An unopened envelope.

18^th hour of the on call duty and 20 minutes into the REM sleep, Dr. Charvin was trying to snatch a nap between the troubled phone calls from the wards. His semi- athletic body was sleeping on the battered mattress and the torn bedsheet; unchanged for at least 3 of his calls now which meant good 7 to 8 days. The pillow was naked and smelly. One had to keep it under the head as tangentially as possible to avoid the humid olfaction. He was sleeping on his right side in a foetal position, his palms tugged under his armpits. The stethoscope still lingered around his neck. The feet were continuously rubbing each other to generate some heat to counter the effect of chill as a clean blanket was a scarce commodity.

The mobile phone rang and within 2 rings it was picked up.

“Sir bed 438, its bleeding. Continuously bleeding, spurting.” A frantic nurse passed on the broken information.

Dr. Charvin calmly asked his own set of questions to investigate the authenticity of the worry; “SISTER! Which patient and under whom? Where is the bleeding from?

The team leader had taken the receiver now, more confident tone continued “Today’s post plasty patient under cardiology team. Spurt from the right femoral site.”

Within the split second Dr. Charvin was on his feet. The brown pupils were dilated, the conjunctiva red. The shabby, unshaven stubble itched and the hair were skewed to left. His feet were well versed for this drill so without the visual assistance he pushed on to his slip on shoes and sprinted. From the 6^th floor to 4^th floor Dr. Charvin climbed down each flight of stair in just 3 big steps and hurried. He knew he had to reach soon.

When he reached the room one sister was applying pressure at the right groin area. The relatives were vulturing around with unhelpful questions. In stern voice he asked the relatives to step outside. Donning the brown latex, he asked the nurses to start IV fluids, to give IV bicarbonate and to send basic blood labs. He made the bed flat and with all his ounce pressed 2 cm above the site of prick. The drowsy aunty howled making the relatives outside more nervous.

The timer ticked 15 minutes. The bleeding was controlled. He called the relatives in and explained the entire episode. The relatives who seemed hostile some time ago were now humble and mellow. The aunty was pain free, thanks to IV analgesia. The Fahrenheit had decreased low.

“CODE BLUE. CODE BLUE. ROOM 411. CODE BLUE.” The wooden speaker at the nursing station clamoured. Dr. Charvin’s adrenaline rush was just settling when he got this bolus. He switched the places with the team leader and ran towards the distress call. From the corridor echoed the parting orders “Immobilise the right lower limb and don’t forget the tight dressing.” The foot steps pacing away were soon unheard.

It was unresponsive Mr. Pattrick in room 411, whom he had admitted at around evening time. He had clinically seen the patient, his ECG, his labs. Apart from relapse of leukemia everything seemed sorted out. The differentials sprung into his mind heart attack, brain bleed, hypoxia but he needed to act first and wonder latter. He himself pulled the bed forward and went to the head end. The pulse was feeble but nonetheless present. He held the AMBU mask in a perfect ‘C’ made out of his thumb and index finger. He shouted “somebody check sugars.” While squeezing the AMBU bag aat every 8^th count. The frail, wrinkled tip of the ring finger was pricked and the drop of blood was taken on the gluco- strip; the glucometer showed the number. It was 28.

When the Code blue team from the ICU arrived, the diagnosis had been already made and treatment had already begun. The second bottle of 25% dextrose was running rapidly into the system and the wakefulness was already better. Mrs. Pattrick glanced at Dr. Charvin; an anticipatory thank twitched her angle of the mouth.

Mr. Pattrick was a strong headed army personnel who had killed a few in 1965 and few more in 1971. It was his 6^th or 7^th admission in past 21 months, approximately the same time when Dr. Charvin had joined the hospital as medicine resident. Each admission was with pancytopenia where the haemoglobin was low which made his features pinched and sallow. The white blood count was less which made him more prone to infections and the low platelet count made him easy to bruise and bleed. He had fought the blood cancer well so far. The factory, production house of these cells ‘the bone marrow’ was dysfunctional. He very well knew it.

