Bloodletting and Miraculous Cures

by Vincent Lam

“Have you got it?” says Nigel.

  “Yeah, I’ve got it.” He slips the tube down the back of the mouth and thinks he sees the tip at the door of the vocal cords.

  “Are you sure?” says Nigel.

  “Absolutely,” says Fitz.

  He isn’t sure. Relax. He breathes. Doesn’t matter, probably. Fitz looks steadily down the blade of the scope, the fibre optic light bright now on the cords. The tube passes through. In. As it goes in, the deflated cuff pushes gently past the cords; he can feel that slight hesitance upon penetration, and then in. The feel of it, once in, reassures him. Trachea, not esophagus.

  “I’m in. Cuff up.”

  Sharon plunges the syringe to inflate the cuff.

  “You got a good look? Saw the cords?” says Nigel.

  Fitz switches the bag from the mask to the mouth of the endotracheal tube, and listens to the chest with his stethoscope as he pumps the bag.

  “It’s in,” says Fitz.

  “Okay. Time?” asks Nigel.

  Sharon says, “Eighteen minutes since we called you.”

  Nigel says, “Pick it up next time, Fitz.”

  “He’s a big guy,” says Fitz.

  “Tape it in,” says Nigel.

  “’Course,” says Fitz, having forgotten the tape until reminded. Then to Sharon, “Another epi.”

  “Then flush the line,” says Nigel to Sharon.

  Fitz’s gloves stick to the tape as he fastens the tube, now slippery with the throat’s froth.

  More CPR, more drugs, and it’s still PEA.

  “Should I tap him?” says Fitz.

  “Fine,” says Nigel.

  “Hold CPR,” says Fitz. He takes the big syringe, the long needle, and slips it under the rib cage, aiming for the heart. He pulls back on the plunger until he hits blood. Nigel thinks, This never works. Fitz sucks the purple fluid into the syringe, pulls out fifty mils, just in case this frees a heart trapped by a pocket of bleeding.

  The man is still in PEA.

  But if you don’t do it, you don’t know that it wouldn’t have worked—because maybe this time it could have worked, thinks Nigel.

  “Continue CPR,” says Fitz, holding the warm, purple-filled syringe.

  It is quieter.

  The three of them watch Maria.

  “Time,” says Nigel.

  Maria’s compressions are becoming slower, more hesitant.

  “Twenty-one,” says Maria, breathing hard into her movements.

  Fitz turns to Sharon, “Bolus a litre.”

  “Make it half. Bolus five hundred, please,” says Nigel. “Hold CPR.”

  Without the compressions, they interpret the monitor. It has lost its faint electrical impulse, has become a straight line—asystole.

  “We could pace him,” says Fitz.

  “What for?” asks Nigel.

  “To try.”

  Nigel shrugs. Then he says, “This isn’t practice, Fitz.”

  Mr. Dizon’s arms are rigid, and jerk at the compressions, becoming resistant to them. All of this is a rhythmic clanking, the castors of the bed shake, shake, as Maria perspires, pushes into his chest again and again. Now a muffled cracking noise, the ribs snap, always sooner or later they break. Maria stops, slips off the bed, looks around.

  “Continue compressions,” says Fitz.

  “I’m too tired,” says Maria.

  Fitz and Nigel look at each other. Fitz looks at Maria who stands sideways, tired.

  “You bag,” says Nigel to Maria, taking the Laerdal bag from Fitz and tilting his head toward the chest. Fitz switches with Maria, who has a streak of sweat down her back under her long hair. Fitz pumps, rocks his whole upper body into the chest. Maria squeezes the bag every few seconds. The clock flashes red. Fitz pounds his first compressions, causing more dull, wet cracking, and now the compressions become easier with the whole chest soft.

  “Give him one of epi,” says Fitz.

  Sharon shuffles in a drawer, fumbles with the box.

  “Don’t you know where it is?” says Nigel.

  “Hold on, I’m getting it.”

  “And two of bicarb,” says Nigel.

  Sharon opens the boxes with a slow deliberateness.

  “One epi, two bicarb,” says Nigel.

  “Time?” asks Fitz.

