I just graduated from medical school, and my new hospital has some very strange rules

You probably think that all doctors are filthy rich, because I sure as hell did in the beginning. Eight years and a fistful of premature gray hairs later, I’m just a few hundred thousand dollars poorer than “broke.” That would matter if I had a family to provide for, but the long hours in med school have led to an end of my last relationship and a countdown on the shelf life of my ovaries.

I was in a “take what I can get and be grateful” situation.

So when St. Francis Hospital in Charleston, West Virginia offered me a position, I packed my sad life into three bags and sought opportunity in the hills of Appalachia. Nineteen of us started in July, and thirteen have since dropped out.

I like to think of myself as the rat that wouldn’t drown.

Some people broke inside after watching children die because they weren’t good enough doctors quite yet (everyone has to be a rookie at some point). It’s doubly hard when you have to inform the dead child’s parents, who then beg you to tell them different news, or scream that they want to die and just please kill them with whatever drug takes away the pain.

But most of my incoming class couldn’t handle the chief of medicine.

Dr. Vivian Scritt is, without a doubt, the biggest bitch I’ve ever met.

Now I know why.

“Nineteen of you start today, and we’ve got a pool going with bets on how long each of you will last,” she told us on Day One. “Don’t feel any pressure, folks. I’ve talked with each of you in private, and my expectations are very low.”

She peered condescendingly over her thin spectacles, snorted, then turned around to walk away.

“You should know when to follow me and when to stay away, because I’m not going to waste time explaining what you should figure out on your own.”

We gawked at one another, all feeling weak and small, then scampered after her.

I was last in line, and felt out of place taking even that much.

“You should have the list of expectations for St. Francis,” Dr. Scritt explained as she walked on, not bothering to look at us as she talked. “I printed eighteen sets of rules so that you would have to challenge one another for them, knowing that one of you would be left behind.”

An icy cold settled in the pit of my stomach as I saw everyone look down at a list of rules that only I did not have.

“If you cannot follow these rules, there will be no place for you in this hospital. It most likely means that you are unsuited to be a doctor, and should consider a profession that demands a weaker mental aptitude.” At that, she turned around to face us all. “And if you think that I’m the type to give second chances after a mistake, you’re woefully underprepared for the world of medicine.” She stopped and looked at each of us in turn, apparently expecting a response that no one dared to offer.

“Well,” she shot out in exasperation, “why are you standing here? People are dying. Get to work!”

*

No one wanted to show me their list of rules, so I had to wait until one of my classmates died.

It took nearly a week.

I was working at 3:00 a. m. because I had only been on the clock for ten hours. I was rushing into another room so that a patient wouldn’t know I was Googling his symptoms (doctors do this FAR more than you realize) when I saw Myron by himself in an O. R.

I stopped immediately. “Myron?” I squeaked. “What the hell is that?”

His arms were working furiously, but his back was turned toward me, so I couldn’t see what he was doing.

Something felt wrong.

Myron was the pick of our litter. He’d been top ten in his class at John Hopkins, and he would remind us of that fact in exchange for answering the questions that we were too terrified to ask Dr. Scritt.

Slowly, I approached Myron, not wanted to startle him. “We’re really busy right now, is there something you need help with?”

He showed no outward signs that he had heard me. Instead, he kept pumping away furiously at the task at hand.

When I was five steps from him, I could see drops of blood flying over his shoulder.

Which made no sense, since he had been alone in the room.

“Myron?” I whispered, barely loudly enough to hear my own words.

I slowly crept around his left side, finally bringing the scene into full view.

Myron’s abdomen was split from sternum to pelvis. His esophagus spilled out, and his stomach sat on the table. A nest of quivering small intestine led from the bottom of his stomach back into his shredded torso.

Myron showed no outward signs of pain.

He was too busy working.

He clutched his own stomach tightly in his left hand, the folds squirting through his fingers like unbaked bread. His right hand was working furiously with a scalpel, sawing his organ into ribbons. Rivers of sweat poured down his forehead with the intensity of the effort.

I tried to scream, but it only came out as a moan.

That was enough to get Myron to notice me.

Slowly, he raised his head. Slowly, he smiled.

It was not a happy smile.

With eye contact locked on me, he licked his lips, angrily stabbed a piece of his stomach, and lifted it to his mouth.

He bit.

He chewed.

Then he lunged.

But most people don’t know how to move with their innards splayed out for all the world to see, and this was his downfall. Myron’s tattered guts caught on the corner of the table, and he fell to the floor.

