Cardiac Arrest

Patients and their relatives don't have a clear idea what CPR entails. It rarely succeeds and is brutal... this post is an account of how a typical arrest scenario unfolds.

Anton stood in the doorway of his hospital sideroom. He wasn’t sure how he got there, considering he was in bed seconds ago writhing in pain. He knew he was sick, but for whatever reason he was now pain free.

“Anton?” whispered the voice of a nurse behind him. He tried to turn around, mystified by why everything was all of a sudden so slow. He felt his movements were dictated by an inexplicable inertia. With sluggish effort he managed to face his bed.

“How peculiar”, thought Anton. Lying in the bed was Anton himself. There was no mistake about it, that sallow figure lying motionless and silent was himself. It was tucked tightly in bed, its head tilted back and its mouth gaping open. Anton cringed as he saw that a sliver of drool had meandered down the gaunt, jaundiced face onto the pillow.

Arched over it was Eva, the nurse who took care of him. “Antoooooon!” she cooed, pinching the shoulder. Achieving no response, she pulled the covers back and saw it wasn’t breathing. Anton had seen this scenario enough times to realise what was going to happen next and it terrified him. He wanted to step forward to stop Eva pressing the emergency button, but also to slap some life into the body. His legs wouldn’t shift, as though cast to the linoleum floor with lead. He tried to shout, except his mouth wouldn’t open.

On hearing the alarm, the room was flooded by ward nurses and doctors. They rushed in past him. None seemed to acknowledge he was there. Eva had already started chest compressions. She had torn open the pyjama top. Her interlocked hands pulsed on the sternum, as though on a trampoline. Judging by the way the chest sagged asymmetrically with each blow; Anton could tell Eva had broken some ribs already. He winced as Eva leaned over and was putting more effort into her compressions. Another nurse had brought in the crash trolley. Anton could tell this was her first time; she took a step back and anxiously watched the calamity in front of her unfold, a hand over her mouth.

A burly doctor had taken over chest compressions from Eva. Anton could tell he was pushing all his weight into it; each compression now accompanied by a hoarse, grunting wheeze from the body. At first it all looked a shambles. Beeping machines competed for sound with shouting doctors, their voices shrill with adrenaline. The TV was still on, an episode of “Dinner Date” playing. Blood was dripping down an arm, and the unmistakable smell of urine and excrement shrouded the body. The compressions continued, a pinkish froth foamed and crackled at the mouth. A nurse had connected the defibrillator, but the screen wasn’t working.

Yet within seconds, it all changed. Anton could see that this was an organising entropy, chaos on a leash. The medical registrar tinkered with the defibrillator and it worked. She took a step back, her arms folded and her eyes surveying the scene in front of her like an army general. A doctor had pulled down the body’s pyjama trousers, exposing the groin and feeling for a pulse. At the same time, on the other side, a doctor was crouched on the floor inserting a cannula into the hand. Anton was shocked by the size of both syringe and cannula, but could do nothing to stop the doctors simultaneously stabbing with the needles; the syringe filling with crimson and the cannula sliding under the skin. The syringe was quickly handed to another doctor, who ran out of the room to process it.   With the cannula in, the other doctor immediately pushed a syringe full of adrenaline through.

At the head of the bed, the anaesthetist was negotiating the body’s airway. It was only 27 years old, and the anaesthetist knew that he would need to put a breathing tube down. It was difficult; the head was bobbing up and down with each compression and there were plenty of secretions in the mouth. With one hand he tilted the head back, his other hand slid an L-shaped device down the throat. Once wedged in, he tugged upwards, at the same time crouching behind the head and looking into the mouth for a clear view. The airway was barely visible, and he had to tug harder. The metal scraped against the front teeth, and they chipped as they knocked against it. “There it is!” he shouted, a nurse handing him the breathing tube. He slid it in and secured it, connecting it to a green bag and oxygen tubing.

