Bloodletting and Miraculous Cures

by Vincent Lam

As we drive, she recites her calculations to me. She has weighed the sums and circumstances with forced rationality. In the rhythmic way she tells it, I can see that she has done the arithmetic many times. She says, “I thought to myself, I can fly him out now, and maybe at home he’ll have a shot at getting better. Or I can wait here. He’s not getting better here, and if he dies I’ll have to fly the body home anyways. Insurance doesn’t pay for bodies.” The insurance company refused to fly him out while he was still talking, because they said he was getting the same care he would get in Canada. He didn’t need another CT scan, they told her. Once he was living on machines, they said that they wouldn’t fly him out because he was brain dead, and there’s no benefit in medevacing a brain-dead man. “They say I could pull the plug and he would never know. The last thing Franklin told me was that he wanted to go home, and I promised him I’d try, so I can’t turn off the machines. How long could I stay here, then? No further ahead, sitting here? No way, so I called my bank.”

  The ambulance dives slightly as it charges into a puddle, and water sprays the windows.

  “You were here for a vacation?” says Niki.

  “On the motorbike. Two-month trip—the idea was to ride to Argentina. We’ve been on vacation for two weeks, well, just one I guess. Second week in hospital. He thought we should do it before we had kids. Today I sold the bike for almost nothing.”

  All around is black, shifting shadow. The ambulance lilts drunkenly in the turns, and I keep my hand on the red oxygen case.

  “So, Niki,” I say. “Looks like a bleed.”

  She nods.

  There has been no CT scan proving this, but every disease has its rhythm, its dancing sequence of steps and turns that acts as a coded storyteller. The pressure in the head tells it, the pupil of one eye wide, the worsening day upon day, the mention of an episode in which the heart slowed—bradycardia—and almost stopped.

  3:15 EST

  The last stretch of uphill switchback road. The ambulance tires spin the gravel on the shoulder. As we approach the airport, the gates of the chain-link fence roll to either side. The plane is precisely where we left it, but facing down the runway, and the pilots stand chatting with the driver of the fuel truck. Seeing us, the driver climbs into the tanker. Its upright exhaust pipe shakes as it starts, and he swings it neatly away toward the hangar. Marcus looks our way and taps his watch. We back up to the airplane.

  “Are you almost ready?” says Garcia, as we delicately unlock the stretcher bearing Mr. Franklin Amiel and his assortment of lines, tubes, and wires from the ambulance to move him across the few feet to the plane. Some of the airport workers stand around us, in their jackets, holding briefcases. “I don’t think they will really close, but are you almost ready?” he says.

  “Ten minutes,” I say.

  Garcia slaps shoulders and jokes with the airport staff. They laugh politely, but in their tiredness they do not appear anxious to make allowances for one plane which has appeared in the night to fly away with one foreigner. Garcia takes our passports from the man with the military cap. Niki and I pause, check the passports in the rear lights of the ambulance, and button them in our pockets. I am now afraid to mention the fire. The night is a cool black, and we seem to be at a moment of delicate balance, a moment when we need to walk the suspended narrow bridge of time and step onto the stable earth on the other side of the chasm with our patient airborne. Around us is darkness, and the shuffle of bats’ wings above the plane. I strain at the slight suggestion of smoke.

  It’s not simple to move a critically ill man. It might seem that it would be like moving a parcel, or shouldering a big, warm duffle bag. But it’s not, because the tubes and lines splay from every orifice, drape the sides of the stretcher, threaten constantly to be kinked and cut off or tugged out of position. The functions of moving air, of regulating fluid, of voiding urine, which a healthy man keeps secret and neat within closed skin and barely refers to while going through life occupied with desire and philosophy, become visible external concerns. How much urine output? What are the lungs’ tidal volumes? Niki has her hand on the endotracheal tube as we slide him forward. I watch it also, for this is the crucial tube that breathes. We move Mr. Amiel slowly, pull the front of the stretcher out, allow its folding legs to reach down and touch the ground. Slowly, forward, now the rear legs of the stretcher fold down. Rolling, easy, and now in the corner of my eye there is a line too straight, plastic pulled tight.

  “Stop! Stop!” I yell.

