(Content Warning: Suicide)
In bocca al lupo.
These were the parting words of Signora Bianchi prior to every exam. It translates to ‘In the mouth of the wolf’, an Italian idiom for good luck. Back then, I was 15 and awestruck by my teacher’s tales of growing up in Italy; how she would choke back a concoction of egg yolks and whiskey for breakfast each day and run rampant in the narrow, pebbled streets until sundown. It was my first glimpse into what existed outside of my hometown of 15,000 occupants, the endless possibilities that were out there just waiting for me to grasp. Maybe for that reason, I – now 23 – decided that Italy would provide an ideal backdrop for my medical elective. Maybe in this strange yet exciting place, I could find solace. Yes, this would be good for me.
I based myself in Orvieto, a small but striking hilltop commune perched a top a large butte made of igneous, volcanic tuff, just ninety minutes out of Rome. It housed the Ospedale Santa Maria, a multidisciplinary 200-bed hospital that was to be my home for the next 6 weeks. My train pulled into the station on Tuesday evening, just as the golden orb set in the western horizon. Its light reflected off the great white cliffs, painting them reposeful hues ofpastel orange and pink. Orvieto sat high and majestic above the expansive valley floor, andfor miles I saw nothing but green plains dotted by small farmhouses and cypress trees. I let out a deep sigh and soaked it in. I thought, good, I hate the sea.
︎I had been at Ospedale Santa Maria for two weeks. In bed 2A lay a Spanish woman dying of right-sided heart failure. The ventricles of her heart had grown thick, futile at pumping blood,and fluid was now creeping into the delicate alveoli of her lungs. Even lying down, she struggled for each breath, her legs swollen so significantly they threatened the seams of hercotton pants. Despite this, she remained a lively character who loved nothing else but to talk for hours on end. I began to find that those who were facing the impending fragility of their own life liked to lecture others on how they should live theirs.
“In this world, you must work hard – time is too short, you must never take tomorrow for granted!” she proclaimed with a thick accent.
I used my stethoscope to auscultate the gentle lub-dub of her failing heartbeat as she divulgedthis dissertation. Frankly, I didn’t listen to a word of it. I’m sure she believed her speech would miraculously inspire me to abandon my life thus far and chase after my true heart’s desires. To carpe diem! But words were just words, and when presented coyly as they werenow, were just a thin veil people hid behind to rationalise selfish behaviours and dangerous impulses. At the funeral, often times people didn’t know what to say to me, so they resolved to giving me a pat on the back and saying ‘Life is short’ — as if those three words were somehow supposed to help acquiesce the surmounting grief within me. Life is long. You could ask anyone who was stuck in a job they hated, or was unhappy in their relationship, or had to wait in the waiting room of a hospital to hear the fate of a loved one. I stared at the checklist sheet on my clipboard, not really seeing. Life is long with far too much pain, that never changed no matter how much I did.
“You must work hard, even if you’re rich!” the woman stated with bulging eyes.
Then, looking pointedly at me, tacked on, “And you look rich.”
︎Friday, the 18th of April. I was reminded of this date constantly, as I wrote up patient notes, ordered blood work, signed off on new prescriptions. My favourite thing to do after a long shift was to head straight to the local bar to alleviate my stresses with an aperitivo. Some of the other junior doctors had gone for dinner at the pizzeria, but I wasn’t in the mood to make meaningless chit-chat with people I didn’t care for. Bar Montanucci was intimate in size and paint flaked off the walls, but this added to its old-world charm.
I ordered a Campari, then a martini, then a Negroni, then an anisette. Every drink I threw back burnt my throat as it added to the confidence growing within me, which compounded to the point where I found myself approaching the man lighting a cigarette by the pool table. He was older than I was, and his tanned skin and defined muscles indicated that he was a manual labourer of some sort. His nose was too big for his face and his ears stuck out, which gave him a goofy but sweet appearance. The important thing was that I had never seen him before, and was unlikely to see him again. I tapped him on the shoulder, and with my words beginning to slur together, I told him why today, April 18th, was so significant to me, though I’m not quite sure he understood my English. I told him how one year ago I woke up with a sister, and one year ago I went to sleep without one. His enthusiastic nodding and toothy smile confirmed my suspicion, but I didn’t mind, as his hands had begun tracing the contours of my waist and his lips were tasting mine. Alternating between drags of his cigarette and more shots of limoncello, I lulled myself into a state of temporary amnesia.
