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  FIRST, DO NO HARM

  LEARNING THE RULES OF RESIDENCY

  BY P. F. MCGRAIL

  Edited By Rebecca Levine

  Copyright © 2020 Delora Publishing

  All rights reserved

  http://www.reddit.com/r/ByfelsDisciple

  Delora Publishing • Est. 1913

  FOREWORD

  This book was inspired by the people who said that it shouldn’t be written.

  In late 2019, Reddit’s NoSleep community had grown a liking for scary tales based around mysterious lists of rules. Inevitably, a vocal group of dissatisfied customers promised to solicit other free content-sharing sites unless the aspiring writers abandoned the notorious trope in exchange for less popular stories that they deemed superior.

  At that point, I knew I had to join the “list of rules” storytellers before the moment had passed.

  But what to write about? I knew better than attempting to force my own will on the plot. Instead, the demons in my head informed me that a group of characters – just around the corner, barely out of sight – was itching share its voice.

  The key to any horror story is the blending of the inexplicable with the familiar. That may seem an impossible task, which is part of its allure. The medical profession, on a scale that is larger by several orders of magnitude, is about living that impossibility every day. Nurses and doctors seek a greater understanding of human anatomy in order to defeat the natural inclinations of that anatomy, and even the most successful endeavors are nothing more than delaying an absolute inevitability.

  Why try?

  The answer, I think, is because of its inevitability. Death is guaranteed; life is not. There is no hope in stopping the fact that we will eventually face death, so its inexorable arrival cannot be a defeat. Finding purpose despite that fact is the ultimate triumph over a concept that would otherwise be considered invincible.

  The aforementioned demons frequently reveal themselves to be the echoes of a hundred people I listened to without hearing, and those voices return to me in the most unexpected ways. The collected strain of every hospital I’d ever visited found its voice when I thought about the list of rules, and the story revealed itself from there.

  We only get a moment before dicing Time invites us to exit stage left. The hope is to use that moment to create something with a longer lifespan that the brief interval we’ve been gifted.

  This book is about that hope and what we do with it.

  -P. F. McGrail

  February 2020

  TABLE OF CONTENTS

  Foreword

  Table of Contents

  Legal Notes

  Chapter One: Rules

  Chapter Two: Flesh

  Chapter Three: Heat

  Chapter Four: Pressure

  Chapter Five: Volume

  Chapter Six: Tao

  Chapter Seven: Electricity

  Chapter Eight: Again

  Chapter Nine: Trees

  Chapter Ten: Endurance

  Chapter Eleven: Undone

  Chapter Twelve: Storm

  Chapter Thirteen: Discomfort

  Chapter Fourteen: Honest

  Chapter Fifteen: Residency

  Other P. F. McGrail Books

  About the Author

  Can I Ask a Favor?

  LEGAL NOTES

  The stories and art contained herein are the intellectual property of the individual author and artist. No duplication may be made without the explicit consent of that author or artist.

  This book is dedicated to every nurse and every doctor

  who decided to spend their life saving ours.

  I should have been dead by now.

  Primum non nocere

  CHAPTER ONE:

  RULES

  TOC

  You probably think that all doctors are filthy rich, because I sure as hell did in the beginning. Eight years and a fistful of premature gray hairs later, I’m just a few hundred thousand dollars poorer than “broke.” That would matter if I had a family to provide for, but the long hours in med school have led to an end of my last relationship and a countdown on the shelf life of my ovaries.

  I was in a “take what I can get and be grateful” situation.

  So when St. Francis Hospital in Charleston, West Virginia offered me a position, I packed my sad life into three bags and sought opportunity in the hills of Appalachia. Nineteen of us started in July, and thirteen have since dropped out.

  I like to think of myself as the rat that wouldn’t drown.

  Some people broke inside after watching children die because they weren’t good enough doctors quite yet (everyone has to be a rookie at some point). It’s doubly hard when you have to inform the dead child’s parents, who then beg you to tell them different news, or scream that they want to die and to please just kill them with whatever drug takes away the pain.

  But most of my incoming class couldn’t handle the chief of medicine.

  Dr. Vivian Scritt is, without a doubt, the biggest bitch I’ve ever met.

  Now I know why.

  “Nineteen of you start today, and we’ve got a pool going with bets on how long each of you will last,” she told us on day one. “Don’t feel any pressure, folks. I’ve talked with each of you in private, and my expectations are very low.”

  She peered condescendingly over her thin spectacles, snorted, then turned around to walk away.

  “You should know when to follow me and when to stay away, because I’m not going to waste time explaining what you should figure out on your own.”

  We gawked at one another, all feeling weak and small, then scampered after her.

  I was last in line and felt out of place taking even that much.

  “You should have the list of expectations for St. Francis,” Dr. Scritt explained as she walked on, not bothering to look at us as she talked. “I printed eighteen sets of rules so that you would have to challenge one another for them, knowing that one of you would be left behind.”