  One straight strand of plastic is caught on the hinge of the ambulance door, pulled tight, and then it falls slack and it’s already too late. Just like that. The central line is pulled out. Its flexible blue plastic tip lies naked on the ground. A dribble of saline fluid wets the tarmac.

  “We’ve still got a peripheral line. Let’s fly,” I say.

  “We need a second line,” says Niki.

  “The time,” I say. But she’s right. It’s too risky to fly with just one peripheral line. We’ve got to put in another, but I’m afraid of the delay because we don’t know anything about Guatemalan airport workers, or about fires. Certainly, we can’t tell them now about the flames. As soon as we’re in the air, we’ll radio about the fire. I tell Garcia that we need a few minutes, and he speaks like a jovial salesman to the airport workers. Their expressions do not change, but they also do not move. Niki flicks Mr. Amiel’s puffy wrist and swollen arm, looking for a vein.

  After four IV stabs into the putty-like flesh of the right arm, it is by some kind of divination that Niki establishes a second intravenous line. I see the air traffic controller’s silhouette in the tower and am relieved. Now that we are ten minutes past their closing time, I feel confident that they will stay until we have taken off. Also, I have not yet paid the airport fees. Carefully, as if shifting a bomb, we move forward again into the jet. Done.

  The air is fresh and full. It is the breath of jungle, of fetid water, and of breathing leaves. We secure the monitors and pumps to the wall of the plane. I am happy that our patient is on board, that the airport is still open beyond its closing time, and for the live wet soil exhaling into the night. Above the plane, bats wheel and strike. Their soft wings make blowing sounds as they sting and grab at insects. If a bat or bird is sucked into a jet engine, it destroys the turbine and cripples the plane, but somehow this rarely happens. The Lear 35, bright in the centre of the taxiway lights, is an apparition in the night. Someone imagined it into existence on the tarmac. Other planes are parked alongside, surrendered to the sleepy shadows. A strand of burnt sugar smell. I grip the tension of near-gratification, of being about to reach success, and remind myself that once we are in the air we will radio them about the fire. It will be as if we just spotted it on takeoff.

  Garcia gives me an invoice on semi-transparent paper—the airport, the ambulance, himself: six hundred and ninety American dollars. I give him eight hundred, and tell him to thank the airport staff. I shout, “Gracias,” and wave to them. This is my only word in eight languages. I pull the doors of the plane closed, and activate the seals that whirr like a spinning drill. Mrs. Amiel is in the back seat, and she has dropped her smile. Perhaps now that she is in the plane with her husband, now that she has paid the ticket and the voyage is under way, she is freed from her hard-smiling imperative of forward motion. The progress will no longer hinge upon the force of her will. It will be up to jet engines in the night, and she can release this bird of horror, open her hands and allow it to fly up like a dark ghost.

  Niki and I buckle into the narrow single seats beside the stretcher. The jets whine. I’m sitting behind Niki, who is closer to the cockpit. I lean forward and say, “Niki, it is a bleed.”

  “You said that already.”

  “Did you see his pressure spikes?” I say and tap my head. “He’s tight as a drum.”

  She leans toward the cockpit to speak to the pilots, so that they can hear through their headsets. I wonder if Mrs. Amiel can hear from the back.

  �
��Can you climb slowly?” asks Niki.

  “Mountains all around us,” says Rafael.

  “Can you pressurize the cabin to sea level?” she says. “It would be better.”

  “We’ve got to get altitude fast,” says Marcus, flipping switches as the jets rise in pitch.

  Niki turns, looks at me.

  I shrug.

  There are mountains.

  She faces forward, and there’s not much more to say.

  Maybe we will be lucky. Relative to the cabin pressure dropping, the pressure in Mr. Amiel’s head will rise. We fly with bleeds, and usually we are lucky. The roar begins with a jet kick, the nose of the plane heaves, the wings make an urgent commitment to the air, and now we’re up, flung into the dark. Ten seconds, fifteen.

  Niki and I watch the cardiac monitor: a PVC, then normal sinus.

  I’m tipped backwards in my seat, and as I turn to the window the runway lights flicker off. We’re alone in the night.

  We watch: normal sinus. Good.

