by Vincent Lam
Laerdal bag—bag used to push air into the lungs, either via a tightly sealing face mask or an endotracheal tube.
Laryngoscope—instrument for examining the larynx, and for visualizing airway structures in order to place an endotracheal tube within the trachea.
Larynx—organ responsible for producing vocal sounds, which is also the passage conveying air from the pharynx to the lungs. Within it are the vocal cords. See pharynx.
Lumbar puncture—procedure in which cerebrospinal fluid is removed from the spinal canal using a hollow needle inserted unto the lower back.
Lumbar vertebrae—five bones of the back.
Lymphoma—a malignant tumour of lymph nodes.
Lytes—refers to electrolytes, the concentration of salts within the blood.
Mac-3—refers to a type and size of laryngoscope. See laryngoscope.
MCAT —refers to the Medical College Admissions Test.
Mitochondria—molecular structure found in every living cell that is the site of energy production for the cell.
Mitral regurgitation—failure of the mitral valve to close, allowing blood to flow backwards from the left ventricle to the left atrium. Mild cases have no symptom or consequence, but severe cases can be dangerous. See mitral valve.
Mitral valve—valve in the heart between the left atrium and left ventricle that normally allows blood to pass from the atrium to the ventricle but not backwards.
Mobitz II—a disorder of the heart’s electrical activity that is potentially dangerous and unstable.
Neuroleptic—class of medications used to treat psychosis. See psychosis.
Neuron—cell that transmits electrical impulses to carry information from one part of the body to another.
Neurotoxic—substance that is poisonous or harmful to neurons. See neuron.
Nitro—refers to nitroglycerin, a medication that promotes the dilation of blood vessels and may relieve chest pain associated with the heart.
Normal sinus—the normal rhythm of the heart.
Pacemaker—device used to produce and maintain normal heart rate in patients who have a heart block. See heart block.
PEA—refers to pulseless electrical activity, a state in which the heart has spontaneous electrical impulses but these impulses do not result in movement of the heart’s muscles or circulation of blood.
Pelvis—the lower part of the abdomen. See abdomen.
Periodic table—chart that details the earth’s primary substances.
Peripheral line—intravenous line that uses veins that are close to the skin.
Pharynx—muscular tube that acts as a passageway for food from the mouth to the esophagus, and as an air passage from the nasal cavity and mouth to the larynx.
Phosphorylation—combination of an organic molecule with a phosphate group.
Poisoning syndrome—constellation of signs and symptoms that appear in a patient as a characteristic manifestation of the patient’s exposure to a certain type of poison.
Psychosis—mental disorder in which the patient loses contact with reality.
Pupil—circular opening in the centre of the iris. The iris is the coloured portion of the eye.
Purkinje system—part of the heart’s electrical conduction system.
PVC—refers to premature ventricular contraction, meaning an isolated contraction of the ventricle without the normal regulatory impulses of the heart’s electrical system. Single PVCs are benign, but multiple PVCs may be a worrisome sign.
Quarantine—period for which a person is kept in isolation to prevent the spread of a contagious disease.
Recombinant thrombolytic—thrombolytic medication that is produced by molecular synthesis instead of by extraction from natural bacterial cultures. See thrombolytic.
Renal—meaning to do with the kidneys.
Repolarization—late phase of the sequence of electrical events in the heart.
Rhythm strip—prolonged paper strip showing the heart’s rhythm. This is typically thirty seconds to a minute long, permitting a more complete assessment of the rhythm.
Ribavirin—an antiviral medication.
SARS —refers to Severe Acute Respiratory Syndrome.
Scrub—refers to standard surgical clothing. Also known as “greens.”
Septic—state in which an infection has led to a patient’s widespread, systemic illness.
Solumedrol—steroid medication, used to reduce inflammation and sometimes used in conjunction with other medications in the treatment of severe infections.
Spinal canal—space in which the spinal cord is found.
Spinal cord—portion of the central nervous system enclosed in the vertebral column.
Stethoscope—instrument for listening to sounds within the body.
Stroke—sudden brain dysfunction caused by interruption of blood flow to the brain.
Stylet—wire placed in the lumen of a catheter to give it rigidity while it is passed into a cavity.
Subarachnoid hemorrhage—bleeding into the subarachnoid space surrounding the brain, usually secondary to a cerebral aneurysm that has burst.
Supine—lying on the back with the face upward.
Thorax—the part of the body cavity between the neck and the abdomen. See abdomen.
Thrombolytic—medication that breaks up blood clots.
