by Ross Pennie
He asked for the MD on duty.
Jeff Suszek, the department’s assistant chief, came on the line. “Hey, Hamish. What’s up? Got a case headed our way?”
“I’ve got two for you, maybe more. Bordering on shock.”
“You at a bus crash?”
He told Jeff the story.
“Can’t help you, Hamish. Patients who fail the ministry’s new CCAE policy have to stay where they are.”
A new policy had started two weeks ago, on the first of March. Doctors and nurses had taken to calling it the Deep Six rule. A cohort study out of Toronto had shown that nursing- and retirement-home residents who were older than eighty, or had been hospitalized within the past twelve months, or were taking more than six drugs, were just as likely to die after transfer to an acute-care hospital as they would be if cared for in their residential facility. In the interest of saving money and hospital beds, and practising medicine based on scientific evidence, the ministry was insisting that the new Community Care Algorithm for the Elderly, the CCAE, be applied without exception.
“Your folks are over eighty, Hamish. So there’s no way we can allow them in. Besides, I’ve got nowhere to put them. Our isolation rooms are full. Twenty-seven patients are lined along the halls of our department, waiting for beds upstairs. I spend the whole day running interference and —” A siren screamed in the background.
“Hell’s bells, Jeff. These folks are going to die if they stay here.”
“The ministry and the latest studies both say they’d be no better off if we take them. Why don’t you shove IVs into them and give them your antibiotic du jour?”
“They don’t do ivs here. Against nursing council policies. No trained staff, no supplies.”
“Sorry, man. The dean, the CEO, and the VP Patient Services are all over us on this one. We gotta keep the beds clear for our elective hips and knees. And the new pancreas program.”
The mandatory targets for hip and knee replacements, imposed by the Minister of Health, were sore points with everyone except the orthopedic surgeons who were putting new joints into vote-rich baby boomers. And the pancreatic islet-cell transplant program was the university’s brand new poster child. Everywhere you looked there were ads asking the public for donations to Help Cure Diabetes, the Epidemic of Our Age. Pancreatic transplantation was a high-tech initiative, and purportedly revenue neutral: curing diabetes would stop the need for dialysis units filled with diabetes-induced kidney failure. Caledonian University was in a race with the University of Alberta to develop a slick, fail-safe transplant procedure that didn’t require patients to take toxic anti-rejection drugs for the rest of their lives. Everyone knew that at least one Nobel Prize was on the line. A cure for diabetes would be huge.
“So what am I supposed to do with these people?” Hamish said. “Let them go into shock and die?” In almost every other country on the planet, there would be a private hospital down the street he could transfer them to. But not in Canada. In 1984 — had the irony attached to that year dawned on the country’s politicians? — big-brother government had outlawed private health care, except for cosmetic procedures. When Canadians got sick, they got government-issue health care or nothing — unless they were rich and could make it to the States.
“Tell you what,” Jeff said. “I’ll send you a taxi filled with all the IV stuff you need. You find someone to look after the infusions. Here — I’ll pass you on to the unit clerk. Tell her what you need.”
Hamish looked around the Mountain Wing’s nursing station in disbelief. Was he actually going to turn this place into an acute-care ward? He’d need backup. He couldn’t manage a ward full of IV drips, day and night, for who knows how long, by himself. Jamieson’s on-call replacement, Dr. Awad, wasn’t going to be any help: Hamish had paged him three times last night, intending to tell him about Betty, but Awad had never answered. It was probably just as well, he figured. An office GP couldn’t be expected to know much about septic shock, toxic megacolon, and running IVs.
One way or another, he’d have to handle this mess himself.
But sooner or later, if no one found the source of the gastro, the effluvium was going to hit the fan in the Belvedere Wing, and they all might need IVs.
CHAPTER 11
At eleven o’clock Sunday morning, Natasha stood in the front lobby of Camelot Lodge rubbing hand sanitizer between her fingers. She’d asked Maria, the anxious receptionist, to page Mrs. Oliveira. The buzz in the common room was subdued compared to last week. Fewer residents than usual were chatting on the sofas, their cardigans fastened tight across their chests. Two women stared intently at their half-complete jigsaw puzzle. Snow-capped mountains, Banff or Lake Louise, were emerging from the jumbled pieces. Dr. Zol had made it clear that Camelot’s no-visitors status didn’t mean no socializing among the residents, but there was no mistaking the pall of dread on every face.
