by Vincent Lam
Marcus, the pilot, used to fly CF-18s but his wife got sick of living in Goose Bay. The co-pilot, Rafael, speaks Spanish, which is good for a Guatemala run. We taxi to our runway. The pilots have their posture of relaxed focus before takeoff.
Acceleration and disequilibrium come instantly in a drugged moment. The jets roar in thrust down the tarmac, jolt through tens of seconds, the nose lifts, back wheels drag for a moment, and then with a sudden calm we ascend the sky. I am sleepy. The earth shrinks and drops—a camera panning out. I used to watch the cities as we took off, tried to spot their monuments, trace their watercourses. Then I discovered this moment, the powerful sedative effect of hurtling down the runway followed by the sudden forceful calm of pushing up into sky. Takeoff has become one of my sleep drugs, especially in the Lear, where the back seat is a few feet from the fuel tornado urging us forward. I breathe slowly, fade away, and am out before we reach cruising altitude.
21:55 EST
A loss of altitude wakes me. How does my body know? We drop through cloud cover over Tampa. The land mass sparkles with electric light, and the water around coastal Florida is a dark, geographical shadow.
Night over Tampa, coming in for fuel. I like to be awake for landings. I don’t expect disaster, but statistically it’s upon landing that we’re most likely to spin into a ball of flame. I would like to experience that rare moment, to have the privilege of my last thought. A routine of acknowledging these small probabilities reassures me. Marcus is flying. He’s slick—was trained to land on aircraft carriers—but I like to be awake.
“Dispatch says the patient had a stroke,” says Niki over the deep exhaling vibration of the wings. The flaps point down, poised to lose speed and altitude.
“Info is from the wife?” I ask.
“Here’s what we have,” she says, and hands me the run sheet.
A handwritten note, rendered into brown pixels by a fax machine, reads:
Dear Sir/Madam,
Here is a summary of recent events concerning my husband, Franklin, which I hope is helpful. December 3: dizzy, bad headache, then got better. December 4: the hotel doctor came, and Franklin was feeling fine. December 5: so dizzy he couldn’t walk, had a worse headache, doctor came, sent him to hospital. Diagnosed with stroke. Then got worse and very confused. December 7: he went to sleep, they said a coma, and a breathing tube was put in. Now they say he’s stable but they can’t help him.
I look forward to seeing you. Many thanks in advance for your help,
Mrs. Amiel
“This is all we have,” I say.
“And you’ve heard about the airport?” says Niki.
“Closes at 2:30 local. They won’t wait for us, huh?”
“Adamant. They close, and we’ve got to be in the air or we’re stuck.”
I read the fax again.
“Bet it’s a bleed,” I say.
“Can’t tell from that,” says Niki, putting up a palm in protest. “Don’t be a jinx.”
I actually prefer flight evacuation’s lack of information. It means that there are fewer options, and it’s all about a simple goal: to collect the patient in Location A and deliver him, alive and hopefully not worse, to Location B. We don’t claim to fix anyone, or to know more than we can. Not like at the hospital, where everyone must pretend to know more than everyone else, and no one can mind their own business.
“Doesn’t matter, we’re going to get him,” I say. We descend until we’re alongside an elevated Florida over-pass. The night is an orange haze of city glow. For a moment, the plane skims through the air at the same height as a transport truck on the freeway, and then we drop to the ground.
Out of the plane. First, to the washroom to pee. We clear American customs as the fuel truck rolls up, warning light flashing. The airport caterer arrives on an electric golf cart with our dinner. Dispatch has ordered us the trays of big, hand-filling sandwiches, and pickles, and coleslaw, and white chocolates in the shape of fighter planes all nestled in a bed of tough, bright green lettuce. Can’t eat the stuff—it’s like paper, simply live packaging to keep the sandwiches fresh. Our flight number is on the cellophane wrappers, and no one is hungry so we put the trays on the floor in the back.
I’m tempted by the flask. Sip just a little. Better watch it, we’ll be there soon. The moment of takeoff puts me to sleep. It’s something about being pushed back into the seat by the strong hand of exaggerated gravity.
