by Ross Pennie
“What about the Official Secrets Act?”
“It was all a long time ago. I’m allowed to talk now.”
“Do you think you’ve ruffled some feathers?”
“Earl Crabtree — he’s one of our mates and a long-time Party insider — forwarded two of my stories to a friend in the Ottawa Press Club, across from Parliament Hill. The word is, the reporters think the current Prime Minister might not see the humour in my behind-the-scenes anecdotes of his predecessors. Afraid I might diminish the Party’s carefully crafted image.”
Hamish had no interest in government or politics and couldn’t see any plausible link between memoirs and epidemic diarrhea.
Betty pulled at her quilt with her knobbly fingers and winced slightly. “I don’t type as fast as I used to. It makes my arthritis play up. Thank heavens for those Xanucox pills.”
“They help, do they?”
“On a good day, they work wonders. Raimunda used to share hers with me. I gather they’re rather expensive. Vik provided them to her for free. You know, because she was Gloria’s mother.” She dipped her gaze, as if embarrassed at speaking out of turn about the recently deceased. “All in the family, if I can put it that way.”
Camelot’s residents, and so many others like them, would be on dozens of medications in a variety of eye-catching shapes and colours. Hamish could see how trading them could become an intramural sport.
Betty’s face crumpled as tears welled in her eyes. “Poor Raimunda died on Tuesday. Such a shock. She was the strongest person here. She kept getting gurgly tummy, before and after she spent that week in the hospital. But I must say, neither her arthritis nor her tummy ever stopped her from helping Gloria with the cleaning.”
Hamish handed Betty the box of tissues from the bedside table and watched as she dabbed her cheeks. “Don’t worry, now, Betty. It’s not Xanucox that upset your tummy or gave you the fever. The drug company is making a fortune out of the fact that Xanucox is easy on the stomach.” Finally, an arthritis medicine that didn’t induce ulcers or intestinal bleeding. And didn’t cause strokes and coronary syndromes like its competitors. “But I need to remind you, it’s not a good idea to share your tablets. You never know what that could lead to. If you think you need Xanucox, you should ask Dr. Jamieson about it.”
He pulled off his gloves and asked her to drink plenty of fluids and stop the antibiotic that Dr. Jamieson had prescribed. It obviously wasn’t working. He promised to check on her again soon and told himself that if she got any worse he’d send her for X-rays of her abdomen. He scanned the room for a bottle of alcohol hand sanitizer but couldn’t find one. He hated washing his hands in a patient’s bathroom. The inevitable clutter of pills and tubes and bottles around the sink gave the maneuvre an unsavoury ick factor. He had no other choice, so he carefully soaped and rinsed his hands, turned off Betty’s taps with his elbows, and shook the water from his fingers. He couldn’t bring himself to touch her frilly towels.
At the doorway, still shaking the water off his hands, something stopped him. A faint, unpleasant smell, rising above the scent of Betty’s lavender soap. He closed his eyes and sniffed. Yes, there it was. Unmistakable. The textbooks said it smelled like a horse barn, but he’d have to trust them on that. It wasn’t the normal odour of urine or feces you’d expect in a healthy person’s bathroom, it was the odour of para-cresol. And it gave him Betty’s diagnosis on the spot.
He returned to her bedside and kept his hands in his pockets.
“You found good news in my bathroom, Dr. Wakefield?” She hadn’t missed the smile of success on his face.
“Absolutely. Tell me, have you noticed anything unusual about the odour of your stools?”
“Really, doctor,” she replied with a teasing grin, “what a thing to ask a lady. Even the Queen doesn’t pass lavender-scented motions.”
“But I mean, do your stools smell any different with this illness than they did the other times you had gastro?”
“Well,” she said, glancing at the floral-scented deodorizer on her night table. “It’s not the sort of thing one brings up in polite company, but I did notice an unusual odour for the first time this morning. Brought me back to my childhood, my uncle’s farm. In Manitoba.”
“Horses?”
“That’s right. How ever did you know?”
“And you’re sure you haven’t smelled that odour here at Camelot before?”
