Against my better judgment and choosing not to slink away to my call room I go to help him. When we look at each other, we are both struck immediately. He, too, does not have a name. For a moment we squat opposite one another, two orang-utans equally lost in a sterile jungle of sleeping octogenarians.

I thought I was alone, he says, just as I ask him how one might be able to recollect his name. He seems offended. If I knew, I wouldn’t be here, right? He tells me he has been nameless for some time now. How long? He has forgotten. He warns me I must find my name again, urgently. Without my name, I cannot become a medical officer or a resident. Perhaps I will not even amount to a human being. I will be stuck a houseman forever.

The thought weighs heavily on my mind but it is wiped clean by the morning rays of light. It is what every houseman prays for. Sunrise.

We are dancing, heedless, at one of the places for lonely people who are trying to find themselves. Maybe this is Capitol, or Marquee, or some other club with a slick-sounding, vaguely sexy name.

I look over at Jiahui, who is dancing with her partner. Under the flashing strobe lights I see the other girl, short, muscled, a tattoo of a Greek goddess running hotly down her left arm. Jiahui laughs, full of carefree joy. I am glad for her. She is a hard, honest worker, smart, always has my back in the trenches. She deserves to be happy. It is her idea to come and I decide to come along although (or perhaps because?) tomorrow is the only off day we have in the month.

Hours pass and we are all increasingly drunk. I am making out with a girl younger than I am, dressed skimpily in black, dark lipstick with dark eye bags. She tastes alkaline, probably her make-up, with the hint of something sweet and tarty and plum-like. We stumble out of the club, holding onto drinks, into the humid night, people spilling out onto the street like vodka overflowing a shot glass. The alcohol running through my veins makes me feel electric, as though everything is possible, makes me feel stupid and young, this is what twenty is supposed to be like, isn’t it, young and stupid and drunk?

I try to call a Grab on my phone for me and the girl but I find that I cannot read the words. Everything is blurred. I am crying, and she holds me. I am trying to explain, choking and sniffling. My mind is filled with the faces of old people, with death, disease, darkness, blood. Tonight, I realise suddenly, is the first time I have seen so many young people, all together, people who were actually my age. Overwhelming. After eight months of overnight calls, I have almost forgotten what it is like. I apologise, drunk and red in the face, and she holds me softly, her skin sweaty and flushed against mine. The tears come thick and fast. I do not know her name and she does not know that I have none to give, but somehow it does not matter.

The next time we are in the wards, Jiahui tries to talk to me about it. We are now both in internal medicine; we are in neighbouring wards, so she comes by often. You are sick, she tells me, you lost your name and now you are losing yourself, but neither of us has a solution.

The medics are kinder people than the surgeons, but in their own way, equally neurotic. The consultant wants me to memorise the names of all the patients, which I do; ironically, he does not even notice my own lack of a name. Rounds are long, four-hour gauntlets. I present a case, proper, for the first time. Your fever history is lacking, the registrar says to me, suspicious. What is the patient’s last job? Has she ever come into contact with rats? Has she ever gone hiking in Sungei Buloh in the past five years? Endless talking, endless questions. In the end the only thing we do is adjust the frequency of lactulose.

Jiahui and I talk about it, in the dark, sharing a call room. Outside, a rainstorm patters harmlessly at our windows. We are on call again together, just like old times. Medical calls are bad, worse than other postings, but we manage; we find a slice of time to chill, huddling next to our laptops, munching on 7-11 snacks.

Medicine is the whispering between clouds, I tell her. Imagine how dark it must be, inside the human body, the thyroid and the lymph nodes and blood whispering secrets to one another, conspiring to some obscure medical disease. On the other hand, surgery is the lightning bolt. Surgery is a bright flash of light, violence, organs exposed on an operating table, hands reaching in. Jiahui lights up when she talks about surgery. She wants to be a liver and pancreatic surgeon. I laugh, glad for her but uncomfortable. Having seen the patients, doing a Whipple’s should be tantamount to attempted murder.

The surgical department likes her, so she will be applying for residency. I give her a hug for good luck. She will make a great surgeon; she already looks like one, a young butch registrar with short hair, there are so many of them. All she needs is a scrub cap and an iced coffee.

Time passes and we move to different wards again. Housemanship, one short brutal year, is ending soon. Somehow, I still do not have my name.

