Like in his early days during his undergraduate course in medical science, Anindya was slowly slipping into the darkness again. This was no ordinary darkness; it began in the evening, when the sun sank below the horizon. Over time, however, the darkness crept into other parts of the day; at its worst, it’d start right from the time Anindya woke up. He knows this darkness better than he knows his home. The darkness whispers in his ears, about his worst failures; his every shortcoming; mistakes he’d made; people he’d hurt. The darkness digs out the harshest things people have said about him. The darkness knows where every insult is buried, where every humiliation is hidden.
Anindya has come a long way from his undergraduate days in a peripheral medical college. That’s where he met darkness for the first time. If you ask him, I don’t think he’d be able to explain how he crawled out of there. He can only remember fragments and doesn’t really want to dig deeper- all he’d say is that it involved some medicines, some exceptionally warm words, some helping hands that were extended unconditionally.
He has come a long way from there and from his home. His home is in a lesser-known corner of this country; like him, his home slowly grew out of its darkness. It now has small flowering plants growing on the roof. It has a dining table where his family sits down to eat and talk lovingly. It has rooms inside which nobody calls him a bloody fool or a sorry excuse for a human being. His home could keep his darknesses at bay, but he is quite far away from that place now, from those people who love him, who do not believe that he was born to harm patients or become the reason for their demise.
Far from Bengal’s green and soft delta, Anindya has now joined a fellowship in a leading medical institute of the country, built on the rough and dry terrain of the Shivalik foothills.
He was welcomed with a suggestion that, obviously, he was not good enough for this institute; he noticed how the eyes and mouths moved, in derision, when his consultants found out they’d never heard of the medical school he’d passed out from. He remembers how every round was a reminder of his smallness and incompetence; how no opportunity was wasted in pointing out how he’d be the biggest trouble for his patients, rather than their ailments. Anindya understood that all of this was in the spirit of constructive criticism, so he could be better. Each day when he was going home, he was carrying behind him the heavy burden of all the adjectives he’d received over the day; the ‘donkey’, the ‘fucker’, the ‘I sure pray to god that you’re not my doctor when I get sick’. The carriage became heavier day by day, and one day he heard it step in, in the guise of the darkness. Anindya was falling back in. The weight of the favours, from his teachers, to make him better, was pulling him down the crater he once so narrowly escaped. He was failing, finally. He was slowly fitting into the definitions his teachers awarded him. He stopped reading with happiness; he was now studying just to breathe. He now knew how to pull the others down if it helped him to remain afloat. He now knew how to hurt a person and use the best excuse for doing so- he was just helping that person get better at what he does. He was now the child of a foolproof system of constructing the sharpest physicians of the country, with insight so shiny that it can blind even the sweetest and most honest of the dreams, observations so piercing that it can cut through the confidence and self-respect like they’re cheese, and ego so towering that its shadow can drown all the insignificant truths and convictions of a person’s life; Anindya, an idiot with a degree he somehow managed to get, was now bitter enough to at least call others idiots, or think of them as idiots, and drown them in the darkness, for their own good.
Anindya was barely living. He was running on fumes of disgust and bitterness; love was an unimportant farce; sarcasm was a weapon; and amidst all this, the darkness had come back.
The night in the ICU is the loneliest place in the world. Anindya steps into the air-conditioned room, its floor slippery enough for a grown person to fall and be lost forever; its walls so white that everything else seemed black, no matter how colourful they might have been outside. The beds lie silently within the bounds of their cubicles, carrying bodies barely breathing, in a world that has dangerously contracted around them to the size of this room.
Anindya is handed over the information about the patients who will be in his care tonight. Bed 1 is on three vasopressors and still her blood pressure is falling steeply. She has lived fifty-eight years, raised her children, but did not take care of her diabetes; now she lies close to a signed document of “do not resuscitate” order- the signature in the end smudged with a salty drop of her eldest son’s helplessness; Anindya sighs and moves on. He feels the darkness has accompanied him; its greedy hands stretching into the first cubicle; its offspring in another home.
Bed 2 and 3 are improving. They’re off the mechanical ventilator. The heavy guy’s pursed-lip breathing tells Anindya about how little this heavy smoker has left, even though he may go out of this ICU tomorrow; the darkness will accompany him. He wants to ask him about what drove him to smoke his life into oblivion, but instead he makes a snarky comment about how ‘this guy’s gonna smoke even on ‘BiPAP’’. Bed 3 is a young girl who took some organophosphate poison, just enough to have her husband scared and realise how important she was. She was about to die in the process and Anindya suspects she may still die after she gets home. He faintly remembers the time he thought that thinking about social issues was also the doctors’ responsibility. Now he knows, he doesn’t simply have the time. It’s best to leave that to politicians who are definitely doing such a wonderful job as long as you choose to remain comfortably blind. Handover trolley rolls down the corridor. Each bed tells stories that now only nudge the scared doctor inside Anindya and don’t even attempt to wake up the human side sleeping on its deathbed. There’s just not enough time.