“Pulse and rhythm check!” announced the medical registrar. The compressions stopped. The burly doctor was visibly exhausted, his scrub top a darker shade of blue with sweat. His colleague volunteered to take the next set and put his fingers on the carotid pulse. The anaesthetist squeezed the green bag, the chest rising in response. For the first time, there were seconds of near silence as all eyes were on the defibrillator screen.

“We’re in VF, get back on the chest” announced the medical registrar, her stance unchanged, her voice cool. She turned towards the doctor who had put the cannula in. “Alice, you ok to shock?”, She nods in response and stands by the defibrillator and changes the settings. Compressions started again, the anaesthetist pumping the green bag.

Alice faced the team, her thumb on an orange button. “Charging!” she says, followed shortly by “Off the chest, oxygen off!”. The compressions stopped again, the anaesthetist disconnected the oxygen and stepped away. All was silent except for Dinner Date. Alice looked around and then firmly pressed the orange button.

Anton’s eyes widened as he saw the body pulse, the chest violently wrench forward and drop of its own accord. His own hope for success, for some sort of positive resolution of this barbarity was mirrored in the eyes of the doctors and nurses as they looked at the defibrillator.

“PEA. Back on the chest, adrenaline!” said the medical registrar, her hands now at her hips. Compressions started again, another syringe of adrenaline given. “When was this going to end?” thought Anton, the body in front of him pale and deformed, living only through the efforts of the men and women around it. He was shocked at an almost infinite resolve, their efforts not waning despite the circumstances.

The doctor who had rushed off with the blood test had now returned, running in with a sheet of paper. He gasped for air as he handed the result to the medical registrar who devoured it with her eyes. She read out the results, with particular emphasis on the pH and lactate. It must have been bad, as one of the doctors groaned. “This is it”, thought Anton. “This is when they give up”.

“We carry on” said the medical registrar. “We haven’t identified a reversible cause yet, but it looks like he was under the surgeons with abdominal pain. Let’s give him some fluid stat and get them down here. Sounds like they were worried he had ‘perfed’ and was septic. He’s awaiting a scan”

With that announcement, everything suddenly stopped. It was like a game of musical statues, everything and everyone was static. Even Dinner Date was paused. “What now?!” wondered Anton. 

He stared at the scene in front of him like it was a wax-work display. It was all so intense. This indefinable, grey area between life and death was a human invention. Which side of the line was he falling towards? These tireless men and women seemed intent on pulling him back. For what? Was he worth it?

His life was pretty unremarkable. He struggled to find his place in the world and this haunted him incessantly. He couldn’t justify his existence. It’s not like he ever wished he was dead... it’s just he always thought if death came to him he wouldn’t have minded so much. Life was persistent, never ending and unrelenting and here was a way out on a plate.

Anton looked at the frozen medics in front of him. He liked the medical registrar, her posture oozing in confidence. The doctor doing compressions was leaning over the body, his face contorted with effort. Eva was holding up a bag of fluid, she had managed to put it up even before the registrar had suggested it.  This scenario was more than ‘just another day at the job’ for these people. There was nothing enjoyable about any of this, yet they obviously put in all they could. It didn’t make sense beyond a sense of duty towards the patient, towards saving a life.

Maybe that’s what life was all about; it didn’t necessarily make sense but you did what you could to preserve it. These people literally waded through bodily fluid to try and save his. They obviously valued his life more than he did. This was enough to make him realise what he wanted.

With that thought the present resumed. The chaos of CPR continued. The medical registrar was looking at the defibrillator, “Pulse check! I think we’ve got a change in rhythm”. She was right. The fluid seemed to have done the trick along with the adrenaline; he was now in sinus rhythm. A wave of relief rippled across the room, and manifested in all the faces there. It warmed Anton to see them all relax, the medical registrar putting them at ease by saying “Well done team”. You could tell it didn't usually end like this.

Although compressions had stopped, the team carried on working. The surgical registrar arrived and furnished a plan. The ITU consultant had also arrived and was in conversation with the anaesthetist at the head of the bed. He was still pumping the green bag. Another doctor was putting another cannula in, whilst another anaesthetist had started putting a line into the radial artery. The medical registrar had left and was seated at the nurses’ station documenting. She was talking to a medical student at the same time, explaining that Anton was lucky. He was young and had a reversible cause for his cardiac arrest. The four other cardiac arrests that week had ended differently. Her conversation was interrupted when her bleep went off and she went to answer it.

