By Wyatt Hong

Of the 20 patients on my list, I saved Mr B for last. Mr B was not on comfort care, but "comfort-focused care," though there was much argument on what the phrase meant. For one, his situation was anything but comfortable. The man had catheters the size of boba straws sticking out of his neck and groin, not to mention the one in his penis. His arms were a polynesia of bruises from IV lines that blew. We fed him through a tube that went into his belly and pumped oxygen through a hole in his throat – you know, the kind they scare you with in anti-smoking commercials.

On the adjustable table by his bed was a whiteboard that he used, or used to use, to communicate with the nurses. Dude couldn't speak for the hole in his throat. I wasn't sure when was the last time he used it. Attached on top of the whiteboard was The Pain Scale with a green smiley face progressing to a red frown with tears. The skittish circle under "Worst Pain Possible" had hardened so as to become permanent.

The attendings from different services had different thoughts on Mr B. The transplant cardiologist Dr Lee, who ran the show in our hospital, dropped by each morning with his retinue of fellows and nurse practitioners and gave his daily two cents. Yesterday, he had suggested adding a fourth pressor to maintain Mr B's blood pressure.

The cardiac intensivist, Dr Gupta, who had trained under Dr Lee back in the day, had put up a small fight, saying whether this would be an escalation of care not compatible with the patient's goals of care.

"I mean, he's already on three." Dr Lee had said, his name and dual-degree embroidered in red cursive on his glacial white coat. "It's not going to hurt him."

"But really, we shouldn't go up any higher from the current dose." Dr Gupta had said, drawing a new line behind his original one, which had been drawn fresh yesterday.

"Let's see how he does," Dr Lee had nodded, staring past the removable sign on the glass door that read DO NOT RESUSCITATE. "Poor guy," he had added.

For the non-medical folks out there, pressors are like caffeine. They squeeze your arteries to shunt blood away from the nonessential parts toward the vital organs of the body. Mr B's toes were black from all the pressors he was on. The black line crept up a millimetre each day. They looked like the toes of a mummy.

Mr B was being mummified.

After rounding on my other patients, I stopped by Mr B's room, maintaining safe distance from the night nurse who was wiping his ass, in case she'd spot me and ask me to help her. His long, grey hair had him looking like Gandalf from The Lord of the Rings. He must have been as tall, taking up the entire length of the bed. Dude could've been a basketball player in his youth. Someone had pulled a blanket over his toes.

"You good Sebastian?" I cracked the door of the resident workroom and asked him with a thumbs-up.

"Yeah, go sleep." Sebastian knew the drill by now.

"Call me if you need anything." By which I meant, "Don't call unless someone dies," in which case he didn't have to because they announced the code blue overhead.

Sebastian, my intern, was a short, blonde kid with a German last name who could've made it in Hollywood if he were eight inches taller. He was the quiet type, didn't talk unless talked to, didn't go by Seb, or C-Bass, but only by Sebastian. In every way, his specialty, anaesthesia, fit him well. I don't think he was sociopathic enough to murder his patients, but I could see him taking leftover ketamine with him to shoot up at home, or underdosing on sedation during surgery for patients who gave him sass. Browsing through the little I recall from medical school, I guess schizoid personality was what he had. Or maybe, he was just shy, having to start residency in the intensive care unit. Maybe I was just like him when I started last year.

"When in doubt – " I tested him before the door closed.

"Google it." He finished my mantra.

At least Sebastian was starting to play along with my jokes once he realised I didn't give a fuck. I was in emergency medicine, a specialty for those who didn't really want to be doctors but wanted to raise their hands when the flight attendants called for one. I was only here to punch in hours for a required rotation. My only goal for the month was to get Sebastian to smile, to give me a real cheek-to-cheek smile.

