by Vincent Lam
Beeeep.
36.6. Afebrile. No fever.
Dolores sat on the toilet, drank a glass of water. The cough seemed to be gone. She took her temperature again, and wrote it down on a scrap of paper from her purse. And again, shoes still dripping onto the bathroom mat. Wrote down the second temperature. Did it five times, all of the temperatures perfectly normal. The cough was gone. She averaged the five temperatures. The average was 36.5. Normal.
The phone rang. It was the nurse in charge of the SARS unit. Dolores had been seen ducking out of the line.
“No, no,” she said, “not a fever. Just dizziness. I get this sometimes, these horrible episodes of dizziness. Usually lasts a few days.
“No, not a fever.
“No, don’t send public health, no, it would be a waste.
“Definitely not.
“I checked five times.
“Yes.
“Yes.
“I know exactly what it is, so book me off the schedule for at least three days.”
(Transcript of an evening news clip of April 3, 2003—reproduced with permission of CBC Television)
Today, an unusual occurrence at the Toronto South General Hospital SARS Unit: This morning, alarms indicated a breach in the SARS respiratory isolation rooms. What is known as a Code Orange alert was activated, placing the facility in Disaster Response mode. After several minutes, the Code Orange was deactivated. Hospital officials assure us that there was no external breach, and that no unprotected hospital staff were placed at risk. Initially, hospital officials refused to explain the incident, but with speculation heightening throughout the day, a statement has been released. It seems that a SARS patient, Dr. Fitzgerald, became unable to breathe and collapsed within an isolation room. As the SARS medical team donned their protective gear in order to enter the room and administer treatment to Dr. Fitzgerald, the SARS patient in the room adjacent to his, Dr. Chen, broke through the glass partition between their rooms with an intravenous pole, in order to initiate emergency treatment for Dr. Fitzgerald. The Code Orange alarm was activated by this glass being broken but, once again, hospital officials insist that no unprotected staff were exposed. Dr. Fitzgerald is reported to be in critical condition. Dr. Chen is reported to have cut his arm on broken glass, but is otherwise stable. The hospital declined to comment on their assessment of Dr. Chen’s actions, which they described as being “outside standard protocol.” Dr. Chen was reached briefly by phone, and stated, “In a critical situation, it takes too long to put on the SARS gear, and people die in the delay, but I’ve already got SARS, so I don’t need the protection.”
Extreme measures at urgent times.
Meanwhile, on the world front, the number of cases has exceeded two thousand. Chinese authorities have announced three hundred and sixty-one new SARS cases and nine new deaths. In Hong Kong, there is strong evidence that the disease has spread beyond its initial focus within hospitals, with secondary and tertiary cases almost certainly occurring in the community at large.
BEFORE LIGHT
21:00—Eighth-floor apartment balcony, south of Queen and Spadina
The sun has left the city. The day collapses into a violet glow—this new purple sky which is the warm birth of night. I look down into the bright windows of houses, at two shadows of boys under a street light, and over the convulsive writhing of a tree’s body in the wind. I resent night, the long awakening darkness that will be flickered by red, yellow, and green at inter sections, slashed open by arcing headlights, this void gasping for breath, and punctured by the sudden smash of fist into shouting mouth. I see an ambulance hurtle straight up Spadina Avenue, like a bullet shot into darkness.
21:25—Bedroom of apartment
I’m in bed. I tell myself not to look, not to check the time. Not knowing makes me anxious, so I open my eyes again, glimpse the glowing orange numbers: 21:26. I flip from my right side to my left side. Breathe slowly, I think. I’ve been lying here for seventeen minutes: nine minutes on my left, then eight on my right. I feel sad and cheated. I resent my overnight shift in the emergency department, which starts at 23:30. I can never sleep before this late shift, and I always feel desperately certain that if only I could nap, if only I could drift off for a few minutes, it would be much better. I turn onto my right side. The door’s edges are rectangles of light. I swing my anxious legs out of bed. I sit. I stand and open the door. Ming is reading, and the living room lights shine brightly.
“Hi,” I say.
