by Steve Low
The intensive care tearoom was a featureless box, with bench seats along adjacent walls. The cushions were covered in dull green vinyl. It was upon one of these that I lay when Boatwood strode in. The professor was bristling with energy, intent on conducting a ward round. I felt more inclined to siesta, it being two-thirty in the afternoon. However knowing my place in the medical pyramid, I jumped to my feet, forcing life into aching limbs. My mouth felt as though it was stuffed with cotton wool. Boatwood peered down at me, through horn rimmed glasses.
“The watchdog of eternal life,” he said. He turned and strode out the door, coat tails flying behind.
I followed Boatwood across the shiny linoleum. Some natural light washed in from the north wall, softening the harshness of the fluorescent tubes. The large room had become known as ‘The Barn’ It had ten beds, all backed onto the north wall. A square white table abutted against the foot end of each bed. At some of the tables, nurses were bent over charts, recording data.
“How long have you been with us now?” Boatwood asked, pulling at his ragged beard.
“Three weeks.”
“You should be getting the hang of it by now.Is your study coming along?”
Without waiting for an answer, Boatwood swooped on the patient in bed one. The patient’s lungs were attached to a ventilator, via his endotracheal tube and the connecting corrugated tubing. The blue endotracheal tube hung out of his mouth like a bent cigar. The ventilator hissed every five seconds, as it pumped the lungs full of oxygen.
“Are you awake Mr Savage?” Boatwood hollered in the patient’s closest ear.
“He’s far away,” the overweight nurse volunteered in a sing-song voice.
Boatwood flashed a skeptical glance at her, his forehead screwing up. He unleashed his stethoscope from his white coat. It was the longest stethoscope tube I had ever seen. Boatwood placed the diaphragm of the scope on Mr Savage’s chest. However the sick man began to cough violently on the endotracheal tube.
“Go with the flow,” the nurse cooed, emphasizing each syllable.
“Jesus,” I laughed, drawn to hilarity by the nurse’s earnest monologue. Now it was my turn for a Boatwood stare. The professor returned to his task, listening all over the chest, his face intent. Then his head swung around, eyes flashing.
“There’s a third heart sound here Davenport - have a listen.”
I pulled out my own stethoscope. I landed the diaphragm squarely on the chest. I heard sound one, sound two, an ejection systolic murmur and a pleural rub.
“There’s a systolic murmur,” I said, my voice barely audible, even to myself.
“Yes, yes, yes . . . but what about the third sound?”
I reapplied the scope. I couldn’t hear it at all. “Oh yes there it is,” I lied.
Boatwood lurched back to the chart table. He traced trend-lines with an extended finger. “The blood pressure is falling, because the heart is in failure. And the blood oxygen saturation is falling, because the lung bases are full of water. What can we do?”
I looked at Boatwood, then away at the far wall. “Well, we can increase the oxygen concentration in the breathing circuit, to prop up the patient’s O2. And we can increase the adrenaline infusion, to improve heart function and blood pressure.”
Boatwood shook his head.
“No. The oxygen concentration he is breathing is at the maximum safe level. At higher concentrations, the oxygen becomes toxic to the lungs.” He smiled. “What can we do that will improve the lungs performance and solve our oxygen problem?”
I was silent. My mind could only think about what a pain is was being asked the questions.
Boatwood’s eyebrows arched upward. “Well come on, what about the PEEP?”
A gangly figure in a white coat came over to join us. It was Niall, the medical student. I didn’t relish the audience.
“PEEP may get more oxygen into the lungs, but the high pressure generated in the lungs by the PEEP, will flatten the blood vessels there and reduce returning blood flow to the heart. And if the PEEP is high enough, it may compress the heart itself. Therefore the heart has less volume to pump out and so the patient’s blood pressure drops.”
“That’s true, but by increasing the adrenaline infusion, we can drive the heart faster and stronger to restore the blood pressure,” Boatwood said. “Come over to the whiteboard – you too Niall.” He led the underlings at a furious pace, across to the central station. “What is PEEP anyway Niall?”
