Dr. Shaw’s hair rippled in an orange-red wave as her stethoscope darted from side to side. The faintest hint of a smile crossed her face, and she gave me a thumbs-up. “Tube’s in, Joey. Restart compressions.”
I leaned forward and pushed, my fingers interlocked over the center of the patient’s chest. One hundred compressions a minute, just as we’d learned in class. With the endotracheal tube in, there was no need to pause for respirations. My hands pressed downward, roughly shoving the unresponsive man below me. He was a stranger to me, a patient on one of the other Medicine teams we covered. “Bobby Randall,” his wristband read. One of the other interns must have told me about him during changeover, but that was hours ago and I couldn’t recall a thing. I needed to read through my changeover list, but first someone would have to relieve me on chest compressions.
“Dennis, can you take over compressions after the next break?” I asked the closest nurse.
He nodded. “Sure.”
Two minutes ticked off the clock.
“Hold compressions,” Dr. Shaw commanded. “Rhythm check.”
Dennis took my position as I stepped aside, searching for the changeover list among the paper folded in my white coat pocket.
A bright green line squiggled across the heart monitor in a slow irregular pattern.
Dr. Shaw cursed. “It’s still PEA.” Pulseless electrical activity, not a shockable rhythm. “Continue compressions. Give another shot of epi.”
A squat female nurse injected an epinephrine syringe. Her name-tag read “Pauleen.”
Dr. Shaw looked straight at me. “Any ideas on what’s wrong with this man?”
I flipped through pages of hastily scrawled notes, struggling to decipher my own writing.
Pauleen answered before I did, piping in with a high-pitched South Asian accent. “Bobby Randall, eighty-one years old, community-acquired pneumonia. Today was first day without fevers. He looked great last time that I saw.”
“Around midnight—two hours ago.”
The name Bobby Randall leapt out at me from my notes. Crap. There was no real information there; his primary team didn’t think he was all that sick. “Changeover says he’s getting better and should go home soon,” I said.
“Then why is he dying now?” Dr. Shaw clenched and unclenched her fists, looking nearly as pale and taut as our patient. “PE? He’s already anticoagulated. Pneumothorax? He’s got bilateral breath sounds. MI? We’ve sent cardiac markers.”
A blur of movement caught my eye. I glanced at the mirror on the wall just in time to see a man in a long white coat hurry past our room. I turned to look over my shoulder, but the man was gone.
“Hey, who was that guy?” I asked. The man looked like a doctor, but why would he walk by a resuscitation without asking if we needed help? We could have used another pair of hands—not to mention a fresh mind.
Dr. Shaw blinked. “Who was what?”
I pointed at the door. “The doctor that just walked past us.”
Dr. Shaw and Pauleen both gave me a concerned look.
“He was right in front of you. I saw him in the mirror.”
“No man walked past the door,” Pauleen said.
My cheeks flushed with embarrassment. Had I dreamed up an imaginary doctor? I certainly felt tired enough to fall asleep standing up.
Dr. Shaw cleared her throat. “It’s been over two minutes. Hold compressions. Rhythm check.”
Dennis felt for a pulse in the man’s neck and shook his head. All eyes went to the heart monitor. Still a non-shockable rhythm.
“Resume compressions,” Dr. Shaw said. “One more of epi.”
The code continued in two-minute cycles of chest compressions and drug pushes.
It was an exercise in futility.
The Eskenazi Health logo hung above the doorplate to Room 6239, three straight lines reaching upward like blue and green towers. The room was dark, so I figured Lily Walters was still asleep. I almost jumped in surprise at her rasping voice.
“Good morning, Dr. Saltare.”
The ceiling light flickered for a second, then blazed to life. Lily’s wrinkled skin was almost translucent under its harsh glare, even paler than usual. She smiled, and I waved in return.
“Ms. Walters! Good morning, how are you feeling?”
“It’s Lily, and …” She burst into a coughing fit, then turned and spat into a pink basin. “Same as always.”
“You seem a little better,” I said. “You’re talking without gasping for air.”
She flashed a wrinkled grin. “Then I’m not talking enough, dear.”
I smiled back and pulled the stethoscope out of my white coat. “Here, let me check your lungs.”