1:55 EST
Descent into St. Therese, a mountain town. It’s a steep landing, and Rafael says to hold on, he’s flying by instrument. We bank, circle around to get the right approach, the yellow airstrip lights twinkling in the distance like stars turned upside down.
As we descend, I see a cloud of red light to the right of the plane. It is smoke in luminescent red globes, hot and bright from below. Like the earth cracking, opening, and venting anger.
“Fire,” I say to Niki.
“Seventy minutes on the ground,” she says, looking out the window. “It won’t get to the strip.”
Neither of us knows a thing about judging distances from the air, about the influence of wind upon flame, or about forest fires in Guatemala. The glowing red clouds roll like fog over the ground. Our plane drops into a cleft in the earth, and the clouds disappear behind the opaque shoulder of a mountain ridge that blocks the burning forest light as we fall toward the airstrip.
“We’re down to seventy?” I ask.
Now the landing lights rush beneath us. There is the roar of slowing, the jolt of wheels on asphalt, and the scale of objects becomes human as if we just woke from a dream. At the end of the taxiway is a brilliant bank of floodlights. We swing around sharply toward it. The ambulance is parked just off from the hangar.
Niki says to Rafael, “Find out about the fire, but not until Dr. Fitzgerald and I are on our way to the hospital.”
“We will assess the situation,” says Rafael. “We will discuss it if it seems right.”
Marcus winks and says, “We’re not going to get stuck here, so hurry back, boys and girls.”
“Radio if we need to get back fast,” I say.
Niki rotates the handle to release the doors, whose halves swing up and down like a jaw. A man in uniform stands next to a man in a cream-coloured shirt that is loose at the waist. The ambulance backs up toward the plane, beeping and flashing.
The man in the ironed cream shirt says, “Dr. Fitzgerald? I am Garcia.” Dispatch had given us his name. He is our facilitator. The air is damp with a fine, clear smell of wet leaves. Also, I think, a hint of burned cake. Birds wheel and dive over the plane. Excited, they circle and snap. “You must go quickly. The airport will close soon, and they will turn off the lights,” says Garcia, pointing to the orange globes along the airstrip.
“Are they always like this?” I ask as I haul out the heavy drug bag. He looks at me, and I realize the pointlessness of my question. I decide to gesture to the birds, “The birds, are they always like this?”
Garcia repeats my question in Spanish. He and the man in the uniform laugh.
“Amigo,” says the man in uniform, “they are bats.”
Garcia says, “The insects love airplanes. They swarm around when the jets land and the bats go crazy.”
The uniformed man takes our passports. He slips them into his shirt pocket, smiles, and flicks his wrist to wave us on. Instinctively, I fondle my emergency wad of American cash—my security blanket. From where we are on the ground, surrounded by the shadows of mountains, there is no fire. We load our stretcher into the ambulance, then the drug bag, portable monitor, hospital bag, airway bag, vent bag, field radio, Garcia, Niki, and myself. Garcia pulls shut the back door. We jolt as it clatters away, and no one has said a word about the flames.
2:05 EST—St. Therese Hospital
Garcia takes us through the front doors into the dark lobby, where a sleepy security guard looks up from his wooden chair. He swings a flashlight at us, nods, and turns it off. The lobby is high-ceiling
ed, with curving stairs at one end leading up to a second-floor mezzanine. All of this I glimpse in a single arc of the guard’s flashlight.
Our stretcher loaded high with gear bags, we follow Garcia through the front building into the courtyard. Between the buildings are walkways roofed with corrugated tin on vine-covered stilts. Between these paths are swaths of grass, the tips going to seed and waving in the courtyard breeze. We ride up the clanking elevator and trundle down a dim hallway.
Outside the intensive care unit, a woman with peeling shoulders sits cross-legged on the floor. Her two greasy braids of sand-coloured hair hang heavily over a blue flower-print dress. Next to her is a knapsack. It is as if she has been kidnapped from suburbia, and in her captivity she listens to a portable tape player.
“Mrs. Amiel?” I say.
She looks up. “Are you here for Franklin?” she asks. She speaks loudly above the headset.