  “Twenty-eight,” says Maria.

  The four of them stand. Fitz pounds back and forth. He feels thirsty and also needs to urinate. He can never get away to pee, and then always more coffee, more coffee through the night. He feels the compressions in his bladder as he jolts forward again.

  Maria bags. She says, “You guys want to call it?”

  Nigel says, “Give it till thirty.”

  Fitz has locked his arms, and watches the monitor, the hill-like tracings that his compressions produce. Just like little hills. There is no atrial electricity, no actual conduction or repolarization. Just picking up the motion.

  “Twenty-nine,” says Fitz. Then, “Listen, I’m getting tired.” The pressure on his bladder is insistent and angry now with the motion and strain.

  “Thirty,” says Nigel.

  Let’s call it already.

  “Okay. Let’s call it,” says Nigel.

  Fitz continues compressions for a few seconds, then ten seconds, then a bit longer until he says, “All right, I’m calling it.” He stops.

  As they leave the bed Nigel says, “Sorry for the disturbance, Mr. Singh. Are you all right?”

  The man in the next bed nods, his sheets pulled up under his chin.

  As they leave the room Fitz says, “What’s his name?”

  “Mr. Dizon.”

  “Who’s going to phone?”

  “Is there someone? Wife or something?”

  Flipping through the chart. “Brother in Etobicoke.”

  “You ran the code,” says Nigel.

  “Sure. I’ll phone. You write a note.”

  “I don’t care. I can phone. I don’t mind.”

  “No, I’ll phone.”

  “Fine. When you’re done, you write the note. I’ll co-sign it.”

  As they leave the floor Fitz says, “You think it was ten minutes when the code blue was called?”

  “Ten minutes, my ass. He was cold as a brick when we got there.”

  A LONG MIGRATION

  MY GRANDFATHER WAS AN ORPHAN. EITHER HE never knew the identity of his biological parents, or he was never willing to reveal this information. For the Chinese, heritage is of great importance, but adoption forms a new and legitimate lineage. Thus my name, Chen, as a grandson descended of an orphan, is from my grandfather’s adoptive merchant family in the province of Guangdong. At sixteen years of age, my grandfather suddenly left Guangdong for Vietnam. He said there was a plot against him that had to do with jealousy over grades at school. My uncle Will said he was told that my grandfather had an affair with the schoolmaster’s young wife. Others said that the schoolmaster warned my grandfather to leave, because the concubine of a local warlord had eyes for him.

  The family matriarch in Vietnam sent my grandfather to Hong Kong for school. My grandmother said that this was because he was a difficult person whom the matriarch didn’t want to deal with, but my grandfather said that he pleaded with her, begged for a higher education until she sent him to Hong Kong.

  In Hong Kong my grandfather, my Yeh Yeh, finished high school. He became a partner in a shipping venture. Yeh Yeh met my grandmother, my Ma Ma. The Japanese invaded Hong Kong, and Yeh Yeh said that he was persuaded to marry my Ma Ma in order to save her from the occupation. Yeh Yeh had papers that would allow him to return to Vietnam. Ma Ma asserted that he took advantage of this situation at a time when her family’s power was thin, to induce her to marry. Both agreed that he was promising though not wealthy, and that she was the princess daughter of her father’s dying empire. Ma Ma contended that Yeh Yeh thought she still had money and married her for this. Yeh Yeh said that he married her because he loved her. Also, he said, it was a gesture of goodwill toward her o
lder brother, who had helped Yeh Yeh enter business and who was worried for Ma Ma’s safety in Hong Kong.

  I was sorting through these histories during that last winter in Brisbane. I had first met my grandfather when he was spending the last of his money touring North America. He was both the heroic and tragic figure of many family stories—at once shameful, legendary, and safely exiled in Brisbane. Now that I was to be Yeh Yeh’s companion in the period preceding his anticipated death, I was anxious to find out what was true and what were the exaggerations of memory.

  The accounts always changed a little depending upon who told them, and my Yeh Yeh’s versions could shift from morning to evening. Rarely did a new version of a story require the old one to be untrue. Instead, it was as if the new telling washed the story in a different colour, filling in gaps and loose ends so as to invert my previous understanding of the plot.

