Bloodletting and Miraculous Cures (29 page)

I check my watch. I slept half an hour. Fifteen more minutes would have been great. There's such a difference between half an hour of sleep and forty-five minutes, forty-five minutes and an hour, an hour and two. Two hours is bliss, a revelation of humanity, a soft dawning morning. An hour is enough—enough that the night has been broken and I can stand on it, casually shuffle my feet over its back. Forty-five minutes is like a deep breath, like a good sigh, a fresh drink, but it is just a moment's reprieve and sad in its ending. Half an hour is laying down and being smacked awake, then the sick feeling.

Dry heave. Hands on the sink. The motion of vomiting feels good, as if expelling the nausea although nothing comes out. Spit. Rinse.

Shuffle down the hall, face greasy-cold.

“Dr. Chen!” It is Magdalena, coming down the hall. It was also her before, I realize. Her voice is more urgent, and I seem to hear better now that I have my glasses.

“Oh, yes, I'm awake. I'm fine, I'm awake.”

“The brady-hypotensive just pulled up.”

“Excellent. That's just great,” I say with thick-tongued deliberateness. “Thank you, Magdalena.”

Shuffle faster.

 

5:28—Moonwalking, making war

Stretcher rolls in, trundles across the floor. The medics, the nurses, me: we move, talk, act as a crowd—bouncing off each other. We mill and grab, become a mob.
Beep beep,
always the monitors,
beep beep.
The blanket is a stunning orange. I say, “Move him into the bed.” The sagging form of man. I say, “Accucheck, please, bolus a litre.” It feels like those films of men on the moon who jump and take a forever leap, who launch a golf ball that disappears against black sky while the narrator says,
All skies would be black without our oxygenated atmosphere. Beep beep beep.
The guy has a shit blood pressure. His skin is the white on blue web-lace lines of death. “Atropine point six going in,” I say as I inject. This is also my nightmare of war; the enemy invisible, shots in the dark, everyone rushing, confused, but in one tiny panicked place all is such calm because the end is near or the end is far, but there is no way to know. Somewhere there is a truce. Nurses and medics shout to grab this, hand me that, push it here, get the blue box. I say to the tall medic with the goatee, “Tell me the story again. Once more.” He speaks in a loud voice, pedantic, eyes on his notes—a recitation over the
ritual. He recounts how they were called, what they found, what they gave him already. I'm pushing drugs again. I say, “Atropine point six. Get me a rhythm strip, Clarice. Clarice! Put that down, it can wait, get me a rhythm strip.” I believe there is music on the moon. In the documentaries, there's always music. Bach, or Mozart. Once, I saw Neil Armstrong with a soundtrack of Erik Satie's piano
Gymnopedies
—the astronauts suspended on delicate melody. Like that, floating, I call the orders, touch the patient, feel his belly, put my stethoscope on his side. I shine light in his eyes, they squeeze reflexively: dreamy, unreal. I say, “Atropine point eight.” Each small move is accentuated. I say something, call out an order, and someone begins to do it, like my own golf ball hurtling away. But maybe it is not heard, so it is not done. Maybe it is done but by the time it is done, I change the order. The patient has changed already. The soldiers run, stab at shadows, hurl themselves at machine sounds.
Beep beep.
I trace the rhythm strip. Aha, a Mobitz II. “Let's put on the Zohl,” I say. Fighting in space, I think they too would use a weapon called a Zohl.

The hydraulic hiss of the ambulance doors. Another crew, another stretcher. I say, “Hi guys, join the party.” The charge nurse angry—why didn't you call? The medic defensive—we called, this is the bradycardia. The charge nurse to the first medic crew—what's going on here, did you call? The goateed medic shrugs—sure, we called. Two patients, same story. I say, “Maybe they
both called, did we think it was one crew?” The charge nurse waves the second stretcher into the next bay. The battle extends, now a voice overhead asks for more combatants, for float nurses. I give the orders for each bay. I think I am being clear but maybe I am not. I say, “No, not that one, give it to the other guy.” I pull back the curtain between the two stretchers, to see them both. I am floating, moonwalking. I am somewhere between the two monitors,
beepbeepbeepbeep.
The rhythms, the drugs, the orders: this is all back there somewhere in my medically sublimated subconscious, like bicycle riding. Floating, everything so slow. Then the second guy in failure, fluid filling the lungs, spilling over. Bad pressure, heart failure. I think,
Bad.
I say, “Dopamine, please.” The first guy paced—it's not picking up well. “Put it up to sixty,” I say. The second guy in vee-fib. Over him now with the paddles: Shock. “All clear!” Shock. “All clear!” Shock, the body jumps.

