Sequence Cause Effect
Doctor is passing by the ward when the music starts. It makes him feel giddy, as if the grey floor tiles are swaying beneath his feet. Five patients moving slowly, but unmistakably dancing, their hair prickly on their scalps. At the front Otto raises a hand, a tremor in the tips of his fingers like the string of a musical instrument. He is wearing an indigo gilet over pyjamas. Step shuffle, step shuffle. They scoop arms into the air, manoeuvring in little steps. Doctor watches from the door as nurse Alex leads the activities, a skim of white light overhead. There is a dulled space between the patients; when one of them moves to the music the others follow in delayed sync, as if leaning on each other from afar. Otto, entangled, enacting the dance’s small reversal; last week Doctor gave another patient, Stephanie, the same drug as Otto and it took her life.
In the afternoon Otto is in bed again, one flaky toe out the blanket, a quiet whistling coming from his throat. His daughter stands at the other side of the bed. Doctor tells her that he has been responsive to treatment. There is a pause.
So –
But we don’t have the option of keeping him here, Doctor says. His supervisor sometimes uses the word ‘luxury’ here, but Doctor doesn’t.
What will you do? She asks.
We can offer home visits.
She asks what Doctor means. He shifts his weight from one foot to the other, hands her a piece of paper. You are eligible, it says at the top.
So – you’re kicking him out?
Doctor feels a blot of anger, wants to scratch the moment out. He does this every day; checks vital signs, analyses scans, keeps a patient diary. Tells people there is no room. She looks at him as if he were telling her to be a cactus in the desert. A silent cactus who can survive for three months with no water, which is how long she’ll be on the waiting list, he thinks.
She finds him again in the corridor half an hour later.
It feels like you’re just playing games with us, she says, her voice one high, choked note. A plastic bag dangles from one of her wrists.
What’s the point of a doctor who just sends people home again?
The hospital falls away, becomes a pain that circles his body. On the step outside the ward he pictures his patients dancing, palms swaying, can almost feel their presence. His colleague Jack is out smoking too. Are you sure Otto should leave, Doctor wants to say. Instead he says, we’re going to vacate him. Jack nods. That’s their supervisor’s word: vacate. Between them is the cool air, the smell of lunch somewhere else turning his stomach, smoke dry in his mouth. He thinks about when he first wanted to study medicine, in the last years of school. When Doctor was a teenager he loved the ticking over of bodies, the self-regulation. Your body will fix itself, he always told friends when they asked for health advice. That’s who he should see tonight: Milo, Milo who’s been saying drinks for a while. Drinks with Milo always happen on a Friday, always near where Milo lives. But Doctor hasn’t gone in - How long? A year? He can’t remember.
Maybe he was just arrogant to take this job, he thinks, coughing. He considers spitting on the ground but doesn’t. This is his penultimate placement before qualifying: first there was orthopaedics, then paediatrics, then a mental health ward. All with their difficulties but somehow easier. Paediatrics felt good, the children’s bodies like beating hearts. At the end you could nod and say: they will be here for many more years. It gave him back a sense of the infinite. The elderly care ward was different, so easy to make a mistake. He cups a heavy chin on his hand. But also - and also - there is Sofia, the obliterating love in his life, who at some point told him that love is an irreversible change, one that we accept and then sometimes forget. We are not the same when we begin and when we depart from each other, he had slowly agreed, piecing the argument together, back to Sofia, like two fingerprints smudging. He calls her now, phone pressed to his ear.
They’re old, Sofia reminds him.
How can we take such big risks with them? I don’t want to experiment with people.
You’re not. They’re old and he’s responding. That’s –
What happens?
This is why I quit, she said.
But Sofia hadn’t quit, she had done the same undergrad as him, she just wasn’t a doctor. Now she works in the Comms department of a medical charity. Sometimes they meet for lunch and she tells him about their campaigns, trying to whittle down the words -
Learn a language to avoid Alzheimers, she says. Try and make that one snappy.
It’s perfectly snappy, it’s a solution.
Don’t go to A&E unless you absolutely need it - that one I reject, Sofia continued, her fork moving with each word. I won’t make people feel responsible for underfunding which is out of their control.
On the phone she asks him when he’ll be home for dinner. I need your help with something, she adds. Doctor smiles. From the steps he watches a paramedic close an ambulance door slowly, its yellow diamonds catching the light. Doctor sips the air, squeezes the brown root of his cigarette, thinks of Otto’s shivery breath.
That night at the pub his friends look at him from around a little wooden table.
How long do you have left? Milo asks.
Two months after this placement, Doctor says. One year left to qualify.
The Milo who is sat across from him, biting a lemon between words, is also the Milo from years ago, egging houses dressed as Frankenstein on Halloween, crispy brown hair, from a posher neighbourhood. He was going to be a journalist, and to find out what’s really going on you need to take risks, Milo used to say. Doctor remembers flicking through Milo’s photos on the way home from first year classes, the times when he still went to parties and drank in the same way these guys drink now. Milo’s photos were of him in places that looked like the moon but sunnier. But now they are talking about the special effects in a film Milo saw recently, then the actor in it, then he looks over at Doctor and says,
We saw the doctors on the news. That’s you, isn’t it?
I’m a junior doctor, yes.
What’s it about again?
Pay, mostly.
Salaries –
Shouldn’t there be a limit to how long you can strike, says James.
