The revised prologue

PROLOGUE

24th December, 2000. Somewhere in London.

The on-call bleep, lying on the table just across from where i am sitting, has just gone off. I check my watch and I notice that it’s 9:08pm.I can still hear the footsteps of my colleague, whose shift had just ended 8minutes ago, walking down the corridor towards the lift. He has just handed over a patient who is ‘waiting to be cleared by the medics’ and as I look at the number that is flashing across the screen of my bleep, I am beginning to think that this is going to be another very busy night.

It is Christmas Eve again and as always it was very easy for me to arrange to be on-call. Most of my colleagues always wonder why I like to work on Christmas Eve but I find it difficult to explain to them that I just have to be working tonight. It’s something that just has to be because it was on a night like this, so many years ago that Tanya died. Tanya, the lovely half-Russian girl who loved me had killed herself on Christmas Eve.

I try not to think of it; I tell myself that time would ease the feeling of guilt but my soul remains restless and nothing I do seems to be enough to pacify her spirit that torments my soul. If only I had fulfilled my promises to her. If only I had ignored my own self-pity and told her the words that she so longed to hear from my lips; If only I could turn back the hands of time. But I too was young and so very foolish. And now the mistakes of my youth will live with me forever…


I was feeling cold on the last night I saw Tanya alive. Even though it was early spring, I remember a cold chill come over me as I had stepped out of the bus that had brought me on the twelve hours trip to Pyatigorsk, the Russian town, which is located on the foothills of the Caucasus Mountains, where she was studying English and German at the Pedagogic University. I had come in from Rostov-On-Don, the city where I was a second year medical student.

But as I remember that night, I am no longer sure if it was really the weather that was cold or if it was the cold breeze that blows over me whenever I think of that night. I have relived that night so many times in my mind and I know that there is so many things that I could have made to happen differently. I could have stopped her from killing herself. But I didn’t.

The taxi I took from the bus station had stopped me in front of her hostel, which is located just off Kalinin Avenue. I had gone up to her room on the third floor of the hostel and she had been alone that night. As she opened the front door, I first noticed that she had a bandage tied around her left arm and it was stained with blood. This meant that she had cut herself again.

Tanya had once told me that she cuts herself as a distraction from the inner pains. She said that physical pain is a lot more bearable than 'the thing' that she felt inside and that whenever she cuts herself, it feels as if ‘something is released and the pain is bled away in the blood’.After I saw the blood-stained bandage, I then noticed her eyes. And I knew that something had gone irredeemably wrong. I could not quite define why I felt that way, but I sensed something and it sent a chill down my spine.

It was also then that I knew that I had lost Tanya and that the person who stood in front of me was a total stranger-a cold life-form that was bereft of life.I could sense no more that hope, which had sparkled in her eyes, almost a life time earlier, when we had taken long walks through the romantic green avenues of Gorky Park, where we fed the squirrels and discovered a desire for each other that seemed so pure and so innocent. A desire that roused her to make the promise of love to me, after our lips had brushed in our first shared kiss, under the shower of the water-fountain as the music of Ala Pugachova had played so softly in the background.

I remember how we had gotten drunk in each others laughter as we watched other young lovers, walking by hand-in-hand with no cares in the world, whispering foolishness into each others ears. I remember the lovely sparkle in her eyes as she had asked me about how comes love has the power to make children out of adults and had then started laughing out of the joy of just having me there with her at that moment…

But those same eyes were now lifeless as they stared back at me on that night in Pyatigorsk. They had been staring inwards and had looked so frightened by what they were seeing. And when I had asked her what was happening to her, she had met my questions with the ghost of a smile and then started to respond in monotones; giving away very little and yet…and yet I knew that she was screaming out to me for help. But what she wanted of me I could not give to her because my life was so messed up at the time.

Later that evening, I had walked out of her hostel and into the cold Pyatigorsk night, thinking of the haunting smile that had lingered on her lips as she had shut the door of her room, quietly behind me. And as I walked into the night, I knew that I should not have left her alone.

When I came back to Pyatigorsk four weeks later it was already too late. I was told that she had packed her bags in the week of my previous visit and had left town. And after that nobody-not even her babushka-knew where she had disappeared to.

Eight months later, babushka had come to my hostel and informed me that Tanya had been found by some strangers. They said that she had been lying in the snow and was slowly bleeding to death from a deep cut on her left wrist. The strangers had called an ambulance, but by the time the ambulance arrived, she had lost too much blood and had died a few minutes later, in the early hours of Christmas morning. They say that before she died, she had kept on repeating one strange name, which babushka says sounded like the name ‘Kasi’. She had kept on repeating that name as she bled out her pain and then finally became still in death…


“Hello, it’s the duty Doctor here. Did you bleep me just now?”
“Yes. Is that Kasi?”
“Yes…”
“Did your colleague tell you about the patient in the A&E?
“Yes…”
“She’s been medically cleared”
“Okay, see you in a bit then…”

I have just stepped out of the long corridor of the main building and I have walked into the drizzling rain. I am walking briskly across the well-lit hospital car park and I notice that an ambulance has stopped in front of the large A&E building. As I approach the building, the back door of the ambulance is flung open and two paramedics have jumped out and are trying to lift out a patient who is lying on a stretcher. A very tall black man, wearing the green porters’ uniform, has wheeled out a hospital trolley up to the back of the ambulance, and the paramedics have hoisted the patient onto the trolley.