I left Sebastian with his herd of COWs and headed to the call room. Boy was I getting good sleep these nights. The call room was a glorified closet with a bunk bed and an attached bathroom, but it was a matter of perspective. Stretching my legs under the scratchy blanket, the same kind they pulled over Mr B's feet, I imagined that I were flying first class on Emirates. If I had trouble falling asleep, I jerked off in my en-suite bathroom to choppy porn over poor cell reception because I didn't want to risk using the hospital Wi-Fi. Some nights, I'd take a hot shower, brush my teeth, taking the full three minutes like they teach you in school, and change into my spare underwear and socks. After a dab of Old Spice in each armpit, I'd smell like a million bucks: Mens sana in corpore sano, as written on the wall of my medical school gym.

I kept my pager under my pillow while I slept. The nurses were supposed to page Sebastian for most things, but some paged me straight for scut work like renewing restraints and cancelling expired orders. When the pager went off, I'd grope for the thing in the pitch blackness of my first class suite and hold it two inches from my face to read the message on the backlit strip, praying with all my heart and soul that it was not a new admission. Mr B rarely caused trouble overnight. For one, he was too zonked out to complain, and two, the nurses didn't really care anymore. I think the ones that got him were happy about the assignment, there being nothing much to do. If he crashed, we would just stand outside his room and watch the man go down. During midnight rounds, if we had one, Daniel the fellow would make a three-second job of Mr B.

"Anything?" he'd ask the nurse, his face buried in the tome of sign-outs that included the entire unit, the cardiology floor, then the consult patients in the general wards and the emergency room, pretty much anyone in the hospital with a heart.

"Same old. You know –"

The nurse's smile would go unnoticed by Daniel, who would be crab-walking onto the next patient.

One night, Mr B's dialysis line clotted and there was a big debate on whether we should throw in a new line. If we left him alone, he'd swell up like a balloon and drown in his own blood. Daniel was too scared to wake up Dr Gupta to ask him whether putting in a new line would be within the goals of care. Daniel was asking my advice on the matter when another patient had a v-fib arrest and kept dying on us after we shocked him back to life. It was hours after they wheeled him off for ECMO that I remembered to check on Mr B.

"How's he doing?" I asked the nurse with the Karen haircut whom I had seen in the parking lot driving a Model X.

"The line's working again." She had this look of disappointment as if all the free EV chargers were taken. "Must be the prayers."

It was a running joke that Mr B's immortality was the work of God.

"Ey doc," Angelo, the Filipino nurse, hailed me when he saw me eyeballing Mr B.

Sebastian and I had switched over to days after a stretch of nights. There being two day teams, our list had half the number of patients, but the work was busier due to morning rounds and calls from consultants. We had inherited two rocks who would never leave the unit, a young black dude whom the hospital took off the transplant list after he was caught smoking meth in the bathroom and, of course, Mr B.

"Anything new?" I asked Angelo, a steaming cup of hospital coffee in my hand. For some reason, all the male nurses in the unit were Filipino. I'd been caught saying "Gracias" to them when I first started work. I'm Taiwanese American, grew up in Iowa where I was the token Chinese kid, and didn't know any better.

"No doc, but his wife is here today." Angelo raised his eyebrows.

"Really?" I hadn't met his wife, had no intention of meeting her. I looked around the unit, ready to turn the opposite direction if I spotted a woman in street clothes.

"She's crazy. She thinks God will save him." Angelo said.

"I heard," I replied in my meerkat stance.

"You know she brought in a minister."

"Mr Padilla?" This one was Hispanic.

"No, not him. A private one."

I had a lot of respect for Mr Padilla, liked the guy tremendously. He often joined us during codes in his black suit and monk collar, holding the bawling family member's hand outside the room while we mashed on the patient's chest. When we called the code, pronouncing the time of death, he'd do his special thing, the moment of silence, when he'd refer to the patient as "a man who loved and was loved by others". I liked hearing the alliteration in that phrase, the change in voice from the active to the passive. Only then would the lifeless dummy seem human, however briefly.

"Well, something must be working." I offered.

"It's crazy, doc. The poor guy."

