The Weight of Blue

Submitted into Contest #150 in response to: Write a story where an algorithm plays an important role.... view prompt

44 comments

Sad Science Fiction Drama

This story contains sensitive content

Content Warning: mentions of assisted dying.


The couple sits across from me, her hand in his, and I ask myself if I have the strength to break their hearts. Her face hides nothing: tears already quiver, ready to fall no matter what I say. His fist rests on a rapidly bouncing knee.


I tear my eyes away from the screen.


“I’m so sorry. There is an incredibly high demand for fertility treatment. You aren’t eligible.”


What comes next is painful enough, but not for the first time, it strikes me that I’m more than just another stranger in their lives. I’m not the passerby walking carelessly through a family photo, nor the tiresome subject of a story they’ll tell over Christmas lunch. For the rest of their lives, they’ll remember my face, my words, on the day they learned they would never have children of their own. 


I miss the days when a patient’s thrumming heartbeat or the whoosh of air in their lungs meant something. It is all about technology now. Someone who never set foot inside a hospital, who never saw the naked hope in a patient’s eyes, decided an advanced algorithm could determine a patient’s eligibility for treatment. All you need are their symptoms, medical history, and genetic profile.


But rising costs of healthcare mean more and more people are missing out.


And I’m the messenger. 


*


Pa calls me on the train home, pulling me away from memories of strangled sobs and tear-stained shirts. His voice is weak.


“My belly’s killing me, son,” he mumbles. “And I can’t crap.”


“You’re constipated again. Did you take your laxatives?” 


He sighs. “I must’ve forgotten. The pain’s too much these days.”


I know he’s not just talking about his belly. Two years ago, he tripped and fell down the stairs - often a death sentence for a frail ex-smoker in his mid-eighties. Instead, he somehow pulled through, even if he’s now dependent on a walking frame to get around. 


Worst of all, the excruciating pain in his hip never went away. My Pa is a fighter, but he’s not too proud to call me in tears first thing in the morning, too stiff to get out of bed. Once, he pinched me hard on the arm, and when I yelped, he told me he felt that in his hip all the time. 


The opioids and anti-inflammatories take the edge off, but they clog his bowels and space him out. I worry he’ll fall again. If he does, that’ll be the end of it.


“Son?”


“I know, Pa. The pain medication is your best bet. You aren’t eligible for surgery.”


“I just want the pain to stop. Can’t you rejig the algorithm or something?”


My silence is enough of an answer. He makes a noise that breaks my heart, sniffs, and hangs up. 


*


A curious pair sits across from me today. She is over ninety and looks it: her skin is tinged yellow and thin as clingfilm, and her back is hunched almost ninety degrees. Even seated, she grips a wooden walking stick to keep herself steady. Yet, she is not the patient.


The elderly man sitting beside her in a wheelchair is her son. Seventy, and paraplegic. He is past the point of tears. He has a downcast look about him, as if he knows he’s the kind of patient the algorithm spits out and sticks under the table, discarded and forgotten.


“It starts in my hips,” he says, “then it spreads down both of my legs into my feet. Feels like I’m being electric-shocked. Stings something awful. Think I’m immune to the medication, doc. It doesn’t do nothing for the pain anymore.”


I nod sympathetically. “That sounds horrible. Yes, you are on the maximum dose. Unfortunately, the scans show that surgery is the only way to relieve your symptoms permanently.”


“Please, doc,” he whispers. “I don’t know how much more I can take. It’s too much.”


His words remind me of Pa. Chronic pain has a way of exhausting hope, and I wonder if there is any purpose in running the algorithm when we can all predict the outcome.


But before I can respond, his mother speaks up.


“I know what you’re gonna say. Time for the bloody algorithm,” she croaks. Her eyes fix on me defiantly, as if I've bullied her child at the playground.


The screen glows an upbeat green as it waits for me to enter his details. As with every patient, an analysis of his bloodwork has already been made. Once I enter the details of his pain, along with a list of medications he has trialled, the algorithm will estimate his potential surgical benefit, weighing this against the average score of other patients.


Unsurprisingly, paraplegia does his eligibility no favours.


I look back at them to begin my usual condolences, but something sticks the words in my throat. It could easily be my Pa sitting there without hope. 


“Congratulations. You’re eligible,” I say. “I’ll have your surgery booked immediately.”


