The doctor takes a drag of his cigarette.

“Poor boy’s limbs are swollen to a mass, a yellow balloon that is just crying out loud to burst. Dactylitis. Common in babies, not so common in kids like Jamie. It's caused by the inflammation on the hands and feet. His yellowish is the jaundice- you know what jaundice is right?” The doctor pauses, waiting for you to answer.

You stay silent

“No?” Disappointment rings through his voice, “Jaundice in this case, to put it simply, is caused by the hemolysis- the breakdown- of the red blood cells. The breakdown of red blood cells is bad at any time, even in the case of the malformed red blood cells of a sickle cell patient.”

You ask what the red blood cell of a sickle cell patient looks like.

The doctor pauses the lifting of his hand, containing the cigarette that he so adamantly advises against to his patients. He turns to look at you, his wretched, fatigued eyes clouded with apathy and dullness. The shine of your new, pristine scrub flaunts itself against his ever so apparent dingy and drab white coat, stained with coffee, food and fluids that your novice self does not know.

“Do you know what sickle cell even is?”

You shake your head.

Silence befalls between you and the doctor, like a curtain after a dramatic ending of a play. Why does he expect you to know? You didn’t have it, neither did your friends or family.

With a tired, monotone voice, the doctor explained.

“Sickle cell is the malformation of the haemoglobin in the red blood cells, causing insufficient oxygen flow to the cells. In haemoglobin there are 4 protein subunits: alpha and beta. Usually sickle cell is caused by a mutation in the beta subunit, HbS. Sickle cell anemia has two HbS’ which means both the Beta globin units are variants. This results in the red blood cells turning into a crescent-like shape, obstructing the capillaries and restricting blood flow to an organ.”

Sarcastically, the doctor chides the parents, “ Since it's an autosomal recessive trait- both parents must be a carrier of it to pass it down to their oh so lovely child. Usually, the ideal parents would get screened to see if they have the trait.”

They didn’t.

Are there any treatments to help, you ask?

For the first time since the conversation, you notice the doctor had a genuine smile. Faint, indeed, but it manages to show the little humanity this doctor had left after it was bled from him like a surgical drain. So different from his usual pitiless demeanor, yet you saw a reflection of yourself in his eyes; either you in the future, or you in the past you couldn’t tell.

“Yeah, yeah there is. We can give some anti-inflammatory drugs to reduce risk of infection, or do some blood transfusions. Just recently, the NHS had approved the CRISPR-gene editing for sickle cell, editing a person's bone marrow's stem cells so they produce functioning, non-distorted red blood cells.” Chuckling, the doctor continues, “It feels like days ago where I was praying for treatments like-”

“Doctor Matthews?” A nurse comes rushing out to the balcony. A panic-stricken face scribbled all over, fear and worry run amok in her eyes. “I’m sorry to interrupt but Jamie’s having a seizure.”

The doctor curses underneath his breath, tosses the stubbed cigarette overboard of the balcony, and rushes out to Jamie. She follows behind, not even glancing at you. Each door is left open, as they run to Jamie, like they are inviting you to witness this catastrophe. But the urge to follow them crashes and burns when Jamie's door opens, and you could hear them. 

“I’m sorry, but you must leave so we can help him.”

You follow the path they left, slowly as the voices of the parents and the doctors become more jarring as you approach Jamie's door. His door was the only one that was almost fully closed, yet a creak of the door grants you access to see the face of the father. 

Defeated- utterly defeated.

Such a pitiful, gnawing face of grief rendered of the wrinkled face of the father. Where was the happiness of a parent whose kid is getting free, state of the art treatment? Where was the hope of a parent that their kid will get better? Where was it?

Your smooth, soft hands tremble, almost losing grip on your student notebook. You close the door and walk. Just walk, hopefully to a solace of peace. You muster the little strength your body could give to put pen to paper:

“Thesis purpose: “Get Screened.”