Stay Gold, page 14
At the departure gate, his mother and sister were waiting. “You’d better go in now, Fiq,” said his mother, gesturing to the queue. He lowered his duffel bag to stash his cap and sweater inside, revealing the two books Daniel had given him for his birthday, months ago.
“You brought the books,” Daniel said, sounding surprised but pleased.
“Of course I did. I’m going to design T-shirts like we talked about,” said Shafiq, suddenly abashed.
“You think you’ll really get down to doing it? I won’t be there to buy you cigarettes and critique your designs,” Daniel teased gently.
Shafiq laughed, grabbing Daniel in a fierce hug, feeling his friend’s shoulder blades protrude through the soft cotton of his Threadless T-shirt.
“When I design my first collection, you get dibs.”
It was quiet in the Cardiac Care Unit, until the old woman wailed.
“Sakit… sakit… tolong sakit,” she cried, her voice cracked and raspy through the thin wall between Daniel’s bed and hers. He envisioned the wizened old lady tossing and turning between metal guard rails, her bony fingers clawing at the sheets. Daniel, who never slept soundly in hospital, jolted awake at the noise. He lay in the dark with his eyes open, anticipating her next shriek.
It came with the thunder, a low growl emanating from miles away, and the streak of lightning that illuminated his room for an instant. Perhaps the old lady was afraid of storms.
Even in his disinfected ward, he could almost smell the humidity in the air – the ripe, grassy wetness that heralded a tropical storm. He had loved that smell once. It meant soccer in the rain, the sky unleashing upon his bedroom window, long naps on Sunday afternoons. Now, the impending rain taunted him. Outside his second-floor window, where one blind had not been fully lowered, the leaves of a banana tree blustered an erratic rhythm that rattled through his room.
Daniel hesitated over the call button, tempted to call a nurse to lower the blind. But it was two in the morning, not yet halfway through the night shift, and he knew they would need their energy for the real emergencies, or the woman in the next room, whose cries had become mangled and throaty, unintelligible in their desperation.
Although the noise frustrated him, Daniel felt bad for her. Once, when his fluid levels had been stable for a week, Pratap wheeled him to the hospital food court for a soursop dessert. Passing by her room, he craned his neck to catch a glimpse of the neighbour he heard from so often but had never seen.
He expected someone larger, someone more capable of producing the horrible, reverberating groans that sometimes lasted all night, but the figure next door was so tiny and frail he almost missed it. She lay on her side facing the window, and only her head, protected by a maroon knit cap, emerged from the sheets.
“Does the old woman have any visitors?” Daniel had asked one of the nurses, who paused at the question before shaking her head.
Since then, he tried not to begrudge her shrieking, even though he knew from experience it would last till morning. Every time he began drifting off to sleep, he was startled awake by fresh howls that didn’t abate until daylight broke. When his mother arrived at the start of visiting hours, Daniel’s eyes burned with tiredness.
“I’m okay,” Daniel said by way of greeting, as she took in the smudges under his eyes. “At least it wasn’t pain that kept me awake,” he said, cocking his head at the next room.
He wasn’t hungry, but he reached for the porridge his mother had brought. It always reassured her when he had an appetite.
“Don’t worry, Mummy,” he said between mouthfuls, “I’m luckier than many people in the world.” He laughed at her incredulous expression, downing an extra-large mouthful of porridge. He could look forward to visiting hours, and in the quiet confinement of the CCU, that made all the difference.
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Tanya ran marathons during her free time, but during a night shift her feet ached with a different kind of soreness. There was no autopilot mode in the CCU, no tuning out her surroundings and letting her body do the work, which was how she ploughed through most of the 42-km races. Night shifts had her constantly leaping up from chairs to answer red blinking call lights outside each room, and left her exhausted at the end of 11 hours. Just before dawn, near the end of her shift, she sank into a chair, crossed her feet at the ankles and closed her eyes briefly.
