Pulsus Paradoxus strode confidently into the clinician’s station, his white coat waving behind him in the breeze he created. Normally this late in his shift his body began to fail him, but today it seemed that it was still a force to be reckoned with, even as his mind began to fail.
“Ah, good, you’re here,” an older stallion in a longer gray coat mused, not removing his eyes from the paper he was reading.
“Dr. Vagus,” Pulsus greeted back. “17 looks to be diuresing well. Pedal edema is gone and his lungs are clear to auscultation.”
Vagus didn’t respond, instead glaring down at the paper in front of him and frowning deeply. “What do you think of this?” he asked, using his magic to float the paper over to Pulsus.
The younger physician nabbed the paper and scrolled over it with his eyes. He exhaled slowly as he took in the information on the EKG. “It...looks like sinus tach.”
“Check the rate strip.”
Pulsus closed his eyes and groaned audibly, cursing himself for his oversight. “Second degree type 2 block…”
Vagus picked up the paper in his magic again, chuckling. “And you wonder why we work you eighty-five hours a week. You gotta learn this stuff.”
Pulsus stood silently nearby as Vagus scribbled notes onto his paper. No nurses were at the station- no doubt they were administering medications and the like in patient rooms.
Pulsus took a deep breath. “...How is she?”
Vagus stopped writing. He glanced over solemnly at Pulsus and shook his head.
“Maybe we can give more inotropes?”
“It’s over,” Vagus responded softly. “I know it’s hard for you because she’s young and it was all unexpected, but...these situations are in the job description.”
Pulsus stood by silently, looking down at his hooves and doing his best not to think of anything.
“You should tell the family.”
Pulsus looked up at his attending physician. “What?”
“You’ve gotten to know the family this week better than I. Besides, it’s your fourth month of intern year, it’s about time you delivered the news. Counsel on donation, while you’re at it.”
Vagus went back to reading his notes. With pursed lips, Pulsus turned tail and headed to his patient’s room.
He paused just outside of the curtain to knock before strolling inside.
“Hello, Ms. Smith,” he quietly greeted, inching into the room. He was unable to keep himself from glancing forlornly at the cream-coated mare on a ventilator lying on the room’s bed. Her once frizzy orange mane was matted against her coat with grease, exposing the central line running into her neck.
“Hello again, Doctor,” an equally quiet voice replied.
Pulsus tore his gaze away from the patient he had been so focused on the last two weeks, his heart rending as he did so. He looked into the eyes of the retirement-aged mare sitting in the corner next to her grandson.
“Do you have time to talk to me?” he asked her.
She turned slowly to her grandson nearby. “Mac? Do you want to stay?”
Pulsus raised an eyebrow as the pony, at his age equal parts stallion and colt, gazed at the doctor, then back to his grandmother, and finally to his mother. His eyes shone with a solemn understanding.
“I would, but...I think I’ll head home. Talk with AJ, a-and make sure she ate.”
“‘Yer a good colt, Mac. Always have been. Don’t you go giving Auntie Appleblossom any trouble tonight, though, ya hear?” his grandma responded rather paradoxically to him.
The colt nodded silently and stood up from his seat on the windowsill. He walked over to his bedridden mother and placed a hoof on hers. Kissing her once on her forehead, he brought his gaze down to the floor and trudged dutifully out of the room.
“Do you think he’ll be alright?” Pulsus asked aloud.
“Ah, pish-posh! When I was his age the colts in my class were shipped off to the war! He can make it home safe after dark.”
Pulsus squinted and did a quick calculation in his head before concluding that the statement was mild hyperbole. Still, it seemed the mare did an excellent job of deflecting questions.
The doctor gazed blankly at her. It was clear she knew what was coming. “I...I’m sorry to have to tell you this. We’ve run out of options. She’s...going to be here with us.”
The older mare cast a wayward look at her beautiful young daughter-in-law lying unconscious on the bed and nodded slowly.
“...We have some decisions to make about her end-of-life care, Ms. Smith.”
She glanced down at the floor briefly, before looking into Pulsus’ eyes and smiling sweetly. “Sit down, sonny. I’ve seen you up and on your hooves all day, you might as well take a breath.”
Pulsus forced a return smile and sat in a chair next to her. “We don’t think continuing the ventilator is going to be of any use. Do...Do you know if she left any instructions? A living will, or something? Even verbal instruction?”
Her lips quivering slightly, Granny Smith shook her head. “Dying was the last thing on her mind. They...they both had a lot more living to do.”
Pulsus closed his eyes and swallowed. “Her husband...Your son...had power of attorney, but since he’s passed, the law tells us who it passes to among kin. Your grandson would be first, but he’s too young; it goes to her parents, next, but...from what little I know, I get the sense-”
“I...I don’t know where her father even is, to be honest,” Granny Smith replied. “They were...estranged is the term, I reckon.”
“Then...it goes to you.”
The older mare merely sat in her chair and pursed her lips. As Pulsus looked at her, his eyes were drawn to her mane, which was done up in a bun. He could have sworn it was grayer now than it had been two weeks ago.
“I guess I knew it would come to me,” she sighed. “Take her off, Doctor.”
“It’s hard, but...I think it’s right,” he offered.
“...There’s something else, isn’t there?”
“The accident was...violent, but she...made it through better than your son did. She’s young and was healthy before. O-other than her heart, everything is in almost perfect order.”
Granny Smith raised an eyebrow.
“Do you know...if she was an organ donor?”