“Positive end expiratory pressure, applied to breaths given by a ventilator,” Niall intoned loudly. I stared at the student. He was as tall as Boatwood, but much thinner. His thin sallow face had no chin to speak of.
“That’s right,” Boatwood said. He flashed bold strokes across the whiteboard, with a blue marker pen. He regaled them with the benefits of higher and higher PEEP. Very high levels were called hyperPEEP. And he, Professor Boatwood from Dunedin New Zealand, was one of the leading researchers in the field.
“I’m advocating using hyperPEEP, because we intensivists are constantly hamstrung by really sick patients, who need more and more oxygen. You might ask ‘Why not give higher and higher concentrations of oxygen?’ Why not give pure oxygen even?” His eyes twinkled and his face relaxed. “Why not? I don’t think the public realises, but pure oxygen is a deadly poison! Breathe it for a few days and the lungs will become inflamed and harden up. And you may well die. So it’s not an option. But hyperPEEP gives you a chance. It expands unused segments of lung and enables you to use lower concentrations of oxygen.” He wiped his brow with the back of a sleeve. He lifted a finger and waved it in front of his audience. “And as far as I’m concerned, the sky is almost the limit. You can give a large amount of PEEP, without causing harm – apart from the blood pressure drop. But I believe I can control the blood pressure with adrenaline.” Boatwood kept at his relentless discourse. As he warmed to his point, so did his face further relax and a hint of a smile penetrated his beard.
We arrived back to the patient. “We’re increasing the PEEP,” Boatwood said to the nurse.
“But it’s already twenty,” the large nurse sang. Boatwood laughed, a long raucous holler, that temporarily silenced the barn. He lunged at the ventilator, snapping the dial around to thirty.
“One day thirty will be a conservative value,” he said, his glasses misting. “We’re doing research on pigs, right now, with PEEP levels as high as seventy.”
“Really,” the nurse cooed. “The lungs must be blown up like balloons.”
“Yes, what about barotrauma?” asked Niall, his Adam’s apple whistling up and down.
“Sure it’s a risk,” Boatwood said. “But remember, the reason for introducing the therapy, is to prevent the toxic effects of pure oxygen.” He swung around to me. “In fact Davenport, you can come and help with the pigs, if you like. Saturday morning, eight o’clock.”
Later I wandered from bed to bed, looking at patients and graphs. I took nothing in. Inside my stomach was in torsion. Boatwood’s organisation of my weekend had darkened my mood. I hated constraints, appointments, meetings. I liked to exit the working weekend with a clean slate. In the ceiling 4XO throbbed – Boz Scagg’s and Lowdown. The seventy’s sound triggered thoughts of Melanie. I wondered if she was on the afternoon shift. I sidled up to bed one, pretending to look at Mr Savage
“He’s done pretty well on all that PEEP,” Jenny McVie said. I looked at her and our eyes met.
“Yes and no,” I answered. “His oxygenation came to good, but the blood pressure has sagged, despite a truckload of adrenaline.” I turned around and leaned back against the chart table. “What time does your early shift finish?”
“Three thirty.” She flicked her hair back with a shake of the head. “Why?”
I smiled at her and walked away. I crossed to the central station. It was an elevated area, enclosed by benches. On the front bench, a large monitor showed the electrocardiographs of all the patients in the Barn. Pretending to be observing the mon
itor, I scanned the bench-tops, locating a clipboard. I brought it over, below the monitor screen. It was the nursing roster. I skimmed across the dates at the top. Tuesday the sixth of March. I ran a finger down the column. At the left margin I found her name – Melanie East. At the join of the column and row was a P. My pulse danced into my fingertips. P was for p.m. She was on the afternoon shift.
I missed her at three-thirty though, due to the untimely arrival of Nigel Green. At three-twenty-five the double doors burst open and a bed surrounded by figures dressed in theatre green came trundling in. The figures held aloft bags of blood and tinkered with syringes as they walked. The bed was backed head first into its space, like a ferry entering port. At the head of the bed, walking backwards and squeezing a ventilating bag, was Green. He beamed at me. “I’ve got a good one for you here Gerry.”
