The syringe felt like a brick in my hoof. Its heaviness caused my hoof to shake. I never had a problem with it before. I’ve pushed millions of them, but they have never felt like this. Was it just fatigue or the situation?
That room was empty except for me and the patient. It was quiet. The only sound was the hum of the monitor and the hiss of the oxygen. My breath was louder than them both. My heart was beating so fast and loud I couldn’t concentrate. Why was the syringe so heavy?
I, of course, knew why. The weight of the drugs weren’t the issue. It was me. I was trying to save this patient. I knew she wouldn’t make it if I didn’t do this. I knew she needed it. That didn’t make it any easier. It was the hardest thing I ever had to do.
The syringe held 5 units of vasopressin. Which was fine if the patient had low blood pressure from shock or some other cause. But the patient didn’t. She wasn’t septic or having a diabetic issue. She had an intracranial hemorrhage. Her brain was actively bleeding. And vasopressin would make her worse.
Her blood pressure would increase, causing the brain to swell. She might be paralyzed temporarily or fall into a coma. But it could save her life. I was sure it would. I just had to make her a little worse first.
I wouldn’t have had to if the doctor wasn’t so unreasonable. It was Dr. Caduceus again. That prick. I couldn’t believe it when I heard his decision.
“Are you fucking kidding me!?” I didn’t think I could be any louder. Luckily, the conference room was soundproofed in case patient information is discussed.
“Nurse Redheart,” the dirt bag doctor said calmly, like a villain. “This is hospital policy. If the patient is beyond our help, we have to transfer them to the most appropriate hospital in the network.”
“You’re talking about a 2 hour transport. The patient won’t survive that!”
“Her vitals are stable enough. The administration is clear about this.”
I slammed my hoof on his desk. He didn’t flinch like Dr. Horse, but he did finally look up from his paperwork. “There is a closer hospital only an hour away that is just as good. Stable Horse Hospital is much closer. The patient should make it there, no problem.”
The doctor sighed and looked back at his charts. At that moment he looked careworn and run-ragged. He looked at the patient’s chart again. Then back at me.
“If she can make an hour she can make two. There is a shift in her brainstem, but it’s not so severe that it will cause permanent damage. If she doesn’t get worse then I’m inclined to send her to Canterlot Regional Network Hospital.”
“Inclined or paid to?” I hissed. It felt more and more that ponies in the medical field were making decisions based on bits, not the patients themselves.
“We have a policy because it keeps the information chain going. My reports have already been flown to Dr. Neigh, and she’s waiting for the patient at the hospital now. If we move the patient to Stable Horse then the reports would get there around the same time as the patient.”
“So paperwork? You’re risking this patient’s life for paperwork?!”
“Continuity of care, Nurse Redheart. I assumed you studied that at least in whatever they called a nursing program out here.”
I opened my mouth to berate him but closed it again. All I learned about being a nurse I learned from my mother. A hoof to his mouth wouldn’t help aid in her memory. This decision seemed so cold. If you have A do B. No matter the situation. Except A is a pony. A real pony in the real world.
“Did you at least meet the patient? Or her family? Do you want to be the one that tells her she didn’t make it because of bits and paperwork?!”
“I will say that we did all we could. And we did. We are sending her the best hospital I can think of.” Dr Caduceus seemed to believe this line. Sure, Stable Horse was not as equipped as CRN, but it was equipped enough. Enough to give her a better chance. And that was enough for me to fight for her.
“Look, Dr Caduceus. I know we had our differences, but I really feel this patient won’t make it there.”
“Is this based on medical knowledge?”
“A feeling.” I could see the wall going up in his eyes as I said it. Feelings don’t belong in medicine. But being a nurse for as long as I have meant you develop a certain feel for how the really sick ones look. The ones that, despite all knowledge and signs, still end up going south. They don’t pass the “look” test.
“Well, Nurse Redheart, I wish I could feel the patients that are just about to die and rush in and save them like you do.” His speech was a pillar of snarkiness and sarcasm. “Alas, I am just a mere doctor with mortal powers of science. Until I can gain your abilities I will rely on that science. I see no reason to not send her to CRN. It’s what the network wants.”
“It’s a death sentence!” I couldn’t seem to get it through his thick skull. That ego was going to burst one day; it was just a matter of how many patients he would take down with it. The other doctors at least listened to us nurses and treated us like professionals. This one just saw us as barely competent layponies that he had to direct in order to personally save each patient.
“And how many others will suffer while you fight me here instead of doing your job? Go be a nurse, Nurse Redheart. Leave the doctoring to me.”
I stormed out of that room ready to throw my nursing cap at him. Or stuff it where the sun doesn’t shine. But this was my parents legacy, and I would be damned if it was left to somepony like that.
My hoof found the cold unfeeling table in the hallway and showed it what a warm-blooded pony could do. But the pieces of the table couldn’t help. They just laid there cold and still unfeeling and no longer useful.
I knew the number-cruncher ponies at the top of the network wouldn’t care. Patients had become statistics. They were a flood of bits and something to be better managed. A constant flow of revenue and flodder.
