Blue Christmas
Page 2
The death stare.
“No, Dr. Wen!” I yelled. “Stay with me! I need to know if you have G6PD deficiency! I’m going to check your wallet!” I reached for the nearest hip pocket.
That got a reaction out of him. He started when I patted his hip. Nothing on my side, so I reached for his right pocket side, and he tried to jerk away from me.
“I want to see if you have a card with your disease or your allergies,” I said, but he tried to stand up before he sank back into his chair.
Too weak to talk. Too weak to stand. Pretty soon, he’d be too weak to sit. If he collapsed, I might have to start mouth to mouth.
Praneeta skidded back into the room with a little red and white bottle. “You want him to chew two baby aspirin?”
“Not if he has G6PD deficiency,” I called back.
She was already heading toward him, twisting the lid of the bottle. “I know you have to chew it. My uncle took some, but he swallowed it, and they made him chew two more, because it activates the platelets—”
“Not if he has G6PD deficiency!” I shouted, but she was already shaking two pills into her hand.
“NO!” I knocked her hand to the side, scattering aspirin on the floor, along with the broken wine glass.
One of Samir’s relatives screamed, and Tom tried to lead her back to the living room, talking quietly under his breath.
“Sorry,” I told Praneeta, “but he can’t have aspirin if he’s allergic. I’m trying to get his wallet.”
Dr. Wen tried to wave me away.
“The ambulance is here!” said Summer, and Mitch hollered, “I’ll let them in.”
“Samir!” a woman cried., I took my eyes off of Dr. Wen.
Samir was sweating. He started talking to her, maybe in Arabic, but he did look queasy. He wiped his head, and then he rushed to the kitchen sink. We heard him retching.
As the paramedics’ boots clattered into the house, I said, “Anyone else feel sick? We’d better get to the hospital to get checked.”
“For what?” Samir’s mother replied, in English.
I met the female paramedics’s eyes in the doorway. “For poisoning.”
I led the non-ambulance car convoy to the hospital and pushed Samir to the front of our group for triaging. Once he was settled in a cubicle, lying in a bed with Praneeta fluttering around him, I set off down the white warren of ER hallways, searching for Dr. Wen.
A nurse stopped me. She looked to be maybe in her fifties, with flowery scrubs, a badly-bleached bob, and give-me-no-guff, unblinking blue eyes.
“I’m Dr. Hope Sze. I have urgent information about Dr. Weijia Wen, the patient who was taken into resuscitation with cyanosis.”
She stared at me. Her name tag said Janus, but I wasn’t sure how to pronounce that, and using a first name doesn’t necessarily ingratiate you.
“Please. I’m not insane.” I flipped through the cards in my wallet until thank God, thank God, I found my lab card, as well as my McGill University card. “I’m a visiting resident doctor from Montreal. There were two patients from the lab who were poisoned tonight, but Dr. Wen probably has methemoglobinemia and G6PD deficiency.”
She walked to the nursing station and picked up a black phone. “One moment, please. I’m calling the charge nurse.”
Crap. Nurses are big on hierarchy. I could be stuck waiting for permission all night. If I could just get a doctor—but they’d be in short supply—
Janus hung up. “She’s not answering.”
I opened my mouth to protest. “Time is muscle,” we like to say when we see a heart attack. The stroke people have modified it to “Time is brain.” In this case, time was lung and therefore brain.
She drummed her fingers on the countertop before she made her decision. “Okay, come with me.” She said, over her shoulder, “If you’re lying to me … ”
“No, ma’am.” I followed her into the halls crammed with patients covered in white blankets. Aside from the fact that the halls were wider and more newly painted, it didn’t look much different than Montreal. Then again, holidays are deadly for colds, flus, slipping on ice and cracking a hip, and the all-time-favourite drunk suicidal patients. Fluorescent lights shone down on us, and a HAPPY HOLIDAYS banner made of red letters on gold foil only depressed me, before we reached some resuscitation rooms with glass doors.
“I’ve got the doctor here. You’ve got one minute to tell him what you’re thinking.”