“Good I didn’t have the disease in the war days; or else even a nail cutter would have killed me” he always clutched his left clavicle while saying this. A fall from the cliff of the height of about 3 storeys had crushed the slender bone into pieces for which he had undergone many corrective surgeries in the past. “I am in the enemy field and my ammunitions are getting over, isn’t it?” he often asked. Dr. Charvin would only grin in return.

By the time he finished the paperwork about the events, it was 3:30 am. He returned to the bed and crashed. He snored out of tiredness. The fan made the synchronous sound ‘tak tak tak.’

In the morning at around 8 am, half fresh, half fed Charvin had started with his rounds. The room 411 was all together a jolly room today. Mr. Pattrick was sitting upright in the bed. An English breakfast was lying on the side table. Like always he cribbed about the lukewarm coffee and crisp toast. The dental brigade was only a handful now and he found it difficult to chew. His wife was speaking to their son, an army man too but posted far away somewhere. Who would have guessed that only a few hours ago the man was unconscious, hypoglycemic, had given high five to the death and came back?

On seeing Charvin he said “Hello doctor!”

The man shook hands with Dr. Charvin and the grip was still tight. Leukemia had not taken the firm handshake from him. Charvin’s hand ached and he consciously tried to keep the handshake as minimal as possible. He could only try.

“I see, you are pretty favourite among the females around? You are a sweet tongued doctor so you must be good at flirting.” Mr Pattrick pulled Charvin closer and naughtily asked “What is your score?” He winked further tightening the grip.

Charvin blushed a bit, his ears and right hand both became pink and before he could say anything, Mrs. Pattrick added “We know dear. Who is she? The pretty fair girl you were talking to yesterday when uncle was being wheeled into the room. She held your hand very cutely and you looked at her similarly. Common now spill the beans. Not the first admission where we are noticing this budding love story of yours.”

“I will tell everything, but first ask uncle to let go my hand. His grip is too tight.” Charvin complained. A jolly chuckle and the clasp ungripped.

Charvin continued “She is my junior. She works in the emergency department. And yes, she is cute.” Charvin glowed and continued further while sheepishly playing with the ear piece of the stethoscope. “In fact, a week more and we are getting engaged.”

“Oh! that’s wonderful!” exclaimed Mrs. Pattrick. “You must invite your uncle, for the engagement and the wedding both.”

Mr. Pattrick said snarly “For that you have to discharge me soon.”

“OK, but first things first, let me check your vitals.” Charvin said.

“Ahh! The vitals can wait. Tell us her name. Where is she? Is she around? Common get her up. Let us meet her.” With a tinge of panting and exhaustion Mr. Pattrick argued stubbornly.

Charvin by then was already applying the BP cuff on his right arm which were flabby now but were bulky and muscular once. He pumped the air to 150- 160 and started lowering it down. Then again pumped it until 120 and lowered it. The third time he pumped only up to 100. The fourth time Mr. Pattrick seemingly irritated grunted “Are you taking revenge of the tight grip?”

“No Mr. Pattrick, you are hypotensive. Your blood pressure is low.” Charvin said with a concern.

“What rubbish? You check again.” Mr. Pattrick coaxed but the discomfort, the dyspnea had only increased by now.

The sister came with fresh set of investigations. The yesterday’s lab reports were already stale. The labs were horrible today. There was evident worry on Charvin’s face now. The up tight concave smile was convex grin now. Mrs. Pattrick looked confused. Charvin dialled a number and walked off the room.

When he was back, he gestured Mrs. Pattrick to come near the door. In the hush tone he said “Aunty, he is very sick. The BP is low, he is breathless. I saw the charts the urine output is low. The haemoglobin, WBC, platelets everything is rock bottom. We need to shift him to the ICU. We may need to put him on ventilator. We must hurry.”

Mr. Pattrick shouted in delirium “NO ICU, NO VENTILATOR.”