That was the last thing Anton remembered before waking up in ITU. They had taken the breathing tube out and were cautiously waiting to see how he was going to do. He had been there for one week; a perforated ulcer confirmed on CT Scan was operated on the day after his arrest. 

He didn't care. He was alive and relieved that was the case.

Tahir

Tahir couldn’t blame his unit for leaving him behind. He was injured; the bullet had burrowed deep into his spine. The blood had stopped oozing, but he had now lost all control or feeling of his legs. He winced as he propped himself up, his back against an abandoned car.

It had all gone wrong. They didn’t stand a chance; their morale as low as their ammunition... their exhaustion mirrored in spirit and numbers. The few of them that had escaped the lost battle took Tahir with them, only to leave him when he was slowing them down. They pooled whatever ammunition they had left between them. It amounted to two clips and they left it along with their best AK-47. No words were exchanged, no forgiveness sought and no bitterness expressed. A mutual understanding pervaded the silence as they shook hands. He didn’t dare blink and neither did his comrades, knowing that it was the last time their eyes would meet.

He had grown up in this neighbourhood. It used to host a symphony of security; the birdsong early morning waned into the hustle and bustle of normality. With the area repeatedly torched by suicide bombs, the birds had fled and the people killed. All that remained was an overwhelming, palpable silence. Tahir felt like he was suffocating in it, his ears humming with every heartbeat. The air, in its stillness, had desiccated under the scorching sun. He could taste the death as he gasped in the heat.

The AK-47 felt heavy in his arms. Its sight suddenly evoked an intense jealousy... but also admiration. It was born to do one thing and it had done it well. It knew its place in the world, and its role in it was as straightforward as its barrel. Tahir winced with the pain in his back. He looked around him and couldn’t help but feel irrelevant. His non-descript upbringing, uneventful adolescence was now coming to an end. Some irrelevant person somewhere on an irrelevant TV station would say, “An estimated 30 fighters died today”. He wouldn’t even warrant an accurate number. It saddened him that this was the case, that the world had always ploughed on, relentless. It almost felt like his life was never really his own, his timeline too fast to catch up with, his choices not his to make.

He knew he didn’t have long, the enemy was fast approaching and he hoped that they would end things quickly. They would drag out the inevitable, using false hope as torture. His enemies on death row had the luxury of knowing exactly when and how they were going to die; no doubts or delusions to corrupt a scheduled end.

He was staring into the distance, and realised in his absent mindedness that he was beaming. Maybe it was the thought of his wife that traced his cracked, blood crusted lips into a smile. Layla was pregnant and had refused to tell him the sex of the baby. He knew anyway; she was hoarding all that was pink in the weeks before he volunteered for service. The prospect of having a daughter brought him so much pride; the thought filled him with warmth. He wondered how Layla was coping without him.

It all reminded him of when he first saw her. It was a blazing hot afternoon. The sun sat unobstructed in an empty sky and bleached the earth into phosphorescence. The electricity was out, and so was everyone. Their homes had converted to ovens and the scattered shade outside provided a chance to complain to all the neighbours. Tahir had joined the crowds, a piece of cardboard in his hand to fan himself and those around him.

Amongst the chaos, he heard the sound of children laughing. She was standing in the middle of the street, circled by boys and girls running and jumping. She was stood over them, in her hand a water hose powered by a noisy generator pump. Her thumb dented the outgoing stream and it splayed into a light rain over them. Time slowed, sound ceased and the silence accentuated the beauty that unfolded ahead of him. Her back was to the sun, her silhouette crisp against the blanched, dusty road. It was her hair which he fell in love with first; unruly, jet-black and ample. Under it was an unrestrained smile, her eyes fiery with emotion. As she moved, her plain, modest summer dress swayed nonchalent, her steps graceful and elegant. For a moment she was the only thing that existed...

