Fiction: Morphine and Simple Mercy

By M.F. Higgs

 

Each time Dr Edwards lost a patient on the operating table, it stayed with him. He remembered the exact moment, as sharp as a knife's edge.

First, he made the incision along the scalp, just under the hairline. Judging by the entry wound, the bullet would have entered the skull a few centimetres behind the right ear, piercing the lateral ventricle, and probably lodging somewhere within the cerebral cortex. Without time for a C.T. scan, there was no way to tell for definite. 

The patient was a large male, approximately twenty-five to thirty years old, and of African ethnicity. The nurse had induced a somewhat heavy dose of anaesthesia, keeping the patient on a constant IV drip.  There was, of course, always the risk of anaesthesia awareness—regaining consciousness during the operation— but in this type of surgery, having him fall into a long-term coma was the more pressing danger. 

What series of bad luck had put this guy here?

After he’d removed the muscle tissue, he bored four precise holes with the craniotome and then cut between the burr holes creating a removable section of the skull. There was a substantial amount of haemorrhaging beneath the bone flap.  He met the nurse's eyes and held his stare. With a moment of hesitation, she understood and, with a shaky hand, inserted the surgical drain to clear the blood. The girl was young, most probably just out of nursing college, and this was likely the first time she had assisted a neurosurgeon in the real world. 

They said you’d get used to the long shifts and late nights, but you never did.  And nights like this, nothing could prepare you for. Every second, a dance between life and death. Bullet wounds to the brain, especially, were nearly always fatal—a twenty per cent chance at best. Luckily, this bullet mainly appeared intact.  He’d been right about the location. Closing his eyes, he pulled down his face mask and took a deep breath. Extracting was always the most delicate part. 

Careful not to damage the hematoma, which swelled in the surrounding blood vessels, he separated the tissue and inserted the forceps, finding a grip on the bullet. 

Debussy played. Clair de Lune. The music looped in his mind during times like these. It helped him stay calm and settle his hands. He’d danced that piece at the Klein Foundation ball—it had taken nearly a year to rehearse the choreography. Accepting the centre of the dancefloor, Marlene, his wife, had shifted so elegantly in his arms that at times she felt like a kite soaring in the wind, and he was the rope tethering her to the ground. Still, as the waltz concluded, they had shared the applause equally.

Outside, past the blacked-out warehouse windows, rain howled in sheets. He could picture the nightclubs letting out the last of their pleasure-seekers, huddling together onto the slick, neon streets of Lambeth—streets littered with Campaign pamphlets from all the major political parties. A referendum had been called on whether Britain should remain in the European Union. It didn’t seem like a question that needed to be asked.

With the bloodied bullet removed, all that was left to do was reposition and secure the bone flap. The patient would need to be closely monitored, and God knows who’d be responsible for his aftercare, but for now, at least, he was stable. Dr Edward’s breath escaped in a long sigh, and relief flowed over him like a warm breeze. The nurse met his eyes again with a quick smile.

 He swore this would be the last time—my debt is paid. A backstreet surgery like this violated every ethical code in the book.

#

He crushed two tablets of Clonazepam on the hotel table and offered her a rolled-up note. She gladly accepted. They already shared a couple of tablets just after scrubbing up from surgery, but in powdered form, the pills had more effect and hit the bloodstream instantly. 

A study found the rate of drug abuse or addiction among physicians to be from thirty to a hundred times that of the general public. How else does anyone get through a double shift that runs from 4 pm till 8 am the next morning? That was just the norm, ask any post-grad physician. You develop a habit, Adderall to get you through the shift, and then Benzos or Xanax for coming down, or something bought off the street if you were at a push.

“So, I can’t keep calling you Dr Edwards all night, can I?” 

Her name was Lena. As he had guessed, she had just graduated from nursing college, which couldn’t have made her more than her early twenties—nearly half his age. 

“Unless you prefer that,” she smirked. “Bet you used to enjoy playing doctors and nurses as a kid, am I right?” 

Lena started explaining in a long-winded kind of way, how each of her parents had abandoned her after they divorced—they spent all their time arguing and trying to outdo each other, never giving a damn where she wound up. Between her rent and nursing college tuition fees, her bills were mounting, so she’d started serving in bars, mostly sleazy places, sports bars and the like, which led her to do a little dancing on the side. To look at her, you wouldn’t have thought it, not in the clothes she wore now. Her body was not the type that made much money dancing on the pole. She did have a pretty face though, child-like and blonde—the look a certain man would pay extra for.