Their faces transform; the walking stick clatters to the floor as his mother almost leaps out of her seat to embrace him. Great, shuddering sobs wrack his body. 


He spurs his wheelchair forward and takes my hand.


“Thank you, doc. This’ll change my life.”


I squeeze his hand back. “You deserve it.”


*


The algorithm doesn’t look kindly on disabled children. For a tool that is meant to be objective, it seems to share many of the biases of whoever created it - or perhaps those of society as a whole. 


The child gamboling before me looks perfectly healthy for a six-year-old with Down Syndrome. Thus far, her development has followed the expected trajectory, and all of her vital signs are within normal parameters. All this despite the lump of cancer cells growing inside her brain.


“Why even run the algorithm?” her father asks. “She obviously needs surgery. You need to get that thing out.”


“It’s part of the healthcare protocol, sir. There’s a process that needs to be followed."


“Screw your protocols. My daughter has a brain tumour. You don’t need a fancy degree to figure out she needs surgery.”


“I’m sure she’ll be eligible,” I say truthfully. I don’t voice my suspicion she might be waiting months for her operation, given the absence of any major symptoms.


“Every minute we wait is a minute that thing’s inside her head, damaging her brain. I just want her to live a normal life. Please, do it quick.”


I run the algorithm. The green screen blinks, then flips to blue. The computer chimes a confirmation. 


“She’s eligible,” I tell him.


“Good. How long?”


I click through several more screens. My heart sinks. 


“Eight months.”


Preparing myself for a verbal onslaught - there is usually at least one per day - we lock eyes for a tense moment. But then he looks away and kneels next to his daughter, whispering something in her ear that makes her giggle. He strokes her hair and wipes his eyes with his shirtsleeve. 


“Why be a doctor?” he says finally. “Why do this, if you can’t help people?”


I consider saying that I did help. That she is getting surgery. But I don’t, because I know those words are just as pointless as my condolences.


“There might be more I can do,” I say.


The child’s positive eligibility test has placed her on the waiting list for an operation. The eight-month timeframe is a guarantee, but if another patient loses their place, she could have surgery within a month. I enter her details, looking for a “less worthy” patient for her to replace. 


Only one patient pops up. 


A paraplegic man who was never meant to be eligible at all.


On the train ride home, when I should think of the ecstatic father bouncing up and down with his daughter on his shoulder, whooping and punching the air, instead I consider my Pa and people like him. The ones society always remembers last.


*


It’s been over a year, and my paraplegic patient is struggling. His pain is severe enough that he over-medicates himself in a futile effort to live a normal life. The electric shocks have spread into his arms, his fingers tingle, and his feet have permanent pins-and-needles. 


I book him another appointment to deliver the news about his surgery. Before they even enter the room, I can hear dull, rhythmic thuds under the mechanical whir of his wheelchair, like a heartbeat trapped in a cage of machinery.


His mother leans heavier on her walking stick, but it is his appearance that affects me the most. His face is wan and sunken; devoid of colour. The pain has taken its toll.


“My boy’s still suffering. Why are we here?” she says without preamble. 


My expression must have given it away, because he speaks first. 


“Never getting surgery, am I?”


His voice is oddly changed, compared to his face. It’s stronger than before. More resolute.


I shake my head, unable to meet his eye. His mother glares at me. Her hand snakes across and rubs his shoulder.


“Then I’ve had enough,” he says.


“What?” she chokes out. Her attention shifts to him, and the hand holding her walking stick starts to tremble.


“Can you do the algorithm again, doc?” he pleads. 


“It won’t change the result,” I reply.


“Not for the surgery. I told you the first time: it’s too much. Can’t live with it anymore. If you can’t fix it - if I can’t stop suffering - at least let me choose a quick, painless way to go. On my own terms.”


She's shaking her head now. She watches her son with an intensity I've never seen. As if she wants to memorise every last wrinkle on his face.


Two desperate pairs of eyes bore into me as I turn back to the computer. I imagine my Pa in such a position - confronting mortality. I wonder if he would look at me the same way.


Ignoring the lump in my throat, I run the algorithm again, this time for physician-assisted dying.


The green screen turns blue, chimes joyfully. Eligible.


He sighs in relief, all the air rushing out of him at once. A bit of colour returns to his face. For the first time in a year, he smiles.


“No,” his mother whimpers.


*


When their appointment ends twenty minutes later, she pauses at the door. 


