by Tilda Shalof
I looked at him and he could tell he’d gone down in my estimation.
“I know it sounds strange, like you’re wondering, like, what’s the reason he went into medicine in the first place? It’s just that’s the part I find the hardest, dealing with patients. I like everything else about medicine.”
He means the science, the puzzles, the problems, and the math. The things that can be controlled, measured, understood, or fixed.
“I’m sure,” I murmured. “Listen, Mike, the young woman in liver failure – her amylase is rising.”
“I’m too tired to think of a differential diagnosis.” He put his head down on the desk.
“She could be developing pancreatitis. Do you think we should do an ultrasound? Some blood work?”
“Maybe.”
IT WAS 2300 hours and as it stood, there was enough staff for the morning, if we didn’t get any more admissions and if no one else called in sick. As I made my rounds from room to room, I kept finding strips of masking tape on the wall or countertops upon which were written messages. There was one stuck on the ice machine that read,
Bear with each other and forgive whatever grievances you may have against one another. Forgive as the Lord forgave you.
– Colossians 3:13
Who was leaving these things? Oh well, they can’t do any harm, can they?
“WHERE’S THE HOSPITAL assistant?” I asked the ward clerk, who was slumped over the phone at the nursing station, talking in hushed tones to her boyfriend. (Laura claimed she once overheard them having phone sex.) “Please call the hospital assistant. We need help to turn a four-hundred-pound patient.”
“She’s taking a nap in the lounge.” She gestured to me to wait, then cupped the phone and whispered, “Hey, Trev, I’ll call you right back.”
“The hospital assistant is sleeping? She just came on duty!”
“She had a late night last night. She’s still recovering. It was heavy, man. She told me to tell you to wake her in about an hour.”
“What do you recommend I use to accomplish that? Dynamite?”
The ward clerk giggled. “She is a pretty sound sleeper, that girl.”
“Where’s Rodney?” I asked reluctantly. Rodney, the other hospital assistant, was a frightening sight, especially at night, with his shaved head, Doc Marten boots, and the dirty, frayed red string tied around his neck. But he had strong and useful arm muscles and without them, Emily, the nurse taking care of the heavy patient, wouldn’t be able to reposition him in bed and make him comfortable.
“How ya doin’, big guy?” I heard Emily ask her patient, Mr. Binder.
He couldn’t speak because of the tube in his throat, but nodded at her words.
“We’re goin’ t’chill tonight, dude, is that okay?” she asked and smoothed back his shaggy hair and smiled at him. “Rod’s here now and we’re goin’ t’turn you and I’ll give you a nice back rub. You jiggy with that? How ’bout some tunes?” She found a heavy-metal rock station on the radio and snapped her fingers to the blast of sound.
How soothing her slangy speech and dropped-off verb endings sounded!
Her patient nodded. His eyes were wide. He must have been taken aback by the respect Emily showed him. How much kindness had this abused and violent, heroin-addicted, paranoid schizophrenic, homeless man ever been exposed to in his life?
GEORGINA, A NURSING supervisor, came by and mentioned to me in passing that the hospital had just received a bomb threat.
“Gosh, do we have to evacuate?” I asked. It would be my first Code Black!
“No, no, not to worry,” she said. “Just look out for any suspicious packages.”
I saw Morty suddenly busy with cardboard, scissors, and string.
“Georgina, I don’t have time to go around looking for bombs,” I told her. “What’s a bomb look like, anyway? Doesn’t Security take care of these things?”
She giggled. Georgina was an older woman, originally from Bombay, who had been put out to pasture years ago and had risen to the role of nursing supervisor. (We often wondered why she didn’t bother to pluck her single, dark eyebrow to demarcate the hairy furrow above her eyes into two separate arches, but that was neither here nor there.)
Morty rolled her eyes. “We’re busy taking care of patients. How do you expect us to look for a bomb?”
“I have no idea, girl!” she said with a jolly bounce of her head from side to side.
“Well, you’ve cooked your goose, Georgina,” said Morty. “If you admit you don’t know, how can you expect us to know?”