  An icy cold settled in the pit of my stomach as I saw everyone look down at a list of rules that only I did not have.

  “If you cannot follow these rules, there will be no place for you in this hospital. It most likely means that you are unsuited to be a doctor and should consider a profession that demands a weaker mental aptitude.” At that, she turned around to face us all. “And if you think that I’m the type to give second chances after a mistake, you’re woefully underprepared for the world of medicine.” She stopped and looked at each of us in turn, apparently expecting a response that no one dared to offer.

  “Well,” she shot out in exasperation, “why are you standing here? People are dying. Get to work!”

  No one wanted to show me their list of rules, so I had to wait until one of my classmates died.

  It took nearly a week.

  I was working at 3:00 a. m. because I had only been on the clock for ten hours. I was rushing into another room so that a patient wouldn’t know I was Googling his symptoms (doctors do this far more than most people realize) when I saw Myron by himself in an O. R.

  I stopped immediately. “Myron?” I squeaked. “What the hell is that?”

  His arms were working furiously, but his back was turned toward me, so I couldn’t see what he was doing.

  Something felt wrong.

  Myron was the pick of our litter. He’d been top ten in his class at Johns Hopkins, and he never hesitated to remind us of that fact in exchange for answering the questions that we were too terrified to ask Dr. Scritt.

  I approached Myron carefully, not wanted to startle him. “We’re really busy right now, is there something you need help with?”

  He showed no outward signs that he had heard me. Instead, he kept pumping away furiously
at the task at hand.

  When I was five steps from him, I could see drops of blood flying over his shoulder.

  Which made no sense, since he had been alone in the room.

  “Myron?” I whispered, barely loudly enough to hear my own words.

  I crept around his left side, finally bringing the scene into full view.

  Myron’s abdomen was split from sternum to pelvis. His esophagus spilled out, and his stomach sat on the table. A nest of quivering small intestine led from the bottom of his stomach back into his shredded torso.

  Myron showed no outward signs of pain.

  He was too busy working.

  He clutched his own stomach tightly in his left hand, the folds squirting through his fingers like dough. His right hand moved furiously with a scalpel, sawing his organ into ribbons. Rivers of sweat poured down his forehead with the intensity of the effort.

  I tried to scream, but it only came out as a moan.

  That was enough to get Myron to notice me.

  Slowly, he raised his head. Slowly, he smiled.

  It was not a happy smile.

  With eye contact locked on me, he licked his lips, angrily stabbed a piece of his stomach, and lifted it to his mouth.

  He bit.

  He chewed.

  Then he lunged.

  But most people don’t know how to move with their innards splayed out for all the world to see, and this was his downfall. Myron’s tattered guts caught on the corner of the table, and he fell to the floor.

  Finally, he screamed.

  I had learned very early in my medical career that compartmentalization is indispensable. That instinct took over my brain in the moment, and I acted clinically.

  Myron was still grasping his scalpel with his right hand. I kicked it—hard—and it flew out of his hands.

  He stared at me and screeched.

  With his entrails still wrapped around the table, I figured my best option was retreat. I moved to the back of the room as a doctor and a janitor burst in.

  And in possibly the most shocking moment of the night, I realized that they were not shocked.

  Myron was anesthetized, subdued, and extracted within a minute of their arrival.

  For a moment, I was alone with a pool of blood and diced stomach lining.

  And something else.

  A sheet of paper lay on the floor, its corner just touching the edge of the creeping blood.

  Myron had dropped his list of rules.

  The practical part of my brain continued to drive me. I snatched the paper from the ground, then quickly exited the room, taking care to avoid the puddle.

  I didn’t want to leave any bloody footprints in my wake.

  I knew that I had to read the list as soon as I was able to find thirty uninterrupted seconds to myself. Three hours later, I had my opportunity, and ducked into a janitor’s closet. With a shaking, exhausted hand, I pulled the chain on a bare bulb, tried to ignore the noxious smell of leaking ammonia, and read.

  St. Francis Hospital Rules – Guidelines for new doctors

  1 – Never, under any circumstances, share your copy of the rules with anyone else.

  2 – If any other doctor displays erratic behavior, leave the area immediately. Do not make eye contact.

  3 – If any other doctor is approached or detained by someone in a janitor’s uniform, do not interfere. Never ask about that former doctor again.

  4 – Never touch any seemingly abandoned Reese’s Peanut Butter Cups. Those are Dr. Scritt’s favorite candy.

  5 – Any child that dies in St. Francis hospital MUST be cremated within 120 minutes of official time of death. If you suspect this rule has been broken, alert Dr. Scritt, and the hospital will be evacuated.

  6 – There is no Children’s Burn Unit at St. Francis hospital. If you find yourself there, continue walking until you return to familiar territory. This usually requires traveling in a straight line down the central hallway for 47 minutes. You will not reach a wall during that interval.

  7 – This rule is on a need-to-know basis.