No one spoke, at this hour. When the night shift nurses arrived at 10pm, freshly showered and ponytails neatly pinned, they chatted about patients, studiously taking over from the nurses on afternoon shift who were leaving for supper with their partners, or home to kiss their sleeping children goodnight.
Between midnight and three in the morning they fantasised about breakfast, the heaping mounds of bak chor mee they would devour when the shift was over, spiked with an extra helping of vinegar and chilli. But there were only so many times in a night they could debate where to get the best kaya toast, or if Tian Tian chicken rice was better than Boon Tong Kee. By the time 5am rolled around, conversations had worn thin. Time passed at a glacial pace, and it didn’t help that from Bed 8, located closest to the nurses’ station, an old woman screamed bloody murder almost every other night.
None of the doctors or nurses could figure out what set her off, only that rain seemed to trigger a particularly big reaction. Otherwise, her groans were random, although once they began it was a fairly safe bet they would last the night. Every alternate hour, when Tanya logged her vital signs (all normal; same as in the day) she checked that the patient’s morphine hadn’t run out, and said a silent prayer for the old woman’s soul. Tanya wasn’t religious – she wasn’t entirely sure who she was praying to – but surely a merciful God would not turn a deaf ear to the old woman’s screaming, or her own fraying sanity.
As the morning sun filtered slivers of light into the ward, a colleague tapped her on the shoulder.
“Tanya, my son is sick and I need to get home so my husband can leave for work. Could you cover for me until the end of my shift please? Beds 3 and 12 are empty and I just have a young patient in 9 who won’t give you any trouble,” she said.
Tanya hadn’t seen the young patient before, but she had certainly seen his friends. She usually turned a blind eye to visitors, sidestepping with a murmured apology as she navigated her nursing cart around them. She could always tell immediate family from cousins and distant relatives – the latter often ill at ease and rarely staying longer than 20 minutes, staring at their phones half the time.
The young patient’s visitors were different. To call them happy would be inappropriate. But they looked comfortable in the CCU, bearing boxes of doughnuts and shiny helium get-well-soon balloons, taking turns to shush each other as they huddled together in his room. When a gaggle of them passed Tanya they smelt like vanilla and peaches and shampoo, a burst of freshness against the familiar antiseptic tang.
So she was surprised to see him looking wan and shrunken that morning, his brown hospital gown as rumpled as her scrubs.
“How are you feeling, Mr” – a quick glance at his headboard – “Selvakumar?” she asked, trying to keep the tiredness from her voice.
“I’ve been better. Call me Daniel,” he said, shutting his eyes.
Tanya changed his IV bag while he lay motionless in bed, exchanging a brief nod with his mother while she did.
“Thanks,” said Daniel when she was done. “How was your shift?” But Tanya was already halfway to the door, her response automatic, her mind already on the next patient.
“No problem,” she called back, shutting the door behind her, and it was only back at the nurses station that she realised she hadn’t answered his question.
____________
Pirakash, Yiwen and Bryan were his last visitors of the day, arriving jauntier than usual.
“We brought you something,” said Pirakash as he entered the room, handing Daniel a paper bag. Inside was a Manchester United jersey with their latest sponsor Chevrolet emblazoned on the front.
“We thought you could wear this while you watch United matches on your laptop,” said Pirakash. The tube in his neck prevented Daniel from pulling it over his head, but he laid the jersey across his chest as his friends got comfortable in his room, settling at the foot of his bed and on the single armchair at the window.
He let their conversation wash over him while he lay back and heard the pillow crinkle. Pirakash had an interview lined up with the Singapore Tourism Board’s graduate programme; Yiwen had a scholarship bond with the Singapore Armed Forces.
They had all graduated that year, studying for their final exams while filling out job applications and taking head shots for their resume. Daniel, who had turned down a Goldman Sachs internship the previous year for a stint at the Ministry of Social and Family Development, was debating between a job in the public sector or joining a public relations agency.
