Time of Death

The last thing I did as Dr. Asha Iyer was lose an argument with my own heart.

It had been a bad night even by the standards of an A&E department that measured its nights in codes. A coach went off a flyover in the rain, and the ones who lived came to us all at once, the way disasters always arrive, in a single wave that does not care that you are one doctor with two hands and a junior who has been awake exactly as long as you have. I had been on for eighteen hours, which the trust would later call a clinical incident and at the time called a Tuesday. I want that on the record, because if there had been a coroner, the coroner would have written it down as the cause, and the coroner would have been right.

I remember a man with a chest like a stoved barrel, and a girl with a femur where her shin should have been, and the particular grey of a face that is about to stop being a face and become a problem. I remember saying the things you say. I remember the clock, because in my work you are always watching the clock, you live by it, you call the time of other people's deaths off it in a flat voice while your hands keep working as though the time were merely a suggestion.

What I do not remember is deciding to fall down.

There was a sound in my ears like a tide coming in. There was a great soft pressure behind my breastbone, almost gentle, the way a thing can be gentle that is also going to kill you. I had spent twelve years learning to read that pressure in other people. I knew exactly what it was. I had time, in the half second the world allowed me, to be furious about the irony, and then to think of the patient in bay four whose bloods I had not chased, and then the floor came up like an old friend and took me.

I did not think of my mother, or a beach, or a white light. I thought of bay four. That is the kind of doctor I was. That is the whole of my sad little eulogy, and given the choice I would have cut it shorter.

You should know that I had no one waiting at home, because I never went home. I had a flat near the end of a Tube line I used as a place to keep my second pair of shoes and a kettle I rarely had the energy to switch on for more than one cup of tea before sleep took me sideways. I had a rota, and the rota had me, and somewhere along the way the two of us agreed that I was not a person, I was a function, a thing the hospital ran the way you run a tap. When the function failed, it would simply be replaced, and the tap would run on. Nobody had ever told me to stop. I decided that meant nobody was allowed to. I made my peace with being used up the way you make peace with a diagnosis you have given up treating, and I called it dedication, and it killed me at thirty-four on a floor I had mopped grateful patients off of for twelve years. Hold onto that. It comes back wearing a kinder face. They always do.

Time of death, I thought, with the last working corner of a brain that had stopped getting blood. Time of death.

And then I was choking.

Airway. Breathing. Circulation. You are handed an order and you hold it, and on a bad night the order holds you. First there was no body. Then there was a body, and it was wrong, it was the wrong size and the wrong age and full of water, and it was drowning. Then there was cold, the kind of cold that is its own emergency, the kind that shuts a body down faster than the water can. Then there was the river.

I did not know it was a river. I knew it was water, moving, dark, with a current that had already decided where it wanted me, and I knew that my chest was full and my limbs would not answer and that I had, by some arithmetic I had no time to do, gone from dying on a ward floor to dying in cold black water in a single seam of dark.

Here is what a doctor is. You can take everything from us, our sleep, our health, our names, the very body we were born into, and you will find that the training is the last thing to drown. It runs underneath the panic like a second nervous system. It does not ask permission and it does not care that nothing makes sense. It simply begins to work the problem, because the problem is the only language we have left.

Airway. There was water in mine.

I got an arm to move. It was not my arm, I understood that even then, it was thinner and weaker and it answered like a stranger's, but it moved, and I dragged it through the water, and the other one followed, and I did the thing the body of a drowning woman least wants to do, which is to stop fighting the current and let it carry me sideways toward the dark mass that had to be a bank. You cannot beat a river, and you do not have to. You only have to stop drowning long enough to find somewhere shallow.

My knee struck stone. I have never in my life been so grateful to be hurt.

I came up out of the Sarith, though I did not know its name yet, into rain. It was raining the way it rains in stories, in sheets, in a downpour that felt personal. I got my hands under me in cold mud and brought up what felt like a pint of river, kneeling in the reeds, the whole borrowed body shaking so hard I could hear my own teeth. And I did the thing I had done ten thousand times to other people and never once to myself. I checked my airway. I listened to my breathing, which was wet and ragged but moving. I put two fingers to the side of my own throat and found a pulse, fast and thready and frightened, and alive.