“It’s Jonathon Edwards,” he told her. The name he happened to share with an Olympic triple-jump champion and, more unfortunately, a rather resolute 18th-century theologian who wrote a sermon named ‘Sinners in the Hands of an Angry God’. A line from the discourse stuck in his mind—all that wicked men may do to save themselves from Hell’s pains shall afford them nothing. A real light-hearted kind of character by all accounts. 

“One night,” Lena went on, “maybe I’d had a little too many shots—this one client wanted a more private experience. I knew the guy was a creep, but I thought, what the hell? I needed the cash, you know? So, I went to one of the backrooms with him. Then he started to get a little handsy.” 

After finishing the last of the powder on the tablet, Lena pushed the twenty-pound note into the hip pocket of her denim shorts. She made no attempt to conceal it. Under the shorts, she wore dark black tights and a matching black t-shirt with a smiley face logo. It made her look younger than she was. She wasn’t his type, not really, but right now he could not need her more. He hated himself for that.

“Which I could usually handle a bit of anyway,” Lena continued, “but the way he grabbed me felt different, like, not just touching but sort of clawing at me. And then when I pushed him away, he got even more aggressive and stuff.” 

Lena paused for a moment, choosing her words. “Well, then I was lucky, I guess, cause over the music, Maali—he owns the club—heard me screaming and all, and burst in the door. Can’t tell you what happened to the guy in the end, but the security busted him up pretty bad before they dragged him out the back.”

Dr Edwards knew Maali Warsame well. He’d met him a few years back. Maali had immigrated from somewhere in war-torn Somalia, a penniless immigrant turned kingpin by all accounts. Anyone who wanted to dip a toe in the South London criminal underworld had to go through Maali.

It’d started with a motorcycle casualty who had been rushed to the emergency room. The injuries to the casualty’s head were serious, but not inoperable. Dr Edwards went to work, and after a four-hour operation, which was touch and go by any standards, the patient was stabilised. He’d stayed in an induced coma for three weeks, during which his father, Maali Warsame, had sat at his bedside, inconsolable.  

A short while after the patient’s recovery and release, Maali visited Jonathon at his home. At the time, he hadn’t even thought to ask how he’d found his home address. Maali thanked him, sincerely, for saving his son and pressed a set of car keys into his palm as they shook goodbye. A brand-new Mercedes-Maybach was sitting in the driveway. Just the type of car he’d always been looking for, classy, expensive, but understated. He learned later how good a judge of a man’s desires Maali was.

#

Jonathon woke the next morning to find an empty bed and the afternoon sun glaring through the hotel’s half-closed curtains. He sat on the edge of the mattress and found his phone in the pocket of his crumpled trousers on the floor. Swiping the screen, he noticed three missed calls from his wife, one at 8.03 am, another at 8.50 am and the final one just over half an hour ago. He pressed the speed dial for voicemail and rubbed his groggy eyes as he held the phone to his ear.

“We had an appointment. The lawyer, remember? Jonathon, I need this settled—done. For God’s sake, you never have time for anything but yourself. All you need to do is sign the papers. Call me back. There might be some space for this afternoon.”

He rushed to the divorce lawyer’s office just before 2 pm, painfully aware of how crumpled his suit trousers and cotton shirt were. He craved a proper home shower, not another day in a lousy hotel, but his home wasn’t his anymore. A fact he was going to have to get used to. Still, he couldn’t bring himself to look for a new apartment. Hope is a talent like any other—and a poor man’s food.

The proceedings at the lawyers was a shit show, there was no two words about it. Despite his best attempts to start a conversation, Marlene had barely looked at him the entire time. She looked good today, though—healthy. Seeing that the degeneration hadn’t restarted was the most important thing, even if the part of her that loved him had died.

It started with the smallest things. A slurred word, a spilt glass, a stumble on the stairs. At her worst, she had become completely paretic—pins and needles that paralysed parts of her body, times when she would flush with a hot fever and collapse to the floor. Moments of disorientation and confusion, where she would stare blankly into space. 

With years of tests and experimental treatments, the specialist had narrowed the possible cause to an extremely rare, always life-changing, neurodegenerative disease called spongiform encephalopathy. Jonathon was somewhat familiar with the disease’s effects—they were similar to multiple sclerosis, except the onset was far more rapid. The prognosis was bleak. The total loss of motor function measured in mere years—five, maybe six. 

