The Winding Road

So. I want to write a great twist.  Maybe even a double twist.  I love them to death, some of my favorite parts of my favorite books are when I come upon something I didn’t see coming and all of a sudden the game is changed. It’s like magic, the way authors can lay down the hints and wrap every thread of a book together so that one twist suddenly makes everything fall into place like a giant puzzle who’s picture was a mystery without that final piece.

But I have this teacher, one of the best personal authorities I have when it comes to literature, who has said before that he doesn’t like twist endings the likes of O Henry and such.  Now, a twist for its own sake, or one that doesn’t improve the story is to be avoided.  And I think he was talking about turning literature into a gimmick - 

“Hey look, I can trick you into thinking one thing and slam you into a brick wall at the end by doing something completely different!  Wasn’t that fun?”  

Yeah, not the type of twist ending I want to write. Instead I want to write something so good it makes me feel like an all-out genius.  My, we authors are a presumptuous crowd, but it's true.

Twists are tough, though.  They can be done so wrong that they ruin the entire book.  So how do you write a good twist?  I’m not trying to plan out an entire book in advance, but twists do generally work best if you know the twist is coming (as the author).  So.  What are my favorite twists and why do they work?  (I'll limit this to twists within the genre I'm writing, so as not to make this post 150 pages long)

*Spoiler alert!

The Fault in Our Stars

Two kids with cancer fall in love.  The girl is in bad shape, the guy dies.  When I found out that it was Augustus that was dying, it completely wrecked me.  I was so sure it was Hazel that was in worse shape, he was in remission, it wasn’t fair. I’ll never forget the line “my scans lit up like a Christmas tree, Hazel Grace.”  Or some such.  I think what really made the twist hard to see coming was the misdirection (like any great magic trick).  I thought I was supposed to be gearing up for the death of Hazel.  I was looking right where the author wanted me to be looking: at the distraction.  So what makes this twist great?  The misdirection, the tragedy of death and young love coming to an end, I wasn’t unwarned – he said at the very beginning that his cancer could come back, and it was the very same thing I was so afraid would happen – to someone else.

We Were Liars

Okay, this twist was great because I knew something was wrong the whole time but I kept ignoring it.  Nothing made sense but I kept ignoring the obvious conclusion – she had a head injury and was seeing things.  The unreliable narrator is sort of a controversial thing – are you cheating?  Are you lying to your audience?  Personally, in this case I think it works because you know she's injured and you know that things aren't lining up.  But a main character outright lying, for instance, would not work for me.  So if a narrator isn’t reliable, but mostly because they aren’t in possession of all the facts, that can work.  Plus it was just so tragic and startling – her best friends were dead and we just loved them all by the time we understood.  So much possibility came crashing down, and suddenly everything made sense.  If a twist can somehow make everything make sense, that’s an accomplishment.  


So misdirection, staying honest, characters not being aware of all the facts of the story are all good ingredients.  But it's still a tricky recipe to get right.  Thoughts?  

Line #1

If we allowed ourselves to crack, I’m sure we would crumble beneath the weight of it all.  Perhaps it is better to keep this cold brick wall between our heart and the world around us, perhaps it is how we survive.

Decency

I don’t believe in final rites - words that must be spoken by priests or other religious leaders in order to help someone secure a place in heaven. But I do believe in decency.

Earlier this year, the largest hospital in my area chose to do away with the positions of paid on-call priests and pastors.  Some have graciously chosen to stay on - on a volunteer basis.  You may say that it ought to be volunteer work in the first place, but the position includes subjecting yourself to the job of being woken or pulled away at all hours in order to council physically and emotionally hurt  or possibly dying strangers.  If some chose not to stay on as volunteers, to retire instead, this sounds very human and reasonable to me.  It is not a job I would envy.