It felt like that sometimes, and when it did I did what I did best: talk to my patients. I reminded myself that underneath all the illnesses and problems to be solved were ponies that wanted to feel better.
I needed them to feel better. Even for a brief moment. I needed the hope they had to seep into me. It felt a little selfish. It was the paradox of helping. You help others, which in turn helps yourself. It makes me wonder if I was helping others for them or me.
I did my best to pass by the pony with the brain bleed. There wasn’t much I could do for her. Standing in that room would just cause my blood to boil again, and my hoof might strike Dr Ca-douche-us instead of that table. So I focused on the patients I could help.
It was a while later when the inspiration hit me. If the patient got worse, she would be sent to the closer hospital. She had a much better chance. I just had to think of a way to make her look worse or just a little worse. That’s when my medical knowledge led me to the right drug for the job.
My hoof was shaking. I never actually hurt a patient before. Not intentionally. If I was found out, I could be fired or jailed for this. Sure I would have my day in court, but could I really justify to her family, the board or even the patient herself what I did was right?
Did I even believe this was the only way? Was I just mad that Caduceus was towing the corporate line and not giving the patient the best he could? Should I really take it this far?
I looked at that sleeping face. The patient had been given a sedative to help keep her calm. Her eyes were closed. It was nothing like the patient that had first walked in complaining of a migraine.
The ER had been busy as usual. Patients trotted in for everything. Stuffy noses, abdominal pains, chest pain or just not feeling right that day. They all flowed into the ER like a tide of discomfort. I did my best to separate the ones that were in trouble and the ones that were just over reacting.
Daisy Chain was a simple pony from out of town. A lot of ponies come here because of all the Princess stuff. Our out-of-the-way, run-of-the-mill town had become an attraction. A tourist spot. The place where a regular unicorn blossomed into a Princess. Historians and hope seekers alike flooded to us to see how this town could have done that. Of course, by doing so they changed the town in the process. But I digress.
Daisy was a hope seeker. A small green unicorn with dreams of just walking around the place and magically finding that spark within her to find her Princess potential. They always seemed to forget how much Celestia had guided Twilight. In their minds, it was just the town.
On her way to fame and monarchy Daisy got a headache. A massive headache. Or at least that’s what she told me. It felt like the world exploded in light and pain. It sounded like a possible aneurysm to me. So I called the doc and rushed in the lab work.
Unicorn magic allowed the doctor to see into the little mare’s head. I stayed with her.
“Do you think Princess Twilight would visit me if I asked?” she asked.
“Well, the Princess of Friendship is very busy. I know she would be here everyday to see her fans, but she stays in Canterlot now. She only visits on rare occasions.” I couldn’t give her the false hope of getting a special visit when I knew it wouldn’t come. But I did my best to let patients know that Princess Twilight thought of them. She did come around once a month or so. It was soon enough.
“I understand. She’s just such a big inspiration to me. Some pony with no friends finding them here and becoming a princess. I was hoping friends would find me here too.”
“Well, you have new medical pony friends. Like me and Candy Striper.” The tech waved in the friendliest way possible. We were in charge of her care. And of course giving her the bad news.
“So my brain is bleeding?!” She looked like she was going to pass out from the thought of blood alone.
“Yes,” I told her calmly. “You might not feel it now, but you have a pretty big blood vessel rupture in there. But we will do the best we can to make sure you come out okay.”
“When I’m better, do you think I could visit Twilight’s Friendship castle or the school?”
“I’m sure you can. If you want, on my next day off I’ll come with you. I have been to the castle a lot of times. Though I can’t really tell you why. Confidentiality.” I winked. I don’t know why that works but it does. Her face lit up.
“You must have treated the Princess and her friends. You probably know them real well. Could you introduce me? Maybe to Fluttershy or Rarity?”
“Well, I don’t know about them, but Pinkie Pie is always around and ready to make new friends.”
“Oh…,” the bright face fell. I knew that look. Sadly, poor Pinkie’s reputation was not the best. “She just comes off as trying too hard or annoying in the books. Is she like that in real life?”
“Er … well,” I stammered. The amount of times I had to have Pinkie removed from the hospital floated through my mind. Pinkie playing with all her instruments trying to make the patients feel better. Pinkie refusing to leave the room because some pony she just met had a problem and she wanted to help solve it. Pinkie bringing in a cake that filled up the lobby to make somepony who was feeling down feel loved. It was noble but not as helpful as she thought. If she was thinking.
“Pinkie is Pinkie,” I said definitively. “Part of having friends is accepting who they are and looking past some of their flaws.”
“I guess you’re right, Redheart. I would love to meet Pinkie or any of the famous friends.” Daisy’s gleam returned and I knew hope had blossomed in her.
I held that hopeful face in mind as I screwed the vasopressin into the IV tube. I just had to press it and push the drug through the saline filled channel and into the patient’s bloodstream. It wouldn’t take long for the effects to show and the patient worsen. Then the doctor would be forced to transfer to Stable Horse. It would only take one push.
