Short story: The singularity of sleep, by Eileen Merriman

Haematologist Eileen Merriman describes herself as a doctor by day, and a writer by night – so she knows about the lack of sleep described in this story. Her young adult fiction novel Invisibly Breathing will be published in March. This story, The Singularity of Sleep was runner-up in the Sunday Star-Times Short Story Awards 2018, sponsored by Penguin Random House. Judge Stephanie Johnson says: ‘‘This is a conventionally written but strong story that gives intimate insight into the life of a trainee surgeon. Felix is under slept, over worked and trying to do his best by everyone: patients, colleagues and family. It is an ‘expert’ story that contains esoteric medical details and small flashes of black humour. Who knew that treating perineal abscesses is ‘disgusting but satisfying’? The steady refrain of the central character’s inability to sleep brings the reader into his exhausted headspace.’’

‘The two main causes of peripheral vascular disease,’’ the surgeon says, ‘‘are diabetes, and smoking.’’ Felix shifts his weight from his left foot to his right. At this moment he couldn’t care less why the patient in front of him has black toes and an ankle ulcer that smells like a public toilet. All he wants to do is lie horizontal, and close his eyes. Twenty-six hours since his alarm went off. ‘‘Doctor Fox,’’ the surgeon says.

Felix fixes his bleary gaze on his superior. ‘‘Hi.’’ There’s a titter behind him, one of the junior doctors. Felix is in-between, a registrar. A long way from being a consultant, a long way from medical school.

‘‘What’s your management plan?’’ Seamus Ryan asks. He’s wearing an alabaster shirt beneath a charcoal suit, no tie. Typical surgeon attire, but his shoes are unusual, black leather with patterned brown leather swirls and metallic toes.

Tearing his eyes away from the surgeon’s feet, Felix says, ‘‘I think he needs a below knee amputation.’’ Ryan’s eyes are unusual too, copper coins.

‘‘You think,’’ Ryan repeats. Felix’s eyes dart around the assembled party – the day registrar, two house doctors, three nurses and a pharmacist – and lastly, the patient, an elderly man with a mouth like a cat’s bottom. A sure sign of a smoker, that cat’s-bottom-mouth, Felix thinks, and quells a rising hysteria.

‘‘He needs a below knee amputation,’’ Felix says, with conviction this time. He holds his breath, waiting to be humiliated in Ryan’s soft, deadly tones.

‘‘I agree,’’ Ryan says, and turns to the patient. ‘‘Do you understand what we’re saying? We’re going to have to remove your leg, about here.’’ His tapered fingers stroke the yellowed smoker’s skin.

The patient blinks, unsurprised. ‘‘Anything to get rid of this pain, doc. When?’’

‘‘Later today. We’ll put you on the acute list.’’ Ryan flips the sign hanging above the bed, so it says ‘‘nil by mouth’’.

‘‘Want to scrub in, Fox?’’

You’ve got to be insane, Felix thinks. But he wants to be a surgeon. He wants to absorb some of Ryan’s charisma, his experience. So he says, ‘‘that’d be great. Thanks.’’

Back in the corridor, Ryan says, ‘‘go home and get some sleep, Fox. I’ll call you.’’ He passes Felix his phone. Felix types his number into the contacts, hoping Ryan hasn’t noticed the faint tremor in his hands.

He doesn’t know why he’s shaking. He thinks it must be something to do with lack of sleep.

Sleep is a black hole, collapse into a singularity with infinite density. Felix wakes drenched in sweat, canary-yellow outlines around his curtains. When he picks up his phone, he sees he has missed a call, and that it’s 11.34 AM.

As he’s trying to unscramble his neural networks, trying to work out the simple act of calling this person back, a text arrives. Theatre 5, twenty minutes. SR.

Felix catapults into the shower and downs a glass of water before jumping into his car and gunning it towards the hospital. The sun burns into his retinae. He feels ill, off-balance. After parking in an on-call car park, even though he’s officially off-duty until 11 that evening, he jogs through the back doors of the hospital.

It’s 12.03PM.

In the theatre change room Felix dons blue scrubs, and blue covers for his trainers. He’s tying a cloth over his still-damp hair when the door to the theatre corridor swings open. ‘‘There you are.’’ Ryan whips his phone out of his pocket, and frowns at the screen. ‘‘Grab a coffee, Fox. I’ll see you in 10.’’

The theatre tearoom is a sea of blue scrubs. The rapid conversation and laughter jangles in his ears. Felix dispenses a double espresso from the machine and walks onto the balcony, looking out over the river below. The caffeine surges through his arteries, hits him behind the eyes. By the time he walks back through the theatre tearoom he’s feeling alert, looking forward to the surgery.

Sleep is over-rated. He’s on top of his game, ready to play God.