However, someone died today. We knew it was going to happen, but as one of the nurses said “she’s not ready to go, the priest hasn’t arrived yet.”  She hung on for a half hour longer than some thought she would, and the medical secretary tried and tried to make sure a volunteer priest would make it on time. But they didn’t make it.  She died, waiting. She died, probably filled with anxiety that she would have to die before the priest arrived, and guess what? Her last worst fear came true.

This is unjust, this is unkind, and this is indecent.

And if I am able to bring this before anyone who will listen to me, I will also add that this is terrible for the name of our hospital.  Family was there, aware that she had asked for a priest that we did not provide.  This is every bit as important as other functions of a hospital, because in the end it all boils down to the experience the patient is provided with - be that in their medical care, or whether or not the nurses came back with water they promised, or whether or not the patient was able to receive their  last rites before being rolled away in a blue-draped box. Patients don’t come back from the morgue, we don’t get a redo.

Of course, this goes beyond last rites for me, because they took away the pastors as well.  The men who, if on call, would arrive and share Truth with trauma victims and men and women who would soon meet the eternity they’ve come so close to.  This is something I cannot give up without a fight.

In a state where drug addiction is an epidemic, and in a country where hate crimes make the weekly news with almost predictable constancy, the last thing we need as a people is to have less men and women promoting peace and giving comfort amidst tragedy.

Perhaps nothing will ever come of this, but my blood cries out at injustice and it runs hot with the passion to right wrongs. And if this patient’s terrible, unfortunate passing can serve some sort of purpose, I will try to be sure that it does.

Because it’s the only decent thing to do.

Rescue 7 on 3rd Street, pt 1

It was 02:32 when Rescue 7 (the ambulance stationed in the thick of the city) responded to the call.  The men rolled from their mattresses and pulled on their uniforms. Within a few minutes they transformed from sleeping figures to medical professionals, ready for the call.

The operator told them as much as she knew - unconscious male patient, twenty seven, at 37b third street. Police en route.

“Could be drugs,” Mike said to Jethro.

“Could be someone partied too hard,” Jethro countered as he began sorting through the calls he’d taken with similar patients, trying to determine which skills he might use.  He knew he’d be taking point on this call, he was only a year out of paramedic school, but Mike was still only an EMT - the lowest rung of the medical ladder. Mike wasn’t even permitted to administer most of the drugs needed for a regular call, let alone an unconscious patient at 2 in the morning.

When they arrived at the address, Jethro grabbed his bag of supplies and lead the climb up the dilapidated porch stairway, avoiding the broken and rotting steps. They’d beat the police, which was unusual, but not completely uncommon. Jethro raised his gloved hand and rapped on the door. A frantic woman, who was probably twenty-eight but looked forty, lead the two men up yet another stairway to the bedroom.

“What was he doing before he passed out?” Jethro asked the girl, who was strangely serene. Unnaturally calm, actually, which set off alarm bells in Jethro’s head.

“Nothing, just watching some tv. He was, like, fine until I looked over and he’d passed out.”

A likely story.

The woman pushed open a door without a knob and Jethro’s eyes found a man lying on the ground.  It was obvious within a moment - Mike had been right. Drugs. No pains had been taken to hide the needle that had done the damage, it was lying next to the man, amidst odds and ends that nearly covered the floor - from dirty laundry to half-full takeout boxes.

At what point do you stop smelling this? At what point do you stop noticing what your life has become? The thoughts crossed Jethro’s mind in a moment as he began his work.

After a preliminary survey of the patient, the overdose was confirmed and Jethro was able to tell that though unconscious, the patient was breathing and his pulse was alright. He was stable, for now.

“Narcan?” Mike asked.

That was the question, and it played in Jethro’s mind.  To administer the Narcan (the antidote for the overdose, which would wake the patient) right away, or to wait until they were loaded in the ambulance and a few minutes away from the hospital. He had to make a decision.  The choice seems simple - you wake the patient up of course, and solve the problem. But patients don’t always wake up feeling civil. The Narcan is similar in effect to a shot of adrenaline and often the patient wakes up angry and confused and in pain.

