Janwar walks faster; maybe endorphins will help keep him from panicking further. Then he remembers Susan. He thinks about Susan, about her nose, about her leggings, and her boots. His hands start itching again. He takes a deep breath. He might or might not have killed a man— No, he definitely killed a man, but it might or might not have been his fault. But either way, he will see Susan on Friday. That’s not as appealing as it was yesterday. It adds another level of panic. How will he be functional enough to talk to her by then? How will he be functional enough to talk to anyone ever? Will everything he thinks of remind him of Diego? How could it not? Everything relates to death. B, A-B, A, B, A…A, B, A-B, A, B-A… Take these bushes, for example. Manicured plants grow in mulch made from ground-up bones. He turns back toward the hospital. The old man is gone, Janwar imagining the old man’s angular features through the black material of Diego’s body bag.
Back in the locker room, Janwar can’t face the number of steps involved in cleaning his body and hair, drying, and redressing, so he swipes Tropical Surge deodorant under his arms. It’s a compromise solution he remembers as a homicide detective’s shower from its prevalence in a certain kind of TV show. He also changes his Band-Aid. At this rate he is going to need a new box soon.
Llew puts his tablet down. “Have a seat, Janwar. You want a drink, is it?” He opens his drawer and displays a bottle of Penderyn: Welsh whisky.
“No thanks.” Janwar’s reptile stomach is not in a position to consume anything.
“Time was when a bloke offered another man a whisky chaser alongside hard news, the other bloke would be grateful.”
“I’d rather you give me the hard news.”
Llew shrugs. “Your loss. I’m not trying to have you.” He closes his drawer. “I already put myself out by handling this instead of involving Sylvie. And mind you, I don’t like being beholden.”
Janwar sits in the black leather visitor’s chair. The fan spins overhead, tilting a little on its axis with each rotation. It makes Janwar feel like his body is rotating around his stomach. He closes his eyes for a second, but it makes the feeling worse.
Llew’s wingtips are flat on the floor this time. The chair sticks to Janwar’s back.
“Let’s skip the back-and-fore,” Llew says. “Diego died from an overdose of lidocaine.” He hands Janwar a copy of the examiner’s report. “The level in his blood is still higher than it would have been if you’d given him a normal dosage for his weight. That would be 7 ml of the 1 per cent solution.”
Janwar slides his dry tongue over his teeth and forces his mouth open. “Which is what I dosed him with.” He hands the examiner’s report back.
“Don’t say stories, boyo.” He blows out through his nose. “You proper weren’t mingy with it.”
Llew shuffles the papers on his desk and holds out another printout signed by the legal counsel and Brett Rutan—an itemized list of the contents of the drawers of the anaesthesia cart. Janwar scans down the list.
Lidocaine 1%, 50 mL vial: unopened.
Lidocaine 10%, 50 mL vial: approx 43 mL remaining.
Janwar’s stomach lets go of his spine all at once. The normal dose of lidocaine is 1 milligram per kilogram of body weight. A vial of 1 per cent solution has 10 milligrams of lidocaine per millilitre. Seven millilitres of 1 per cent solution is 70 milligrams. Seven millilitres of a 10 per cent solution would be 700 milligrams, enough to be fatal within forty-five to ninety seconds.
“One more,” Llew says. A printout signed by the pharmacist from the dispensary, showing that the vials they placed in the cart made up the standard package of anaesthesiology drugs, including two vials of lidocaine, one 1 per cent and one 10 per cent, both 50 millilitres. Llew places the papers in an accordion file and locks his drawer. “Really speaking, it’s a proper poor lookout for you.”
Janwar doesn’t say anything.
“Keeping your mouth shut is a good idea. You haven’t apologized or said anything to show you’re responsible, is it?”
Janwar hasn’t. He shakes his head.
“Don’t. There’ll be no end of trouble if you do. Brett might hunt you down again in a minute, but I don’t expect there’ll be anything he needs to clarify.”
Janwar nods. He’s still afraid his voice will start to vibrate along with the rest of him if he says anything.