It was hard to believe that nearly a week had passed since last Tuesday when she and Dr. Zol had inspected the kitchen. And still nothing to explain the cause or source of eight weeks of febrile gastroenteritis. Perhaps, she decided, Colleen was on to something. Those large bags in the deep-freeze could be leftovers diverted from shelters and charities. She shivered at the thought of food being recycled without attention to maintaining its temperature in the proper germ-free range: either very hot or suitably cold. And then she pictured Dr. Wakefield’s freegans diving into Dumpsters at the back of the city’s restaurants, hauling soggy meals out of the garbage. Her hands went cold.
The room pressed hot and dry on her face. She pulled off her winter things and hung them on the rack. She checked her watch and hoped it wouldn’t be too long before Gloria made her appearance. Circling the room, she exchanged brief hellos with the residents, then studied the artwork on the walls. Half a dozen sentimental Trisha Romance prints glowed with portrayals of impossibly fluffy snow blanketing cutesy villages. Did little girls ever look that perfect at minus twenty? Why didn’t the artist reflect the people of modern Canada? Celtic freckles might be adorable, but so was brown skin kept flawless with generous applications of shea butter.
On the wall toward the back of the room, she came across a painting that spoke to her instantly. It was an original, not a print, and it showed a soldier striding across a battlefield. Craters pockmarked a landscape littered with burnt-out Jeeps and tanks. A bundle of rags hung limply in the soldier’s arms. The setting sun lit a background of jagged mountains in a spectacle of pinks and violets. She looked closer and saw that the soldier’s dishevelled bundle was actually a child, her eyes round and wide. There was nothing the least bit sentimental about this artist’s work. Its emotional tone reminded her of a Renaissance Pietà, but the vivid colours spoke more of the Hindu Ramayana.
Natasha tore her eyes from the painting and checked her watch again. Eleven-fifteen and Gloria still hadn’t answered her page. They’d agreed to review the gastro situation and see what support Gloria needed for her infection-control measures. The woman did have her hands full. Maybe she was busy making funeral arrangements. Dr. Wakefield said they hadn’t buried her mother yet.
At the far side of the common room, next to the tall windows, a scooter tire caught Natasha’s eye. She peeked around the corner into the hallway leading to the elevator and saw Mr. Greenwood and a male companion standing at attention. They were gazing through the windows, watching two other men, from Craig & Lafferty, load a sheet-covered gurney into a black van. The elderly pair, dressed in flannel trousers and navy blazers, had their right hands tipped to their brows in formal salute. Natasha stepped back, hugged her briefcase, and stood still.
For a minute or more the two veterans didn’t move. Tears spilled down their cheeks, but their salutes didn’t waver. Even after the van driver bolted the vehicle’s rear door and drove out of sight, the two men stood motionless. Finally, Mr. Greenwood began to wobble. He grabbed the handlebar of his scooter and dropped onto the saddle. His companion then terminated his salute with a cris
p forward motion, closed his eyes, and briefly bowed his head before lifting his backpack from the floor. He pulled a hanky from a side pocket and wiped his face.
A few moments passed. Natasha wanted to slip away unnoticed, but decided she’d be less of a distraction if she stayed perfectly still. When Mr. Greenwood turned his scooter toward the common room, he halted immediately. “Oh goodness, Miss Sharma. I didn’t see you standing there.”
Natasha bit her lip, embarrassed at intruding on their private moment.
“Don’t mind us,” Mr. Greenwood continued. “We were just saying goodbye. To our dear friend Melvin. Gave them trouble right to the end, he did.” He wiped his eyes and blew his nose with a tissue he drew from the basket attached to the handlebars. His light-grey eyes, though bloodshot, brightened. He turned to the gentleman standing beside him. “Have you met my very good friend and bridge buddy, Earl Crabtree?”
Natasha stepped forward and extended her hand. “Glad to meet you, Mr. Crabtree.”