Thyroid cartilage—see cricoid pressure.
Thyrotoxicosis—syndrome due to excessive amounts of thyroid hormone.
Torso—external structures of the thorax. See thorax.
Tox screen—refers to a toxicology screen, a range of tests that may analyze blood or urine samples to identify the presence of substances within the body. Typically, this is used to identify poisons or substances of abuse.
Toxicology—study of poisonous materials and their effect on living organisms.
Trachea—the air passage between the larynx and the lungs. See larynx.
Tragus—projection of cartilage in the pinna of the outer ear that extends back over the opening of the external auditory meatus. (Author’s note: Or as Chen would say, “…that little triangle of springy flesh that arcs backwards over the ear canal.”)
Transvenous pacer—pacemaker device that is inserted via a vein, necessitating access via a central line. See pacemaker.
Trop—refers to troponin, a protein that is released by cardiac muscle if it is damaged. The measurement of troponin’s presence in the blood often serves as a marker for cardiac damage.
TSH—refers to thyroid stimulating hormone, and can be used as a measure of thyroid function.
Vee-fib—refers to ventricular fibrillation, a state in which the heart’s muscles move chaotically, and not in a purposeful way. In this state, blood is not delivered to the body. Unless reversed, ventricular fibrillation is followed by death.
Vent—refers to a ventilator, equipment that maintains flow of air into and out of the lungs of a patient who is not able to breathe independently.
Vertiginous—refers to the state of vertigo, in which a person feels that his surroundings are in a state of constant movement.
Vocal cords—two folds of tissue that protrude from the sides of the larynx to form a narrow slit across the air passage. See larynx.
VSA—refers to vital signs absent, a state in which normal indications of life, such as breathing, pulse, and blood pressure, cannot be found.
ACKNOWLEDGEMENTS
I thank those who have helped me begin to learn the art of writing, especially Margaret Atwood, Maya Mavjee, Kim Moritsugu, Howard Norman, Jane Urquhart, and Michael Winter. I am especially grateful to Margaret Atwood, whose generosity, wit, and brilliant advice have been inspirational.
Many friends and fellow writers have commented upon these stories, and I am grateful to them. In particular, I thank Richard Munter and Sam Hiyate for their early feedback and support for this book. I have a deep gratitude towards my parents, my wife, and both of our families, who have always encouraged me in both medicine and literature. Thanks to
Anne McDermid, my agent, and her excellent staff.
Although this is a work of fiction, it is informed by what I have learned from becoming and being a doctor. For this reason, I am indebted to all those who have taught me medicine: senior physicians and nurses who have shared their wisdom, my fellow medical students and now colleagues, and the patients whom I have been privileged to care for.
ABOUT THE AUTHOR
Dr. Vincent Lam was born in London, Ontario. His family is from the expatriate Chinese community of Vietnam. He studied medicine in Toronto, and is an emergency physician. Dr. Lam’s non-fiction has appeared in The Globe and Mail and the National Post. His fiction has been published in Carve. Dr. Lam’s first novel, about a Chinese compulsive gambler and school headmaster in Saigon during the Vietnam War, will be published by Doubleday Canada. He lives with his wife and son in Toronto.
MORE PRAISE FOR
BLOODLETTING & MIRACULOUS CURES
“A compelling first book of fiction…. A running start at a high-voltage literary career.”
—Toronto Star
“There’s no information like inside information, and Lam puts his to good use…. [His] fiction strikes a balance between clinical and emotional detail…. In this impressive first book, by all appearances, Lam’s concern for his flawed characters and their difficult choices comes naturally.”
—The Ottawa Citizen
“If you want to know what a person must go through to become a practicing physician in a Canadian hospital, reading this riveting collection will give you a better picture than if you pored over a truckload of treatises on public health.”
—Calgary Herald
“How far does a physician’s responsibility to the patient and society extend? Lam deals with the complex issues of duty and conscience…[and] demonstrates a surgical use of wit to create realistic characters whose foibles are gradually exposed.”
—Winnipeg Free Press
Copyright © 2005 Vincent Lam
Anchor Canada edition 2006
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LIBRARY AND ARCHIVES CANADA CATALOGUING IN PUBLICATION
Lam, Vincent
Bloodletting and miraculous cures / Vincent Lam.—Anchor Canada ed.
eISBN: 978-0-307-37202-4
I. Title.
PS8623.A467B5 2006a C813'.6 C2006-903850-3
Published in Canada by
Anchor Canada, a division of
Random House of Canada Limited
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