The divorce lawyer continued reading Marlene’s sanitised settlement agreement. The slightest hint of emotion, even in the form of a letter, was beyond his wife now. He was barely listening, and the lawyer knew fine well. Still, she continued—

… I think it’s time we face the truth. I can’t even remember any feelings I ever had for you. How did we ever work? It certainly isn’t working like this. I get that your job has you away a lot, all those long hours and hotel stays, but this can’t be how a marriage should be. Let’s steer clear of any legal trouble. I can’t go into the details here, but you know what I’m getting at…

Through the large plate-glass window of the lawyer's office, Jonathon watched a British Airways plane soaring low over the Shard, making a shallow descent to Heathrow. When did I last have a holiday? He couldn’t remember. Certainly, not one he’d gone on without Marlene.

#

The elevator doors opened at the towers 34^th floor. Light from the floor-to-ceiling windows glared off the dining table’s silverware and through the huge crystal chandeliers. He winced his eyes. The two oxycodone were doing little to dull the splitting pain in the back of his head. 

After a twelve-hour stint at the operating table, he’d filled out a quick prescription and taken it to the dispensary, where the pharmacist didn’t question him twice when he requested the pills. Perhaps they were too busy to check, but more likely, they were used to turning a blind eye to doctors filling out an emergency line for personal use. 

 The room was called the Ren—the Shard’s opulent ballroom dining suite, which came complete with private chefs. How much of this city did Maali own? Certainly, he had a few of London’s bankers and politicians in his back pocket. Maali sat in the chair nearest the window, picking at a plate of expensive food—Panna Cotta with a coulis the colour of blood orange. 

“Ah, my friend. Glad you could find some time to see me.” He gave his usual wide grin that had actually felt sincere at one point in time. “You look a little beat.” Maali dabbed at his mouth with an ivory-white napkin. “Sit. I will have the chef prepare you something.”

 Jonathon sat at the far side of the table. “I’m good.” He hadn’t eaten since the night before, but the pills were turning his stomach. “What’s so important?”

“Straight to business. I like that.” Maali gestured to the waiter with an impatient nod and the waiter cleared his plate immediately. “How did the meeting go with your wife? She's still upset about all that?”

“All that”, like it had been some minor inconvenience. Then he wondered how in hell Maali had known about the meeting. Maali raised an eyebrow as if anticipating the question. Best not to press the matter, he’d be only too happy to parade the scope of his power. 

“She’s more like a stranger these days. I keep thinking maybe the good times will come back to her, that she’ll remember. But to her, I’m just... whatever I’ve become.”

“People change, no?”

I certainly have, Jonathon thought. Maybe that’s exactly what Maali was getting at. “I signed the papers, so it’s done now.” 

A twinge of pain shot through the numbness. An image of Malene in the final stages of her condition came back to him. A time when the motor neuron degeneration had progressed significantly. The way she struggled to do simple things, move, talk, eat, and even fought to breathe at times. Her whole body would convulse, and he’d hold her—strong enough to stop the shakes but gentle enough as not to hurt. 

“I had to try. She’s better now because of what we did.” 

Maali nodded slowly. “That was completely up to you, my friend. But everything comes at a cost, no? Let me guess, you couldn’t help yourself but tell her.”

“I—I only told her enough.”

“Guilt is a gristly thing to stomach. I know this.”

“I never wanted anyone to be harmed.”

“You’re not a stupid man, Dr Edwards. You know my business, right, my friend?”

Maali was right—Jonathon knew and chose to turn a blind eye. They’d used a form of growth hormone in his wife’s treatment that is naturally secreted in the brain, abundant in kids and adolescents. There was no synthetic alternative, and harvesting it from live donors wasn’t exactly risk-free. Going through the proper medical channels wasn’t an option.

“This is partly why I asked you here,” Maali said, interrupting the silence. “We need you to carry out the surgery again.”

“Sorry, what?” 

“Don’t worry, you will be well compensated. It so happens that one of my, let’s say, political adversaries is becoming rather a nuisance. It’s all rather boring. A perverse game—criminals become celebrities, legislators turn a blind eye, the media tries to play god, and everyone still calls this a civilised society.” 