“We don’t have much time. The airport will close,” I say.
Mrs. Amiel nods as if this is perfectly natural, that the airport would be on the verge of closing just as we arrive to transport her comatose husband. Niki introduces herself and Garcia. Mrs. Amiel takes off her headset and smiles. She says, “Spanish tapes. I’m trying to learn. There’s no hospital tape, though. It’s all about ordering beer, and how to describe the colours of dogs.”
“We’re going to speak to the local doctor and move your husband onto our stretcher,” says Niki.
“Everything is in Spanish,” she says. “They are kind, but everything is in Spanish.” Her smile is hard and dead, speaking the voice that she is trying to keep sharp.
“Garcia will help us,” I say.
Mr. Amiel glows under the lamp at the head of his bed. Another three beds like his are in this room, each a shrine to care surrounded by pumps, poles, tired nurses, and the sleep-deprived Dr. Manolas. Mr. Amiel’s blood pressure is 65/45, which is a good pressure for a newborn baby. Temperature is 41.8. Hot. I rub his sternum with my knuckles, and he arches his back very slightly. I squeeze his big toenail between my thumb and my pen, and there is the slightest withdrawal of the right leg. The toenail begins to bruise. Garcia translates for Dr. Manolas, the intensivist: Mr. Amiel had a bradycardic near-arrest the day before and was given atropine. Blood pressure is in his boots, even with the dopamine drip. With the back of my hand, I feel Mr. Amiel’s hot, dry skin. His tongue protrudes slightly from his mouth to the side of the taped-in breathing tube. One pupil is bigger than the other, and neither of them wink at my bright flashlight. Probably he’s already coning: the brain swells and squeezes itself to death in the back of the skull. The smell of skin as it melts into a hospital bed is a rank scent of jungle decay, slightly sweet. Niki checks the lines and the vent settings.
Garcia translates: Mr. Amiel came into hospital still talking, but too dizzy to walk. He was vomiting from the dizziness and unable to drink. Initially, the CT scan of his head was normal. His nausea was treated and he was given fluids. Over several days he became more sleepy, then confused. Three days ago he became comatose, and was diagnosed clinically as having a hemorrhagic stroke.
“And the subsequent scans?” I ask.
“Unavailable,” says Garcia after asking Dr. Manolas.
“The scanner has stopped working.”
“And the fever—it has been investigated? Urine? Blood cultures?”
Garcia speaks to Dr. Manolas. After talking back and forth, he says, “They say the fever is due to increased pressure in the brain. They placed a device—a Thompson bolt—in his head, but they have removed it because they cannot send it with him.” So that’s why the head is bandaged.
Dr. Manolas shows me a careful record of Mr. Amiel’s intracranial pressure. Big spikes, like cliffs. Too high, too fast.
Through Garcia, I ask Dr. Manolas about details, bits of information framing therapeutic pitfalls that he and I both understand. He is intelligent, well-read, and knows that the treatment has not been as modern as his reading. I make my professional sympathies evident and say that I am impressed with the clarity of the flow sheets in the chart. I ask if there has been consideration of neurosurgery. It took a day to get a neurosurgeon three hundred kilometres away to discuss the case on the phone, says Dr. Manolas, and by that point Mr. Amiel had already blown a pupil. Also, it is hard to appeal to a neurosurgeon without a recent CT, he says. We do not say it directly, but we talk around the regret of a lost opportunity: the narrow time frame in which an expanding death in the form of a bloody intracranial expansion can perhaps be drained, can sometimes be sucked out like an evil spirit to leave the scintillating brain intact. I say that this is an unfortunate case, and that obviously Dr. Manolas has done everything in his power. He speaks in Spanish, looks at Mr. Amiel and then at me. Garcia says, “Dr. Manolas’s heart is broken to see that a man is lost far from home.”
In the hallway, where the only light leaks from patients’ rooms, I ask Mrs. Amiel whether she understands the situation. “He is physically delicate,” I say. I try to continue, to explain specifics. I want to clear my conscience by mentioning the proximity of death.
