Death and the Intern

The Delicate Art of Kneecapping – Blue Monday

Janwar will anaesthetize eight patients before he kills one.

This isn’t a probability; it will happen on Wednesday. The solution has been planned for a long time, planned before Janwar even applied to the placement at Civic. Janwar doesn’t know anything about his role. And he won’t until he has played it.

On Tuesday night, a man wearing a hooded sweatshirt holds a pungent dishtowel over Diego Acosta’s face while his partner smashes Diego in the knees with a bat. The two men then drag Diego behind an advertisement for MEC-brand dog backpacks, where they rifle through Diego’s pockets. They take his wallet and cellphone, although the theft is for show: later that night, the henchmen crush the cellphone and shred the cards from the wallet before they toss all the fragments into the Rideau Canal, not far from where a university student drowned himself a few months ago.

The henchmen do take the cash before they dispose of the wallet, however. Henching doesn’t attract the ascetic.

At the emergency room, the doctors say Diego is healthy aside from his fractured kneecaps, which is true, these thugs being professionals in the delicate art of kneecapping, among other body modifications both temporary and permanent. Diego’s knee surgery is scheduled for the next day.

Horace Louisseize supervises Janwar during Diego’s operation on Wednesday morning. As a medical student intern, Janwar is not allowed to perform anaesthesia unattended, so a senior staff member has to be present.

From the hallway, Janwar hears rubberized wheels squeak and Llewellyn Cadwaladr’s singsongy voice saying that a certain half-soaked fuck should watch where he’s going.

José Almeida rolls the anaesthesia cart into the OR, freshly filled at the dispensary.

Janwar draws 7 millilitres from a vial labelled “1% solution of lidocaine” into a syringe, enough for Diego’s 70 kilograms, followed by the appropriate amounts of fentanyl and propofol. He prepares another syringe of rocuronium and switches on the ventilator.

By then José has already departed to retrieve the materials that the surgeon, Victor Kovacs, and the attending, Karan Gill, need for surgery.

Rasheeda Mohammed is the scrub nurse assigned to the operation. Following Janwar’s instructions, she attaches the ECG leads, pulse ox, and BIS, and swabs Diego’s arm.

As Rasheeda performs her tasks, Janwar walks Diego through what is going to happen: Janwar will inject a mixture of drugs into Diego’s IV feed, and less than a minute after that, Diego will be out cold until the operation is over.

Janwar pats the BIS, a blue machine the size of a shoebox, and points at the display, which at that moment reads “97.” He explains that when he administers anaesthesia, Diego’s brain activity will slow and that number will drop, and once it drops enough, the surgeon will conduct the operation by peeling back the skin, drilling into the bone, and laying the latticework to brace Diego’s patellas as they heal. Janwar will watch the glowing number and adjust the IV drip to keep Diego unconscious, as well as monitor his vitals to make sure everything goes fine.

This is what Janwar says to Diego, and what Janwar believes—that everything will go fine.

Instead, everything goes fine according to the solution, which is not the same as going fine for Janwar, since Janwar does not come out of the solution looking good. And it’s definitely not the same as going fine for Diego, who doesn’t come out of the solution at all: the permanent removal of Diego is the solution.

Diego doesn’t know any more about the solution than Janwar does—although, being the problem, he does possess information concerning the series of events that have led to his forthcoming negation. He doesn’t flinch as the IV goes into his vein. Diego thinks the hospital is a safe space. But he is wrong. The hospital is a much less safe space for him than the street.

Rasheeda tapes the IV down. Janwar slides the first syringe into the port in the tubing and depresses the plunger.

Diego’s ECG spasms into the twisted party-streamer shape of torsades de pointes. Before any of the staff can intervene, the display flatlines.

Janwar shouts that Diego is in cardiac arrest and orders José to page for a crash cart.

José snatches up the intercom and makes the request, but by the time the cart thunders down the hallway and screeches around the corner, Janwar and Horace and Victor and Karan and Rasheeda and José all know Diego is not coming back.

But right now it’s Monday morning. Diego is still asleep in his own apartment. He is a consultant; he has no meetings scheduled. He can sleep in.

And Janwar is about to anaesthetize his first patient.