“Aha,” I said, forcing untidy hair behind an ear. I handed Green the ventilator tubing. “What’s your minute volume?”
“Nine litres. Forty percent oxygen will be O.K. No PEEP. She’s needed a little vitamin A”. Green pointed at the adrenaline syringe pump. A technician fussed about, plugging in the power cables from the syringe pumps. “Have you met Tony Drummond Gerry?” Green asked. “He’s our bypass pump and respiratory technician.” I leaned over the ventilator and shook hands, even though we had met and shaken hands a few weeks before. Drummond was showing no sign that he remembered me.
“How are you,” Drummond said.
I manufactured a smile and turned away towards Green. “What’s your flow rate?”
“Adrenaline? Five mls per hour.” Green arranged all the tubes and leads into parallel lines over the pillow case.
“So you haven’t used any hyperPEEP,” I said, grinning at Green.
“That’s a dirty word around here,” Green said frowning. “We’re trying to help the patient, not knock her off.” He looked over at Drummond, as if for support. The technician nodded, his smooth face mask-like.
“Bed one has been on thirty centimetres for a few hours,” Gerry said.
“Yes well, in my book, that’s the upper limit. I don’t believe an institution like this should be indulging in marginal therapies such as hyperPEEP. As far as I’m concerned, the therapeutic window for PEEP, is between five and thirty centimetres of water ”
“What about the rabbit studies?” I asked.
Green laughed, slapping a knee. “Come on Gerry . . . Are we operating on rabbits?” He made a wide sweep with his arm, “These are real people. Look, the methodology of those studies is open to question. The professor is way out on a limb with this one.” He looked across again to Drummond, who again tilted his head in agreement. Green swung his stethoscope across the woman’s chest, checking that the chest was inflating on both sides.
“How many bypass grafts here?” I asked
“Four. One’s a mammary, so keep the blood pressure over a hundred will you?”
With Green settled in the central station, writing notes, I walked out to the back of the unit. Single rooms, with large plate glass windows, lined the back hallway. A balding male nurse, was in the first room. I carried on to the second one. I saw Melanie there, leaning over the chart table. Her dark hair was thrown forward, revealing the curve of her neck. Her white uniform ended at knee level. A hint of lacy petticoat, hung below. I hesitated at the door – apprehensive. Sensing me there perhaps, she looked up.
“How are you,” she said. She gave me a broad smile. The sound of her voice, hit me like a punch. I lurched into the room, like a new private on his first parade. I leaned awkwardly against the back wall, making a ham fisted job of looking casual.
“Recovered from the party?” I said. She moved effortlessly around the patient, emptying the urine measure, taking blood off the arterial line, zeroing the pressure transducers.
“Not a problem. How about you?” She kneeled down to check a suction drain bottle. I followed the lines of her calves, down to her black leather shoes. She stood up and tossed her hair back. “Have you come to see me, or the patient?” she said. Our conversation meandered in this fashion, an insecure probing of the minds. Eventually the door opened and Nigel Green came in.
“How’s super-nurse?” he asked, unveiling his superlative again. I watched them interact. Melanie was tolerating Green’s verbal treacle. Later, long after Green had disappeared into the night, Melanie appeared out at the central station, where I was writing notes. She was warming her hands around a cup of coffee.
“You’ve been relieved.” I stated
“You’re really observant, aren’t you,” she said, leaning up against the counter.
“I’m trained to keep an eye out for trouble.”
“Trouble?” she laughed. “I’m not that much of a problem - I don’t think.”
“I bet you are,” I said, biting the end of my pen. I drew it out like a cigar. “I bet you take a bit of taming,”
“Taming?” You make it sound like I’m some wild animal . . . I’m just your normal emotional girl.”
I gazed at her glowing face “”I’m starting to feel emotional, right now.”
“You get on with your work boy,” she said. I watched her walk over to speak with Jenny McVie. Along the axis of my body, I felt electric, vibrant, trembling. I shifted uncomfortably on the stool.