Nurses were the ones who spent all day with Mr B, turning him every few hours to prevent ulcers, moistening his lips with a sponge stick, and, a new development, changing his bloody diaper, and this gave them the right to sway medical decisions. After all, some nurses like Dana had been here for decades, back when the attendings were residents. I'm sure she had dirt on each of them. Maybe they used to fuck in the call room – who knows what happened in the good old days? Point being, there was growing pressure from the nursing staff to pull the plug on Mr B, expressed each morning in the manner of a mother advising her grown-up son and sandwiched between phrases like "But what do I know, I've only been a nurse here for 30 years."

The question was whether Mr B was in pain, whether he was suffering, and whether we were prolonging his suffering. This was hard to know, given that the man couldn't speak nor write.

Personally, I wasn't sure whether I would want to be kept alive with my toes turning black and my gut sloughing off. At least we pumped him with enough fentanyl to keep him comfortable, or so I liked to believe. Another day, however foggy, might still be better than death. Something is better than nothing, right?

"What would you do?" I asked Sarah in bed one night. You weren't supposed to talk about your patients outside the hospital, even with your spouse – there was a law called HIPPA against it – but every doctor I knew did it. It was supposed to help prevent burnout, or "moral injury," the term in vogue these days.

"I don't know. I guess it's hard to decide when you're not in the situation yourself." She paused scrolling through Zillow, her face lit by the rectangle of her phone. "There is no chance?"

"There is no chance."

"Like zero chance."

"Zero chance."

"I don't know. I might still keep you plugged in. I mean, who knows?" She resumed scrolling.

I knew she loved me.

The day shifts were busier but easier on the body. Being awake in daylight and sleeping under the stars, you felt human and not like a chimpanzee in a psychology experiment. Unlike many residents who felt guilty about leaving the workroom to go eat, I always had my lunch outside, and I took Sebastian along with me. Working days had one major benefit of the cafeteria grill being open, and whatever moral injury I had suffered since getting up at five I swallowed down with curly fries doused in ketchup.

"I never get tired of these." I held one up the length of a garage door spring. Maury the grill guy had just lifted them out of the fryer when I had gotten in line. "How's the sandwich?

"Good." Sebastian had gotten his usual, a schoolboy's ham and cheese sandwich on white bread with dill pickles on the side: a serial killer's lunch, if you ask me.

"Where are you from Sebastian?" Residency was such that you could spend two weeks with a guy and have no idea of his basic demographic.

"Mm." He hurriedly swallowed the food in his mouth, his Adam's apple rising and falling with the bolus. "Minnesota. How about you?"

"Iowa. We're basically neighbours." I pointed out our common ground.

He nodded, acknowledging the fact, and went back to his sandwich. If he had asked, like some, where I was from from I'd have gone into how my parents moved to the states from Taiwan when I was three to study engineering at the University of Iowa – my dad liked to joke, in his usual self-deprecating manner, that his doctorate degree was namesake for his laundromat Dr Clean – that yes, I was Chinese, that Taiwan was China, only under democracy, et cetera. until, invariably, I'd be asked to recommend an authentic Thai restaurant nearby.

"What's your plan after residency?" I asked, this time waiting until his mouth was empty.

"I'm not sure yet. I'm considering doing a fellowship. How about you?"

"Planning to be a trophy husband."

"Smart man." He gave me a thin smile, just enough to let me know that he was playing along. "What does your wife do?"

"She works for Uber – like, for the company, not as a driver." I added in case he thought I was still joking. "You seeing someone?"

I had mistimed my question, prompting another chomping session. I knew how white bread stuck to the top of one's mouth. I could see his tongue working behind his lips.

"Yeah, I'm engaged." Sebastian wiped his mouth with a napkin. "My fiancée is back in Minnesota, finishing up medical school. She's applying this cycle."

"Oh word. What's she going into?"

"Paediatrics."

"Damn, I hope matches in LA."

"That'd be really nice." He nodded to himself as if it were someone else's life we were talking about.