Tahir's thoughts were interrupted. He could hear the enemy approaching, their foreign mix of dialects recognisable. His finger was on the trigger, his mouth reciting the Shahada and he waited.

It always ends too soon, he thought.

She

Kolya was on his way out when he caught a glimpse of the Man. It wasn’t his lavish attire, bespoke and tailored with taste which caught Kolya’s attention. Nor was it his good looks, bordered by a sharp, angular jaw and topped with an entropic quiff.

What attracted Kolya to this Man in particular was the way he drank. He was sitting next to Bob, whose acrimonious divorce from both wife and job had redefined his life as one of drink and drunkenness. Whilst it was the drink that made Bob drink, cyclically drowning his guilt with glut, the Man drank with purpose. He would stare at the shot in front of him, his expression stern with restrained anger. In one swift, directed motion he would scoop the shot with his fist and pour it down his throat. This ritual would be repeated with each successive drink poured by the bartender, whose pitiful whimpers did nothing to stem the flow of alcohol.

“Hi”, said Kolya, dragging a stool and seating himself by his target. The Man slowly turned to Kolya, the creases along his face accentuated by an expression belying a proud curiosity. Kolya instantly regretted engaging with the Man. The absurdity of the situation had silenced him into ineptitude. He looked anxiously to the bartender, who raised his eyebrows in silent support.

“So you want to know why I’m drinking myself to a stupor?” said the Man, his baritone delivering the words slowly, giving each syllable value. His eyes were fixed on Kolya’s who could see his own reflection swallowed in the empty pupils. Kolya looked away in bewilderment; the intensity of the Man was overwhelming. He hungrily downed another shot before turning to Kolya and began his soliloquy.

“I was sitting by the jukebox over there with my business partners celebrating.” The Man had raised a pointed finger, aiming at a retro-jukebox glowing in the corner. “Our recent success was the reason for our celebration… but it was I who they were toasting. They thought I was a genius, a phenomenon of the business world. With each drink they raised their voices with praise and then indulged their envy with more praise. They satiated their absolute hatred of me with these theatrics, and they revelled in their collective hypocrisy. I absorbed the attention, fuelling an ego I imagined actually existed. We were all guilty of this charade of dishonesty and spite, and our lives defined by it.”     

The Man paused. His staring eyes were now burning with feeling, his emotions volatile with drink. Kolya was taken aback by the Man’s flamboyancy. It was almost like a theatrical performance and it seemed like the alcohol had sharpened it.  He had another swig before continuing.

“I justified a life constructed on lies, apathy and plain boredom. I rejected morality, ethics and even God for this depravity and I flourished in it.” Kolya saw that one corner of the Man’s mouth had twisted into a content nostalgia. His eyes glistened as he lowered his voice to a whisper.

“There comes a moment in every man’s life that defines his existence. The days leading to it are all in preparation... and the days that follow are remnants of its glory. In the midst of our debauchery, ‘She’ walked in. Her awkwardly adorned frame swayed apologetically, as if embarrassed by its own frailty. Her face… although plain… had betrayed a sense of tried and tired innocence, exhausted by the burden of unappreciated purity. There seemed to be an intensity in her eyes… they shone in the depth of her greyscale silhouette as she stood in front of the lights.”

“I don’t know why, but seeing her as I did… it shook me to the core. This façade… this outer shell I had so carefully moulded over the years instantly melted away. I felt exposed and overwhelmed by …shame. I was embarrassed of who I was, what I represented. I was a victim of my own ego’s delusions; I truly believed I was worth something…but underneath the lies…”

His voice trailed off into silence. He was staring ahead into a mirror behind the bar and in a monotone said, “I don’t recognise the man in the mirror. He’s wearing my clothes, but that isn’t me. Why is it that I’ve spent my whole life aspiring to be my own imposter?”

