Before She Sleeps

by Bina Shah

  Julien

  As he walked into the hospital, Julien Asfour tripped on the same crack in the floor he’d been complaining about since he first started work at Shifana Hospital six months ago.

  His toe caught well and truly in the crack, he lost his balance, and he landed on the floor on his hands and knees with a sickening thump. A current of pain shot all the way up his wrists. A violent blush galloped from his ears and chin to his cheeks and forehead. Two nurses standing nearby hid their grins, then hastily looked the other way as he got up with a grunt and dusted off his hands, grimacing. His knees would be beautifully bruised tomorrow.

  The youngest doctor appointed to the best hospital in Green City, Julien was mindful of his reputation as a medical prodigy: he had graduated first in his class, winning a gold medal for pioneering a cancer treatment that sent medication through nanopores right into the lung cells. He couldn’t afford to show any sign of personal weakness, or vulnerability. He was being watched by his superiors, by his professors, by his former classmates. Maybe the Leaders, quick to reward exceptional performance, might keep an eye out for his progress. If he did well, who knows where he could end up in five or ten years’ time?

  His name was Asfour, the ancient Arabic word for finch, the most ordinary of birds. Finches were not showy, they didn’t sing like the nightingale or distinguish themselves with honor as birds of prey. They were Green City’s most popular pets, one or two in almost every home, living in cages for most people’s amusement. Julien had always identified with the tiny creatures, thinking himself ubiquitous and sturdy, nothing out of the ordinary.

  As he dusted himself off, making a note to warn Maintenance for not yet repairing the broken tile, a nurse came running up to him.

  Julien waved the nurse away. “I’m fine, I’m fine.” Then he saw the worry twisting the man’s face like crumpled paper. “What is it?”

  “Dr. Julien. There’s an emergency! I can’t find any of the senior physicians. Dr. Falak is already in surgery and Dr. Seremian’s off today.”

  A few doctors were away on scheduled leave, but a mystery stomach flu had sickened some of their replacements and the hospital was struggling to keep up with the flow of patients. Julien’s shift wasn’t due to start until the afternoon, but he thought he might make himself useful in the meantime.

  He frowned. “Has Dr. Bouthain been informed?”

  “Bouthain’s at a conference. I didn’t know who else to go to.” The nurse was already a few steps ahead of him, urging him onward. But why was he signaling Julien away from the main emergency hall and down a corridor that few people used at this time in the day?

  Julien sprinted ahead of the nurse, turned the corner and nearly knocked into the young woman lying face down on a gurney, unconscious and unveiled. Her face, turned to the side, was clammy and pale, her breathing shallow. There were streaks of gold dust on her cheeks and arms.

  Julien stopped short, staggered by the sheer impossibility of such a sight. “What the hell … who is this?”

  “I don’t know,” stammered the nurse. “Someone left her outside the hospital, just dumped her on the ground and drove off. I’ve never seen anything like it, I didn’t know what to do.”

  Julien tuned out the nurse’s babbling as he bent forward to help the young woman. It was second nature to him, to speak to her and see if she was responsive; to see if her pulse was strong or thready; to find out if her airways were obstructed. He was forming a list of possible diagnoses—brain bleed, overdose, electrocution—before he touched her skin to lift her chin and observe the rise and fall of her chest. When he pulled her eyelids up, her eyes were rolling back in her head, pupils unfocused and unseeing. All this he observed in an instant, before making a choice that would lead to another and another, a tree of choices that could lead to either life or death.

  “Miss? Miss! Miss, can you hear me?” Julien called out. She was unresponsive to his voice, the pulse at her wrist the weak thrum of swallow’s wings underneath his fingertips. The only signs of life: a heavy sweat on her forehead and the whisper of her breath on his cheek when he turned his head to watch her chest.

  Julien ran the body scanner over her from head to toe, and an alarm immediately rang out. As he read the results, his throat tightened: she was suffering from a ruptured ectopic pregnancy, with possible—no, probable—internal bleeding. Her blood pressure had dropped and she was already in shock.

  “What do we do?” said Mañalac, the nurse who had brought him to her. As their fearful eyes met, Julien realized that Mañalac had never dealt with a female patient before. In five years of medical school, Julien had treated only a few women for minor, insignificant problems: a chest infection here, a broken ankle there. Women came to the hospital to give birth, but the students were not allowed to see them or observe their labor until their final year, and that, too, only behind heavy walls of observation glass. Pregnant women were only handled by the most senior doctors. Their heavy stomachs were treated with the reverence assigned to only the most complicated, challenging diseases; the senior doctors fought among themselves for the prestige that came with treating them on a completely different floor of the hospital that was heavily monitored and guarded; regular workers never even laid eyes on those women. Julien had yet to be given the opportunity to start his specialization in women’s care.

  The robots he had used in all his surgery drills were constructed in exactly the same way as the female lying pale and unmoving on the table in front of him. Only the janitor or a training bot would have been more forbidden to help the girl than Julien and Mañalac. But today the surgical department was operating half-staffed, as Mañalac had said. It would be at least fifteen minutes before the proper surgeons could be notified, and by then the girl could die.