Llew’s talking again, staring into Janwar with his burning blue eyes. “But here’s the good news. Although you messed up, and you’re always going to know it and I’m always going to know it, and José and Rasheeda and Horace and Victor and Karan are always going to know it, and the administrators of your university program are always going to know it, somehow the God of Anaesthesiology up there in his white scrubs is smiling on all of us, and nobody has any reason to palaver over the situation. Since Horace was the supervising physician, he’s going to get a good lamping for not noticing you took the wrong vial. But it’ll blow over soon enough. Your university’s malpractice insurance and Horace’s will cover whatever rises. But mind out, you botched it, not Horace. A supervising physician can only do so much, and everyone’s going to side with him. Protect our own by here, we do.”
“What about—” Janwar starts to say, his voice remaining thankfully level.
“What happens with your program is between you and them. But mind out, I’m the one filing the paperwork. Keeping me happy is in your interest, boyo. You did something radically wrong, and it’ll stay with you for the rest of your life. It might get you booted out of medical school, no matter what I say to UBC, but at least it’s not going to add to your student debt. And before you ask, I’m not going to let you drop the placement. Keep on what you raised. Now go home, boyo, put yourself straight, and show up in the morning ready to work.” He picks up his tablet. Condo towers are laid out across the screen like giant scalpels.
Janwar’s brain accelerates out of control as soon as he is inside Dr. Flecktarn’s apartment. Today’s thunderstorm batters the windows with IV-bag-sized raindrops. He sits at the kitchen table with his head down on the glass. His stomach has turned inside out. He can feel its acidic contents dissolving his organs. He feels bad, as in “is experiencing negative emotions and associated physical symptoms,” and also feels bad, as in “has been an objectively bad person and is accurate in his analysis of himself as such.”
He drew the correct amounts. He wasn’t distracted. The spectre of blood backing up Mr. Gagnon’s IV slides in front of his eyes and he swats it away. There are three options.
One: Janwar remembers wrong. He expected the label to say 1% solution, and so he saw it that way and drew from the wrong vial, the one labelled 10%.
Two: The vial he drew from was labelled 1% but contained a higher percentage of the drug than it should have. He can’t think of how the switch could have happened between the cart leaving the dispensary, which is right around the corner from the OR, and when Janwar unlocked the cart, but that doesn’t mean it didn’t happen. But then the bottles, or labels, would also have to have been switched back before the compliance officer saw them. That part would have been easy: during the chaos of Diego’s last seconds, anything could have happened without Janwar noticing.
Three: The examination results have been falsified, which means that the perioperative board rep and the examiner involved in the autopsy are lying, and probably even more conspirators besides.
Occam’s razor suggests that the simplest explanation is probably the correct one. But Janwar is fastidious about labels. If he isn’t at fault, who is? Guilt is one thing to process, but conspiracy is completely different. Janwar’s rationalizing of the situation can’t handle the introduction of this new variable, and he explodes into a full-on chthonic breakthrough.
He doesn’t think anything for a while until a white nebula with yellow edges floats across his vision. He adjusts the position of his head on his folded arms to reduce ocular pressure. The nebula collapses into darkness again.
Janwar wants not so much to go to sleep as to s
witch off. Does that count as suicidal ideation? Will he hurt himself? Should he call a crisis line? Or an ambulance? His head is under immense pressure and the squeal of his nervous system blocks out all thoughts and outside noise.
He lifts his head and opens his eyes. His phone is in reach. He could look up a crisis line. Or he could call Dr. Brank, since it’s now only 4 p.m. in BC. But he feels a visceral revulsion at the idea: he is confronting a serious external problem and to approach it as a cognitive behavioural exercise, as he knows his therapist would want him to, will not help him. This isn’t a panic attack about whether a size 36 shirt is too baggy for his IV-tree frame. Best case, he killed a man by accident; worst case, he’s fully responsible for killing a man. He has no way of knowing which is true right now. The street lights flicker on. The City of Ottawa is testing new street lamps in his neighbourhood, so the pools of light are all different sizes and colours, one more thing that should be neatly ordered but is instead out of control. Nothing will happen to clear up his questions until morning at the earliest.