“Run along for a minute,” she sniffs to her son, waving a hand as if he’s five years old again. The whirring fades into the corridor.


“How can I help?” I ask, dreading the answer.


She blinks and looks up at me. “I’m ninety-four, dear. Everything hurts, and all of my senses are failing. There’s not much left to live for. Only him.”


“I see.” I’m already moving back to the computer.


She shuffles close behind, still sniffing. I sit down, open up her file, and enter in her details. 


“Are you sure about this?” 


Her eyes take on the glaze of long-held memory. There's the shadow of a smile.


“Yes. As sure as when I first wanted a child of my own.”


I run the algorithm, reminded of what it had once taken from a devastated couple in the same seat. I consider why an equation capable of denying new life can equally save it. How a system designed to preserve lives can easily take them.


And I ask myself if I still have the strength to bear the algorithm’s message.


It now deliberates the weight of one life - or two.


Green turns to blue.

June 10, 2022 21:47

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44 comments

Zack Powell
15:32 Jun 11, 2022

Hey, I'll say it: This is not only my favorite story that I've read of yours, Shuvayon, but it's now solidly in my top 5 Reedsy stories of all time. Your constructive criticism on my most-recent story was incredibly helpful and I really wanted to repay the favor, but there's truly nothing I can say here that would improve the quality of this story. This is heartfelt, it's honest, it's tender and depressive and beautiful, and I loved reading it. I'm really at a loss for what to say on this one. Everything was well-written and there were a lo...

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21:04 Jun 11, 2022

See, now that you've said this, Zack, I don't care how this does in the contest because it's gratifying that at least one person loved it. It's always nice to get "official" recognition, but I find I value comments such as yours just as highly, if not more. So, THANK YOU. :) This is the perfect opportunity to tell you that "Love Ain't Blind, Grief Is" is one of my absolute favourites on Reedsy, and I've read it multiple times on different occasions for inspiration. Also, there was a time last month when I read "Friendly Advice" and literall...

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10:01 Jun 17, 2022

Zack, with some stellar advice I've made significant changes since you read this. Would really appreciate your eyes on it before the deadline - but no worries if not. :) You already made my week with your comment lol

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Riel Rosehill
12:23 Jun 11, 2022

Oh wow. You wrote this in five hours? First day the prompts out? Call me impressed - I so wish I had this in me. I really liked this story, and as someone who worked at an opticians where you have to tell people things they don't want to hear sometimes, found it totally relatable. This poor guy was just trying to do his job. I loved how you made him give an appointment when he shouldn't have just for him to be forced into a situation when he had to take it away, argh, that was some satisfying twist of cruel fate. About the ending: it wor...

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12:47 Jun 11, 2022

Thanks for the lovely comment Riel! Yeah, submitting early was weird - I’ve got this weird empty feeling now. Not sure I recommend it lol I’m glad the ending was okay! And that’s a really good point about euthanasia. Didn’t even occur to me. Thanks for picking that out. :) I thought calling it “assisted suicide” was too on-the-nose, but maybe “assisted dying” is better. Really appreciate your time! Look forward to reading more of your stories. :)

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21:53 Jun 10, 2022

Author's Note: I wrote this just now in a five-hour frenzy - it kind of poured out. It was inspired by one of my enduring memories from early in medical school: an elderly patient with terminal disease told us she wanted to withdraw treatment because she'd suffered enough, and her even more elderly mother sat there in tears at the bedside. An image that is hard to get out of my head. This concept of scoring systems for treatment eligibility is based in reality, but I took a lot of liberties with the medical aspects of the story. I really ...

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Charlotte Morse
08:46 Jun 25, 2022

Hi, I'm a newby here and this is my first ever comment - but I had to, your story was excellent (shhh, don't tell anyone, but I think it should have won!). Having a son with Downs Syndrome I was particularly pleased the child made it through, BUT do you really think she would have? Or that with those algorithms she would have even been allowed to be born? I'd love to think so, but in my experience, fear it would be unlikely. Your sentence 'For a tool that is meant to be objective, it seems to share many of the biases of whoever created it -...

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23:41 Jun 25, 2022

Hi Charlotte - welcome to Reedsy! And thank you for such a kind comment. :) To be honest, I hadn't thought about that, and it's a great point. I love it when readers pick up on these things, and it's not surprising you did, given your own experiences! Now that I think about it, I'm going to say the child would survive, and the reason she was allowed to be born was because the algorithm (at least as I've written it) only decides eligibility for treatment rather than right to conceive (or carry a baby to term).