Kolya didn’t know how to react. He slowly looked at his own face in the mirror, the Man’s words echoing in his mind. He developed a sudden revulsion for the reflection. He recognised it as his own, and it was this familiarity that terrified him. He wanted to distance himself from himself, and realised the futility of it all. Those hollow eyes, the gaunt face encasing them were his forever. He panicked… why had it only taken till now to gain insight? Who was the face in the mirror?

The Man smiled as he noticed Kolya’s perturbation. He nodded at the bartender, who proceeded to pour Kolya a drink. Kolya glared at the Man, then at his reflection… then proceeded to gulp the shot in front of him...

(Below is a poem I wrote a while ago along a similar theme)

Chimeric in both Mind and Soul
I sit, my head a mess
Another battle, Mind and Soul commence
My eyes are deafened by darkness
And ears are singing total silence

I sit alone and contemplate
As my heart pumps lead
There is no sound left to hate
Except the voices in my head

I sit, a mere prisoner
Of a war without a goal
But I can't escape my masters
The voices of Mind and Soul

I sit, I listen as the war grinds
To a halt, and so does the pain
Soul triumphs over Mind
As one Waxes, the other Wanes

I sit, a sigh of relief
That it ended this way
But I know that Mind
Will kill Soul someday

The Abyss

Meursault opened his eyes. The sky above was hollow, its infinite blue stained only by the sun. His body was numb, the heat of the desert throbbed below him. He closed his right hand into a fist, gripping the hot, fluid sand that made his bed. His mind was fogged; he couldn’t understand why or where he was. As the minutes passed, his sluggish consciousness attempted to make sense of it all.

He could hear the raging fire. The smell of kerosene fumes masked that of charred meat. It annoyed him, how unsurprising this all seemed to him. The acid taste of this inferno laced his mouth, finally forcing him to sit up.

In front of him lay the mangled carcass of the Airbus A330, alight in a triangular inferno. Trailing the fuselage was a long and straight trench, the result of the airplane’s journey as it hit the ground. It was alight throughout, the kerosene trail a blazing scar in the desert landscape. Smoke billowed from the scene, a top-heavy tower of black leaning with the breeze.  

    

Meursault slowly stood up, his bare feet swallowed by the sand. “Where are my shoes?” he asked himself, shifting his feet in and out of the ground. He remembered taking them off before take-off. The man beside him had praised their brand, said they were ‘durable’. He cursed his luck in losing the shoes, his eyes unblinking at the fire ahead.

Then it hit him.

That man! What happened to him? What about the other passengers?! He looked around, his eyes frantically scanning his surroundings. His stiff legs cycled as he tried to run through the sand, circling the fuselage. His heart was racing and continued to do so when he completed a lap and realised, to his horror, that he was alone.

The adrenaline seared through his body. He began to piece together the events leading to this nightmare. He was overwhelmed. Where? How? Why?!

His flight had taken-off. He had placed his shoes under the seat in front of him. He was watching ’Singin’ in the Rain’. The movie had just begun, and was interrupted when the captain’s voice was suddenly broadcast within the cabin; a high pitched, panicked voice instructing everyone to ‘adopt crash positions’. Without warning the airplane plummeted from a height of 30,000 feet. The movie continued to play.

How long did this descent last? Meursault stared into the line of burning kerosene cut through the dunes. It had felt like an hour, like he was in suspended animation. Gravity had ceased to exist. Passengers were planted to their seats by seatbelts, their arms flailing in the air, snatching at the swinging oxygen masks. Screams drowned out the occasional sob and the rattling chassis responded with creaks and groans, the engines roaring. The man next to Meursault was still. His eyes were clamped shut and his hands gripped the armrests, his knuckles white. He was reciting a prayer to himself. The lady behind him shrieked with every rattle, lamenting the premature end to it all.

As for Meursault, he was silent. He couldn’t explain this lackadaisical sense of apathy. It was almost like he didn’t care for his approaching death. The more he tried to search for some form of emotion, or feeling, he was greeted with emptiness. He looked at the horrified faces of the other passengers, hoping to empathise but without success. He felt there was a void, an abyss which he was standing on the edge of. It felt familiar, like he was balancing on this very precipice his whole life. He would have never dreamt of making the leap before. Now it seemed like the most natural thing to do. Why had such a convoluted sense of liberty appeared now? Why had he accepted his potential non-existence with such ease?