“What’s wrong?”
“Can’t sleep.”
“Try to rest. Resting is good.”
“I hate my job, Ming. I despise it. I have to get out of this. I can’t do this forever.” I stand in the doorway in my T-shirt and underwear.
Ming doesn’t look up. “You hate everything before your night shift. In general, you sort of like your job.”
“Right now, I hate it.” I am aware of the whiteness of my naked legs.
“Fine. Hate it. Feel better?”
“A little.”
She looks up. “You should lie down.”
“Can you come and snuggle?”
“Sure.”
I turn on the air filter for its white hiss. Ming takes off her pants and we lie down. I tell myself to pretend that we’re going to bed for the night, that we will be safe until morning. If I could just believe this. Then, with my wife’s warm back pressed against my belly, I would sleep. It is urgent that I sleep. I am panicked that I should sleep. The fact that I have to work through the night makes it absolutely crucial that my consciousness fade, that drool begin to fall from the corner of my mouth onto the pillow, that I dream in that liquid way which permits all possibilities. Sleep, dream, I think. But this imperative makes me more and more aware that I am not asleep, which makes me force my breathing to become long and drawn out, and then I feel breathless.
In medical school, they once brought a relaxation specialist to our class. She guided a hundred and seventy-seven students, all sitting in the tall and echo-filled lecture hall, through an exercise. We visualized looseness spreading from our toes, to our ankles, to our knees, to our bellies, as tension flowed out of our skin. Some people put their heads on their desks, pens fell from their hands, and they snored. I couldn’t get past my ankles. My toes felt too big to relax. My feet ached. I couldn’t make my ankles go limp. I asked myself whether the stronger minds were those who were able to allow the relaxation to take them over, to submit to the slackness of their bodies, or those like myself whose knees and necks continued to fidget and fight. Then I became irritated with myself—why did it matter who had the stronger mind?
Ming coughs, and shifts. She is lying still for my benefit, but it’s not quite the same because typically she falls asleep first. That’s how it works. Usually, I become aware of her breathing passing into the involuntary wind of a sleeping body, and this is a trigger for me. This is the thing that must happen before I can let go, before I begin to forget my waking self. Ming coughs a second time.
She says, “I forgot. I have to make a phone call.”
“Can you snuggle a bit longer?”
“It’ll be too late to call.” She touches my thigh. “Sorry, you want me to come back after I’m done?”
“It’s okay,” I say. I turn so that our curved backs touch each other, and she climbs over me to get out of bed.
“Relax,” she says. “You need it.”
22:50—Kitchen
“Have you had enough?” asks Ming.
I have just eaten two big bowls of the leftover stir-fried shrimp on white rice from dinner. I ate them with a gluttonous determination that I feed myself, that I need it, that at least my night should be fuelled.
“I guess,” I say. Already, I feel the beginning of nausea. My night shifts are underlined by a persistent, hanging, sick feeling.
The bottom cup of a pot of tea sits before me. The tea bags steeped while I drank three successively stronger cups, each with two heaping spoons of sugar.
<
br /> 23:20—Lakeshore Boulevard
My shift starts in ten minutes. I’m the second car at the light, stopped right before the Gardiner on-ramp. The first car is a gleaming, bright-white F150 crew cab. Who drives a pickup truck in the city? Small man, big car. Custom chrome bumper. Loser.
The light’s green, buddy. Fuck, get a move on!
The light’s green, after all.
Braaaaaaaap.
I thumb the horn long and excessively as I pull out, floor it in second, and blow past the F150. He’s talking on the phone, giving me the finger, stomping on the gas now, and trying to cut me off as I duck in front of him in the final metres before the ramp and gun it onto the Gardiner eastbound.
Sucker, I think. I feel justified in driving this way. I sometimes see people driving recklessly and I wonder whether they really have such a worthwhile place to be. What makes them feel so important? Don’t they realize how terrible car accidents happen? But right now, just at this moment, I have somewhere important to go. I am a linchpin of the city’s emergency safety net. I am a night-shift martyr, and if Mr. F150 doesn’t notice the green light, he should be dusted off with a vigorous horning.