Then, two days before his final paper, his legs began swelling again. His skin was stretched taut, ankle bones disappearing beneath distended, puffy skin. It felt uncomfortably familiar.
“Let me finish my papers, and then we’ll call Dr Shankar,” he told his mother, for once not bothering to hide his swollen legs. He wasn’t running a fever and had no other symptoms so they came to a compromise, and his mother made an appointment with Dr Shankar for the day after his final paper.
When he finished his last exam he came home to drop off his stationery, change into a fresh shirt, and take the family for drinks at Ku De Ta. His father wore his good shoes and both his mother and sister earned a few appreciative looks at the bar, although only Melissa bothered to respond. Daniel ordered a bottle of champagne and raised a toast. It was Mother’s Day.
He had been hoping for a new course of diuretics from Dr Shankar, but the morning of his appointment Daniel took a long shower, letting the cool water massage his scalp. Involuntarily he thought of the daily sponge baths in hospital, how the nurses did their best to wipe him down but he never felt completely clean. He pushed the thought from his mind and his fingers through towel-dried hair, then packed a spare T-shirt and a new copy of 8 Days magazine in his backpack, and loaded his MacBook with the latest season of legal drama Suits.
Still, he wasn’t surprised (and was even pleased with his foresight) when Dr Shankar admitted him. Just for observation, at first, and then for a stronger course of diuretics than before. Since then, NUH had become home. His slippers lay beneath the bed for short excursions to the food court, and his bedside table was quickly filled with gifts and food.
In the beginning, when he was first admitted, visitors bore little treats – KOI bubble tea, a java chip frappucino from Starbucks, a frozen yoghurt from Llaollao with strawberry slices stacked high and tart. Sean, returning from a family vacation, came with a duty free plastic bag full of alcohol, which he snuck into the ward.
“For my discharge party,” said Daniel, who arranged the bottles on his meal table for a photo. “It’s going to be epic.”
Then doctors limited his fluid and sodium intake, so the drinks had to go, and the salty, store-bought snacks quickly followed. At first, when his mouth grew dry and his urine became the colour of cardboard, he thought they were his body’s normal reactions to the diuretics. His calves shrank, growing scaly as they did, and doctors looked puzzled until one of them suggested, could it be dehydration? Had the course of diuretics been too strong, or gone on too long?
“We don’t have a lot to go on. Babies born with your condition don’t usually make it twenty-four years,” said one of them apologetically.
The goal, they said, was to find a happy medium between the two. But May melted into June and turned into July, and every time the doctors tried to send him home with the right dosage of drugs, something would tip the balance and he would wake up shivering in the middle of the night, burning with a fever that signalled a new infection, requiring a new course of antibiotics to treat it.
The hardest part was that no one had concrete answers. Even the cause of these episodes was not completely clear.
“We didn’t manage to completely strip your heart of scar tissue during last year’s surgery. I think the remainder of scar tissue, mostly around the back of your heart, is preventing it from working as it should,” said Dr Shankar.
Daniel felt, rather than saw, his mother’s shoulders tense and knew she thought of the massive internal bleeding he had gone through, how Dr Shankar had been forced to halt surgery to stem the blood loss, how the trauma had made his liver and kidneys threaten to stop working. He learnt all this second-hand, waking up jaundiced and battered after 21 days.
“We’re noticing the signs of right heart failure, which could just be a natural progression of your heart defect,” said another of his doctors one evening, and though Daniel’s heart had not been functioning properly for some time, hearing the words was discomfiting.
“We don’t want to make any promises, but we’d like to discuss a new option,” said Dr Tay, another cardiologist.
“Normally, heart transplants are done on patients with left heart failure, which is commonly caused by coronary artery disease. But we’d like to make a special case and consider you for a heart-liver transplant. It’s never been done before.
“You’re young, and all things considered, the rest of your organs are healthy. As you can imagine, hearts don’t come by every day, so we want to make sure that the recipient’s body is the healthiest possible host for its new heart.”