  My ears fill. I swallow, make myself yawn, ears pop open and now the airplane screams—full throttle taking us higher.

  On the monitor: several PVCs, a run of bigeminy.

  “Can you level off?” I call out to the cockpit.

  “We’re not clear yet,” shouts Marcus.

  Out the window, I glimpse the red bursting cloud on the ground, spreading heat beneath us, its flames licking leaves, fanning the guilt of my silence.

  The monitor: a slow, wide rhythm like the teeth of a saw.

  My hand on his wrist: no pulse.

  The monitor: still that wide, slow rhythm like television static.

  My hand shoved into his groin: pulseless.

  The monitor: a jitter of movement, no more.

  “Start compressing,” I say to Niki.

  The Lear is still nose up, and everything is tilted back. I release my belt and reach uphill for the cardiac arrest drug box. Niki is out of her seat, standing with her feet wide, her torso curled in the short cockpit to pound Mr. Amiel’s chest.

  “So there you go,” she says to me as if it’s my fault.

  We know the story, this twist. Just as Dr. Manolas and I talked around the loss of therapeutic opportunity, Niki and I know this plot without saying it. The bridge of air rescue can lead to this cliff. My ears are tight again. I swallow, they clear. The swelling in the narrow back compartment of Mr. Amiel’s head grows as the cabin pressure drops. It squeezes the brain stem, which protests that this will be the last abuse, that its last remaining functioning cells will join their dead companions, and now in their swollen growth they tell the heart to stop. The heart says, Fine! Leave me be, for I too will die now.

  I climb downhill to the back of the plane. The compartment of the Lear is twelve feet long, and I tell Mrs. Amiel that her husband, six feet away, is having a cardiac arrest. Prospects are poor. Does she want us to proceed?

  “Go ahead, try for a while,” she says. “I understand the situation. Really, I completely understand the situation. I did my crying before you arrived.”

  I say that we will try for twenty or thirty minutes, and return to Mr. Amiel and Niki. CPR. Three epi. Two atropine, Mannitol, D50, bicarb. We take turns compressing, and it aches the upper back to compress in the Lear. We are acting. I am glad for the second IV, because the first one blows after two minutes, and it would be a sorry act if we were injecting drugs into a single blown IV. After twenty minutes I wonder if it looks obvious that we are simply playing our roles. He has no pulse, no rhythm, but we administer the drugs anyway because I said we would try for twenty or thirty minutes. Mrs. Amiel is six feet away, and she has done everything she promised her dying husband.

  At twenty minutes I look back at her, and she waves her hands in front of herself like an umpire calling “Safe!”

  “No more,” she says.

  “There’s no chance remaining,” I say. Sweat runs under my flight suit.

  “Stop,” she says.

  I go to the front of the plane and say, “Okay, let’s call it.”

  Niki stops compressing, and removing this action reveals that Mr. Amiel has been completely inert all this time. The monitor shows a straight, true line.

  “We levelled off ten minutes ago,” says Marcus. “Didn’t tell you. We didn’t want to interrupt you.”

  “Thank you,” I say. “Thank you, everyone.”

  We pull the sheet over his torso, package him neatly, and I move to pull it over his face.

  Niki stops me. “Ask her if she wants the face covered. Some people don’t.”

  I go to the back. “I’m sorry for your loss,” I say. “Would you like to spend a quiet moment with him?”

  “I said my goodbyes already. Days ago,” says Mrs. Amiel. Her face is collapsed, but also more relaxed, as if relieved that the anticipated grieving is upon her.

  “Do you prefer we cover the face, or not?” I ask.

  “It’s up to you,” she says. “Do what’s best.”

  We have been flying for just over thirty minutes. The Lear does. 77 Mach, but the pilots have kept as low as they can, which means flying slower. How far are we from St. Therese? I have no concept of the distance now that we are in our throbbing, hurtling bird of night. We are over the Caribbean. At this moment I remember those burning clouds, that smell like sweet coal embers lighting the jungle floor. I clamber to the cockpit.

  “Can you still radio St. Therese?” I ask.

  “They’re down for the night,” says Marcus.

  “We have to tell them about the forest fire,” I say.

