Death Knell

Trigger warnings: Graphic descriptions of gross stuff, death, Hell, lots of cursing.

“Doctor, they need you up in the ICU. They have a crashing patient that needs an airway.”

Luckily, the ER wasn’t exploding. Everyone was stable… for the moment.

That could always change.

And frequently did without the slightest warning.

I turned, grabbing the orange go-box that contained intubation equipment, an IO that could drill through bone in three seconds flat if we needed emergent access, and various other life-saving odds and ends.

“Ally is already up there, so you’ll have one nurse that knows what the fuck is going on,” the charge nurse said, rolling her eyes. The last time we responded to a code upstairs, one nurse, rather than doing chest compressions or running meds, had been on an urgent phone call with Domino’s ordering a pizza.

I was already halfway down the hall but yelled back, “Have them order me a pepperoni pizza with extra anchovies!”

***

I stared up at the staff elevators. One was currently out of order, draped in yellow ribbon reading, “OUT OF ORDER”, while the other—according to the red flashing number above—was parked on the seventh floor… the ICU.

Where I needed to go.

Dammit.

Precious minutes leaked away, minutes in which someone’s precious heart muscle necrosed and died without oxygen, when the numbers finally counted down from seven.

Thankfully.

I wasn’t relishing a nice sprint up seven flights of stairs while lugging a heavy-ass box and arriving at the ICU looking like I could use a round of chest compressions myself.

The silver door slid open, and I stepped inside. Overhead fluorescents flickered as I pressed the “7” button and I frowned, gazing up. This fucking thing, always on the fritz. One of the elevators was always out of commission, down for repairs on parts that were only available from countries halfway across the world, at exorbitant prices, naturally.

The lights steadied, casting blazing heat, and the elevator clanked into gear, and ascended. I ran through a mental checklist of supplies I’d need on my arrival in the ICU: RSI meds, the crash cart, suction canisters—

WHAM!

The elevator stuttered. A worrisome grinding noise erupted, sending vibrations through my feet, rattling my dental fillings, and the lights went out, plunging everything into pitch-blackness.

The darkness was total.

Suffocating.

Stifling, like undisturbed air in a deep underground tomb long sealed.

Thick.

I raised my hand in front of my face, my fingertips tickling my forehead, and saw nothing.

And the silence… deafening.

The sounds of blood whooshing through my veins and my breathing—rapid, nervous exhalations—dominated my world. With an unsteady hand, I reached out and swiped my hand across the wall. Firm plastic bumps graced my palm and my sweat slicked hand ran over them; I was bound to hit the emergency response trigger. With a hammering pulse that echoed in my ears—vibrating the tiny bones within—I waited and swallowed with a wince. All my saliva had deserted me, and my throat clicked at the meager spit that plunged over sandpapered mucosa.

CLANG!

Rapid movement.

Down.

My body flew upwards and my head smacked painfully off of something hard and unyielding. “FUCK!” I bellowed, hearing the crack of my skull splintering with sickening clarity and felt hot, tacky blood pouring from the wound. I dropped roughly on my ass and threw my hands over my head, placing firm downward pressure on the wound. An involuntary hiss escaped my lips as a firecracker of anguish exploded, painting my body bright, lighting up every sensitive nerve ending with pain so excruciating it sucked the air straight out of my lungs.

The explosion of agony did nothing to light my metallic vault—the darkness endured.

The pain escalated, building until it felt as if it would cleave me in half and a fuzziness descended over me. Had I a crumb of light, I’d have glimpsed the telltale gray coalescing dots dominating my vision, my peripheral vision narrowing into only a minute pinprick. Overhead, lights flickered, revealing—

A pair of glowing red eyes peering out of deep recesses. An utterly ink black face devoid of any recognizable facial features stared into my eyes, into my soul. Then… the thing sharply dipped its head, revealing aged yellow horns, one broken at the tip. Maroon and black centipedes wound around the horns, wiggling pincers dripping red droplets—poison? No, no, that’s blood—that dribbled into small puddles of blood on the elevator floor.

Plink.

Plink.

Plink.

My mind shattered, my sanity spilling out like tainted grains of sand tumbling from an hourglass. I screamed, tasting copper on my tongue—blood brought up from my raw vocal cords—and the darkness enveloped me. My consciousness dimmed, and I succumbed to the siren call of nothing.