Maali stood from his chair, standing by the east-facing windows. He let out a long sigh as his gaze drifted across the cityscape. A lazy afternoon sun cast shadows from Canary Wharf's tall, glass buildings onto the narrow, cobbled streets of Old London. Those grey stone gentlemen’s clubs and smoky English taverns where Samuel Johnson, TS Eliot, Wordsworth and Keats dissected and stitched together the written word, prescribing joy and sorrow, life and death. Those same college campuses and dusty libraries that Jonathon had studied in. 

“Old England? It’s on life support, gasping for relevance,” Maali said, gesturing out towards the vista.

The last thing Jonathon needed was a speech. “How’s this my business?” 

“We need this politician of ours out of the way. His rise to power has become a problem for my importing business. And we can’t just turn around and kill him, no? That would be a little uncivilised. All you need is to inject him with the hormones like last time.”

“It’s not quite that straightforward. And even if I wanted to, I really can’t. It wasn't exactly planned.”

“Let us see what happens.” Maali grinned, his hands rising in a careless shrug. “We just want him a little, let’s say… a little confused.” 

“I mean—it's complicated.”

“Nonsense. You have done it before. What’s one more little favour, my friend?” Maali didn’t wait for a response. “The gears are already in motion. Our patient comes in every year or so for a facelift, where they put him under. Vanity is a sin, no? Then you carry out the procedure. A simple thing.”

Beads of sweat built up on Jonathon's side, soaking into the cotton. The drugs were making him feel light-headed and nauseous. “This is—”

“Perhaps you do not realise the situation you’re in. I am not asking. Say, the hospital was to find out about your out-of-hours operations. Quite the scandal, no? And for your wife to know the whole truth. This could all easily be arranged.”

Jonathon had nothing to say.

“I’ve booked a room for you.” Maali tossed a keycard on the table. “They’ve set it all up for you, how you like.”

#

After bathing her carefully, he carried her to the bedroom and sat her on the edge of the bed. Her whole body breathed—skin flushed red with curls of steam rising from her shoulders. Even sitting, she struggled to keep balanced and slumped over to her side. 

Sifting through the hangers along the clothes rail in the wardrobe, a sort of relief washed over him when Jonathan found it, like an addict searching for his last stash place. The ballroom dress, blue fading to black with neat silver trim, ruched and flared at the skirt. The dress was his wife’s favourite, the one she wore to the galas—the one she graced the ballroom with. 

Slowly, he straightened her up and began to dress her. She made no effort to speak, but her eyes remained fixed completely on his. The same turquoise eyes, like portals to a distant world, right there, almost as beautiful. 

He requested the song from the speaker and Debussy’s lamenting piano played the first soft notes of Clair de Lune. Lifting her, he rested his arms around her back and swayed her gently in time with the waltz. A single tear ran down his cheek as the symphony softly wept. Time seemed to stop, suspended, until his arms could hold her no longer. He laid her down and tucked the duvet around, then, lying beside her, ran his fingers through her still-damp hair. 

“Malene,” he whispered, “Do you remember? How on Sunday we’d take a bottle of wine up to Greenwich Park and watch the sunset fall over the city? How we’d just talk all night and dance under the starlight?” 

He placed a soft kiss on her forehead. “Like those stars, I drift apart a little each day, bit by bit. I will be yours as long as there is light in the universe—as long as the sky is above us—and longer still. Promise me …” 

His body curled onto hers, the heat rising from the sheets like a warm ray of sunlight. He whispered in her ear, “Yes, I know. I love you too. I want to leave this world. I want to come home. With you, it’s the closest I ever came to being happy.”

Lena began to stir, her fingers twitching, convulsions running through her body. It had been around two hours since he had administered the succinylcholine, and its effects were wearing off. 

He couldn’t tell how lucid she was—probably she was aware for the most part. But she never once mentioned anything that happened—that he was thankful for. In fact, he couldn’t imagine doing it with anyone else now. It was okay as long as she consented, right? He never meant to harm anyone.

#

The street lights on the A1 flashed past—a blurred, pulsing stream. Across the moors, the rolling hills of the Yorkshire dales were silhouetted against a sky touched silver by the last breath of daylight. Silver, the colour of weeping birch trees. He’d grown up next to such forests near his father’s hometown—the Birks of Aberfeldy. Up there, he’d secured a bunkhouse for a few weeks, just until he was certain Maali’s people weren’t on his back.   