Coming off the ramp, I’m in third. I zing the tach past five thousand before shifting up, gunning the engine of my silver Benz. I have a mild sense that I should be embarrassed, that I’m a doctor driving a cliché. The F150 is trying to keep up. No way, man. I once thought I would defy stereotype, that I would always ride transit. At some point I realized that Mercedes are such nice cars. It’s about the quality, I tell myself and anyone who sees the car. And you would be surprised how little I paid for it. It’s an excellent used-car value. It is a shiny CLK 430. Sporty. I can’t deny that. I should be embarrassed, but really I’m not. You see, just below the silver paint is a layer of feigned sheepishness, which masks a sense of justification, because really I feel like this car is my due. Shouldn’t I have a kick-ass car? Don’t I deserve it?
I hit one-thirty in fourth, pass a taxi on the right, shift up, move back into the left lane. Mr. Pickup Truck is trying to follow. His heavy chrome lurches to the side as he changes lanes. Laughable! I want the cops to stop us. They will pull us over and I will show them my Dr. Chen badge. We will recognize each other; they bring people in to me all night long. I will shrug and say, You know how it is, officers. Hospital—the emergency department. They need me. The cop will wave me on, saying, Night, doctor, and I will zoom away. They will bust the pickup truck instead. I see the custom bumper flash in my side mirror. I pull ahead and cut him off.
I’ve never been pulled over before. The pickup truck now darts three lanes to the right, passes a panel van, and surges forward. I tap the accelerator, amazed at how quietly this car does one-sixty. Do they take you to jail for speeding? Now, I slow down. I’m suddenly concerned that I may not have the man-to-man, doctor-to-cop macho charisma required to get off a speeding ticket. I slow to just a little over the posted limit, see the F150 approach from behind, pass too close, and sweep in front of me.
Go on, little man. I’m above this sort of thing. He pulls away.
23:35—Toronto South General, emergency loading entrance
Six ambulances, two coppers. The ambulances are angle parked outside, backed into the spaces. The police cars have their noses forward and engines running. It is festive, frenetic, a late-night party. Inside, the fluorescent lights cry out, scream brightly, and the waiting room bubbles with faces. The full daytime lighting gives an out-of-earthly-time feeling, like in a convenience store before dawn. Eyes and hands and shouting at this masquerade ball. Stretchers in the hallway with ambulance crews. Five, I count. Sixth must be in the resuscitation bay.
The charge nurse says, “Twenty-two in the waiting room, six hours behind. Got your runners on, Dr. Chen?”
A man in a purple windbreaker asks, “Are you a doctor? You the doctor?”
“They keep telling me that,” I reply.
23:40—Room 8. Mrs. Withrow: eighty-two years old with dizziness
“Hello, Mrs. Withrow, I’m Dr. Chen.”
“Thank you so much.”
“Pleased to meet you. Don’t thank me yet.” I pull up a chair. “I understand you’ve been dizzy.” I was taught that sitting creates the perception of time. I cross my legs and maintain good posture.
“Extremely, terribly dizzy.”
“How long has that been?”
“Oh, a while.”
“A while.” I nod. “How long is a while?”
“It’s been bad for quite a while. Also, my foot is sore.”
“Quite a while.” I nod again. “All right. Would you say that a while is like a day, or a week, or like a month, or for instance a year? Give me a rough idea.”
Mrs. Withrow ponders this, she gazes up, looks at me with confidence and says, “Let’s just say a while.” She presses her lips with finality. “What is your diagnosis, doctor?”
“Let me ask you this, Mrs. Withrow: When did you start thinking of coming to hospital?”
“I’ve been thinking about the hospital for a long time. But just recently I decided to call an ambulance.”
“How long ago is recently?”
“What do you mean by that?”
“Recently,” I say. “When you say ‘recently,’ do you mean just this afternoon, or today, or a few days, or a week?”
“I didn’t catch the question, doctor. I’m sorry. My hearing aid’s at home. Could you speak up?”