Something shined in the mare’s eyes, and she reached down into a small purse. Rummaging through a set of cards, she pulled out a wrinkled one and looked at it for the better part of half a minute. “I guess...She did think about dying a little.” She placed the card down on the windowsill where her grandson had been sitting only moments before.
Pulsus took the card, glanced at the signature on it briefly, and tucked it into his white coat.
“How will she…” Granny Smith opened and closed her mouth as she struggled to find the words, “What will...Who…”
“Her liver and kidneys will probably go to Canterlot or Chicacolt. The nearest big transplant centers are there. Her corneas, though…”
Granny Smith squinted and gazed into the doctor’s eyes. “Who-what now, sonny?”
“A part of her eye,” he explained. “It’ll stay here.”
“A-and we’ll still be able to bury her?”
“Of course.”
She nodded.
A quiet beep echoed in the room as the ventilator automatically adjusted it’s tidal volume. The sheets crinkled slightly as the midsection of the young mother in the bed rose and fell.
“Her eyes...where will they go?”
“Just the front covering of the eye. We have a little filly here that will be able to see again because of them.”
“Tell me about her.”
Pulsus’ eyes crinkled as he recalled what he could. “I’ve only seen her once. I’m not a pediatrician or an opthamologist so I’m not responsible for her care. From what I remember, though...She’s around your granddaughter’s age. Maybe a year or two older. A magenta earth pony with the cheeriest attitude I’ve ever seen in somepony with a problem that bad. I didn’t know foals could be so patient and...happy.”
“...She sounds wonderful.”
“...She is. I’d be blessed to have a foal like her one day.”
Pulsus’ ear flicked as he heard some gurgling. Looking down, his eyes were drawn to a baby foal carrier, and a little yellow and magenta blob stirring under a tiny blanket. “My goodness, I didn’t even notice,” he said to no one in particular. As if on impulse, he reached down with a hoof to the baby, who reached out with her own to make contact.
He looked back to Granny Smith. “I-is…”
She nodded. “Two months.”
He glanced to his patient, and then to the little hoof touching his. “I didn’t even know…”
“I left her with family until now, but today, something told me to bring her to see her mother. Now I know why I felt that way.”
The baby gurgled happily, and Pulsus pulled his hoof away. The little pony closed her eyes again. Pulling himself up to his full sitting height, the doctor fidgeted with his forehooves. “I, uh, I can’t imagine how hard the last two weeks must have been for you. How hard all this must be.”
“I have my faith to lean on. We all do.” She smiled. “It’s a peace no one understands until they feel it.”
“Well, you’re taking it extremely well. You have a strong heart.”
“We Apples cry on the inside. Besides, I got my three grandkids to take care of, now. Ain’t no time for moping.”
The baby fidgeted again, cooing softly.
“Got to...Got to take care of her,” Granny Smith choked, running a hoof across her eyes to dry them.
Instinctively, Pulsus extended a hoof around her, and she leaned her head against him as he held her. Aside from the whooshing of the ventilator, all was quiet for a few minutes.
“Do you and the family want to be here?” Pulsus asked her. “When…”
Granny Smith shook her head, much to his surprise. “Doctor, I’ve seen you take care of her like she was your own these past two weeks. You treated her with a love only my son ever did. And I’m sure you would have done the same to him if he had made it out of the operating room like she did.” Removing her head from his barrel, she looked deeply into him and nodded once, as if punctuating what she was saying. “I trust you with everything. It’s her time, and we’ve all said our goodbyes, as best we could.”
She stood up, collecting her saddlebags. “Pear loved everypony. Just promise me she’ll get to help as many ponies as she can, ‘specially that little filly.”
“I’ll see to it personally. Are you leaving already?”
“I sure am,” she responded confidently. “Got me a family to take care of.” Reaching down to pick up her youngest grandchild’s carrier in between her teeth, she strode out of the room.
Pulsus sat in silence for a moment. Slowly, a list began to form in his mind of surgeons to consult, machines to turn off, and papers to sign. “And I’ve got a job to do, too.”
“And that’s why under standard conditions, the-”
The school bell rang, interrupting Cheerilee mid-sentence. She cringed as the foals in the room shrieked with joy.
“Excuse me!” she called. “The bell doesn’t dismiss you, I dismiss you!”
The foals ignored her futile plea, all running out the door as fast as they could to get to their afternoon of play and family time. All except one.
“Hey Miss Cheerilee,” Apple Bloom mused as she skid up to the teacher’s desk, “I got a question.”
Cheerilee shook her head to clear her thoughts and her attitude. “Of course, Apple Bloom.”
The filly slapped the math test she had received back that afternoon on the desk. “I don’t understand how I got number nine wrong!” she pouted in her distinctive twang. “Isn’t the answer twelve?”
Cheerilee picked up the test and scanned over it, the small black stitches around the edges of her irises glinting so softly that nopony would ever see them if they weren’t looking for them. “Hmmm,” she hummed aloud. “Did you remember your order of operations?”
“What? Again!? Lemme see that,” Apple Bloom cut back, nabbing the exam out of Cheerilee’s hooves.
Cheerilee saw Apple Bloom look at her test. She saw the swaying of her bow, she saw the disappointed but determined glint in her eye, she saw her confident but diminutive stature, and she saw her bright future. She saw it all with gratitude.
Cheerliee saw Apple Bloom.
Cheerilee saw.
“Ah, whatever. Thanks Miss Cheerilee,” Apple Bloom chirped as she ran out the door with her test to join her friends.
Cheerilee smiled as she saw her leave. “What a beautiful filly.”