Residency put your life on hold. For cases like Sebastian's, if his girl didn't match into a program in Los Angeles, they would have to be long distance for three, four years, if the relationship survived that long. Talk about my case: Sarah and I were married only on paper because our wedding had gotten cancelled due to COVID, and we still hadn't had one. Some surgical training programmes were seven years long. Three years of fellowship on top of that made a decade. You had to be a sociopath to go through such an odyssey. It wasted your youth. One could say it was a better way to waste your youth than another.

"Starbucks?" I offered.

"No thanks, I'm going to head back and work on my notes." I had never seen Sebastian drink coffee: another red flag. Perhaps he had made up the story about his fiancée.  Maybe he kept her corpse in his freezer.

"My man." I gave him a thumbs up. "Call me if you need anything."

A Venti iced mocha from the hospital Starbucks, my natural remedy against moral injury, in one hand, and my pager in the other, I went on my wellness walk, which made a square around the hospital campus. Being in the middle of Los Angeles, there was plenty to sightsee: people crushing margaritas at a French bistro in daylight, the security guards by the Chanel store in their Agent Smith shades, the celebrity-spotting furniture store with seat cushions the price of my rent. No one paid any attention to me in my scrubs and surgical mask, lowered past my chin to make room for the straw. I kept my badge hidden in my pocket in case I made it into a paparazzi shot.

I didn't think about anything in particular during my walks. I let the subconscious do its thing. It's debatable whether I was sleepwalking. Invariably, the laughter of the beautiful, margarita-crushing patrons would get me thinking on what these people did for a living and, conversely, what I was doing with my life. Quitting was always on my mind, but there was my medical school debt, then the fact that my parents would disown me though I was their only child. My Korean in-laws, who liked nothing about me other than my degree, would take their daughter back for sure. I was on a narrow plank across a gorge. I couldn't just step off. Last month, an intern in New York had jumped off a parking structure, giving a flicker of life to the metaphor.

"You'll get there," Sarah liked to tell me when these thoughts bubbled over my lips like crab foam. But what if once you got there you were no longer yourself? There was that famous tragedy of the Stanford neurosurgery resident who died of lung cancer during his seventh and last year of residency. It could be something else, if not cancer, then finally old age. Imagining myself at seventy was as difficult as imagining Mr B at 30, but I'd get there eventually. One day, some young doctor would be standing over me, coffee in his hand, and asking the nurse, "Anything new?"

Some afternoons, Dr Gupta stopped by the workroom to give a lecture, to the dismay of the residents who had to feign enthusiasm and listen to him say "essentially" a hundred times.

BRIDGE

Dr Gupta was writing in the corner of the whiteboard when I opened the door, panting from running back to the hospital from my walk after getting Sebastian's text.

LEAST INVASIVE  --------------------------------- MOST INVASIVE

He wrote on either end of the board then drew a horizontal line across it as I sat down next to Sebastian, sweat beading under my scrubs. I figured Dr Gupta was giving a talk on bridge therapies for heart transplant.

"Can someone give me examples of the least invasive therapies?"

"Milrinone." Jason, the sister team resident, volunteered. Jason was an internal medicine resident gunning to be a cardiologist. He reminded me of the boy scout in the Pixar movie Up, and I hated it when the nurses got us confused.

"Good. What else?" Dr Gupta chucked his marker and tried a new one which was worse than the first.

"Dobutamine," Jason volunteered again.

"Good." Dr Gupta said. "Essentially, all inotropes, pressors, the medical therapy we use to temporise the failing heart. Now what are examples of the most invasive therapies?"

"ECMO." Jason again.

"And what does ECMO stand for?"

"Extra-corporeal membrane oxygenation." Again, Jason.

"Yes, ECMO is essentially cardio-pulmonary bypass." Dr Gupta tried a third marker then went back to the first one. "There are two kinds of ECMO." He drew a toddler's diagram of the heart and lungs and went on to describe the differences between V-V ECMO and V-A ECMO, while a food coma, untouched by the 150mg of caffeine in my mocha, weighed down my eyelids.