He could call his parents, but he can imagine Ajay’s response: “No, my son wouldn’t kill a man.” Which would mean that either Janwar hasn’t killed a man or he isn’t Ajay’s son. And Garati’s hyper-rational past-precedents-based approach: “Exercise will make you feel better. You may not feel like it will now, but you know that it’s helped in the past. Why don’t you go for a run?” Or maybe she’d look at it from a legal perspective—although she’s a corporate lawyer for the BC Ferries Corporation, not a criminal lawyer—grilling him in order to determine exactly what his culpability might be, whether there’d be a case for the prosecution. Thinking about his parents and how they’d feel if he has fucked up his entire career adds yet another variable to the equation.
And if he called a crisis line, would he be able to talk about this to a complete stranger? Janwar’s thoughts are spinning faster than he can sort them into coherent streams. He decides to masturbate, and then realizes that he already is, and has been doing so for quite some time now. His hand is down past the elastic waist of his scrubs, though there isn’t a sexual thought in his head—and furthermore, he realizes that for a much longer time, though intermittently, and not 100 per cent of the time, he has been masturbating when he is stressed out and unhappy, not when he is horny, which has to be setting up some pretty awful Pavlovian connections in his brain that might be a problem the next time he is able to sleep with a lady. Which might be Friday.
The low point of stress-masturbating took place several years before, after he’d misjudged a run-up while cliff-jumping at Thetis Lake with friends and missed hitting an outcropping of submerged rocks by no more than four feet. At work the next day, he was so stuck in an obsessive loop about it that masturbating in the bathroom of the Canadian National Institute for the Blind seemed like the only way he could hard-reset himself, and when he followed through, using institutional pink lemon-scented soap as a lubricant, he didn’t even feel ashamed.
Janwar closes his eyes again and leans back, trying to think of sexy images, of removing high boots and black tights from attractive women he has known, but then the bootless, tightless legs are waving to him from the water thirty feet below and he is standing at the cliff’s edge, taking myriad different run-ups. He is hitting the granite, his body crumpling, bone fragments spraying out like dust. His friends are dragging him back to shore, and he can’t feel anything. He is in a wheelchair, paralyzed, unable to move his arms or legs, unable to move his mouth, unable to breathe, until the next lightning flash outside burns through his eyelids.
He withdraws his hand from his pants and stands up. Janwar’s normally a spiced-rum drinker, but the only hard alcohol on the shelf is Wild Turkey. He pours himself a glass and swallows all of it, coughs, leaves the tumbler in the sink, and moves toward the bathroom. He reconsiders and takes the bottle with him.
He removes his clothes and steps into the shower with the bottle in one hand, sinking down onto the nonslip floor, crunching his knees up so he can fit. B, A-B, A, B, A…
Exhibit D
TRANSCRIPT OF AUDIO RECORDING FOUND ON SUSAN JONESTOWN’S CELLPHONE
SPEAKING: SUSAN JONESTOWN
Saturday, July 5
Called my manager at Lazarus Coffee. Asked if I could pick up a couple of shifts at the hospital location, the stand-up counter by the entrance. That’d give me cover for wandering around the Civic. She needs someone this afternoon, which is perfect.
Logged into the news archive through the Carleton Library site and am looking up articles about Civic Hospital. Just me and my whisky and my school’s database subscriptions. And it’s 9 a.m. so whisky is off limits for a while. I’m going to make some coffee. It’s the next best thing.
Out of milk.
The Ottawa Civic Hospital, like Carleton, seems to show up in the news only in stories about bad things happening to women.
There was even a female anaesthesiologist who had assaulted her patients, a Dr. Venolia Parker. There’s a CBC article about her, “Ottawa Doctor Faces Sexual Abuse Discipline.”