He let the information sink in, pretended not to notice Daniel’s parents exchanging a brief, worried look, or how Daniel pushed himself up in bed so he could sit a bit straighter. Then he went on to outline the process.
“Before the transplant, we’ll link you up to a device that will take over the work of your right heart. You’ll be prepped and ready, lying down 24/7 so the moment a heart is available, we can wheel you into surgery,” said Dr Tay, looking much more optimistic than Daniel felt.
“So I won’t be able to move around at all?” he asked, hearing the doctor’s excitement and trying to keep the scepticism from his voice.
“Well, we can allow you to be propped up slightly to have your meals,” said Dr Tay. “But otherwise, it’s critical that you’re ready as soon as the opportunity presents itself. We could find a donor as soon as next week or next month,” he said.
“Or never,” said Daniel quietly.
“Well, yes,” said Dr Tay. “But give it some thought. I know you weren’t expecting this, but we’re doing everything we can to give you the best shot at a normal life.”
When his parents left that night Daniel tried to sleep, but Dr Tay’s words left him wide-eyed and alert, his mind racing with fear and anticipation. It had been a long time since he had thought about a heart transplant.
Once, at 16, he waited till he was home alone before googling “Heart transplant success rate”, and spent the afternoon reading about the selection process and the odds. A heart transplant is an option when the heart no longer works well enough and a person is at risk of dying, he read off WebMD, shuddering as he realised that though he couldn’t last an entire soccer match, he was at no risk of dying. After he learnt that 25 to 35 percent of transplant recipients did not survive past the first year, Daniel banished the thought to the back of his mind.
He had not revisited it since, and that night Daniel was surprised he remembered the figures. 30 percent, or a one in three chance that he only had a year to live. But Daniel didn’t want another year – he wanted a full life, a proper life, the normal life that Dr Shankar had optimistically described before both his surgeries.
Very briefly, as though indulgence might jinx the possibility, Daniel allowed himself to imagine a normal life – one where he bought regular-priced health insurance and doctor’s visits were limited to the annual flu and two-day MC. Where he could drink an entire cup of iced Milo right now if he wanted, and join the conversation that had turned to food and soccer.
“Eh, have you all been to JB Ah Meng?” Pirakash was asking the other two.
“Oh yah, the Geylang one right? They have this really good san lou bee hoon. It’s bee hoon fried into a crispy pancake. Damn good with belachan.”
“Eh, let’s go this weekend. Can you guys make it? We can play soccer in the afternoon, burn some calories and then top it up with zichar,” said Pirakash, scrolling through his WhatsApp chats for enough people to form a team.
Just then, Tanya knocked on his door with a pack of biscuits and a cup of water, which Daniel knew had been logged into his chart of daily fluid intake. “In case you get hungry at night,” she said, setting it down on his meal table.
“Sorry we stayed so long,” said Yiwen, as the trio rose simultaneously.
“I didn’t mean to break up the gathering.” Tanya made an apologetic face.
“No worries, it’s late. I’ll come back tomorrow,” said Pirakash. He shut the door of Daniel’s ward, waving as he backed away.
When Daniel was sure they had gone, he exhaled and let the smile melt from his face. The cool, quick-dry fabric of the soccer jersey had become warm against his skin, and he draped it over one guard rail.
He pictured himself wearing it in a soccer match, astroturf springy under his boots as he feinted past two defenders and sliced the ball past the goalkeeper just before the final whistle blew. Afterwards he jogged back to the sidelines, and by the time he was done high-fiving his friends, his heart rate had returned to normal.
“Supper, anyone?” he’d ask. “I could use some crispy bee hoon and an iced Milo.”
Two weeks later, as Singapore turned 50, Daniel’s kidneys stopped working.
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When Daniel was alone in his room, he rarely pressed the call button. So Tanya was surprised to see it light up just past midnight, when most patients were asleep and the ward was so silent it amplified the faint mechanical ticking of her watch.
