In retrospect, the irony was that the ultimate diagnosis was the furthest thing from her mind.Karen Saunders, senior medical student, was in her scrubs and on duty by seven. The University of Illinois Hospital had succumbed to a bleak Chicago February, and its dynamic verve had long since been replaced by a melancholy gloom. But unlike her colleagues, Saunders wasn't shuffling her feet; she was bright. This was her final acting internship, and while the harsh fluorescent lights stung her eyes, and the two hours of sleeping fully clothed on the on-call room couch had led to a pounding headache, her enthusiasm prevailed. She was in high spirits; so far, it had been a good week. Saunders circled the wards, checking the status of her patients, glancing over as a new admission rolled in across the scuffed linoleum floor. She smiled to herself; in the past few days, Saunders had effectively assisted on two cardiac arrests, solved a tough case of gastrointestinal bleeding, and diagnosed more than one cirrhotic liver. Now, her self-efficacy soared. In her mind, Saunders was on top of the world. She had been a good student, faced challenging patients. And, in a few short months, her time in medical school would be complete. She could finally move out of the crowded city with her fiance', buy that new Prius, and start her dream residency near home; she had matched in Stanford. Oh, how she missed the West Coast. "Hey, Karen." With a start, Saunders spun towards the voice. Beside her was Aaron Kahn, her senior resident. Kahn's long, haggard face sported gray stubble. Dark blue circles sagged under his eyes. He was her least favorite on staff. Even so, Saunders waved cheerfully. "Rough night?" Kahn gave a brisk puff and handed her a manila folder containing notes on her assigned patients and new admissions. His manner was naturally curt, aloof. "Some new admittance. One will be transferred to the ICU." Saunders frowned, following Kahn's gaze, spotting the patient. "What is it?" "Pancreatic cancer, metastatic. Probably terminal." Kahn cleared his throat and thrust an index finger towards an occupied bed. "But that guy's CT said angiomyolipoma. Treatable. We're talking chemo. Don't worry about them too much though. Stick to your own patients." Saunders took his folder and thumbed through the printouts; Kahn never liked hunting down medical records electronically. "Fair enough," she replied. Kahn landed his hand on her shoulder and squeezed. She winced; snoozing on the couch always made her right arm fall asleep. "Cool. Keep them alive for me," said Kahn, in a patronizing tone. "I need to follow up with an attending on the other team, but I'll be back in a few. Oh, and don't forget to use SOAP format in your write-ups. Your last two were a mess." "They were?" Saunders blinked, surprised. The acronym 'SOAP' stood for the words 'subjective', 'objective', 'assessment', and 'plan'. It was standard narrative format for documenting a patient's chief complaints. She was usually pretty thorough. Kahn gave her a nod, turning to leave. "Oh, I do recommend you check out the patient in that last room before heading out though. Weird one. Spins a good yarn, if you can spare the time." Saunders squinted at him as he left, hating how easy it was for him to talk down to her, ruin her mood. Tease her curiosity so early in the day. It wasn't long before Saunders had given in, drifting into the marked room. A pale, puffy-cheeked woman in her mid-fifties lay snoring loudly in the nearest bed, a thread of drool hanging from her lip as a lock of hair fled with each breath. Quietly, Saunders consulted the woman's labs and notes on the computer just outside the door. Her eyes narrowed as she read. "Okay," she said, uncertain. Because it seemed it was; Mrs. Lange's was an unremarkable case. Slightly high sodium, maybe from dehydration. High glucose, likely due to her steroid treatments. Nothing unusual for the autoimmune disease she was being treated for. Perhaps Kahn meant that Mrs. Lange was a good storyteller in general? It was possible. Disappointed that there was nothing more to solve, Saunders stepped away from the computer. She took one last look at Mrs. Lange and was about to move on to her next patient when a small, squeaky voice called out from across the room: "Are you my doctor?" Surprised, Saunders turned. A girl in her late teens peered out from behind the privacy curtains of the room's second bed. She had a willowy physique, thin and dark-skinned, with big brown eyes that gave her a frightened look. She wore a hospital gown, and her hair was fashioned in tidy braided rows. It was the same hairstyle Saunders had worn when she was nineteen. "No... but is there something I can help you with?" Saunders glanced around; there was no indication that anyone had attended to the girl at all. Without a beat, she approached, sliding the curtain away. "Has anyone seen you yet?" The girl shook her head, pulling the bed sheets up to her chin, pressing her lips in a timid way. "No worries, I can help." She held out a hand. "My name's Karen Saunders." The girl hesitated, then took it and they shook hands; her grip was as light as air. "Angela Bell." Saunders drew up a stool beside the bed, so that the pair of them sat at eye level. Curious, she opened Kahn's folders and searched his notes, chewing the inside of her cheek. Perhaps he had left Angela's case for her to solve. Could this girl the patient he was referring to, the one who could 'spin a good yarn'? Saunders looked up and smiled. "So, how are you feeling?" "I'm seeing colors," said Angela. "Colors?" Her voice was softer than a whisper. "Yeah." "What kind of colors?" Saunders asked. Angela swept her hand over her braids, her neck. "All of them. They're fuzzy-looking. Like ripples in a pond." Saunders wrote this down. She had no patient history, no tests to work with. She was flying blind. "Is that all?" "Uh-huh." "Any headache or eye pain?" "No." "And you haven't consumed anything unusual?" "Not that I know of." Saunders wrote this down too. A thrilling sense of guilt and daring took her; these were unique symptoms and an unknown patient, one that she hadn't been assigned. "And your vision?" she said, producing an ophthalmoscope. "Are you seeing