The doc pulled back the curtain and stared at me quizzically. He was Asian, which I didn’t expect. Despite his hair greying at the temple, he looked no more than forty, which is young for a doctor.
“Yes?” he said.
I said, “Methemoglobinemia.”
His eyebrows drew together.
“I’m Dr. Hope Sze, and I think Dr. Wen has methemoglobinemia.”
It took him a half-second. “I agree. But who are you?”
“I’m a resident doctor from Montreal. I’m doing research here for a month, and I was the doctor at the party. The medical doctor,” I added, since the party had been almost 100 percent Ph.D.’s. “Could I come in?”
He paused for one second. “You can’t touch anything or anyone. You don’t have any hospital privileges, right?”
“Right. Although I do have the CMPA coverage from Montreal.”
“Doesn’t cover Ontario. Okay.”
I followed him. His scrubs almost trailed on the ground because he was so short. He gestured at Dr. Wen, who had a tube running down his throat and a respiratory technician adjusting the controls on his ventilator. Even with the tubes coming out of his mouth, I thought Dr. Wen still looked grey, except for the purplish lips.
“The chocolate blood was very suspicious," said the ER doctor. "He stayed cyanosed even after intubation and oxygenation. We sent off blood gases right away, and his PaO2 was normal, but his sat was in his boots. I diagnosed methemoglobinemia, and I’ve ordered methylene blue.”
“Wait! I think he has G6PD deficiency. As you know—” A little tag we add on, which means, just in case you didn’t know—“methylene blue would increase the risk of hemolysis.” That means that the body would break down more red blood cells. Dr. Wen needed more healthy red blood cells to carry oxygen, not less.
The emergency doctor raised his eyebrows, but he said, “Janus?” Apparently, it was pronounced like Janice. “Do we have his wallet?”
She magicked it up and sorted through the cards until she found one that said, in bright red letters, “G6PD deficiency.”
I breathed a sigh of relief. This case was so far above my pay grade, but now Dr. Wen should get the treatment he needed. The ER doctor started giving orders for an exchange transfusion. In a normal blood transfusion, you’re adding red blood cells, but in Dr. Wen’s case, first we had to siphon off the poisoned ones before transfusing him with normal ones.
Once he’d made the arrangements, the doctor turned to me. “I’ve never seen methemoglobinemia before tonight. I don’t know that I would have figured it out as a resident.” He stared at me with narrowed eyes. The RT and the other nurses, including Janus, watched me as well.
This wasn’t a friendly hospital. I’d have to earn my wings all over again. I said, “He and Samir were acutely cyanosed. I figured they were poisoned. I doubt Dr. Wen takes street drugs, and Samir got sick right afterward, so it was the food or drink. Samir probably doesn’t drink alcohol, narrowing it down to the food. I didn’t eat the meat, and I’m not sick. So it’s most likely the meat.”
“That caused methemoglobinemia?” The doctor and Janus exchanged a look.
“I’m sure they can check all levels in all the food, but that’s what I’d bet on. Dr. Wen ate the most, and he’s not a big guy, so it wouldn’t take much to poison him. I’d guess it was sodium nitrite or something like that.” There’s an old saying, Poison is in everything, and no thing is without poison. The dosage makes it either a poison or a remedy. Unfortunately, the smaller you are, the more toxic the dose.
When I finally made it to the family room, it was like the party had relocated to one tiny, tearful room with two beige couches and more police officers. Praneeta was crying with the mom, auntie, and grandmother. Summer was patting Praneeta’s back, but she looked relieved to see me. Mitch and Chris hovered in the doorway with Tim Horton’s coffees that no one else was drinking.
Praneeta looked up when she saw me, her lovely eyes filled with tears. “I have to talk to you.”
“Could you excuse us?” I asked Samir’s family. “It’ll only take a minute.” From the look on Praneeta’s face, we needed privacy. Somehow, Summer drew them all out of the room, and I closed both doors and even rolled the grey blinds closed.
Praneeta blurted out, “It’s all my fault.”