I woke at 3am. The man from the bar was asleep next to me, his bare chest heaving up and down with the sound of his breath. The moon peeked through the cracks of the window shutters, emanating a gentle glow. It reflected off the white detailing of a swimming costume slung on the back of a chair. My sister loved to swim. She revelled in the feeling of being underwater, the feeling of being weightless and insignificant. She would dive fearlessly into the water and swim further and further into the unending depth, which used to scare me, even though I was supposed to be the older sister. They found her body just off the cape, a lifeless skeleton washed up by the tide. I couldn’t bear to enter the ocean anymore. The suicide was confirmed in a note left for our parents, but I never found a note for myself.
The stranger next to me grunted as he rolled over in his sleep. The moonlight casted shadows across his face, accentuating his ugly features, and his semblance to a monkey only struck me then. Disillusioned with alcohol, I hadn’t noticed his balding hairline or protruding gut before. Seeing it now made me want to puke. I looked back at the swimming costume. Asharp pang hit my stomach, and I felt a cold wave of loneliness creep up on me, spreading like wildfire until it was all-consuming. Tears started rolling down my cheeks, though I couldn’t tell you why or how. How could I be surrounded by so many family and friends who claimed to love me, and yet feel this alone? And though I was physically naked and completely vulnerable to this man, I felt nothing, like there existed this great hollowness within me. What was the difference between us, then, and a cold statue of two individuals frozen together in stone? I think I finally understood Epictetus when he said almost 2,000 years ago, ‘For because a man is alone, he is not for that reason also solitary; just as though a man is among numbers, he is not therefore not solitary’.
I perked up to look at the moon again, but it escaped behind some storm clouds. When the lights go out, so do our disguises.
Have I ever truly mattered to anyone?
The hospital was a living contradiction. A lot of happy things occurred within these walls, but of course, the same walls also saw a lot of sadness; hopeful individuals being told their cancer had relapsed, diagnoses of chronic conditions that would forever change how a little girl or boy would live their life, mothers and fathers dying in front of their children. But despite the whirlwind of emotional challenges that added to the medical complexities ofmany, many patients, I put it all aside and faked a smile for my last patient. At that point, I was finishing an 18-hour shift following a week of being the on-call doctor, and was glad to soon be reunited with my bed. My eyelids were fighting fatigue as I entered the room. Mr Rinaldi had a hip operation two days ago and was waiting to be discharged home. However, while I was performing the check-up, he was panting like a dog, his face red with sweat dripping off his chin. I listened to his lungs, clear; I checked his vital signs, steady; I took his temperature, normal. It didn’t appear to be pneumonia, nor heart failure. Besides, it was hot that day, so I assuaged his concerns and requested the nurses move him to a cooler roombefore finally heading home for some much-needed rest.
My sleep was disrupted by a phone call from the senior medical consultant, only four hours later.
“I just responded to a Code Blue for Mr Rinaldi. His breathing capacity was cut in half and his skin was blue by the time I got there. He had a massive pulmonary embolism. You were the last doctor to see him.”
My heart was beating out of my chest; I couldn’t speak.
The consultant continued, “You’re lucky he’s still alive”.
I was overcome by a mix of relief for Mr Rinaldi and disgust in myself. I was sleep-deprived, mentally exhausted, and my poor judgement had almost cost this man his life! That thought made me sick to my core. What deluded game was I playing, thinking I could be a doctor? My cheeks pricked with unpleasant heat. I was supposed to know the ins and outs of human biology, be counted on to make the right decisions. How the hell was I supposed to save people? I couldn’t even keep my own sister alive.
The consultant spoke: “Hey. Word of advice? Make some friends here. You’ll never make it if you think you can do everything on your own.”
I nodded silently at those words as the guilt and remorse began to manifest physically as waves of nausea. After ejecting last night’s dinner, I returned to bed for a few more hours of restless sleep.
Following my near-fatal mistake, the other junior doctors avoided me like I was some type of bad luck charm. One of the other girls however, Maria, was very sympathetic to me following the incident. She had offered to cover my night shift that week and confessed to me quite poignantly of the time she fatally prescribed the wrong drug dosage to a patient. I was shocked – this field was unforgiving to those who made mistakes, and to admit to it was to be accepting exile. I was grateful to know her secret though; her honesty and willingness to be vulnerable made me feel that little bit less alone. Brought together by mutual scandal, we became an unlikely duo in the hospital, supports for each other when there was no-one else.
