Picture of Shubham ShanShubham Shan is a medical student in the Class of 2019 at the University of Toronto


She arrived on an inclined stretcher, grasping her Venturi mask like a child holding on to her favourite toy. Flanked on both sides by paramedics, her eyes were splinted wide open by shock and her chest heaved up and down rapidly. She was a queer shade of purple — like spoilt red wine diluted with water — and her gaze flitted around the emergency department as if looking for someone familiar. The paramedics passed her off to the doctor then left, shaking their heads. I remember watching the doctor take the patient’s puffers. The patient swore loudly and snatched them from his hands; first the orange, then the blue. She cocked the puffers like guns, inserted them into her mouth, shot the mist deep, and inhaled. She coughed for what seemed like an eternity. She was what we called a “blue bloater.”

When I saw her again, she was lying on a tattered mattress with bright blue sheets in a freshly bleached acute care room in the emergency department. Her condition had gotten much worse. Her abdomen caved in paradoxically whenever she breathed in. Her eyes were bloodshot. Every time she exhaled, it sounded like an infant’s rattle. Her right hand clutched her two inhalers while her left hand had a vice grip on the oxygen mask. Her eyes were partly closed; her skin was still blue. Two intravenous lines decorated her left arm. Her feet were swollen, and her legs were tattooed with a spider web pattern in varying hues of blues and purple. When she saw me approach, she didn’t speak — just followed me with her hooded crimson eyes, gripping her inhalers tightly as if she feared I might snatch them away.

“Hi. My name is Shubham. I am from Internal Medicine Team 5. I will be taking care of you. Do you prefer Ms. Azules, or Ophelia?”

She did not reply. The background beeping of the machines continued, and the rattles that seemed to emanate from deep within her chest punctuated the silence between the beeps. It sounded like a well-coordinated orchestra.

I tried again. “How are you doing today?”

She still did not reply, but continued to stare at me. Her hand clutched the inhalers tighter as two tears rolled down her discoloured cheeks.

I continued my attempts to talk to her. Every single time, she would cry silently and grasp her inhalers tighter.

The next day, I went back to see her with my senior. She had been moved to the 13th floor. She has C-O-P-D, my senior spelled out — this permutation of four letters defined her. She didn’t have the energy to continue holding her mask. Her left hand lay limp by her side, twitching every few seconds. Her crab-like right hand grasped the inhalers, the blue and the orange. Her chest’s rattling had grown louder and more musical.

I was told later that she was “terminal,” and that water was slowly filling her lungs: drowning her from the inside. She was also what we called “end-stage,” as if she was a character in the last act of a tragedy like her namesake. She was also what we called “a good learning case,” my senior said, so I paid attention.

Moments before she died, she had a gathering of health care workers entering and exiting her room. I was given the responsibility of listening to her chest and describing what I heard, like any astute student would. I put my stethoscope on her chest. I heard her heart. I heard the rattling of her chest clearly now, as if her lungs were choking. The only sounds she made were from the overflow. It rattled once. It rattled twice. It rattled thrice. I heard her last breaths, and then I heard the water take her.

When my senior asked me to describe the sounds I had heard, I couldn’t. I had tried to pay attention to the sounds she made, but all I could remember was that for the first time since I had seen her, her right fist had opened and the inhalers had plummeted to the floor. I picked one up and pressed them — first the blue, then the orange. The inhalers rattled and spat out very little white mist. Both of them had been empty all along.


Note: The patient in this work is fictitious. Any resemblance to real persons, living or dead, is purely coincidental.