When Felix scrubs up and walks into theatre, the patient is already draped and intubated. The rhythmic hissing of air as it moves in and out of the patient’s lungs, the metronome beats of the patient’s heart, are enough to make Felix’s own pulse slow. The surgical theatre is his world, where he most wants to be.

Ryan beckons him over. ‘‘Ready to roll, Fox?’’ ‘‘Ready.’’ Felix takes the bowl of iodine and swabs from the theatre nurse, and starts washing the discoloured leg in front of him. The skin is eerily cool, and devoid of hairs below the knee. The toes are purple-black and wizened, like prunes.

When Felix has finished, Ryan says, ‘‘pass the boy a scalpel’’. Boy, as if Felix is 16 rather than 26. But Felix doesn’t mind, because now he’s slicing through the waxy flesh, Ryan cauterising the tiny vessels as blood dots rise to the surface of the skin.

‘‘Wait,’’ Ryan says suddenly. ‘‘Where’s the music?’’

The anaesthetist walks over to the DVD player on the bench behind her. ‘‘Green Day?’’

Ryan smiles. ‘‘Perfect.’’ Then they start again, clamping large vessels, dissecting nerves as they listen to Are We the Waiting and Give Me Novocaine and Homecoming.

‘‘Busy night you had,’’ Ryan observes, after Felix has cut through the tibia and fibula, and the dead half of the leg is deposited in a stainless steel basin. ‘‘Two appendixes, three small bowel obstructions and four GI bleeds, right?’’

‘‘And the gallbladder,’’ Felix reminds him. ‘‘Oh yes, fat, female, and 40,’’ Ryan says, reeling off the adage they all learned in medical school, for how to spot a person at risk for gallbladder stones.

‘‘You forgot fertile,’’ Felix says, watching Ryan tie off a perforating vessel.

‘‘Fertile, of course.’’ Ryan’s coppery eyes settle on his for a moment, and Felix feels a strange twinge in his belly. ‘‘Here, you want to give this a go?’’ After passing him the forceps, Ryan guides Felix’s hand towards a clamped vessel. Felix catches a whiff of sandalwood and sweat, and the feeling in his stomach spreads to his groin.

‘‘Like this?’’ He glances up. Seamus Ryan’s mouth twists.

‘‘Like this,’’ he echoes, and Felix feels as if he’s teetering on the edge of a precipice, but he doesn’t know what lies below.

‘‘Nice,’’ the surgeon says, his voice low. And Green Day are singing Whatsername, and the patient’s lungs are inflating and deflating, and Felix feels as if he’s travelled up to the roof of the theatre and is looking down on the scene below, at the surgeon’s hand on the junior doctor’s wrist, and the beads of sweat on the junior doctor’s brow, and he can even see into the junior doctor’s chest, how his heart is squirming behind his ribcage, a bird trying to spread its wings, beating faster and faster.

But I’m not . . .

I’m not . . .

After they’ve made a skin flap and sewn it over the stump, they strip off their bloody gloves and gowns and retire to the tearoom. Felix is buzzing all over, his mind still flying circles around his fading body. Ryan brings him egg sandwiches, coffee, a piece of carrot cake baked for an unknown occasion.

‘‘You did well,’’ he says. It’s quieter now, a pair of nurses chatting about the rugby in the corner, an anaesthetist checking Facebook on his laptop.

‘‘That was awesome.’’ Felix can’t stop looking at his hands. Not his hands, but the surgeon’s hands; his long fingers, the neatly trimmed fingernails, the walnut-shell skin. ‘‘Have you got a list this afternoon?’’

‘‘Yeah. But you should go home, get some

sleep.’’ Ryan is checking his emails on his phone. ‘‘Got a girlfriend, Fox?’’

Felix looks away, runs a finger around the corner of his mouth. ‘‘Yeah.’’ He’s feeling hot all over now.

‘‘She doesn’t mind your long hours?’’ ‘‘Oh,’’ Felix says. ‘‘She does.’’

Ryan exhales. ‘‘They all do.’’ He clamps his hand around Felix’s shoulder. ‘‘Wait until you start your trauma run. Those were the worst six months of my life.’’

It gets worse? But Felix doesn’t want to show any sign of weakness. Also, he doesn’t want Ryan to take his hand off his shoulder.

‘‘Get some sleep,’’ Ryan says, standing up. ‘‘I’m on call tonight, so try to keep it to a dull roar, huh?’’

‘‘A dull roar, sure,’’ Felix says, although the roar in his ears is anything but dull. ‘‘Time for bed.’’

Ryan raises an eyebrow. Felix flushes, and leaves.

Seconds after he sets foot in his front door, the phone rings.

‘‘Dad, I’m on nights.’’

‘‘I know, but it’s about your mum,’’ his father says. Felix’s stomach tumbles. His father never calls him, usually.