Still, so much could happen between that moment, kneeling beside the patient in his grungy room, and the time it would take to load him. If he coded, well, that wasn’t going to happen. He had to make a decision.

Where was the cop? He should’ve shown up by now, Jethro thought to himself.

“Jethro?” Mike was trying to keep the deer-in-the-headlights look from his eyes, and though it had only been five minutes since they first walked through the door, Jethro knew he had to make a decision.

NOK/Emg

Twelve updates to complete and I’ve only just arrived for my shift at the ER. So I grab a clipboard and a demo sheet, then head to room 14 to update with my first patient for the evening.

I’m only a “patient access associate.”  You could say I’m the lowest rung on the ladder of importance at the ER, but that might be giving me too much credit. I’m the first person some people see when they come through the doors of the ER: when I’m not running updates I just sit at the front desk, register and wristband the patients, then take down their signatures (which give doctors permission to treat them, so yeah, I guess I’m not completely useless).  However, I’ll never save anyone’s life, diagnose afflictions, or even administer something to ease the pain, so it’s easy to feel a little useless.

Today I was on update duty, the dreaded job that entailed lots of walking and talking and asking uncomfortable questions.

I stopped outside room 14 and listened for a moment. Doctors and nurses don’t appreciate being interrupted and I hate being in the way, so it’s better all around if I can avoid barging in. I didn’t hear any voices though, so I double checked my information. She was a young, female patient with abdominal pain and nausea. Not uncommon chief complaints, but the patient can present in a wide range of discomfort (or lack thereof).  I took a deep breath, knocked softly, and stepped in.

I was greeted with a small girl in her early twenties with dark brown hair.  She seemed more uncomfortable from her circumstances than from her pain, and I greeted her with a soft smile. I learned early on that false cheeriness is not appreciated, but my sympathetic (almost apologetic, I’m afraid) smile usually doesn’t offend.

“Hi, I’m with registration,” I said to the girl. “Do you mind if I do a quick update with you for our system?”

“Sure,” she said. She was sitting with her feet dangling off the edge off the bed, too short to reach the floor. Her color seemed good, perhaps the nausea wasn’t so bad or it had let up a bit. Her arms were crossed over her stomach, in a way that made my eyes linger there for a second longer than I meant to.

It’s part of the job, when working the front desk, for me to sum people up as quickly as possible. Even though I’m “just in registration,” since I’m often the first person a patient sees, even before the triage nurse, it’s my job to take their story and boil it down to a “chief complaint” so that the triage nurse has an idea of what they’re walking in on when the time comes for their initial evaluation. Plus, if someone comes in and explains anything that sounds like a stroke or a heart attack, Ineed to go tell a nurse. Stat.

If I were to sum her up after the twenty seconds and three sentences we’d exchanged, plus the nausea sh was complaining of,  I would’ve called her chief complaint “pregnancy.” But who knows? I’m not medically trained. A urine test is smarter than me at this point.

“Can you confirm your date of birth for me?” I asked, and she did. I then ran through my list of basic information questions, like mailing address and phone number, primary physician and marital status (single by the way).

Then I came to the tricker part.  Her Next Of Kin and Emergency contact fields had been left blank from whenever we’d seen her last.  These questions were my least favorite to ask, being somehow so much more personal than everything else.

“Who would you like listed as next of kin?” I asked, hoping she’d have a ready answer and that we simply didn’t have time to get that information before.

Her eyes flicked from then floor back to mine. “Um, there’s nobody I guess.”

“No one?” I pressed. “This could be anyone, someone we could contact...?”

I left the end of the sentence unfinished, I always do. I’d hate coming right out and saying “You know, if today or if ever you’re here dead or dying and this information is all we have to go off.”

She bit the inside of her lip. “The address I gave you is my school address, I just got here two months ago and haven’t really made any... there really isn’t anybody here. But I guess I can give you my foster brother.”

