My mental health has been deteriorating rapidly over the past year, so I thought it would make me feel better to finally write some things down as the Prozac is beginning to have its effects. I’m not one to write a diary, but there are a few odd bits I’d wanted to keep a record of over these past few months.

Jesus, this feels so stupid, a grown man ranting to a piece of paper. Is this really necessary? Oh well, since I’ve just corrupted the virginity of this sheet with my scrawny, useless musings, I might as well continue.

I’m not an emo teenager, a hooligan, or a patient in a mental asylum. Just things I thought you might’ve expected upon hearing the word ‘Prozac’. Perhaps it might concern you even further to know that I’m a full-time cardiac surgeon, who performs risky open heart surgery on several vulnerable patients a day, often those barely hanging onto the edge of life, whose destinies are decided by my hands, who wouldn’t stand a chance of opening their eyes again if my scalpel so much as quivered. Oh, pardon me, it doesn’t concern you? Because it’s just a story, and you’re not bothered if someone dies, because people die all the time in stories?

Well I hate to say it, but you’re right, you sadistic bastard. Luckily (and unfortunately for your bloodthirsty desires), not many people die in this story, despite the mentally unstable author who some may have already deemed unfit to perform surgery. Drop your unfounded prejudices because I do my job well, I save their meaningless little lives day after day as I should, and I don’t go psycho on my patients for your sick entertainment. Although, I will admit that during things like open heart surgeries, it’s pretty hard not to start playing ‘what if?’ games with yourself. It’s not like I want to, and I certainly don’t have such thoughts every time, but any surgeon, firefighter, skydiving instructor, lifeguard or anyone who tends to gamble with lives in general, would be lying if they said they had no idea what I was talking about.

For example a few years ago, at the end of one cardiac transplant after all the final checks had been done and the guy’s chest was about to be sewn back together, I remember thinking to myself while everyone else was looking away momentarily, ‘what if I just scraped off a bit of tissue from the lining of his aorta? Just a little?’ Of course, I knew well enough what would happen, six years of medical school weren’t for nothing. After a day or two the pressure would rupture the big fat artery and blood would erupt from it, spilling into his chest cavity and simultaneously drown and bleed him to death. It would be very unlikely to lead back to my doing, since everyone in the room had agreed checks were all done and proper procedure had been followed – in addition to my perfect track record of zero patient deaths at the time. Perhaps it would be an interesting emotional experience too – my first death, I hadn’t yet experienced such a momentous event in my medical career, one which nearly all my fellow surgeons had been through. Just what would it be like to see his wife kneeling and weeping at my feet, and to feign sympathy for the terribly tragic loss that occurred as a result of the common complications of such a high risk procedure? Would it affect me?

My curiosity might’ve gotten the better of me that day, if I hadn’t decided that my flawless reputation was more important. And obviously, because I knew one shouldn’t kill a patient because it’s morally questionable. Sorry, I meant, absolutely inexcusable.

Anyway, I may have digressed a little, so back to the topic I had at hand. My first experience with death actually happened just two months ago, around twenty years into my medical career, which I must say is a blessing because it’s rare for any surgeon (doing the major stuff like hearts and brains, of course) to last a year before somehow seeing a patient kick the bucket. Then again throughout my school and career life, I’ve always been considered a humble surgical prodigy and an excellent tactician when it comes to medical emergencies.

But what made this death so unusual, apart from the fact that it happened under my experienced and watchful eye, were the odd and truly disturbing events which unfolded before it occurred. And before you ask, ‘did you finally give in to your psychotic temptations?’ I will tell you that, no, I had no control over the strange circumstances of that night, surrounding the death of Mrs Doris Hindley. Perhaps the overwhelming feeling of being utterly out of control for the first time shocked me, sending me into my current wrecked state. I’ve never been superstitious, yet I often wake in the middle of the night, drenched in sweat, the image of her wrinkly, screaming face burned into my mind, the events of that night replaying in my nightmares.

Mrs Hindley was a vile, pruny little old lady with a high-pitched and whiny voice like a cow pissing. She was living alone and had no family, and she’d been to the clinic for a stent replacement some time before. She would return several more times during that month, banging on my window, cussing and complaining about the nurses.

“Who’dya think you are, treatin’ a sick little ol’ lady like a Jew in the Buchenwald?” she’d yell.

At first, I investigated the problem, but soon we realized that she was the problem. All sorts of lies and shit were coming from her mouth and she would repeatedly come to the surgery to dump it. After she’d finally grown tired of harassment, she returned a few months later diagnosed with end-stage heart failure and had somehow been granted a transplant by the hospital, despite many younger and much more deserving patients in desperate need of the procedure. I had read her files during an unpleasant initial consultation regarding the procedure; she wasn't due for discharge until twelve entire weeks after the operation.

The moment I saw her shriveled face and smelt the stench of her pickled onion breath in my clinic once again, I knew this would end in one of two ways: either she would come out of the surgery dead, or she would live and I would have to quit my job. One of the nurses fastened her gown, as I filled in paperwork.

“Hello again doctor,” she grumbled, lifting a quivering hand. “I know what yer’ thinkin’.” The nurse left the room.

“Oh yeah? And what would that be?”

“Yer’ thinkin’… I won’t make it through, ain’t ya doc? ‘Cause my skin is yellow, my breath is foul, I ain’t deserve this place among the livin’.”

“I never said that Mrs Hindley.” I clenched my teeth. “In fact, I have every hope you will be just fine. However, we both know it’s-“

“- risky procedure, ain’t it?” The interruption was really harsh and unexpected. I paused momentarily. She turned around, her lips drawn into a crooked smile, exposing the rows of blackened teeth in her gob.