Start CPR on the second guy. Gravity is diluted, and it is so slow…it all happens drifting sideways. I say, “Push Amio three hundred.” It's as if it's compressed into one single moment of rushing, shouting, wrappers on the floor, blood on the arm, foot poking out from under the sheet. I am over him again with the paddles, another zap of electric current. Again. “All clear!” Shock again. No good. “All clear! Shock.”

On and on, five minutes, ten minutes. The second guy getting cold.

The second guy dead.

“What's happening, doc?” says Zack.

I say, “He died.”

“What do you need?”

“Get me a transvenous pacer.” I turn away from the second patient.

The first guy's external pacer is not picking up reliably. I puncture a hole in his groin, thrust the large-bore metal needle home, thread the wires up into the heart.
That's better. He's picking up well now.

I call cardiology to take him upstairs.

 

6:10—Sitting behind the desk in the resuscitation room

The five bays fill my field of vision. I have the feeling of morning although there is no natural light here. A sunrise on the dark side.

I pick up the phone and call the desk clerk. “Mo,” I don't know her full name, only know her as Mo, “it's Dr. Chen.”

“Hi.”

“You know that pizza place on Gerrard? They also deliver chicken wings, right?”

“It's six in the morning, doc.”

“Maybe shawarma, or something?” I am hungry, craving meat.

“Just Tim's. You want a soup? But they don't deliver.”

“Soup. Oh, nah. Forget it.”

“Doc, wait a second—”

“Yeah.”

“What's the name of the guy in bay four? I gotta do the papers.”

“What guy?”

“Bay four.”

“It's empty. There's no one there.” I'm looking at it. Empty. A cleaner sweeps up a mess.

“But wasn't there—”

I wonder if Mo wants the name of the cleaner. Then I see what she means.

“Oh, you're right, there was someone there.”

“What's his name?”

Mo is asking about the man who was there until five minutes ago, until he was wheeled into the pink room to wait for the coroner. I make that leap of understanding.

“Oh, the dead guy?”

“Right. What's his name?”

“Umm…I don't know, let me see. I think the papers are here. Didn't the ambulance guys leave the call sheet? Must have. Hmm…I was writing in the chart. Now, where the heck. Well, that's a good question, Mo. Maybe if I—”

“Never mind, doc, I'll come look for it.”

“Sure. Sorry.”

Hang up.

Things like this confuse me. Lost papers, cleaners.

 

Until 6:55

I rush through the department. I run from room to room, write on charts, wake up patients, send them
home—tell them persuasively that all their tests have proven to be normal. In a frenzy of thread and needle drivers, I sew up two men who slashed each other with broken bottles of cheap shiraz. They cry and hug each other. The security guard has confiscated the bottles. I refer patients to specialists. I make phone calls. I wake surgeons and internists. I cast a broken ankle. The debris of night is falling into the hospital. I fix the broken fist of a drunk engineering student who does not know how to punch.

Dr. Pielou, the internist, comes to me with a chart in his hand.

He has just woken up, and he's ready to fight. He says, “Dr. Chen, you are referring Mr. Stanley with cellulitis.”

“I am.”

“This is
cellulitis.
”

“That's what I wrote on the chart: recurrent infections. Both legs.”

“Why don't you put the patient on antibiotics and send him home, Dr. Chen?”

“You'll understand when you see the patient.”

“No, I won't. I refuse to see him. This is unacceptable. Can't you handle a
cellulitis?
”

“Dr. Pielou. Go see the patient and you will understand why you have to admit him.”

Dr. Pielou sits down on a rolling chair, crosses his right leg in a delicate way over the left. There is only one chair. He says, “I would like you to
explain
to me
why you are referring this patient with
cellulitis
before I go and see any such patient, Dr. Chen. I don't want my time wasted.”

“Within two seconds, when you walk in the room you
will
understand. Stop wasting both of our time.”