  During those months, Yeh Yeh pissed blood every morning. Sometimes it would be just a pink-tinged trickle, but often there would be flecks of clotted blood like red sequins swirling in the toilet bowl. Yeh Yeh had me inspect the toilet daily to give my opinion. One day it was red like ink.

  This was the break after my first year of medical school. My family expected that I would use my wealth of clinical knowledge first to care for grandfather, and second, to alert them when things neared an end. I would pronounce his impending death, and this would set in motion a flurry of rushed phone calls to travel agents. On jets from around the world, my relatives would hurry to Australia to be with grandfather as he died. I felt obliged to forecast correctly. It would be awkward if all of Yeh Yeh’s children flew to his bedside only to find him recovering from some brief crisis and not dying. Then they would wait, their workplaces would hound them, and they would finally be obliged to depart with grandfather still alive. Alternately, if I called too late, my aunts and uncles would make a frenetic dash hoping to witness grandfather’s last living moments, and only be able to attend Yeh Yeh’s funeral.

  In my luggage, which was packed in Toronto, my grandmother sent an oblong wooden box that contained a series of small brown bottles held in felt indentations. Each thumb-sized bottle was capped with a tight cork, and tied around with string. There were two straight rows of these healing extracts. A paper label in Chinese was pasted on each bottle, and the strings were different colours. Each morning, after his urination, grandfather dressed himself while his tea was steeping. Always suspenders on last. He lifted this box from a drawer, removed the next in the series of bottles, and drank its contents. Then he poured a mug of tea for himself, and one for me. Yeh Yeh never said anything about this box of medicines. He was good at talking but had difficulty speaking about what was most important. My grandmother, Yeh Yeh’s first wife, had divorced him forty-three years ago and now lived in Toronto, the geographical other side of the world. Yeh Yeh put the empty bottle back in its slot, and the box back in the drawer. He was quiet for a while as he drank his tea. Every morning he told me to thank my grandmother for this gift, as if forgetting that he had told me to do so the day before.

  Seeing the toilet bowl dark with the red-ink urine, I said to my grandfather, “These things can happen. Let’s see if it settles tomorrow. Drink lots of tea today.” I wanted to sound knowledgeable about the issue of bloody pee.

  The next morning, it was a happy rose-coloured stream with clots like coarse sand. I felt certain that I would forecast the end accurately. I gazed into it, looking deeply through the urine into the drain, asking the liquid what it foretold. I also peed into the toilet, and the red swirled up like an eddy. Alive for a moment. I flushed the toilet and it funnelled out almost clean, with a little bit of staining at the water line.

  “You’re very smart,” said my grandfather. “It is better today.”

  Renal cell carcinoma. They had operated once. My Yeh Yeh had refused a second operation. Just as well, said Dr. Spiros, it would only prolong things.

  My grandfather lived in a cottage at Glenn Hill Retirement Village. There was a long cinder-block building fronted by a watered lawn. This building was divided into individual units, all accessible from a walkway. These were called cottages. The residents of the cottages ate in the main dining room along with the residents of the dormitories. The main difference was that the cottage-dwellers were able to walk and dress themselves, while many of the dormitory residents were wheeled to meals. Yeh Yeh did not participate in conversation at Glenn Hill meals. If asked a direct question at the dinner table, he would pause, raise his head as if unsure that he had been addressed, and say with a sad wave of his hand, “No speakie Englis.”

  In Vietnam, Yeh Yeh had been the proprietor, headmaster, and star lecturer of the Percival Chen English Academy. Early in the morning, my uncle Will—who was finishing high school at that time—would find his father sleeping on the couch in the front room. Yeh Yeh would still be wearing his tuxedo from the previous night of drinking, gambling, and bedding prostitutes. My uncle would help his father upstairs into bed. Yeh Yeh would sleep in the morning, and look fresh again by afternoon to go to the school. He had no fixed teaching schedule, but would appear in classrooms intermittently. Star lectures. That’s what the students paid for, to be in his school, to be taught by Percival Chen. Decades later, there were alumni reunions in California. Many credited my grandfather with teaching them both English and an attitude for success. At that time, the Americans were sending platoons and money into Vietnam. English was a language of opportunity. Yeh Yeh’s fortune was made but never accumulated. It was quickly gambled, vigorously transformed into cognac, and enthusiastically given away in late night transactions. There was a plaque from the Saigon Rotary Club on the wall next to his mirror: To Percival Chen—For Exemplary Generosity and Community Involvement.