He realised he was a coward. He had lived his whole life in perpetual despair, unsure of his value in the world. He felt like his life was without purpose; a sequence of irrelevant days at the office, the culmination of poor choices. It was an absurd and meaningless existence, yet he persevered. He always hoped life would adopt him for what he was meant to be. This impending doom had suddenly made the choice for him, and as things stood in his life he didn’t seem to mind.   

Meursault’s thoughts were interrupted by a laugh. In amongst the chaos, he had not paid attention to the lady sitting across the aisle from him. She was middle aged, brown haired and wore a smart grey suit. She held a hand over her face, partially covering a smile. She wore headphones and was concentrating on the screen in front of her. She was also watching ‘Singin in the Rain’, and giggled for a second time. It was a dainty laugh, one that would have been infectious in a different setting.

The man next to her was hysterical but she didn’t flinch. Meursault couldn’t believe what he was seeing. The woman must have felt his eyes on her because she slowly turned around and looked at him, a remnant of her laugh still traced on her face. Their eyes locked, and he saw in the infinite darkness of her pupils that very same abyss. His surroundings dissolved around him. It was just the two of them, floating in silent darkness.

Slowly, her smile expanded, her white teeth showing. To Meursault’s horror, she began to laugh. It was a syllabic laugh, each intonation a note in a tremulous cadence. Her dimples were contoured with wrinkles, her eyes gleaming with fire. Terror gripped his heart, and he wanted nothing more than to get away from it all.

The last thing Meursault remembered was that he had unbuckled his seatbelt. He guessed that this was probably what had saved him from the crash and thrown him safely away from the inferno. Was he grateful that he survived? He couldn’t tell. He felt that fate had pulled him out of the abyss and back onto the precipice again. Will he ever have that freedom from responsibility, humanity and most importantly life itself to face his mortality again?   

Mersault was answered by the distant sound of a helicopter. He looked up and saw its incoming silhouette on the horizon. It looked like a fly, floating on a mirage. He felt a tear roll down his cheek as he realised he was to be saved. His irrelevant past washed away, its absurdity replaced with hope for a justified, fruitful future.  Life in its inevitability would always give him a chance, whilst death was a journey of no return. He shuddered at the thought of the laughing woman who had chosen the latter. He walked towards his future, leaving the precipice behind with the memory of that laughter burning in the fuselage. 

The Duel - Part 3/3

(Part 1 - Part 2)

III

“Pechorin, let me explain” said Grushnitsky as he casually threw the pistol aside. “I am not the man you saw twelve hours ago.”

Pechorin was finding it difficult to grasp any feeling, let alone why Grushnitsky just spared his life. Grushnitsky proceeded to tell Pechorin about his transformation, its stimulus and how he had a new thirst for life. He was gesticulating excitedly as he recounted the events since their last meeting, but Pechorin couldn’t hear anything. He had stopped listening ever since Grushnitsky dropped his pistol.

He was furious that a cretin like his brother had managed to shatter him with such ease. His brother had, without effort, exposed the demon within him. This was an insult he could not endure. The loathing of his brother was now insurmountable. He couldn’t bear the thought that this man had found salvation, whilst he was damned to endure the monster within himself.

He felt betrayed. He thought he was ‘important’, but realised the world kept the reality of his insignificance insignificant. “Is this who I am doomed to be?” thought Pechorin, staring intently at the ancient pistol in his hand. He knew he had a choice, but knew that choice was made for him long before.

Grushnitsky had now reached the end of his plea. “I have gone through much today, and have decided to dedicate the rest of my life to rectifying my mistakes, the first of which will be our brotherhood. Brother, do you forgive me?” Pechorin looked up from the pistol.

“No.”

Grushnitsky’s lip twitched, and his face twisted into genuine bewilderment when Pechorin lifted his arm and pointed the pistol at him.

“My turn.” said Pechorin, already assuming the stance of a professional marksman.