“Yes, indeed,” she echoed. “Cooked my goose. Indeed. I cook it well done!”
“Everything else okay, Georgina?” I asked.
“Thanks for reminding me, girl. There’s a family that keeps calling the hospital. Their father died in this unit and they’re missing his glasses, his teeth, and his wallet. Have you seen them around anywhere?”
“Can’t say I have. His wallet I can understand, but what do they need his glasses or teeth for? He’s dead, didn’t you say?”
“Yes, I know, hon, but they want him buried with his glasses and teeth.”
“You know what my grandmother would say about that?” Laura asked and then told us. “Shrouds don’t have pockets.”
We couldn’t find the items, but just as she was leaving, Morty called her over.
“Georgina. I found this. I think it’s for you.”
She handed her the little box she’d fashioned out of cardboard. Inside was a little piece of paper that read: “KA-BOOM!”
“Oh, you girls! So funny!”
I informed the resident about the bomb scare. “I’m not going to lose any sleep over it,” he said, peevishly, “probably because I’m not going to get any sleep in the first place.”
“Listen, we need to transfer Mrs. Melissa Derczanski.”
“Remind me again who –”
“She’s Laura’s patient. She’s the sixty-eight-year-old who needs neurosurgery, which is done only at the other branch of our hospital ‘corporation.’” I couldn’t help using the term with a tone of distaste. “She came here for vascular surgery and developed complications. Now she needs neurosurgery, which is only done over there now.”
“Someone should inform patients that they aren’t allowed to have two things wrong with them,” said Laura, listening in.
“The surgeons are ready for her, but the paramedics haven’t shown up to transfer her over there,” I explained.
Laura had a new observation. “Here’s proof that we baby boomers are aging. My sixty-three-year-old patient’s first name is Melissa. One day elderly patients will have names like Grandma Tiffany, Grandpa Jason. Listen, Mrs. Derczanski is deteriorating fast. She needs a brain surgeon.”
“I’ve spoken to the transfer team and they say it’s going to be at least another hour,” I told the two of them. “They were en route to us when they had to divert to another call – teenagers who took an overdose of Ecstasy. I’m going to call the dispatcher and tell them Mrs. Derczanski has been upgraded to urgent.”
I returned to Mr. Lilly in Nicole’s room.
“What can we do?” we asked each other with our eyes.
“It’s so sad,” said Nicole, “what we do to the elders of our society.” She shook her head. “Look how groomed his hair and nails are, how well-used his rosary is.”
I knew that hers was, too. She had placed it in his hand; into a blue vein on this hand a needle had been inserted to deliver a saline solution. I stood and watched the drops, one by one, falling like sand through an hourglass.
“I gave him just 2 milligrams of morphine because he was struggling so much against the tube. Mike is going to put in an arterial line.” She shrugged, trying not to care as much as she did. Nicole filled a basin with warm soapy water and gave her patient a sponge bath, inch by inch, keeping him covered with lots of towels. I helped her for a few minutes.
Everyone else seemed to be doing okay.
Pamela was
reading a magazine outside her room. Her sedated, unconscious patient was stable and undemanding. She had called in before her shift to request this particular patient. She said she was tired, had a migraine, was getting over the flu and PMS, too.
“That girl’s a lazy bum. She hasn’t moved off her chair all night,” Laura came over to the nursing station to tell me. “I’m going to draw a chalk outline around her patient and prove to her in the morning that she didn’t move him all night.”
“Look,” Laura cornered Mike and continued her rampage, “you better pull some strings, call David Bristol at home, do whatever you have to, but get my patient over to a neurosurgeon at the other hospital. Her neurological weakness is getting worse from hour to hour. She’s barely moving her left side. If they don’t get here within an hour, there’ll be no need to come at all. She’ll have totally stroked out by then and be paralyzed. Short of carrying her over there on my back or putting her in a taxi …”
“Okay, okay, I get the message,” said the resident.
“I’m going to call Dr. Bristol at home,” I said.