The following day, I had much of the day free. A crisp Northerly breeze blowing up the harbour, tempted me to the shoreline. I parked up at the University Yacht Club, which in essence, was little more that a dilapidated wooden shed, and a steep concrete slipway. My car stereo pumped at full volume, as I rigged the sail. I raced through the preparations, hungry to pitch myself against the white-capping bay. My mind throbbed with the new situation. I savoured the name yet again – Melanie East. Yes it seemed perfectly agreeable. She had revealed something. No doubt about it. All that talk about emotions. That was the giveaway. She was interested alright.
I carried the sail and board to the water’s edge. I lifted the sail to the wind and stepped up onto the board. I pumped the sail into my body to generate liftand speed. As the board rose onto the plane, it accelerated abruptly. My body exalted to the wild ride. Hanging out over the thrashing sea, I screamed out with the full force of his lungs. “I want you, Melanie East. Yes. . . I need you. ”Halfway across the bay, I climbed up a wave and flew into the air. Adrenalised and crazy, I released the board in mid flight. “Yes!” I yelled, smashing head first into the green pulsing sea.
Later, working the evening shift, I struggled. I knew from the roster, that Melanie wouldn’t appear. The shift dragged, as I waited for the last cardiac patient to arrive. I stared out the windows behind the monitor stacks. Darkness insidiously overtook the landscape. Daylight saving had ended. The big windows, murmured in the evening breeze that ghosted about the upper reaches of the clinical service’s block. I watched the car lights winding up to the northern motorway. I thought of her out there, breathing, moving about. His insides slumped and seemed to drain away. My throat was contracted into a dry lump. As I watched the evening sky outside, it seemed to darken over and become night in a few short seconds. I turned away.
A day later Eleanor moved crumbed fish about the fry pan. “Isobel phoned,” she said.
“What does she want,” I asked. I was a bit surprised. Isobel hadn’t gone too much out of her way to engage us since we’d come back to Dunedin. She had been back in Dunedin herself for little more than a year. After 12 years spent in Europe she had emerged as a registered nurse, much to everyone’s surprise – especially Graham’s. Secretly he was probably quite chuffed that she was aligned to his great profession, even specializing in theatre nursing. I had been stunned. The 60’s radical following the family road. But Junot, who had also emerged from the underworld had it in perspective. Family culture was like a magnet. It was so hard to shake off the blueprint. It was hard to argue with him. After all Graham and Julia had produced two doctors and a nurse.
“We’ve been summoned over to dinner on Fri
day night.” Eleanor continued.
“OK. That should be interesting.” I said, thumped my bag down onto the kitchen table.
“Or a bit of a pain,” Eleanor said, wrinkling up her nose. She didn’t relate well to Isobel and Junot’s legacy of the street.
“Anyone else?” I asked.
“Yes, some guy Junot’s met in the real estate market. Apparently the guys wife works in the ICU with you. Melanie someone or other.”
I was almost floored by the coincidence, My heart climbing out of my chest, I left the kitchen. In the darkened living room, I could see moonlight glistening on the harbour.
“She-it” I said.
Water dripped off my elbows, onto the grey linoleum. I towelled myself languidly without any plan. The wall heater blasted the room full of hot air. I yawned at my reflection in the bathroom mirror. I knew what I needed most. I needed a drink – a strong one.
The `therapeutic window’ was the desirable place to be. It was Remington, who had borrowed the term from clinical pharmacology and reapplied it to recreational alcohol and drug use. They all knew how good it was to be there – in the ‘window’. It was more a question of how to get there. And once inside, how long could you stay there, before drifting out the bottom? Or worse, you might shoot over the top into toxicity and end up `losing it’.
I was almost entering the ‘window,’ when Eleanor and I pulled up outside Isobel’s flat. Three double gins had seen to that. I felt really good. Isobel answered the door.
“Hi there,” she sang huskily. “Short time no see.”