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H L McQuaid
09:11 Jun 21, 2022

A powerful, thought-provoking, and wrenching story, that is unfortunately, a reflection and prediction of what 'innovation' in a broken health care system leads to. This would also be an amazing short film. The dialogue was superb, if it I had to pick the most memorable line, it might be: “Why be a doctor?” he says finally. “Why do this, if you can’t help people?” Gut punch. Well done.

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09:29 Jun 22, 2022

Thank you very much for this kind comment, it made my day. :)

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Kelsey H
04:38 Jun 20, 2022

I love these kind of futuristic stories which are both something horrifying yet also something which seems like it could really happen. It worked really well how you wove the personal stories of the doctor and his father and the patients through with the totally impersonal algorithm which only saw the medical issues. The theme of parent-child love is so touching here, especially the elderly mother and her son. I love how the doctor tries to override the machine as a humane gesture yet still the algorithm wins out in the end. Also really enj...

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05:44 Jun 20, 2022

Thanks Kelsey, I really appreciate the read and comment. So kind, as always. :) Full disclosure, though - the version you read was not the version I wrote in five hours. After I posted it to Reedsy, it went through an entire week of editing and an overhaul of the ending. Even now, after some more feedback I've received, it feels far from finished. Oh well lol

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23:42 Jun 19, 2022

What will life be worth in the future... something to be noted. Amazing story with fantastic plot progression. Nice twists and turns!

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00:44 Jun 20, 2022

Thank you so much! Glad you liked it. :)

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Aesha Amin
03:44 Jun 19, 2022

Heya, I just sent this to all my friends to read as soon as I finished reading. I was so frustrated with the algorithm as if it existed. And I admit I cried a little when the main character was talking about his father. It was all so subtle but so impactful. Thank you for the story!

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00:46 Jun 20, 2022

Aesha, this is such a kind comment - thank you. It made my day!

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Andrea Doig
16:34 Jun 18, 2022

Gosh that’s a sad story. And a scary one too. The future is upon us and it doesn’t look too rosy. Well written and a nice flow. Enjoyed your style and clever use of the prompt - I chose this one too. The saddest part was the end.. “run along son” … wow I guess our kids are always our kids right?! Thanks for sharing x

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00:47 Jun 20, 2022

Thank you for the lovely comment, Andrea, and I'm glad you picked that up - exactly what I was going for! Also ironic since he's in a wheelchair lol :)

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Arya Dixit
15:41 Jun 18, 2022

This story is so incredibly touching, sad, and completely believable. The state of healthcare is getting worse instead of better, and I love how you called out the systemic bias that prevails in healthcare. Beautifully written and tone of your writing fit it perfectly. If I had to give a suggestion it would eb to work on your dialoges a little more, but honestly, I think it's in great shape regardless.

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00:49 Jun 20, 2022

Thanks Arya, really appreciate the compliments and feedback. :) I'm still working on crafting believable dialogue, so thanks for highlighting that. Something to keep in mind for next time!

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Amanda Lieser
14:59 Jun 18, 2022

Hello! Oh my gosh! I really loved this story because of the incredible world that you built within in. Sometimes, with sci fi it’s difficult to not have a million follow up questions, but I was surprised as how easily I felt I could imagine this universe you created. Maybe that’s a scary thought. :) I am intrigued on how you started this plot idea-was this a story idea that came suddenly or did you feel like you’d been tinkering with it and then the prompt put the final puzzle piece together? I also thought it was interesting how you shed ...

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00:53 Jun 20, 2022

Hi Amanda! Always a pleasure. :) To answer your question, it was the first one - a new idea that came up just for this prompt. The first line actually came to me before the idea did, then it sort of progressed quickly from there. I'm so glad you picked up on the subtext with the MC and his father! No worries - look out for my comments on Something Domestic and The Tumbleweed. Thank you again. :)

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Amanda Lieser
01:25 Jun 20, 2022

That’s so cool to hear your process. Sometimes I’m more fascinated by the process than the story. Can’t wait to hear from you soon! :)

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Elias Leventhal
13:49 Jun 18, 2022

Wow, this is not the kind of theme I expected from this prompt, but it's incredibly creative. Great job on this story!