"Now, there is all this in the middle." He pointed at the blank space on the board. "Who can tell me some examples? Someone other than –"

He left his sentence unfinished, which showed that no attending really cared enough to remember your name even if you answered all his questions right.

"Impella," I volunteered when the silence got unbearable.

"Someone other than – I'm sorry. Yes, good." Dr Gupta wrote VENTRICULAR ASSIST DEVICES to the left of ECMO.  "An Impella device is essentially a pump that we thread into the left ventricle that sucks blood from its proximal end and pumps it out the distal end toward the systemic circulation. Now, the Impella device is supposed to stay in for a week or two, a month maximum even in extenuating circumstances per FDA approval. The issue is, what happens if we put one in and the patient no longer is a candidate for heart transplant?"

"We get Mr B," I answered.

"Essentially." He turned from the board towards us. "We get the case of Mr B."

From what I know, Mr B had been walky-talky when he arrived in the unit. Sure, his heart barely pumped, but it wasn't anything some inotrope whipping couldn't fix. Looking at notes from months ago, he had declined the first heart that became available out of religious reasons because his wife had had a bad premonition about the donor who had died from fentanyl overdose. A week after that, his heart took another hit, an inferior MI, and couldn't take the whipping anymore. Like a Dostoevskyan mare in extremis, it bent over and didn't budge. It was during this time that the Impella device was placed. The problem was that Mr B, like the poor mare, never came to. The neurology team thought this was from anoxic brain injury from his cardiogenic shock, but when they scanned his brain, they found innumerable embolic strokes. Mr B was taken off the transplant list. All this had happened in June: the thing had been whirling in there for two months now.

"Remember that all these therapies are bridges to the definitive treatment, which is, essentially, a new heart. None of it will ever fix the underlying pathology. Unfortunately, for Mr B, the bridge leads nowhere," Dr Gupta concluded and capped his marker.

I imagined a computerised scene in The Legend of Zelda: an infinite, gravity-defying bridge that extended from a marshy edge of the fantasy world, the materials assembling themselves from thin air under your feet as you ran, like an airplane's trajectory across a simulated globe on the in-flight screen, except that the arch never ended.

Before signing out to the night team, I paused by Mr B's room and stood there listening to the beeping monitors.

"Doesn't this remind you of Interstellar?" I hummed the beginning of Hans Zimmer's soundtrack for Sebastian.

"I actually haven't watched it. I heard it's good." Another red flag.

"It's the best movie ever. You need to watch it tonight."

I imagined that we were on a spaceship, approaching a wormhole that would take us to the opposite end of the universe. You could almost hear the whirl of the Impella in his heart.

Mr B was on an eternal flight.

My 80-hour work week had the issue of bleeding into my time at home. I'd be in bed, exhausted and ready to fall asleep, but my brain would still be spinning like a playground merry-go-round just abandoned, random events from the day popping in and out of my vision. The more I tried not to think about it, the more I was thinking about it. Could you believe it – I would even simulate codes in my head. All this against my will. I'd be standing at the foot of the bed running the code, Angelo and Sebastian in line for CPR, Dana screaming out "15 seconds till pulse check!" What was the rhythm on the monitor? Wide-complex. Fast. Yes, that was V-tach. "Charge it up, baby!" I yelled to Maury the grill guy by the defibrillator. "Clear!" The body jerked like a rag doll. "Continue CPR!" I yelled at Angelo.

"Honey?" It was Sarah.

"Yeah?"

"Are you listening?" I was in my room. I was lying in bed next to Sarah. "Have you thought about the San Diego trip?" she asked.

"What San Diego trip?"

"Remember I told you? The trip with my parents?"

"When is that?"

"Next weekend, when you're done with this rotation."

"I see." That meant I had already spent three weeks in the unit. 'The days are long but the years are short,' my seniors liked to say, which seemed to me the worst way to grow old.