This mare deserved to live. This mare deserved to chase her dreams. She deserved love and heartbreak and tummy aches from eating too much chocolate with Pinkie. She deserved life. I just had to press this plunger and she would have it.
Of course, this plunger could also end her life just as quickly. If her brain swelled too much, it could kill her. The skull could only take so much pressure on the inside of it and the brain would be squeezed. We didn’t have the facilities to start drilling holes in her head to release the pressure.
Or I could paralyze her. She could be stuck in a wheelchair. Her life would be looking up at the sky, wondering why our town didn’t fulfil her dreams and only brought her nightmares. Why couldn't she walk rather than soar through the sky. A pony lost without the hope of life getting better.
Or, worse, it could leave her in a permanent vegetative state. The bright face I was clinging onto would be forever slack and vacant. The dark hole of her dilated pupils showing that nothing moved underneath. It would just be a shell I saved. If that would even be considered saving.
All these horrible doubts flooded my mind. If breaking my own moral code led to such severe consequences, I would probably quit medicine and never trust a “feeling” again.
My hoof moved away from the plunger. I looked at that bright hopeful pony asleep in her bed. Could I risk all those dreams, all that potential, all that life over a feeling?
“First, do no harm.” The words floated to me in my mother’s voice. It was one of the first things she taught me. The Hippocampic oath. Hippocampus was the founder of modern pony medicine. He laid out his treatise thousands of moons ago, teaching ponies how to treat their patients. How witchcraft and superstition weren’t as useful as testing and science.
My mother lived by those words. They were the foundation of medicine. If you can’t fix it yourself, the best thing to do is not to cause further damage. I couldn’t fix this. I couldn’t reverse the effects quickly enough if things went really wrong.
This would be causing harm. I knew it. That’s why the plunger remained frozen. That’s why my hoof shook so much and the syringe had been so heavy. I was about to do harm and my very being fought against that.
I looked at that sweet mare in the bed. Could I really cause harm to that, whatever my intention was? I have seen ponies justify many horrible acts. Were they that much different than me? Did I think I knew better than the law or Hippocampus? It’s how we become like Dr. Caduceus and management. It’s how we grow cold.
I left the room as the sound of that filled vasopressin syringe striking the garbage can was lost to the sound of me shutting the door. I couldn’t do it. I couldn’t have that responsibility on my hooves. I couldn’t harm a patient. I felt awful for nearly doing it. I needed to get out of that room.
The roof was cold. Night, and with it a deep bone cold that wouldn’t let me leave. I sat on the roof blowing out a long nicotine-laden cloud. Those stupid things were in my hoof again. It took a lot of effort the first time, and they had been chipping away at my mind every lost patient. Now they won. I hope they were happy.
I had watched the emergency wagon roll away with Daisy aboard hours ago. I didn’t go back into that room the rest of my shift. But I couldn’t leave without knowing she was safe.
But I couldn’t go back inside. If I did I would find out. I would know what I already felt I knew. Could I handle that? Could I look that doctor in the face again if I had been right?
The door to the roof opened and my twin sister Tenderheart was on the other side. I sank down away from her sight, but I wasn’t fast enough.
“Ah ha! There you are. I’ve been looking everywhere for you. Kerfuffle is here and-“
She noticed it. I tried to pull the little glowing stick in front of me. It didn’t work and I nearly ashed on my other hoof.
“I saw that! Redheart! Again?” Tenderheart walked over with sharp quick steps. I hid my shame and my smoke in front of me.
“Look, sis, I don’t know what happened today to put that in your hoof, but I won’t get mad at you for it.” Tenderheart smiled at me. It was a genuine smile, not her sarcastic type. “Also, who am I to judge?”
In one smooth motion she produced another and lit it in her own mouth. She took a full drag and let it out with a sigh. “I won’t tell, if you don’t. This place can get to you sometimes. You have to have an outlet for it. Sure, it’s the opposite of what we tell everypony else, but vice comes with virtue.”
I stared over the edge of the roof again, blowing another plume of vice into the air. I didn’t want to think about the implications of what this act meant. I just did it. Something to distract me from my guilt and frustration. Tender knew.
“Look, Red. You can hang out here all night if you want to. You can kick your own ass over all the things you did for each pony that went wrong. But in the end we have to pick ourselves up and walk in that ER again. Not because of anything other than we are nurses. It’s what we do. And no pony is the wiser. But we don’t need them to be, right?”
I nodded. Tenderheart pulled in another long drag and smiled. “Now you have a mare waiting for you. She can help a bit. Or at least make you forget for a few hours.”
“Right, Kerfuffle is here… I should go. Night, Tender.” I got up to leave and tossed my cigarette under my hoof. I released the smoke into the air as I left my sister to the same crutch.
“Oh, and Red…”
I paused.
“That brain bleed didn’t make it. Just thought you should know.”
I nodded and walked off the stairs. Kerfuffle might have her hooves full with me tonight.