Protocol: A Short Story

It was colder in the ICU that morning than usual. Doing her best not to shiver, Dr. Matthews attuned her ears to what the hospital director was saying: “You can’t do anything.”

It was a gut punch, too sudden and direct to absorb. She was familiar with these bleak words, often pronounced over flatlined patients. But, this time, they hit her ears differently. They were not the conclusion of a long battle for life but a command: “You may not do anything—unless he asks.”

“Sir, this man is unconscious,” she said. Her voice was hushed, though she knew the prostrate form before her would not wake even if she screamed.

“Protocol stands. You can do nothing unless he asks.”

“He can’t ask,” she said, feeling stupid, “he’s unconscious.”

“Protocol stands,” the director repeated. “We can’t afford any more lawsuits. So he has to ask—all patients have to ask. Nonverbal consent is no longer enough.”

The conversation repeated itself nearly word for word as Dr. Matthews made her rounds, the director following her like the reaper she knew stalked these bone-chilled halls.

“What of him? He can’t ask either,” she said over another man. This patient was awake, but tubes crawled from his gaping mouth like Kraken tentacles. His eyes roved to and fro in mute terror.

“He has to ask,” said the director. “Otherwise, whoever has power of attorney has to.”

She patted the man’s hand, and his eyes stilled for a moment, soothed by the brief normalcy of this gesture.

Passing the NICU an hour later, Dr. Matthews and the director paused by a foggy incubator. A premature infant, delicate ribs poking through red skin, contorted inside.

“Its parents would have to ask,” the director said before she could say anything. The plexiglass muffled the infant’s cries, but they grated on Dr. Matthews’ ears as if accusing her for not offering to help. “I wasn’t asked,” seemed a sorry excuse, but she mouthed it at the baby anyway. It shook its purple fists at the ceiling, and she understood how it felt, shut up and alone in its little container.

Dr. Matthews and the hospital director performed their futile dialogue throughout the remainder of the morning.

“She can’t ask,” Dr. Matthews whispered over a woman sleeping fitfully, her lopsided mouth grimacing.

“She might…eventually,” said the director, but both knew that if this patient did ask for anything, it would be with difficulty, through the slur of a stroke victim.

The doors of the trauma center burst open as they passed, and a couple of teenagers rolled by on gurneys, freshly delivered by their own overconfident driving. Dr. Matthews rushed to their side, grasping for their limp hands and following the transport workers down the hallway. “Surely, I can—”

“They have to ask,” said the director. “Surely you understand the protocol by now.”

When a code blue was announced, Dr. Matthews rushed to the scene. An elderly man was being pumped with ruthless mercy. He had not signed a DNR. His ribs cracked audibly as a male nurse struggled to beat his heart back to life. Finally, he took a choking breath and heaved, vomit marking his re-entry into the land of the living.

“No,” said the hospital director, without even looking at Dr. Matthews. She bit her lip and fought back the guilt churning in her stomach.

After this dreary rehearsal had been performed before every one of her patients, the director retired for lunch. How he could eat, Dr. Matthews could not understand. After years of experience in this gruesome field, she still had to sip peppermint tea for a few hours before even thinking of a meal. Dr. Matthews stood frozen, feeling the vacuous cold wrap its arms around her, holding her busy body still.

“Nobody here can ask,” she said uselessly to the double doors as they bumped shut behind the director. She continued to stand for what could have been a minute or a month. The windowless halls of the hospital were always cold, and the light was always unmoving, fluorescent. The only way to mark the days and seasons was to note patients’ clothing as they were wheeled in and out. Bloody coats indicated winter and falling upon sharp ice. Scuffed cardigans suggested the fog of autumn evenings. Tank tops revealing bruised biceps spoke of cruel summers.

A cry tore Dr. Matthews from her daze. Hearing it alone was a ten on the pain scale. Her training took over, and she sprinted toward its source. The cry erupted from the unconscious man she’d seen that morning. His eyes were open, staring without seeing and seeming to track something invisible as it danced along the ceiling. Veins threatened to strangle him from within, popping and stretching along his throat with each scream. Like a student violinist, he played a hair-raising melody upon those pulsing blue strings, but Dr. Matthews did not cover her ears: This was what she had been waiting for. If ever someone were asking—pleading, begging, offering to trade his soul—for help, this man was. She set her skillful hands upon his glistening forehead and took a breath. Then, bowing her head, she set about her work with her eyes closed:

“Our Father, who art in heaven, hallowed be Thy name….”

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