“I’m glad you’re aware of that.”

Within an hour that rotten old banana peel was sedated and her open chest lay well sterilized, ready to be sawn into. During the operation, I initially thought I’d given up on my plans to slit a valve and send her off, but I began having second thoughts. Reason being that we’d all have to deal with this wrinkled motherfucker for months afterwards, and it just wasn’t worth the time. If you weighed a human life with a few hours of hassle, it’s obvious which comes out on top. Yet in the case of Mrs Hindley, the most vile of creatures, there was no family, potential, and little in the way of money or property. Perhaps the precious organ of life she was wasting would go to someone else instead. In fact, I’d always half suspected that either she’d tampered with the hospital records or the staff just wanted to shut her up, because it’s usually young people who get the transplant organs first. About halfway into the operation, I gradually became serious about it.

Her own heart was about to be cut out. I wanted to minimize damage to the transplanted organ so it could be removed and re-used if necessary, so it took a few mental trials before I decided what was best to do with least risk of framing myself. Once I’d figured it out, I waited for my chance, and when the coast was clear, I went in for the kill.

I thought that would’ve been it, done and dusted, everything gone to plan. But something stopped me. I couldn’t do it. It must’ve been whatever prevented me from answering those ‘what if’s every other time. A conscience of sorts? Perhaps I’d gotten used to saving patients from myself. My mind was erupting with potential consequences; what if I got caught? No, it was impossible if I did it right. What if the transplant organ didn’t get transferred? We would deal with that later. What if my reputation was harmed? No, I’ve had a twenty year success streak, and she was like, a hundred years old, so people would think it was inevitable.

What if… what if I didn’t want to have blood on my hands for the rest of my life?

My fingers twitched, scalpel poised over the area, my mind in perpetual conflict with itself. I felt a bead of sweat trickle down the side of my face.

Suddenly, without warning, the old lady’s bony chicken hand reached up and grabbed my wrist. I was so startled I almost dropped the goddamn scalpel into her chest. I froze in place for a few seconds, in a state of utter panic. Her eyes were still closed, but the force with which she gripped was immense.

Then I continued to stare in horror as her eyes began to flicker open, and her ugly features silently began to contort into the most tortured expression of excruciating pain I had ever seen. Her legs began to shake and thump violently on the operating table and her grip began to increase in strength. Mucus began drooling out of her mouth as she took in short and wheezy breaths, her eyes bulging like golf balls.

I finally snapped out of my trance.

“Anaesthetic!” I shouted, “The patient’s woken up! Quick! Hurry!

Everyone turned their heads in terror. The anesthetist began fiddling with the machine, but Mrs Hindley’s eyes stayed wide open.

“What the hell are you doing?” I yelled.

“There’s already way too much Remifentanil running through her veins, we can’t-“

“The fact that she can even move her legs means it’s not enough, if you haven’t figured!

There had been a few accidental cases of anesthesia awareness at the hospital – it’s far more common than one would imagine, about one case in every five hundred, but one during open heart surgery is a nightmare beyond imagination. As far as I knew, proper procedure had been followed rigorously, so it was simply not possible. Panic ensued in the theatre. All the others headed to the Boyle’s machine in a hurry, checking the IFT, checking the mask and trays of surgical paraphernalia, shaking their heads in frustration and reinforcing plugs and valves to no avail. She began letting out the most perturbing choking and moaning sounds. I stood in silence, chained by her death grip, desperately trying to work out what was happening. Her veiny eyes suddenly looked into mine. No, it shouldn’t have been happening. It was absolutely impossible, according to decades of medical research. There was no way.

Ye lied to me doctor,” she croaked, the words muffled under her mask. The crooked smile began to appear on her face again, this time exposing all her monstrous teeth, clenched with inhuman force.

Her arm dropped as her body fell limp, and her line went flat. I guess this would be where the story ended for Mrs Hindley. Investigation was thoroughly conducted, and nothing of interest ever surfaced. I reckoned that I should’ve done more to help their findings, but there was nothing I could think of which obeyed the laws of nature. Maybe it was because deep down, I subconsciously knew the reason, and that was why it mentally affected me so much.

The aftershock was more than I could handle. Sometimes, when I fell into a depressed state, I would tell people it was just from the impact of experiencing the first failure in my career. But I knew it was much more than that. I thought of resigning that day, though after evaluating the pros and cons I decided such a lifelong career was hard to come by, and I would be needed to stick around. But of course, I decided to take a long break before getting back to work.

Anyway, that’s my odd story over. Quite the story to tell at parties, you’d imagine, but I prefer to keep it to myself. I guess science will never figure out what happened in that operating theatre, but I continue to question every night. I had the worst nightmare about it once – I found myself lying on the operating table, looking up at Doris Hindley, clad in a surgeon’s mask and gown. Her crooked smile began to form once more as I felt the excruciating pain of every incision in my open chest. I felt every time one of the membranes of my organs split open. I tried to kick and scream and call out to the other surgeons, but my body wouldn’t budge. When I’m alone in bed, drifting out of consciousness, her words repeat in the darkness, driving me insane until I finally pop another pill. I just want to ask her one question – how did you know?

It’s been two months since the incident but as you can see, I doubt I’ve mentally recovered yet, so I hope getting my worries down on paper will help. My back pain seems to have gotten worse as a result of my stress, so I’m due to have back surgery next week to fix a herniated disk in my right leg. If the operation goes smoothly, I should be back in the theatre next month and ready to begin work. Hopefully I never have to deal with such a troublesome patient again. I was thinking that maybe before the procedure, I should reinforce to the staff the fact that I’m a surgeon myself, to make sure they check everything twice. Never mind, I’m sure it’ll be fine.