Signed, Sealed, Swindled

Content Warning: This story contains depictions of unethical medical practices, endangerment of vulnerable individuals, and themes of professional misconduct, trauma, and emotional distress. Reader discretion is advised.

I should’ve asked more questions when my supervisor handed me the clipboard.

“First solo shift, Nurse?” he said, smiling like we were sharing a secret. “We’re piloting a new outreach partnership with Saint Ives Clinic. Off-site, off-hours. A bit unorthodox, but you strike me as someone who can handle herself.”

I blinked. “Saint Ives? That’s not in the hospital directory.”

“It’s independent. They serve high-need patients. Fast-paced. Minimal red tape. A good place to sharpen your instincts.”

That should have been the first red flag; the discretion level was like a selling point. But I was barely two weeks into my first job as a newly licensed RN, eager to prove myself. Hopelessly naïve.

I nodded. “Sure. I’ll go.”

The clinic was quiet when I arrived. The kind of quiet that made the fluorescent lights buzz louder than they should.

The waiting room was spotless and strange. No computer monitors. No visible charts. Just a rotary phone, a dusty plant, and a clipboard labelled Night Intake. Taped behind the desk was a sign in cracked vinyl: Closed Until Further Notice.

I adjusted the scarf around my head, trying not to sweat through my scrubs. A minute later, the door opened.

“Lina?” A man in pale blue scrubs approached with a paper bag in one hand. “I’m Dr. Rahim.”

He looked younger than expected - maybe mid-thirties - with sharp eyes and an unnervingly smooth voice.

“Got you something,” he said, setting the bag on the desk. “You’ll need the sugar. Long night ahead.”

I managed a smile, still unsure if I was being tested or welcomed.

The first patient arrived at 11:04 p.m. A woman in her fifties, no ID, no health card. She handed over three hundred in cash and refused to meet my eyes.

“She just needs a local anesthetic and some drainage,” Dr. Rahim said casually, snapping on gloves without washing his hands.

I hesitated. “Shouldn’t we file something? Consent? A chart?”

He didn’t look up. “Do you want to help people or not?”

The second patient was a man in his sixties. Trembling, jaundiced, smelling like cigarettes and spoiled milk. He slid a crumpled envelope across the counter and muttered something about an “old liver wound flaring up.”

I tried to take vitals. Dr. Rahim waved me off.

“Just keep pressure here,” he said, guiding my gloved hands to the man’s lower abdomen. “I’ll take care of the drainage. He doesn’t do well with needles.”

The whole time, the man moaned but said nothing else. His eyes didn’t focus. He was half-conscious.

I knew this wasn’t how things were supposed to work. I was fresh out of school, but not clueless. I wasn’t supposed to assist in procedures without proper supervision, and this wasn’t supervision; it was something else entirely.

But Rahim was calm. Confident. Like he’d done this a hundred times.

And I was too stunned, too eager, too unsure of my place to push back.

I told myself I was helping.

I told myself he knew what he was doing.

By 2 a.m., we had seen five patients. None were recorded. No medical histories. No documentation. Just cash envelopes - some thick, some thin - which Rahim locked away in a filing cabinet I didn’t have the key for.

The most unsettling part was how normal he made it all seem.

Backdoor treatment. Quiet suffering. No questions asked.

I stepped outside for air. The rain had picked up, soft but insistent, clinging to my sleeves. I tugged my hijab fabric tighter under my chin, trying to ground myself.

Maybe he’s right, I thought. Maybe we’re helping people who’d fall through the cracks.

Then I heard it.

A child coughing.

From inside the clinic.

I rushed back in.

Down the hallway, the door to one of the storage rooms was slightly ajar. I nudged it open.

A metal cot was pushed against the wall. On it, a little girl, maybe six, maybe younger, lay curled under a gray blanket. Her cheeks were flushed with fever. An empty IV bag hung limply above her head, taped to her tiny arm.

She looked at me. Wide eyes. Silent.