It’s good - I support it, but they can’t really not work.
I’m not actually –
Are you striking?
Doctor’s friends look at him, his fingers on the edge of the beer mat. He wonders if he is imagining their searching expressions.
We trust them with our lives, says Darren.
James turns to them. I agree though, he says. They need better conditions or we’re all fucked.
In the pause Doctor watches the slice of lemon bob like a medallion in his glass.
Are you still in paediatrics? You liked that, didn’t you?
Doctor nods, thinking of the infinite. Of Otto and of Stephanie who took the wrong medication.
Milo sits upright.
You know Matt Thomson? He announced. He’s pregnant. I mean, Anna is pregnant. I reckon he’ll keep it. I mean they’ll keep it Or like, as far as I know from knowing him.
Imagine if this was our grandparents’ time, they’d be old for this.
Darren looks back at Doctor.
Look at the picture, you know about this stuff. What kind of baby are we talking? Fully cooked, still raw?
About four months. Sort of a real baby at this point.
They hover their hands over the phone screen white noise, form-solid, electricity or breath.
Here’s its head
An alien in the fridge kind of baby
At the bar Doctor can see his reflection stretched in the brass above like a comic strip. His friends are getting up to dance, hips knocking glazed wooden tables -
Doctor’s friends are singing a song together The song is waves.
Doctor thumps a hand on his side and feels his tongue fat in the bottom of his mouth,
touches the metal ring on his finger. Doctor opens his mouth wide
Wide like the front door of a house. Doctor’s heart is the floor
Someone in the carpeted room full of coats thick pint glasses, someone says -
Leave a little room then –
Dancing in the middle of the pub? The tables are right here, fucking idiots.
Palms swaying, weight shifting.
Doctor thinks of the whistle-throat man whose name he can’t remember, his mind a shuffling blank. Of when he thought he would be able to care for people. There is a word behind Doctor’s teeth. The search for a name. And there is blonde Milo laughing safely into the night, beer froth at the corner of his mouth, or in a lunar landscape, his boot knocking a rock, scudding along the floor. Milo’s responsibilities which fit the circumstances of his life -
You’re going to end up alone, Doctor murmurs
What mate? Huh?
You don’t know what actual responsibility is, Doctor replies
Alright
Okay
Alright man
I don’t get what your problem is -
Someone is pushing Doctor a little, then pushing really pushing then almost knocking him over – two eyes, two dots on a domino coming towards him, swaying. Shoulders bump and jostle. A security guard at the door is advancing towards the group, his eyes full of precise, sharp identifications.
Is there a problem?
Doctor flaps open the door of the pub and runs. Skips three bus stops, catches one not even seeing the route. The bus cocoons through the night. Sitting somewhere near the back, Doctor sweats off some of the beer. Faces shuffle between sleep and work.
The first dizzy hours Bodies move through the deciduous world Through the sick and the hungry unnamed new, new -
Death fizzes at the hospital floor, but still we cling to sequencecauseeffect
The bus doors open. For a minute Doctor watches an electrician working across the street, two green doors open like a wardrobe in front of him, imagines two snapped wires in the electrician’s hands, electricity at his feet. The softening current. Doctor stands in the doorway and Sofia on the stairs. Midnight, one, all the hours Doctor has no answer for.
I’m not that much later than I said I only finished a few hours ago.
Her eyes and his. The lights are off in the corridor. Sofia walks away from the doorway he is still standing in. Calls out something from the kitchen.
Well.
You’re awake anyway The kitchen light splitting the house
She is pushing and pulling doors and plates in the kitchen
He is opening cupboards
You’re hungry aren’t you.
Well –
Want this?
She slops something at him. He takes a bite, breath audible as he chews.
It’s frustrating you are so late.
I want to quit, he mumbles back. I can’t keep abandoning people –
You think you don’t have choices but you do, Sofia calls out to him. Doctor is standing by the sofa. His patients all crowd in They are learning to dance, palms swaying, weight shifting, hips pointing one way then another
His heart is the floor his mouth is open like a door –
There are no more beds. I am leaving, Doctor mouths to his patients. Shadows trace
over them
Doctor stretching out on the living room floor, open-belly starfish.
I’m sorry I love you Yeah I know
I’m sorry
Everything is fine
Yes
I’m sorry to everyone, really.
Sofia the science communicator. Sofia who knows how to tell people all of this. Articulate it. How to sell it, even. Lying on the floor, doing push-ups in the air. He rolls over, sees the chest of drawers Sofia always leaves open, the playstation he bought a few months ago, the cable touching his feet the grey carpet the grey carpet on his face. He loves playing playstation. Watching the figures move like grasshoppers through angular landscapes. Sofia tells him where to mind, where people hide behind trees or in houses, or crouch down tired, where he can gun them down. He loves Sofia whose head floats above him now. He thinks of the woman waiting for her father to receive more care. Doctor laughs, the carpet a desert behind his head.
Sofia -
Doctor hiccups a tiny hiccup of vomit into his mouth and suppresses it again. Hides his eyes. His palms tingle with sweat.
Yes
I want
(white noise)
A baby.
Ali Maeve Sargent is a writer from London. Her work has appeared in Lighthouse, and in 2022 she was shortlisted for the Out-Spoken London poetry prize and longlisted for the Aurora Prize for Writing.