I slowly develop a mixed sense of jadedness towards the situation. A part of me is increasingly desperate to find my name. I loiter in the wards after work, looking at lost-and-found drawers, checking the various rooms used by the house officers. Maybe I will find some other houseman’s name, left behind, which I can slip over my persona and use temporarily, until I find my true one. Another part of me does not care. I let the daily rounds distract me; monotony blunts my soul.

The Ministry sends supervisors to check on me, to review my learning. I have learnt, I inform them, and I have become a better doctor. I give five stars on my feedback. The supervisors nod and thank me politely, not realising that they do not have my name, that I do not even have a name at all. Sometimes I get angry at them. Maybe they have stolen my name, hiding it somewhere behind their polite smiles, but I never have the energy to be angry for long.

My final ward is a subacute ward buried inside one of the upper levels of the nearby community hospital. It is not actually a rehabilitation ward, although that is what it seems like at first. Most of the patients have come here to die. There are three or four deaths every week, almost one every day. These are the do-not-resuscitate deaths; all I do is update my seniors and call their families. I ask them to bring the patient’s NRIC, which we need to fill the death certificate.

One of the first deaths I have on the ward is an old lady, a dialysis patient. She came for her usual breathlessness but as it turns out this time it is not water in her lungs, but cancer. The kidney doctors talk to her family, long and hushed conversations, and then my registrar tells me to tell the patient that we are stopping dialysis.

When I tell her, I expect her to cry or say something but to my surprise there is something like relief on her face. Both her legs are cut off due to vascular disease, so to be honest she cannot do much other than lie in bed staring up at the ceiling. I think about how many dialysis sessions she has had, a thousand cycles of blood over the past decade, and this morning had been her last one and she did not even know. I think about how many exams I have sat for, how many hours I spent studying for A-Levels and the month-long final medical exams and all of that just to tell this woman that we are stopping dialysis for her and that she will die in two weeks. After a while she looks at me and she says thank you quietly. I do not know what to say.

After a few days, she dies. I call the family to tell them and they come to the hospital but they forget to bring her NRIC. As a result they cannot move her body to the morgue so the nurses cover her with blankets and lower the air-conditioning temperature so her body will not rot too fast.

The last death while I am on the ward is an old man. I round him for the final few weeks of my medical posting before realising. It is the same elderly gentleman from my orthopaedic posting, the one with difficult veins. I do not recognise him at first. He is much drowsier than before, snoring mostly, hardly agitated. He is also much skinnier, almost skeletal, bones poking out of his skin. The orthopaedic surgeons would love him now, I think grimly to myself. Looking through the discharge summaries I realise with indignation that despite all my efforts to get the blood the surgeons had not even operated on him. In the end, they had just sent him home with a broken hip to lie in bed. Since he can no longer walk, he has caught a bad pneumonia, and now he is dying. We flush him with antibiotics, but each day he becomes increasingly breathless.

One morning I walk into the ward and notice him sitting up in bed. His eyes are wide and alert, and he is speaking to the nurses. He is rallying, the ward nurse tells me, shaking her head. His time has come. I go over to him, hold his hands. We talk for a while, about his past life, his children, his family home where he had lived for the last forty years. He raises an ancient wizened finger to point at me. I know you, he says. I know your name.

My mind blanks. How can it be possible? Is it just his dementia? But now I realise why he seems familiar. We are both much older but I begin to recognise him. He must be a neighbour, or perhaps my bus or canteen uncle from primary school, or my babysitter in kindergarten. Someone in the background of my childhood, someone perhaps my parents knew. He leans over to me, his wrinkled face a sly toothless smile, and tells me my name, whispering into my ear. When I hear it I know beyond a doubt that it is mine, and suddenly I am free again.

He dies in the afternoon. I am not on call today so after I settle his death, I go home. After all the postings and the days of consecutive work and the 30-hour calls and the 100-hour weeks, I am now utterly spent. Too tired to even register the relief from having finally found my name. I fall asleep easily even though I am not even sleep-deprived or post-call; my exhaustion is deep and total. When I wake, I will have graduated housemanship and become a medical officer. But all that matters to me now is my sleep, fitful, healing, full of dark dreams.

I dream now of something forbidden. I dream of something that is impossible for me to know or remember, but that comes to me anyway, deep within my darkest memories. I dream not of death, but of birth, again. It is my own. It is dark, warm. Liquid wraps my body, layers and layers of comfort. Then pain and light and noise and steel and gasping for air. Blood washes me, painting me with life. And I can hear my mother’s voice, cooing. She is saying my name, saying it again and again, the name that she has chosen and given to me; whispering it to me, she names me, a name that will always be mine, for forever and ever and ever.