I took down his phone number and address, grateful that there was somebody out there for her, trying to ignore the fact that he lived half the country away.

“Is there anyone else?” I asked.

“My grandmother is who I used to live with, but she doesn’t answer the phone anymore. Can’t hear it.”

I nodded and swallowed hard.  “Okay, well that’s everything I need for right now.  Thank you for your time.”

I turned to go and put a hand on the door knob. I still had eleven other patients to go update with and probably more coming in every minute, but I couldn’t just leave her.

I turned back.

“Is there anything I can get for you?” I asked. “A warm blanket?  Anything?”

“Actually, some water would be good,” she said. “I’ve been here a couple of hours and I’ve been thirsty.” She was embarrassed to ask, I could tell. But beneath the embarrassment was a desperation for a basic need, and I understood. Not completely, but enough to know that this was a small way that I could really help.

“Sure,” I said, eager to fill the hole her filtered story had shot through me.  “I’ll check with your nurse and as long as it’s alright, I’ll be right back with it.”

She smiled and thanked me, and I glanced at the dry-erase board for the name of her nurse. After I tracked down the nurse, busy at her desk, I meekly caught her attention (I hate being in the way) and asked if the patient in room 14 could have a drink of water.

The nurse stopped what she was doing, checked and the looked back up at me. “Sorry but no, not yet.”

I nodded, and went back to the room. I listened, knocked softly, and then entered.

“I’m sorry,” I said, coughing a little in an attempt to clear the tightening in my throat.  “You nurse said you can’t have water just yet.  But as soon as you can, I’m sure she’ll be able to get some for you.”

The girl’s eyes misted over. She had nothing else to look forward to. No one was coming to take care of her. No one would call her tomorrow and make sure she was alright.  All she had to look forward to was the water I was bringing, and she couldn’t even have that.

“I’m sorry,” I said. I honestly, truly, helplessly meant it.

She nodded and shrugged. “It’s fine.”

I left then, hoping she wouldn’t cry once the door had closed behind me, but feeling pretty certain that she would.

I walked back to my desk to plug her information into our system.

People say that at a hospital you’re just a number, you’re looked over, and you’re just a nuisance to the terrible staff. But I don’t know, I’ve seen a lot of doctors and nurses that just honestly care. Besides, as I sat there and entered her “number,” into my computer, the hole in my chest throbbed and my face grew hot with the tears I held inside.

That girl was not a number. But there was nothing I could do.

I said a quick selfish prayer then, thanking God for my undeserved emergency contacts.

3am after the storm

I still think about that day, or night I suppose. I still lie awake at night and replay it, wondering what I should’ve done, wondering about the scenarios in which I realistically could’ve avoided it.  When I first ran into the people that were a part of that night, when I ran into them here in the after that is, it made me sweat. It’s a strange sort of panic, my face turned red while my lungs inhaled remembrance and exhaled regret. It still happens now and again, though I pretend it does not.

It was my hurricane. Please don’t think I take that metaphor lightly, I don’t.

Like with hurricanes, I had warning. I knew it was coming and I tried, oh I tried to stave it off.  I saw the bleeding and pressed gauze over the wound and taped the bandage against my skin. And then I kept movng, denying my mind when it whispered that I should check the dressing again - that it might have bled through, that it needed more attention than I was giving it.

But I didn’t check it again until it was too late. And then the hurricane set in and I no longer denied the fear and pain and helplessness.

But now, here in the after, the hurricane is over and residents are banding together to find a way forward and through and upwards.   This wound is healed, though it did not leave a scar to prove the pain, to justify the fear, or to make sense of it all. I can’t walk with my head held high when I remember the hurricane, it is still too fresh and somehow soaked with shame. It is a dearly held lie of mine that it’s always okay, even when it’s not.  (Pride can kill, you see.) But I try not to think of my hurricane during the day, and at night... well, I try to let it teach me.

Perhaps I will learn to recognize a wound before it drains me.

Perhaps I will.