“Certainly not. Goodness, Dr. Wakefield, what are you getting at?”
“I have good news for you. Well, good news in the sense I know what’s wrong and how to fix it.”
“Don’t keep me in suspense, Doctor. What is it?”
“Clostridium difficile. C diff for short. That distinctive horse-manure odour proves it.”
She paused, as if trying to remember something. When it came, her eyes burned with understanding. “It’s my antibiotic, isn’t it? Just like in the papers. All those old people dying in hospital. They came down with C diff diarrhea after being plied with antibiotics.”
“In your case, though, we’ve caught it early. You have a private drug plan, don’t you?”
Vancomycin was very expensive — forty dollars a day, and the minimum duration of therapy was two weeks. Metronidazole, much cheaper at just twenty cents a day, was the government’s preferred C diff drug. Trouble was, it often failed, and mild cases turned lethal. Vancomycin rarely failed if started early, but the provincial government’s universal drug plan for seniors covered it only if C diff had taken the patient to death’s door and back three times in the previous six months. It was a crazy false economy cooked up by heartless bureaucrats in a fancy office somewhere in Toronto.
“Oh yes,” Betty said, “the federal government generously rewards its faithful servants when it puts them out to pasture.”
“Good. We’ll go straight to the best drug. Four capsules a day and you should be well on the mend by Sunday. Though I’ve got to warn you — you’re still going to feel pretty rocky tomorrow.” He hoped he wasn’t being overly optimistic about how she’d feel on Sunday. “Be sure you keep up with your fluids, and I’ll check on you tomorrow.”
He passed her bathroom door, his hands still firmly in his pockets. The smell of para-cresol hit him again, this time with an alarming uneasiness. C diff in the elderly could be viciously unpredictable. The patient might not look too bad today, but tomorrow their large bowel could ignite into a lethal explosion of toxic megacolon — like those folks Betty had been reading about.
CHAPTER 9
It was almost nine on Friday night by the time Zol got Max home from indoor soccer after dropping Travis off at his house. As usual, Travis slipped away without a word, and no one greeted him at his front door. He was an unusual kid. A large, purple birthmark covered the right half of his face, and he lurched to the left when he walked. He never said a word to any adult, certainly not to Zol, and according to Max, not to his coaches or his teachers either. When Travis wanted something, he whispered in Max’s ear and relied on Max to provide a simultaneous translation. The poor kid stumbled awkwardly on the soccer pitch, usually right in front of the goalie. Still, he seemed to love the game.
The two boys had been drawn together since kindergarten, each with a physical distinction that set them apart: Max with his spastic left arm, Travis with his birthmark. Neither considered himself sick or handicapped, but Zol had always sensed the bond of the other between them. Calling the dark purple nevus on Travis’s face the map of Norway was Max’s way of describing it in complimentary terms, especially since Travis claimed his mother was descended from the Vikings. There didn’t seem to be a father in the picture. As far as Zol knew, there was nothing wrong with Travis’s intellect. The boy was a great gamer and had pulled his weight when he and Max did a project together on the Inuit.
Max was so tired he barely balked when Zol scrubbed the post-game orange drink from his face and handed him his pyjamas. He fell asleep on the second page of tonight’s installment of Lem
ony Snicket, just as Colleen pulled into the driveway. Zol eased off Max’s bed and turned off the light. After soccer, Max was always down for the count.
Zol rustled up a corned beef sandwich and a green salad for Colleen while she put her feet up in the sunroom. He never touched canned meat himself, but kept a couple of tins of Fray Bentos on hand for her. She called it bully beef and said it reminded her of happy picnics with her family in the Drakensberg Mountains, on holidays from Cape Town. Zol handed her the sandwich and poured two fingers of Lagavulin for himself. He loved how her eyes crinkled when she smiled, and the girlish way she swept her braided ponytail off her shoulder as she snuggled beside him on the loveseat. With the lights turned down, her hair glowed more copper than gold. But she looked tired. Watching Gus must have kept her up most of last night.
“How’s Betty?” Colleen asked.
“Not so good. Hamish went to see her today. Says she’s got C diff from the antibiotic the Lodge’s family doctor prescribed a couple of days ago.”