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13:53 Jun 18, 2022

Thanks Elias, I'm glad you enjoyed it. :)

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Suma Jayachandar
14:40 Jun 17, 2022

Shuvayon, I'm a little late in reading and commenting. The vignettes that you have painted here are so heartfelt, tragic and tender. The format works beautifully for what you want to convey. The privileged take the first dibs in the limited resources- that's the first unwritten code of civilization, isn't it? Even if it's something as hallowed as healthcare. And as someone who wields this loaded dice, the protagonist's heartbreak is palpable. The beauty of this piece is, this algorithm can be seen running through so many domains. Truly thou...

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00:05 Jun 18, 2022

Thank you for such a kind comment, Suma. Greatly appreciated, as always. :)

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Aeris Walker
08:57 Jun 17, 2022

I truly enjoyed this story. You depicted the deep, fierce love between parents and their children, no matter the age, in a clear, visceral way. I thought this line was very thought provoking, really capturing the whole theme of this story: “For a tool that is meant to be objective, it seems to share many of the biases of whoever created it - or perhaps society as a whole.” I mean, you could write the next dystopian hit with a theme like this. I would have never thought to write about an algorithm in health care, but you made this work in ...

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10:05 Jun 17, 2022

Thank you, Aeris - you've touched on exactly what I was going for. From reading your work, I know you do eerie and beautiful exceptionally well, so this compliment means a lot!

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Aeris Walker
10:46 Jun 17, 2022

Aw, well thank you back! I look forward to reading more of your stories 😊

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J.C. Lovero
13:06 Jun 16, 2022

You already know how I feel about this story 🥹😍🥰

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13:12 Jun 16, 2022

I do - and your feedback was invaluable. Just made some changes to the ending based on what you said. :)

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J.C. Lovero
01:04 Jun 17, 2022

Call me biased, but I LOVE the changes you made. Enjoy the yellow notification dot. 😊 😇 🤣

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01:19 Jun 17, 2022

Well, game-changing, story-fixing feedback is good and all, but the dopamine buzz from a notification? I know what I prefer! Hahaha

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J.C. Lovero
02:06 Jun 17, 2022

Love the new title, btw 😍 🥰 😘 Have another yellow dot. K I'm done LOLOL

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02:09 Jun 17, 2022

Currently drowning in dopamine

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Zelda C. Thorne
13:25 Jun 15, 2022

Wow I agree with everyone else. Powerful story. Symmetry with the dad, push and pull between all the characters. The MCs impossible situation is what many healthcare professionals deal with at some point, unfortunately. It made me angry and frustrated for him. Well written, obviously. I second everything Zack said.

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14:23 Jun 15, 2022

Thanks friend! You're too kind. :)

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17:48 Jun 14, 2022

Great story Shuvayon, one that is moving but somehow weighs heavily too. The algorithm seems so plausible when I think about how digitalised healthcare is becoming. And the ethics behind resource allocation and what a life is worth… massive issues that you’ve skilfully played out with your characters. Your story raises some impossible, unanswerable questions.

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23:48 Jun 14, 2022

Thanks, L. Appreciate the comment and glad it was thought-provoking. :)

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Michał Przywara
21:17 Jun 11, 2022

Wow, this was a great read! The algorithm itself is already a fantastic story, but when the two patients collided -- oof. That hit hard. That kind of healthcare decision is terrifying. The worst part of it is, the algorithm isn't evil. There are good reasons for it. Our resources for helping people are limited, and ironically, the longer and better we live, the wider we open the door to a bigger population needing more help later. But of course, that's precious little comfort for a patient in need, or for the poor worker doing the triage....

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22:02 Jun 11, 2022

Michał, your comments are always so insightful. I portrayed the algorithm as sort of the 'enemy' here, but I'm so glad you were able to see the subtext in that it could be seen as a necessary evil. Thank you for highlighting this. Lol, sometimes the writing flows, and other times it doesn't - this one was just on the extreme end of the spectrum! Thank you for reading - I have "Rhubarb Pie" on my reading list (I see it's already Recommended - good luck!) and look forward to what you come up with next. :D

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Katy B
14:16 Jun 11, 2022

The first person, present tense works super well in this story. The present brings the suspense to the forefront, and the first person makes the reader more invested. I see what you mean about the ending seeming rushed... I'm not sure what I would do instead. Good job!

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21:58 Jun 11, 2022

Cheers for reading Katy! All good, I've got a week to mull it over, so we'll see what happens...

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