Hektoen International

A Journal of Medical Humanities


Nicholas Feinberg
New York City, New York, United States


London in the Fog by Lesser Ury

Outside their window, the sky is dark and the streets are empty. Fog slides off the lake and turns the pavement slick and black. The wet air is a blanket that quiets the city. Silence fills the space between the buildings and pours into the bedroom where the women are sleeping. Waking with a small gasp, she turns quickly to her phone. Groggily, but with practiced fingers she unlocks it and turns off the 5 AM alarm. Softly she slides her feet to the floor and pads down the hall to the kitchen, toothbrush and toothpaste in hand. A quarter turn of the knob and a trickle spills out of the faucet. Not too loud, she thinks. Brush, rinse, spit, brush, rinse, spit. Back in her room, she pulls on stiff fabric and steps into the shoes that remind her of Dutch children. Next comes the stained white coat with its overfull pockets, then the rubber snake of her stethoscope. Last of all she zips into the big down coat that reaches almost to her ankles.  Carefully, she leans over the warm, softly breathing sleeper and kisses the creamy skin at her temple. She does not want to wake her—just to nudge her towards a pleasant dream. She steps out the door and locks it, then heads down the stairs into morning air that is thick and cool on her cheeks. She holds her breath and stamps her feet to stay warm. When she has to exhale, her breath is hot and she pretends she is a dragon.

She hears the bus before she sees it. It arrives like a massive, snorting bull—angry whine of the brakes, hissing as it kneels, peep-peep-peep as its doors swing open. She climbs on and picks one of the many empty seats. Inside the bus it is warm and she holds her breath again, this time to stay awake. As she and the driver bounce along, she swipes through flashcards displaying odd words: syncope, angina, Leser-Trélat sign. A younger self wanted to go to Hogwarts, and the language of her cards stirs up faint nostalgia.

How did she get here? Why is she here again? Why is she here, again? Where is here? What makes her think she should be here? Where is she going? She catches herself as her lids begin to droop and her head dips. These existential questions find her in the undefended place between sleep and waking. So far retreat and forgetfulness have been her successful stratagem.

When she started medical school she had been so proud, smug almost. She knew she was smart, and that not many people were more able to learn, recall, and apply. The tests did not lie—they were standardized. The years had polished away the smugness, and an ocean of information had washed away the pride. “I do learn,” she thinks. “I learn every day how little I know.”

Coughing from the front of the bus pulls her out of her thoughts. The bus is still empty and for a moment she thinks she imagined it—”hypnagogic auditory hallucination,” whispers the afterimage of a flashcard. But there it is again, this time with a groan, and a lurch of the bus to the right. The bus slows and stops at an odd angle to the curb. The driver leans out of his chair with a pained look on his face. He takes a faltering step and slumps to the floor. She stares as the scene unfolds in slow motion.

His head strikes the corrugated rubber floor and the thump hits her like a punch. All of a sudden she is out of her seat and standing over the driver. “ABC,” she thinks, remembering what she had been taught. “Airway, Breathing, Circulation.” She kneels, then jumps back up and slams the column shifter into park. “Sir, sir, can you hear me?” she asks, shaking his shoulder. He nods and gives a weak “yes.”  A – ok.  B – ok. She holds two fingers to the side of his neck and pauses. Beneath her fingertips she feels rapid and irregular pressure. C – bad. Glancing up at the man’s face, she sees that his eyes have closed and she tries to rouse him with another shake. This time there is no response. Holding her ear close above his mouth, she hears nothing. A – bad. B – bad. C – bad.

In a flash, her phone is out of her pocket on the floor beside her, calling 911 on speakerphone, doing chest compressions. “911, what is your emergency?” She explains who she is and where she is, then “Middle-aged male with likely MI, I’m doing CPR now.”

The voice on the phone stays with her and listens as she pumps his heart and acts as a bellows.  Each push forces a little air from both of them. After every thirty compressions, she presses her mouth over his and holds his nose. She tastes nicotine and coffee before she blows air into his lungs. Then the space around them is consumed by sirens and the bus is filled with blue and red light. Two emergency medical technicians in matching uniforms pull her up and away. One puts a mask over the man’s face, and the second presses hard and fast on the spot she has already bruised.

In the ambulance, lines are placed in veins, and boluses of fluid and medication pushed through them. Her patient has a pulse. “Sorry doctor,” says the EMT turning to face her. “I didn’t see your coat before.” She looks down and notices her jacket has fallen open and the collar of her short lab coat is showing. “Oh no, I’m not yet . . .” she blurts, but the EMT has already turned away. She leans back against the cool metal wall of the ambulance and drifts off to sleep.



NICHOLAS FEINBERG is a fourth year medical student at Columbia University College of Physicians and Surgeons expected to graduate May of 2017.


Spring 2017  |  Sections  |  Fiction

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