Lily took deep shuddering breaths as I listened and tapped on her back. Both lungs were wet and dull, but less so than before. She coughed again. “How do I sound?”
“A whole lot better than when I saw you last night.” The last time they’d called me to her room, I’d half expected that Lily wouldn’t survive. Instead, she had improved, and Bobby Randall died. Goes to show how little you can trust a prognosis.
“You see me far too often, doc.” She gave me a worried look and slid back down in bed. “Do you ever leave the hospital? You’re far too much like my brother.”
“Evan. He was a doctor too. But that was a long time ago.” Lily stared at the ceiling, gazing into distant memory. Then she hocked up another mouthful of foam. When she recovered she said, “Move along, dear. Don’t let your other patients wait on account of me.”
“OK.” I certainly had no shortage of patients to see. “I’ll see you later, Lily.”
“You too, Doc.”
My fingers flew across the keyboard, copying lab results and x-ray reports into yet another progress note. Flipping through the electronic chart, I somehow pulled up a physical therapy report instead of the medication list that I wanted. Goddamn keyboard commands. I slammed a fist on the desk in frustration.
“Joey,” Dr. Shaw interrupted in a gentle tone. “Are you okay?”
“I’m fine,” I said through a yawn.
She laughed. “No, you’re a brand new intern and we’ve had one hell of a night on call. You’re stressed out.”
I opened my mouth to protest, but she was right.
“Where are you on orders?” she asked.
“Done.” I ran through a completed checklist. “I’ve put in all the meds, labs and scans, and called Nephro on Adams. Stokes is discharged and out the door.”
Dr. Shaw nodded in satisfaction. “Notes?”
“Just finished all of yesterday’s.” The chaos of last night had not left me much time for documentation; I’d spent the past hour and a half on catch-up notes.
“And today’s? How many notes do you have left?”
I peered at the list for some time, almost too tired to count. “Eight. Eight more progress notes.”
Dr. Shaw gave me a pitying look. “Tell me which notes are done, and I can help you out with the others.”
“We’ve got plenty of time,” I replied. The clock on the wall read 11:55 A.M., and duty hour regulations said we had to leave by 1 P.M. I could finish my notes in an hour, I didn’t need to be rescued.
“No sense killing yourself, Joey.”
I yawned again, in spite of myself. Rest was starting to sound really good. “I’ve signed Yoder and am almost done with Walters.”
She nodded again. “Finish up Walters, change over, and go home. I’ll take care of the other seven.”
The brilliant steel lines of Eskenazi Hospital arched upward as if reaching for the sun. Its futuristic glass angles shone with reflections of orange clouds. I might be stuck here in Indiana, but at least I was working in a new hospital. The call rooms were spacious and didn’t have any roaches—unlike some hospitals I knew in Los Angeles.
I made my way through the lobby and into the main elevators. White coats, red and purple scrubs, and blue hospital gowns piled on to the elevator car. Stopping on every floor made for a ponderous ascent. By the time the doors swung open on the sixth floor I wondered if the stairs would have been faster.
A loud alert tone sounded from the speakers above. I tensed up in anticipation of some disaster.
“CODE ORANGE, SIX NORTH, ROOM SIX TWO FIVE ONE. CODE ORANGE …”
The announcement repeated itself. “Code Orange” was shorthand for a violent or threatening patient. I broke into a jog toward the room in question. A group of wide-eyed visitors blocked much of a hallway, and I pushed my way past with a quick “Excuse me.” The altercation was audible even from around a corner and half a hallway off.
“You all stay back,” a deep male voice snarled. He sounded familiar, a patient on my service. “I’m leaving! Get outta my way!”
“I’m sorry, Mr. Parker,” a high pitched voice with a lyrical accent said. Pauleen, was it? “You still very sick. Please must stay.”
“You can’t make me,” he said.
I rounded the corner to see a shriveled old man waving a thick wooden cane at a pair of nurses. I recognized him as Cade Parker, hospitalized for pneumonia and sepsis. Blood dripped out of his arm where he’d torn out an IV line.
Cade saw me too, and his face brightened with recognition. “Doc, you’ve gotta get me outta here.” He staggered forward and had to catch himself with the cane. A moment later he was back in an aggressive pose, panting with exertion and trying to wield the cane as a sword.