  “What forest fire?” says Rafael.

  “Don’t you remember? We saw it from the air. I didn’t want to say anything on the ground.” I imagine the flames undulating, spreading, coursing down the hills to the homes of the airport staff with their shares of the American-denomination tip. I feel sick with the sudden panic of guilt, for hurtling past this information in order to get this one patient, and myself, onto this plane. Could Rafael have forgotten? I think of Dr. Manolas and his courtyard hospital, his Thompson bolt and my business card in his pocket. What will they do if the flames come to them? They have no Lear jet. I say to Rafael, “Over that ridge, we saw the fire.”

  “Oh yes,” he says without looking back at me. “We asked them while you were at the hospital. They’re burning the sugar cane for harvest.”

  The smouldering clouds, the sweet hint of an odour drifting into the hospital courtyard. Rafael had almost forgotten this agricultural observation, this detail, until I had asked.

  “That fire, it’s deliberate?” I say.

  “They burn the leaves to process the cane,” says Marcus. “A controlled burn. Think of that, when you put sugar in your coffee.”

  “Controlled burn. Remarkable,” I say.

  I pull the sheet over Mr. Amiel’s face, so now it’s just the three of us in the cabin. I sit down, my seat near Mr. Amiel’s feet. The sky is a deep blank hole, and within it I see our wingtip lights blinking. I have a restful awareness that Mr. Amiel is officially dead, that we have completed our obligation to the living.

  After some time, it strikes me that we are in an airplane. It is night. We have gained altitude and are cruising fast. A bouquet of lights appears in the window—must be Havana. I’m thirsty. This thirst is like the day after a long-distance argument on the telephone with an old friend, when you realize that he is still on the other side of the telephone line, and that what you were fighting about was what you always disagreed about but were never able to say, and you wish that he lived around the corner so you could go out together for a drink. It is that thirst. We are on an airplane with a wife, with a deceased husband, and if we vanished in the sky, then at least for a little while no one would notice.

  We haven’t touched the catering trays from Tampa. I go to the back of the plane where the trays sit next to Mrs. Amiel. “There’s lots of food. Are you hungry?” I ask.

  “No appetite for days.”

  “Maybe
you should eat. Some crackers?” I say. I might be a doctor or a flight attendant.

  “I can’t,” she says. Her blue eyes have flecks of brown in the iris.

  Whether to look away now, or in a moment from now? There is this balance of professing humanity without invading privacy. Should I keep eye contact for another few seconds, or turn away? I nod slightly. I turn away, crouched in the short cabin. I take a food tray. It has one violet and white orchid under the cellophane, nestled into the jungle of olives and vegetable sticks. They breed these flowers to be tough and unwilting.

  “Dr. Fitzgerald,” she says.

  “Yes,” I say, turn.

  “What do you think of…I guess I mean, of how everything happened.”

  “Mrs. Amiel, I’m very sorry. This is a terrible thing.” I kneel in front of her in the back of the plane. The only options are to crouch half-bent or to kneel. “This kind of stroke could have happened anywhere. Just as easily in Toronto.”

  “And if it had happened in Toronto?” she says. “I guess I’m wondering if things would have gone differently.”

  “That hospital in St. Therese may be less fancy than one at home, but I looked at the records and discussed the case in detail with Dr. Manolas,” I say. I look at the brown flecks in Mrs. Amiel’s eyes. Without a moment’s hesitation and with the greatest tenderness I have within me, I lie. I say, “I think that your husband got the crucial treatments he could have received at home. Sure, they didn’t have all of the tests and scans, but he got all the main things that could have given him a chance.”

  Lies are about belief, about a reality suspended because we want to believe the lie. Both the teller and the recipient must trust each other for everything to hang together. I sense this trust between us and say, “You did everything you could do. So did we. Your husband could have died just as easily in Toronto. I am truly sorry for your loss.”

  7:30 EST—Tampa

  This new rising sun is a second afternoon, since we didn’t sleep last night. Rays of light shatter over the elevated expressway, which curls around the airport. Cars flash past the sun like an inverted strobe light—a strobe shadow. We’ve been on the ground for an hour, and lenses of clean, clear dew appear on the metal skin of the plane.