***

My skull throbbed, feeling identical to a nasty cavity I’d had back in second grade when sweet treats spelled agony for me. I groaned, coaxing my eyes open to thin slits. Dusky light filled my vision, fending off the darkness. I cautiously raised my head and a sick vertigo seized me, tilting me about like a low budget carnival ride missing a few screws, completely disorienting me. I squeezed my eyes shut, fighting back a bolus of partially digested food threatening to make a sudden re-appearance, and breathed in deeply.

The spell passed.

I opened my eyes.

The elevator door stood half open and a sickly, muted light streamed through the opening. Motes of dust hung in the air. The air surrounding me was stale and warm, as if fresh air hadn’t circulated through in some time.

Strange…

The hospital’s temperature usually hovered around 68 degrees—patients were always bitterly bitching—all of them hoarding linens from the blanket warmer, shrouding themselves like glacial mummies.

Had the elevator crashed?

Did someone pry the doors open?

And if so, why did they leave me in here?

Unless they went for help.

That had to be it—they saw my crumpled form and went for help.

With effort, ignoring the thunderstorm roiling between my ears, I pushed myself up and struggled to my feet. Grasping the cool, metallic walls of the elevator, I waited for the lightheadedness to pass. Slowly, it ebbed away. My thinking became less muddled and my mind cleared. I cautiously took several steps and thrust my head through the opening, scanning the hallway beyond.

Dust bunnies rolled like tumbleweeds, guided by unseen currents that couldn’t have come from the air conditioner, given how stifling the atmosphere was. The ubiquitous sickroom green all hospitals were by law mandated to paint every wall remained, but… thick cracks lined the walls, reminding me of ivy tendrils invading crumbling brick.

What was going on here?

Damn, how long was I out?

I squeezed through the opening; thankful all my workouts were finally paying off—a larger person couldn’t have hoped to squeak through. I looked back at the elevator, directing my gaze upwards. The glass above the doors that normally displayed floor numbers was splintered, and orange flowers of rust proliferated amongst the gleaming metal that lined the door. Faintly, from further down the hall, I heard water droplets dripping—a steady patter. I pictured a pipe—corroded, decaying—water leaking from a meager hole. I walked, each step made gritty by glass and dirt crunching underneath my shoes. A crop of goosebumps rose on my arms despite the relative warmth, and I rubbed my arms vigorously, failing to infuse them with any heat.

The dripping grew louder.

I came to a set of double doors—doors I recognized.

Doors I’d walked through every shift.

A badge was required for admittance. The doors opened into a restricted portion of the hospital and it wouldn’t do to have patients wandering around the radiology suites, fucking around on the CT scanners. I pulled my badge, unwinding the thread in my badge reel—a circle stamped with Jesus saying, “Ask me about ROSC”—and swiped where I expected the badge reader to be.

Except—

Where the reader used to be—ought to be—there was only a massive hole punched into the wall. Crumbles of molding drywall littered the floor.

I gazed into the hole and recoiled.

A massive rat laid within a nest composed of bloody locks of hair, tattered gauze, and wires with exposed innards. A multitude of mewling, pink, sightless babies clustered around her, suckling her milk. The rat turned her head, peering at me with white-cataract clouded eyes. Yellowed teeth poked from her mouth; their ends stained maroon. She gave out a chitter that cascaded down my spine with a chill and I let out a yelp, my arms pinwheeling as I lurched backwards.

The repellant mother and her pups faded from view, hidden once again.

“What in the hell is happening here?” I muttered, ignoring the twisting of my guts.

I pushed the door, and it opened partway before sticking with a sickening grind—no wonder—large chunks of cement and gravel littered the floor. I thanked my parents for blessing me with a slight stature and I crept through the gap. The dripping grew louder, staying steady, and I peered up, my breath catching with a rasp.

An arm, or rather, all the bones normally hidden behind skin and sinew, greeted my stunned eyes. Phalanges, metacarpals, carpals, radius and ulna were wed in holy matrimony, gleaming like a newly purchased wedding band. A thick humerus dangled from a small hole in the ceiling tile. Not a piece of flesh remained. It was a model arm that could have come straight from the page of one of my medical school anatomy books—perfectly preserved. Rusty droplets—water, dear God, I hoped it was water—dripped down the index finger, sending forth ripples in the puddle below. I wondered where the rest of the body was and pictured a crumpled skeleton on the other side of the tiles, forever afflicted with a rictus grin, but quickly dismissed that line of thought.