“Your fault?” I glanced from her to the door where Samir’s family had disappeared. “Did you help prepare the meat?”
Praneeta started crying again. “No, not really. Samir said I should relax and enjoy the party.”
Finally, it clicked in my exhausted brain: the way she’d run to get aspirin from the bathroom instead of grabbing a purse from the hallway. The ex-boyfriend hanging up mistletoe in Samir’s house. She was living with Samir, not visiting him. “You were the one who gave Samir that bag of salt.” I bounded to my feet and reached for the door. The police would want to know this.
“I would never hurt Samir!”
“Not on purpose,” I agreed, even though I didn’t know if that were true. “So why did you give him a bag of sodium nitrite and tell him it was salt?”
She lowered her head and her voice. I had to step closer to her to hear her. “I didn’t give him that bag.”
I waited for her confession while tears flowed down her cheeks. Big brown eyes. Picturesque tears. And yet, somehow she was tied to the poison.
“I didn’t have anywhere to go after I broke up with Carson. My parents were angry at me for living with him, and my sister’s husband didn’t approve, either,” she whispered. “Samir was so nice. He said he had this whole house that his parents were renting for him. I could stay for a few days. No one would know.”
It made sense to hide out from her ex-boyfriend. Given Samir’s religion, they would have to keep quiet. Not an easy mission, especially when his family descended to cook up a storm. And yet her ex had obviously figured out where she was staying. “Why did you tell your Carson where you were?”
“He was so sweet. He said he was sorry. He brought me a whole bunch of my stuff yesterday. Things I left behind. Even silly little things, like the mistletoe and some of the groceries I’d bought but hadn’t used. I guess one of those must’ve been that bag of salt. And I’ve never gotten so many plants at Christmas!”
I made a face. “Those plants are all poisonous,” I said. “Holly, ivy, mistletoe. I knew that when I brought the poinsettia, but I was surprised to see two more of them. Your ex was sending you a message.”
Her red-lipsticked mouth dropped open. It was like being mean to a brown Barbie doll.
I said, “They’re not as bad their reputation. Most adults won’t eat enough to get sick, but a child might. Or a cat or a dog. And they’re smaller, so they get poisoned more easily.”
She blinked a few times. “No, I’m sure Carson just got them for me for Christmas. He loves the holidays. He put up a Christmas tree in November, with mistletoe in our bedroom. He wouldn’t want to hurt anyone. He loves dogs!”
“What about people?”
She shook her head. “He loves me—”
“Let’s get back to that bag of ‘salt.’ You said he brought you groceries. I carried the bag in the kitchen. Wasn’t it labeled in Arabic?”
She nodded slowly. “I think it was. Arabic and English. Both. Sometimes my sister buys me groceries at ethnic stores because it’s cheaper.”
Ethnic families struck again. Or did they? “I told the police to check what was in the bag. They’re going to the house now. I bet it he put something else in that bag.”
“Like what?”
“Sodium nitrite. It’s not hard to get a hold of it. They use it to preserve meat. But you’re not supposed to soak meat in it for half a day, and I bet that’s exactly what Samir’s relatives did.”
Praneeta sniffed hard. “You’re just guessing. You don’t know that’s what Carson did. He brought me my things—”
“He brought you poisonous plants and a preservative that almost killed Dr. Wen because he’s the biggest eater with G6PD deficiency.”
“No!” Praneeta rubbed her eyes before she started to sob in earnest.
I patted her hand clumsily. I’m no good at things like tact. I should bring Summer back in here. There was only one more thing bugging me “I’m sorry to give you the bad news. I should have let the police do it. I don’t get why Carson would hang mistletoe up for you and Samir, though. I assume he’s taller than any of us—”
“Six feet.”
“Right. So he was the only one who could reach it easily before the party. Not that you couldn’t get a ladder out, of course.”
“He wasn’t putting it up for me and Samir. He put it up for me and him. When I came back from the bathroom, Carson pointed at the mistletoe and tried to kiss me. I said no. He—he didn’t force me or anything. He’s a good guy. He just yelled at me and drove away.”