I edged toward him, staying just out of reach of his makeshift weapon. “Mr. Parker, listen to Pauleen. You’re in no shape to leave the hospital.”
“This hospital’s haunted, and I ain’t staying.”
Clearly the poor man was delirious.
“They’re in the walls,” he continued. “They’re under our feet!”
I turned to Pauleen. “Get me 2 milligrams of Ativan. Now.”
“Make that half a milligram,” Dr. Shaw corrected. “He’s frail.” I hadn’t even noticed she was here.
Cade’s eyes widened and he waved his cane side to side. “No! You have to …” He gasped for breath, puffing out both cheeks like some wizened fish. “You have to believe me. Ghosts everywhere!”
“Don’t worry, sir,” Dr. Shaw said. “We’ll make you feel better.” She grabbed the end of his cane. Cade flailed wildly and stumbled sideways. I managed to catch him before he fell and added a hip fracture to his problems. He struggled and babbled but lacked the strength to resist. Together we helped him to his bed. Pauleen brought the Ativan. Minutes later the old man was sound asleep.
“Good morning, Lily,” I said as I pushed through the curtains at Lily Walters’ door.
“Morning, Doc,” she said in her usual rasp. “Notice anything new?”
I surveyed the telemetry numbers next to her bed, then looked at her. Lily was frail as always, her hair sparse and white, and her skin like crinkled parchment paper. Still, she seemed to breathe easier than usual. “You look good, Lily. Are your lungs finally better?” I leaned down with stethoscope in hand.
“I think so, but that’s not what I meant.” She paused long enough for me to listen to her lungs, which were far better than before. Then she pointed toward the end of the windowsill. Three short pine-green candles burned on a dark wooden altar crowned with ornate turquoise inlay.
I stared, embarrassed that I hadn’t noticed earlier. Surely the open flame violated of all sorts of regulations. I considered asking her to put out the candles, but she looked so proud of them. They seemed small enough and far from any oxygen lines, so I just said “They’re pretty.”
“They’re my brother’s,” she replied.
“Oh, did he come by to visit?” I couldn’t recall ever seeing visitors in Lily’s room, and she’d been in the hospital since before I started. A familiar face would do her a lot of good.
“Not yet, but I hope he will. Evan was a doctor, you know.”
I nodded. “Well, I’d love to meet him when he drops by.”
“I’m sure he’d love to meet you, too. Don’t work too hard, okay?”
“Sure, see you later.”
I rifled through the stack of lab values and test results that I’d just printed out, going over nine patients’ worth of data. I only wished I knew enough to come up with a plan for all of them.
Dr. Shaw picked up her own sheaf of paper. She glanced around our team room at me, social worker Stefanie, and pharmacist Thom. “I feel like walking rounds today. Everyone ready for a stroll around the wards?”
I stood up enthusiastically. “Heck, yeah.” Sit-down rounds were too abstract for me, an exercise in pontification. Walking the floor and seeing patients face-to-face made far more sense—even if it did take longer.
Dr. Shaw smiled at me, but then turned aside with a concerned expression. “Stefanie. Is something bothering you?”
Stefanie’s fingers drummed on the table. “Yeah. You heard about Cade Parker, right?”
Dr. Shaw nodded in my direction. “Dr. Saltare and I had to restrain him this morning. He was delirious, hallucinating about ghosts.”
Stefanie grimaced. “Problem is, he’s not the only one. I’ve heard more loony tales of evil spirits, voices, and faces in six months here than ten years at the old Wishard. Rumor is the place is haunted, and the patients are starting to believe it.”
Thom laughed. “Just the patients? What about the social workers?”
I held back a smirk. Did people in the Midwest really believe in such nonsense? “A brand new hospital and it’s already haunted?” I asked. “That’s just silly. Everyone knows ghosts prefer mental hospitals.”
An uncomfortable pause hung in the air. Stefanie and Thom gaped at me as if I’d said something intolerably stupid. I shrugged, wondering what was going on.
“You don’t know?” Dr. Shaw asked
“The ground we’re sitting on was a mental hospital for many decades,” Stefanie explained. “LaRue Carter Memorial Hospital. I worked there in the early nineties, before they moved it to its present site. Many of our patients may have had friends or family institutionalized here. So there’s a reason for their superstition.”