It was probably better if I didn’t know.

I walked, more than happy to leave the arm in my rearview mirror and took a mental inventory of my supplies. I’d left the orange go-box in the elevator, or… at least I’d thought I had. I didn’t recall seeing it when I came to, not that I’d searched for it. No way in hell was I going back for it, picking through rubble, dodging skeletal arms and bloated rats. I searched my scrub pockets. I had my stethoscope, a set of trauma sheers that could cut through most things—even bones per the manufacturer—and various pens. That was it. Sure, I might be able to strangle someone with my stethoscope or plunge a pen in their delicate eye… but I was more or less screwed in the way of weaponry.

“Unngggggggh.”

I stilled and held my breath.

What the fuck was that?!?

Carefully, avoiding sudden movements, I peered about, seeking out the source of the groan.

In the dim light, I made out a crumpled heap further down the hallway. The bundle shook violently—reminding me of the many seizure patients I’d seen in my career—and let out a shriek that turned my blood to cold sludge.

Not good. The fine hairs on my arms prickled up.

Another colossal twitch.

Then stillness.

The noise came again, at first a low hum which thickened as if someone poured honey down their throat while speaking. My teeth chattered—barely audible over that hideous humming—and I clenched my jaw, fighting against the massive case of the heebie jeebies that threatened to overpower me. Adrenaline hit my bloodstream, sending my heart galloping.

Fight or flight?

Were those my options? I could haul ass back to the broken elevator and wait for some other horror to claim me or… I could continue.

My fingers closed over my trauma shears—just in case.

A deep breath in and out. My nerves calmed some. I swallowed, wincing at the dryness in my throat, and cautiously picked my way through the debris.

Towards the heap.

And… that noise.

What if somebody was hurt? I thought.

Or… what if somebody was planning on hurting you?

Also, a good argument.

As I grew closer, a burned scent saturated the moldy smelling air, filling my nostrils.

So familiar… I cast my memory back, puzzled.

Ah!

My surgery rotation, everyone dressed in blue scrubs, my arms aching from gripping a retractor for hours. The surgeon clutching an electric bovie, its red-hot tip kissing flesh with a crackle similar to bacon sizzling in a skillet, and the unmistakable scent of burned flesh rising, dissipating into the sterile OR air. Except… this scent wasn’t nearly as clean—it carried an undertone of sweet rot. The figure shifted again, bringing scorched clothing and ruined meat into view. A tickle of recognition brushed my consciousness—there, then gone—when a blackened hand seized my wrist. Flesh crackled and my trauma sheers clattered to the floor. Eyes snapped open—two luminous orbs full of glittering intelligence set within a befouled face—staring with an intensity normally seen on the faces of operating cardiothoracic surgeons.

Wetness spread around my wrist. My eyes darted and I watched blisters on… the thing’s palm burst open, drenching my skin in purulent fluid. I let out a wheezy gasp and tried to pull away, but the hand displayed an unnatural, unnerving strength. The eyes widened and the face broke open, revealing bone white teeth that curved into a snarl.

“Doctor, how good to see you again!” came a craggy voice, low and sinister.

My mouth fell open, and I shuddered.

What… what was going on here?

And that voice… it sounded—

Familiar?

As if sensing my bewilderment, “Wondering who I am? I’m surprised you’ve already forgotten.” The thing shook its head, its skin crinkling with the movement. “Although… it was a few months ago that we met, so I can’t begrudge you that. You see so many patients.”

That prickling recognition intensified. I shuddered and looked into those eyes, icy blue and striking, and—

I remembered.

He’d been working on a water heater, lit the pilot light, and his body burst into billowing flames. When the medics brought him to me—covered with 99% third-degree burns, blackened, crackling skin, weeping clear fluid, his oral mucosa hopelessly swollen and raw—those blue eyes seized on my own, sending a nasty chill through me. I’d done all I could: cut a hole in his trachea and inserted a breathing tube, placed a central line through layers of ruined flesh, but he died in my ER two hours later… a kinder outcome than living through the hell he’d be subjected to had he survived.