  On the telephone to Canada, I asked my dad whether grandfather really had forgotten all his English, or whether he just pretended to have lost it. My father said that when they were children, they all thought their father was a master of this language. Yeh Yeh told me that he had always faked it, that at the British school in Hong Kong he had learned that the British display great confidence when they don’t know something. Later, at his own school, when he couldn’t spell something he was teaching, he simply avoided writing it down. He claimed that he never really spoke English properly, but had convinced people that he did. The hired teachers were Canadians, Brits, and Australians. These people corrected spelling mistakes for the students, so he didn’t need to. I suspect my grandfather understood more English than he admitted, but that he could not take interest in conversations at Glenn Hill. Aren’t the potatoes salty today? In his cottage, Yeh Yeh kept a bottle of Remy Martin XO cognac in the cupboard above the sink.

  My grandmother claimed that grandfather had ruined her life by gambling and womanizing. She said that his behaviour led her to nag and fight him, and this created bitterness in her. It was this wound that had made her such an admittedly difficult woman, she said. Sometimes she explained this after yelling at me or another family member. My grandfather said my grandmother ruined his life, because early in their marriage her nagging and fighting compelled him to seek solace outside their home. For a Chinese man living in Saigon when Vietnam was still Indochine under the French, this meant mah-jong houses. They would bring hot dim sum late into the night, and smiling compliant women at any hour. There was nowhere else to go, he said. Yeh Yeh admitted that it was wrong of him to spend so much time and money in unfaithful ways. He recognized that this would anger any wife, but said that he sought these comforts initially because there was no peace at home. My father told me that although the school was lucrative, Yeh Yeh never had any money. The school fees went directly to loan sharks. Yeh Yeh bought a new Peugeot with push-button gears, but once the family had to sleep in the school for several months because they could not afford to rent a house.

  In Brisbane, my grandfather had many friends. Enough of the Chinese in Vietnam had emigrated to Australia that he still had social standing in this new
, hot, white country. We were often invited to dinner. One couple who took us out was younger than my grandfather, but older than my parents. Dr. Wong was a retired orthopaedic surgeon who had graduated from the Percival Chen English Academy before studying medicine in Glasgow. After retiring, Dr. Wong had become an Anglican minister. He and his wife, with Uncle Will’s encouragement, were trying to convert my grandfather to Christianity before he died. Grandfather was a prime candidate. He was previously sinful and glamorous, now reduced to economic subsistence although still drinking XO cognac and gambling once a week (I had become the chauffeur for these outings, which my uncle was not to be told about). We were having a dinner of scallops, delicate oysters, and the lobsters without claws that they catch in Australia. My grandfather produced his flask and asked the waiter to fill a glass with ice. He poured cognac for himself and offered it around the table, but no one took any. The minister and his wife were teetotallers. Yeh Yeh poured some for me. We talked about Jesus.

  My grandfather was receptive and interested, although during years of friendship with Dr. Wong he had politely and charismatically sidestepped the issue of faith. He questioned Dr. Wong about the parable of the sower. Yeh Yeh asked whether God would mind if he had sown seeds that lay ignored for a long time before sprouting. Dr. Wong said that it was all the same as long as there was faith at the time of judgment. I imagined my grandfather weighing the odds. Death was an awaiting certainty and beyond that the odds were unknown, but there was nothing to lose by laying a few bets on the Bible. What was in the past could be repented for, and the future was short.

  They set a date for the baptism.

  My grandfather didn’t drink tea in restaurants, because he didn’t want to fill his bladder and have to pee blood during dinner. He sipped cognac on ice. A great deal of food remained on the table when everyone stopped eating, mindful of their cholesterol and their diabetes. They counted on me to finish everything, which I tried to do.