“This is a poor consult, Dr. Chen.” He tut-tuts, and shakes his head, which causes his second chin to wiggle from side to side.

“You want to know why I am referring Mr. Stanley?”

“Yes.”

“Shall I tell you?”

“Enlighten me, Dr. Chen.”

“The patient is fat, Dr. Pielou.”

He uncrosses his legs, pulls his white coat tightly over his belly and says, “Many people have weight issues.”

“No, not just fat,” I say. “Mr. Stanley is morbidly obese.”

“What exactly is your point, Dr. Chen?”

“No. No. Actually, the truth is that this patient makes the notion of morbidly obese seem skinny. I would prefer not to express these thoughts out loud, but since you insist, let me describe the patient to you.” I leer over Dr. Pielou, coming very close to the chair and looking down at him as I wave my hands in illustration. I speak too loudly. The nurses stare. I say, “Mr. Stanley's arms hang over the edges of the stretcher. Not the elbows. With the elbows
inside
the stretcher, the flesh of his arms wraps and hangs over the railings of the stretcher.
Have you noticed how most legs are longer than they are wide? This patient is amazing. You will be fascinated, because the width of the legs is similar to the length of each segment. It's incredible. The legs, instead of being tubular, are more like two globular structures, with feet emerging from the ends. Therefore, Mr. Stanley cannot see his legs to determine whether the infection is getting better or worse. He cannot put his legs up, because they will fall on him and knock him unconscious. He cannot walk. He has a specially reinforced, motorized wheelchair. If I give him oral antibiotics, the tablets will become lost in his elephantine digestive tract. If I send him home, he will come back as a huge septic mass of blubber. That is why
you, Dr. Pielou,
must perform the
heroic
task of admitting the patient to hospital and saving him from himself.”

I look down at Dr. Pielou, who cranes his neck in order to maintain our fixed, hard eye contact. I tower over him, lean forward and hope that he will tilt backwards so far that the chair will fall over. I am not tall enough to achieve this, so I turn and walk away.

The rolling chair scuttles across the floor as Dr. Pielou loses balance and tumbles to the ground with a soft smacking sound. I turn, and he is pulling himself up. He says, “Dr. Chen, control yourself.”

Still walking away, I say, “Thank you for seeing the patient, Dr. Pielou.”

 

7:00—The morning doc comes. I'm happy to see her

“How was it?” she asks.

“The usual.”

 

7:15—Southbound on the Don Valley Parkway

Windows down, sunroof open, the rush of morning air is a tornado in the car. Despite this, I'm sleepy. The music pounds loudly—U2's
Passengers: Original Soundtracks 1.
I need the thumping, driving rhythm to disrupt my sleepiness. I have a cold bottle of water from the hospital fridge. I sip. I make myself sip again, even though I'm not thirsty. The bottle sweats and I roll it on my neck.

The traffic is not stop and go, but all the lanes are full. It is rush hour cruising with sudden spasms of acceleration and deceleration.

My eyes are about to close. A grey Saab cuts me off.
Beeeeeep.
I honk.

I slap myself on the right cheek.

Shout out loud, sing to the music, “Boopity boop!” rocking my head. There're no words in this section, so I'm just shouting, “Boppity bop!”

My eyes pull tight, shut.

On the left cheek, I slap myself hard.

Those muscles above the eye are so weak. The eyelids are determined to snap shut like springs, like traps. Slam on the brakes, thrown forward.
Jeez. Almost, too close.
The line of brake lights is suddenly alive in front of this angry snake halted. I've stopped a foot from the grey Saab.

“Daaa daaa daaa,” I shout. Slap myself.

The woman in the Malibu on my right looks at me, both of us sitting here in our cars.
Did she see me slap myself? Oh well, it's no one's business.
I slap myself again. She looks ahead, rolls her window up.

“BAPPITY BOOPITY ARRRRRRRR!” I yell for the stimulant effect.

I've tried to figure out the risks. What's more dangerous? Is it the mornings when the drive is slow, and I have more time to fall asleep? Or, is it the mornings when the drive is fast and I have less time to fall asleep, but the consequences of unconsciousness would be more dire? I can't decide. Driving slowly, I wish for the fear of driving fast while sleepy, because sometimes this fear wakes me up.