He wouldn’t gamble with a healthy man’s life. Intentionally inflicting what essentially amounted to brain damage, that was a line he wouldn’t cross. Back in his university days, he was a man of morals, joining the protests when Maggie Thatcher introduced the poll tax, and marching at Hyde Park against the reformation of the Criminal Justice Bill. What had happened to him? The man who had studied medicine to make a better world. 

When his mother had passed, that was when he’d decided to become a doctor. She wasn’t even sixty years old. She’d died from a cardiac embolism, having been released from the hospital the day before—a simple operation, just anyone taking the time to assess her condition properly could have saved her life. He’d vowed never to let something like that happen again. Now, he had barely the strength to save himself.

He'd left the house, contents, and all the other stuff to Malene, contacting the lawyer that morning to make the arrangements. What cash he could, he withdrew from his savings accounts. All the meds, the care, the experimental stuff—it all cost a fortune. Even so, he somehow pulled together nearly fifty grand in cash. He was sure he’d find work somewhere in a medical practice or private healthcare once he was sure it was safe. He could sell the car, too. 

Lane assist and cruise control glided the huge Maybach through the night in near-total silence, and he felt relaxed for the first time since setting off. The A1 motorway wound through small villages and slumbering hills, bathed in the moon's gentle glow. He imagined that from above, it must look like a dark river swimming with headlights.  Leaning back and settling into the soft leather, he swiped the phone screen and pressed play on the voicemail. Just one more time, he needed to hear her voice. 

 

I’m okay, Jonathon. Please know that. All these doctor appointments and test after test, does any of it really matter? We have only so much time, and I want to live what little I have left in peace. They gave me an injection of some steroid or other just now. It’s helped in the past, for a short while anyway, but I think it does me more harm than good in the long run. I will refuse it next time if I can.

 Sometimes, if I try to hold something in my mind, with all my strength, I can just about remember. So, I’ve been repeating these thoughts over and over so as not to forget them. I wanted to leave this message for you while I have the chance. 

Thanks for taking care of me. It breaks me apart a little at a time, not being able to say these things to you without slurring my speech or forgetting mid-sentence. I couldn’t have made it this far without you, and there would have been no point in pushing on. I see you trying. You keep looking at me like I’m something to repair, but some things... they don’t get fixed. This is just me now... messy, tired, and human. 

I live in what little memories I have. They come and go like the rain, and I wouldn’t change a thing, not for all the time in the world.  

I’m happy, I really am. Is it so bad? Every time you hold me, I remember just what a miracle it is to be alive. I think it might have been just minutes ago you were in the room, but to me, it’s like an eternity without you. I see your smile, and it’s like meeting a long-lost friend all over again. I remember now. I’d lead you to the dancefloor, then find you when the night was over, and we’d drink champagne on the balcony. I loved those nights—I love you so much, always.

Promise me, Jonathon, you won’t lose yourself to this. When the time comes, let me go. For you to be happy is more important to me than anything.

 

Submerged in the light, a black Range Rover was trailing behind him—an unmarked police car, he guessed. He slowed, waiting for the vehicle to pass, but it stayed close, directly in the lane. He was sure he’d stayed under the speed limit. 

The Range Rover started to flash its headlights—they wanted him to pull over.

He waited for a lay-by and then slowed the car to a halt. It was probably some misunderstanding. From the rear-view mirror, he watched a police officer approaching the driver’s side through the blinding torchlight. 

Jonathon slid down the window. “Sorry, was I—” 

The officer clicked off his torch. Without a word, he handed over a phone. Jonathon put the receiver to his ear and listened. 

“Hello again, my friend.” The voice on the other end was Maali Warsame. “You didn’t think we’d track the car? Really, I’m disappointed you think so little of me. Might I suggest turning around and coming home?”

Home? 

Jonathon hadn’t been home in quite some time. Maybe that was the closest thing he had. He pressed his back against the cold leather seat, just searching for an escape route. The road stretched out before him—an empty promise. Where did he think he was running to anyway?  There was no way forward and no way back—only that small mercy to cling to. 

After the job was done, he hoped Lena would be in the hotel room waiting.

 

 

 

 

 

M.F. Higgs is an author from Edinburgh with a deep connection to the Highlands, having spent years exploring its landscapes, climbing Munros, and studying its rich folklore. He has published a few stories (sci-fi and realism) in several literary magazines.