Maria had pleaded with me for weeks now to go to the seaside with her, and I had finally, albeit reluctantly, agreed to go. As she navigated our rental car carefully along the winding roads of the Amalfi Coast, I looked out across the expansive, blue horizon. I saw thin girls in colourful bikinis swimming lazily by the shore, sailboats stuffed with tourists travelling between ports, and wild youths cliff-jumping recklessly off tall, intimidating ledges.
“Oh, come on! You’ve got to come down to the beach with me! The water will be warm, and apparently it’s the clearest water in the world!” Maria begged, eyes darting carefully to checkbetween the curving road and my unconvinced expression.
I didn’t feel very much like telling her of the reason behind my aversion to the beach, so I smiled meekly and said I’d think about it.
Maria ended up spending much of our trip inside our stuffy hotel room, as she had themisfortune of acquiring gastroenteritis from some rancid crayfish our first night there. By the last day of our vacation, I had exhausted all the churches, markets, and hikes Amalfi had to offer, and Maria was still showing no signs of recovery. Maria, fed-up and exhausted by debilitating fatigue and my relentless stubbornness, practically shouted at me: “Just shut up and go! We’re in one of the most beautiful places in the world and I’m stuck in this tiny shoebox of a hotel room! I know you can swim, so what’s stopping you?”
I was taken aback by the brusqueness of her comment, but it seemed to muster some internal motivation. Whether it was due to reluctance to talk about my sister aloud, or maybe a combination of guilt, sympathy, or even fear of Maria, I hesitantly changed into my worn-outbathing suit, checked which bus route stopped at the beach, and made my way down to the sea.
It was an exceptionally hot day. My back stuck to the leather bus seat and the air was laborious to breathe. Sweat dripped down my chest and caused my white, cotton dress to cling to my body, leaving little to imagination and inviting more lascivious male gazes than I would have liked. When I finally reached Fornillo Beach, it was overrun by eager tourists who had staked every last sunbed and left no patch of sand unoccupied. I had already turned back to return to the bus stop when a small trail entrance caught my eye. The mouth of the narrow, dirt path was barely visible, hidden by overgrown foliage. People seemed to just walk by without a second thought of where it might lead. Curious to see what views the trail had to offer, I followed the dirt path until I found myself at the place where I had seen the boys carelessly fling themselves into the water a few days earlier.
I ventured out on the large, flat rock. The cliff-edge petered out slightly before the vertical geometry dropped down into the treacherous sea below. I had a fear of heights as well as the sea, but still I crept up to the cliff-edge, as though something magnetic was drawing meonwards. The rock felt solid and grounding beneath the soles of my sandals, while the sea continued to rage violently against the rock-cliffs below me, tumultuous and reckless. As I leant forwards and peered into the swirling waters below, images of my sister immediately flooded my mind. I wondered if this was the same image she saw before she took her ownlife, what her last thoughts might’ve been before she jumped. Desperation? Regret? Somewhat unconsciously, I began to undress. The rhythmic sounds of waves crashing againstthe cliff-face echoed through my body and drew me deeper and deeper into the moment. I no longer felt in control of my own thoughts or being, and was overcome by this elusive spirit, ahigher power to which my body belonged. My heartbeat rang through my eardrums as I bent my knees, preparing to leap into the unknown. Images of Signora Bianchi, my high-school Italian teacher, flashed through my mind. In bocca al lupo. I jumped.
The water was numbingly cold as it attacked my body. I hadn’t touched the ocean for almost 2 years and now, it engulfed me, lit me on fire from the inside out. I felt every cell in my body turn on, alive and electric and screaming. The current pulled my body back and forth like it was nothing but a ragdoll, my eyes stinging as they were contaminated by the salty liquid. I tried to focus, but a million thoughts raced through my head in an unceasing marathon. Bubbles of precious oxygen escaped my mouth and the icy temperature nowpervaded my core. The thoughts began to slip from my mind as it became preoccupied by thegrim reality of the present moment. The panic subsided, but only because it became too painful. I surrendered myself to the ubiquitous nothingness. I thought again of my sister. Ithought of how loving and fierce and beautiful and kind and strong she was. Was, in the sense that I would never be able to hold her, hug her, or kiss her again. Was, in the past tense. My own warm, salty tears mixed with the biting seawater that surrounded me.
I didn’t want to be stuck in the past tense.
And so I kick my legs, the tip of my nose breaking the surface first as I come up for air.