“Is she going to be okay?”
“You know Hamish. Without ever saying it exactly, he lets you know he’s prepared for the worst.” In the bloodless tone Hamish used whenever he was concentrating or anxious, he told Zol that only time would tell how things would turn out. Either Betty would get better soon, or she’d go fast. That’s the way C diff worked in the elderly.
Zol took a swig of the neat Scotch and swallowed hard. He closed his eyes and let the fiery wave of peat and iodine bathe his throat.
“Tell me about Gus,” he said, after another scorching swallow. “You didn’t say much in your phone message.”
“To be honest, after he stayed home last evening and the entire night, I wasn’t hopeful when I started out this morning. I knew he wouldn’t be Dumpster diving in broad daylight.”
“But?”
“Today he took me on a fascinating tour of the city. For three hours. First we went to Ancaster, for a stop at that coffee pub on Wilson Street — the place with the drive-through the neighbours made the fuss about.”
“Delia’s Donuts?”
“That’s it. He picked up a box there. Doughnuts, I’d guess.” She paused for a bite of salad. “And then he took the 403 down the Escarpment, got off at the Main East exit, and stopped at the Convention Centre and the Royal Hamilton Hotel. Then two more stops. The HamNorth Mission on Ferguson Street. And a nondescript house on Sanford Street North. The place has seen far better days.”
First the trendy heights of Ancaster, then the true grit of downtown Hamilton. Life could get pretty rough in Hamilton’s north end. What was the manager of an exclusive home for wealthy seniors doing at a homeless shelter and a place that sounded like a halfway house?
“Any idea what he was doing?” Colleen asked.
Zol sipped his Scotch and shook his head.
“Playing Robin Hood,” she said.
“What?”
“Taking from the rich and giving to the poor.”
“I don’t get it.”
“He collected food at the first three stops and dropped it off at the last two.”
“He hauled it out of Dumpsters?”
“No, no. They gave it to him.”
“Gave it to him? Just like that? What sort of food?”
“I didn’t dare blow my cover by getting too close. But I managed a few pictures with my telephoto.” She opened the bag at her feet and lifted out a camera. Not a point-and-shoot, but a hefty single-lens reflex. She pressed a few buttons and showed him the image on the screen.
“That’s Gus, all right,” Zol said. He was standing at the rear of his blue Dodge van and holding a large tray. “What’s he carrying? Are those sandwiches?”
“It’s hard to see on the screen, but yes, I’d say a gourmet assortment. This is taken at the service entrance to the Hamilton Convention Centre. He carried out seven similar trays — five of sandwiches and two of fresh fruit — and loaded them into his van.”
Colleen pressed a button and up came another photo. This showed Gus Oliveira from a distance, carrying a large cardboard box toward the same van parked in a lane beside a large building. Zol recognized the striped green awnings of the Royal Hamilton Hotel. Colleen pressed the button again to show a closer view of the box. The photo angle didn’t give a view inside, but the box was full, and silvery objects were projecting through the open top.
“It was a big box, and Gus was puffing quite heavily as he carried it. Looked like it was full of odd-shaped packages wrapped in aluminium foil.”
“What did he do with this stuff?”
“He dropped the trays from the convention centre, and one of the boxes from the Royal Hamilton, at the HamNorth Mission. There were too many people milling around the sidewalks for me to take pictures. They were waiting for the place to open for lunch.”
She pressed the button again. The next shot showed Oliveira on the front porch of a typical north Hamilton house. Battered wooden steps led to a cluttered porch; the roof sagged heavily to one side. Gus had two boxes in his arms. Zol could just make out a female face peering through the partly open door.
“She doesn’t look too pleased to see him.”
“I think it’s a women’s shelter. See the stroller and the tricycle in the corner? They don’t have those in halfway houses for cons.”
“What about the box from Delia’s Donuts?”
She fiddled with the camera then showed him the screen. The shot caught Gus at Camelot’s kitchen door. He had a large smile on his face and was carrying a colourful flat box and a large, foil-wrapped package. There was no mistaking the pink and green logo of Delia’s Donuts, nor the packet from the Royal Hamilton Hotel.