  “We have to get her into surgery right now,” said Julien authoritatively, to disguise how badly he was quaking inside.

  “No, Dr. Julien! We can’t.” Mañalac shook his head vehemently. An old hand at Shifana, he was trained to obey the doctors without question; however, he was even more well versed in the repercussions of breaking with hospital protocol. Hospital admissions were entered immediately into the city records; the use of all surgery rooms, drugs, and supplies were recorded, down to the smallest bandage. Putting the first cannula into her hand would set off a cascade of electronic tags that would lead right back to them.

  Julien heard himself saying, “Do you trust me?” This time his voice was strong and sure, coming from a place as yet unsounded inside him.

  Mañalac stiffened, as if insulted by the question. “Of course I do, Dr. Julien.”

  “Then please, help me. I’ll answer for everything.” Could Mañalac see how much Julien’s hands shook? “I’ll handle the system. And don’t worry: I’ll take complete responsibility for everything.” Mañalac had to know he was lying; Julien waited for him to refuse the order. He looked over Mañalac’s shoulder once more, to make it clear that he already considered the girl his patient. He gave Mañalac a moment to realize that Julien would risk everything just to be able to see her open her eyes.

  Mañalac turned and followed his glance to stare at the unconscious girl, unable to beg for her own life. He sighed softly. Julien knew he’d won when the nurse nodded, tapped his device to look for a free theater, then carefully waited for a response. But instead of triumph, all Julien felt was a sudden wave of gratitude—and hope.

  Soon they were wheeling her through back corridors to an outpatient surgery wing in the basement, where all the day’s scheduled procedures had been canceled because of the unexpected shortage of staff. Julien hoped the rest of them would be too overwhelmed to notice what he and his team were up to.

  Two surgery assistants appeared like ghosts in their gray surgical scrubs, the same color as Mañalac’s uniform. The first, Ram, prepped Julien, while the other, George, hooked up Sabine to the monitors and put an oxygen tube into her n
ose. He quickly removed her clothes and wiped her stomach clean with antiseptic, then raised her legs.

  Julien, waiting, glanced around at the intricate machines, the high ceiling, the observation panel—all empty now. How intimidating he’d found it as a medical student during his surgery rotation. Now he was a captain commanding a ship, Mañalac and the two assistants his able seamen, and the ill young woman his passenger. He was determined to bring them all to safe shores. He closed his eyes for a moment and was astonished to find himself asking an unknown force for help, for steady hands, for success. Doctors weren’t their own gods, after all.

  Julien

  Mañalac had been keeping an eye on the cardiac monitor as it tracked her heartbeat and blood pressure. Ram and George pushed IVs into her arms, administering saline in one and keeping the other free for anesthesia. Shock could claim a patient faster than any other malady; they had to stabilize her quickly so that her body could cope with the surgery ahead.

  “I need her blood count, please.” Julien said. “Give me her serum lactate levels, the metabolic panel, type and cross-match, Rh factor, everything. Oh, and be gentle with her. Treat her as if she were your sister,” he added. George’s eyes narrowed quizzically above the surgical mask over his nose. Even Julien was surprised at himself. Something had truly taken him hostage, making him say and do the unthinkable. Was it her femaleness or the fact that he held her life in his hands?

  All Green City citizens had blood taken from their heels at birth, dried and stored on special filter papers. Digital microfluidics could be used to make a quick analysis on the sample, if a citizen was ever in a medical emergency. Julien had been thrilled to learn how all was hidden in that tiny drop of blood, a ruby-red treasure that revealed its secrets only to those who knew how to read its arcane code. And he was one of those few code-breakers to whom drops of blood and strands of DNA and cells and atoms could actually speak.

  Ram quickly took a drop of blood from her finger, put it onto a digital blood chip, and waited thirty seconds for a quick reading. The sample wasn’t matched to an official Green City ID, but it revealed that she was twenty-one, young and strong, never pregnant before. Julien listened as Mañalac rattled off the woman’s blood type, hormone levels, genetic history, previous diseases.

  “Drugs?”

  “There’s something, but I can’t tell right now. We’d need to do more tests. Still, yes, I think she ingested some kind of chemical in the last twenty-four hours.”

  “Any abortifacients?”

  “I don’t think so.”

  “Do you think she’s had a reaction to it? Is that why she collapsed?”

  “Could be, but it’s not anaphylactic.”

  “All right, let’s have twenty units of O positive ready. She’s going to need them soon.”

  George removed the bags of serum from the blood safe, while Mañalac quickly performed more scans. She was roughly five weeks pregnant, but the fetus had implanted itself in the fallopian tube, which was ruptured. An ectopic pregnancy, and now blood was just beginning to pool inside her abdominal cavity. Julien was both vindicated and horrified when he realized that if they didn’t operate now, she’d die.

  Her blood pressure was back up just enough for Julien to start. Mañalac handed Julien the laser scalpel, and they all watched him intently as he readied for the first cut. Their eyes were anxious but trusting. George and Ram held their instruments poised to follow his lead. Mañalac held Sabine’s hand and whispered words of reassurance to her, as if she could hear him, in whatever realm she was in, halfway between life and death. “You’ll be all right, just hold on. Dr. Julien will take care of you. Don’t worry.”