‘‘Mum? What’s wrong?’’

‘‘I took her to hospital last night, with chest pain. The doctors say she’s had a heart attack. They’ve put two tubes in her arteries . . .’’ ‘‘Stents?’’ Felix interrupts.

‘‘Yes, I think that’s what they said. But she’s asking after you and she . . . we . . . wonder if you could come home.’’

Felix sags against the wall, running a hand down the side of his face. His skin feels greasy, and all he can smell is disinfectant and latex and expelled bodily fluids.

‘‘I’ve got night shift tonight,’’ he says. Then he asks some more questions, trying to gauge how unwell his mother is, which coronary artery territory was involved, whether there are any signs of heart failure but his father doesn’t know anything.

Frustrated, Felix says, ‘‘I’ll drive down tomorrow afternoon, after I’ve had some sleep.’’

‘‘Great. I’ll ring you if there’s any change.’’ His father hangs up. Felix stumbles into his bedroom and falls onto the bed, fully clothed. The air is thick, stagnant. He closes his eyes, but his brain races on. His mother’s clogged arteries. Black toes, black hearts, bone saws and scalpels. Ryan’s hand on his wrist, his shoulder, Give Me Novocaine, and he can’t sleep and he can’t sleep.

At 4PM he sits on the couch, drinking coffee and watching a pair of Siamese twins talk about their sex lives on TV. Grace comes home at five, and cooks Pad Thai for dinner.

‘‘You look like shit,’’ she says. ‘‘You should get some sleep.’’

‘‘I know,’’ he says.

He goes to bed. He doesn’t sleep.

Night falls. Felix drives to work feeling buzzed and exhausted at the same time. Inverted lights shimmer across the estuary. The traffic lights appear to have inverted too, red where green should be and green where red should be. Perhaps that would explain why he sails through a red light, narrowly avoiding getting T-boned by a Range Rover, or why he is suddenly jerked into wakefulness by someone leaning on their horn behind him. When he opens his eyes, green light spills into his eyes. It reminds him of a song on the radio.

When he walks into the Emergency Department, the day registrar is waiting to hand over his patients. Three abdominal pains, two rectal bleeds, one perianal abscess.

‘‘Awesome,’’ Felix says. Perianal abscesses are disgusting but satisfying, instant relief with a simple incision and drainage.

Moss quirks an eyebrow at him. ‘‘Enjoy. Also there’s some guy with groin pain in resus the ED guys keep bleating about. Not sure why they want our opinion.’’

‘‘Awesome,’’ Felix repeats, taking the pager off Moss. ‘‘Enjoy your sleep.’’

He lines up two of the bellyaches for a CT scan and sends the third home. One rectal bleed isn’t bleeding anymore; the other has a simple case of haemorrhoids. He’s about to arrange theatre for the perianal abscess when an emergency doctor walks past.

‘‘Did Moss hand over a guy with groin pain to you?’’

Felix blinks. The young woman has pigtails, and is wearing black and white striped stockings beneath a black tunic dress.

‘‘Groin pain,’’ he repeats.

‘‘He’s just arrived back from CT.’’ She leans over him to bring up the scan on the computer. ‘‘Radiology reg thinks he’s sprung a leak in his aorta.’’

Felix stares at the stranding around the aorta, the contrast leaking into the surrounding tissues. ‘‘What’s his blood pressure?’’

‘‘Eighty,’’ she says.

‘‘Fuck.’’ His heart racing, he follows her into resus one. The guy’s young, 50s maybe, his skin chalky. Felix lays a hand on the guy’s belly.

‘‘Pulsatile mass, did you even feel his abdomen?’’ He snaps at the Pippi Longstockings lookalike. ‘‘Oh, easy in retrospect,’’ she snaps back. ‘‘What’s wrong?’’ The guy asks. The room shifts around Felix, inhale-exhale. He takes his phone out of his pocket.

‘‘What have you got?’’ Ryan sounds very alert, even though it’s nearly two AM. ‘‘Ruptured triple A,’’ Felix says. ‘‘Awesome,’’ Ryan says.

It is awesome. Here they are in theatre, again. Queen croons Bohemian Rhapsody as Seamus Ryan lays scalpel to skin. At the moment the blood hits the ceiling Felix feels as if he has split into two halves, simultaneously looking down and up at the same time.

‘‘Jesus,’’ Felix-on-the-floor says. Felix-on-theceiling blinks, and wipes blood off his face. Type O, apparently. Ryan’s hands are deep within the abdomen, slipping through writhing coils of bowel to the mainline, the aorta. We Will Rock You reverberates around the theatre as Ryan places clamps above and below the aorta. Felix-on-thefloor, swinging on his retractor, is entering the grey zone between wakefulness and sleep.