I drop my voice into a theatrical baritone. “Mrs. Withrow. Are you dizzy right now?”
“You don’t have to shout. I’m not deaf, just hard of hearing.”
I stop. Open my mouth. Close it. “Right now, are you dizzy?”
“Well, no, not at all. I feel better already. Thank you.”
“That’s wonderful,” I say in my deepest, operatic boom. “I’m so pleased to hear that you feel better.”
The overhead speakers: “Doctor to resusc now. Doctor to resusc now.”
I stand up. “Excuse me.”
23:46—Resuscitation bay 1. Mr. Santorini: forty-eight years old with chest pain
He breathes hard, looks scared.
Jill hands me an electrocardiogram. I read the twelve punctuated, jagged lines on the grid paper in the way that my ancient predecessors peered into tea leaves, or gazed at bones thrown in the sand. The electrocardiogram tells fortunes, is a sudden lightning-strike omen.
I say, “Mr. Santorini, I have some bad news and some good news.”
“What’s the good news?” he gasps. He is sweating, melting into the stretcher.
“I’ll tell you the bad news first.”
“Doctor, it’s a thing I have: good news first.” He wipes the sheet at his forehead.
“The good news is that we have a treatment for your problem.”
“What problem?”
“That’s the bad news. You’re having a heart attack.”
“I disagree,” he says. “That can’t be.”
I say to Jill, “Two IVs, he’s had aspirin? Great. Nitro point four q five times three, chest X-ray, trop, coags.”
“He’s got no veins,” says Jill.
Mr. Santorini is a big man. Not huge, but big in the pudgy-fleshed way that makes it difficult to get intravenous lines into veins.
Jill says, “Lenny! Lenny, come here, you try his other arm.”
Lenny draws the curtain open. “What?”
Jill says, “He’s infarcting. I can’t get an IV. Try the other side.”
Lenny says, “Oh.” Then he disappears.
Mr. Santorini says, “It’s not a heart attack. It’s something else. I rollerblade like a fiend—you should see me. An hour a day, like a maniac. I’m an exercise addict,I can’t be having a heart attack.” A bead of sweat is suspended at his chin.
“Exercise is great, Mr. Santorini.” I have the clot box out. I draw up sterile water to mix the thrombolytic. “Jackrabbit Johansen, you know him? Legendary skier. Phenomenally fit. Died of a
heart attack. Listen, I have to tell you about something. We have what’s called thrombolytic, a great treatment for your problem. It’s a clot-busting drug. A heart attack occurs when a clot is stuck in your coronary artery, and this medication opens that up, could save your life. There’s a little risk with it. Just a very small danger, but we have to inform you of it. A very small, tiny number of people who get this drug have a stroke.”
“Wait a minute? Stroke? What are you saying? Can you die from stroke?”
“That’s possible, but unlikely. Rare rare rare.”
“I can’t be having a heart attack. You should see me on blades. Flash, they call me. Listen, I need a phone. I need to make a phone call.”
“The thing about this treatment is that we have to give it as soon as possible.”
Jill yells out, “Lenny! Where is Lenny? These damn agency nurses, why can’t this hospital staff the place properly? You know, Dr. Chen, this place is so screwed up.”
I stand out of Mr. Santorini’s field of vision and hold a finger to my lips at Jill. She giggles. This seems very funny to her.
I say to Mr. Santorini, “We have a motto: time is muscle. Time’s ticking, and it’s your heart muscle. So you see, I really want to give you this treatment, as long as you accept this incredibly small risk of stroke.” I inject water into the vial of powdered thrombolytic.
Jill has got the needle into a vein. I see flashback: blood in the barrel. The metal has bitten the vein and we’re on our way. Jill says to me, “All day it’s been just myself and this unbelievable agency nurse, this Lenny character. Am I supposed to do everything? It gets to the point that people will die, and there’s nothing I can do about it.” Mr. Santorini’s arm jumps as she begins to feed the cannula and the needle jolts. Jill keeps it in the arm with her thumb, says, “Sir, don’t move.”
I say, “It’s very important we get the IV into you.”