“Sir I must object! We don’t know if this pistol is the faulty one or not! Sir I beg you to forgive your brother and leave this madness behind!” interjected Fyodor.

“No. He wanted a duel. I am a man of my word and shall give him one”

Grushnitsky, paled seeing his brother so bloodthirsty and obliged. He placed his hands by his side, and looked at Pechorin with those eyes which tormented him so much.

“I’m sorry it came to this” said Grushnitsky. Pechorin stared at his brother down the barrel of the pistol. He realised that regardless of which pistol he was holding, faulty or not, it would not have made a difference to the outcome at all. Grushnitsky's forlornly expression showed that he too understood this.

“Sorry? I wish I was too, Grusha” said Pechorin, as he pulled the trigger.

The Duel - Part 2/3

(Part 1 - Part 3)

II

Pechorin had chosen Fyodor, the family butler, as his second. Pechorin took a deep breath and tasted the familiar kerosene acidity which dominated his childhood. He and Grusha would come to the docks, playing hide and seek amongst the crates and cranes. The ships, now undisturbed stood silently in water so still it appeared frozen. It felt staged, surreal. Was this a tragedy or a drama, and did he have a say as its protagonist?

His thoughts were interrupted by a scurried shuffling up ahead. “Finally! They’re here. Typical lateness. Are the pistols ready Fyodor?”

“Yes Sir. I have loaded both as instructed. Are you sure you don’t want to know which one is faulty?”

“I’m no cheat Fyodor”

“Of course not Sir. Both pistols will discharge in an identical fashion but only one of them will successfully fire a bullet.”

Pechorin was surprised at his own composure. His only preparation for the duel was to put it into his diary, as a matter of habit. He wasted no second during the day thinking about it and immersed himself in business. He was disappointed that even now, with the approach of his opponent, his heart beat slow, almost intentionally lackadaisical.

Grushnitsky was accompanied by Alyosha, a young labourer on the docks. Both were short of breath as they stopped in front of Pechorin.

Pechorin was taken aback. Grushnitsky was a transformed man. It wasn’t his clean shaven face or carefully sculpted hair. It wasn’t the healthy glow in his cheeks or the crisp tailored suit. Pechorin only noticed all of this after he looked into Grushnitsky’s eyes. There was an intense shine to them, the crystal clarity of a new-born man.

Pechorin’s heart began to play a faster beat. Seeing his brother so positively changed had awoken in him revulsion and disgust. He could taste the hate in his mouth and any part of him shocked by it was quickly smothered. He didn’t want his feelings to show, so took a short step towards his brother.

“Grushnitsky, I trust you are ready?”

Grushnitsky’s face horrified Pechorin. It was beaming, and featured a smile contoured by dimples.

“Yes Pechorin. I am ready” said Grushnitsky with confidence. Fyodor then gave a pistol to each man.

“Heads or Tails?”

“Heads” said Pechorin, his beady eyes not leaving Grushnitsky for an instant. Fyodor flipped a coin, and saw that it was Tails. Neither opponent flinched, both intently looking at each other. Pechorin grew increasingly unsettled by Grushnitsky’s innocent, persisting smile.

“The rules are as follows. You are to stand 10 paces away from each other. Mr. Grushnitsky will take the first shot, Mr. Pechorin the second. You are allowed to inspect the weapon if you wish Mr. Grushnitsky.”

“There is no need.” said Grushnitsky. Fyodor shrugged his shoulders, and counted 10 paces between the men. Pechorin couldn’t take it any longer. Shooting a drunken vagabond was one thing, but this? He wanted an explanation for this betrayal, but he couldn’t bring himself to ask for it. Grushnitsky raised his pistol and aimed it with a steady hand at Pechorin.

This didn’t happen as he had hoped. Pechorin lifted his trembling hand, the open hand oscillating in synch with his racing heart. He suddenly realised that death is a contradiction; acting as the ultimate wake-up call in its capacity as eternal sleep.

Grushnitsky’s smile turned into a grin. With one smooth movement, he raised his arm into the air, pointed the pistol at the sky and fired.