  Julien had already ruled out a laparoscopy; radical surgery was the only option. All his medical texts and lectures in Kolachi came rushing into his mind. Nothing, however, had prepared him for the reality of this woman on the table in front of him, This was not the way he’d imagined a real woman laid out before him for the first time.

  Julien aimed the laser scalpel at the woman’s smooth, pale skin. He was aware, at the far edges of his focus, of the roundness of her belly, the light hairs below her navel. With a delicate touch, almost a lover’s caress, he traced the beam of light down her abdomen, three inches in length. The blood swirled around the incision; Ram quickly suctioned it away.

  Deeper and deeper, past thin layers of tissue, then thicker layers of muscle, until he penetrated the layer that enveloped all the vital organs. A few deft strokes opened up the cavity. While George kept suctioning away the blood, Julien quickly found what he was looking for with the help of the scanner: the internal reproductive organs, uterus, fallopian tubes, and ovaries. “You’ll recognize them because they look like the scales of justice,” his professor had said in the lecture hall, then quipped, “Although there’s no justice as far as a woman is concerned.” They’d laughed then, but Julien remembered his words now and winced. They were operating on her without her consent, without informing her next of kin. Would she wake grateful or violated? He’d had no choice when her life was at stake. He put his thoughts aside and concentrated hard, examining the ovaries. “Small and white, of healthy size and color, they look completely normal—no pathology, no injury here,” he said out loud. “The uterus, too, is healthy pink—that’s very good.”

  “Hypovolemic shock?” said Mañalac.

  “I don’t think so, we’re lucky, but let’s keep an eye on her blood pressure now. If it surges, we might have a bleed, and that’d be a disaster.”

  Next, he had to find the damage. The scanner grew smarter with each procedure, but it had definitely not been programmed to identify this kind of problem in the female body. Julien put the scanner aside and tried to spot the ruptured tube with his naked eyes. He wondered aloud: “Which one? Left or right?”

  Then he spied a small rending apart of tissues, like fine frayed threads, in the lateral wall of the left fallopian tube. He caught his breath: he’d have to widen the space and tease the fetus out, bit by bit. Could he save the tube, rather than removing it completely? He couldn’t stand the idea of making this woman anything less than perfect and whole.

  He used tweezer-thin robotic forceps and clamps to lift the tube up and away from the surrounding organs. The tube came up easily in his grasp, the small curved funnel a place of transition, too narrow to bear the burden of a growing embryo. Normally the fertilized egg would drop into the uterus, ready to catch the small clump and hide it deep within its protective folds. Nature had made a mistake this time, and he would have to work fast to rectify it. At least now the end was in sight.…

  He nudged the tear farther apart. A tiny lump no bigger than the end of his finger slipped out from the tube, accompanied by a fresh spurt of blood. It had not yet assumed the curled shape of a fetus, with rudimentary hands and feet, dark spots for eyes, a small hump where the brain was growing larger than the rest of the body. But it still was the earliest stages of a living being, and its miniature size threw them all off balance.

  “My god,” breathed Ram.

  “God has nothing to do with this,” said Mañalac testily.

  “Oh my god,” echoed George, provoking another glare from Mañalac.

  “Quiet, please.” Julien kept his gaze steady on the tube. As soon as the entire sac was out, he judged that the tube couldn’t be saved after all. The rupture was too extensive, damaging too much of the tube, as well as the artery that supplied it with blood. He quickly removed what was the rest of the fallopian tube, incising and cauterizing once again, precisely and efficiently.

  “Well done, Dr. Julien,” said Ram, when it was finally over.

  “What are her vitals now?” he murmured, listening to George rattle them off. But Julien felt little joy at the success of the operation. He’d ignored all the rules of the hospital, as well as the Perpetuation Bureau’s directives on the immediate reporting of endangered pregnancies. The a
drenaline was fading away, leaving him afraid once more. He had succeeded as a doctor in Green City by obeying the rules so far. In a single morning this woman had made him break every rule in the book.

  “Thank you, good work. Clean her up, please. Let’s get her … Ram, can you check the rooms, please?”

  “You’re going to put her in a room?” said Mañalac.

  “I’ll have to talk to Dr. Bouthain, figure out how to enter her into the system,” Julien hedged. The clarity he’d known during the surgery was fading fast. He should have reported her presence, the emergency, to the Bureau immediately. Why hadn’t he done that? Surely they’d understand that he’d acted as a doctor; saving a life first, filing the necessary reports later.

  George and Ram were bustling around the table, unhooking the woman from the oxygen and anesthesia lines, settling her limbs and cleaning her up. Soft beeps from the machines punctuated the distant, tinny voices on the announcement system that signaled the end of the early morning shift and the beginning of the next one. Julien would have to return to work soon.

  Mañalac bent his head to his device, pressing buttons again and again and shaking his head. The device chirped. Mañalac read the new information and whistled. “Dr. Julien, look at this!”