Bed 6 harbours a lady with a heavily damaged lung. She’s a new patient, so handover runs longer than usual. She has bronchiectasis; merciless infection and inflammation taking turns in digging large holes into the substance of her lungs. Pus forms and stays, doesn’t come out; bacteria call it their home; rewards her with regular bouts of severe pneumonia; she gasps for breath with a sharp wheezing sound during her good days; she needs a ‘non-invasive’ ventilator on her bad days; and now is her worst time. She is drowsy with all the tiring fights clearly in the yesteryears; a non-invasive mask is clamped tightly and snugly in her skeletonised face; her chest barely rises with the mechanical life the Hamilton ventilator tries to breathe into her; she inches towards her last failure, and Anindya feels the whole room filled with darkness. Darkness licks its lips. Anindya feels the greed of his companion- the hunger, the obscene demand.
Subhlata is 38 years old. Anindya looks at her file after the handover. She has been suffering from this disease for the last 5 years, and has been hospitalised three times in that period; twice in the last 6 months- a clearly declining trend. He looks at her lab reports- the gradually diminishing lung functions, the tell-tale malnutrition with florid anaemia and hypoproteinemia, the dropping TAPSE and the enlarging right ventricle- her lungs are now slowly eating away reserves of all other systems she has.
Anindya sighs- he will have to let the darkness have her.
He calls the husband inside the ICU. As usual, he assigns him a tag of “Subhlata’s attendant- the husband” and does not care about his real name; he addresses him with ‘sir’, but with hardly any respect or compassion that should be associated with that address. He calls him sir because that is what everyone calls the other here. The word sir has lost all its weight and meaning- it is something you call a person even if you’re eventually going to end up calling him a moron. He still likes it better than “bhaiya” and “Haanji” that usually precede a heavy psychological assault as he has observed in the past. He likes how civilised all assaults and insults are here; it is like the Geneva Convention of medical education.
He talks with the ‘husband’, who has also brought their son with him; the boy is fifteen, but his eyes look as if they’ve seen decades more than his years. Anindya notices the deformed digits of the husband; he hardly has six fingers in two hands; rest are small, twisted and wouldn’t be of any help. He is wearing a Kurta that gives off the stench of despair and poverty; his eyes, on the other hand, brim with confidence that seems almost criminal to harbour, at least for him, in this situation. He tilts his head forward, keeps a smile on his lips out of respect and hope, and joins his hands together as he listens to Anindya.
Anindya speaks bluntly; he tells him that an invasive ventilator, requiring a tube to be inserted down her windpipe, may buy them some time as she recovers, but there would be a high chance that she may never come out of the ventilator; in such situations, many sign a “do not intubate” order to minimise the suffering of the ailing. Anindya knows that he doesn’t have to explain that signing that order means no escalation of treatment and Subhlata shall slowly slip into the darkness, where many would say she already belongs.
The husband listens. His customary smile fades away, but his eyes hold onto the hope, and that seems irritating to Anindya. The son looks tired, but he, too, shares the moronic fire in his eyes. While the darkness engulfs them from almost all directions, Anindya could still see their eyes floating like fireflies arrogantly ignorant of the obvious doom.
The husband speaks in the end, in a voice that is hardly shaken, and with a depth of confidence that far surpasses that of Anindya’s.
“She will pull through, doctor. Please try. She will pull through.”
There’s a catch in his voice now, but he hides it promptly; he doesn’t want his son to hear it; he doesn’t want the darkness to smell it. He doesn’t want his wife to even imagine it.
“She’s so young. Our son is just growing. She will pull through.”
They do not sign the order. The boy holds the father’s deformed hand. They leave the ICU; the father’s knees were shaking, but he hid it well. While the darkness sees it, the boy misses. They leave after calling Anindya a god of all-power.
Anindya sighs. His research guide knows he is a moron. His co-guide knows his skills are at best poor. His colleagues know he is a waste of space. His seniors call him a slowpoke behind his back. Anindya doesn’t have any assessment of his own anymore. He sees himself in the words of others and he finds that just too.
This moron of a human being, this husband to a 38-year-old near-corpse now thinks of Anindya as a god!
The darkness sits on his chest and tightens itself; Anindya knows he is incompetent; he is not a good physician; he is a moron himself; the hopes of the husband makes him feel like running away and crying loudly somewhere far from this place; he feels like burying his face deep inside a desert where nobody could hear or find him; he feels like flying back home and yell from the top of his lungs to his unsuspecting parents “your son is a failure, an idiot, a moron, a donkey, a bloody fool- don’t you feel proud, please.”
He takes a deep breath. The darkness almost got him; he is buried neck-deep in it. Sinking, but slowly; he shakes his head, breathes deeply again once or twice. The darkness leaves him some space and goes looking for prey; it will come back.
Anindya walks slowly beside Subhlata; she is emaciated; he looks at her fingers. Her nails are cleanly cut; her fingers are deformed, just like her husband’s. They look like they were caught in some machine, a common affliction among factory workers. Anindya looks at her tired chest; she is so thin that her engorged right ventricle could be seen thumping through the left side of her sternum; her neck vein fills up with every breath. This is how people look in their twilight.