“Actually,” said Mr. Greenwood, “it’s doctor. The Ph.D. kind.” He smiled at his friend and winked at Natasha. “Unlike Zol and Dr. Wakefield, he doesn’t get his hands dirty. Professor of history.”
“Emeritus, now,” said Dr. Crabtree. “Retired years ago. Please, call me Earl. Though you’ll hear Phyllis calling me Crabtree.”
“She’s one of our chums,” Mr. Greenwood explained. “Phyllis Wedderspoon. Maybe you’ve met her already. Our chauffeur and Internet hound. And former Latin teacher.” He dipped his head and gave Natasha a look suggesting it was wise to watch your manners around Latin teachers.
“She hates losing at bridge,” Professor Crabtree added with a chuckle.
“And paying for Internet service,” Mr. Greenwood said. “She surfs online at the library, where it’s free.”
It was surprising how quickly these two had changed their tone. Maybe that’s how you survived to almost ninety. A positive attitude gave you resilience. Natasha thought of her mother, only forty-six, prone to moping like a miserable crone. Mummyji could spend hours weeping on the sofa when Natasha refused to have dinner with one of the nerdy Indian guys the family had picked for her to sample.
Mr. Greenwood started rolling toward the centre of the common room. “So, Natasha,” he called over his shoulder, “come and sit for a minute. Tell us what you’re up to.”
She offered to carry Professor Crabtree’s sporty backpack as they filed behind the scooter, but he held it firmly and said, “No need, my dear. I’m fine as I am. Old age is contagious, you know. The more you let people do for you, the less you can do for yourself.”
The three of them found a quiet corner. Professor Crabtree stayed standing until Natasha sat down, then invited her to describe how she approached her work.
As a field epidemiologist investigating any outbreak, she told them, her job was to track down every symptomatic case in a cluster and determine the common exposures among the people affected — foods, water, objects, places, other people. You did a blitz of the cases and the environment, matched the two, and usually found the offending germ and the contaminated agent carrying it.
Professor Crabtree massaged his knee with his palm, then winced as he shuffled his feet. “Now that the situation here has escalated, and we all seem to be at risk from an aggressive illness, what is your Plan B, Miss Sharma?”
“Ideally, I’d like to list, and cross-reference, every morsel ingested by every resident in the past two months.”
“Good Lord,” said Professor Crabtree. “My dear, you’re asking the impossible.”
“I know. A person would have to be a savant to remember what they ate the day before yesterday, let alone last week or last month.”
Professor Crabtree smiled and tapped the side of his head. “Most of us are no longer pros in the memory department.”
“Speak for yourself, my friend,” said Mr. Greenwood. “Nothing wrong with my memory.”
“Okay then,” said Professor Crabtree. “Tell us what you had for lunch the Thursday before last.”
Mr. Greenwood scratched his chin, looked up at the ceiling, opened his mouth as if to speak, then closed it again.
“There you are,” the professor said. “Albert Schweitzer said that happiness is nothing more than good health and a bad memory. You’ve got a bit of both.”
Natasha’s gaze strayed to the painting of the soldier carrying the terrified child bundled in rags. She’d loved her university electives in art history more than any of the sciences she’d majored in. Her parents fretted that mooning over the paintings of dead artists could never be turned into a secure living. They’d insisted she continue with biology.
“I see you noticed my painting,” Mr. Greenwood said, diverting the conversation from the competence of his memory. Had he noticed the work had set her heart racing, that it haunted and inspired her in the same breath? “What do you think of it?” he asked.
The piece must have come from a high-class gallery, the sort of place that didn’t feature Trisha Romance. “It’s very moving,” she said. “Did you purchase it at an auction?” She’d always wanted to attend an art auction. They sounded exciting. And sophisticated.
“Auction? Heavens, no. I painted it myself. Acrylic on canvas.” Mr. Greenwood dipped his chin and looked pointedly at his friend. “And from memory. North Africa. ’43. Those are the Atlas Mountains.”
Natasha’s tongue went so dry she could hardly get the words out. “You . . . you painted that? You . . . you were there?”
“We both were,” said Mr. Greenwood. “Canadian Army. Along-side the Gurkhas and damn good fighting men from India. We were seconded to the British.”