She interrupts me, saying, “Yes, I know. I completely understand the situation. I understand.” She nods quickly. “The insurance company didn’t want to fly him. Said there was no point.”
“But finally they agreed,” says Niki.
“We’re still negotiating,” says Mrs. Amiel. She must be a kind woman, because negotiation is a kind term. “In the meantime, I borrowed the money against our house. I’m glad we own a house.”
I know what she’s paid, and her ardent triumph at having covered this bill shows that she can’t afford it. Used to own a house, I think.
“I’m sure that’s what he would want,” says Niki.
“It’ll be touch and go,” I say. I was about to tell her that he may die at any moment, and that even if his physiology stabilizes, he’s beyond the point where she’ll have her husband back. I can’t say that now, because the money issue embarrasses me.
As we bump into the elevator, the gauze pad falls off his right eye. The eyelid falls open in a slit, and the eye stares suddenly at me, showing its sleeping world of white conjunctiva and black pupil. I slide the eyelid shut and retape it. Niki and I watch the lines and monitors as we trundle out of the elevator, down the walkway, toward the courtyard. Dr. Manolas pulls the foot of the stretcher. We’ve got to get in the air, I think. They haven’t radioed. I suppose that everything is fine, but we can’t be caught on the ground. There’s a fire on the other side of that ridge, I tell myself abstractly, as if it will disappear as soon as we take flight.
2:55 EST
The courtyard has a pungent grass-dew scent. The dark hospital windows around us are empty eye sockets that cannot watch, cannot see the way we now walk lopsided, the straps of the heavy bags pulling at our shoulders. Our patient is belted into the stretcher. Niki walks alongside him and every few seconds she squeezes the firm rubber bag that pumps air into Mr. Amiel’s lungs. It is the kind of bag that reinflates on its own, that pops back into its original shape.
As we lift the stretcher into the ambulance, I catch the distant burnt cake smell. Dr. Manolas helps to pull the stretcher up, and a sudden guilt comes over me. Fire burns what it touches. I say to Garcia, “Tell Dr. Manolas that we saw a fire from the plane. He should know, so he can see what needs to be done. There are many patients here.”
Garcia seems confused, but speaks to Dr. Manolas in Spanish. Then Garcia says to me, “Dr. Manolas hopes to see you again one day, and would like to visit your country. He asks for your email, and prays that God will keep you safe.” Niki is in the ambulance, and I heave the end of the stretcher to push it toward her. Garcia says, “You should give this doctor something, as a courtesy. It will be good for you, if you come back here some day.” In the dark, broad leaves slap each other in a random, syncopated rhythm. Niki gestures to the Guatemalan ambulance driver about the way she wants monitors placed, lines hung. I zip open the wal
let of company money, pull out fifty dollars and give it to Dr. Manolas. Garcia climbs into the front seat. He talks into the radio, and Niki yells at me to get in. “We must go,” says Garcia, “there is little time.”
I give Dr. Manolas my card with email address, which follows the money and slips like water into a pocket.
“There is fire close by,” I say in English, and make gestures that are meant to represent flame. Doesn’t he understand me, if he reads English medical journals?
“Dr. F,” calls Niki, “airborne in twenty.”
Dr. Manolas laughs and holds out his hand. He must be happy with the money and my email address. Our palms slap together, we shake, and all around us the leaves that I cannot see make a sound similar to our hands meeting. I smell a sugary smoke. Does no one else notice?
“Get in!” says Niki.
Dr. Manolas didn’t seem to understand my flame gestures, so I make sounds like burning. Maybe it’s better to go. What can he do, even knowing that there’s a fire? At that moment, I decide that I have said all I need to say. I jump in, and the door closes with a cheap tin clang. Only once the ambulance rushes down the driveway and lurches up the road do I feel like I have abandoned a friend.
Mrs. Amiel is in the ambulance’s fold-down seat. Our equipment bags are piled high beside the stretcher. As we swing around a corner, the heavy red oxygen case falls on Mr. Amiel’s legs, and he does not flinch. I pull it off quickly. Mrs. Amiel does not react in any way—her face is as wooden as her husband’s legs.