‘‘Here,’’ Ryan barks, placing another retractor and handing it to him. ‘‘Don’t let that move.’’ Felixon-the-ceiling watches in awe as Ryan sews the graft into place. It’s a Kind of Magic has just begun when the anaesthetist swears, and a series of alarms go off. That’s when Felix sees the ECG tracing on the monitor, ventricular fibrillation, oh shit.

‘‘Stand back,’’ the anaesthetist yells. Ryan and Felix leap back, bloody hands held high as the anaesthetist presses the paddles over the patient’s chest and shocks the heart. Then it’s all on, chest compressions and rounds of defibrillation and adrenaline, and Felix-on-the-ceiling flits around the theatre like a bird as Felix-on-the-floor presses on the patient’s chest until he feels a rib give way. ‘‘Shit,’’ he says.

‘‘Don’t stop,’’ Ryan says. So Felix doesn’t, not until the ECG has been nothing but a flat line for at least 10 minutes, not until he is covered in blood and sweat and aching all over. He could almost fall into the hole inside the patient’s abdomen and curl up inside there for a while. Warm. Dark. Oblivion.

But he doesn’t sleep, not yet. After he’s showered, he sits in the tearoom, drinking coffee with shaking hands. A junior doctor has left two messages on his phone, something about a patient with a fever, but Felix is in no state to respond. Seamus appears about 10 minutes later, his hair wet, and asks Felix if he’d like some fresh air.

Felix says, ‘‘fresh air, hell, yes.’’

‘‘Hell, yes,’’ Seamus echoes, and gives him one of the smiles that have been making his gut twist all day. Felix accompanies Seamus outside, through the car park and beneath the weeping willows. It should be quiet, but a Queen song is looping through his head, the title of which he can’t remember just now.

To Felix’s surprise, Seamus lights a cigarette and passes it to him. Felix hasn’t smoked in years, but he draws the smoke deep into his lungs and now it feels as if he has split into half again; Felixon-the-ground and Felix-in-the-trees. Seamus says, ‘‘you can’t save everyone.’’ Felix-on-the-ground leans against a tree trunk. ‘‘I should have gone to see him sooner.’’ He can hear the river, somewhere nearby. Blood surges in his ears, a rising tide.

‘‘Ah.’’ Seamus’ breath is warm on his cheek. ‘‘Not a typical presentation.’’

Felix-in-the-tree inhales. Felix-on-the-ground doesn’t say anything. His mouth and hands are full of the man he wants to be, swollen flesh on swollen flesh, blood beneath his nails and flowing beneath his skin, and as Seamus fills his every crevice he remembers the name of the song.

‘Felix.’’

The ceiling is unfamiliar, but the person sitting beside the bed is Grace, sweet Grace. Felix lifts his hands. His atoms have reassembled. He is Felix-in-the-tree, Felix-onthe-ceiling, Felix-on-the-ground.

Grace says, ‘‘they found you in the theatre corridor. Do you remember?’’

Felix lowers his hands. ‘‘He died,’’ he says. ‘‘The guy with the triple A.’’

Grace frowns. ‘‘Triple A?’’

‘‘Ruptured abdominal aortic aneurysm. We tried to fix it. But his heart . . .’’ On the wall above his head he sees oxygen tubing, suction. ‘‘The emergency doctor,’’ he says, trying to rewind. ‘‘She looked like Pippi Longstockings.’’

Grace starts talking, words like psychotic

episode and induced by lack of sleep and medication flying out of her mouth.

‘‘My phone,’’ Felix says, his voice rising. ‘‘I want my phone.’’

Grace gives him his phone and leaves, promising to return later. Felix finds the missed call from Ryan, the text inviting him to theatre. He finds his phone call to Ryan to tell him about the guy with the ruptured aorta.

He’s about to text him when he hears footsteps halt outside his room.

‘‘Fox.’’ Seamus Ryan is standing in the doorway, wearing his charcoal suit. The elaborately detailed shoes are gone, replaced by a pair of plain black brogues. ‘‘Get some sleep?’’

‘‘The triple A,’’ Felix says, quickly, desperately. ‘‘Happens to the best of us. You can’t save everyone.’’ Ryan steps towards him. There’s that stomach-twisting smile, the soft voice in his ear, a faint whiff of cigarette smoke. ‘‘You’ve got good hands . . . Felix.’’

Felix wants, needs, to ask Ryan about the rest of it; the trees, the river, it, but at that moment a hospital aide enters carrying a tray of food.

Ryan steps back. ‘‘Get well soon, Fox,’’ he murmurs. ‘‘Make sure you get some . . . fresh air.’’

After the surgeon has gone, Felix closes his eyes, seeking the infinite density of his soul. But all he can hear is Freddie Mercury singing Another One Bites the Dust.

And he doesn’t sleep, and he doesn’t sleep.