a shadow in the dark

by P.X. Vayalumkal

I don’t know why I’m here.

The paper sheet crinkles as I sit up on the stretcher. There is a pale blue, checkered curtain, half-way open at the end of the cubicle. Behind it, I can see nurses rushing back and forth, a secretary at a desk taking phone calls. There are alarms beeping all around me and people being ushered from place to place – some with belly aches, some with bruises on their faces, others with casts on their limbs.

I don’t know why I’m here.

I feel fine. I scan my body and everything feels good - not a pain or an itch or a rash that I can see.

In walks a man about my age, no, maybe younger, early to mid-40s. His hair is black apart from the tufts of grey on his temples. He’s got a stethoscope around his neck, wearing wrinkled, blue scrubs.

“Hello sir,” he says. Quite formal. “I’m Dr. Samson Joseph, one the ER doctors.” At least, he introduces himself. That’s nice. “Your chart says you’re having chest pain?”

“Chest pain? No doc, I feel fine.”

“You’re not having chest pain?”

“Nope.”

“Did you have chest pain earlier?”

“Nope.”

“You are Mr. George, right? Forty-nine years old, Chacko George?”

“Yup, that’s me.” It’s been my name since the day I was born. Chacko was my grandfather’s name too. He was born in Changanasserry, Kerala, India. First place in the world to have a democratically elected Communist government. First state in India to have 100% literacy. I, on the other hand, was born in Hamilton, Ontario, Canada. First place where a long distance phone call was made by Alexander Graham Bell and the first city to have a Tim Horton’s. My grandfather told me to take reading seriously and I did. That’s why I became an English teacher.

The man in the wrinkled, blue scrubs takes a hold of my wrist to check my identification band, and is confused as to what he’s read. “No chest pain?”

“None.”

“Then why are you here?”

“I don’t know why I’m here.”

“Do you know where you are?”         

“This is the ER.”

“And do you know what year it is?”

“It’s 2025.”

“And the month?”

“It’s January.”

“The date?”

“Can’t forget that. It’s January 23rd.”

He asks me again if I’m having chest pain and I tell him no again.

“Sir, the nurse has written in the triage note that you came by ambulance because you were having chest pain at home? Do you remember that?”

“Ambulance? Not me.”

“Have you taken any alcohol or drugs today?”

“Drugs?” Me? My left eyebrow rises. Who does he think I am?      

I’m Chacko George, son of Mathew and Bina George. I’ve been teaching high school English for twenty-five years now. This semester I’m teaching my grade nine students The Book Thief by Marcus Zusak. Many of them are not familiar with the narrator, Death, but, as he forewarns in the opening, “You will know me well enough and soon enough.”

“You have no recollection of how you got here?” he asks again.

“No.”

He seems irritated. I guess if I were in his shoes, I would be too – a waiting room full of sick patients and he’s trying to figure out, just like I am, why I’m here when I feel fine.

“Can I go home?” I ask. “I need to get home.”

At first, he looks at me like he wants to say yes, but then reconsiders.

“Who do you live with at home?” he asks.

“My wife. I do really need to get home to her.” We’ve been married for twenty-two years. I’ve known Molly since she was in nursing school. At first, she didn’t seem too interested in me. It only took a love poem or two. Actually, I wrote her sonnets, like the one Shakespeare used to write in iambic pentameter, the rhythm of the heart. I guess it worked. Strange that she’s not here now though. She really shouldn’t be alone today.

“I’m going to call your wife at home. Is that ok?”    

“Be my guest,” I tell him.

He turns and leaves the room, leaving the curtain open again. I can hear a lady groaning in the cubicle beside me. A toddler is coughing up a storm in another room. Maybe I should just get up and leave.

Maybe I should come back with a tool box. The medical instruments on the wall are crooked, sitting at a forty-five degree angle. The overhead light has wires visible from the handle. The paint on the wall is chipped and stained, with who knows what kinds of bodily fluids. And then there’s that beeping. What’s with all the beeping?

A man in wrinkled, blue scrubs pulls back the curtain and walks in.

“Hi, Mr. George. I just spoke with your wife on the phone.”

“And you are?” I ask. He doesn’t even have the courtesy to introduce himself.

“I’m Dr. Joseph. I was speaking with you just a few minutes ago.”

“Do you know why I’m here?” I ask. He looks at me with his head tilted at the same

angle as the instruments on the wall.

“Your wife said you were in the washroom, about to take a shower, when you began screaming because of chest pain. You looked pale and sweaty, so she called the paramedics. You don’t remember any of that?”

“No, doc, I feel fine.”

He tells me this is most peculiar. I’d say so. Why am I in the ER if I feel fine?

“What do you do for work? You’re not exposed to any hazardous chemicals or fumes, are you?”