Isobel was by appearance still part of the hippie scene. Her head was swathed in dreadlocks. In the operating theatre, she stowed the whole intricate maize up into the standard issue cloth hat. In Dunedin that meant white with navy-blue trimmings. Her wrap around skirt looked like an advert for lazy days in Kathmandu. Here we were again, both in Dunedin. Amazing to think we’d both run away from this same city back in 1975 – not at the same time – I’d quit several months after Isobel . . . But we’d both come to good in many ways during the succeeding years. I’d ended up making a belated entry into medical school and had married Eleanor (a long and difficult pursuit). Isobel had travelled extensively and done the nursing training and reconnected with Junot. The latter had toned himself down a little since his time in Nelson many years before. He was having a go in the real estate area and on this night wore a floral shirt with white voluminous pants. His hair was only shoulder length now – not halfway down his back as it was during the aggravating Nelson visit.
“A touch of Malibu tonight,” I said to Junot provocatively. Junot laughed and pretended to cuff me around the ear. He had good insight into how the transformation from hippie to property aspirant appeared. He was good at laughing at himself and I liked that.
Melanie and her husband were waiting in the living room.
“Nice to meet you,” Rikki East said, wine glass in hand. Beside him was Melanie, in a short black skirt, a white top and a transparent lacy jacket. My eyes couldn’t help but linger on her for a moment, as the three women, Eleanor included, burst into animated conversation and sat down around a coffee table. I noticed that Isobel and Melanie seemed to know each other. The men gathered by default around a mantle piece, at the opposite end of the room, below Isobel’s Gretchen Albrecht painting. Rikki, a stout affable guy with a Mexican moustache started a discussion about property valuations. Junot nodded and frowned. I clung to the coat-tails of the conversation. I noticed Rikki looked a lot like Bernie Leadon out of the Eagles and thought about asking him if he was a musician but realized that was a ridiculous assumption. Unable to get interested in property, I stood silently, allowing my peripheral vision to take in Melanie. She stole a glance at me and smiled.
“Everyone up at the table,” Isobel announced. I noticed she was staggering a bit as she sought the kitchen. She and Junot had almost certainly had a smoke before everyone’s arrival. I managed to get myself sitting beside Melanie. I pulled off the manoeuvre adeptly, making it appear to be a random event. I felt the quickening pulse in my veins and drained a quick glass of red wine, seeking another realm to support my actions..
Eleanor gave me a haunted look. Wedged between Junot and Rikki, she was probably anticipating a double whammy of the property market.
We piled into the food, Junot launching the first dig. ‘Taking the piss’ seemed to be endemic in our generation. “So Melanie, where did you pick up that husband of yours? He’s such a shark!”
“No, no,” she laughed. “He picked up me. I would have gone for a priest or a judge – someone with some integrity.”
Laughter flowed then died away. The pointed intonation of her voice and her fragrance were simultaneously arousing for me. I checked myself mentally. I had to be careful not to alert Eleanor to my out of control mindset. When the conversation, flowed away from our corner of the table. I stole a glance at Melanie. Reassuringly she held my gaze for a second so I drifted a knee across to touch one of hers. A slow movement, it could almost have been involuntary. After a few moments, I felt her respond with pressure. Such was my alcohol intake, I was starting to lose the thread of the banter. I knew I had to slow up, or I would be doomed to passive silent observation – or worse, giving the game away
“You’re a friend of Tim Remington’s?” Rikki was speaking to me.
“We go back a bit,” I slurred. This bizarre moment lodged in my mind – to be recalled many times later - the knee pressure with the wife below the table – the conversation with the husband above the table.
“He’s pretty smart that guy, actually,” Rikki continued. “I was involved in getting them their house in Balmacewan.”
I felt the knee pressure come and go like a slow massage. The drink, the conversation, the knee pressure.. It was like a dream. I really had to focus on Rikki. I didn’t look at Melanie at all. I kept my eyes on Rikki’s face. My heart was thumping – pulsing up into my neck.