The man tilted his burned skull, giving me a view of red puckered flesh with the remnants of singed hair, and said, “Ah, you remember! Doctor, you did all you could for me, and I thank you. But death was better, don’t you agree?” He dropped my wrist, and I rubbed it on my scrubs, desperate to rid myself of the foul fluid. Despite his burned body, his grip left a frosty ring around my wrist.

“What… why? What is this?” I asked. I winced at the wobble I detected in my words.

His grin widened, scarred skin cracking. “Oh… you’ll see. We are all here. Waiting for you.” He chuckled, sounding as if he was gargling ground glass.

Waiting for me?

What the fuck?

I moved past him, sparing him one last glance, keeping my pace slow even though my body was begging me to run.

His sickly giggle receded.

More figures lined the derelict hallway, most sparking my brain with horrid recognition.

The ghostly white four-year-old with blue lips who’d drowned in the family pool and, despite our best efforts, died with lungs filled in chlorinated water; Sal, one of our frequent fliers, whose aorta tore inside his body, swiftly killing him before we had any hope of getting him to the OR; and so many more—failed codes, overdoses, heart attacks, brain bleeds, everything.

All patients I’d lost.

The four-year-old vigorously waved as I passed and I returned the gesture, ignoring the skittering fear scratching my rib cage. Some just stared, their faces impassive and devoid of expression. Others smiled at me; their hands outstretched as if they wished to clutch their failed Messiah. I shrunk away, fearful that coming into contact with their dead flesh would fracture my tenuous hold on reality and drive me mad.

I reached the end of the hallway and came to yet another set of double doors. These led to the ER, my hallowed home for years and years.

Reaching my hands outwards, poised to shove the doors open, I paused.

Did I really want to see what lay beyond? I shook my head. No, I didn’t want to see, but what was the alternative? Return to my broken elevator, curl into a ball, and hope it was all a bad dream?

I was fresh out of choices.

I pushed the doors open.

***

The mint green hallway was the same… but different.

Thick black cracks spanned from the ceiling, proliferating like germs as they spread downward, marring the normally smooth walls. Bloated spiders with glittering red eyes crawled from crack to crack, some toting bloated egg sacs that pulsed like a diseased heart, threatening to belch forth thousands of deadly babies. I shivered and forced my gaze away.

The treatment rooms on either side of me appeared molded and decayed. Cardiac monitors with shattered screens hung from the walls, twisted stretchers with threadbare sheets covered in blood stains were strewn about, and medical supplies littered the floor—4x4 gauze, alcohol wipes long dried out, and a variety of sharp implements, their tips stained with garish crimson.

I turned the corner.

The nurses’ station.

Computer monitors sat at varying intervals, their screens long burnt out or splintered inward as if a disgruntled nurse attacked them with a baseball bat. The tracker board hung like a forgotten idol behind the monitors—normally tracking every patient and which room they were in—its screen glowing a vacant white, reminding me of the television set in that Poltergeist movie. Someone… or something, had graffitied the screen with swirling red letters and symbols, pentagrams, upside down crosses, and—

Welcome to your own personal Hell was scrawled across the board. Red liquid—Paint? Blood?—dripped from the letters.

“Do you like it?” came a voice from my right.

I jumped, tripping over a toppled IV pole, and landed on my ass. A cramping twisted through my bowels—such was my fear—and I fought to keep my shit inside of me. I scanned the room, terrified of what I might find. My eyes landed on a face I’d recognize anywhere.

Dr. Smith, my residency mentor.

My mouth fell open.

Dr. Smith—he’d been dead for nearly a decade, yet—here he was, standing in front of me, fixing me with a curious look that contained the barest hint of a smile curling his lips.

I croaked out, “What is happening to me?”

His grin widened, taking on a malicious glint, and my fear and trepidation skyrocketed.

What was happening here?

An honor guard of all the patients I’d watched die and now my very-dead mentor?

What the fuck…

Salt and pepper stubble dappled his cheeks, giving him a slightly rugged appearance. His face appeared just as it did the day we met—pleasant laugh lines deepening with each smile and joke told, hazel eyes full of life, and—

His neck.