“Wow, you’re brave,” said Nicole, joining me at the nursing station to dip into the crumpled bag of sour-cream-and-onion-flavoured potato chips that we were sharing throughout the night. “He’ll tell you to figure it out yourself.”
“He should be informed about what’s going on.”
“You’re a pistol, Tilda,” said Frances, smiling at me, watching all of this from her room.
“Can you believe we raised her from a pup?” asked Laura.
“Yes, and now look at the monster we’ve created,” said Frances proudly.
“A viper,” said Laura, which was high praise, coming from her.
“CORINNE’S PATIENT IS dying.” Laura came over to tell me. It could have been Laura in charge; she knew everything that was going on. “Corinne’s fairly new, so I’ll go help her out a bit. Once her patient dies, make sure you call housekeeping right away to come and clean the room, so you’ll be ready in case you get a new admission.”
“Don’t listen to Bossy Boots,” Frances called over to me. “You do your own thing.”
“You’ve got to have the bed ready in case someone needs it,” Laura said. “They’re dying to get in here tonight!” She pointed to the single, hermetically sealed window and howled at it like a werewolf. “See, it’s a full moon.”
“I know,” I said, thinking out loud. “As it stands now, the ICU is full. We’d have to send someone out if there’s an arrest or an Emerg patient elsewhere. It will have to be Dr. Laurence because he’s the most stable. I’d better go warn Valerie to be ready.” Valerie was Dr. Laurence’s nurse.
“The Laurence family won’t be too happy about it,” warned Valerie, “especially if we move him out in the middle of the night.”
“I know, I know. I’m only telling you in case we have another admission such as an in-house arrest or an admission from the Emerg. Just so you know.”
“If Dr. Laurence does have to transfer out tonight, make sure you tell someone to catch the family quick before they come in the morning and see the empty bed and freak before we have a chance to explain.”
Her “nag list” of issues to be discussed with the resident was long tonight. She had written it on a strip of surgical tape on her table on wheels in the same embellished handwriting in which she wrote her long manuscripts, novels of mystery and romance.
Excessive adventitious sounds in all lung fields. A new finding. Temperature elevated to 37.5. Chest sounds crackly. Please check X-ray. Infiltrates noted bilaterally. Blood cultures drawn. Please order chest physiotherapy and change antibiotic for more gram-negative coverage?
No bowel movement in three days. Needs a laxative.
Patient needs subcutaneous Heparin for deep vein thrombosis prophylaxis.
There was another note, this one stuck to the door of the Greek patient with HIV.
If a man has sexual relations with another man, they have done an abominable thing and both shall be put to death.
– Leviticus 20:13
Who would post such a notice there? Surely not Suman, who was the nurse taking care of that patient. I looked around. A few of the religious nurses were on, but they wouldn’t be imposing their beliefs on others in this way, would they? Probably the work of someone on a mission to save heathen souls. Surely it couldn’t be Father Szigetti. The priest had probably been in the ICU this afternoon when Mrs. Daley died, so maybe he knew something about it. Corinne came to me and I saw she had been crying.
“This is going to go on all night,” she said. “My patient is practically dead, but the family keeps pressuring me to keep her going. They’re sitting around her bed staring at the monitor. I swear, those green lines on the screen make them keep hoping she’ll recover. Every time her blood pressure takes a dive, they tell me to go up on the inotropes, increase the oxygen, but I’m now at maximum doses of everything. They’ve got a little granddaughter in there, who keeps singing ‘Jesus Loves Me’ in Chinese. It’s breaking my heart.”
I felt for Corinne, who was caught in the middle of this situation. I felt for the patient, whom I hoped was too far gone by now to be aware of what was going on. I felt for the family; I knew their grief would soon engulf them. But that night, as the nurse in charge of the ICU, the main thing on my mind was what would I do if I needed that bed.
“I’M GOING TO put a pulmonary artery catheter in,” Mike said wearily.
“In whom?” I asked.
“Mr. Lilly. I’ve got to do it.”