“At the bargaining phase, I couldn’t put one past him. He had his finger right on the pulse. Sure as hell he wasn’t going to meet the vendor half way”
“Yeah,” I agreed. “Smart cookie.” The conversation continued around innocuously, eventually drifting away along the table again, as Isobel chimed in. Out of the limelight, I glanced at Melanie. The eye contact was sustained. I ran a hand onto her knee, caressing the warm flesh lightly. In a few moments a hand came down upon mine. Beneath the white linen, our two hands squeezed, in silent embrace.
Homeward bound, Eleanor and I crossed a railway over-bridge and descended onto the one way system. The streets were deserted, apart from a solitary figure hurrying past the chocolate factory. Eleanor turned on the car radio, perhaps to fill the silence. The sound waxed and waned as we travelled. I wondered if she had seen something. I stared blankly out the side window. My throat had constricted again. I thought of Melanie, wrapped now in a purple overcoat. Being driven home, or driving home, legs angled into the front compartment - feet in Italian leather, adjusting the clutch - the brake, the accelerator. Ascending Pitt Street, the city lights glowing below. A scatter of raindrops flayed the window. I gazed down, through the semi-translucency. The backdrop barely registered then. But now of course it is recalled easily. In the forefront of my mind, Melanie East shimmered. Pristine – brand new – like a goddess. I felt her infiltration, seeping through my pores. I shrank before its importance.
Saturday morning came and Boatwood strode around the lab, switching on ventilators and monitors. His brow knitted, he pored over the protocol, running a finger along the lines of print. On a bench-top sat clear vials of oleic acid. The drug was a deep yellow colour. I felt drawn to look at them, aware of their destructive power.
We wrestled down the first pig. The animal staggered on its feet. The pig’s food had been medicated earlier. I anaesthetised it with gas and maintained an airway while Boatwood obtained intravenous access. The professor injected a muscle relaxant into the drip line. As the breathing dec
lined with the onset of paralysis, I was able to take over respiration with a resuscitator bag and pass a tube into the trachea. I attached the breathing circuit from the ventilator to the top of the tracheal tube. We repeated the process eleven more times, until all the pigs were asleep and on ventilators.
“You draw it up, will you,” the Professor said. His eyes were glowing like a small boy with a new train set. “It’s 0.11 mls per kilo. I’ve got the weights of the pigs here.”He handed me a clipboard.
I drew up the toxin slowly. I felt like an executioner. When I had twelve labelled syringes on the bench-top, I turned my attention back to Boatwood. The Professor continued to radiate excitement.
“Right. The baseline PaO2 measurements are between 110 and 140 mls of mercury,” he announced. He looked up from the computer screen. “That’s with an inspired oxygen of 0.28 and a tidal volume of 10 mls per kilo.” He smiled benevolently through his beard. “O.K, have you got the acid?”
Systematically we moved down the line of piglets. I injected the yellow liquid. Boatwood recorded each injection time. “Alright,” he announced. “We wait for forty-five minutes, then we apply the hyperPEEP to the study group.”
At forty-five minutes, we took more arterial blood samples before applying the PEEP. I injected the samples into a blood gas analyser on the bench top. The printer whirred continually, as it spat out the results on a thin strip of paper.
“All the forty-five minute arterial oxygen measurements, are well below the starting levels,” I said, studying the reel of paper.
“Lung injury occurs incredibly quickly after oleic acid injection,” Boatwood said. He began stalking amongst the ventilators, racking up the PEEP by turning a control wheel on the side of each ventilator. His stiff white coat, with starchy erect collars, flapped as he bustled. “The control-group have ten of PEEP, the experimental-group seventy. I’ll do the eight hour measurements and you can do the sixteen.” He ran fingers through his beard. “Make sure you calibrate the blood gas analyser, before you enter the samples.”
I did some mental arithmetic. Sixteen hours time. I would have to come down to the lab at two in the morning.
“Two o’clock,” Remington howled. He had one arm around his girlfriend Alana, the other around a parking meter. “This is the tongue hanging out at its most extreme. It’s Gerry Davenport, the new colonic hoover.”
“What could I say,” I said, wishing the chance encounter with my friends hadn’t happened. “Sorry Prof, but I’d rather sleep than get up and poison your unfortunate swine.”