The Duel - Part 1/3

(This story is heavily influenced by "A Hero of Our Time", "The Brothers Karamazov" and the movie "The Assassination of Jesse James by the Coward Robert Ford")

(Part 2 - Part 3)

I

Pechorin sat in his study, reclined in a chair and stared at the ceiling. He could still hear them downstairs, his father’s wake now in full swing. “How many eulogies does a dead man need?” muttered Pechorin. His guilt laden heart responded with heaviness. He loved his father, more so than his siblings. It was he who cared for him when he was diagnosed with cancer whilst his siblings squabbled over potential inheritance.

It was for this that his father had given him the entire shipping company upon his death. Pechorin held his breath as he heard a speech finish below, only to be replaced by another. “Where were these parasites when he needed them?” exclaimed Pechorin, the carvings in the ceiling blurred as his eyes pooled.

“You’re the parasite” hissed a shadow by the door. Pechorin closed his eyes, carefully wiping the resultant tear tracks. His movements were intentionally slow, and the silence accompanying them had almost muted time. Now sitting up, Pechorin looked at the sulking shadow and forced a smile.

“Grushnitsky! My brother! What a pleasure.” said Pechorin.

“The pleasure is certainly not mine.” growled Grushnitsky. He was visibly more drunk than usual; his dishevelled beard complemented his fraying suit. Pechorin stayed silent, trying to decipher the drunkard and his scheme.

Grushnitsky wobbled into the study and planted himself in front of Pechorin. He slowly bowed, until his face was level with his brother’s, their eyes locked. Pechorin held his breath; the stench of alcohol laced with vomit was one he wasn't familiar with. Grushnitsky’s eyes were black, soulless, their emptiness made Pechorin uneasy.

“I demand satisfaction.” said Grushnitsky, an inappropriate pause pervaded each syllable.

“What?”

Grushnitsky, without flinching lifted his finger and pointed at a pair of pistols, the pride of their father, which hung above the fireplace. His lifeless eyes remained fixed on Pechorin’s.

“You want a duel?!” gasped Pechorin.

“Yes.”

“This is the 21^st century Grusha. If you have issue with me you see my solicitor.” said Pechorin, calmly. Grushnitsky’s face warped into a terrifying grin.

“Just like Dad you are. You are a coward.”

Pechorin was immediately up on his feet, his face betraying his anger. His pride was his Achilles heel, and Grushnitsky knew this all too well. Pechorin could feel the adrenaline poisoning him. He could see that his brother wasn't joking.

“Why?”

“Why not?”

“I’ve done nothing to deserve this. You’re drunk Grusha.”

Grushnitsky vocalised his grin, a cackling laugh ensued.

“I despise you Pechorin. I despise that you have what I have not. I despise the fact you are alive. It would have been a wonderful day if both you and father were in that coffin.” slurred Grushnitsky. His words had visibly shaken Pechorin, who at this point had succumbed to his dented pride.

“You know one of the pistols can’t fire.” muttered Pechorin.

“Ah! So you’re considering it! Wonderful!” said Grushnitsky, his face epitomised malice as he began to pace the room. “That’s the maaa-aagic of it. One of us gets the faulty pistol. We proceed with the duel. Fate will decide the rest.”   

Pechorin’s mind was hard at work. His conscience was unusually silent, and his long suppressed hatred of his brother materialised in an overwhelming wave of anger. He knew his brother did not stand a chance; Pechorin was a highly skilled marksman whilst his brother would most certainly be too drunk to hold his bladder, let alone fire a weapon. At worst he would intentionally wound his brother, maybe in the shoulder, as a warning.

“Meet me at the docks at midnight. Bring your second.” said Pechorin solemnly.

Grushnitsky forcibly grasped his brother’s hand. Pechorin felt his brother’s soiled hand rub against his soft palm. Grushnitsky winked at his brother, spun around and ran out of the study.

For the next few minutes, Pechorin stood in the same spot, his eyes staring at the pistols and his mind trying to make sense of it all.