Apparently Dr. Parker testified before the Ontario College of Physicians and Surgeons that she went into a fugue state during the incidents and had no understanding of what she was doing. She felt dizzy and the next thing she knew, her mouth was on the complainant’s nipple. She testified she was having a rough time, was thinking about killing herself almost constantly, was diagnosed with OCD, and had some family issues with her husband and children. And she’d been abusing OxyContin for several years.
The article also includes her psychiatrist’s take on the situation. She’s identified only as Dr. B and no longer lives in Ottawa.
“‘Her actions did not stem from a place of sexual desire. Instead, she was regressing to infancy whenever she had a chthonic breakthrough, looking for the sense of security she had experienced while being breastfed, which her mother had allowed her to do up until age three,’ Dr. B said.”
The assaults happened twelve times, Dr. Parker either placing her mouth on a patient’s nipple or resting her cheek against a patient’s breast. As a result of Dr. B’s spirited Freudian psychology and the fact that there was no penetration, the woman got off easy. She was banned from anaesthesiology because the ability to sedate people, combined with the privacy of the surgical screen, could be too much of a temptation. She was allowed to see male patients only and even had to wear a tag that said as much when she was on duty at the clinic. But she ended up getting transferred to an administrative capacity elsewhere in the hospital.
I’ve got a subject to interview.
CHAPTER 5
Infinite Gain – Records – The Blade – Rio Mapocho – Minsky’s Diner – Reasonable and Productive – Standard Parts Missing – The Wrong Thing to Say
Thursday, July 10
Thursday morning, in the light of day, Janwar feels like a human being again—a human being with a headache; a human being who might or might not still be responsible for the death of another human being; a human being who might fail out of medical school; a human being beset by lingering dream images of Brett Rutan, the perioperative board representative, tying him to the O-train tracks with plastic tubing and then departing as soon as the red-snouted LRV appeared in the distance, dinging its bell like a demented carnival ride—but a human being nonetheless. One who could take things, if not one day at a time, at least one minute at a time. Dr. Flecktarn’s bourbon is almost depleted. Flies buzz around the bottle. Janwar has been listening to country music, because when he turned the radio on to introduce the outside world, the dial was tuned to CHEV, not his usual CBC, the singer lamenting his proximity to the tomb. But now Janwar has to get to the hospital, and, for the moment, that thought takes precedence over everything else. He even leaves the flies alone.
Outside, all of last night’s rain has already evaporated, but he can feel it lingering in the atmosphere. Once Janwar catches the number 7 bus, which puts him in a controlled environment that is quiet a
nd air-conditioned, he can relax enough to see the situation with a little distance.
It reminds him of Pascal’s wager, which goes like this: You don’t know whether or not God exists. You can either live as if He does or live as if He doesn’t. And you won’t find out until you die.
If you believe in Him and He doesn’t exist, you occupy yourself with prayer for part of the time you’re alive, which is a finite loss. You lose the time you spend praying. If He does exist, you get rewarded in the afterlife—an infinite gain.
If you don’t believe in Him and He doesn’t exist, you haven’t wasted any time praying, so you experience a finite gain. If you don’t believe in Him and He does exist, you experience infinite loss in the afterlife, possibly involving fire and brimstone for all eternity.
So, if you believe in God, you end up with either a finite loss or an infinite gain. And if you don’t believe in God, you end up with either a finite gain or an infinite loss.
If that’s Pascal’s wager, this is Gupta’s wager: he is responsible for Diego’s death or he isn’t. He has two possible courses of action.
First, he can believe he is responsible for Diego’s death, as he’s been told. Guilty until proven innocent. In that case, there’s nothing he can do. He’ll have to go through the remainder of his placement as if the death hasn’t happened, which he isn’t sure he has the confidence to do. He’ll be forever second-guessing himself. Whether or not he gets kicked out of medical school, or fails this part of the program, he’ll always be the medical student intern who killed a patient in his first week, which is about as bad as it can get. So: finite gain (not wasting time if he’s guilty) versus infinite loss (not having the ability to clear his name, destroying his future).
Death and the Intern Page 8