She didn’t know what to say. Her grandfather had fought in North Africa but spoke very little about it. He’d died at home in Delhi more than a decade ago. Had he met these Canadians, or others like them, during the war? These two gentlemen hadn’t blocked their memories, and they still retained their sense of humour and a wholesome affection for each other. She wished she’d known her grandfather as more than a cheerless old man with a raspy cough.
The intensity of Art Greenwood’s unexpected talent overwhelmed her. She stared again at the painting, then down at her notebook. It was several moments before any of the words on the page made any sense to her.
She forced herself back to her agenda, to reviewing the data she’d collected on her previous visits to the Lodge. She’d already gone for the obvious targets.
She tapped her scribbler. “There’s obviously something I’ve missed. Something crucial. I just wish . . .”
“What about the soup?” Mr. Greenwood said.
“Oh, Art. You’re always going on about the soup,” said Professor Crabtree.
“Well, I can’t help it. I hate cold soup.”
“Like vichyssoise and gazpacho?” Natasha asked.
Mr. Greenwood thumped the handlebar of his scooter. “I mean soup that’s supposed to be hot but is served barely lukewarm. In a cold bowl, to boot.”
Natasha made a note about the soup, more to keep Mr. Greenwood happy than anything else. The lab had looked for pathogens in the sample of soup Dr. Zol took last week, but had found none. Of course, negative results on one batch didn’t put Nick’s soup completely in the clear. If soup was kept lukewarm for prolonged periods, and never heated above seventy degrees Celsius, it would be ideal for keeping microbes alive. Perhaps she could divide the residents into soup-eaters and non-soup-eaters, then compare the incidence of gastro in the two groups.
“I’ve been thinking about our pills,” Mr. Greenwood said. “Vik Horvat, our pharmacist, has had more than his share of distractions lately. And that’s got me worried.”
“Come now, Art. Betty and the others have some sort of infection,” Professor Crabtree said. “What’s that got to do with Vik and our pills?”
“All I’m saying is that if Miss Sharma is interested in everything we put in our mouths, she ought to look at our pills. We sure swallow a hell of a lot of them
.”
“Viktor Horvat may have his troubles,” the professor said, “and I grant you, his English is atrocious. But he’s a damn good pharmacist.” He waved a finger, reminding Natasha of Dr. Wakefield when he was about to make an important point. It seemed to go with the academic territory. Unlike Dr. Wakefield’s, there was nothing sleek about Professor Crabtree’s index finger. It was gnarled at the tip, like her grandmother’s. “He keeps everything organized for us in those little blister things.”
“He supplies your medications in convenience packaging?” asked Natasha.
Mr. Greenwood nodded. “Does it for everyone here, except for the three show-offs.”
Professor Crabtree caught Natasha’s puzzled look and explained that Camelot had three residents who made a big deal of not needing prescription medications. He tipped his head to the far side of the room where the two ladies were poring over their jigsaw puzzle. “The puzzle sisters — Maude and Myrtle — only take multi-vitamins. Those puzzle pieces are so damn small, good eyesight must run in their family.”
“And Phyllis, of course,” added Mr. Greenwood, “takes only a baby aspirin.”
“Vik better do a good job of our pills,” Professor Crabtree said. “Thanks to Gloria, he’s got this place sewn up. Steeltown Apothecary has a nice little monopoly running here. Funded by the government, through Ontario’s drug benefit program for seniors. Not bad for a guy who escaped from Sarajevo with not even a dime in his pocket.”
“Speak of the devil . . . here’s Phyllis,” said Mr. Greenwood, looking in the direction of the reception desk at the other end of the room. “Better watch out. Looks like she’s in high dudgeon.”
Phyllis Wedderspoon stamped the slush from her boots on a mat near the entrance, then breezed into the common room like a ship in full sail. Her full-length fur coat glowed with the sheen and flow of real mink. Her dark felt hat, a cloche, was festooned with an extravagant yellow feather. The well-worn handbag dangling from the crook of her forearm looked like real crocodile, probably purchased long before Greenpeace and World Wildlife. But her plastic galoshes screamed Wal-Mart.