Airway. Breathing. Circulation. Three for three. Against all sense, against the floor I had died on, three for three.

It was a young throat. That was the first thing my fingers told me that my eyes had not. The skin was smooth and the jaw was small, and the hand I had pressed there was a girl's hand, slim, soft, a loose ring sliding on a thin finger, nails that had never once scrubbed in for theatre. I held that hand up in front of my face in the rain and looked at it for a long time.

"Okay," I said out loud, in a voice that was not mine, higher and clearer and rough now with river water. "Okay. We'll deal with that."

We'll deal with that is the most useful sentence in medicine. It means I have noticed the catastrophe, I have filed it, and I am not going to feel it until there is time, and there is never time. I had built an entire life out of that sentence. It turned out to work just as well on the apocalypse of waking up in a stranger's body as it did on a bleeding artery. Good to know.

I took stock head to foot, the way you take stock. The body was young, female, maybe early twenties, underweight in a way that worried me, soaked through a plain length of cotton sari-cloth that clung and gave no warmth at all, the wrong garment entirely for cold water, no shoes. Hypothermic, or fast on the road to it. Half drowned. And, I realised as feeling crept back into the slim cold limbs, deliberately so.

Because nobody walks into a river like this by accident. The reeds were trodden flat. There was a shawl snagged on a stake at the waterline behind me, folded, set down, not torn off. This body had come to the water on purpose. This body had walked in to stop, and the water had been about to oblige, and then I had arrived, like a relief shift nobody had called for, and started its heart beating toward the bank.

I did not have time to feel what that meant either. I filed it under the longest, oldest heading I have, the one labelled later.

Lights, then. Up the slope, swinging, and a voice calling a name into the rain, a name I did not know and would, within the minute, have to answer to.

"Lady Devar," the voice cried, cracked and old and terrified. "Lady Devar, oh, child, where are you, oh, gods, the river, not the river."

An old woman, coming down the bank with an oil lamp the rain kept trying to kill, the loose end of her sari clutched up out of the mud in one fist, moving too fast for her hips, the way you move when the person you are running toward is the last one you have left.

I am a doctor. I have spent my life walking toward the people who are calling for help and being the answer when there was one, and being the one who says I'm sorry, we did everything we could, when there was not. I did not know whose body this was. I did not know what a Lady Devar was, or what she had done, or why she had walked into a black river in the rain. I knew, the way I have always known, only the next correct action, which was to lift one cold borrowed hand toward the lamp so the frightened old woman would see I was still in the world.

"Here," I called, in the voice that was not mine. "I'm here. I'm alive."

I had no idea, yet, how much of a lie that was, or how true I was going to have to make it.

The old woman reached me and went down on her knees in the mud and gathered me against a chest that smelled of woodsmoke and sour milk and old fear, sobbing the name over and over, Lady Devar, Lady Devar, and over her shoulder, between the swinging lamp and the rain, I got my first proper look at the place I had drowned my way into.

A city, walled, on the far bank. Carved stone and lime-washed brick, steep, dark, climbing a hill in tiers toward a great pale temple lit from within at the crown of it, a spire rising off it into the rain. No glow of electric light anywhere, not one. Oil flames in niches, smeared by the wet. The shine of rain on stone steps that ran down to the water in long flights. And the smell, under the rain, of woodsmoke and tanneries and the particular sweetish rot I would have known anywhere, in any century, in any body.

I had smelled that rot in textbooks made flesh, in three outbreaks on two continents, in the worst nights of my old life. It is the smell of a great many sick people in a place with no sanitation. It is the smell of disease that has gotten into the water and the walls and is winning, in a place that drinks from a river the colour of the one I had just been pulled out of.

Wherever I was, whoever I was now, I had woken up in the middle of a plague. And I had woken up downstream of it.

The old woman pulled back to see my face, and whatever she found there made the relief drain out of her own. "Lady Devar," she whispered, and the joy was gone, replaced by something nearer to dread, "you came back wrong. Your eyes. Child, what walked out of that water?"

I did not have an answer she could survive. So I gave her the one true thing I had, in a dead woman's cadence, in a drowned girl's body, in the first minute of a life I had not asked for and was not going to waste.

"Take me to the sick," I said. "Now. While there's still time to count."