"So you're okay with it?" She paused scrolling on Zillow and looked at me.

"Yeah, sure." This was my only golden weekend, equivalent to a civilian's normal weekend, before I had to return to the emergency room for another stretch of nights.

"Ok, I'll tell mum."

Sarah's parents were heavily involved in our relationship. This I should've known before marrying a Korean girl. After their grandchild hopes got dashed – Sarah was on my side on this matter, at least not until I finished residency – their newest involvement was real estate. They wanted Sarah to be a homeowner. Mortgage rates were at a historical low due to COVID, they said. This was the golden hour. They could chip in half of the downpayment. The other half would, of course, come from my parents. I told Sarah this wasn't how things were done in America. In America, one's parent gave birth to you and left you to do drugs. If you somehow made it to college, or props to you, medical school, they didn't pay a zit of your tuition. Your choice, your debt – this was the American way. To be frank, my parents didn't have that kind of cash lying around. What little they had saved from ironing shirts and altering sleeves they had spent on our wedding, which too, is paid by one's parents in Korea.

Which is to say, I should have had Korean parents.

I closed my eyes again. I listened to Mr Padilla's calming voice. He was speaking over the dead body, a man who was friend and family to many, who loved and was loved by others. I draped a blanket over the man's caved chest. I took the moment of silence.

"He's pretty lucid today." A traveller nurse – I didn't know her name – said when Sebastian and I were eyeballing Mr B before rounds. Many older nurses, pretty much everyone except Dana, had quit during the pandemic, creating a market for travelers who bounced across the country for short-term gigs and made bank. Moving every few months probably had its downsides, including having to feel like the new kid at school each time, but I guess the money was worth it. This particular one was wearing scrubs so tight they looked like yoga pants.

"Yeah?" I slowly made my way toward the head of the bed, ducking below IV lines like Vincent Cassel in Ocean's Twelve. There was barely any room to stand among the various pumps and monitors, each beeping at a different register. Through the blinded window behind the bed, I made out the mansion-studded Hollywood Hills, glittering in the sunrise ricocheting off infinity pools.

I gently pushed the Impella controller to the side, taking care that the power cord not come unplugged. Dr Gupta had said the thing only had an hour of backup battery, which was probably dead by now. At the head of the bed, I heard his ventilator-assisted breaths, as regular as a hydraulic press in a Tesla factory, or rather, the steam iron my mom used to press across miles of shirts that was lullaby to my five-year-old ears.

Come to think of it, I had never been this close to Mr B.

His eyes were open. They were the lightest shade of blue. They were the prettiest things in the room.

"Hi Mr Bailey, how are you doing?" I yelled. I had quickly learned to assume all old people were deaf.

He made a gasping sound as his breath escaped from the hole in his throat. He pointed his trembling hand at the whiteboard on the side table.

"You want the whiteboard?" I yelled louder. I wanted to get across the rift.

More gasping sounds.

Sebastian squeezed toward the other side of the bed and handed him the board with The Pain Scale then held it by his chest after seeing Mr B didn't have enough strength to hold it. Sebastian placed a marker between Mr B's fingers.

what is

Thankfully, the marker worked. We waited patiently. These were his last words across the rift, before he finally crossed over to the other side. I finished the sentence in my head: the meaning of all this.

His arm dropped after finishing the sentence, drawing a blue line on the blanket.

"What is alo?" I read out loud his will.

"That's so funny. I was just talking to Christy about it." The traveller laughed. "It's a yoga apparel store. It's the new Lululemon."

"It's a yoga store." Sebastian yelled at Mr B.

Mr B had closed his eyes. I thought I saw him smile ever so slightly. I checked his pulse under my finger. It was there, slow and thready, like ripples at the edge of a marsh. I kept my finger on it.

"Do you know what yoga is?" Sebastian yelled again.

It was still there. I looked over at Sebastian. Sebastian was smiling cheek to cheek.

All of us were smiling as we held onto the bridge.

_____