Finally, he screamed.

I had learned very early in my medical career that compartmentalization is indispensible. That instinct took over my brain in the moment, and I acted clinically.

Myron was still grasping his scalpel with his right hand. I kicked it – hard – and it flew out of his hands.

He stared at me and screeched.

With his entrails still wrapped around the table, I figured my best option was retreat. I moved to the back of the room as a doctor and a janitor burst in.

And in possibly the most shocking moment of the night, I realized that they were not shocked.

Myron was anesthetized, subdued, and extracted within a minute of their arrival.

For a moment, I was alone with a pool of blood and diced stomach lining.

And something else.

A sheet of paper lay on the floor, its corner just touching the edge of the creeping blood.

Myron had dropped his list of rules.

The practical part of my brain continued to drive me. I snatched the paper from the ground, then quickly exited the room, taking care to avoid the puddle.

I didn’t want to leave any bloody footprints in my wake.

I knew that I had to read the list as soon as I was able to find thirty uninterrupted seconds to myself. Three hours later, I had my opportunity and ducked into a janitor’s closet. With a shaking, exhausted hand, I pulled the chain on a bare bulb, tried to ignore the noxious smell of leaking ammonia, and read.

St. Francis Hospital Rules – Guidelines for new doctors

1 – Never, under any circumstances, share your copy of the rules with anyone else.

2 – If any other doctor displays erratic behavior, leave the area immediately. Do not make eye contact.

3 – If any other doctor is approached or detained by someone in a janitor’s uniform, do not interfere. Never ask about that former doctor again.

4 – Never touch any seemingly abandoned Reese’s Peanut Butter Cups. Those are Dr. Scritt’s favorite candy.

5 – Any child that dies in St. Francis hospital MUST be cremated within 120 minutes of official time of death. If you suspect this rule has been broken, alert Dr. Scritt, and the hospital will be evacuated.

6 – There is no Children’s Burn Unit at St. Francis hospital. If you find yourself there, continue walking until you return to familiar territory. This usually requires traveling in a straight line down the central hallway for 47 minutes. You will not reach a wall during that interval.

7 – This rule is on a need-to-know basis.

8 – A small quantity of sulfuric acid is kept in every room. This is ONLY intended for use on patients with severed spinal cords. If they attack, a hypodermic injection of H2SO4 into the cranium is the only way to subdue the subject.

9 – The morgue must house at least 13 cadavers at all times.

10 – If find yourself on the hospital roof with no memory of how you got there, you have only two choices. Either wait for an extraction team to find you, or jump four stories to the sidewalk on Court Street.

11 – If you see Room 1913, do not look directly at the numbers. Do not open the door. This is, by far, the most important rule.

My heart stopped when the door opened.

Dr. Scritt was staring at me. What little emotion shined through her exterior seemed to be surprise.

We both stood, frozen, for five seconds of agonized silence.

“Dr. Afelis,” she drawled gravely, “I’m shocked.” She stared down at the bloodstained list of rules in my hand.

I reached for words. Any words, because literally any response would make me look less guilty than I did in that moment, staring up at my boss’s boss’s boss and saying literally nothing in my defense as she weighed my soul with her eyes.

And I said nothing.

“You took a list that wasn’t yours, and were nowhere to be found after your coworker experienced such an unnatural incident.” Dr. Scritt huffed through her nose. “It seems that you’re willing to do the unthinkable in the name of getting what you need. And Myron couldn’t’ even follow the most important rule.” She clenched her teeth. “I had a four-year streak of predicting which incoming doctors will break the soonest. This will ruin my chances in the office pool.”

The ghost of a smile graced her lips before she turned to leave.

“Get to work, doctor. You’ve got three hours left on your shift, and those symptoms aren’t going to Google themselves.”

I didn’t realize that I’d been holding my breath until I heard my own gasp for air.

Shaking, I slowly emerged from the janitor’s closet. I quickly stuffed the list of rules back into my pocket, reflecting on the fact that I had just achieved what might be considered an actual win.

Perhaps, just maybe, I would keep my head above water at St. Francis after all.

I turned to head down the hall when I stopped in my tracks.

Everything was unfamiliar. What the hell had happened?

I glanced all around. The design of the hallway was familiar, but everything was off. I could hear people talking in the rooms, but the immediate vicinity was devoid of all people but myself.

Nothing made sense.

Then I looked up.

And I’ll be honest, I peed just a little when I read the sign.

ST. FRANCIS HOSPITAL – CHILDREN’S BURN UNIT

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