  8 – A small quantity of sulfuric acid is kept in every room. This is ONLY intended for use on patients with severed spinal cords. If they attack, a hypodermic injection of H2SO4 into the cranium is the only way to subdue the subject.

  9 – The morgue must house at least 13 cadavers at all times.

  10 – If you find yourself on the hospital roof with no memory of how you got there, you have only two choices. Either wait for an extraction team to find you, or jump four stories to the sidewalk on Court Street.

  11 – If you see Room 1913, do not look directly at the numbers. Do not open the door. This is, by far, the most important rule.

  My heart stopped when the door opened.

  Dr. Scritt was staring at me. What little emotion shined through her exterior seemed to be surprise.

  We both stood, frozen, for five seconds of agonized silence.

  “Dr. Afelis,” she drawled gravely, “I’m shocked.” She stared down at the bloodstained list of rules in my hand.

  I reached for words. Any words, because literally any response would make me look less guilty than I did in that moment, staring up at my boss’s boss’s boss and saying nothing in my defense as she weighed my soul with her eyes.

  And I said nothing.

  “You took a list that wasn’t yours and were nowhere to be found after your coworker experienced such an unnatural incident.” Dr. Scritt huffed through her nose. “It seems that you’re willing to do the unthinkable in the name of getting what you need. And Myron couldn’t even follow the most important rule.” She clenched her teeth. “I had a four-year streak of predicting which incoming doctors will break the soonest. This will ruin my chances in the office pool.”

  The ghost of a smile graced her lips before she turned to leave.

  “Get to work, doctor. You’ve got three hours left on your shift, and those symptoms aren’t going to Google themselves.”

  I didn’t realize that I’d been holding my breath until I heard my own gasp for air.

  Shaking, I emerged from the janitor’s closet. I quickly stuffed the list of rules back into my pocket, reflecting on the fact that I had just achieved what might be considered an actual win.

  Perhaps, just maybe, I would keep my head above water at St. Francis after all.

  I turned to head down the hall when I stopped in my tracks.

  Everything was unfamiliar. What the hell had happened?

  I glanced all around. The design of the hallway was familiar, but everything was off. I could hear people talking in the rooms, but the immediate vicinity was devoid of all people but myself.

  Nothing made sense.

  Then I looked up.

  And I’ll be honest, I peed just a little when I read the sign.

  ST. FRANCIS HOSPITAL – CHILDREN’S BURN UNIT

  CHAPTER TWO:

  FLESH

  TOC

  Have you ever walked through a hallway where everyone knew that you didn’t belong?

  Imagine experiencing that in your own place of work.

  I kept my head down and my ears up as I traveled through the central corridor of the children’s burn unit of St. Francis Hospital.

  This hospital doesn’t have a children’s burn unit.

  Even though I passed by a sign that proudly claimed it had been donated by the “Friends of Crespwell Academy for Superb Children.”

  Nope. This place didn’t exist. I’d been working at St. Francis since July, and I knew it had not been here before.

  Maybe there was a wing that I had missed, right?

  But after advancing in a straight line for ten minutes, I knew that was nonsense. I didn’t go around any corners or encounter any walls. I certainly would have noticed a half-mile hallway if it were real.

  The people were… off, as well. There was a heavyset nurse with frizzy hair who stared with distrust as I passed. I encountered her three different times along the same corridor, desp
ite the fact that she could not possibly have moved ahead of me.

  Another nurse, frail and nervous seeming, tried to hand me a bag of blood. When I refused, she threw it angrily on the ground, where it splattered.

  I kept walking without looking back. My list of rules had been very clear about the fact that I was to continue in a straight line for 47 minutes if I found myself in this impossible place.

  I glanced down at my watch. It was 3:09 a. m., six minutes since I’d arrived in this impossible corner of hell.

  The employees became more insistent as I walked on.

  “Doctor!” a resident yelled at me as he jumped out of a room, “The patient is coding! We need you, stat!”

  I carefully avoided eye contact as I moved past him.

  “DOCTOR!” he screamed, “You’re killing her!”

  I wiped away a tear as I continued forward, ignoring the unholy scream that came from the room. I’d heard enough patients to know what a death wail sounds like, but I had no choice.

  A minute later, I came across a pool of standing blood. It reached across to both walls of the hallway and stretched twenty feet in front of me. As I watched, I could see it growing. A surly-looking man in a janitor’s uniform stood by, arms crossed, staring at me.

  I didn’t think he was actually a janitor.

  Without slowing down, I plodded through the blood. Squish, squish, squish.

  Damn. These were my favorite pair of Crocs.

  I entered a clear patch of hallway and checked my watch. It was 3:22; I’d been walking for nineteen minutes, thirteen longer than last I’d checked.

  The newfound quiet was more unnerving than the blood had been.

  Then, steadily, I could feel tension growing in the air. Imagine a strange man standing two inches behind you, who you can smell but not see, as his breath warms the back of your neck.