spots, flashing? Do you feel like there might be something in your eye?" The girl shook her head; it was a confident gesture. "And I don't wear glasses either," she said. Saunders frowned. "But you're seeing unusual colors." "That's right." Saunders lit the scope and tested each pupil; they constricted under the light. Then she looked inside each eye-but the retinas and vessels appeared healthy. She furrowed her brow; given the girl's condition, Angela shouldn't be in a bed at all. Unless this was neurological. "So, how long have you seen these colors, Angela?" Angela shrugged. "For as long as I know." "You've always see them?" She clicked the scope light off. "Always." Saunders was stumped. "Do you see them around lights, or in words and numbers? Or, do loud sounds cause you to?" "I see them surrounding people." The girl's sincerity caught her off guard. Saunders felt suddenly dizzy, but she hadn't eaten breakfast; this happened all the time. "Surrounding people, you say?" "Yeah." Angela bit her lip. "They're unique for everyone." Saunders pulled her chair closer. "How so?" The girl blushed and looked down. As the only daughter of a divorced probation officer, Saunders knew vulnerability when she saw it. She softened her tone. "Angela, it's alright. I'm here to help." There was a span of silence. Angela continued to pick at a loose thread in the bed sheet. There was something about her that made her appear older than she was. It was her precise gestures, or something in her behavior. "I can...tell when someone's happy or mad," the girl said finally, in a low tone. "Based on the shape. It's like a halo, but it can be smooth, wavy, jagged-and the colors..." Angela's words faded, as if she was afraid to say. "What about them?" Saunders pressed. "Well," Angela said, hesitating. "They tell me when someone isn't well." Saunders leaned back on the stool and tapped her pen on her notes, gnawing her tongue. It was suddenly clear that she was out of her depth; neither neurology nor psychiatry were her strengths. And hallucinations could mean any number of serious causes without further testing, like a brain tumor. It was time to call in her senior resident and yet, she couldn't help but wonder... Saunders looked out the door and saw Kahn's treatable patient in the bed across the hall. He was overweight, lying flat on his back, staring forward into space as the television droned. Saunders thought a little experiment wouldn't hurt. "Angela," Saunders said, wondering how to ask elegantly, "what color is that man's, uh, halo over there?" Angela craned her neck, looking out the door and across the hall. The answer came quicker than Saunders expected. "Green," Angela said, certain. "With smooth ripples." "And your neighbor, this woman beside us?" Angela turned her head and blinked at Mrs. Lange, who was still snoring and salivating with gusto. "Also green. They're both sick, but will get better soon." Goosebumps crawled across Saunders's skin. Outside the room, a nurse wheeled a bedridden patient down the hall, discussing his pancreatic cancer. She stopped short and peered into their room, giving them a funny look. Saunders ignored her; this girl, this case, was far too entrancing to ignore. Far too surreal. Saunders swallowed, a husk forming in her throat. "Okay, what about the nurse outside, Angela? What color does she have?" "Blue, wavy," Angela said. Her eyes began to glaze. "She's unhappy but healthy." "And...the man lying in that rolling bed?" Saunders only then realized that it was Kahn's terminal patient, the ICU transfer. Angela glanced at him and shivered, quickly turning away. Saunders touched the girl's hand supportively; it was as soft as the linen beneath it. "Angela, what color-" "Red," she said, her voice thick, raw. "Dark red. That man is going to die." There was a swooping sensation in Saunders's stomach; it was like the girl had heard Kahn's prognoses, as if she could read Saunders's mind. She clenched her teeth to prevent her jaw from dropping. It was all too bizarre. How did she know? Unnerved, Saunders looked down at her writing and suddenly felt flush with confusion. Her notes, they were no longer clear; they were scribbled, chaotic. Further flustered, she turned back to Angela. The girl's questioning expression was not unlike the face that Saunders gave her mother when she too was a teen. Hell, with her tidy braids, this girl could have even passed for her? The sudden realization arrived with the force of a speeding freight train. There was a horrible sensation in her chest. The blood drained from Saunders's cheeks as she spoke her next words. "Angela," her lip began to quiver, "what color is my halo?" The girl searched her face dispassionately, her eyes now fully glazed, tearing. "Red, Dr. Saunders. Deep red." "I see." Angela's hand seemed to evaporate beneath hers as Saunders steadied herself on the stool, her palm pressing on the now empty bed. Her headache returned with a vengeance. She wiped her brow. It was then that she felt a presence behind her. But she knew who it was; the nurse from the hall. She closed her eyes. "Nurse?" she said. "Yes, Doctor?" "Could you call a neurological consult for me, please?" "Of course, Doctor. Of course." "Thank you."
Karen Saunders passed away six months later, surrounded by family and in the comfort of her own bed. She never did buy her new Prius, nor did she ever start her dream residency in Stanford. The mass at the base of her brain had been too aggressive, grew too fast. But Saunders had lived up to her own expectations; she had seen the signs, interpreted the symptoms. Faced her most difficult case: her own. She had been a good student. Her peers claimed that she knew about her illness but was hiding it from herself all along. Even so, months later, a document continued to surface in the ward. It was a note about a young woman who could see one's fate in colors: Karen Saunders, the girl who knew when.
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Short, but far from sweet, this twisty tale from M. C. Kaske-AKA Matt Kaske Cirigliano-intrigued me. I'm still not entirely sure who the protagonist encountered and I guess that's the point. A nifty debut story for AR-not so? Your reply in our Forum, please. -GM