Within the matter of few minutes his chest was wheezing. The chest muscles were indrawing and trembling. The neck was falling now and it took a lot of effort to look up. The saliva dripped from one side of the mouth and Mr. Pattrick was unnoticed about it. Mrs. Pattrick was at the bed side now. She held Mr. Pattrick’s hand. “I know pappy, its probably your time to go now. As promised, no ICU, no ventilator for you. You have lived your life with dignity and if it is your time to go it would be with dignity. I promise Pappy. I promise. I love you.” She kissed him on the forehead. Her vision blurred due to tear drops.

Charvin was not ready to give up that easily. He argued “No we can save him. We shift him to ICU put him on ventilator. We give him blood products. We give him medications to increase the blood pressure and heavy antibotics. I have arranged everything. Like always he will see through it. He is a solider after all.”

Mr. Pattrick in a coherent mumble said; Charvin had to get closer to listen “I want to die looking at my wife, holding her hand. I don’t want to die among the unknown faces. They would give me chest compressions as soon as my heart stops. My lingering soul won’t be able to see that.”

Clenching his left clavicle as always he continued “You…, you are a good kid. I don’t mind dying in front of you.”

For the first time Dr. Charvin noticed the magnanimity of the helplessness. Without the last fight he was not ready to accept defeat while the war veteran very well knew that not all battles are won by conquering; some are won by surrendering too.

When the consultant under whom the patient was admitted came for rounds, she was sympathetic, soothing. She warmly smiled. She gently patted on Mrs. Pattrick’s shoulder which outweighed thousands of words said by Dr. Charvin. She simply said “take negative directive for escalation of treatment. Keep him comfortable and pain free.”

Dr. Charvin drafted the negative directive. Mrs. Pattrick signed it without even reading it and only shallowly hearing it. The little time which he had, she wanted to be there with him. Their decision was clear and unanimous. Till death do us apart but until then conjoint they would be in mind heart and soul.

Dr. Charvin drank the routine 11 am coffee which used to come from the hospital canteen. As the show must go on, so is true with the life. Dr. Charvin finished his rounds and wrote couple of discharge summaries. His attention was towards the phone call which he would get from room 411 at any time. A part of him thought “please God, don’t take him away; not on my guard.” The other part said “you have admitted him, you declare him; complete the circle of life.” None was in his hands; he knew it very well.

At around 2:30 pm, about 12 hours after the Code blue, he got a call for the room 411. He was in the OPD on the ground floor. He ran blitzkrieg. When he reached the room, Mr. Pattrick was gasping for air. His eyes widened with each gasp. The air hunger was visible. Charvin gave the chest rub to the old man. He barely moved. His body was cold. He was pale like a peeled apple. His nose was cyanotic and the toes showed discolouration.

Mrs. Pattrick requested “Dr. Charvin you have been helpful and kind throughout. Don’t be so harsh on yourself. You tried. We all tried. Mr. Pattrick is really very fond of you. He wanted to attend your wedding but that is not possible now. He wanted to give you something. To you and to your fiancé. May you grow old and grey in love as we did is all I can bless. Please don’t deny it. It was his last wish.”

Saying this she forced an envelope in Mr. Pattrick’s right hand. “Pappy Dr. Charvin is here. You wanted to give him something. Here it is. Give!”

Mr. Pattrick couldn’t speak, couldn’t breathe but he did shake the hands tightly for one last time. The blood cancer couldn’t weaken his grip ever. He had won. Two hours later the monitor showed zero in each of the department. The ECG showed flat line. All Dr. Charvin could say was “its over.” And then he bit his lips, pinched his left elbow with right hand. Due to continuous use of socks and shoes, his left toe margin was swollen with pus pocket. With the second toe he pressed the first one really hard. He wanted to divert the tears. The physical pain was only a dam for it.

The envelope still remains unopened with Dr. Charvin. The name of his fiancé still remains unspoken to the Pattrick family.