I snorted. “What are we supposed to do about it? Remind our patients that you can’t hit a ghost with a cane? I don’t see the Ghostbusters on our phone list.”
Thom chuckled, but Stefanie looked annoyed. “I just wanted you to know that a lot of people are spooked,” she said. “Cade Parker isn’t the only one acting irrationally.”
Dr. Shaw stood up and gestured to the door. “That’s enough. Let’s get to work.”
As we passed by the room where Bobby Randall died, I couldn’t help but think of the doctor I’d glimpsed in the mirror. Surely he was just some surgeon or radiologist working at night. I might have been tired, but not tired enough to see ghosts.
My fingers tapped on the desk instead of the keyboard, and the admit note came no closer to completion. As I pondered over what to write, an ugly chorus of chimes shattered my train of thought. I snatched my pager out of its holster and squinted at its little glowing screen. The number was all too familiar. I dialed the 6 North nurses station almost by reflex.
“This is Dr. Saltare. I was paged?”
“Doc, you better’d come quick.” It took me a second to recognize nurse Dennis. His voice didn’t quite sound right. “Pauleen is in Lily Walters’ room and …”
“How bad is her breathing?” Lily’s fluid status had been precarious for days. Too little fluid and her kidneys would shut down, too much and her lungs could drown. We’d ordered a fluid bolus during rounds. Maybe it’d been too much for her to handle.
“Her breathing is fine, Doc.” Shrill female voices echoed in the background of Dennis’s call. “Judging by the all the commotion, Lily’s feeling a lot stronger. You might wanna hightail it up before we have to call a Code Orange.”
“I’m on my way.” I’d never thought that being a doctor would involve wrestling senior citizens. At least not this often.
Two flights of stairs and a hallway later, I heard their voices. Pauleen’s musical accent clashed against Lily’s grumbling baritone. Dennis accompanied me into Lily’s room. Pauleen and Lily glared at each other across the bed, and neither acknowledged our entry.
Lily’s normally pale cheeks were bright crimson. She waggled a finger and half-wheezed, half-yelled. “Get out! I want a different nurse! This is my room! You …”
Pauleen talked over her. “You are crazy. It’s not allowed.” She shoved a handful of forest-green candles under my face. “This woman was lighting fires. She could burn down the hospital.”
“No,” Lily said. “The lights are for Evan. He just wants to help. Why won’t you let him?”
“La Muerte Evan,” Pauleen screamed. “You would summon the dead. You can’t trust ghost talk!”
I gave Pauleen a stern glare and raised my voice. “There’s no need to be unprofessional. We can dispose of the candles, and that’s it.”
Then I turned to face Lily and my mind reeled. At first my eyes refused to comprehend what I saw. Lily’s face had been replaced by a mirror image of my own, only it seemed to glow with a faint white light. The rest of her body appeared as dull and emaciated as before. The lips of that ghostly face—my lips—began to move, but failed to make a sound. This couldn’t be happening. Surely it was some trick of the light. I rubbed my eyes and looked again. Still my visage stared back at me.
I turned to Pauleen and Dennis. The wild fear in their eyes told me that they saw it too. A burst of white light drew my gaze back to Lily. The apparition floated above her now, its face and white coat identical to my own. It drifted to the turquoise-rimmed altar, and its fingers swept over the hollow where the candles had been.
A sudden wave of despair overtook me. Tears ran from my eyes, but when I reached to wipe my cheeks they were dry. What have I done, and what was the point? Years of training and I couldn’t even save Bobby Randall. I looked up at the wraith and found that I could not look away from his eyes. The eyes were so much like my own, but so sad. I knew then that I had killed him. I’d killed Lily, I’d killed them all, every patient in this hospital, and I deserved only death.
The ghost floated onto the windowsill and extended an arm through the window, into the utter blackness of night. An invitation, the sweet, sweet release of a six-story fall. Just a few steps! No! What am I doing? It didn’t matter. Regret was all that mattered. An arm reached out to restrain me but I shoved it aside with ease, advancing toward the window. If only I’d been a better physician this wouldn’t have been necessary. The night sky called to me.