“What’s all this about?” Zol asked. “Doesn’t sound like Gus is a freegan.” He’d looked up freegans on the Internet, after Hamish had mentioned them for the second time. “They don’t take handouts. They’d rather dig their food out of Dumpsters when no one is looking. Late at night, I imagine.”
“I’ve got my hunches, and I’m going to keep following him. But first, you’ve got to let me finish my supper.” She paused, her fork poised over her salad, then laughed. “Am I wise to trust the proven-ance of all the ingredients?”
CHAPTER 10
Hamish tiptoed into Betty’s room on Saturday morning and opened the curtains a crack. Art said she’d fallen asleep barely five minutes ago after a restless night. Phyllis had sat up with her until dawn, helped her to the bathroom so many times she couldn’t count. The air reeked of the para-cresol from Betty’s C diff–infected stools. Her lips were dry, her eyes sunken, her pale face dissolving into the pillows.
Hamish lifted her bony hand and felt her pulse. The beat was feeble, her heart rate far too fast. Her vital body fluids, lost in all those liquid stools, hadn’t been replaced. Too weak to drink, she was withering like the desiccated geraniums forgotten on her windowsill.
She needed IV fluids as soon as possible, before she slipped into shock and her kidneys shut down.
He called Reception and told the woman to page Gloria, tell her he needed to meet her in the Mountain Wing in five minutes. Art had said there’d been a death on that wing overnight. That meant at least one empty bed over there for Betty. He’d get some IV fluids into her immediately, then see about transferring her to a hospital bed at Caledonian University Medical Centre.
Fifteen minutes later, Gloria strode into the Mountain Wing. Dark circles ringed her eyes, and her hair hung limp about her face. Her blouse looked like she’d hauled it straight from the washer. According to Art Greenwood, Phyllis had heard the Oliveiras arguing about Gloria’s mother’s funeral arrangements, something about charter flights from Lisbon. The body was on hold in the funeral home pending the arrival of relatives from Portugal. It seemed Gus wanted to follow tradition and see his mother-in-law buried immediately, but Gloria insisted on waiting for her family to arrive. The strain of the delay was obvious on her face.
“I know you’ve got your hands full, Mrs. O
liveira,” Hamish said, pointing to the charts scattered on the counter, “which makes me surprised Dr. Jamieson didn’t transfer these gastro cases to Caledonian before he left on holiday.” While he’d been waiting, Hamish had checked on the patients and found three of them, like Betty, dangerously ill, on the brink of organ failure.
“My staff do excellent job, Doctor. After Dr. Szabo inspected, we hired an extra nurse.”
“That’s still not enough. Your staff can’t keep up with the workload.” The poor fellow who just died would have consumed all the attention of the nurse and personal support worker on the night shift. “These patients need IV fluids. And so does Betty McKenzie. I’m bringing her over in a few minutes so we can get that started now.”
Gloria crossed her arms and shook her head. “Intravenous treatment is against nursing-home policy. Nursing council says we can’t do it.”
“But you have RNs on duty.”
“I cannot guarantee an RN for every shift.”
Same old story: RPNs — registered practical nurses — weren’t allowed to supervise a simple IV, no matter how experienced they were. “Well then, these people have to be transferred to Caledonian.”
Gloria frowned and donned her reading glasses. She shuffled through the charts then held up two of them. “These clients have advanced directives — no transfer.”
She pointed to the first page on the top chart. It read: Routine care and oral medications where possible. No intravenous therapy. No transfer to an acute-care hospital under any circumstances. Above all, comfort measures. No resuscitation in the event of cardiac arrest.
The no-transfer order certainly didn’t apply to Betty, nor to the Mountain Wing’s third dehydrated patient, who had crippling arthritis that kept her bedridden but didn’t stop her solving stacks of Sudoku puzzles.
Hamish picked up the phone and punched in the number for Caledonian University Medical Centre’s emergency department. He had at least two patients to send them, but if he didn’t warn them, the nurses would have a fit and make things difficult the next time he showed his face there.