“We will be sleeping,” Alana said. She reached up and touched me on a cheek.
I watched them walk on up the street. Alana was a theatre nurse and often worked with Isobel. Already she and Isobel were friends – even though Remington and Alana had only been back in Dunedin as long as myself and Eleanor. They were both a bit bohemian. Isobel was the hippy and Alana the punk. I wished Eleanor would strike up friendships that quickly. But she was crippled with reserve.
Eleanor was faced away from me when I got into bed. She grumbled a bit as I lifted the duvet, but otherwise her breathing remained regular. Relieved, I let my head relax into the pillow. It wouldn’t be long until the alarm-bell rang. Below, in the city, Saturday night rumbled. I imagined the revellers buzzing, the cafe people chatting, the movie goers transfixed. I thought how little Eleanor knew of my inner self. Physical images of Melanie reappeared. Words we had spoken together recycled – her knee against mine, her hand descending upon mine under the table cloth – that moment, a thunderbolt. The prospect of the alarm, sounding in a few hours time, became unsettling. Stomach acid burned at my throat. I thought of the piglets. Their lungs flooded with exudate – oleic acid misery and half of them, had lungs inflated to bursting point. Little hearts squeezed. Back to Melanie – the purple coat falling open – a flash of thigh - tantalising curves – pale smooth skin – dark hair fashioned, asymmetric, across one eye.
The alarm shattered the night. My heartbeat raced, then steadied. I groped for the clock, shutting it down. Eleanor grumbled. I slipped out to the kitchen. There my clothes lay, draped over an old wooden chair. Through the back door, dew glistened on the porch. In my rush to get going, I buttoned my shirt up unevenly. Ripping the shirt open, I dislodged a button. It spun across the linoleum. I fly kicked it under the refrigerator.
I drove down Pitt Street, huddled down behind the wheel. A small area of visibility appeared at the base of the fogged windscreen. I tried to enlarge it, by running the wipers. Instead my hole of transparency smeared over.“ Christ,” I ranted. I wound down the side window and drove on, head out in the breeze.
It was warm inside the pharmacology building. The corridors seemed interminable. The overhead lighting stabbed at my eyes. An odour of floor polish rose to meet me. Inside the lab, the ventilators hissed asynchronously. The air was denser now with a pungent smell of animal. The piglets lay in parallel on the floor, their flanks ballooning with each breath.
I crossed to the bench and sat down on a high stool. Before me, sat the blank screen of a desk top computer. I reached down to the floor and switched on the hard-drive. I rubbed my eyes and yawned as the screen flickered and flashed with the warm-up images. A wave of nausea washed through me, as I considered the task ahead. I stood up and traversed the floor to the first pig. A brown clipboard, rested on the ventilator top. I picked it up and began to check the baseline parameters on the ventilator. Tidal volume 100 mls, minute volume 1 litre, inspired O260 percent, airway pressure 210! The figure made my senses sharpen up rapidly. The indicator for airway pressure, was jammed on the right side of the dial. I slapped the glass cover of the dial, with the backs of splayed fingertips. Surely the airway pressure wasn’t that high – far too high.
“200 plus . . . Jesus that’s high. What the hell’s going on?” I was talking to myself. “Should be the PEEP, 70, plus the breath, say 20. That’s 90.” I checked for an obstruction of the ventilator tubing. There was none. “Surely the bastard isn’t getting all this pressure.” I ran to the work bench, wrenched open a drawer and grabbed a stethoscope. I inserted the ear-pieces as I scrambled back to the pig. I clapped the diaphragm onto the little chest. The breath sounds were muted. I percussed over the rib cage. I heard hyper-resonance everywhere. It meant the chest was over inflated with gas. I reached up and groped for a carotid pulse. None. “Christ, he’s a goner.” I shouted to the empty room. It had to be a pneumothorax. A lung had ruptured and the rupture was acting as a valve. Each breath was stacking up pressure in the confines of the thoracic cavity, crushing the heart, lungs and the great veins. I rotated the PEEP valve back to zero and ran back to the draws below the bench-top. I grabbed a large intravenous catheter. I struggled to rip the sterile wrapper away as I came back at the pig. The needle drilled into the chest wall between two ribs. Immediately, air streamed out the catheter, with a strident hiss. The deflation seemed to take an age. As the chest volume reduced, I ran fingers up onto the neck, searching for a return of the carotid pulse. There was nothing. It was too late. The pig was dead.