Oh, his neck!

A throbbing black mass budded outward from where his Adam’s apple should be, its tendrils spreading outward—some were thick and ended abruptly at his chest, while others were hair-thin and extended to the furthest regions of his body.

I remembered laryngeal cancer. That’s what he died of.

I was seeing the cancer with my own eyes, as it was, unhidden by skin or muscle.

His eyes danced merrily. “This place can be alarming; I’ll admit. You saw all your former patients in the hallway, right? I saw the same shit. Every single patient I’d lost in my long career—all greeting me. Haven’t you put it together yet? You were always a smart cookie, ready to spout out the correct answer during residency. Think!” He tapped his forehead and the necrotic mass jiggled on his neck.

Despite my mounting fear and disgust, I rolled my eyes. Wherever I was, I was still getting pimped by my attendings, lovely. I took a breath in, tasting the fetid air on my tongue and said, “Well… last thing I remembered was the elevator making a horrible noise and hitting my head.” I reached my hand to the back of my skull, delicately probing, and felt a starburst of sunken, broken bone. My heart dropped. “Well… I think… I must be concussed to all hell or I’m in a coma. If I had to venture a guess.”

His grin grew even wider, exposing molars blackened at the roots, “Almost, almost!” He gestured about widely, sweeping his hands about as if he were Vanna White showing off new appliances. “Look around you. What do you think?”

I swiveled my head around, hearing the tendons in my neck creak, and looked about. Heaps of trash and medical supplies, darkened husks of rooms, and… the tracker board with that hasty red scrawl: Welcome to your own personal Hell.

“Um… am… am I in hell?” I stammered, pointing at the tracker board. My finger trembled.

He clapped, the sound harsh to my ears, “Yes! In a manner of speaking! You are in Hell! Gosh, you were always so smart, so quick to catch on.”

My blood chilled, or at least, a deep chill cascaded through me—who knew if I still had blood?

If what he said was true.

“Hell? Why am I in hell? Did I die?” The questions spilled out and my mind whirled.

How could I be in hell? I was a good person in life, dedicating my life to medicine, to my patients.

Why would I end up here?

“As a matter of fact, you are dead. Or at least, you are hovering in the death realm, which is good enough to earn yourself a ticket here. Lovely this time of year, too.” He was still sarcastic, even in death.

“But… I’m a good person. Why am I here? Didn’t I earn at least Purgatory if I can’t go to Heaven?” I asked, remembering my long-ago catechism classes. I’d been baptized expressly to avoid such a fate, holy water washing over me, serving as a protective barrier against sinister evil.

A deep pressure settled in my chest, under my sternum.

He shook his head, looking grim, “There is nothing else. No Heaven, no Purgatory. Just Hell. Mother Teresa and Gandhi ended up here, although their Hells look a lot different from yours. Your earthly life is considered when your Hell is constructed. All your losses, all of your pain, and it’s fashioned into a very special place for you, like this!” Again, he swept his arms around in that maddeningly grandstanding way.

Hell? I was in Hell?!

“But… why are you in my Hell then?”

He extended his index finger. “Great question! When you arrive in Hell, you get a guide of sorts. It’s always someone you know; someone you were close to in life that has already passed on. My Hell is like yours—dead patients and family members. Had you ventured out of the hospital, you’d find a barren landscape, identical to the one you live in on Earth except everyone is gone, other than the remnants of your dead friends and family. They aren’t really there, of course, not like I am right now. Hell is rather isolating. I expect most doctors have a similar version of Hell. Police officers probably see anyone they shot and killed. Hell serves as a constant reminder of your failures in life.”

The sensation in my chest sharped and squeezed as if someone unseen applied steadily increasing pressure, let go, and then doubled their efforts. My skull ached, and I thrust my fingertips to the wound. They came away wet, slick with bright red blood. Faintly I heard a high-pitched whine—another familiar noise—and someone yelling, “CLEAR!”. Hot lightning coursed through me, setting every nerve aflame. Each limb twitched, contracting painfully, nearly tumbling me to the dirty floor.

Dr. Smith’s eyebrows steepled, his facial muscles twitching into an expression of concern. He tilted his head, as if listening to something on a different frequency that only he could hear. His head dipped in a quick, curt nod. “Hell isn’t ready for you, it seems,” he said. His voice came out sounding warped, like a slowed down record.