Leaving poison behind him. Great guy. “You’re going to have to give all this information to the police. His full name, his address, his number, his pictures. Everything.”
“I can’t believe it.”
I could, but then I don’t believe in human nature anymore.
“One last question,” I said. “Who owns the little bonsai in the living room?”
“Oh. Samir was angry that Carson brought me so many plants. He suggested I donate them to the hospital, but I love plants. So Samir gave me the bonsai.” She blushed, lowering her eyes.
I hesitated. I shouldn’t tell her now, but I might never see her again. Although people don’t usually shoot the messenger, they do avoid her. “Not now—not until you’ve sorted everything out—but in a few days, or weeks, or months, I’d like you to check that yew tree. It has a note hidden in the soil. Or at least it did during the party. You might want to talk to Samir about that.”
Three days later, she texted me two pictures. One was a selfie of her and Samir and Dr. Wen. Dr. Wen looked a little frail, and was still in bed, but from the way he was looking at the camera, all of his brain cells were firing. He was probably sharing his Cell article with the ICU staff right now.
Praneeta was in the middle. Her smile looked forced. Maybe that’s me reading into it because her ex-boyfriend had been hauled in for questioning. She looked tiny and beautiful, of course, from her meticulous eyebrows to her red bow of a mouth, but a bit tired.
Samir beamed. He had his arm stretched around Praneeta. He’d always been a happy guy, but I’d never seen him that pleased, even when he was talking about the Banting and Best Fellowship.
The second picture Praneeta texted me was of a note darkened with dirt but still perfectly legible. It contained just three words, and maybe I do have a bit of seasonal spirit left in me, because it brought tears to my eyes: “I love yew.”
The True Story Behind "Blue Christmas"
Once upon a time, I was an innocent resident attending Grand Rounds in Montreal.
Grand Rounds is supposed to be a good opportunity for medical students, residents, and staff to learn together once a month.
Instead, it can become an academic bloodbath where everyone tries to prove who has the biggest, er, brain.
Grand Rounds usually follows a simple algorithm: the presenter, usually a resident MD doing post-graduate training, presents a case. The audience has to yell out questions to reveal clues in the history and physical exam and investigations.
The pres
enter tries to present a case that stumps the doctor audience, and the audience tries to make the diagnosis first. It's sort of like a game show where you win bragging rights instead of $100,000.
My friend Anna once presented on how to treat nuclear radiation because, no matter how much training everyone had gotten, she figured that they wouldn't be well-versed on nuclear warfare or accidents.
She was right. Her presentation was greeted mostly with silence, which was better than derision.
Side note on the medical hierarchy: emergency medicine residents doing a third year of fellowship are considered "lower" than the five year ER residents, so I kept my mouth shut during most rounds. I did my part presenting and analyzing cases at journal club, but mostly, I listened.
If you looked past the posturing, you could learn a lot. Not all of it was especially useful to me. The Australian doctor showed so many slides of poisonous sea creatures native to his country that my brain summed it up as, "In Australia, there are many beautiful things that will kill you. Wash most stings and bites with salt water, but the blue-ringed octopus will paralyze you."
Although the nuclear radiation and octopuses were eye-catching, this was the case that caught my eye:
Paramedics are called to an apartment because five adults (three men, two women) of Middle Eastern descent feel light-headed and dizzy. Two of the men are vomiting. The younger woman is unconscious. Their skin is cyanosed, or turning blue. All of this started after dinner.
A third man, who didn't eat anything, feels fine.
At the hospital, all five patients are visibly cyanosed. Their oxygen saturations range from 72 to 96 percent instead of the usual 92 percent and up.
When lab comes to draw their blood, it looks black.
The five patients receive methylene blue after the staff talks to the poison control centre and presumptively diagnose methemoglobinemia.
Within 15 minutes, their cyanosis resolves, their oxygen levels come up, and the three affected men feel better. Both women need ventilation, one for two days and one for four days, but all five of them recover completely.