I looked across the line of pigs, the hyperPEEP group and the control group. I noticed for the first time, the taint of Navy blue under the pink fur as if they were all battered and bruised. I could feel the blood exit from my face and the prickling of a break-out sweat between my shoulder blades. The oleic acid was doing its thing. I felt transiently barbaric – immoral. I approached the next adjacent ventilator pressure gauge with trepidation. Again it was jammed to the hard-right. Like a zombie, I raced through the same resuscitation procedure again – again with the same result. I approached the third pig – by now a resuscitation automaton – fully alert - skin prickling. I knelt down beside the animal, poised to enter the chest. But under palpating fingers, I felt a little pulse wave thumping. I glanced at the pressure gauge on the ventilator front. Peak pressure, 102 cm H20, 32 for the breath and 70 for the PEEP. I felt a faint vibration of relief inside. No deflating catheter was required
. Pigs four and five were also survivors. Not so number six. My penetrating catheter went too far this time and a shot of blood exited through the needle and a crimson stain grew upon my stone washed denim. I withdrew a few centimetres, until the exudate changed to air. Again the heart didn’t restart.
I started on the low pressure pigs. I glanced at the pressure gauge on the ventilator front – peak pressure, only 30 centimetres of water – 20 for the breath and 10 for the PEEP. Again there was a fast thready pulse. All the control animals were sick, as expected. The oleic acid had made them that way. But they were all alive. I felt further relief inside. And with it, the seeds of realisation germinated. HyperPEEP was a killer! Gibbs and Green were right. The professor was on to a loser. His maniac idea was a death sentence. I surmised that all the control group pigs would be alive, and I was right. There was not one burst lung amongst them.
It came into my head to ring Boatwood, with the bad news. The voice that croaked on the end of the line, was uncomprehending. The receiver was dropped. The pitch of the voice rose. Ten minutes later, Boatwood crashed through the door, hair and beard dishevelled. His pyjama top poked out from under his suit jacket.
“This is a bloody disaster,” he shouted. He rushed over and surveyed the deceased swine. His stethoscope flashed from chest to chest, while his large fingers searched for nonexistent pulses. “I don’t believe it,” he said. He perused the ventilators, checking the settings. I hadn’t switched them off. They carried on, pumping gas into the lungs of the dead.
I stood over the kneeling professor. “You think it was too much PEEP?” I asked.
Boatwood looked up, his forehead corrugated and his shoulders slumped. “I’m not the only one doing this,” he said. “They’re doing it in Baltimore. They’re doing it in Utah as well – admittedly with different animal species. And they’re using 50 cm.” He covered his nose and mouth, with a hand. “The thing is, these pigs have died from a burst lung. Not from hyperPEEP compressing the heart and killing cardiac output. Three burst lungs. Maybe it’s something intrinsic to pig lungs – a susceptibility to high airway pressure.”
We stood in silence for a moment, staring at the cyanosed hides. “Switch the dead ones off will you,” Boatwood said. The ventilators alarmed as they lost power – a curious sound, rising in pitch, but falling in volume. And as the sounds died away, Boatwood rushed around to the monitoring station, looking at data – searching for something positive in his experiment. Within minutes he had found it. “Without the benefit of statistical analysis,” he announced, “the remaining hyperPEEP pigs are oxygenating better than the control group.”
I felt like saying that sure that was good but three of them were dead. Instead I asked about the blood pressure data.
“Well yes, the control group have a stronger circulation,” Boatwood said. “But that’s to be expected.”
We spent another half hour taking samples and replacing near empty IV fluid bags before Boatwood called it a night.
Chapter 4