“I teach high school English, so no - unless you consider the body odour of teenagers after gym class hazardous fumes.” The grade ten class comes in after phys. ed. and the smell can be atrocious. This semester they’re reading Tuesdays with Morrie. Funny how it takes a dying man to teach us about living, right? Really, it should be on every high school’s syllabus. Morrie said we never forget those who have died if we remember the feeling of love we had for them. That’s how I felt when my grandfather died. He dropped suddenly one day while we were visiting Changanasserry. He had severe leg pain and fell to the floor in a cold sweat.

I remember going to his side and he just looked up at the crucifix hanging on the wall and said, “The cross is my strength. My strength is in the cross.” Then he turned to me and said, “Monay,” calling me son, “Death is not extinguishing the light; it is only putting out the lamp because the dawn has come.” He said that to me right before he died, with a stillness and calm like a lake at sunrise. Can you imagine? It was only a decade later when I was in graduate school that I realized he was quoting Rabindranath Tagore, the great Indian poet and Nobel Prize winner. The doctors said my grandfather must have died from a heart attack, but how did that explain his leg pain?

The man with the wrinkled, blue scrubs asks if he can examine me and I nod yes. He starts checking my head and neck, listening to my heart. He checks my pulse on one wrist and then the other. He makes me raise my eyebrows, squeeze his hands, lift my legs up and down, walk and then sit. He shines a light in one eye then the other. I look left and then right, up then down.

“Everything seems normal,” he says, scratching his neck.

“I think I’ll go home then.”

“Mr. George,” he says, “I’m a bit concerned. On the one hand, you feel fine. On the other hand, your wife was worried enough about your chest pain that she called 911 and you can’t remember any of that. You can’t even remember me from a few minutes ago.”

“Where is my wife? I do need to get home to her.”

“She’s on her way. In the meantime, I want to get some blood work and a CT scan of your head.”

“A CT?”

“Yes. Hopefully, that will give us some answers. They call it the donut of truth.”

Truth? Albert Camus once said that fiction is the lie through which we tell the truth. My grade eleven students are studying Camus through his book, The Stranger. My father would always quote that line about a man who lived only one day could easily live for a hundred years in prison; his memories from one real day of living would keep him from getting bored. I miss my father. He died just before I met Molly. He had a gallbladder attack with pain from his front to his back. He went for an ultrasound in the same ER I’m sitting in now. I was with him in the ultrasound room. He died right there in front of me. I saw the tech’s face after they stopped CPR and I told her it wasn’t her fault. I’m not sure she believed me.

“Have a seat in this area,” the man in the wrinkled, blue scrubs says. “We’ll talk again when I get all of your results.”

I take a seat in a room full of patients, some attached to IV poles, some retching into clear plastics bags with paper funnels on top. There is beeping all around me, as nurses zip here and there, when one finally punches some buttons on a machine and the beeping stops. Only a nurse, it seems, has this magical power. I lean my elbow on the arm rest, and fall asleep with my head in my hand.

I wake with Molly calling my name.

“Thank goodness I found you,” she says. “I had to park all the way on the far side of the parking lot. How are you feeling?”

“I feel fine.” I look around and see nurses, and IV poles and patients retching into clear plastic bags with paper funnels on top. “Let’s get out of here. We should really get home today.” I don’t know why I’m here.

“Mr. and Mrs. George?” It’s a guy with a stethoscope and wrinkled, blue scrubs. “Can you come this way with me?” he says. Molly seems to trust him, so I follow. He leads us to a small cubicle and pulls the curtain. “I’ve reviewed all your test results. Your CT scan looks fine. Your ECG is normal, but your bloodwork shows a mild elevation in your cardiac enzyme.” When did I do a CT scan? Bloodwork? I look down at my arm and there’s an IV cannula with a dressing over top of it. Who put that there?

“The level isn’t high enough to definitely say you’ve had a heart attack, but it’s high enough that we need to repeat your blood work in a few hours to see if it’s rising.”

“Are you the doctor?” I ask him.

“Mr. George, you seem to be having a problem remembering things. I saw you earlier today. You told me you don’t remember why you came here or coming in the ambulance. I’m not sure why yet. I’m going to have the nurses move you to a monitored bed.”

“But I feel fine,” I say. “I think I’d like to go home. We need to be home now.”

“Chacko, just listen to him,” my wife says. “Doctor, something’s not right. Are you sure it’s not a stroke?”

“His scan his normal and his neurological exam is normal…”

“Apart from his memory,” she interjects.

“Apart from his memory,” he concedes. What’s wrong with my memory? I remember the day when my only child, James, was born - January 23rd, 2015. Today’s his birthday. He was six pounds and seven ounces, nineteen inches long. I noticed a dimple on his right cheek when he would reflexively smile and a small circular birthmark on his left ankle. He had a so much hair, it covered the top of his ears.