“What? Why—” I started, but a quivering sensation surged through my head, blooming into a terrific, flowering agony. Questioning and thinking were out of the question. Again, I heard—closer and more distinct—

“CLEAR!”

I stared at Dr. Smith, hoping he might enlighten me, explain what the fuck was happening when the world wavered around me. Dr. Smith’s features melted together and changed, his face morphing into something that reminded me of the innards of a rotten peach—the mass on his neck remaining a solid black; the peach pit. Dingy surroundings blurred, running together like tainted dish water swirling down a drain. A distinct sense of vertigo gripped me. My body whirled around in space, whipping about faster and faster, reminding me of the time I hopped on The Gravitron at the county fair. A sense of awe struck me as I watched the spectacle unfolding in front of me, everything spinning feverishly, becoming one indistinct mass of color that twirled through every color in the visible spectrum. Dusty galaxies rotated around dying stars about to go supernova. Icy comets roved the cosmos searching for a home, and deep trenches rimmed with fire winked before me. A deep baritone laugh filled with malice and ill-intent rose from those pits. The sound washed through me, leaving a glacial dread in its wake. A massive sucking noise erupted, growing in volume. I felt invisible fingers, huge and powerful close around my body, exerting a steady pressure around me and a hard yank, pulling me through a microscopic white pinhole that I initially mistook for a distant star and—

***

My eyes opened.

Bright lights overwhelmed my taxed retinas and a deep ache echoed through my chest. I took a deep breath in and winced at the sharp, stabbing pain in my ribs. Faces appeared in my vision; the ED charge nurse and several other nurses, some I recognized, others I didn’t. I heaved my body up to a sitting position with supreme effort, my limbs protesting, and my head throbbing. I realized they’d stripped me naked to the waist—sticky patches clung to my chest between my breasts and on my side, each connected to thick wires that attached to a defibrillator. Spent epinephrine syringes littered the elevator floor. Heat rose to my cheeks on realizing my nakedness and I lifted my arms to cover myself—no need to give everyone an eyeful.

“Don’t get up! You might have a cervical spine injury!” The charge nurse admonished with her Mom Voice on full blast. “We weren’t as worried about collaring you as we were about getting your heart restarted, so LAY DOWN!”

Getting my heart restarted? Holy shit… I’d actually died.

I died…

Obediently, I laid back down, gingerly placing my injured skull back on the floor. Strong hands gripped my head, and someone snapped a cervical collar into place, protecting my precious spinal cord from injury. Someone placed a toasty blanket, fresh from the warmer over me, shielding my nakedness from view. I breathed out a sigh of relief, flinching at the brief throb from my ribs. They placed me on a spinal board, then a stretcher, and whisked me away to the ER.

***

One of my colleagues rushed in, called in 911 by the charge nurse when she’d discovered my inert, bloodied body in the elevator after it’d malfunctioned… again. He ordered the requisite labs, imaging, and packaged me up for transfer to our sister hospital.

The damage?

One fractured skull with a small, underlying cerebral contusion, broken ribs from vigorous CPR, and… a heaping helping of existential dread.

I recovered.

The neurosurgeons patched up my skull, placing a thin plate over the shattered area. My delicate ribs knitted themselves together and soon my bruised lungs no longer ached with each breath. After plenty of physical therapy where I coaxed my body back to working condition and with a nice cash settlement in hand from both the hospital and elevator company, I returned to work but only half time.

I no longer regarded death as the natural conclusion of a life well lived—or poorly lived, depending on the reason for said death. There was no eternal reward for good behavior. I knew if I lost any dying patient, that the poor soul would not be welcomed into a nirvana packed with dearly departed loved ones. Instead, I knew my patients were fated for a Hellscape designed especially for them, and I bitterly fought for each life that came in. Both for them, but also for me—I didn’t want to doom someone to Hell and… I didn’t want to feel their accusing eyes crawling all over me when it was my time.

I remembered my Hell, that cavernous laughter that followed me from there—a death knell that lives within my deepest nightmares now—and… I remembered Hell awaits us all and will claim us all… eventually.

But with the aid of modern medicine and some luck, I can hold off the Devil.

For a little while longer... anyway.