The 4-North nursing station was deserted, an eerie silence permeating the ward. Slouching in a battered rolling chair, I dialed intensive care. I drummed my fingers on the table as the computer strained to load the hospital’s outdated medical record system.

The line connected after three rings. “Dr. Bhargava, ICU,” a man said in a hurry.

“Dan Briggs, surgery resident, returning a page,” I replied, sitting up.

“Yeah, I paged about Mitchell in bed six.”

“Mitchell, the consult?” I asked. “Sorry, I was heading to ortho clinic. Dr. Larsson’s on call and said he’d evaluate the patient.” I retrieved the ICU roster and began to pull up the patient’s record.

“Yeah, he did. That’s why I’m calling you.”

I sighed. “What do you mean?” I took a sip from a can of diet orange soda. It was warm with a cloying aftertaste, and I tossed the can into a nearby trash bin in disgust.

“Mitchell’s status post car wreck about a week and a half ago. Akers did a craniectomy for a massive head bleed, but he’s still intubated and has an NG tube, and is very slow to wake up.”

“So, he needs a trach and a PEG.”

“Yeah. Can you talk to your attending?”

“Dr. Larsson?”

Dr. Bhargava coughed. “Ahem.”

“You mean anyone other than Dr. Larsson.” I pursed my lips.

“Well, yeah,” Dr. Bhargava replied. “It doesn’t matter if it’s Jones, Lehman, or someone else. Anyone who can still hold a damn scalpel without falling asleep.”

I shook my head. Only one more week on this rotation.

“Look, I know all you residents are in a tough spot. Frankly, we all are.” The intensivist’s voice softened. “But we can’t waste more time and resources transferring yet another patient to the U for simple surgery. Just do what you can. Thanks.” He hung up.

I rolled my eyes. On the monitor was Dr. Larsson’s note, which as usual was poorly written and contained multiple typos. They were also the same recommendations he always gave for every patient regardless of the cause of injury or illness:

48y wtih head trma Cant talk eat.

Rec cbc cmp, bleed time, abg, cxr, us abd pelvis, fecal ocult bloo

When I’d first asked the lab technician about “bleeding time” at the start of my rotation, he said, “Everyone knows Dr. Larsson means PT/PTT.” Since Dr. Larsson didn’t know how to enter a computerized order, he would just give verbal orders to the nearest nurse, who would simply smile and nod. The ICU always completed necessary lab studies long before Dr. Larsson was ever called, so whatever he asked for was either excessive or redundant.

There was also no recommendation in the note about doing surgery. Again. I’ll be damned if I have to sit through another root cause analysis just because he forgot to establish an appropriate treatment plan.

I logged off the computer and headed to the nearest stairwell. Downstairs on the second floor, the hallway that greeted me was dimly lit and as empty as 4-North. A musty, mothball-like odor lingered in the air. The door closed behind me with a heavy clunk, the sound echoing off the peeling gray-green walls.

Twenty large oil portraits of past prominent physicians on staff were suspended on these walls. The canvas directly facing me was that of Dr. Larsson himself, from years past. He cut a formidable figure, wearing a neatly pressed dark gray suit with red bow tie and pocket kerchief, icy blue eyes like a pair of piercing cold scalpels. The words “Jacob O. Larsson, M.D., F.A.C.S. Associate Chief of Staff, Chair of Surgery 1976-1994” were engraved in elegant cursive script on a bronzed plaque bolted onto the bottom edge of the cherrywood frame.

Interspersed between the portraits were several small, faded black-and-white and color photographs, placed under protective glass panes and accompanied by descriptive laminated placards. One picture displayed an endless row of occupied beds lining a long, sunlit hallway, a sanatorium for tuberculosis patients. Others showed vast stretches of fallow fields dotted with squat, blocky stone buildings; grim-faced polio survivors inside iron lungs; clusters of patients in wheelchairs resting under leafy trees; a line of children in dental chairs, accompanied by a man wearing a head mirror and holding a tray of tonsillectomy equipment; and a white-haired doctor injecting a vaccine into the arm of a nervous-looking young girl.

I approached the frosted ICU double doors and they whirred open. Two weeks ago, I had pleaded with the per diem Dr. Jones to take Dr. Larsson’s appendicitis consult, so maybe I’d get lucky again and find him lunching in the lounge.

A few feet behind the entryway stood Dr. Larsson, stooped over his ever-present aluminum front-wheel walker, glassy-eyed and mouth slightly agape as if he’d just awakened from a nap. Over his white dress shirt and light blue, loosely done bowtie, the collar of his wrinkled lab coat was haphazardly folded on itself. A stethoscope dangled out of one pocket, the earpieces hanging perilously close to the cracked vinyl flooring.

Dr. Larsson began trundling toward me. As he drew closer, a drop of water fell from the ceiling, splashing over his brow. He shook his head and tried to maneuver his walker around a yellow “Caution Wet Floor” sign by his feet, but knocked it over into a puddle instead.

I retrieved the wet sign and propped it in place. Looking up, I saw a large, brownish water stain, creeping like an amoeba around a flickering fluorescent light. One of the discolored ceiling panels sagged with moisture, threatening to collapse. Another droplet landed with a soft plop on the floor.

Dr. Larsson followed my gaze before squinting at me from behind thick-lensed glasses and mumbling “Hello.” He shuffled past me, his walker clacking rhythmically, and eventually disappeared down the hall.

Someone should tell him…someone had to tell him.

Gordon Sun is a surgeon and telehealth expert exploring how healthcare and technology interact, in both realistic and speculative realms. His stories have appeared or are forthcoming in Penumbric Speculative Fiction Magazine, Mad Scientist Journal, Westwind, Ars Medica, and other publications.

Photo by Oscar Sutton on Unsplash