Just then, the nurses move me to a stretcher where they connect a bunch of wires to my chest and wrap a blood pressure cuff around my arm. Every few minutes when it squeezes, my hand goes numb and turns red.

Then it starts - an ache between my left ribs. It’s fleeting, just mild. It comes a bit stronger, and then it’s gone again. I tell Molly. She calls a nurse.

The nurse presses a button on the monitor and I feel the cuff inflate again.

“Call Dr. Joseph,” she says to one of her colleagues. “His blood pressure is low.”

“I feel fine,” I tell her. The pain has resolved.

A man in wrinkled, blue scrubs with a stethoscope around his neck appears at my bedside. He looks familiar. He doesn’t bother to introduce himself. So rude.

He asks if I’m having pain and I tell him no. He asks if I was having pain before and I said it was there, but now it’s gone.

“The nurse called me because your blood pressure is low.”

“Actually, I feel pretty good now.”

He spreads his hands across his forehead and begins rubbing his temples.

“Mrs. George,” he says to my wife, “I’m worried about your husband, but I don’t know how to put his symptoms together in a way that makes any sense. When I get this feeling, it makes me consider only a few diagnoses. We’ll send him for another kind of CT scan and we’ll talk soon.”

Within minutes, the nurse whisks me back to a room with a machine that looks like a donut. I have never seen anything like it before. The tech tells me a few things and I am connected to the IV and feel a warmth throughout my body. There is whirring and buzzing all around me.

“Hold your breath,” I hear the tech’s voice say and then there is some beeping. “Breathe,” the tech says again.

Once the scan is done, the nurse and tech move me back to a stretcher and then back to the ER. The nurse connects me to the monitor. She checks my blood pressure again. All normal.

I fall asleep.

When I awake, I am grimacing in pain.

“What is it?” Molly is at my bedside. When did she arrive?

“My ribs hurt,” I say holding the mid part of my back on the left. It’s a searing pain and just as quickly as it came, it’s gone.

Molly calls the nurse, who looks at the monitor, reassures my wife and then walks out, as a man with a stethoscope and wrinkled, blue scrubs walks in. He makes a few clicks on a computer terminal and turns the monitor towards me. I see some pictures in black and white.

“Mr. George, this is your CT scan.” I had a CT scan? “This is your aorta,” he says. All I can see is a tube shaped like a cane, but there are stripes going down its length, so it looks like a candy cane.

“Those stripes shouldn’t be there,” he says. He goes on to say how this is a serious problem, a life-threatening problem.

“I don’t know what you’re talking about. I feel fine. It’s January 23rd. We need to get home,” I tell him.

“You need emergency surgery. This is causing your pain and I believe your memory problems too.”

Surgery? Who is this guy? Who would operate on a man who feels completely fine? What’s wrong with my memory? It’s January 23rd. The day my son was born ten years ago. I won’t ever forget that day.

It’s the day he died.

Cause unknown.

In the delivery suite.

In this hospital.

 Death extinguished his light, and it didn’t feel like the dawn. Morrie would say death changes a relationship, it doesn’t end it - but it felt like the end for us. It felt like the end when my grandfather died. It felt like the end when my father died too.

That day, Molly and I entered a long, almost never-ending darkness. It felt like searching for a light switch in a room where none exists, then realizing there’s a string hanging from a light bulb that you have to pull and when you finally pull it and hear a click, nothing happens. It takes time for your eyes to adjust until you see a shadow in the dark and realize somewhere, beyond where you are, light still exists.

I pull off the monitors and disconnect the IV. We need to get home to remember my son, to remember James. Each year we light a candle and pray. We look at the few photos we have of him, so he is never forgotten. I unwrap the cuff around my arm and stand up. Time for me to leave this place of sickness and death, of torment and suffering. Why is Molly crying? I tell her I feel fine and we need to get out of here. I grab my things and start walking down the hall. The pain in my side returns. My legs feel weak and my vision is blurry now. Everything goes black.

I wake up. There is beeping all around me. It’s a big room, with three or four IV bags surrounding my bed, with IV lines connected to my neck and arms. There is a large dressing over my chest. Molly is praying beside me. I can hear her whispering, repeating, “The cross is my strength. My strength is in the cross.” A sign outside the room reads ‘ICU.’

Molly tells me a story about chest pain. I don’t remember that. I can remember my grandfather, my father, and my son. She says I’m lucky to be alive because of a man with a stethoscope and wrinkled, blue scrubs, a nurse, and a CT scan, but all are forgotten.

The light of dawn breaks through the window. It must be January 24th.

I don’t know why I’m here.

But I will.

P.X. Vayalumkal

BIO: P.X. Vayalumkal is an ER physician and that lives with his wife and children north of Toronto. He is currently an Assistant Clinical Professor in the School of Medicine at Toronto Metropolitan University. His short story, “The Slate,” will be published in Intima Journal on November 1st.