“You’re not,” I said, incredulously.
“He may still be salvageable. I need to know what’s going on in the guy’s left ventricle. Was this a pure respiratory event, or is there a cardiac component, too, like congestive heart failure?”
“Can’t someone just die any more?” I asked. “I mean without an iv? I mean the natural way?”
“That’s the point,” said Mike. “We can now do things better than natural. In the old days, people used to die. Now, we can buy them more time. In the old days, dying was a painful process. Now we have ways of making it more pleasant for people. If we can do that, why shouldn’t we?”
I thought about it. “Oh,” was all I could come up with. “I always assumed natural was best.”
“But we can improve on what’s natural.”
“Listen,” I said. “Why don’t we wait and see? Maybe he’ll become conscious and then he can tell us himself if he wants all this done or not.”
“Technically speaking, informed consent isn’t required for this procedure. It’s medically indicated. We’d be negligent if we didn’t offer it.”
“Just because we can do something doesn’t mean we should.”
“It wouldn’t be right not to give him a chance.”
“How is it going to change your treatment, or is this merely an academic exercise?”
At that, he looked sheepish. “In the morning, Bristol will ask if I’ve done it and –”
“Say no more.” I put up my hand like a traffic cop to halt the flow of words.
Now when people ask me if my work makes me sad, I’ll have a new answer, I thought as I stewed over this conversation: “No, not sad. Angry.”
Corinne came to tell me that her patient had died. There was no blood pressure, no pulse, no cardiac output, no breathing. “The only problem is,” she said, “she has an internal pacemaker and it keeps on firing and I don’t know how to turn it off. The family are confused, because they see these occasional blips on the screen and they can’t compute that she’s dead.”
“Where’s Mike?” His on-call room was dark. “Wake him up, will you, Laura? Hey, do you have any idea who’s been leaving these notes all over the place?” I pulled at another strip of tape, this one on the frame around a computer screen:
Professing themselves to be wise, they became fools.
– Romans 1:22
“Some religious psycho,” Laura said with a yawn. “By the way, the par
amedics just called. They say they’re on their way to pick up my patient. I hope it’s not too late. Mike? He got called down to Emerg to see a patient. Call the Coronary ICU. Ask them if their cardiologist can come over and turn off the pacemaker,” she suggested. “Hey, you can tell him to prepare to meet thy pacemaker.”
“You have to deactivate the pacemaker,” the cardiologist said to me over the phone in a slurred, sleepy voice. “Move the magnetic doughnut ring around the anterior chest wall until you knock out the pacemaker and get a flat line.”
“What magnetic doughnut? Could you please come and do it? I’ve never done it before,” I said, glaring into the phone at him.
It’s your job. I woke you up. Admit it. You don’t want to get out of bed. That’s what’s going on here.
“I can’t come,” he said. “Someone’s arresting. Get the magnetic ring, it’s probably on the fridge door. Move it around the chest, up and then down and then all around.”
“Up, down, and move it all around,” I repeated, jiving a little to a disco beat in my head. I was giddy. The place was getting to me. I looked at my watch: 0400 hours.
The patient was dead but the pacemaker continued to make the heart beat purposelessly. After several tries, I finally found the exact location on her chest that made her heartbeats stop. Then and only then was the family convinced that she was dead. That was the signal for the wailing and keening to commence. They clasped their hands together and shook them up and down in the direction of their wizened old matriarch. She had been a midwife back in rural China, delivering all the babies of the village. She had laboured on her hands and knees in upscale Toronto homes, scrubbing floors for years as an immigrant worker who never spoke a word of English.
A grandson sobbed loudly and shoved his wire-rimmed gold glasses up to his forehead and pressed his fingers against his eyelids to stem the flow of tears. The room was full of people now, chanting in Chinese, sobbing and kneeling on the floor beside the old woman’s bed, bowing deeply. All the mourners were equal in their grief: the teenager and her uncle, the little singing toddler and the old cousin, the patient’s elderly husband and the deaf, mute nephew.