The ventilator tells him that Subhlata can barely breathe by herself.
Anindya knows that once he puts that endotracheal tube down her throat and allows those positive breaths to take over her destroyed lungs, she is probably not going to come out again.
Reluctantly, he asks everyone to get ready for an elective intubation.
He takes off Subhlata’s mask and gently calls her name. He knows he won’t be able to respond. It’s a standard bedside test to assess the necessity of ‘invasive ventilation’.
He was wrong. Her eyes open, with so much effort, yet she opens them alright. And Anindya sees the fire. The moronic fire, the uncompromising fire; darkness could not get in there; she was fighting it with her last breath. Anindya asks her to squeeze his hands, and she does try; Anindya asks her whether she knows what time it was- she doesn’t just try to answer- she gestures Anindya to stoop closer to her mouth, and says, “I am feeling good. I am feeling good”. Streaks of silver in her hair are too similar to Anindya’s mother; her dry throat sounds like his mother asking for water at the end of a feverish night. This is not the voice of a dying lady; this is a mother’s call to her last resort: her child.
“Make me live.”
It takes Anindya minutes before he gets back into his senses. This lady, she is not here to lose. She has not given up. Anindya looks at the wall behind her bed and sees what he never thought he could see. He sees specks of fear in the darkness, floating like fireflies of hope; He sees an animal retreating in the face of pure willingness to survive.
Anindya appears to have found an unlikely comrade in his fight, and something gets ignited inside him; an engine hums into life. Anindya feels like fighting.
For now, he starts Subhlata on diuretics; it will help her drain all that unnecessary load of water in her circulation, unload her heart. Her heart is failing; it was the right side of her heart in the beginning, now the left side has followed suit. Anindya will decongest her. He increased the positive end expiratory pressure of the ventilator; it will take care of the left heart failure, but won’t that worsen her right heart failure? He opens an article on the computer and reads while the ventilator alarms interrupt in between, but today he was not stopping, not giving up. He writes in his notes “intubation deferred” while in his mind, he writes- “I will give her another shot at life”.
He judiciously adjusts the ventilator pressures. His eyes were unhealthily stuck to the screens of her ventilator, following the trends of tidal volume and respiratory rate in a frenzied manner. He never sleeps in the ICU, mostly out of fear of missing something and getting scolded by his consultants; today, he is up because he is chasing hope.
He suddenly discovers that the ICU is not as dark as he had thought earlier.
After about two hours, Subhlata’s eyes open by themselves. She gestures for water. The ventilator shows that all the breaths are generated by her, with very little help from the machine. At the same time, the windows of the ICU brighten up with the hint of the rising sun; darkness is wiped clean off them.
The husband comes in in the morning; he has not slept through the night. His eyes are red like the newborn sun. His eyes turn slowly, scared, when he looks at his wife’s bed; Anindya has removed Subhlata’s mask. She smiles at him; her smile is of peace and of victory; her skeleton face feels more alive than Anindya’s fear-nourished one. There is a tear in the husband’s eyes. His fireflies meet hers. His name is Aseem. Their son’s name is Vijay. Subhlata will now go back to weaving from her home. Aseem will carry the clothes on his cycle to the market. Vijay helps his mother when he comes back from his school. He is doing well there and will continue to do well. Anindya sees their home now. There is very little light, very little height, very little space. But it feels way more spacious than his life. All the darkness is wiped clean off their walls; a thousand fireflies sparkle across their struggle. Anindya sees it all. Their deformed hands meet. They speak very little; they know the battle is never won, it is only fought. But they fight it with faith; faith in each other; they repair their home with love after each devastating storm. Flowers grow in whatever desert they choose to live in. They water the flowers late in the day, when it is the time of the darkness to lurk.
Anindya explains to them that Subhlata will need a small machine at home to help her breathe, and that she needs to cough up her sputum regularly. The son listens to the directions carefully. His lean hands appear strong enough to carry the world. Hope spills out of his heart. Anindya’s voice breaks unexpectedly. The human in him turns in its bed. It was morning.
Morning handover starts on time. Anindya explains to his reliever about how Subhlata fought and won a losing battle. The reliever smiles sarcastically; says “she will be back to her sorry state in no time, sir”; Anindya fails to agree with him. As he looks at the hands of Subhlata, at the stumps where her fingers used to be, his face lights up with a stupidly hopeful smile, and he says, “She may be, but I think she can beat it again”. His colleague says nothing out of respect and disagrees in silence. Anindya hopes he could see the fireflies too.
When he gets home, he pulls out his critical care textbook and starts reading before falling asleep. He decides to tell his consultants that he knows about his own shortcomings, but he doesn’t want anybody to die and has done and would do anything and everything to save a life. I don’t know if he ever said that out loud, but I know he has thought about it a lot. As he slips into slumber, he feels Subhlata’s undying voice staying by his bedside, and the darkness is nowhere to be seen.
Anindya wakes up at the end of the long night and bids another farewell to the darkness; fireflies fly all around their abandoned fear-house.