Then the flames appeared, dancing in red and orange and yellow. A thunderclap rumbled through my ears and suddenly my thoughts were my own again. “What …” My voice came out in a dry rasp.
Pauleen extended an arm to help me up. “La Muerte had you, Doctor.”
I blinked. Three candles blazed away on the altar. “Thanks.”
“I’m so sorry,” Lily sobbed. “Evan didn’t mean to hurt you. He was so much like you, until …”
“Evan killed himself.” I knew. “Right here, in the old hospital, not this new one.” I could still feel his presence, but there was no sign of Evan in the room. Not even in the mirror.
Dennis pointed to my right. “He went into that wall.”
“Then we have to follow him.” I wasn’t sure why, but I knew that we had to.
Pauleen scampered to block my way. “Doctor, you can’t! He almost killed you!”
“No.” I couldn’t explain my confidence, but I squeezed past Pauleen and out the door. Evan was trying to help, he just wasn’t very good at it. It didn’t take long to find him. A quivering light emanated from Room 6251—Cade Parker’s room. The poor man was telling us the truth all along. I felt sorry for having sedated him.
I crept through the curtains and saw Evan, translucent and kneeling at the far side of Mr. Parker’s bed. The ghost was no longer my twin. Instead he was smaller in frame, narrower in face, and with straight hair instead of my curls. I glanced backward to see if Dennis or Pauleen had followed me in, but I already knew they hadn’t.
“Evan,” I said, addressing him by name, “I know you weren’t trying to hurt me.”
The ghost looked back, tears of despair glittering in his tormented eyes.
I joined him at the bedside. “Lily says you want to help. I believe your sister.”
Evan screamed without a sound, yet the venom of his emotions echoed through my skull. I can’t help because you can’t help, he said. You’re not a real doctor. You don’t deserve your patients’ trust. You don’t even care about your patients.
“You’re wrong, Evan.” I glanced down at Cade Parker’s immobile form. He was curled up on his side, his face scrunched up, breath coming in shallow gasps. Something about his posture was profoundly wrong. Had the ghost harmed Cade as well?
I pulled out my stethoscope to listen to Cade’s chest. His breathing was rapid and ineffective, his heartbeat slow and irregular. Shit! Was he oversedated? That would be my fault, not Evan’s. I rubbed his shoulder in an attempt to wake him. “Mr. Parker,” I called. “Cade. Can you hear me?” He didn’t budge. I gave him a rough shove. “Cade, wake up!” Neither Cade nor Evan moved.
“He’s unresponsive,” I said loud enough for Dennis and Pauleen to hear. No sign of either nurse. Were they still so scared of Evan? I turned back toward Cade and took out a penlight to examine his eyes. His right eye was hugely dilated and unresponsive to light. My heart dropped in dismay as I realized why his arms and legs looked so wrong. His entire left side was spastic and posturing, a sign of a massive stroke. The monitor showed a pulse ox of 92%, so at least his airway was holding up. For now.
I sprinted to the nurses’ station. “Dennis! Pauleen! Mr. Parker’s unresponsive. He’s got a blown pupil on the right and spastic paresis on the left. Keep an eye on his vitals while I call Dr. Shaw and Neurology.” As I picked up the phone I saw Evan drift in front of me, floating through the air as before.
Evan smiled with pride and fulfillment, glowing brighter than the full moon outside. A moment later he was gone.
“That was a damn good catch, Joey.” Dr. Shaw beamed like a proud mother. “Mr. Parker could have died if not for you. What possessed you to do neuro checks in the middle of the night?”
“I don’t know.” A memory danced beneath my consciousness, but I couldn’t quite tell what it was. “A hunch, maybe?”
“That’s one hell of a hunch. And you’re one hell of a doctor.”
“Two hells,” I said. Two hells? Where did I come up with that?
Dr. Shaw gave me a knowing grin, as if I’d just explained everything. I sighed. Why was everyone so mysterious around here? Must be a Hoosier thing. Oddly enough it didn’t bother me. Even in a strange hospital in a strange town, somehow I felt at home.
David S. Chang is a physician and Indianapolis native who thinks that medical residency is stressful enough without ghosts.