“What… what is this?” I whispered.

“She’s undocumented,” Dr. Rahim said from behind me, his voice level. “Her aunt’s trying to get her papers sorted. Foster care will eat her alive. She’s safer here.”

“You’re treating children in storage closets?”

“I’m protecting them,” he said.

I turned to face him. His smile was gone.

I backed away from the cot, heart thudding in my chest.

“This isn’t what I signed up for,” I said.

His jaw tightened. “Nobody ever signs up for the hard choices.”

I could’ve walked out right then.

But I didn’t.

I spent the rest of the shift between other patients and checking on the girl. Around 5 a.m., her fever broke. She even smiled at me once.

I wanted to believe it justified everything.

I wanted to believe that bending rules for the right reasons was still ethical.

But the truth clung to me like antiseptic on my clothes.

Three nights later, the clinic was raided.

They found unlicensed prescriptions. Unsanitary equipment. Records of off-the-books procedures. A stash of sedatives tied to black-market sales.

I wasn’t arrested. I was “cooperative.” I gave statements. I cried. I tried to explain.

“She’s a new grad,” my supervisor told the investigators. “Barely two weeks in.”

But they didn’t need to say it for me to hear it:

She should have known better.

Dr. Rahim fled the province. His license was already under investigation for unrelated misconduct. I doubt he’ll ever face consequences.

The girl was taken by child protection services.

I don’t know where she is now.

Sometimes I dream about her.

Sometimes I still hear her coughing.

I couldn’t eat. Couldn’t sleep. When I did, I saw her; the girl on the cot, or sometimes myself in her place, with Rahim’s latex hands moving in slow, awful precision.

The guilt sat heavy. No matter how often I washed my hands, it clung to me.

I whispered du‘a at night, the kind I hadn’t said in a long time.

Not loud.

Just between me and the One who already knew everything.

Weeks passed. I got moved to another assignment. No one spoke about Saint Ives again.

But I did.

In my head. In the silent spaces. I kept asking myself: Did I save anyone? Did I harm someone? Did I stay quiet when I should’ve screamed?

One day, I rode the bus to a small building on the city’s west side. The foster agency.

I didn’t go in.

I sat across the street for twenty minutes, watching the entrance. I wondered if she was still there. If she remembered me.

I pulled a folded note from my pocket. I’d written it the night before.

I’m sorry I didn’t do better. You deserved better. You deserved a safe place, not a secret room with flickering lights. You deserved nurses who weren’t afraid. I’ll spend the rest of my career trying to be one of them.

Lina

I didn’t deliver the note.

I left it on the bus.

Six months later, I started volunteering with a mobile health van that serves unhoused people. Real protocols. Real supervision. Real stories.

It’s not glamorous.

But it’s real.

One night, I helped dress a wound on an elderly woman’s foot. She held my hand the whole time.

“What’s your name?” she asked.

I paused.

And then I said it.

“Lina.”

Just Lina.

No fake confidence. No buried guilt.

Just me.

Before I left that evening, I opened my planner and wrote three words on the inside cover:

First, do no harm.

This time, I meant it.

Afterword:

This story is rooted in the ethical struggle many healthcare workers face: the tension between what is expected and what is right. In Islam, this concept is reflected in the prophetic maxim:

“Lā ḍarar wa lā ḍirār”

“There should be neither harm nor reciprocating harm.”

(Sunan Ibn Mājah, Hadith 2341; authenticated by al-Albānī)

This principle reflects a foundational moral law: to prevent harm, even in silence or passivity. Signed, Sealed, Swindled is not meant to glorify moral failure or hesitation, but to explore what it means to wake up to one’s own complicity, to seek forgiveness, and to choose a different path forward.

For anyone who has ever felt they should have spoken up sooner, acted more bravely, or lived more truthfully, this story is for you.

May it serve as a mirror for those navigating complex systems, and as a reminder that integrity, like healing, often begins in the quiet act of saying: “No more.”

— Saffiya H.