A male nurse who has just come out of the A&E building has been handed over a drip bag with an IV-line running into the right arm of the patient on the stretcher and as I pass by, I notice that the patient is a pale-faced middle aged white woman and she seems to be in a lot of pain.
I have stepped into the warm brightly lit reception hall of the A&E and I notice that it is crowded as always. A scruffy looking white man, whose offensive smell of alcohol can be smelled from the entrance, is talking at the top of his voice to a middle aged Asian man in a Sikhs turban. The unfolding commotion is disrupting the long queue of people, who had been patiently waiting for their turns to be attended to by the elderly female reception clerk. She was was now standing behind the glass security panel and looked quite flustered by the commotion.

‘Join the bloody line…!” The man in the turban is shouting at the disheveled gentleman.
‘No, you go back to your country you bloody paki!’

I notice that at the far end of the hall, two police men are standing next to a large black man in handcuffs. The man in handcuffs seems to have a swollen left eye and I can see what appear to be blood stains on the left side of his torn white shirt. The police men are talking among themselves and it looks like they are going to intervene in the unfolding commotion.
“Kasi…!” I hear the familiar voice of Kate, the Psychiatry Liaison nurse, calling me from behind and I turn to see her coming towards me, carrying some papers in her hands.

We have now walked into the restricted area together and have closed the reinforced glass doors behind us, shutting out the noise in the waiting area.
“Can you tell me a little bit more about the patient?”
“She is a sixteen year old girl with a recent impulsive paracetamol overdose”
“Has she been medically cleared?”
“Yes, she took twenty tablets and her bloods have come back okay…”
“Is she known to our services?”
“This is the second time she is presenting in the last few months. She has a past history of self-harming and attention-seeking behaviour, basically another PD-in-the-making…”

I winced when she described the behaviour as ‘attention-seeking’. A lot of the staff, working in the front-line services, has come to dislike the personality-disordered patients or the PD’s as they are called. These patients have been much traumatized in their childhoods are now finding it a difficult to cope with the challenges of interpersonal relationships. It is as if their feelings of emptiness and frustration are such that even the staffs, who work with them, eventually end up feeling emotionally drained from the realization that their lives are too complicated to really sort out.
“There she is over there…”

The person she is pointing out to me is a young girl of what looks like a mixed African-Caucasian racial background, possibly Asian. I notice, from her long legs that are pulled in under her chair, that she is quite tall for a sixteen year old. I suppose it’s her very slim frame, of somebody who has been starving herself of food that makes her to appear a lot taller than she really is. She is seated on a blue plastic chair with her head bowed and her long black hair is cascading over her slender fingers that are holding up her head.

As I approach, I can hear the sound of sobbing coming from her. I have checked the name on the case-note, which the liaison nurse has just handed over to me.
“Hello…” I say as she raises her head and looks from me to the nurse. Her face is slender and beautiful and her large brown eyes look so puffed up and tired…
“Amina, this is the duty doctor…”the nurse says“…Kasi, I really have a lot of work to do. Can I leave her with you?”
“You know what the policy is about male staff needing chaperones…I’m sorry”
“I’m Dr Obieze…” I say, addressing the young lady
“…I am the Psychiatrist-on-call and I have been asked to come and talk with you. Is that okay?”
“Yes”
“Can we go to the consulting room over there?”She is nodding and has slowly gotten up from her chair. She is now following me to the adjoining consulting room and the nurse is walking just behind us.
“Please sit down….” I say offering her a seat and deciding to wait for her to settle down a bit, but she remains standing.
“I know it must be difficult for you, but please sit down and let’s see how we can help you…”
“Amina sit down and stop crying so that the Doctor can ask you some questions”

She has decided to sit down, but her sobbing is not abating. The tears continue to stream down from her swollen eyes and I notice that the front of her sweat-shirt is already soaked in tears. I am reaching for the box of tissues on the table next to her.
“Here, have a tissue, okay and maybe you can tell me why you are crying…”
“I want to die and you cannot help me!”!” she declares and starts to sob again.

I have picked up her notes to flick through and have decided to allow her to cry a bit more. I notice that the nurse is glancing at her watch, but I am ignoring her as I flick through Amina’s notes, checking for any significant events in her life that may have been documented. She has already been here before and it is important for me to have an understanding of what her underlying psychological make-up is. I am reading that she was abandoned by her single-parent mother and then adopted by a middle-aged couple. She was then sexually abused by her adoptive father and has since been living in one care home after another for the past eight years. Poor girl.

What really can I do for her? What will my mere words do that will erase the stained slates of her troubled soul? Can I offer her anything that will give her a new beginning and make her learn to trust life again? I am feeling frustration already and I have not even started to talk to her. I am watching her sob and I see how her whole body heaves up and down in fits of pain from her unhealing life wounds.

“My boyfriend has just left me….” She says in-between sobs and starts to wipe her puffed up eyes with the fragmenting tissue-a metaphor for her life-that have now become so soaked with the streams of her unending tears.
“Here, have another one….”I say offering her another tissue.

I am watching her and as always I hear Tanya’s voice calling my name, crying out to me to save her.
What do you want me to do Tanya, that will be enough for you to set me free…?

Amina is groaning in emotional pain and I can hear the words of her unvoiced cry. I can hear her reaching out to me for help, but I am feeling so very powerless before her.
“I am here to help you…”